Summary of Common Conditions Seen in OSCEs
| System | Conditions | Key investigations |
| Neurological | Stroke Bulbar palsy Myasthenia gravis Motor neurone disease Parkinson’s disease | CT/MRI brain Electromyogram Acetyl choline receptor antibodies, CT thymus |
| ENT | Throat cancer Pharyngeal pouch | Nasal endoscopy |
| Xerostomia/Sjögren’s syndrome | Dry mouth Symptoms of rheumatological disorders | Schirmer’s test Anti-Ro and anti-La antibodies |
| Oesophageal: motility | Achalasia CREST Chagas disease | Barium swallow Oesophageal manometry Serology for Chagas disease Scl-70, anticentromere and antinuclear antibodies for CREST |
| Oesophageal: structural | Malignancy Benign stricture Hiatus hernia | Barium swallow Oesophago-gastro-duodenoscopy + biopsy Full blood count |
| Gastrointestinal | Stomach cancer Gastritis Gastro-oesophageal reflux disease Peptic ulcer | Oesophago-gastro-duodenoscopy |
| External compression: thyroid | Goitre Thyroid cancer | Fine-needle aspiration + biopsy Ultrasound neck/thyroid Thyroid function tests Radioiodine studies |
| External compression: heart | Mitral stenosis Left atrial hypertrophy Aortic aneurysm | Echocardiogram Chest X-ray CT chest |
| External compression: lungs | Lung cancer | Chest X-ray CT chest |
| External compression: mediastinum | Mediastinal lymphadenopathy | Chest X-ray CT chest |
| Globus hystericus | Anxiety Psychological symptoms | Rule out organic causes |
Hints and Tips for the Exam
Malnutrition
Dysphagia is a very concerning symptom, and it is understandable for any candidate to get fixated on the diagnosis and treatment. Do not, however, forget that eating is essential for a patient’s health and well-being, and a patient who is unable to eat may start to suffer from the effects of malnourishment if dysphagia is severe and prolonged. This is especially so in the elderly. So, in your management plan, make sure you talk about the importance of carrying out a nutritional assessment of the patient, and about considering ways of managing it while a definitive diagnosis and management plan are established. You could consider liquid supplements such as Ensure (if the patient is able to take liquids), as well as nasogastric and PEG feeding.
Liquids or Solids or Both?
This is often forgotten by students despite being absolutely fundamental to the diagnosis. Patients who have dysphagia for both solids and liquids are more likely to have a problem with motility (e.g. achalasia), whereas patients with dysphagia only for solids are more likely to have a structural defect (e.g. cancer or a mass).
Questions You Could Be Asked
Q. What changes associated with dysphagia might you see on barium swallow?
A. ‘Tapering’ with achalasia, or an ‘apple core lesion’ with oesophageal cancer.
Q. What is ‘Chagas disease’?
A. An infectious disease predominantly found in South America. As it is an infectious disease, the investigation of choice is microscopy, culture and sensitivity of the blood or cerebrospinal fluid. It is treated with an antiparasitic agent.
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