OSCE Toolbox | Weight Loss 1 - Scenario

By Femi Lana • April 01, 2024 • Last reviewed: •

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Summary Expert

In this scenario, a patient presents with weight loss. The student should identify the most probable cause, answer any questions, and provide advice.

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 Lily Edwards (Lil-ee, Ed-werdz).

Opening statement: “I have noticed that I’ve lost some weight recently and I’m not too sure what’s happening.”

Patient Details:

Provide this information when prompted.

Name: Lily Edwards

Age: 35 years old
Symptoms:
- If asked about weight loss: "I have lost about 4kgs in 1 month."
- "I've noticed that my heart beats quite fast sometimes, and when this happens, I tend to sit down to try and relax."
  - "I don't think there are any specific triggers for the palpitations"
- "I haven't been sleeping well. I find it difficult to fall asleep."
- "I've noticed my hair has become thinner, and it tends to fall out more than usual, especially when I'm washing it."
- "I've also noticed that my periods have become more irregular over the past six months. Instead of having them monthly, they're now unpredictable, sometimes with months between them."
  - “I think it could be early menopause. Would this be possible since I have had my kids I am quite concerned about this to be honest with you.”

Past Medical History:

- “No medical conditions.”

Medication History:

- “Not taking any medications.”

Allergies:

- “Allergic to penicillin. I get a widespread rash over my body.”
Family history:
- "My mum used to take some tablets for some 'metabolism problem'."

Lifestyle factors:

- If asked about stress: "The symptoms are stressing me out a bit, but I'm not a worrier really, I get massages and stay relaxed most of the time."
- “I have a healthy diet. I have noticed that my appetite has increased over the last 3 months, but I still eat the same amount as usual. I go to the gym regularly too, twice a week.”
- “I have never smoked."
- "I drink alcohol only on special occasions."
- "I do not take any recreational drugs."
- “I live with my husband and two children.”

- “I work full-time as a receptionist at a dental clinic.”

If the pharmacist asks:

“I have not done anything to help my symptoms. Nothing else has made it worse that I am aware of either.”
"My symptoms are stressing me out a bit. I hope it is not cancer."

Questions:

What do you think is going on - Try push the student to give an answer if they seem hesitant to provide an answer e.g. "Well, could you at least tell me what idea you have of what is going on"
What do I need to do now

Mark Scheme

Introduction

0 / 2

Introduce yourself with an appropriate greeting

+1

Confirms patient details - name and age

+1

Diagnosis

0 / 1

Discusses a correct diagnosis of hyperthyroidism.

+1

Management/Advice

0 / 2

Suggests an appropriate management plan.

Referral to endocrinology for testing - dexamethasone suppression tests.

+1

Advised on lifestyle factors that can be improved such as sleep hygiene techniques, avoiding stimulants such as caffeine or alcohol, exercise, and a healthy diet

+1

Communication

0 / 7

Demonstrates empathy during consultation

+1

For example, asking how their symptoms are affecting their daily life. Reassures patient that is unlikely to be early menopause.

Uses appropriate language for the person and situation.

+1

Uses volume, tone, pace, and emphasis appropriately, and gives time to ask questions.

+1

Knowledge and understanding of the topic are apparent.

+1

The conversation is structured and flows well.

+1

Concludes well, helping with 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

Any criteria marked in red must be met to pass this station.