We will be doing a series of Sample Osce cases for you to practice and review, followed by a case review the following week.  Read the Stem, proceed to rehearse the case, what questions would you ask, will you do a physical exam? If so what will you examine? Be sure to talk out loud explaining what you are doing and why you are doing it. “I’m listening to the heart for any evidence of murmurs etc…

CASE 1:

68 year old Anita MacDonald has presented to the clinic today reporting that she has been feeling “down” for the last 3 months. She reports that her husband passed away 4 years ago and is in otherwise good health. In the following 8 minutes please conducted a focused history. Do not perform a physical exam. Do not perform a mini mental status exam. At the 8 minute mark the examiner will ask you a series of questions.

SOLUTION:

• Enters room, hands sticker to examiners
• Washes hands
• Introduces self to patient
• Patient delivers opening response/line
• Asks about onset of Sx
• Asks how long Sx have been present
• Asks about SIGECAPS
  • Sleep changes more/less
  • Interest in daily life
  • Guilt – feelings of worthlessness, hopelessness, etc
  • Energy – lack of
  • Concentration – can they focus? are they easily distracted
  • Appetite – more? less?
  • Psychomotor – are they lethargic? are they agitated?
  • Suicide? have they had thoughts of self harm? harming others? If so do they have a plan? who?
• Ask about other redflags
  • Hearing voices others don’t hear
  • Seeing things others do not see
  • Paranoia
• Social Hx
  • Who is at home with them?
  • Support? family, friends?
  • Pets?
  • Smoking? Alcohol? Recreational Drugs?
  • Income/Work/Welfare
• Previous Medical Hx
  • Depression? Mental health?
  • Overall Medical Hx
• Medications
• Review of Systems if time permits/any other concerns
• FIFE
  • How do you feel about your mood?
  • Do you have an ideas about what has led to your mood factors
  • How is this affecting your function?
  • What are your expectations?
• Close the interview
• Prepare to answer series of questions such as:
  • What is your next step in management of this patient?
  • What is your primary diagnosis, give 2 differential Dx
  • If this patient were actively planning to harm themselves what would be your next step?