LOCOMOTOR SYSTEM OSCEs

The Locomotor System OSCEs consist of stations relating to Orthopaedics, Rheumatology, A&E, Dermatology and Infectious Disease (i.e. STDs and not malaria, TB, PUO, etc). Last year there were 13 OSCE stations of which were 2 rest stations. Note that this year, the unobserved stations are likely to form part of the Data Interpretation Paper Aii which was not sat last year.

Observed Stations (Paper B)

1. Sexual history
You are the SHO in the GUM clinic. You have to take a sexual history from a homosexual patient who has never been to the clinic before, who is complaining of a urethral discharge. He has had purely oral sex with an unknown partner he met in a pub. Make sure you deal with the less intimate aspects of the history first. Ask questions relating to all the symptoms of GUM. Ask about past STI, drug history, including illicit drugs, and allergies. DONT JUMP STRAIGHT INTO THE SEXUAL HISTORY, OR YOU WILL FAIL. Sign-post that you will have to ask the patient some questions relating to it in order to assess his risk of acquiring an STI. Ask the patient whether they are sexually active or not, and take it from there, asking them the who, when, where, how & what of a sexual history: Who Who did you have sex with? Man or woman? Regular or casual partner? Do they have any symptoms? When was the last time you had sex? Where did you have sex? Where are they from? How - How many partners did you have over the last 3 months? Get brief details about each, e.g. gender, nationality, any symptoms, paid for sex?) What What type of sex did they have? Vaginal, oral, anal? What are they using for contraception?

If the patient is female also take a menstrual and smear history. The symptoms presenting to GUM clinics which you should ask specifically in all cases are:

GUM DIS
Genital ulcers (sores) Urethral discharge (or vaginal discharge) Mouth ulcers Dysuria / Dyspareunia Itching/ Impotence/ Intermenstrual bleeding Spots (on penis)/ Swellings / Scrotal discomfort

For all these symptoms ask when it was first noticed? Whether it is improving or getting worse & whether it ever occurred before.

2. 3.

GALS Joint Examination

The sexual history and GLAS screen will definitely come up.

Shoulder or knee examination look, feel, move. See Apley & Solomons Physical Examination in Orthopaedics. There may also be examination of the RA hand.

4.

Suturing

Observed Station on suturing a wound making 2 knots for maximum marks. Before suturing, make sure youve explained the process to the patient, the field is sterile, youre wearing gloves and tetanus prophylaxis has been ensured (i.e. booster in the last 10 years).

5.

Chest Pain

This is a viva based OSCE, where you are asked questions relating to the procedures you (together with an assistant nurse) would perform on a 50 year old patient coming to A & E complaining of crushing central chest pain radiating to the left arm. Check your ABCDEs and glucose. Always MOVE the patient: Monitor (General Observations - temp., PR, BP, RR & pulse oximetry) 100% Oxygen Peripheral Venous access (and take bloods) ECG

Dont forget appropriate analgesia - aspirin will relieve the pain of pericarditis, GTN will relieve an angina pain and diamorphine is useful in an MI (learn the BNF doses). Take a history and examine the patient. You might be asked about how you would manage the case acutely if it was an MI.

BATMANS
Beta blockers (unless in obvious cardiac failure) Aspirin Thrombolytics (state contraindications) Morphine (requires CCU monitoring) Anti-emetic/Anticoagulant (high risk of developing a DVT or stroke) Nitrates (will not relieve an MI pain, but other vessels are also likely to be narrowed) Statins

Locomotor Examination
Unobserved Stations (Paper Aii)
1-3. Dermatology Stations
There are 3 dermatology stations where you have to identify the skin pathologies present from photos of faces, scalps and nails (9 of each). If theyre black, its SLE - SLE is 10 times more common in the black population.

4.

Genital Herpes

This is an unobserved station, MCQ based, where you will have to make the most likely diagnosis from a written history and PE. You will have to give the correct three treatments for genital herpes (acyclovir, saline baths and analgesia) and answer a few questions relating to the problems.

5.

Avascular Necrosis

Unobserved Station. Youre given a few pictures and X-rays. There are then a few MCQs relating to this avascular necrosis.

6.

Common Locomotor Problems

Unobserved Station - know the classical features of the common Locomotor Problems. This is an MCQ based station on the hand signs of OA and RA, joint X-rays, rheumatology blood tests and investigations (e.g. synovial fluid analysis).