MBBS OSCE · haematology
OSCE — Chronic Leukaemia (CLL & CML)
Eight-minute OSCE station on Chronic Leukaemia (CLL & CML): 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 Leukaemia (CLL & CML).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Chronic leukaemia encompasses two distinct indolent clonal marrow stem-cell disorders. Chronic lymphocytic leukaemia (CLL) is a CD5-positive B-cell neoplasm of mature-appearing lymphocytes (lymphocytosis over 5×10⁹/L, smudge cells, lymphadenopathy, splenomegaly), staged by Rai or Binet, treated only when symptomatic (watch-and-wait early), with FCR chemoimmunotherapy or targeted agents (ibrutinib BTK inhibitor, venetoclax BCL2 inhibitor). Chronic myeloid leukaemia (CML) is a BCR-ABL1 myeloproliferative neoplasm driven by the Philadelphia chromosome t(9;22), characterised by leucocytosis with left shift, basophilia, splenomegaly and low LAP score, divided into chronic, accelerated and blast-c
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 | Lymphocytosis over 5×10⁹/L with smudge cells and CD5+CD23+ B-cells on flow cytom |
| Safety | Marked leucocytosis with left shift, basophilia, low LAP score and splenomegaly |
| Safety | Rapid enlarging lymph node, rising LDH, B-symptoms in known CLL - suspect Richte |
| 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.