OSCE stations examArab board of surgeryAden training center

Yemen

Dr Tamimi

Station No1• You will meet Mr. Ahmed 23 years old , who was

previously healthy,• One day abdominal pain in the right lower

quadrant • Please ask three important question regarding

this pain • Examine his abdomen , ask for two important

blood investigations• Best imaging study , possible diagnosis • Options of treatment

SN Points to be asked Done Not done

5.CBC =0.5C-reactive protein=0.5

6.Abdominal ultrasound=0.5

7.Acute appendicitis =0.5

Open appendectomy=0.5Lap appendectomy=0.5Drain± =0.5

.

Total

SN Points to be asked Done Not done

1. Introduce himself, good appearance and confidant= 1

2.Severity of pain=0.5Associated GIT symptom=0.5Similar attack=1

3.

Permission for exam=1Point to pain site=0.5Tenderness =0.5Rovsing =0.5

4.Psoas test=0.5Cough test0.5

Checklist station NO 1

Station NO 2

• Young adult man give history of blunt abdominal in injury sustained during football match.

• Treated conservatively,, and then readmitted again with severe upper abdominal pain with mild distension

• Please ask two important points in the history• Examine the abdomen • request one imaging study• One important blood investigation• Diagnosis and options of treatment• One important complication

SN Points to be asked Done Not done

6.Pseudopancreatic cyst=1

7.Internal drainage =0.5External if infection=0.5Conservative if small=0.5

8.Laparoscopy =0.5Open =0.5

9.Pancreatic fistula

10.

Total

SN Points to be asked Done Not done

1. Introduce himself, good appearance and confidant= 1

2. Time of injury=0.5Fever =0.5

3.

Ask about pain =0.5Vomiting =0.5

4.Take permission to exam=0.5Mass exam=1Cullen sign+gray terner =0.5

5.Abdomen CT=0.5Serum amylase again raised=0.5

Checklist station NO 2

Station NO 3

• You are going to meet adult man 60 who give history of right parotid swelling .

• He was informed by the family doctor that he may have advanced cancer and referred to you

• Please examine this patient • Mention the possible diagnosis • Arrange for two important investigations • Options of treatment

See the teeth=0.5Closed mouth blowing=0.5

Closed eye=0.5Try open the eye=0.5

Wrinkled forehead=0.5Mixed parotid tumor =0.5

FNAC =0.5MRI =0.5

Surgery superficial parotidectomy = 0.5

Thank the patient after exam=0.5

Total

SN Points to be asked Done Not done

Greeting the patient , introduce himself, take

permission, and stand to the right = 1

Ask for pain before palpation=0.5Site =0.5Skin over=0.5Size= 0.5

Hard consistency=0.5Mobility=0.5L nodes =0.5

Facial nerve affection=0.5

Checklist station NO 3

Station 4

• At the pediatric surgical unit , your senior consultant send you to explain the procedure of day case surgery to young child 2 years with single pediculated rectal polyp

• He was fully investigated and fit for intervention.

• His mother in the office waiting for you • Please explain every thing regarding the surgery

and possible related events

Medication like pain control=0.5

Discharge at night =0.5

Complicationspain=0.5

Bleeding=0.5infection =0.5

When to return=0.5How to contact=0.5

Total

SN Points to be asked Done Not done

Greeting the patient , introduce himself, take

permission, and stand to the right = 0.5

Investigations ,fitness =0.5Consent form=0.5

Fasting 4h =0.5Bowel preparation =0.5

Anesthesia GA =1Proctoscopy or

sigmoidoscopy =1Identify the polyp =0.5

Look for other plyp =0.5Excision =0.5

Start feeding =1

Checklist station NO 4

Station NO 5

• You are going to meet miss Fatima , she is a

close relative of 40 years old female that give history of breast lump since 3 months

• Please take focused history • At the end give your possible diagnosis • Initial important investigation• Best diagnostic investigation • Options of surgery• Prognosis

6. Any mass in the axilla = 0.5

7. Family history =1

8. Left breast carcinoma=1

9. Bilateral mammography =1

10. FNAC =1

11.Breast conserving surgery =1

MRM and axillay clearance =1

Total

SN Points to be asked Done Not done

1.Greeting the patient ,

introduce himself, take permission, and stand to the

right = 0.5

2. Which breast affected =0.5

3. Painful or painless= 0.5 Ask about the size and rapid

growth =0.5

4. Nipple discharge =1

5. Changes in the skin = 0.5

Checklist station NO 5

Station NO 6

• Your professor asking you this morning to meet the family of an old male 76 years with metastatic adenocarcinoma of the stomach

• HB 6g/dl, elevated urea and creatinine• He request to explain his bad recent

condition and to plan an effective terminal care

Medication like pain controlDrugs =1

Non drugs ( religious ) =1

Care forBed sore=0.5

Mouth hygiene=0.5hypothermia =.5

Home care0.5 We are ready to help any time

=0.5

Total

SN Points to be asked Done Not done

Greeting the patient , introduce yourself,=1

Explain how bad this cancerMets, age =1

No place for surgery or any palliative =0.5

Nutrition Entral =0.5Parentral=1

Stoma =1Blood transfusion=0.5

Checklist station NO 6

Station 7

• You will meet a husband of young lady who said to you that his wife is already diagnosed as acute cholecystitis

• He blamed the first surgeon that he lie on him and want to operate on her urgently.

• He prefer you to do the operation if necessary • How can you behave in this situation• Would you operate on her or not ? And why ?

SN Points to be asked Done Not done

6.Ask to return again=1

7.Once he blame for nothing he

will blame you =1

8.Ethical and Dr –Dr relationship=1

9.

10.

Total

SN Points to be asked Done Not done

1. Introduce himself, good appearance and confidant=

0.5

2.Ethical consideration=1Our professor =0.5

3.

Reassurance =0.5Ask if examine the pt =0.5Investigate him=0.5

4.Explain why urgent =1Risk of this delay =0.5

Mention option of surgery=1

5.Same intervention or may be

better =1

Checklist station NO 7

Station NO 8

• You will meet a brother of Miss Noora which involved in road traffic accident and brought to you in shock state and still not well responded

• Initial investigation showed spleen injury • How can you explain all the events related to

such serious case

SN Points to be asked Done Not done

6.Infection after splenectomy+0.5Vaccine =0.5

7.

8.

9.

10.

Total

SN Points to be asked Done Not done

1. Introduce himself, good appearance and confidant= 1

2.Reassure =1FAST=2

3.

Blood transfusion=0.5Emergency surgery=0.5Consent form=1

4.Remove spleen=1

May be other trauma=1

5.Dead on table =1

Checklist station NO 8

Station NO 9

• Your professor ask you to meet a co-patient ( relative ) of a gentleman 63 years old give history of bleeding per rectum and mucous discharge,, he will give you histopathological report after taken biopsy per anus 5cm from the anal verge. And the result was poorly differentiated adenocarcinoma

• Please gently break this bad news and arrange your further management ?

SN Points to be asked Done Not done

6.Post operative chemotherapy

=1

7.Neoadjvant chemo

radiotherapy=1

8. Side effect of surgery like impotence =1

9. Side effect of chemotherapy =0.5

10. Prognosis = 0.5

Total

SN Points to be asked Done Not done

1. Introduce himself, good appearance and confidant= 1

2.Try to break this bad news correctly ,sympathy, body language ,religious = 1

3.

Need of imaging study for distant mets like abdominal

CT= 1

4.Surgical treatment ==

abdomino- perineal =1Surgical treatment = stapler

anastomosis =1

5.Colostomy =1

Checklist station NO 9

Station 10

• You are 5th year registrar in arab board of surgery

• Your senior asked you to discharge male patient operated for abdominal gun shot with temporary colostomy and stable pelvic fracture

• Arrange the possible instructions• Further follow up

SN Points to be asked Done Not done

6.Reverse colostomy after 8-12

weeks=2

7.Another surgery and

anesthesia =1

8. Side effect of surgery like failure , infection =1

9.

10.

Total

SN Points to be asked Done Not done

1. Introduce himself, good appearance and confidant= 1

2.Surgical wound clean=0.5Your condition stable =0.5

3.

Change position =0.5Colostomy care =0.5

Psychological support=0.5

4.Train to change the bag=0.5Skin ulcer or hypermia =0.5

5.Complication as stenosis ,

hernia , prolapse=1.5

Checklist station NO 10