Objective Structured Clinical Examination
MOCK EXAM
Scene: You are seeing this patient in OPD:
A 55-year-old woman presented with 6 months’ history of
weakness, fatigue and weight loss.
You have 8 minutes to do the following:
1- Obtain comprehensive History
2- You will be observed for your communication manners
3- Discuss the differential diagnosis and investigations for the
problem with the examiner.
1
Detailed History (for Simulator)
- You are 55 years old woman presented with 6 months’ history of
weakness, fatigue and weight loss.
- You noticed that you became weak and easily fatigued over the
past 6 months.
- You gradually lost 8 Kgs over the past 6 months.
- You have on and off abdominal pain, mild to moderate and
diffuse, not colicky. NO aggravating or relieving factors.
- You feel dizzy at several occasion during the day, especially when
you stand up quickly.
- You were told many times that your blood pressure is low and
reaches 90//60.
- There is no history of fever or night sweats.
- No history of diarrhea, no Cough or sputum production.
- Systemic reviews are unremarkable.
- You do not take any medications and never tried herbal medicines
- Your Past medical and surgical histories are negative.
- You are not smoker and you are a house wife.
- You have no contact with T.B patients/ No past or family history of
Endocrine diseases or T.B.
- You have 4 children, youngest is 20 years old (delivered when you
were 35 years old).
- You had severe bleeding at the time of your last child delivery,
you were transfused with 4 units of blood.
- You breast fed the child for 1 month only, after which you could
not breast feed him because your milk dried (no more breast milk)
- You never had periods after that (at 35 years of age.
2
Adrenal Insufficiency Checklists
Resident Name: Start Time:
Resident Number: End Time:
Evaluator Name:
1. Please evaluate the candidate knowledge & communication manners.
2. Please instruct the candidate to obtain comprehensive History.
3. Please observe the candidate, don’t interrupt him/her while
interviewing the simulator.
4. Please evaluate the candidate items according to the following
scoring system:
Mark 0: not performed
Mark 1: performed incompletely
Mark 2: performed completely & competently
2 1 0
1. Communication manners:
- Introduces him-herself/explains task for the patient.
- Attentive to patient's answers /Acknowledging of patient.
2. History related questions:
- Course of symptom, onset, progression.
- Magnitude of weight loss, over what time?).
- Associated symptoms (fever, abdominal pain, night sweats).
- History of Diarrhea, Dizziness low blood pressure.
- Past medical and surgical history.
- Family history (Endocrine diseases, T.B.).
- Social history (smoking, occupation), Number of children.
- Drugs (Use of steroids, doses, duration) Herbal Medicines Intake.
- Menstrual history: bleeding requiring blood transfusion in the last
delivery followed by loss of menses, inability to lactate last child.
3
2 1 0
3. What is the most likely DIAGNOSIS?
- Adrenal Insufficiency, Primary OR Secondary (sudden stopping of long
term steroids, Sheehan's syndrome).
4. Give 2 important INVESTIGATIONS in order to make the diagnosis?
- Chemistry Profile.
- Random Cortisol and Short Synacthen Test.
3.57 X ...…... Scoring Points
TOTAL = ...…... %
Below, Mark overall approach to the task
Clear Pass Borderline Pass Borderline Fail Clear Fail
>70% 60% - 69.4% 50% - 59.4% < 50%
Evaluator Signature: Date:
