Released examples: Structured Oral Examination (10 minute viva)

Psychiatry
The station will comprise one 10-minute scenario based on a single presentation.

Example 1:
You are an intern working in the Emergency Department. A 35 year old man is brought in by friends.
The friends state that he had been increasingly anxious, ringing them late at night and talking about
having to “take measures to escape the plot”. One friend was so concerned he spent last night with
the patient to make sure he was OK. The patient is agitated, fearful, hypervigilant and insists on
speaking with you privately without his friends present. He tells you that his life is in danger and he
has to leave the Emergency Department immediately. He states that over the last month he has
noticed increasing evidence of a plot against him e.g. cars following him on the street, passers-by
giving him meaningful glances.

 Elicit further relevant information about the patient (from the examiner) in order to make an
assessment of the problem.
 Present an initial management plan including recommendations to the nursing staff about
managing the behaviour.

Example 2:
You are an intern working the evening shift covering the surgical wards in a large public hospital. The
ward nurse asks you to review a 65 year old man who is day 2 post right hemi-colectomy for
colorectal carcinoma. He has become increasingly agitated over the last 24 hours and has had periods
of aggressive behaviour towards members of the nursing staff.
 Discuss how you would go about obtaining further relevant information about the patient
(mention possible sources of information and what you would ask for).
 Present an initial management plan to the examiner including recommendations to the
nursing staff about managing this patient.

Primary Care 10-minute Viva example (depression in primary care)

Mary Thomas, a 52 year old bank worker, comes to see you. She is a new patient of the practice,
having moved from Melbourne last year because of her husband’s work. She tells you that her
husband recently left her for a younger woman, and she is worried that she ‘may have caught
something from him’. She asks if you can do a check up for this. When you talk to her, she hardly
looks at you, looks very tired and drained and is very tearful.
 How do you approach this consultation? What more do you want to know about Mary?
 Mary asks how you can help her. Based on your observations and Mary’s concern’s, what are
some of the important aspects of management that you would consider?
SAMPLE PSYCH VIVAS – STUDENT BRAINSTORMED LIST

A 20-year-old man has been diagnosed with schizophrenia. Explain to his family what this means,
and the likely management and prognosis.

A 50-year-old woman presents to you, her GP, with 4 weeks of low mood and poor sleep. How will
you assess and manage her?

A 35-year-old man is brought by police to the emergency department after attempting suicide.
How will you assess and manage him?

A 70-year-old woman is brought by her daughter to you, her GP. The daughter is concerned that
her mother has been acting strangely of late, spending money excessively and talking very quickly.
Assess and manage her.

A 26-year-old woman is sent to a psychiatrist by her GP with a two-year history of excessive hand-
washing, which has led to her losing her job. What is the likely diagnosis and management?

From previous viva practice sessions

A 40-year-old businessman is brought in by his wife who says he has been increasingly irritable,
talkative and demanding, as well as making high-risk business ventures. He does not think he
needs treatment. How would you approach this?

A 28-year-old woman is BIBA, tearful and threatening self-harm. She denies having taken any drug
overdoses. There are superficial lacerations to her right wrist. She is irritable and crying. How
would you assess and manage her?

Released Vivas (Med/Surg/ED) – related to psych/ethics/consent (5 minutes each)

A 21 year old man is brought to the Emergency Department by police. He is aggressive and
disorientated. How would you assess and manage him?

An 80 year old woman has been in a nursing home for 6 months. She is often confused, weak and
requires assistance to walk. She develops bronchopneumonia and following discussion with her
daughter, it is decided not to treat her. The patient’s son contacts you and insists that treatment be
given. How would you manage this situation?

An 80 year old woman presents with haematemesis from a large gastric ulcer. Endoscopic methods of
control have failed, bleeding has recommenced, and urgent surgery is planned. Her relatives request
that nothing further be done as she is too old for surgery. How would you manage this situation?

A 56 year old man is currently being investigated for recurrent syncopal episodes. He is self-employed
as a courier driver and has been advised that he cannot drive until his condition has been controlled
for three months. However his wife informs you that he is continuing to drive. How would you
manage this situation?

A 75 year old man is admitted for repair of an aortic aneurysm. He has symptoms suggestive of early
leakage. While being prepared for surgery, he decides that he does not wish to have surgery and
requests that the IV line and the urinary catheter be removed. How would you manage this situation?

A 60 year old woman has known gallstones and suffered an attack of pancreatitis two months ago.
She has been strongly advised to have a cholecystectomy but does not wish to undergo surgery. How
would you manage this situation?
Released examples: Clinical Skills Examination (12 minute OSCE) Psychiatry

Instructions to Student:
You are working in a general practice. This patient is well known to you. He is a 25-year old parent of a
6-year old girl – the mother left soon, after the girl’s birth and there has been no contact since. The
patient works full time as a local delivery truck driver. Your record shows the following about this
patient:
 He regularly drinks heavily at the weekends
 He intermittently presents on Monday “feeling seedy” for a medical certificate for the day off
 He is otherwise in good health, with frequent presentations for minor sporting injuries
 He is not taking any medication; smokes 10 cigarettes per day; there is no other drug history
 He does not have any history of psychiatric illness
 He is generally good and caring parent. He has no regular childcare
 His relationship with his family is strained – they blame him for his wife leaving
 His father was violent, heavy drinker during his childhood and still drinks but less
 The patient came today for the removal of sutures to a small scalp laceration sustained 8
days ago in a fall at the pub after the football. He was briefly unconscious. He was taken,
intoxicated, to the emergency room of the local hospital at 1:00am 8 days ago, the wound
was repaired and he was discharged several hours later. Your nurse has just removed the
sutures. She has alerted you to discuss the patient’s drinking and parental responsibilities.

Your tasks are to

 Discuss with the patient his pattern of drinking and harmful consequences
 Make appropriate recommendations for dealing with the problem

Instructions to Examiner:
The assessment aims require the student to:
 Recognise that alcohol overuse – binge pattern – is the likely problem
 Discuss the problem and actual consequences
 Seek out whether there are any aggravating as yet undisclosed issues or current stressors
 Counsel the patient about the risks to his daughter and relationship with care for her
 Advise reduction or cessation or cessation of alcohol use – discuss
 Demonstrate knowledge of hazardous/harmful drinking levels (NHRMC guides for men safe
up to 6 standard drinks no more than 3 days per week)
 Be able to communicate concern in a non judgemental and non threatening ways so as to
maintain report and ensure engagement in an ongoing review and case management