CRACKAMC CLINICAL SIMULATOR
Neurology OSCE Suite: Trapped Nerves & Radiculopathy
Station 1: John Miller (38) – The Wake-Up Call
Candidate InstructionsSetting: GP Clinic. Complaint: Right hand “going dead” at night.
Tasks: i. Focused history/ICE. ii. Verbalize Exam. iii. Management Plan.
Persona: You are exhausted and irritable. You’ve woken up at 3 AM every night for 3 months.
The Narrative: “Doctor, I’m really worried. My right hand goes completely dead—burning and pins and needles. I have to jump out of bed and shake it like I’m flicking a thermometer. It’s my thumb and first few fingers; my pinky is fine. I work 10-hour shifts at the factory using a heavy 15kg pneumatic wrench.
Hidden Concern: My grandfather lost his leg to ‘poor circulation’ from smoking. I smoke 10 a day and I’m terrified this ‘dead’ feeling means my hand is dying and needs amputation. I won’t tell you this unless you ask ‘What is your biggest worry?'”
Sample Doctor Dialogue
The Narrative: “Doctor, I’m really worried. My right hand goes completely dead—burning and pins and needles. I have to jump out of bed and shake it like I’m flicking a thermometer. It’s my thumb and first few fingers; my pinky is fine. I work 10-hour shifts at the factory using a heavy 15kg pneumatic wrench.
Hidden Concern: My grandfather lost his leg to ‘poor circulation’ from smoking. I smoke 10 a day and I’m terrified this ‘dead’ feeling means my hand is dying and needs amputation. I won’t tell you this unless you ask ‘What is your biggest worry?'”
“John, I hear how much this is affecting your sleep. Aside from the pain, is there anything specific you’re worried is causing this?” … “I understand your fear about circulation given your family history, but based on your ‘flick sign’ and the specific fingers involved, this points to Carpal Tunnel Syndrome—a trapped nerve, not a blocked artery.”
Station Rubric
Critical: Must ask about neck pain (Radiculopathy). Must mention night splints.
Key Points: Identifies Median nerve, mentions smoking cessation, work ergonomic review.
Key Points: Identifies Median nerve, mentions smoking cessation, work ergonomic review.
Task i: History & ICE
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Task ii: Physical Exam (Verbalized)
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Task iii: Diagnosis & Plan
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Station 2: Sarah Jenkins (42) – The Phone Leaner
Candidate InstructionsSetting: GP Clinic. Complaint: Left hand numbness/clumsiness.
Tasks: i. Detailed History. ii. Provocative Tests. iii. Step-wise management.
Persona: Professional telemarketer, frustrated and clumsy.
The Narrative: “My left hand feels like it’s fallen asleep—specifically my pinky and half the ring finger. I spend 7 hours a day on the phone leaning my left elbow on a hard desk. I’ve started dropping my coffee mugs and earrings. I sleep with my elbows curled up tight like a mummy.
Hidden Concern: I saw a documentary on MS (Multiple Sclerosis) about people dropping things. I’m convinced my brain is failing. If you don’t give a clear diagnosis, I will ask ‘Could this be MS?'”
Sample Doctor Dialogue
The Narrative: “My left hand feels like it’s fallen asleep—specifically my pinky and half the ring finger. I spend 7 hours a day on the phone leaning my left elbow on a hard desk. I’ve started dropping my coffee mugs and earrings. I sleep with my elbows curled up tight like a mummy.
Hidden Concern: I saw a documentary on MS (Multiple Sclerosis) about people dropping things. I’m convinced my brain is failing. If you don’t give a clear diagnosis, I will ask ‘Could this be MS?'”
“Sarah, I’m going to tap the inner part of your elbow here… does that cause a shock?” … “That response is Tinel’s sign at the Cubital Tunnel. It’s very likely your nerve is just being squashed by the way you lean at work, rather than a brain condition like MS.”
Station Rubric
Critical: Differentiate Ulnar vs Median (Pinky focus). Check for hand muscle wasting.
Key Points: Froment’s Sign test, recommend Headset, “Towel splint” for elbow.
Key Points: Froment’s Sign test, recommend Headset, “Towel splint” for elbow.
Task i: History & Triggers
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Task ii: Physical Exam (Upper Limb)
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Task iii: Counseling & Plan
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Station 3: Robert Blake (55) – The Complex Neck
Candidate InstructionsComplaint: Weak hand and stiff neck.
Tasks: i. Differentiate Peripheral/Central. ii. Red Flag Screen. iii. Referral Plan.
Persona: Stoic foreman, “old school,” dislikes doctors.
The Narrative: “I can’t turn the key in my door anymore. My neck has been stiff for years, but I had a minor car accident 4 weeks ago. The numbness is in my hand but also feels like a strip of leather running up the inside of my forearm. I can’t spread my fingers to hold cards.
Hidden Red Flag: If you ask about my walking, I’ll admit I’ve felt ‘wobbly,’ like I’m walking on cotton wool. I’m terrified I’ve had a mini-stroke and will end up in a wheelchair.”
Sample Doctor Dialogue
The Narrative: “I can’t turn the key in my door anymore. My neck has been stiff for years, but I had a minor car accident 4 weeks ago. The numbness is in my hand but also feels like a strip of leather running up the inside of my forearm. I can’t spread my fingers to hold cards.
Hidden Red Flag: If you ask about my walking, I’ll admit I’ve felt ‘wobbly,’ like I’m walking on cotton wool. I’m terrified I’ve had a mini-stroke and will end up in a wheelchair.”
“Robert, I’m concerned that the numbness goes up your forearm and you’re feeling unsteady on your feet. This suggests the issue is in the neck affecting the spinal cord (C8/T1 level) rather than just the hand. We need an urgent MRI.”
Station Rubric
Critical: Identify sensory loss above the wrist (C8). Check gait/lower limb reflexes (Myelopathy).
Key Points: Link car accident to symptoms, explain Cervical Radiculopathy vs CTS.
Key Points: Link car accident to symptoms, explain Cervical Radiculopathy vs CTS.
Task i: Focused History
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Task ii: Motor/Sensory/Red Flags
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Task iii: Diagnosis & Urgent Plan
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Station 4: Betty White (72) – Chronic Wasting
Candidate InstructionsBackground: Rheumatoid Arthritis. Complaint: Thinning of hand muscle.
Tasks: i. Assess safety. ii. Exam bulk/power. iii. Discuss Surgery.
Persona: Dignified grandmother, afraid of losing independence.
The Narrative: “I’ve had tingles for 10 years, but now the muscle under my thumb has just vanished. It’s flat and weak. I’ve stopped cooking because I burnt myself on the stove and didn’t even feel it. I’m scared to hold my grandchildren. My neighbor had a ‘botched’ surgery, so I’m terrified of the knife.
Clinical Status: Numbness is now constant 24/7. Splints no longer help at all. I feel ‘broken’ and too old to fix.”
Sample Doctor Dialogue
The Narrative: “I’ve had tingles for 10 years, but now the muscle under my thumb has just vanished. It’s flat and weak. I’ve stopped cooking because I burnt myself on the stove and didn’t even feel it. I’m scared to hold my grandchildren. My neighbor had a ‘botched’ surgery, so I’m terrified of the knife.
Clinical Status: Numbness is now constant 24/7. Splints no longer help at all. I feel ‘broken’ and too old to fix.”
“Betty, I see the flattening of the muscle here (Thenar wasting). This means the nerve is so squashed it can’t feed the muscle anymore. Because you’re burning yourself and losing muscle, we can’t wait anymore—splints aren’t enough. Surgery is needed to prevent permanent damage.”
Station Rubric
Critical: MUST recognize Thenar wasting. MUST refer for surgery (Conservative = FAIL).
Key Points: Assess APB power, discuss safety at home, address fear of surgery.
Key Points: Assess APB power, discuss safety at home, address fear of surgery.
Task i: Safety & History
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Task ii: Physical Exam (Wasting)
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Task iii: Surgical Counseling
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