UDM1 — UDM1 TASK 2: OBJECTIVE STRUCTURED CLINICAL EXAMINATION AND PATIENT TREATMENT PLAN

UDM1 — UDM1 TASK 2: OBJECTIVE STRUCTURED CLINICAL EXAMINATION AND PATIENT TREATMENT PLAN

D346 Objective Structured Clinical Examination (OSCE) Scenarios

In order to respond to D346 Task 2, you must identify and review the OSCE scenario that corresponds to the first initial of your last name, as follows:  

                                                                       Last Name               OSCE                  Page #

A-D	OSCE 1	pg. 2
E-K	OSCE 2	pg. 3
L-R	OSCE 3	pg. 4
S-Z	OSCE 4	pg. 5

OSCE 1

You will assess Diana Rose, a 22-year-old female who works full time (second shift) as a patient care technician at a local hospital where she lives in Augusta, Georgia. She was referred to you by a urologist for a CMSE due to somatic symptoms unexplained by medical examinations. Her mother accompanies her. She has been doctor shopping, trying to render a verdict that she has a severe kidney disease, which physicians are overlooking. Her chief complaints are severe back pain and yellow urine.

Vital Signs:   

• Blood Pressure: 120/62 
• Heart Rate: 90 
• Respirations: 22 

Height: 5’8″             

Weight: 140 

Labs/Diagnostics: 

• Blood Tests: Within normal limits 
• Urine Analysis: Within normal limits 

OSCE 2

You are meeting with Taylor Winston, a 42-year-old male patient. He was admitted to the psychiatric hospital earlier today for suicidal ideations. He has been living with his mom after his divorce one year ago. The mom is in the waiting room but has shared that her son has been withdrawn, not showering regularly, wearing the same clothes for days, and not eating well for approximately three weeks. The mom states that she had no idea how bad her son’s emotional state was and thought he was experiencing stress related to his work. The patient told his mother that he no longer wanted to shoot himself with his mom’s handgun. His mom was concerned for his safety. She took the gun to her sister’s house and brought him to the ED for psychiatric evaluation.

Mom denies that her son has any history of psychiatric disorders or suicidal behavior/attempts in the past. She stated that she has another son, age 32, that lives out of state. Her sons do not have a close relationship due to the large age gap. Her son works in construction and has been recently calling in sick due to his symptoms. He rarely leaves his room and stopped going to the gym and out with his friends. Mom was asked about neurodevelopmental history. He was born at 40 weeks, with no delivery complications, and has met all developmental milestones with no history of learning disabilities. 

Vital Signs: 

• Blood Pressure: 130/64
• Heart Rate: 98
• Respirations: 16

Height: 5’10”          

Weight: 160

Labs/Diagnostics:

• Blood Tests: Within normal limits
• Urine Drug Toxicology: Negative for drugs/alcohol
• EKG: Normal sinus rhythm

OSCE 3

You are evaluating Angela Tate, an 82-year-old female, who was brought in by her daughter due to concerns of subtle changes in behavior—progressive forgetfulness that started over the past year. She was referred by her primary care provider after receiving a thorough evaluation for medical causes of her symptoms. 

She has difficulty recalling recent events and started using a small pocketbook calendar to help her remember when to pay her bills. In the past, she loved attending family gatherings, but in recent months, she has declined multiple invitations. Per the daughter, her mother was an eloquent speaker and writer. She would present at conferences for her former career as a marketing executive and retired 20 years ago. In recent months, she has noticed that her mom sometimes pauses in mid speech, and her use of words has changed. Her daughter states that she would speak in more sophisticated terms and now uses more general terms to describe things. In addition, she has been misspelling words. 

Per the daughter, the changes are not apparent to people who are not close to the patient but have become noticeable to her children. Her daughter states that the patient has three adult children, two that live 20–30 minutes away from the patient, and one that lives in another state. She has a good relationship with her children and maintains frequent communication with them. The patient was married for 53 years, and her husband died seven years ago. The daughter is concerned about her mother’s state and believes that she should live with one of her daughters. The patient feels that the daughter is overreacting and agreed to an evaluation.

Vital Signs: 

• Blood Pressure: 115/63
• Heart Rate: 63
• Respirations: 17 Height:  5’7″

Weight: 125 pounds

Medical History: Osteoporosis

Surgical History: Hysterectomy 40 years ago due to endometriosis

Medications: Multivitamins and calcium supplements

Social History: Drinks a glass of wine three to four days a week; exercises five days a week for 30 minutes per day; active in church and leads a women’s group weekly

Psychiatric History: History of postpartum depression 50 years ago; patient attended psychotherapy for six months and has not experienced depression since; family history of Alzheimer disease on maternal side; mother had Alzheimer disease and died at the age of 91; sister, who is four years older than patient, was diagnosed with Alzheimer disease

Labs/Diagnostics:

• Lab: Within acceptable limits 
• EKG: Within normal limits

OSCE 4

You are a PMHNP meeting with Gerald Smith, a 62-year-old male patient who was brought in by his son for symptoms of extreme sadness, loss of life meaning, and intense loneliness since the death of his wife one and a half years ago. Gerald was married to his wife for 44 years. They were high school sweethearts and had a very close and loving relationship throughout those years. They were also very close to their five children and grandchildren and hosted yearly family reunions. Everything changed when his wife contracted COVID. Five days after being admitted to the hospital, she died. 

Gerald lives by himself in their family home that they have owned for over 40 years. He has five children, ages 42, 40, 39, 38, and 37. Family has visited with him frequently and felt that bereavement was to be expected, especially since they were married for a long time. His children have tried to coordinate family reunions and celebrations, but Gerald often declined; or, when he would attend, he wouldn’t interact with family like he did before his wife’s death. 

His children decided it was time to have him evaluated by a mental health professional when Gerald stated that he sometimes hears his wife talking to him. He was also a very happy and outgoing individual, but since his wife’s death, he has become bitter. He is still working part time at a local grocery store. 

Vital Signs: 

• Blood Pressure: 121/87
• Heart Rate: 76
• Respirations: 18 Height: 5’9″

Weight: 167 pounds

Labs/Diagnostics: 

• Blood Tests: Within normal limits
• EKG: Within normal limits

UDM1 — UDM1 TASK 2: OBJECTIVE STRUCTURED CLINICAL EXAMINATION AND PATIENT TREATMENT PLAN