MBBS OSCE · General Medicine
OSCE — Antiphospholipid Syndrome (APS)
Eight-minute OSCE station on Antiphospholipid Syndrome (APS): 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 Antiphospholipid Syndrome (APS).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Antiphospholipid syndrome (APS, Hughes syndrome) is an acquired autoimmune thrombophilia defined by persistent antiphospholipid antibodies (lupus anticoagulant, anticardiolipin, anti-beta-2-glycoprotein-I) causing venous and arterial thrombosis and pregnancy morbidity (recurrent early miscarriage, late fetal death, severe pre-eclampsia/HELLP, placental insufficiency). It is primary (no autoimmune disease) or secondary (most often to SLE). Diagnosis needs one clinical criterion (thrombosis or pregnancy morbidity) plus one laboratory criterion, the antibody persistent on two occasions at least 12 weeks apart (revised Sapporo 2006). The lupus anticoagulant paradox — it prolongs the APTT in vitr
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 patient with unexplained arterial or venous thrombosis — antiphospholipid |
| Safety | Recurrent miscarriage (3 or more under 10 weeks) or late fetal loss — APS; scree |
| Safety | Prolonged APTT that does not correct on mixing study in a thrombotic patient — l |
| 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.