Important: Exam dates, fees and policies can change. Verify time-sensitive details on the official Medical Council of Canada website.

Home / Station 3: Palpitations followed by syncope

NAC OSCE preparation

Station 3: Palpitations followed by syncope

Complete the task in 11 minutes. Reveal the full standardized-patient script, examiner prompts and structured debrief only after your attempt.

Station time

11:00

Ready for an 11-minute attempt.

Candidate instructions

Palpitations followed by syncope

11 minutes

Discipline: Internal Medicine
Station type: Focused history
Setting: Emergency department

Your task

Take a focused history. Summarize risk, differential, investigations and disposition.

Information available at entry

HR 84/min regularBP 126/78 mm HgRR 16/minSpO₂ 98%T 36.7°C

Coach prompt: Distinguish high-risk cardiac syncope from benign causes.

In Exam Mode, coaching cues are hidden. Ask a partner to use the standardized-patient script after you start the timer.

Finished your attempt?Reveal the full station only after completing or stopping the timer.

Complete station package

Standardized-patient script and structured debrief

Station 3 of 30

Standardized-patient profile

NameMr. Jacob Martin

Age46

Pronounshe/him

RolePatient

Demeanour: Comfortable now but worried.

Opening statement: “I felt my heart suddenly racing while jogging, then I blacked out.”

History and standardized-patient responses

Event

Candidate explores	Standardized-patient response
Circumstance	Occurred during jogging.
Prodrome	Abrupt palpitations and lightheadedness; no warmth or nausea.
LOC/recovery	About 20 seconds with rapid recovery; no confusion, tongue biting or incontinence.
Injury	Minor elbow abrasion; no head strike.

Cardiac risk

Candidate explores	Standardized-patient response
Symptoms	Brief chest tightness with palpitations.
Prior episodes	Two exertional palpitation episodes in the last month.
Disease	Known hypertrophic cardiomyopathy, not followed recently.
Family	Brother died suddenly at 39.

Other

Candidate explores	Standardized-patient response
Volume loss/bleeding	None.
Neurologic	No focal symptoms or severe headache.
Substances	Uses pre-workout stimulant; no cocaine.

Physical findings

Systolic murmur increases with Valsalva.
Neurologic exam normal.
No orthostatic hypotension.

Examiner prompts

High-risk features?

Exertional syncope, abrupt palpitations, structural heart disease, family sudden death and minimal prodrome.

Initial tests?

ECG, telemetry, glucose, CBC/electrolytes/renal function, targeted troponin, echocardiography and urgent cardiology assessment.

Discharge?

No; monitored evaluation and urgent cardiology involvement are required.

Differential diagnosis

Tachyarrhythmia
HCM-related obstruction/arrhythmia
Other structural heart disease
Vasovagal syncope
Orthostatic hypotension
Seizure

Investigations

ECG and telemetry
Glucose, CBC, electrolytes and renal function
Troponin if ischemic concern
Echocardiography
Ambulatory monitoring after specialist review

Management

Monitor and escalate
Stop stimulant and avoid exertion
Treat identified arrhythmia
Urgent cardiology review
Driving restriction advice by jurisdiction

Communication behaviours

Explain why brief syncope can still be serious
Invite witness collateral
Check understanding of restrictions

Critical safety actions

Do not label exertional syncope vasovagal
Recognize family sudden death
Do not discharge because current vitals are normal

Model closing summary

This is high-risk exertional syncope preceded by palpitations in a patient with hypertrophic cardiomyopathy and family sudden death. Arrhythmia is the leading concern. I would obtain an ECG, begin telemetry, check relevant blood work, arrange urgent cardiology assessment and echocardiography, and advise no driving or exercise until risk is clarified.

Common pitfalls

Failing to ask whether it occurred during exercise
Overemphasizing seizure
Ignoring stimulant use
Routine outpatient discharge

Reference starting points

Verify current recommendations and local protocols before clinical use.

Continue practising

Choose another complete 11-minute station

1. Chest pain in a 58-year-old 2. Acute dyspnea with wheeze 3. Palpitations followed by syncope 4. Upper gastrointestinal bleeding 5. Sudden focal weakness 6. Fever with hypotension 7. Acute right-lower-quadrant abdominal pain 8. Fever on postoperative day five 9. Severe leg pain after tibial fracture 10. Consent for lumbar puncture 11. First-trimester pain and bleeding 12. Postpartum low mood and unusual beliefs 13. Contraception counselling 14. Fever in an eight-week-old infant 15. Child with severe wheeze and respiratory distress 16. Two-year-old with language delay 17. Adolescent confidentiality and sexual health 18. Depression with suicidal thoughts 19. First-episode psychosis 20. Severely agitated patient 21. Older adult with acute confusion 22. Recurrent falls and dizziness 23. Driving safety in early dementia 24. Breaking a new colorectal cancer diagnosis 25. Disclosure of an insulin medication error 26. Refusal of blood transfusion 27. Cardiovascular examination in heart failure 28. Respiratory examination with pleural effusion 29. Focused neurologic examination for stroke 30. Painful swollen knee