OSCE-Style Clinical Case Simulation

Emergency Medicine | Attending Level

STATION 1 of 5 - INITIAL PRESENTATION

Setting: Emergency Department, 02:17 AM

Triage Note:

"52-year-old male, brought in by EMS. Found by wife, unresponsive on the bathroom floor. GCS 11 on scene (E3V3M5), improved to 14 en route. Vitals per EMS: BP 210/118, HR 44, SpO2 91% on room air. 12-lead transmitted - sent to your workstation."

On your arrival to Resus Bay:

The patient is now alert but confused and diaphoretic. He can tell you his name but not the date. His wife is at bedside, visibly distressed.

Wife states: "He's been complaining of a headache since yesterday afternoon - the worst of his life, he said. He took some Tylenol and went to bed. I found him on the floor about 40 minutes ago."

PMH (per wife): Hypertension (poorly controlled), Type 2 DM, ex-smoker (30 pack-years), no known cardiac history.

Meds: Amlodipine 10mg daily, Metformin 1g BID. No anticoagulants.

Allergies: NKDA.

Station 1 Questions:

1a. What is your immediate resuscitation priority in the first 2 minutes?

1b. List your top 3 differential diagnoses in order of priority. Justify each briefly.

1c. What is the single most time-critical diagnosis you must rule out immediately, and what is your first-line investigation?

Type your answers when ready. I will score, provide feedback, and unlock Station 2.

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