MBBS OSCE · emergency-toxicology
OSCE — Anaphylaxis
Eight-minute OSCE station on Anaphylaxis: 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 Anaphylaxis.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Anaphylaxis is a severe, life-threatening systemic hypersensitivity reaction that is rapid in onset (minutes to hours) and may cause death. It is a CLINICAL diagnosis — treat on suspicion. FIRST-LINE treatment is INTRAMUSCULAR ADRENALINE 0.5 mg (adult) into the anterolateral thigh, repeat after 5 minutes. Position the patient SUPINE with legs elevated (never sit/stand). Adjuncts (antihistamine, corticosteroid, oxygen, IV fluid) come AFTER adrenaline. Observe for 6 to 12 hours because a BIPHASIC reaction recurs in up to 15 percent of cases. Discharge with TWO adrenaline autoinjectors, an action plan, and an allergy referral.
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 | Sudden onset + rapid progression + involvement of skin AND at least one of airwa |
| Safety | Anaphylaxis can occur WITHOUT skin signs in up to 20 percent of cases — do not w |
| Safety | Patient who suddenly feels faint, sits up or stands, and collapses — empty vena |
| 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.