Example Station 1
You are a Physician Associate in GP and Mr Richard Williams a 59-year-old man presents with weakness of his right hand.
Please take a focused history
Perform the necessary examinations. If you are not required to perform an exam the examiner will inform you
Finally explain you working diagnosis to the patient and your next management
You have 2 minutes.
Name: Richard Williams
Age: 59 year old
Retired theatre director
You are Richard Williams a retired theatre director. You have come to the GP today after being urged by your wife. You wanted to get a few things checked out to reassure her. You have been developing this odd gradual weakness in your right arm. If asked directly you have noticed that over the past 6 months the weakness has progressed quite quickly and more pronounced after you use the hand, especially after gardening which you enjoy. You work a lot with your hands and this is making it difficult to perform tasks. If asked directly, inform the student that you also get cramping in your forearm, and upper arm and you have noticed some twitching in forearm as well. You have also noticed that in the last 3 months you have been experiencing problems with your speech, you think it’s slow and you get out of breath from talking and on few occasions, people asked if you were actually drunk. If asked directly you have also been feeling tired all the time and feeling sleepy during the day which is unlike you. You have not had any loss of consciousness, no headaches, no other limb weaknesses, no dizziness, no memory issues, no changes to your behaviour or personality, no problems with your balance, no problems with swallowing and no issues with your tongue.
I - You don’t think this is out of the ordinary and it may be a natural part of getting old
C - You are not concerned about anything
E - You want some reassurance
Past Medical History
HTN, hypercholesterolemia, TIA (7 years ago)
No past surgical history
Clopidogrel, atorvastatin, Ramipril
Ex-smoker (quit 5 years ago, was smoking 10 a day for 20 years). You drink between 10-20 units of alcohol weekly. You don’t really exercise much as you’re feeling tired all the time, but you try to work on your garden. You live with your wife in 2-bedroom bungalow.
Only if asked directly you inform the student that your father had stroke and died at the age of 60. No motor neurone disease
Examination findings should be given to the student once they begin to perform each section:
There is muscle wasting in the upper limbs
There is no muscle wasting in the lower limbs
There is some fasciculations in the right arm
Power is globally reduced in the upper limbs, and 4/5 in the lower limbs
Tone is normal in all limbs
Reflexes are normal (biceps & triceps)
Normal sensation in all limbs
Others have scored
This station is quite in depth and tests both your history taking skills as well as your examination skills. It’s important to be mindful of the time that you have when performing a long station like this in such a short amount of time. You should remember that in the OSCE you can be asked to perform certain examinations and be asked to skip parts of it, so listen carefully to the examiner and read your candidate sheet carefully. Fortunately, here you don’t have to give the actual diagnosis but you are still expected to manage the patient effectively.