MBBS OSCE · General Surgery
OSCE — Anorectal Disorders
Eight-minute OSCE station on Anorectal Disorders: 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 Anorectal Disorders.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Anorectal disorders span haemorrhoids (Grade I–IV; rubber band ligation first-line for II–III), anal fissure (posterior midline 90%; topical GTN 0.4% or diltiazem 2%; chronic = lateral internal sphincterotomy), anorectal abscess/fistula (cryptoglandular origin; Goodsall rule: anterior = straight, posterior = curved to midline; fistulotomy for low, seton/LIFT/advancement flap for high), pilonidal sinus (natal cleft, hirsute young males; excision ± Limberg flap), anal cancer (HPV 16/18; Nigro protocol 5-FU + mitomycin C chemoradiation), rectal prolapse (elderly women; rectopexy/Delorme/Altemeier) and pruritus ani.
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 | Multiple or atypical anal fissures = Crohn disease, HIV, STI until excluded |
| Safety | Non-healing anal ulcer/fissure = biopsy to exclude anal cancer |
| Safety | Complex or recurrent fistula = consider Crohn disease; never divide a high fistu |
| 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.