OSCE stations

Question 1

Strategies to quit smoking

Answer 1

Highest chance for success is a combination of support and use of quitting medications:

(1) Self-help material from Quit Victoria e.g. DVDs
(2) Quitline available 24/7
(3) One-on-one advice/counselling e.g. motivational interviewing, CBT with doctor, counsellor etc
(4) Community Quiting courses run by Quit Victoria
(5) Online resources e.g. websites, quittxt (provides regular SMS messages including tips and encouragement)
(6) Nicotine replacement therapy - available in gum, patches, lozenges, inhlaer
(7) Prescription medicine
- Buproprion (zyban, prexaton) - reduces withdrawal symptoms
- Vareniciline (champix) - reduces cravings, negative mood and reduces rewarding effects of smoking

Question 2

Motivational interviewing core skills

Answer 2

Engaging:
OARS
- Open ended questions
- Affirm and build patient self-confidence
- Reflect - convey empathy and understanding
- Summarizing
Focussing: on desire, ability, reason, need, commitment
Evoking: DARN-C: desire, ability, reason, need, commitment
Planning: where should we go from here?

Question 3

Murtagh 5 basic activities of human

Answer 3

Energy for activity 
Sex drive 
Sleep
Appetite
Ability to cope with life

Question 4

Murtagh diagnostic model

Answer 4

Probability diagnosis
Red flags - VINOA - vasculopathy, infection, neoplasm, others, abuse
Masquerades DDDTASU - diabetes, depression, drugs, thyroid, anemia, spinal dysfunction, UTI
Pitfalls - (dont forget pregnancy)
Yellow flags - depression, anxiety, socio-economic problems etc

Question 5

10 step management station

Answer 5

1. Tell the patient the diagnosis
2. Establish patient knowledge of diagnosis
3. Establish patient beliefs and concerns
4. Education about the diagnosis (why/pathogenesis, what/natural disease)
5. Develop management plan
   - Immediate treatment
   - ROPES: referral/review, occupation/driving, prevention specific and general, education and reassurance, SNAP
6. Warn of consequences if don’t manage
7. Reinforce information
8. Provide takeaway information
9. Evaluate the consultation
10. Arrange for follow-up (determine for yourself what a suitable length of time would be)

Question 6

Conditions for private driving

Answer 6

6/12 visual acuity in better eye
110 degrees of horizontal vision with binocular and 10 degrees above and below the midline
No scotoma within a central radius of 20 degrees of foveal fixation
Tested with automatic static perimetry

Question 7

Diagnosis of diabetes

Answer 7

Prediabetes:
Fasting: 5.5-6.9 
Random: 5.5-11.0
2 hours: 7.8-1.1.0
HbA1c: 5.7-6.4:

Diabetes:
Fasting: 7
Random or 2 hours: 11.1
HbA1c: 6.5

Question 8

Immunizations for diabetic patients

Answer 8

Influenza once yearly
Pneumococcal
• Non-indigenous: < 65 – single dose and revaccinate at age 65 or after 10 years whichever later. > 65, single dose and revaccinate after 5 years
• ATSI - < 50 yo single dose and revaccinate age 50 or after 10 years whichever later. >50 – single dose and revaccinate after 5years
Tetanus – booster at age 50 (unless booster has been given within 10 years)

Question 9

Asthma first aid

Answer 9

Sit patient upright - calm and reassure patient
4 puffs of blue/grey reliever (ventolin, asmol) used with spacer if available
1 puff at a time 4 breaths in between
Wait 4 minutes
Give 4 more puffs
If still not breathing normally, call an ambulance and continue giving 4 breaths every 4 minutes

Question 10

Explain use of PEF

Answer 10

Stand straight
Hard and fast blow 
Meter must be held level 
Do not cough, do not lean forward
Repeat 3x and take best result