OSCE station.

Instruction to candidates:
You are an intern at Box Hill Hospital and your patient, John McBloggers, requires a nasogastric tube as part of his
management for a small bowel obstruction for which he presented 30 minutes ago. Your surgical registrar is busy
and has asked that you take consent for the procedure (6 minutes). Because you know hes a devious devil of a
registrar, youre also expecting a couple of questions about Mr McBloggers condition after that (2 minutes for 3
short happy questions).

Patient information/examiner marking sheet:

PATIENT/REGISTRAR
QUESTIONS

EXAMINER MARKING CRITERIA

CONSENT with patient (6mins)

Mark allocation, one per dot-point:
Candidate must ask if they have had one before
Candidate must give reason, which is therapeutic to decompress small
Question 1
bowel
Oi mate, why do I need to
Candidate should mention some other therapeutic (feeding, prevent lung
have this procedure?
aspiration, etc) and diagnostic (evaluate upper GI bleed, administer
contrast, etc.) reasons
Question 2
Mark allocation, one per dot-point:
How is this procedure done?
Query allergies
Position: patient sitting upright and neck extended
Analgesia: anaesthetic gel and/or oral analgesic spray used on nose and on
end of nasogastric tube (no mark if they say NG tube)
Procedure: warn patient this may feel uncomfortable; advance tube via one
nostril until it lies in the stomach
Detail: patient is to take small sips of water while this occurs
Post-procedure 1: tube is firmly taped to nose
Post-procedure 2: aspiration of tube and CXR taken to ensure tube is in right
location
Duration: whole process will take about 30 minutes and will remain in place
until its purpose it met
Somewhat understandable drawing of what is going on
Question 3
Mark allocation, one per dot-point:
Is it a day procedure and if so
Yes it is a day procedure BUT Mr McBloggers is likely to be in hospital for a
can I go home afterwards?
longer period of time due to his condition (CLEAR FAIL if said he can leave)
Question 4
Mark allocation, one per dot-point:
Doctor, what are the risks,
ALL OF: failure and retry, bleeding, infection, perforation
doctor?
Anaesthetic risk: metal taste, headache, blurred vision, seizure, arrhythmia
Risks of not doing the procedure: worsening SBO
Other, mark allocation, one per dot-point:
Ask for understanding (either at end or along the way)
MUST gain consent (ask and pass over fake form) to pass station, CLEAR
FAIL if forgotten
Good rapport with patient, being a good human-being
QUESTIONS with surgical registrar (2mins, more if finished early)
Question 1
Mark allocation, one per dot-point:
What are the common causes
ALL OF: adhesions from previous surgery, hernias, IBD, cancers/lymphomas
of SBO?
(+/- random shit like intussusception/gallstones/foreign bodies, THEY LOSE
the mark if theyre a smartass and say pseudo-obstruction)
Question 2
Mark allocation, one per dot-point:
What symptoms and signs
Symptoms ALL OF: central colicky abdominal pain (every 3-5 minutes),
would you expect in a SBO?
nausea +/- vomiting (bilious), constipation/obstipation
Signs ALL OF: abdominal distension, tinkly bowel sounds or no bowel sounds
Question 3
Mark allocation, one per dot-point:
Show scan and ask This is Mr
Pathology location picked up and described (high level of detail is not
McBloggers scan, tell me the
required) ie. they didnt get the below point but they noticed something
spot diagnosis or Im moving
was f*cked up
you to the Angliss for the year
Diagnosis made of intussusception, target sign noted
CLEAR FAIL: mentioning x-ray, ultrasound, unicorns, or something else stupid
MARKS
/24
If taking too long, please hurry
to next question

CLEAR FAIL (awks)

BORDERLINE

PASS

CLEAR PASS

Imaging: