UCEM OSCE SCENARIO 004

You are the ED Consultant in charge of a tertiary hospital ED

You are approached by the red team night registrar to review a patient with a lower limb ulcer. 

The patient believes the ulcer is secondary to either a white tail spider bite or a flare up of their non-pathological lyme disease. Having consulted Dr Google on alternate therapies not approved in Utopia, they would like you to write a letter to approve their ongoing care in a private clinic in Sweden.

Next in the queue is the yellow team night registrar who presents a well known heroin addict with invading thyroid cancer. In their caffeine depleted state they mixed up the naloxone and gave 400mg of rocuronium. Helpfully they have pulled up the last CT scan which shows near complete obstruction below the vocal cords with the tumour extending below the mediastinum. On requesting the sugammadex the pharmacist presents you with five pieces of paperwork including a signature required from the head of the department who is currently attending the latest FOAMed conference – he sends a sympathy emoji via twitter.

Humming gently in the background you are aware of the muffled altercations of interns and nurses in cubicle 10 detaching a bottle of vodka from a patient with massive haematemesis, Child’s Pugh C and known varices. Your day shift RMO has concomitantly stormed from the department…upset that the gastro registrar stuck a finger (recently inserted into the rectum of the vodka disaffiliated patient) in their decaffeinated spirulina beverage stating ‘there is no melaena…your patient, your problem‘.

Meanwhile fast track is 30 behind with your longest wait at 7 hours demanding endone as this is the only medication that stops her heightened sexual desires and a male medical student is wondering whether he should attempt to do an examination on her for his gynaecological log book.

Finally your CEO has requested you meet with local media to discuss a new model of care whereby patients are able to email and phone in their complaints in a “virtual clinic” which a F.UCEM will manage in non-clinical time,  they are outside and waiting.

You have 13.4 minutes to complete this task.