Quizzes & OSCEs > Example OSCE 2

Example OSCE 2 - Bulimia Nervosa

Candidate Instructions

Mrs Jones is a 28-year-old former model, who now works as a fashion editor in a glossy women’s magazine. She presents to her GP saying that she has had problems with her eating and weight for many years now. As part of her work she recently read an article about eating disorders, much of which seemed to apply to her. She and her husband, a 30-year-old photographer, are planning to start a family soon and she is not sure whether her chaotic eating would have an effect on this. She would like to know if there are any treatments available to her that might help.

 

Please take a history from Mrs Jones.

 

Briefly explain to Mrs Jones the most probable diagnosis.

 

This is a 5-minute station.

 

 

Simulated Patient Script

You are Imogen Jones, a 28-year-old editor of a women’s magazine. You used to be a model and have always been very successful. In your job currently you’re seen as a bit of a rising star. People have always admired you, considered you very capable and independent, both professionally and emotionally, and in particular they have commented on your physical beauty from a very early age. Nobody would ever think that your life was anything but perfect.

 

You, on the other hand, fear exposure as a fraud. You think that really you’re someone who has only reached her position professionally through luck and ‘sheer good looks’. When younger models started appearing on the scene, you gave up modelling because you were starting to feel old and anxious. You think your husband only married you for your beauty but you cannot say this to him. He upsets you at times with his frequent talk about the new young models he photographs. You find it difficult to discuss emotional issues and almost impossible to express anger or discontent. You often feel low and very alone with your difficulties but you are not consistently depressed and have no suicidal ideas or thoughts of harming yourself. You would like to have a baby to change your current situation.

 

All your life you have been preoccupied with weight and shape. As an adolescent you had borderline anorexia, and although your mother was concerned for a while, you were able to throw her off the track. By the age of 20, you were unable to maintain your restrictive pattern of eating, and in your desperation to stay thin, you started to vomit your food. From that time on, you have been secretly bingeing and vomiting on a daily basis (you binge 1-2 times a day and vomit not only after the binge but also several times during a binge). A binge is defined as eating an objectively large amount of food in a short period of time, accompanied by a sense of having lost control. In the past year you have started taking laxatives (docolax, up to 12 a day depending on how big you feel the binge has been). You enjoy exercise when you get around to it (going to the gym) and wish you did a bit more, but whenever you’ve started regular exercise, you’ve never been able to keep it up. You have never used diuretic and slimming pills. Your periods are irregular, occurring anytime from 21 days to 2 months apart. You are terrified of putting on any weight and becoming ‘fat’.

 

During the interview, you want to talk openly about your problems, but this is the first time you’ve spoken to anyone about them and you feel ashamed of your inability to control your eating. During the interview you present as a capable, businesslike highflying fashion editor but with a vulnerable young women just below the surface who is longing to reveal her difficulties and receive some support.

 

 

Examiner Instructions

The candidate has been given the following instructions:

 

Mrs Jones is a 28-year-old former model, who now works as a fashion editor in a glossy women’s magazine. She presents to her GP saying that she has had problems with her eating and weight for many years now. As part of her work she recently read an article about eating disorders, much of which seemed to apply to her. She and her husband, a 30-year-old photographer, are planning to start a family soon and she is not sure whether her chaotic eating would have an effect on this. She would like to know if there are any treatments available to her that might help.

 

Please take a history from Mrs Jones. Briefly explain to Mrs Jones the most probable diagnosis. This is a 5-minute station.

 

 

Assessment

  1. Communication Skills

    • Introduction

    • Interview Skills

  2. Detection of Symptoms of Bulimia

    • Bingeing

    • Vomiting

    • Laxatives

    • Morbid fear of fatness

    • Current weight and height

    • Menstrual history

  3. Negative Presence of:

    • Exercise

    • Diuretics

    • Dietary restriction

    • Slimming pills

    • History of anorexia

    • Duration of bulimia

    • Negative history of depression

    • Negative history of self-harm

    • Explanation of diagnosis to patien

  4. Simulated Patient Marks Emphaty