OSCE Revision Checklist

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Introduction

The Geeky Medics OSCE Revision Checklist is a one-stop checklist to help you prepare for OSCEs. We’ve included links to relevant Geeky Medics OSCE guides for more information.

Where possible, to help you prepare for the UK Medical Licensing Assessment (MLA), we’ve also organised our OSCE content by area of clinical practice.

For a complete list of practical skills tested in the MLA, check out our article here

You might also be interested in our premium collection of 1,000+ ready-made OSCE Stations, including a range of examination, communication skills, data interpretation and documentation stations ✨

Acute and emergency 

Acute and emergency presentations in OSCEs are extremely varied and may include several conditions involving any system.

For acute and emergency OSCE stations, you may have to perform a simulated ABCDE assessment. This is a systematic approach and the standard of care used to assess and treat critically ill or injured patients immediately. It involves taking observations, suggesting or carrying out investigations and treating problems as they are identified. 

Basic Life Support (BLS) for adults and children may be tested as part of an ABCDE station. In a simulated cardiac arrest station, you may be required to consider possible reversible causes of cardiac arrest (4 Hs and 4 Ts). 

Key conditions

Common acute and emergency conditions presenting in an OSCE include:

ABCDE assessment and OSCE components

  Examinations Clinical skills Prescribing Interpretation
A
  • Look for signs of airway obstruction (foreign body, fluid, secretions)
  • Can the patient talk? 

N/A

B
C
  • Fluid prescribing in adults and children  
  • Antibiotic prescribing 
  • Hypoglycaemia correction 
  • Antidote administration 
  • Fluids and oxygen, as above 
E
  • Head-to-toe examination looking for injuries, skin changes, signs of infection or sepsis 
  • Medical history 
  • Temperature assessment
  • Fluids and oxygen, as above 
  • Temperature management 

N/A

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Respiratory system 

History

Patients with respiratory pathology can present with various symptoms including, but not limited to, breathlessnesshaemoptysis, cough and wheeze. Taking a focused respiratory history is a skill often assessed in OSCEs. 

Key conditions

Common respiratory conditions presenting in an OSCE include: 

It’s also important to consider non-respiratory causes of breathlessness or cough, such as conditions causing chest wall or diaphragmatic weakness (e.g. Guillain-Barré Syndrome, myasthenia gravis), airway compression (e.g. superior vena cava syndrome), haematological abnormalities (e.g. anaemia) or toxicity (e.g. carbon monoxide poisoning in burn injuries). Similarly, acute heart failure may present with breathlessness and fine bibasal crackles. 

Examination

The respiratory examination frequently appears in OSCEs, and you’ll be expected to pick up the relevant clinical signs using your examination skills. It is most likely that the examination will be focused on identifying a specific condition.

It’s essential to learn the causes of finger clubbing (remember COPD does not cause clubbing) and the various types of cardiothoracic surgical incisions, as well as the common clinical findings (i.e. changes to percussion, auscultation and vocal resonance) that occur in specific diseases.

Paediatrics is full of respiratory presentations, so it’s helpful to learn what adaptations are needed for the paediatric respiratory examination

Clinical skills

Key clinical skills tested under the respiratory system include:

Interpretation

Anything tested as a clinical skill may require interpretation. Most commonly, arterial blood gas (ABG), venous blood gas (VBG) and spirometry.

You will not be asked to perform a chest drain insertion or a diagnostic thoracocentesis at an undergraduate level; however, understanding the procedure (e.g. indications and contraindications) and how to interpret the pleural fluid results could be tested. 

Chest X-ray

A chest X-ray (CXR) is one of the most common interpretation stations to assess your understanding of the respiratory system. 

You may also need to know how to request and document a chest X-ray in the notes. 

Counselling

Counselling stations may include an explanation of any of the conditions listed above, as well as the investigations and/or management required. Explaining a diagnosis of asthma or COPD, as well as the treatment with specific inhalers, is common. 

Other common topics include smoking cessation, discussing recommended vaccinations with patients with long-term respiratory illness (e.g. COPD) and counselling for specific specialist investigations (e.g. bronchoscopy). 


Cardiovascular system

History

Chest pain

Lots of conditions can cause chest pain, ranging from benign to life-threatening. A structured and comprehensive chest pain history can help establish the underlying cause and score you top marks in your OSCE. The SOCRATES mnemonic is a comprehensive way to explore pain symptoms. A thorough cardiovascular history when assessing a patient presenting with chest pain can also help to assess the likelihood of a cardiac aetiology.

Common cardiovascular conditions to appear on an OSCE causing chest pain include:

Breathlessness

Hints towards a cardiac aetiology include syncope, angina, peripheral oedema, dyspnoea at rest, orthopnoea, paroxysmal nocturnal dyspnoea, ‘pink frothy sputum’, absence of cough, and presence of cardiac risk factors (e.g. increased BMI, high blood pressure, high cholesterol, family history of coronary artery disease). 

Common cardiovascular conditions to appear in an OSCE causing breathlessness* include:

*These conditions commonly present with both chest pain and breathlessness.

Palpitations

Common cardiovascular conditions to appear in an OSCE causing palpitations include:

For more information, see our guide to palpitations history taking. Palpitations may be due to several non-cardiac conditions (e.g. anxiety, hyperthyroidism). 

Less obvious presentations of cardiovascular disease

In an OSCE, cardiovascular conditions will not always present with chest pain, breathlessness and/or palpitations; consider the following:

Cardiothoracic surgery and vascular surgery

Cardiothoracic and vascular surgery may also be tested; commonly encountered pathologies include varicose veins, aortic dissection, and popliteal artery aneurysm.  

Examination

Cardiovascular examination

The cardiovascular examination station comprises general examination, peripheral pulses, jugular venous pressure (JVP), chest inspection, cardiac palpation, chest percussion, chest auscultation, and auscultation with accentuation manoeuvres. You may encounter cardiothoracic surgical scars, including those for coronary artery bypass grafting and pacemakers

The paediatric cardiovascular examination requires a good understanding of cardiac anatomy and possible congenital heart defects; as well as an opportunistic examination style! Commonly, cardiovascular examinations test your ability to recognise heart murmurs

Peripheral vascular examination

The peripheral vascular examination is performed to elicit signs of peripheral vascular disease. Peripheral vascular disease describes reduced circulation of blood to a body part. Patients may present with intermittent claudication, critical limb ischaemia or acute limb ischaemia

One of the recommended additional investigations in a peripheral vascular examination is the ankle-brachial pressure index (ABPI) to assess limb perfusion, which can also be tested in an OSCE setting. 

Focused examinations

In OSCE scenarios, you may be asked to perform a focused examination to determine the presence (or absence) of a certain condition, such as a deep vein thrombosis or varicose veins. It is important to confidently elicit the main diagnostic signs of each condition.

Clinical skills

You could be asked to perform several clinical skills as part of a cardiovascular assessment, including blood pressure measurement and performing and documenting an ECG and ABPI measurement. 

Interpretation

ECG

Knowing how to record an ECG is a fundamental skill for your clinical competencies, OSCEs and when you start working as a doctor. Being able to interpret an ECG starts with understanding the ECG; once you’ve mastered that, you can learn how to read the ECG.

ECG interpretation stations may test your ability to recognise common ECG patterns, such as ACS, AF, WPW, HCM, SVT, sick sinus syndrome, bundle branch block (BBB) and heart block

Chest X-ray

While your chest X-ray OSCE station will likely test your ability to identify lung pathology, it’s necessary to remember that a methodical approach to CXRs includes assessing the heart size and borders.

Counselling

Counselling stations may include an explanation of any of the conditions listed above, as well as the investigations and/or management required. 

Common counselling points related to the cardiovascular system include:

  • Health and lifestyle changes 
  • Interpreting a lipid profile and/or explaining statins or other lipid-lowering agents
  • Explaining a procedure (ECG, echocardiogram) 
  • Primary prevention 
  • Secondary prevention 
  • Anti-coagulation
  • Explaining a diagnosis of hypertension and anti-hypertensive medication 
  • Explaining a diagnosis (e.g. STEMI, AF) 
  • Explaining a procedure (e.g. angiography) 
  • Discussion regarding ‘Do Not Attempt Cardiopulmonary Resuscitation’ (DNACPR) 

Gastrointestinal system 

The gastrointestinal (including liver) area of clinical practice includes upper and lower GI tract surgery.

History

Gastrointestinal history taking is a skill that is often assessed in OSCEs. Patients commonly present with a change in bowel habits, dysphagia, nausea and/or vomiting, weight loss or weight gain, abdominal bloating and abdominal pain

When approaching the most common conditions that affect the gastrointestinal tract, it may be helpful to sort them according to anatomical location.

The acute abdomen refers to the rapid onset of severe symptoms of abdominal pathology, which may require surgical intervention; it is important to keep these differentials in mind when approaching the diagnosis of abdominal pain. 

Anatomical location Common disease
Oesophagus, stomach
Biliary tree and pancreas
Small bowel
  • Inflammatory bowel disease (Crohn’s) *note, Crohn’s can affect any part of the gastrointestinal tract 
  • Coeliac disease
Large bowel
Anorectal area
  • Haemorrhoids
  • Anal fissures
  • Anal fistulas 
  • Faecal incontinence
  • Cancer (e.g. anorectal cancer
Miscellaneous 

Always remember that there are other non-gastrointestinal causes of abdominal pain, such as pyelonephritis or diabetic ketoacidosis

Examination

For the abdominal examination, learning the causes of jaundice, hepatomegaly, and splenomegaly is helpful. Surgical scars on the abdomen are another commonly tested topic; understanding what procedures the patient may have undergone may allow you to identify the likely underlying pathology quickly.

It is also essential to be able to examine stomas; the core components of the stoma examination include site, number of lumens, spout, effluent, surrounding skin and knowledge of the major complications associated with stomas. 

To complete an abdominal examination, it is typically recommended to suggest an examination of the hernial orifices and a rectal (PR) exam, if indicated, depending on the findings. PR and hernia examinations can also form standalone examination stations. 

A paediatric abdominal examination is often performed to assess abdominal pain and/or distension. Care must always be taken to ensure no undue pain or discomfort is caused to the child. Rapport and trust can be lost quickly, and further examination might be impossible.

Clinical skills

The ability to safely perform nasogastric (NG) tube placement is a key skill that medical students are commonly required to practice in simulation. Students should also be able to explain the procedure in lay terms and describe the key indications (e.g. feeding, administering drugs or draining the stomach’s contents).

Interpretation

Abdominal X-ray interpretation is commonly tested. A chest X-ray may also appear in a gastrointestinal station to assess the placement of an NG tube.

Blood test results are also commonly provided as part of a gastrointestinal system station, such as interpreting liver function tests or haematinics.

Counselling

Counselling stations may include an explanation of any of the conditions listed above, as well as the investigations and/or management required. 

Common communication stations include iron counselling, explaining an endoscopy or a colonoscopy or talking about alcohol use. Discussions about bowel cancer screening may require explanations of the screening programme, stool sample collection, normal or abnormal results and the urgent suspected cancer (‘two-week wait’) pathway. 


Renal and urology 

History and key conditions

Common history-taking stations in renal and urology may include discussing lower urinary tract symptoms (e.g. dysuria, increased urinary frequency) in both males and females and exploring haematuria.

Urological history taking has a specific structure to help elicit key urological symptoms and risk factors. 

Renal vs urology

Urology is a surgical speciality that deals with diagnosing and managing diseases of the male and female urinary tract, including the kidneys, ureters, bladder, and urethra.

Nephrology (renal) is a medical speciality focused on diagnosing and managing diseases that affect kidney function. 

Key conditions

Renal  Urology 

 

Examination

The renal system examination is a specific examination that focuses on assessing a patient’s fluid status (fluid depleted, euvolemic, or fluid overloaded) and assessing for signs of renal disease.

The testicular examination helps to test your understanding and ability to differentiate between several urological conditions, including hydrocele, epididymal cyst, spermatocele, varicocele, epididymitis, torsion and malignant lesions. In males, the prostate gland can be examined via PR examination; this allows assessment of the prostate size, symmetry and texture.  

A chaperone should be offered routinely before conducting any intimate examinations. This applies to all patients, regardless of whether you are the same gender as the patient.

Clinical skills

Clinical skills occasionally tested in renal and urology include urinalysis (including documentation) and measuring and recording urine output

Prescribing in renal impairment is a crucial skill. AKI occurs in around 20% of emergency hospital admissions, and prescribing safely helps to reduce the risk of long-term renal damage. 

The most commonly tested clinical skill is catheterisation (male and female); you must understand the indications, contraindications, complications and step-by-step procedure. As a medical student, catheterisation should be performed under direct supervision on placement; however, as part of OSCEs, you will be asked to complete the procedure under simulation with mannequins. 

Interpretation

Interpretation of blood results is common in renal and urology stations; typically, urea and electrolytes (U&E), creatine kinase, calcium and vitamin D, and prostate-specific antigen (PSA). It’s important to remember that conditions such as anaemia and secondary and tertiary hyperparathyroidism may occur as the result of secondary chronic kidney disease. 

Abdominal X-ray interpretation is commonly tested. The abdominal X-ray can identify renal stones and staghorn calculi in the renal tract system. 

Communication

Counselling stations may include an explanation of any of the conditions listed above, as well as the investigations and/or management required.

Counselling stations for renal and nephrology include discussion regarding PSA levels, recurrent UTI, recurrent renal stones (e.g. modifying risk factors), diabetes-related renal complications (e.g. worsening albumin-creatine ratio) and dialysis counselling.


Surgery

The surgery area of clinical practice includes general, plastic, breast, oral and maxillofacial surgery, and transplantation.

History and key conditions

As part of breast surgery, it is essential to know how to take a breast lump history.

For general surgery, common presentations include abdominal pain; therefore, it’s essential to understand the differentials of an acute abdomen

For transplant surgery, you need to understand the basic principles of transplantation medicine, how transplant recipients are assessed and an overview of the operation, immunosuppression and its complications. 

Breast surgery General surgery 

 

 

 

You could also be asked to assess a post-operative patient (e.g. as part of a simulation scenario). This could be from any specialty, but common presentations may include:

  • Pain
  • Nausea and vomiting
  • Bleeding
  • Confusion
  • Breathlessness
  • Fever
  • Reduced urine output

Examination

Breast surgery

Breast examinations are performed for several clinical reasons; patients commonly present with breast lumps, nipple changes, nipple discharge or overlying skin changes. As breast cancer is one of the most common cancers in the UK, it’s essential you know how to conduct the exam and differentiate between different pathologies. 

General surgery

An abdominal examination and PR examination help diagnose gastrointestinal bleeding, inflammatory bowel disease, haemorrhoids, constipation, trauma, and other disorders.

A chaperone should be offered routinely before conducting any intimate examinations. This applies to all patients, regardless of whether you are the same gender as the patient.

Clinical skills

Under surgery, you may be tested on your surgical scrubbing and gloving and surgical gowning technique.

Whilst you will not be expected to be an expert on suturing or suture materials at an undergraduate level, it’s important to understand the basics of equipment, suture material and general technique (e.g. setup, knot tie, wound care and follow-up). Common suture types include deep dermal, horizontal mattress, vertical mattress, subcuticular and simple interrupted

Interpretation

In general surgical stations, abdominal X-ray interpretation is commonly tested. Important findings may include:

  • Free air under the diaphragm – suggesting perforation of a viscus
  • Distended loops of the bowel, collapsed colon, differential air-fluid levels and thickened bowel wall – suggesting intestinal obstruction 
  • Detection of ingested foreign bodies 
  • Detection of abdominal masses or tumours 

Counselling stations may include an explanation of any of the conditions listed above, as well as the investigations and/or management required. 

Explanation of a procedure is commonly tested as part of surgery. It’s important to practice information giving and explain to the patient in lay terms. It’s also possible that you may be required to simulate a pre-operative assessment. Breaking bad news or discussing a possible cancer diagnosis (i.e. two-week-wait protocol) is also common. 


Musculoskeletal 

The musculoskeletal (MSK) area of clinical practice includes rehabilitation, trauma, orthopaedics and rheumatology.

History

Common presentations under MSK include painful joints, swollen joints, back pain and falls. Orthopaedic and rheumatological history taking focuses on the onset of joint pains, the patterns and symmetry of joint involvement, the number of joints involved, and a review of any relevant systems.

The SOCRATES mnemonic is a helpful tool to establish many of these features. It’s also important to remember to ask about any history of trauma. 

Metabolic bone diseases are a broad spectrum of disorders, including Paget’s disease of the bone, osteoporosis, osteomalacia and Rickets. These conditions may present with weakened bone, loss of bone, frequent fractures or delayed growth in children and are often characterised by deficiencies of minerals such as magnesium and calcium, as well as vitamin D. 

Examination

Examination  Possible findings

Hip

Knee
Spine 
Hand and wrist
Elbow examination

Ankle and foot 

 

Shoulder

GALS

pGALS

For any hot, red, painful joint, always consider the possibility of septic arthritis.

Interpretation

Musculoskeletal X-ray interpretation can feature in OSCEs, so it’s important to practice this skill to develop a structured approach. Specific X-ray interpretation stations may include hip, wrist, lumbar spine, ankle and shoulder.  Additionally, for cervical spine X-ray interpretation, it is useful to have a basic understanding of the most common patterns of spinal fracture.

In paediatric MSK injuries, always consider the possibility of non-accidental injury and safeguarding procedures. 

Counselling

Counselling stations may include an explanation of any of the conditions listed above, as well as the investigations and/or management required. For example, explaining a diagnosis of psoriatic arthritis

You must have a good understanding of Disease-Modifying Antirheumatic Drugs (DMARDs), such as methotrexate, which are a class of drugs indicated for the treatment of inflammatory arthritides. Similarly, corticosteroid counselling may include explaining the indications, complications and special circumstances for changing the dose of steroids (e.g. ‘sick day rules’, tapering regimes).


Obstetrics and Gynaecology

History

An obstetric history involves asking about a patient’s current and previous pregnancies. Some of the questions are highly personal. Therefore, good communication skills and a respectful manner are essential. Similarly, fertility history taking requires constant awareness and sensitivity to the patient’s emotions. 

Key conditions

Obstetrics Gynaecology 

Examination

The examination stations as part of obstetrics and gynaecology are varied; however, they are united by a need for excellent communication and maintaining respect for patient dignity. A chaperone should be offered routinely before conducting any intimate examinations. This applies to all patients, regardless of whether you are the same gender as the patient.

The obstetric abdominal examination is routinely performed throughout pregnancy; small adjustments are needed for the examination depending on gestational age. A bimanual vaginal examination may need to be performed in several different clinical scenarios, including unexplained pelvic pain, irregular vaginal bleeding, abnormal vaginal discharge and as part of the assessment of a pelvic mass. 

A cervical screening test (previously known as a smear test) could appear in OSCEs, and you’ll be expected to demonstrate excellent communication and practical skills. As part of all the examinations above, you will need to know how to use a speculum and perform a speculum examination, as well as take swabs

Interpretation

As part of obstetrics and gynaecology, you may be required to demonstrate an understanding of the mechanism of labour and the core components of a cardiotocograph (CTG); however, sophisticated interpretation will not be expected at the undergraduate level.  

Discussions regarding antenatal screening may combine several different skills, including your understanding of screening, your ability to break bad news, and your ability to interpret results (e.g. combined test, increased nuchal translucency). 

Counselling

Counselling stations may include an explanation of any of the conditions listed above, as well as the investigations and/or management required. 

Hormone replacement therapy (HRT) counselling can be a challenging station as it requires a good understanding of the different HRT regimes as well as the advantages, disadvantages and risks. 

Contraceptive counselling

Contraceptive counselling is common; good knowledge of the methods of contraception is important, including discussions about condoms, the implant, depot injection, combined oral contraceptive (COCP), progesterone-only pill (POP), intrauterine system (IUS/Mirena) or copper intrauterine device (IUD). Emergency contraceptive counselling is an often repeated station that requires a sensitively structured history, good medication understanding, safety netting and promoting future safe sex practices.  


Sexual health 

History

For sexual health, it’s important to know how to take a comprehensive sexual history. Sexual health histories may also require you to take a comprehensive history of female lower urinary tract symptoms

Sexually transmitted infections

Examination

A bimanual vaginal examination may need to be performed in several different clinical scenarios, including unexplained pelvic pain, irregular vaginal bleeding, abnormal vaginal discharge and as part of the assessment of a pelvic mass. If an STI is suspected, visualisation of the vagina and cervix can be achieved with speculum examination, and swabs can be performed to help diagnose the disease. 

A chaperone should be offered routinely before conducting any intimate examinations. This applies to all patients, regardless of whether you are the same gender as the patient.

Counselling

Counselling stations may include an explanation of any of the conditions listed above, as well as the investigations and/or management required.

Sexual health communication stations are sensitive. It is important to build a strong rapport early and remind the patient of the confidential nature of the discussion. As well as explaining a diagnosis, it is also important to know about methods of prevention – including safe sexual practices and medicines such as pre-exposure prophylaxis (PrEP).


Mental health

History

As part of mental health, you should know how to take a comprehensive psychiatric history, including how to focus on exploring key symptoms of specific conditions, such as eating disorders, anxiety, depression and the first-rank symptoms of schizophrenia. It’s important to consider the need for a psychiatric risk and suicide risk assessment when taking a history.

A specific history encountered as part of mental health is alcohol history taking, and relevant questionnaires such as the ‘CAGE questionnaire’ and Alcohol Use Disorders Identification Test (AUDIT-C).

Key conditions

Category Conditions
Affective (mood) disorders 
Anxiety disorders
Schizophrenia and other psychotic disorders 
  • Schizophrenia 
  • Schizoaffective disorder 
  • Psychotic disorder 
Somatic symptoms and related disorders 
  • Medically unexplained symptoms
  • Somatic symptom disorder
  • Illness anxiety disorder 
  • Conversion disorder (functional neurology symptom disorder)
  • Factitious disorder 
Substance-related and addictive disorders
Eating disorders 
Neurodevelopmental disorders, child and adolescent psychiatry 
  • Attention Deficit Hyperactivity Disorder (ADHD
  • Autism Spectrum Disorder (ASD)
Personality disorders 
  • Avoidant 
  • Dependent 
  • Obsessive-compulsive 
  • Paranoid 
  • Schizoid 
  • Schizotypal 
  • Borderline 
  • Histrionic 
  • Narcissistic 
Perinatal mental health
  • Postnatal blues (‘baby blues’)
  • Perinatal depression 
  • Post-partum psychosis
Organic brain disorder 

Examination

The main examination in psychiatry is the mental state examination (MSE). The MSE provides a snapshot of the patient’s current emotions, thoughts and behaviours at the time of observation. As part of the MSE, you may also have to conduct a brief mental capacity assessment.

As part of psychiatry, you may be required to perform a focussed assessment for extra-pyramidal side effects (EPSEs), a common side effect of typical antipsychotics (e.g. haloperidol).

Counselling 

Counselling stations may include an explanation of any of the conditions listed above, as well as the investigations and/or management required.

You should be able to explain the common types of psychiatric medications, including how they work, how to take them and the main side effects. The most common classes of medications include antidepressants, antipsychotics (e.g. clozapine), mood stabilisers (e.g. lithium) and anti-dementia agents. You may also have to discuss voluntary, involuntary and emergency admission as part of the Mental Health Act (MHA) with a patient. 

Electroconvulsive therapy (ECT ) counselling is a common OSCE topic in psychiatry scenarios. It often includes dealing with a patient’s concerns about treatment and being able to answer questions in a sensitive but informative manner.


Dermatology 

History

Skin diseases are varied and visible; however, the visibility of the lesions does not undermine the importance of good history-taking in dermatology.

As part of a thorough dermatological history, you must take a systematic approach whilst also considering specific additional questions such as the initial appearance and evolution of the lesion, presence of itch or pain, skin type, history of sunburn or tanning machines, history of atopy, family history of skin disease and skin cancer.

Category Conditions
Skin and subcutaneous tissue infections
Bullous disorders and severe skin reactions 
Dermatitis and eczema
Papulosquamous disorders
Urticaria and erythema
Skin cancer
Other 

All diseases marked with a ‘*‘ are dermatological emergencies!

Examination 

There are several key principles in performing a thorough examination of the skin. It is important to inspect the lesion closely, noting the site and number of lesions and any overlying or surrounding skin changes.

Each lesion should be considered in size, shape, colour, morphology and margin. If the lesion is pigmented, it is important to assess the ABCDE features – Asymmetry, Border (irregular), Colour (two or more colours within the lesion), Diameter >6mm and Evolution of the lesion over time.

For rashes and non-pigmented skin lesions consider the texture, consistency, mobility, tenderness and temperature. For further examination in dermatology it is important to consider evaluating the remaining skin, nails, scalp, hair and mucous membranes; as well as reviewing any other systems relevant to the presenting complaint. 

Counselling 

Counselling stations may include an explanation of any of the conditions listed above, as well as the investigations and/or management required.

Check out our counselling stations for acne vulgaris or psoriasis


Ophthalmology 

History

Red eye, diplopia and loss of vision are common presenting complaints in ophthalmology. Taking a structured ophthalmic history can help to differentiate between different causes.

It is important to distinguish painLESS loss of vision from painFUL loss of vision and sudden loss of vision from gradual or transient loss of vision, as these all have different underlying pathologies. Similarly, it is also helpful to separate when a patient presents with red eye it may be helpful to classify these according to whether the presentation is painFUL or painLESS.

It’s important to consider that visual loss may be ophthalmological (due to eye pathology) or neurological (due to nervous system pathology). 

  Red eye No red eye 
Painful, visual loss
Painless, visual loss N/A
Painless, no visual loss

Examination 

Examination of the eyes and vision frequently appears in OSCEs, either individually or as part of the cranial nerves assessment. You’ll be expected to pick up the relevant clinical signs when assessing visual acuity, blind spot and colour vision.

Assessment of the anterior segment of the eye can be achieved with either the ophthalmoscope (traditional device or Arclight) or slit lamp examination. 

Clinical skills 

Slit lamp examination is a powerful tool for systematic ocular examination. It is not a skill that will be tested as part of an undergraduate medical degree, but the basic principles and diagnostic capacity should be understood.

The retina is the only portion of the central nervous system visible from the exterior; therefore, fundoscopy is a frequently tested skill owing to the potential to uncover several pathological processes. 

Interpretation

It can be helpful to review the fundoscopic appearance of retinal pathologies as any of these may be tested, especially if using a simulated fundoscopy model. 

Counselling 

Counselling stations may include an explanation of any of the conditions listed above, as well as the investigations and/or management required.

For example, explaining a diagnosis of glaucoma, explaining eyelid care for blepharitis or how to use eye drops.


Neurosciences  

History

History stations in neurology are varied. Common presenting complaints include headache, dizziness, seizure, and loss of consciousness. The ability to take a history from a patient presenting with a transient ischaemic attack (TIA) or ischaemic stroke is also a necessary skill. 

Key conditions

Key conditions in neurology include:

Examination

Cranial nerves

You’ll often be expected to assess a subset of the twelve cranial nerves and identify abnormalities using your clinical skills. Notable special tests include:

  • Cranial II (optic): offer to test the blind spot, colour vision and visualising the retina (fundoscopy)
  • Cranial nerve III (oculomotor), IV (trochlear) and VI (abducens): offer to test the movements of the eyes in the figure of ‘H’ to assess for any nystagmus and diplopia
  • Cranial VIII (vestibulocochlear): if hearing loss is present, consider Rinne’s and Weber’s to differentiate between conductive and sensorineural hearing loss

Limbs

Examination of the upper limb and lower limb may be split into testing sensory and/or motor function. A good understanding of the brachial plexus and nerve supply to the upper limb and gait abnormalities can help you to quickly identify pathology. When testing the power of specific movements, it is best to use the MRC scale.

Focussed examinations

Focussed examinations to test for specific conditions are also common in neurology. You may be expected to examine a patient for the presence of Parkinson’s disease or conduct a ‘Head impulse, Nystagmus and Test of Skew’ examination (HiNTs exam) in a patient presenting with persistent vertigo, nystagmus and a normal neurological exam to help differentiate between central and peripheral causes of vertigo. 

The cerebellar examination is another focussed examination that attempts to elicit clinical signs of cerebellar disease. 

As part of an A to E assessment, a brief neurological assessment should be performed during D (Disability); this may include calculating a Glasgow Coma Scale (GCS) or ACVPU scale.

Paediatrics

Examining the neurological system is different in young children compared with older children and adults. The components of the complete exam are extensive and usually cannot be performed in a classical fashion. The approach may be carried out on a cooperative school-aged child – but always be mindful of keeping the examination fun. In paediatrics you’re likely to encounter fits, faints and funny turns in childhood

Interpretation

Interpretation statins in neurology include cerebrospinal fluid interpretation or CT head interpretation.

Counselling 

Counselling stations may include an explanation of any of the conditions listed above, as well as the investigations and/or management required. For example, explaining a diagnosis of epilepsy 

Consider the importance of communication skills in neurosciences stations, including communicating with patients with aphasia.


Endocrine and metabolic 

History

Endocrinological conditions present in several ways, including fatigue/tiredness, weight gain or weight loss and pain. 

Organ Conditions

Pituitary gland

Adrenal cortex

  • Adrenal insufficiency (Addison’s disease) 
  • Cushing’s syndrome
  • Congenital adrenal hyperplasia 
  • Primary hyperaldosteronism 

Thyroid

Other

Examination 

The two main examinations for endocrinology include diabetic foot and thyroid examination.

It is also possible to be asked to examine for the presence of a specific disease, such as Cushing’s syndrome or acromegaly, where several different systems must be examined. The ABCDE management of DKA is also a commonly tested area. 

Interpretation

Stations may focus on the interpretation of blood results, such as electrolytes (e.g. hyponatraemia, hypercalcaemia, hyperkalaemia) or interpretation of other blood results to form a diagnosis (e.g. bone profile)

Counselling

Counselling stations may include an explanation of any of the conditions listed above, as well as the investigations and/or management required.

Commonly tested is explaining a diagnosis of type I or type II diabetes and the medications that can help to manage it (e.g. metformin). It may be helpful to review the basic physiology of how the adrenal and gonadal axis work to help simply explain any endocrine diagnoses. 


Other OSCE stations

Outside of all these topics, other stations commonly encountered include:

History 

Examination 

Clinical skills

Communication


Suggest an OSCE station

Are we missing an OSCE station from this list? Let us know!

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