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Home / Station 8: Fever on postoperative day five

NAC OSCE preparation

Station 8: Fever on postoperative day five

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

Fever on postoperative day five

11 minutes

Discipline: Surgery & Perioperative Care
Station type: Clinical reasoning
Setting: Surgical ward

Your task

Take a focused history after colon surgery. Explain examination, investigations and initial management.

Information available at entry

HR 112/minBP 104/66 mm HgRR 22/minSpO₂ 95%T 38.8°C

Coach prompt: Identify postoperative infection and need for source control.

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 8 of 30

Standardized-patient profile

NameMr. Omar Rahman

Age61

Pronounshe/him

RolePatient

Demeanour: Tired and uncomfortable.

Opening statement: “I started shivering and the pain around my incision is getting worse.”

History and standardized-patient responses

Current symptoms

Candidate explores	Standardized-patient response
Wound	Increasing pain, redness and cloudy drainage since yesterday.
Respiratory	Mild cough; no dyspnea or pleuritic pain.
Urinary	No dysuria after catheter removal.
Abdominal	Passing flatus; no distension, vomiting or generalized pain.
VTE	No unilateral calf pain.

Operation

Candidate explores	Standardized-patient response
Procedure	Open sigmoid colectomy five days ago.
Devices	Peripheral IV only.
Prophylaxis	Receiving VTE prophylaxis.

Background

Candidate explores	Standardized-patient response
Risk	Type 2 diabetes.
Allergy	None.

Physical findings

Incision with 6 cm erythema, warmth, tenderness and purulent drainage.
Abdomen otherwise soft; chest clear; calves symmetric.

Examiner prompts

Most likely cause?

Surgical-site infection; assess for deeper incisional/organ-space infection.

Anastomotic leak features?

Increasing abdominal pain, peritonism, ileus, tachycardia, sepsis, feculent drainage or collection.

Plan?

Sepsis assessment, cultures/blood work, drainage/source control, antibiotics for systemic/deep infection, CT if leak/collection suspected and urgent surgical review.

Differential diagnosis

Surgical-site infection
Intra-abdominal abscess/anastomotic leak
Pneumonia
UTI
Line infection
DVT/PE
Drug fever

Investigations

CBC, electrolytes and renal function
Lactate/blood cultures if septic
Wound culture
Targeted urine/chest tests
CT abdomen/pelvis if leak/collection suspected

Management

Treat sepsis
Urgent surgical review
Drain/source control
Empiric antibiotics when indicated then tailor
Supportive care and glucose control

Communication behaviours

Explain several sources are possible
Do not blame the patient
Give clear reassessment plan

Critical safety actions

Tachycardia may be an early leak sign
Source control is central
Do not dismiss fever as routine

Model closing summary

On postoperative day five, fever, tachycardia, worsening incisional pain, erythema and purulent drainage make surgical-site infection most likely. I would assess for sepsis and deeper infection, obtain blood/wound cultures as indicated, involve the surgical team immediately, provide drainage/source control and antibiotics when appropriate, and obtain CT if an abscess or anastomotic leak is possible.

Common pitfalls

Rigid 'wind/water/wound' thinking
Ordering every test without hypothesis
Missing leak
Antibiotics without drainage

Reference starting points

Verify current recommendations and local protocols before clinical use.

Continue practising

Choose another complete 11-minute station

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