🏥 MRCGP OSCE | Clinical Skills Assessment

Station 1: Chest Pain – Acute MI & Emergency Management | Candidate instructions

🔴 HIGH ACUITY – 10 MINUTES SIMULATION ⏱️ Simulated time: 10 min encounter
✓ Role: GP in surgery. Mr. Allah Rakha, 51y, severe chest pain since 10 min. Take focused history, differentials, manage emergency. Use checklist to simulate your actions.
🫀 PATIENT: Mr. Allah Rakha (51 yrs)

👨‍⚕️ Opening: "Doctor, I have severe chest pain for the last 10 minutes. Like a heavy weight on my chest & I'm short of breath."

🗣️ Patient answers (OD-PARA-MI):
• Onset: walking uphill carrying groceries
• Duration: 10 minutes, constant
• Site: centre & left side of chest
• Progression: severe, constant, 7-8/10
• Associated: nausea, profuse sweating
• Radiation: left arm to little finger, neck & jaw
• Relieving: rest helps a little
• Aggravating: exertion
• Medicines: Paracetamol OTC — no relief
• Investigation: ECG done (shows anterior infarct, doctor reviews)
⚠️ Differentials (Quick D/D answers):
• Pinpoint with one finger? ❌ No, all over chest.
• Pain worse on movement? ❌ No.
• Chest trauma with breathlessness? ❌ No.
• Unilateral rash? ❌ No.
• Travel >5h? ❌ No.
• Blood in phlegm? ❌ No.
• Sudden tearing to back? ❌ No.
• Pericarditis features? ❌ No.
🚩 RED FLAGS / RISK FACTORS:
• Smoker: 2 packs/day • Alcohol: 4 units/day • Family hx: father died MI age 60
• Hypertension: Yes • Diabetes: No • Work stress: company downsizing • Home stress: wife left recently
• Weight loss/fever/hemoptysis: No.
🤝 When you recommend admission:
"But doctor my flight is booked to see my newborn granddaughter in few hours."
Your response (shared decision): explain that it could be heart attack → agreement: "Ok doctor I agree to get admitted."
No accompanying person → asks to inform family.
🔍 DIFFERENTIAL DIAGNOSES checklist (consider):
✔️ MI (Anterior) | Unstable Angina | Pericarditis | Dissecting aneurysm | PE | Pleurisy | Pneumothorax | Musculoskeletal | Costochondritis | Shingles | Oesophagitis | Bornholm’s disease.
📋 RED FLAGS (must ask): Weight loss ❌ | Fever / night sweats ❌ | Hemoptysis ❌
📊 [ECG FINDING] ST elevation in anterior leads (V2-V4) — anterior myocardial infarction.
🩺 YOUR MANAGEMENT & DATA GATHERING (Tick as you complete)
📋 STEP 1: History & Red Flags (OD-PARA-MI + D/D)
🚨 STEP 2: Emergency Immediate Management (MI protocol)
⚡ Key drugs order: Morphine 2.5mg IM + Metoclopramide + Aspirin 300mg PO. High-flow O2.
📝 STEP 3: Explanation, Consent & Safety Netting
🩺 POST-MI COUNSELLING (Separate station / integrated)
*Based on RCGP/CSA marking domains: Data gathering, Clinical reasoning, Emergency management, Safety netting, Post-MI counselling, Communication.
🏥 Simulated OSCE Station – MRCGP style | Based on given case of Mr. Allah Rakha (anterior MI) & Post-MI counselling Mr. Mahmood integrated | Emergency management: Aspirin, morphine, metoclopramide, O₂, IV access, urgent cath lab referral.