After years of preparation, extensive reading, sleepless nights, marriage breakdowns and caffeine – your week of being show ponies has arrived as the F.UCEM examinations are upon us. Giving hope to those who pray to the Utopian FSM we have managed to locate and leak one of the OSCE examination questions for the upcoming exams – hope it helps.
UCEM OSCE SCENARIO
You are the ED Consultant in charge of a tertiary hospital ED
You are approached by a medical student who would like you to teach them about a blood gas that they have taken from a patient they have seen in the ED. You notice them to be exhibiting signs of psychosis with concomitant amphetamine intoxication. On discussing this with the student, they reveal they are homeless and living in a car with a homicidal cat called Boris, who has intermittent familial periodic paralysis secondary to hypokalaemia with a concomitant non-raised anion gap metabolic acidosis.
During the conversation with the medical student, your junior registrar, overwhelmed by a busy night shift, collapses with a first presentation seizure after taking an overdose of paracetamol since discovering she’s pregnant. In trying to help, your underperforming senior registrar who has failed a number of WBAs, accidentally electrocutes the airway nurse whilst trying to recite the shockable pathway of adult advanced life support. The nurse subsequently falls onto a trolley of sharps that have not been discarded. They belong to a patient who has recently returned from Kenya who has read a pamphlet on Ebola and is demanding plasma exchange in order to cure them. Their partner who is a naturopath wants to trial high dose vitamin c and is insisting on taking the patient home despite their ongoing epistaxis.
Meanwhile, the shift coordinator informs you that ten patients from a nearby stadium collapse are en route. Your emergency department is full and your short stay ward is full of patients who all require admission. The emergency department director has been kidnapped in Peru and the Hospital CEO would like to meet with you now to discuss purchasing a new ultrasound machine as your current one has been broken by the on duty surgical registrar who has made your intern cry after accusing them of making an inappropriate referral.
You have 17 minutes to complete this task.