MBBS OSCE · General Medicine
OSCE — Alcoholic & MASLD Liver Disease
Eight-minute OSCE station on Alcoholic & MASLD Liver 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 Alcoholic & MASLD Liver Disease.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Alcohol-related liver disease and metabolic dysfunction-associated steatotic liver disease (MASLD, formerly NAFLD) are the two leading causes of chronic liver disease worldwide. Both follow the same histological spectrum — steatosis to steatohepatitis to fibrosis to cirrhosis (and hepatocellular carcinoma) — driven by different insults (alcohol versus obesity, type 2 diabetes and metabolic syndrome). Alcoholic hepatitis is the severe inflammatory form: AST greater than ALT (ratio over 2), both under 300, with jaundice and a high MCV, graded by the Maddrey Discriminant Function (32 or more is severe) and MELD. Management centres on abstinence and addiction care for alcohol-related disease (wi
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 | Alcoholic hepatitis with Maddrey Discriminant Function 32 or more, jaundice and |
| Safety | MASLD with advanced fibrosis (FIB-4 high, or FibroScan over 8 to 10 kPa) — speci |
| Safety | Steatohepatitis with new ascites, variceal bleed or encephalopathy — decompensat |
| 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.