A ORE Part 2 station on MedMock, start to finish
This is an illustrative ORE Part 2 station written by MedMock to show what the station is like: the brief, everything the examiner says, the candidate’s answers and the feedback were all written by us, not recorded from a real session. The feedback is laid out the way MedMock marks this exam. It is here to show the format and the standard, not as a model answer to learn by heart.
The brief
Candidate instructions (15-minute structured oral after 2 minutes of reading time): A 34-year-old woman develops sudden facial flushing, widespread urticaria, inspiratory stridor, wheeze and dizziness three minutes after taking a pre-procedural dose of amoxicillin in your dental waiting room. Her pulse is 128 bpm, blood pressure is 78/44 mmHg, respiratory rate is 30 breaths/min and oxygen saturation is 89% on room air. Explain to the examiners how you diagnose and manage this emergency in the dental surgery.
Medical Emergencies in Dental Practice Viva: the full transcript
You have read the scenario. What is your immediate diagnosis, and what are your first actions in the dental surgery?
This is life-threatening anaphylaxis to amoxicillin, with upper and lower airway compromise—stridor and wheeze—hypoxia and distributive shock. I will immediately call for help from my dental nurse and reception team, ask them to bring the medical emergency drug kit, oxygen cylinder and automated external defibrillator, and dial 999 for an emergency ambulance stating 'anaphylaxis'. I will stop any further exposure, lay the patient flat with her legs raised to restore venous return—or allow her to sit up slightly only if respiratory distress makes lying flat impossible, while never standing her up—and assess her using an ABCDE approach.
What is your definitive first-line drug treatment, including the exact dose, concentration, route and anatomical site?
The immediate first-line treatment is intramuscular adrenaline 500 micrograms (half a millilitre of 1:1000 adrenaline) injected into the anterolateral aspect of the middle third of the thigh. At the same time I will administer high-flow oxygen at 15 litres per minute via a non-rebreather reservoir mask, titrating once stable to target oxygen saturations of 94 to 98 per cent, and attach monitoring for pulse oximetry, blood pressure and heart rate.
Five minutes after the first intramuscular adrenaline injection, she remains hypotensive at 76/42 mmHg with persistent stridor. What do you do next?
Because there is no improvement at five minutes, I will administer a second dose of intramuscular adrenaline 500 micrograms (half a millilitre of 1:1000 adrenaline) into the opposite anterolateral thigh, and repeat every five minutes if cardiorespiratory features of anaphylaxis persist while awaiting the ambulance crew. I will keep her supine with legs elevated, continuously reassess her airway for impending obstruction, and be ready to commence cardiopulmonary resuscitation if she deteriorates into cardiorespiratory arrest.
Once the paramedics arrive and stabilise her, what hospital transfer, documentation and post-incident actions are required?
I will hand over to the paramedics using a structured SBAR summary including the exact time of onset, the amoxicillin trigger, the vital signs and the exact times and sites of both 500 microgram intramuscular adrenaline doses. She must be transferred to the emergency department for observation because of the risk of a biphasic reaction. Afterwards, I will document the event contemporaneously in the dental records, prominently update her medical history and allergy alert for penicillin allergy, report the severe adverse drug reaction via the MHRA Yellow Card scheme, and audit our practice emergency drug kit and team debrief.
Thank you. That is the end of the station.
Example feedback
92 / 100
Identified stridor, wheeze, hypoxia and hypotension as life-threatening amoxicillin-induced anaphylaxis and initiated an ordered ABCDE assessment.
Gave exact IM adrenaline dosing (500 micrograms of 1:1000 adrenaline into the anterolateral thigh), high-flow oxygen and 5-minute repeat interval.
Covered early 999 call, SBAR paramedic handover, emergency department observation for biphasic reaction, allergy record update and MHRA Yellow Card reporting.
What went well
- Recognised life-threatening anaphylaxis immediately from airway (stridor/wheeze), breathing (SpO2 89%) and circulation (BP 78/44 mmHg) compromise and called 999 early.
- Stated the exact adult Resuscitation Council UK intramuscular adrenaline dose (500 micrograms of 1:1000 adrenaline, which is half a millilitre) into the anterolateral middle third of the thigh, with correct 5-minute repeat dosing in the opposite thigh.
- Correctly prioritised posture (supine with legs elevated, avoiding standing the patient up), high-flow oxygen, structured SBAR handover, biphasic observation, allergy alert updating and Yellow Card reporting.
What to improve
- Explicitly mention having airway adjuncts (oropharyngeal airway and bag-valve-mask) ready at the chairside in case upper airway oedema progresses before paramedics arrive.
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