Trial OSCE exam: 'Sarah&Clarence3' by ClaireGo

You are taking part in a trial exam created by ClaireGo. There are 8 OSCEs in this exam (80 minutes).
 

You have 3 minutes reading time. This OSCE will run for a maximum of 7 minutes.

Scenario:

John is a 48yo man who has presented to your ED with concerns about his right foot. He has a background of poorly controlled diabetes and peripheral vascular disease with previous toe amputations of his left foot.

The attachment is for examiner's use

View attached:   Attachment 1

Instructions for the candidate

You are the consultant on. You are to examine John's foot in regards to his presenting complaint and then present your findings to the vascular surgeon who has come to review.

Domains being examined

  • Medical Expertise
  • Prioritisation And Decision Making
  • Communication
 
The candidate has 3 minutes reading time. This OSCE is expected to run for a maximum of 7 minutes.

For the actor

John:
You are currently comfortable. You noted the lesion on your foot about 2 days ago and it has increased in size since then. It does not hurt. You have a claudication distance of 20m, although recently it has been down to 2m. You do not have rest pain.

If too much history is sought, state "I just told the other doctor all of this, he just said you were going to have a look at my foot".

Vascular surgeon:
You know John from prior encounters. You want a detailed description of the examination findings. You may prompt for Buerger's Test and an ABI.

For the examiner

Display attached photo when inspecting foot

Domains Assessment Objectives

Medical Expertise
Timely and thorough examination of the lower limb

Prioritisation And Decision Making
Appropriate differential diagnoses

Communication
Establish rapport with patient, clear instructions
Clear description of findings including differential to vascular surgeon

Other Assessment Notes

Introductions and ensure comfort

Clinical stability
- ensure not septic; check vitals, BSL

Inspection
- colour
- swelling/wasting
- ulcers/sores (arterial macro vascular vs microvascular; vs venous)
-- Arterial macrovascular - punched out, well-defined, pale, cool, often dorsum foot
-- Arterial microvascular - distal, painless
-- Venous - irregular, pale surrounds, pink base, warm & oedematous, often malleolar
- skin and hair changes
- check between toes
- check heel

Palpate
- warmth
- pitting
- cap refill
- pulses (DP, PT, popliteal, femoral, consider auscultate for bruit) & nodes

Test
- Buerger's test if evidence of arterial compromise
-- lift to 45 degrees -> pallor
-- drop off edge of bed -> cyanosis
- Sensation (light touch, dorsal columns: poprioception, vibration)
- ankle-brachial index
-- normal ~0.9
-- < 0.4 = critical ischaemia
-- high = arteriosclerosis