OSCE Scenarios ONE You are a 72 year old lady. This morning you were hanging your freshly laundered curtains, when you suddenly felt dizzy and you remember nothing after that, until your friend was calling your name. You have no idea how you ended up on the floor. You have had a few dizzy spells No SOB or chest pain. You have the odd “missing heart beat” not too troublesome. Otherwise you are fit and well. You were not incontinent during the attack. TWO You are a 42 year old professional trombone player. You are rehearsing for a tour abroad. Last night you seemed OK just a bit tired and possibly had a bit of a fever.
This morning you woke up with severe left sided chest pain aggravated by deep breathing and coughing. You are very frightened because your sister had a pulmonary embolism after the birth of her baby. There is no sputum or haemoptysis. You had slight asthma as a child. You haven’t got much of a cough, but feel SOB and frightened to breathe deeply. Your general health is good and you’ve had no serious illnesses in the past. THREE You are a 35 year old man who came to A&E with pain when passing urine and discomfort for 3-4 days. You think that there was a little blood in your urine once.
You are gay and not practice safe sex. (DO NOT VOLUNTEER THIS INFORMATION UNLESS YOU ARE ASKED. ) You are not particularly bothered about HIV. Generally your attitude is rather cavalier and have had several sexual partners in the past. FOUR You are the wife of an 82 year old man and you brought him into A&E because you are frightened and worried about him. For the last 3-4 days he’s been increasingly confused and today he started to get verbally abusive. He has never had psychiatric problems. This is most unlike his normal self. He feels a bit hot to you and his urine has been a bit smelly.
He has mild, diet controlled diabetes and “some prostate problem” otherwise he has been remarkably healthy. FIVE You are the father of a 3 year old girl. Your wife and you separated 2 years ago and she is the main carer for the child. You have her every other weekend. You are rather vague about the child’s health, mainly because she does not live with you. DO NOT VOLUNTEER THE FOLLOWING INFORMATION: You have been sexually abusing the girl for some time and obviously don’t want your ex-wife to find out, or anyone else for that matter. Therefore, you want this problem sorted out now.
SIX You are a 72 year old heterosexual man. For the last few weeks you have noticed increasing difficulty with passing urine, terminal dribbling and a pressure feeling in your lower abdomen,. Your general health is fairly good but lately you have lost some weight and you’ve become impotent. SEVEN You are the mother of a 3 year old boy. This afternoon he fell off the slide in the park (about 2m high). He was sick once about 5 minutes after the accident, he was NKOD but has complained of headache ever since. He is alert and had something to eat about half an hour ago which stayed down.
You are worried about the effects of the injury and have no idea what to look out for. EIGHT You brought your 6 month old baby to A&E as you are very anxious about her. She developed a cold, cough and temperature 3 days ago. She has not been eating well but she has no D&V. This morning you noticed that she is covered in a rash from head to foot. She is up to date with her immunisations (BUT DO NOT VOLUNTEER THIS INFORMATION. ) In a nearby school there are three confirmed cases of measles. You are convinced that your child has meningitis and you know this can be a fatal illness.
Therefore, you think she should be admitted to hospital. NINE You are a 30 year old unemployed man. You have been abusing a variety of drugs, including diazepam, dihydrocodeine, amphetamine and cocaine in the past. You have an agreement with your GP that he will prescribe 90 tablets of Diazepam 5mg a month. However, recently you have been quite agitated and been taking more than the prescribed dose. When you are broke for money you also sell some of your tablets on the black market. You came today asking the receptionist to reissue your prescription saying that the previous was stolen from you.
You are determined not to leave until you get some more tablets. Anyway, you can’t see what all the fuss is about. A few more tablets are neither here nor there and you are fed up with these dragons, called receptionists. You decided to duff them up a bit! TEN You are the mother of a 12 year old boy. He fell and cut his knee this morning at school. You brought him to A&E and after a long wait one of the junior doctors stitched his knee. The A&E charge nurse checked that your son has not had a tetanus booster since he was 3 years old and informed you that he needs a booster today.
You agreed to this. The young doctor proceeded to administer the injection that the nurse gave him. The young doctor was very friendly and nice to your son but appeared nervous with shaky hands. After he gave the jab he seemed very anxious and it transpired that it was the wrong injection. He hasn’t checked the vial before administering the vaccine. You are flabbergasted and furious and threaten to sue the hospital. ELEVEN You are a27 year old man from the Ivory Coast. You have been resident in the UK for 3 years and recently returned to your country for a family visit.
As you lived in Africa most of your life you did not think it was important to take malaria precautions. You’ve been feverish and felt rotten for two days with the light hurting your eyes, your neck and back of your head and you have terrible griping pains in your upper abdomen on both sides. DO NOT VOLUNTEER THE INFORMATION THAT YOU HAVE JUST COME BACK FROM AFRICA! TWELVE You are a 29 year old woman who works as a solicitor in a big city law firm. This is a very prestigious job with high pressure and long working hours. Your main way of de-stressing is going to the gym at night.
Two days ago your “back went” for the third time in six months and this morning you could hardly get out of bed and get dressed. The pain is really severe, especially when you bend down and at times like a knife in your back. You are not too bad at rest. The pain does radiate down your buttock to the back of your leg, but you have no pins and needles, loss of motor function or abnormal sensation. You are fed up and worried you might lose your job if you keep taking time off. One of your friends is a doctor and he told you that X rays are useless and you must have an MRI scan to see if you’ve got a slipped disc.
You won’t budge unless the A&E doctor agrees to do this. YOU WON’T BE FOBBED OFF! THIRTEEN You are a 58 year old Pakistani man,. You were diagnosed as a diabetic in 1999 and hypertensive in 2001. You take metformin, gliclazide and enalapril. Last week you came to the practice nurse for a blood test and this morning the practice receptionist rang you to say that you must come in to see the doctor to discuss the result of your recent blood test. You are really worried and think there is something horribly wrong. Your mother and aunt were both diabetic and died
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