Professional Documents
Culture Documents
Instructions
The
patient
in
the
next
room
is
Earl,
who
is
66
years
old.
He
has
presented
reluctantly
to
your
practice
after
pressure
from
his
wife
who
thinks
she
has
noticed
a
change
in
one
of
the
moles
on
his
back
over
the
past
few
months.
You
have
been
given
this
patients
past
medical
history.
You
are
not
expected
to
ask
any
further
history
from
this
patient
You
have
8
minutes
to
discuss
with
the
examiner
three
(3)
differential
diagnoses,
these
should
be
the
most
likely
diagnoses.
You
should
include
at
least
two
(2)
positive
and
two
(2)
negative
features
of
this
history,
other
than
those
listed
above,
which
support
or
refute
your
diagnoses.
You
should
expect
the
examiner
to
ask
questions
around
your
reasoning.
TASKS
Differential
diagnoses
with
reasoning
8
minutes
Year
2
OSCE
Practice
2011
Set
2,
Clinical
Reasoning
Station
History
of
Presenting
Complaint
Earl
-
a
66
year
old
male.
Occupation
Dairy
farmer.
Social
Hx
Lives
with
wife
on
farm
in
small
town
3
hrs
West
of
Toowoomba.
2
sons
and
1
daughter,
all
adults
and
living
several
hours
away,
good
relationship
frequently
visit.
Drug/alcohol
smoker
40
pack
year
Hx.
Drinks
carton
of
beer
every
2
weeks.
Nil
recreational
drugs
Presenting
complaint
Wife
noticed
change
in
mole
on
back
over
past
2-3/12.
Story
Always
had
lot
of
moles
since
childhood.
Several
weeks
ago
wife
mentioned
possible
change
in
mole
on
back.
Not
sure
if
mole
was
long
standing
or
new,
had
never
noticed
before.
Felt
mole
was
getting
darker
and
possibly
bigger.
Earl
has
not
noticed
anything,
resistant
to
go
see
Dr.
States
I
have
dozens
of
the
things
Doc,
had
them
for
years,
I
dont
think
this
is
any
different
Has
not
noticed
any
pain
or
itching
of
mole.
Has
had
no
recent
temperatures
or
sweats.
As
not
complained
of
any
weight
loss.
Very
active
and
busy
on
farm,
some
concerns
with
getting
more
tired
and
finding
the
work
harder,
puts
this
down
to
getting
old.
Has
had
several
skin
lesions
excised
in
the
past,
most
have
come
back
as
solar
elastoses
and
IEC.
2
lesions
returned
as
low
grade
SCC
and
one
BCC.
Had
a
course
of
Efudex
(5-fluorouracil)
cream
for
Rx
of
sun
damage
on
face
~10
years
ago
completed
course
but
did
not
like
it
due
to
pain
and
discomfort.
Has
worked
on
dairy
farm
entire
life
except
2
years
of
National
Service
at
age
20
where
he
was
sent
to
Vietnam.
Rarely,
if
ever,
wears
sunscreen
though
usually
wears
hat
outdoors.
He
completed
high
school
education
to
Grade
10
before
beginning
work
on
the
farm.
He
is
still
very
active
on
the
farm
and
gets
a
lot
of
physical
activity
though
his
work.
He
feels
his
diet
is
good,
his
wife
usually
cooks
and
he
claims
to
get
his
5
vegetables
and
2
fruit/
day.
He
has
had
his
vaccinations
from
his
national
service,
and
a
tetanus
booster
after
a
dirty
cut
~
15
years
ago.
He
has
not
been
overseas
except
for
his
national
service
and
a
visit
to
family
in
England
~10
years
ago.
Both
parents
are
deceased,
mother
died
of
breast
cancer
at
age
70
and
father
of
lung
metastases
from
an
unknown
primary
at
age
69.
Has
one
brother
who
is
in
good
health
at
age
70.
Year
2
OSCE
Practice
2011
Set
2,
Clinical
Reasoning
Station
General Health He feels his general health is good, he is active and not often sick. Inspection Generally well looking elderly male in o obvious distress. Pale skin with multiple naevi distributed across face, arms and torso. Extensive solar skin damage over face and arms. Lesion Pigmented, papular lesion, firm to palpation. Diameter = 6x10mm
Past Medical History: Multiple skin lesions excised: solar elastoses, SCC and BCC. HTN - 2001 Obstetric History N/A Past Surgical History: Appendicectomy aged 8 yrs old Immunizations : From national service Tetanus booster - 1996 Lifestyle Smoking 20/day 40 pack year Hx Alcohol carton full strength beer/2 weeks Diet normal Exercise good Hobbies fishing Pets 2 dogs, lots of cattle
Family History: Both parents deceased: Mother age 70 Breast ca Father age 69 lung mets, unknown primary.
Demographics Occupation Dairy farmer Living arrangements lives at home on rural farm with wife Family 3 adult children, 1 older brother.
Year
2
OSCE
Practice
2011
Set
2,
Clinical
Reasoning
Station
Instructions to Examiners
The
patient
in
the
next
room
is
Earl,
who
is
66
years
old.
He
has
presented
reluctantly
to
your
practice
after
pressure
from
his
wife
who
thinks
she
has
noticed
a
change
in
one
of
the
moles
on
his
back
over
the
past
few
months.
The
candidate
has
been
given
this
patients
history.
The
candidate
has
8
minutes
to
discuss
3
differential
diagnoses,
including
positive
and
negative
features
of
this
history
which
support
or
refute
their
diagnoses.
Conduct
of
this
station
Ensure
the
candidate
understands
the
tasks
he/she
has
to
do.
The
candidate
is
expected
to
discuss
3
possible
differential
diagnoses-
citing
at
least
two
(2)
positive
and
two
(2)
negative
points
in
the
patients
history,
other
than
those
listed
above,
that
support
or
refute
their
choices.
They
are
expected
to
have
a
balanced
reasoning,
and
have
prioritised
the
most
likely
diagnoses.
They
should
be
able
to
justify
their
reasoning
with
questions,
if
required-
they
are
expecting
some
questioning
from
the
examiners.
If the candidates appear to have chosen an unlikely diagnosis- please ask them to justify their choice. Prompting the candidate for another diagnosis is permitted to allow them opportunity to discuss a more likely diagnosis. TASKS Differential diagnoses with reasoning 8 minutes
Differential Diagnoses 1. Superficial Spreading Melanoma Positive Change in pigmented lesion Hx of fair skin and multiple naevi Hx of extensive sun exposure/damage and minimal protection Hx of previous skin cancers Possible family Hx in father. Lesion asymmetry, irregular border, variegated colour, diameter > 6mm.
Negative Unsure if lesion new or long standing Has not noticed change himself No pain/itching or systemic symptoms
4. Seborrheic keratosis Positive Rapid growth over past 2-3 months. Change in pigmented lesion
Negative No itching Has not noticed change himself Lesion does not appear hyperkeratinised
5. Pigmented Basal Cell Carcinoma Positive Change in pigmented lesion Hx of solar damage and previous BCC
Negative Significant atypical appearance Lack of typical BCC architecture Rapid growth/change.
6. Traumatised naevus Positive Hx of multiple naevi Atypical appearance darkening (haemorrhage into lesion)
MARKING
Examiners
are
asked
to
grade
students
performance
on
a
scale
of
0
-
4
in
the
areas
on
the
mark
sheet
in
capitals.
The
standards
for
awarding
these
grades
are;
0
=
Unequivocal
fail:
Student
was
unable
to
demonstrate
history
or
examination
skills
without
significant
prompting,
OR
displayed
unethical
or
unprofessional
behaviour.
Student
lacked
a
comprehensive
approach,
and/or
needed
considerable
prompting
to
complete
the
task.
Student performed a systematic examination or history but did not complete some components in a number of areas of the marking guide. Student had a systematic approach, required little or no prompting, was confident and completed most components of the marking guide.
Student had a high level of proficiency, well above what would be expected of a student in Year 2.
Examiners
are
required
to
make
an
overall
judgement
about
the
students
performance
in
each
area
on
the
marking
sheet.
The
specific
items
listed
are
there
to
remind
examiners
about
issues
which
might
be
considered.
It
is
not
intended
that
these
items
should
rigidly
translate
into
a
score.
It
would
be
helpful,
particularly
when
feedback
is
being
given
to
poorly
performing
students,
if
there
is
some
notation
in
the
comments
column.
Also
examiners
may
find
it
helpful,
when
considering
what
grade
to
award,
to
have
indicated
in
the
comments
column
when
items
were
omitted
or
when
prompting
was
required.
Global
Score.
This
mark
does
not
form
part
of
the
students
overall
mark.
The
score
should
reflect
the
students
empathy
and
overall
performance,
and
is
from
the
examiners
perspective
only.
Year
2
OSCE
Practice
2011
Set
2,
Clinical
Reasoning
Station
Feature General Organised summaries of diagnoses Appropriate diagnoses chosen Prioritises diagnoses Clear communication for presentation Differential diagnosis ONE Most likely and reasonable diagnosis Appropriate supportive points Appropriate negative points Differential diagnosis TWO Reasonable diagnosis Appropriate supportive points Appropriate negative points Differential diagnosis THREE Reasonable diagnosis Appropriate supportive points Appropriate negative points Adequate Reasoning Balanced reasoning Shows understanding of diagnostic signs with questioning
Comment
Pass Mark = 15/20 Pass/ Fail (Circle as appropriate) Comments (essential if the candidate has failed the station) Global Impression- from examiners only- score 0-4