MBBS OSCE · Cardiology
OSCE — Acute Aortic Syndrome
Eight-minute OSCE station on Acute Aortic Syndrome: focused history, examination priorities, investigations, emergency and definitive management.
On this page
Study tools
Exam tags
Brief (to candidate)
You will assess a patient with a presentation consistent with Acute Aortic Syndrome.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Acute aortic syndrome (AAS) is a spectrum of life-threatening aortic emergencies — classic aortic dissection (intimal tear with a false lumen), intramural haematoma (IMH), and penetrating aortic ulcer (PAU) — that share a common pathophysiology (medial degeneration and wall shear) and an identical initial resuscitation strategy. Stanford type A (ascending aorta involved) is a surgical emergency: untreated it kills at 1 to 2 percent per hour from symptom onset, and across IRAD's 17 years type A in-hospital mortality fell from 31 to 22 percent with surgical mortality falling from 25 to 18 percent, while medically managed type A stayed at 57 percent. Emergency repair is a supracoronary tube graft, a Bentall or a valve-sparing root replacement, extended into the arch when the arch is involved. Stanford type B (descending aorta only, distal to the left subclavian) is managed medically first — a beta-blocker to a heart rate of 60 to 80 bpm then a vasodilator to an SBP under 120 mmHg, or the lowest pressure that preserves end-organ perfusion — with TEVAR reserved for complicated type B.[1][2][3]
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Seeks the dissection red flags: abrupt tearing chest, back or abdominal pain with a BP differential over 20 mmHg between arms or arm and leg, prompting immediate CT aortogram and IV impulse-control[1] |
| Safety | Recognises malperfusion — back or abdominal pain with a pulseless cold leg, acute kidney injury or mesenteric ischaemia is complicated type B and needs urgent TEVAR[1] |
| Safety | Treats syncope as ominous — it occurred in 13 percent of IRAD patients and signals tamponade or retrograde extension; bedside echo, and emergency surgery if type A[2] |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.
References3ShowHide
- [1]Isselbacher EM, Preventza O, Hamilton Black J 3rd, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines Circulation, 2022.PMID 36322642
- [2]Pape LA, Awais M, Woznicki EM, et al. Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection: 17-Year Trends From the International Registry of Acute Aortic Dissection J Am Coll Cardiol, 2015.PMID 26205591
- [3]Levy D, Sharma S, Farci F, et al. Aortic Dissection StatPearls, 2026.PMID 28722992