OSCE Toolbox | Oral Symptoms 1 - Scenario

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Scenarios

By Femi Lana • September 24, 2025 • Last reviewed: 24/09/25 •

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Summary Beginner

In this scenario, the student pharmacist is tasked with counselling a patient who has been experiencing dry mouth. The student must provide appropriate advice, answering any questions they have.

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 OSCE station.

Revision Topics

Be aware, this may reveal any answers!

Student Instructions

Actor Instructions

This may reveal scenario objectives!

You are Fatima Al-Mansoori (fAH-ti-mah ul-mun-SOO-ree)

Opening Statement: “I’ve been getting this horrible dry mouth recently and it’s been bothering me a lot.”

Patient Information

Name: Fatima Al-Mansoori

Age: 47 (DoB: 6th July 1979)

Symptoms:

“For the last year or so my mouth always feels dry and my lips are always cracked. I’ve tried drinking more water but it doesn’t help.”
“I think my breath has started to smell because of the dryness - my mouth never feels fresh. It’s quite embarrassing because I have to talk a lot for work.”
“I sometimes wake up in the middle of the night because of how dry my mouth is and it’s affecting my focus at work.”
“I’ve got pain in one of my teeth, I think I’ve got another cavity - I’ve had quite a few in the past, I’m planning to see my dentist to get it sorted.”
“My sense of taste is okay but I’ve not been enjoying my food as much.”
If asked about eye symptoms - mentioned below in ‘past medical history’

Important negatives:

“I’ve not been having to urinate more often.”
“I haven’t noticed any weight loss.”
“I’ve not had any joint pain or aches.”
No other symptoms

Past medical history:

“I’ve had dry eyes for a few years now - I buy eye drops but they don’t really help. I’ve learnt to deal with it but I do think it's starting to affect my eyesight.”
“I get thrush in my mouth quite often - I actually just finished a course of anti-fungals recently.” If asked how often, say “At least three times this year.”

Medication history:

“I recently had a course of anti-fungals for thrush - Fluconazole is what I usually get.”
“I don’t know which eye drops I use - they’re just saline ones my husband buys me.”

Allergies:

“I don’t have any allergies.”

Lifestyle factors:

“I eat very healthy - it’s all home-cooked food. I only drink water as everything else irritates my mouth”
“I don’t drink alcohol.”
“I quit smoking years ago. I used to smoke maybe half a pack a day for 5 years.”
“I don’t really exercise - I make sure to go on walks a few times a week.”
“I work as a receptionist - it’s getting difficult to do my job because I’m struggling to stare at the screen all day and getting embarrassed to talk to people because of my bad breath.”

Questions to ask (use to prompt the student if they miss these areas):

What do you think is causing my symptoms? (Prompt them to give their thoughts as this is important to say the marks)
If they mention Sjogren’s syndrome: How does this relate to my thrush and cavities?
Is there anything I can do to improve my symptoms?

Mark Scheme

Introduction

0 / 2

Introduce yourself as the pharmacist with an appropriate greeting

+1

Confirms patient details: Name and age

+1

Answer Q1: What do you think is causing my symptoms?

0 / 3

Student uses symptoms to come to an appropriate diagnosis:

Explain to the patient that although dry mouth is usually not caused by an underlying problem, they have some concerning symptoms that may need further investigation.

+1

Explain that the long-term nature of their dry mouth, their dry eyes, frequent oral thrush and frequent dental cavities suggest there is a problem with their fluid production.

+1

Explain that this may be a condition called Sjögren's syndrome, where the glands that produce fluids like tears and saliva don’t work properly leading to dryness.

+1

Answer Q2: How does this relate to my thrush and cavities?

0 / 1

Explain that saliva has antibacterial properties and reduced production accelerates tooth decay and increases the risk of oral infections like thrush.

+1

Management

0 / 3

Makes appropriate health referrals:

Refers patient to GP with suspected Sjögren's syndrome

+1

Refers the patient to dentist concerning dental cavities.

+1

Refers the patient to ophthalmology to discuss dry eyes and vision changes.

+1

Communication

0 / 5

Use appropriate language for the person and situation.

+1

Ensures the patient understands what has been discussed and understands what to do if they experience any concerning symptoms.

+1

Signposts and refers patients to relevant resources e.g. NHS website

+1

Conclude the conversation professionally, reassuring the patient and offering to assist with any further questions or concerns.

+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.