Trial OSCE exam: 'Claire and Jess' by ClaireGo

You are taking part in a trial exam created by ClaireGo. There are 9 OSCEs in this exam including 1 double stations (100 minutes).
 

You have 3 minutes reading time. This OSCE will run for a maximum of 17 minutes. DOUBLE

Scenario:

It is 0830 in your outer urban emergency department. You have just got your morning coffee when one of the night residents asks your help with an early morning cyclist who came of his bike.

This is a double station:

Your tasks are to:
- take a focused history from the patient
- do a focused examination of patient
- discuss further investigations and management as deemed appropriate

Domains assessed:
Med Expertise - 30%
Communication - 40%
Teaching and Scholarship - 30%

ps please do not open attachment until 10 minute mark. Image courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 19252

View attached:   Attachment 1

Instructions for the candidate

Domains being examined

  • Medical Expertise
  • Communication
  • Scholarship and Teaching
 
The candidate has 3 minutes reading time. This OSCE is expected to run for a maximum of 17 minutes. DOUBLE

For the actor

You are Michael, a keen cyclist who was on his way to work at 0730.

You came off your bike and it threw your forward and to the side - but a little vague about what happened

You think your hit your head on the way down as your helmet was smashed

If asked:
- you can't exactly what your head hit or why you fell off
- you felt light headed on the scene
- vomitted
- another cyclist called the ambulance
- you vomitted in the ambulance
- they gave you something for vomitting
- you have had another vomit in emergency
- you can't recall exactly what you had for breakfast
- no pain anywhere else - a little grazing on both hands

AMPLE - allergic to penicilline
PMH
- asthma - on ventolin
last ate 0630 - you think, i always have breakfast around then
SH - work in city as engineer, have a finance, Lucy, can't recall her number though..

For the examiner

This a double station.
It is loosely based on the double station of 2016.2 which was clearing a c-spine.

Four components for medical expertise
- focused quick trauma history
- focused clinical exam
- indicates evidence base for requesting CT head - e.g. ACEM, canadian c-spine, local protocol
- focused interpretation of the CT head

Canadian CT head rules:
High risk
- GCS <15 @ 2hours - i.e. they need to do a formal GCS
- suspected open or depressed skull fracture - i.e. feel around the head
- signs of base of skull fracture - i.e. they need to look for haemotympanum, racoon eyes, battle sign, look up nose for rhinorrhoea
- vomitting 2 or more (note no mention if vomitting through ondansetron in the rules, i think evidence is that if they have a significant head injury that they will vomit through ondans) ?reference anyone
- age > 65

Low risk
- retrograde amnesia 30 min
- dangerous mechanism *
* pedestrian struck by vehicle, ejected from MVA, fall > 1 / > 5 stairs

C-spine - not a focus of this station but appropriate if they request hard/soft collar until CT head + C-spine
NEXUS = NSAID - no neurology, no spinal tenderness, normal alertness, no intoxication and no distracting injury
or Canadian C-spine - both can't clear the neck clinically

The next half of the station should focus on teaching the resident about interpreting the CT head e.g. Blood can be very bad
B Blood
C Cisterns
B Brain
V Ventricles
B Bone

Domains Assessment Objectives

Medical Expertise
Knows canadian CT Head rule / ACEM head trauma
states needs c-spine immobilisation
interprets CT head appropriately

Communication
Clear
Concise
Precise

Scholarship and Teaching
Check level of junior doctor
Teaching on the run principles
Checks understanding
Allows time for quesitons

Other Assessment Notes