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    Psychiatry Sample Osce Exam e

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    Mr. Wilson is an 82-year-old widower who has been taking high doses of alprazolam and lorazepam for anxiety for many years. He recently ran out of his medications and presented to the community clinic extremely anxious, unable to sleep, and demanding refills. The nurse practitioner examines him and finds him restless but physically well. They are seeking guidance on managing his benzodiazepine withdrawal and ongoing anxiety issues.

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    Psychiatry Sample Osce Exam e

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    316 views4 pages
    Mr. Wilson is an 82-year-old widower who has been taking high doses of alprazolam and lorazepam for anxiety for many years. He recently ran out of his medications and presented to the community clinic extremely anxious, unable to sleep, and demanding refills. The nurse practitioner examines him and finds him restless but physically well. They are seeking guidance on managing his benzodiazepine withdrawal and ongoing anxiety issues.

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    Mr. Wilson is an 82-year-old widower who has been taking high doses of alprazolam and lorazepam for anxiety for many years. He recently ran out of his medications and presented to the community clinic extremely anxious, unable to sleep, and demanding refills. The nurse practitioner examines him and finds him restless but physically well. They are seeking guidance on managing his benzodiazepine withdrawal and ongoing anxiety issues.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    316 views4 pages

    Psychiatry Sample Osce Exam e

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    Mr. Wilson is an 82-year-old widower who has been taking high doses of alprazolam and lorazepam for anxiety for many years. He recently ran out of his medications and presented to the community clinic extremely anxious, unable to sleep, and demanding refills. The nurse practitioner examines him and finds him restless but physically well. They are seeking guidance on managing his benzodiazepine withdrawal and ongoing anxiety issues.

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    Psychiatry

    Sample OSCE

    In this station, you will play the role of an on-call psychiatrist who is contacted by a nurse
    practitioner in an outlying community medical clinic. The nurse practitioner is meeting with
    you to request advice regarding the care of a recently examined elderly male patient.
    The examiner will play the role of the nurse practitioner.

    You have approximately 20 minutes to complete this station.

    CLINICAL CASE

    Mr. Wilson is an 82-year-old widower who lives alone in an apartment. He is a retired


    accountant whose wife died three years ago. They did not have children. He is mostly alone
    except for meeting a group of friends for lunch on a weekly basis. He takes an
    antihypertensive medication for high blood pressure but is otherwise physically healthy. He
    does not drink alcohol or use illicit substances.

    Mr. Wilson has always been described as a “worrier”, but experienced a period of more
    intense anxiety in the context of work approximately 25 years ago. At that time, he was
    started on alprazolam 0.25 mg 3 times daily by his family doctor. Since retirement, he has
    felt that the medication has not been working as well in treating his anxiety. He found he
    was worrying more and noticed frequent insomnia. In response, his doctor gradually
    increased the dose of alprazolam to 1 mg 3 times daily. Three years ago, his doctor also

    1
    Psychiatry – Sample OSCE

    prescribed lorazepam 1 mg at bedtime when Mr. Wilson complained of worsened insomnia


    after his wife died. Over time, Mr. Wilson began to use more alprazolam than prescribed to
    cope with “having a bad day”. He also took an extra lorazepam if he woke up during the
    night and could not fall back asleep. On several occasions, he had called his doctor to ask
    for a refill because he had run out of medication earlier than expected.

    Recently, his doctor tried to lower the dose of alprazolam, but after a short trial, Mr. Wilson
    said he could not tolerate the increase in anxiety symptoms. He was aware that it might not
    be safe to take such large doses, but refused to consider continuing on a lower dose.

    Mr. Wilson acknowledges that he now spends much of his time between doses thinking
    about when he can take his next dose. He rarely leaves his apartment for longer than a few
    hours; he feels he needs to be home in time to take his next dose. Two days ago,
    Mr. Wilson ran out of alprazolam and lorazepam. He called his doctor’s office for an earlier
    refill, but his doctor was on vacation. He decided to come to the community medical clinic
    because he was not feeling well.

    During the examination, he told the nurse practitioner that he has been feeling extremely
    anxious, with nausea but no vomiting. He has not been able to sleep for the past two
    nights, has been feeling restless, and has been pacing around his apartment. He is
    demanding to have refills for alprazolam and lorazepam to relieve his anxiety. He feels as
    though he “can’t go on like this”, but denies suicidal ideation and has had no prior suicidal
    ideation or attempts.

    The nurse practitioner describes Mr. Wilson as a well-dressed elderly man who looks his
    stated age. He was not able to sit still for long in the waiting room or in the examining
    room. He was oriented to time and place, and did not appear confused. His vital signs were
    within normal limits, with a heart rate of 90 beats per minute, and a temperature of 37.5
    degrees Celsius. The nurse practitioner is asking for guidance on how to help with the
    management of this patient’s anxiety.

    2
    Psychiatry – Sample OSCE

    QUESTION 1
    Thanks for meeting with me. I’m very concerned about Mr. Wilson - he appears to be so
    distressed. Why would he be presenting this way?

    Competency: Diagnosis

    QUESTION 2
    When I examined him, he looked somewhat restless, but his vitals were normal and he
    didn’t look physically unwell. I question whether he is actually going through
    benzodiazepine withdrawal. How would I determine if this is the case?

    Competency: Diagnosis

    QUESTION 3
    I’m new in this community clinic and haven’t managed benzodiazepine withdrawal before.
    Mr. Wilson is asking me to provide him with a refill and is insisting on going home. What
    should I do? Should I restart the benzodiazepines?

    Competency: Clinical/Patient Management

    QUESTION 4
    When I suggested Mr. Wilson come off the benzodiazepines, he said he couldn't possibly
    consider it, given how anxious he feels right now. So what steps could I take now to help
    him through a successful withdrawal down the road?

    Competency: Clinical/Patient Management

    3
    Psychiatry – Sample OSCE

    QUESTION 5
    How should I approach stopping the alprazolam and lorazepam, assuming he eventually
    agrees to do so?

    Competency: Clinical/Patient Management

    QUESTION 6
    Mr. Wilson told me that he “just can’t go on like this” if he doesn’t get some relief. He told
    me he isn’t suicidal, but I want to make sure he’s safe. Do you think he’s safe to go home?

    Competency: Clinical Reasoning/Judgment

    QUESTION 7
    Okay, I think Mr. Wilson is safe to go home right now, and I’m able to see him again in a few
    days. But I’m concerned that his doctor keeps prescribing benzodiazepines. Should he
    continue to see his doctor, or should I take over his ongoing care?

    Competency: Collaborator

    Overall Competency: Professional Communication

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