MBBS OSCE · Rheumatology
OSCE — Ankylosing Spondylitis
Eight-minute OSCE station on Ankylosing Spondylitis: 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 Ankylosing Spondylitis.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Ankylosing spondylitis (AS) is a chronic, progressive inflammatory disease of the axial skeleton and entheses — the prototype of the seronegative spondyloarthropathies. Strongly associated with HLA-B27 (about 90 percent). Presents as inflammatory back pain (insidious onset under 40 years, worse with rest, better with exercise, morning stiffness over 30 minutes, alternating buttock pain) with sacroiliitis (often bilateral and symmetric) and, late, a bamboo spine. Extra-articular: acute anterior uveitis (unilateral painful red eye), aortic regurgitation, apical lung fibrosis, secondary amyloidosis. Diagnosis by the modified New York criteria (1984) for established AS, or the ASAS 2009 criteria
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 | Insidious back pain under 40 years, worse with rest, better with exercise, morni |
| Safety | Unilateral painful red eye, photophobia, blurred vision in a patient with known |
| Safety | Any neck or back pain after even minor trauma in a fused/kyphotic spine - assume |
| 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.