Notes

thyroid exam tends to be a surg OSCE now
Rheumatological examination is also possible but is more likely in the form of a hand examination or arm/leg laceration examination in a surg OSCE.



Surg

Examination
• 2015 – Lower limb laceration
• 2015 – Thyroid exam
• 2014 – Leg laceration, had to ask very quick history (what have you done, feeling dizzy/light-headed, any bleeding disorders/anticoag therapy). Examine the patient starting with vitals, lying the patient down +/- elevating the leg, put gloves on and remove bandage, then examine nerves, BVs, tendons etc)
• 2014 – Surgical hand exam
• 2013 – Hand exam post-chainsaw accident, had small laceration with no signs of damage to underlying structures after examining fully
• 2013 – Thyroid exam, given a vignette (patient presents with palpitations, anxiety and lump which has disappeared) perform just the exam and the examiner will give you more info on the lump
• 2013 – Deep laceration to leg, in ED, bled a lot, do clin exam, axe fell on leg
• 2012 – Thyroid exam on 54yo who is concerned she has a thyroid nodule and thyroid disease. Discuss your findings. After exam, patient was concerned there was a nodule, but you had to say nothing was wrong
• 2012 – Hand exam on student, has had knife injury to left forearm. Appropriate exam includes primary survey (DRSABCD), vitals, hand exam. All normal. Had to give other investigations – secondary survey, neuro exam, fluid status assessment. After exam pretends to faint, we need to lower head of bed, raise legs and re-perform primary survey and vitals.

Surg exam is usually a hand/leg exam, or a traumatic hand/leg laceration, or abdominal examination, or thyroid examination. In the 2015 supp both the thyroid and normal hand exam were used since surg can also include one of these in the ‘special station’.

Management/history
• 2015 – Acute abdo history, diagnosis was kidney stones causing renal colic. Needed to give management
• 2015 – Acute pancreatitis history, no interpretation, with some questions
• 2014 – Cholecystitis history, need to explain pathology and complications of gall stones then explain standard treatment of biliary colic in layman’s terms. The symptoms needed clarification, since just because the patient had gallstones on ultrasound it doesn’t mean the pain was related, so relevant history was needed. Didn’t need systems review for a focused history. Treatment is cholecystectomy. Other treatment options don’t work very well and weren’t worth mentioning. She didn’t like the idea of surgery in general so needed a good explanation on risks/benefits etc (NARCOB mnemonic)
• 2014 – Acute pancreatitis, take history then build diagnosis from exam findings, investigations etc. (was very obvious), then answer a lot of patient questions about pancreatitis and its complications etc (what it is, causes, sequelae)
• 2013 – Explain chronic pancreatitis to patient with aetiology and management, and interpret CT to show pancreatic pseudocyst
• 2013 – PR bleeding history, 35yo man, ask exam findings, explain likely diagnosis of haemorrhoids (no familial syndrome+35yo=near impossible likelihood to be cancer)
• 2012 – Hypothyroidism history, feeling down, tired, wt gain
• 2012 – Vaginal discharge history (unsure if this was surg) with investigations, differentials (thrush/STI)
• 2012 – Acute pancreatitis history

Special station
• 2015 – Mammogram explanation to young woman. Important to explain that besides the extremely low chance of breast cancer, because of the density of the fibrous breast tissue it would be impossible to see any cancer anyway in a woman this age using a mammogram
• 2015 – Mammogram
• 2014 supp – Abdominal x-ray interpretation (gas under diaphragm), gave you a history and exam findings and you just had to present the case over the phone to your reg and then your recommended management
• 2014 – Imaging, colleague has missed recent tute on how to read an x-ray, explain how to go about reading one and what you can see in this one. Following first explanation you were also told they missed the CT tute and had to show them how to read one on a computer (same patient). Needed to teach stepwise approach, answer and questions and get diagnosis of x-ray and CT vaguely correct, which was small bowel obstruction. If you noted the caecum was not dilated (which would indicate a large bowel obstruction if dilated), and the obstruction was complete and distal
• 2014 – Mammogram
• 2013 – Mammogram in asymptomatic 25yo
• 2012 – Student has missed tute on abdominal x-ray (AXR), give a method for looking at AXR, go through an x-ray, give a differential and possible causes, then go through some CT scans. Erect AXR showed small bowel obstruction. Had to identify organs on CT including the stomach which had swallowed contrast agent
• 2012 – Mammogram, 28yo, take a history and explain appropriate management. There are two mammograms available. Useful facts: incidence of breast cancer in the next 5 years for a 28yo is 0.1% and sensitivity of a mammogram for breast cancer in a 28yo is 30%. Patient was concerned that breast tenderness wasn’t related to menstrual cycle, grandma was just diagnosed (75yo) with breast cancer. Two kids, doesn’t drink or smoke. X-ray not advisable in this group, low risk patient. Advise follow up if symptoms persist and ultrasound
• 2012 – Thyroid explanation where 38yo woman has had tests for thyroid disease. Discuss results, explain diagnosis, explain the surgical treatment and alternatives, explain the risks and complications, ask if any questions. TFTs: TSH 0.1, T4 7. US-thyroid measures 1.8x2.6x5.6 on left, and 1.6x2.4x6.1 on right, and is diffusely nodular

Special station is often an imaging question but it can be anything from the surg rotation.