MBBS OSCE · General Medicine
OSCE — Acute Liver Failure
Eight-minute OSCE station on Acute Liver Failure: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Acute Liver Failure.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Acute liver failure (ALF) is severe acute liver injury with coagulopathy (INR at least 1.5) and any degree of hepatic encephalopathy, developing within 26 weeks in a patient without pre-existing cirrhosis (Wilson's disease and reactivation of chronic hepatitis B are the accepted exceptions). The commonest cause in the developed world is paracetamol (acetaminophen) toxicity; in the developing world viral hepatitis (HAV, HBV, HEV) predominates. Other causes are idiosyncratic drug-induced liver injury (anti-TB, antiepileptics), autoimmune hepatitis, ischaemic/shock liver, Budd-Chiari, Wilson's disease, mushroom (Amanita phalloides) poisoning and pregnancy-related syndromes (HELLP, acute fatty l
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 | Acute liver injury with encephalopathy and INR at least 1.5, no cirrhosis - acut |
| Safety | Grade 3 or 4 encephalopathy or rising intracranial pressure - cerebral oedema, t |
| Safety | Massive paracetamol overdose with arterial pH below 7.3, high lactate or INR ove |
| 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.