MBBS OSCE · Cardiology
OSCE — Bradycardia and AV Block
Eight-minute OSCE station on Bradycardia and AV Block: 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 Bradycardia and AV Block.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Bradyarrhythmia in adults means a resting heart rate below 60 bpm (the clinical threshold drops to below 50 bpm when truly symptomatic, and athletic resting bradycardia of 30 to 40 bpm is physiological). The two master categories are sinus node dysfunction (sinus bradycardia, sinus arrest, sinoatrial block, sick sinus syndrome) and atrioventricular (AV) block — 1st degree (PR over 200 ms, benign), 2nd degree Mobitz I (Wenckebach, usually benign, AV nodal, atropine-responsive), 2nd degree Mobitz II (infranodal, high risk of progression to complete block, Class I indication for pacing even when asymptomatic), and 3rd degree (complete heart block, AV dissociation, Class I pacing). Common aetiol
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 | Asystolic pause over 5 seconds (or any pause causing syncope) — Stokes-Adams att |
| Safety | Complete heart block with wide-complex escape (ventricular rate under 40, unstab |
| Safety | Mobitz II 2nd-degree AV block — high risk of progression to complete block; admi |
| 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.