MBBS OSCE · General Medicine
OSCE — Chronic Cough
Eight-minute OSCE station on Chronic Cough: 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 Chronic Cough.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Chronic cough is a cough lasting more than 8 weeks in an adult. After a chest X-ray to exclude serious disease (lung cancer, TB, ILD, heart failure, bronchiectasis) and review of smoking and the drug list (especially ACE inhibitors, which must be stopped), a non-smoker with a normal X-ray off ACE inhibitors has one of the 'big three' common, treatable causes in most cases: upper-airway cough syndrome (UACS, post-nasal drip), asthma / eosinophilic bronchitis, and gastro-oesophageal reflux disease (GORD, often silent). Work-up is the 'anatomical diagnostic protocol' — empirical, sequential therapy of each cause, re-assessing response. Cough that persists despite this is refractory and reflects
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 | Haemoptysis, weight loss, or a smoker with chronic cough - chest X-ray and CT; e |
| Safety | New cough in a smoker, or a change in a chronic cough - investigate; do not assu |
| Safety | Cough with dyspnoea, fever, night sweats, or an abnormal chest X-ray - investiga |
| 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.