MBBS OSCE · General Surgery / Gastroenterology

OSCE — iron-deficiency anaemia and suspected colorectal cancer

An 8-minute OSCE assessing focused history, DRE, investigation ladder, staging principles, and surgical/adjuvant planning for suspected left-sided colorectal cancer presenting with altered bowel habit and iron-deficiency anaemia.

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Exam tags

NEET-PGINICETUSMLEPLAB

Brief (to candidate)

A 62-year-old man has 3 months of alternating constipation and diarrhoea, rectal bleeding mixed with stool, and 6 kg weight loss. Hb 9.0 g/dL, MCV 70 fL. Father had colon cancer at 58. You have 8 minutes to assess him and outline diagnosis, investigations, and management principles.

Candidate instructions

  1. Take a focused GI/bleeding/family-history and perform/describe abdominal exam + DRE.
  2. State the most likely diagnosis and side-based pattern.
  3. List investigations including staging and tumour marker role.
  4. Outline operative principles if localised left colon cancer and adjuvant therapy for node-positive disease.
  5. Mention Lynch surveillance if hereditary pattern confirmed.

Examiner checklist

DomainKey actions expected
History/examAlarm symptoms; family history; DRE; mass; anaemia symptoms
DiagnosisLeft-sided CRC until proven otherwise; IDA + >40 y bleeding → colonoscopy
InvestigationsColonoscopy+biopsy; CT CAP; baseline CEA (monitoring not diagnosis)
Surgery/oncologyOncological resection, ≥12 nodes; stage III FOLFOX/CAPOX (MOSAIC)
HereditaryAmsterdam/Lynch concept; colonoscopy from ~25–30 if Lynch
Safety-netEmergency obstruction → resuscitate; Hartmann if unstable left obstruction

Model key actions

  • Never attribute new rectal bleeding over 40 to haemorrhoids without colonoscopy.
  • TME for rectal cancer; neoadjuvant CRT for stage II–III rectum.
  • SEMS bridge only in selected stable malignant left obstruction.

Common errors

  • Ordering CEA as a screening/diagnostic test.
  • Primary anastomosis insistence in unstable obstructed left colon.
  • Missing DRE and family history.

Extended examiner probes

  • Why not CEA for screening? Poor sensitivity/specificity; monitoring only.
  • Stage II adjuvant? Not routine; consider high-risk features; MSI-H stage II may not benefit from 5-FU.
  • Low rectal cancer 3 cm from verge? MRI, neoadjuvant CRT if indicated, TME; APER if sphincter not preservable.
  • Obstructed unstable sigmoid cancer? Resuscitate, antibiotics, Hartmann procedure rather than risky primary anastomosis.
References4Show
  1. [1]Dekker E, Tanis PJ, Vleugels JLA, et al. Colorectal cancer. Lancet, 2019.PMID 31631858
  2. [2]Davidson KW, Barry MJ, Mangione CM, et al. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA, 2021.PMID 34003218
  3. [3]André T, Boni C, Mounedji-Boudiaf L, et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med, 2004.PMID 15175436
  4. [5]Votava J, Kachlik D, Hoch J Total mesorectal excision in rectal cancer surgery. Various / surgical standard, 2020.PMID 32200705
OSCE — iron-deficiency anaemia and suspected colorectal cancer · MBBS OSCE · NeetVellum