MBBS OSCE · Rheumatology
OSCE — Calcium Pyrophosphate Deposition Disease (CPPD / Pseudogout)
Eight-minute OSCE station on Calcium Pyrophosphate Deposition Disease (CPPD / Pseudogout): 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 Calcium Pyrophosphate Deposition Disease (CPPD / Pseudogout).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Calcium pyrophosphate deposition (CPPD) disease is a crystal-deposition arthritis caused by calcium pyrophosphate dihydrate (CPP) crystals forming in articular cartilage and fibrocartilage (chondrocalcinosis) and shedding into joints. It is the commonest crystal arthritis of the elderly and the second commonest overall after gout. Prevalence rises sharply with age, reaching 30 to 60 per cent in those over 85. Presentation is a spectrum: acute CPP arthritis ('pseudogout') mimicking gout (classically the knee, wrist); chronic CPP crystal inflammatory arthritis (RA-like); osteoarthritis with CPPD (pseudo-OA); or asymptomatic chondrocalcinosis. Associations are ageing, osteoarthritis and metabol
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 | Acute monoarthritis of the knee or wrist in an older adult — pseudogout (CPPD); |
| Safety | Chondrocalcinosis in a younger patient (under 55) — screen metabolic cause (hype |
| Safety | Acute monoarthritis — aspirate to distinguish pseudogout from gout AND septic ar |
| 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.