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Candidate
Actor
Mark Scheme
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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

 

Drug History

 

Clopidogrel, atorvastatin, Ramipril

NKDA

Social History

 

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. 

Family History 

 

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 

Mark scheme

Introduction

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History of presenting complaint

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ICE

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History

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Preparations

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Upper limb neurological exam

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Lower limb neurological exam 

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Interpretation 

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Management

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End

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Submit

Your score

100%

Your Score

Average score 

57%

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.

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