MBBS OSCE · General Medicine
OSCE — Adult-Onset Still's Disease
Eight-minute OSCE station on Adult-Onset Still's Disease: 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 Adult-Onset Still's Disease.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Adult-onset Still's disease (AOSD) is a rare systemic autoinflammatory disorder (the adult counterpart of systemic juvenile idiopathic arthritis) presenting with quotidian spiking fevers (evening peak), an evanescent salmon-pink rash, arthritis, sore throat, and markedly raised inflammatory markers (ferritin often very high) with negative autoantibodies (ANA, RF negative). It affects young adults (16 to 35). Three patterns: self-limited monocyclic, polycyclic (relapsing-remitting), or chronic articular. The feared complication is macrophage activation syndrome (MAS) / secondary HLH — a life-threatening hyperinflammatory emergency. Diagnosis is clinical (Yamaguchi or Fautrel criteria), after
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 | Young adult with quotidian spiking fevers, salmon-pink evanescent rash, arthriti |
| Safety | AOSD with new high fever, falling white cells/platelets/fibrinogen and rising fe |
| Safety | Persistently spiking fever despite antibiotics — reconsider infection; AOSD is a |
| 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.