MBBS OSCE · General Medicine
OSCE — Concussion & Traumatic Brain Injury
Eight-minute OSCE station on Concussion & Traumatic Brain Injury: 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 Concussion & Traumatic Brain Injury.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Traumatic brain injury (TBI) is a disruption of brain function from external mechanical force, graded by the Glasgow Coma Scale (GCS) into mild (GCS 13 to 15, about 80 percent — concussion), moderate (GCS 9 to 12, about 10 percent) and severe (GCS 3 to 8, about 10 percent). Injury is divided into primary (mechanical, instantaneous, largely irreversible — skull fracture, contusion, diffuse axonal injury) and secondary (delayed, PREVENTABLE — hypoxia, hypotension, raised intracranial pressure, ischaemia, infection); preventing secondary injury is the main target of treatment. Concussion produces transient headache, dizziness, confusion, nausea and amnesia without structural injury on imaging,
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 | GCS 12 or lower, or a fall of 2 or more points on serial GCS — urgent CT; neuros |
| Safety | Lucid interval then decreasing consciousness — extradural haematoma; emergency C |
| Safety | Cushing's triad (hypertension + bradycardia + irregular respiration) — markedly |
| 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.