OSCE Toolbox | Nausea 1 - Scenario

By • March 03, 2026 • Last reviewed: •

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Summary Intermediate

In this scenario, the community pharmacist counsels a patient who has come in complaining of persistent nausea. The student must take a history, make a diagnosis, and suggest an appropriate over-the-counter medication.

Please ensure that this scenario and mark scheme align with the most up-to-date guidelines from the UK NICE and the BNF when using it for your OSCE assessment.

You will need a student pharmacist and an actor for this scenario.

Revision Topics

Be aware, this may reveal any answers!

Student Instructions

Actor Instructions

This may reveal scenario objectives!

You are Chloe Bennett (KLOH-ee BEN-it)

Opening statement: “I need something for nausea. I’ve been feeling really sick.”

Patient information:

To be given if the student asks.

Name: Chloe Bennett

Age: 29

Past medical history:

- “None”

Medication History:

- “I’ve been taking semaglutide injections for 4 weeks. I got them online from a fitness influencer.”
  - If asked for more information:
    - “It’s much cheaper than going private. And I can’t get it on the NHS because I’m not big enough but I’ve tried EVERYTHING you can exercise-wise and diet-wise.”
    - “They just send it in the post.”
    - “I don’t know what dose it is.”
    - “I just keep it in my bathroom cupboard.”
    - “It’s working. I’ve already lost 4 kilos.”

Allergies:

- “None.”

Symptoms:

- “I’ve been vomiting on and off for 3 days. It’s just food. I can’t eat much though, I have one small meal a day because of the injections.”
- “I have a mild discomfort at the top of my stomach. It’s like a 3 out of 10 and it’s not always there.”
- No blood in vomit.
- No other symptoms.

If the pharmacist ask:

“I weigh 72kg and I’m 165 cm, I think my BMI is 26.4. Although I’ve lost 4 kilos since I started the injections so I’m 68kg now.”
“I’m managing small sips of water throughout the day.”
“I drink at weekends - maybe 5 or 6 drinks.”
“I run for an hour 3 days a week and exercise in the gym for an hour 3 days a week too.”
“I don’t smoke.”
“I haven’t eaten anything unusual recently.”
No infectious contacts or recent travel.

If the pharmacist questions the online purchase:

Initially defensive:

“It’s the same thing celebrities use.”
“It’s natural, it just makes you eat less.”

If the pharmacist explains calmly: “So is it dangerous?”

If referred to GP/A&E: “I don’t want to go to hospital. Can’t I just stop it?”

Mark Scheme

Introduction

0 / 2

Introduce yourself with an appropriate greeting

+1

Confirm patient details: Name and age

+1

Medical History

0 / 6

Confirms past medical history

+1

Confirms medication history including dose, frequency, indication, including any over-the-counter products and herbal remedies

+1

identifies semaglutide use

Check for allergies

+1

Identifies product obtained online without prescription

+1

Identifies unknown dose

+1

Screens alcohol intake

+1

Important to assess risk of pancreatitis

Diagnosis

0 / 1

Recognises that nausea and vomiting are known GLP-1 side effects but that persistent vomiting for 3 days is not expected

+1

Management

0 / 5

Makes the correct decision:

Recommends urgent GP review

+1

Does not overescalate to A&E in the absence of red flags

Explains the decision clearly to the patient

+1

e.g. “Nausea is quite common when people start semaglutide, especially if the dose increases. But because you’ve been vomiting for three days and you’re taking this without medical supervision, I’m concerned that we need to make sure this is just a side effect and not something more significant. I don’t think this is an emergency at the moment because you don’t have severe pain or other worrying symptoms. However, I do think it’s important that a GP assesses you properly, checks your dose, and makes sure it’s safe for you to continue.”

Recommends stopping further injections until reviewed by the GP

+1

Advises that semaglutide is prescription-only in the UK and that purchasing it online from an unregulated source risks counterfeit products

+1

Provide non-pharmacological advice for nausea

+1

This includes having small frequent meals, avoiding fatty foods, staying hydrated, avoiding alcohol, avoid overly sweet or spicy foots, eat slowly. The student may also recommend an OTC antiemetic, but this is not a priority over advice and referral.

Challenging misinformation

0 / 2

Explains that ‘natural’ or celebrity use does not equal safe

+1

Encourages safer weight management pathways

+1

The GP can recommend alternatives.

Safety netting

0 / 2

Advises clear red flag symptoms requiring urgent A&E

+1

severe abdominal pain, persistent worsening vomiting, fever, jaundice

Encourage a follow-up visit after GP review

+1

Communication

0 / 5

Knowledge and understanding of the topic is apparent

+1

Demonstrates empathy

+1

Ensure the patient understanding and signposts to further resources (e.g. NHS website or BNF)

+1

Concludes the conversation well by asking if there are any further questions

+1

The student did not say anything that could harm the patient

+1

This includes but is not limited to, providing incorrect information or medication, misdiagnosing conditions, neglecting to inquire about allergies, making incorrect referrals, or failing to act on red-flag symptoms.

Time Management

0 / 1

Completed the scenario in time and achieved 70% of marks

+1