MBBS OSCE · Neurology
OSCE — Brain Tumours
Eight-minute OSCE station on Brain Tumours: 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 Brain Tumours.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Brain tumours are intracranial neoplasms — primary (arising from glia, meninges, cranial nerves, pituitary or germ cells) or secondary (metastatic, roughly five to ten times commoner than primary). The WHO 2021 classification defines them by integrated histology and molecular markers (IDH mutation, 1p/19q codeletion, MGMT methylation, BRAF, H3 K27). Presentation: raised ICP (morning headache, vomiting, papilloedema), seizures, progressive focal deficit. MRI with gadolinium is the imaging gold standard. Management: maximal safe resection, radiotherapy, chemotherapy (Stupp protocol for glioblastoma — radiotherapy 60 Gy plus concomitant and adjuvant temozolomide), dexamethasone for vasogenic
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 | New-onset seizure in an adult — think brain tumour; urgent MRI with contrast |
| Safety | Headache worse on waking, with Valsalva, plus papilloedema or vomiting — raised |
| Safety | Progressive focal neurological deficit over days to weeks — urgent MRI with cont |
| 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.