MBBS OSCE · General Surgery
OSCE — Diverticular Disease
Eight-minute OSCE station on Diverticular Disease: 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 Diverticular Disease.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Diverticular disease encompasses a spectrum from asymptomatic diverticulosis (70 to 80% of cases) through symptomatic uncomplicated diverticular disease (SUDD) to acute diverticulitis and its life-threatening complications. False (pseudodiverticula) = mucosa and submucosa herniate through the muscularis propria at sites of vasa recta penetration. The sigmoid colon is affected in 90% of Western populations (right-sided in 15 to 75% of Asians). Over 50% of people older than 60 are affected. Hinchey classification (stages I to IV) and the WSES 2015 severity grade guide surgical management of perforated diverticulitis. Management ranges from dietary modification to emergency Hartmann's procedure
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 | Generalised peritonitis with free intraperitoneal gas = perforated diverticuliti |
| Safety | Persistent rectal bleeding in a patient with known diverticulosis — exclude colo |
| Safety | Colovesical fistula (pneumaturia, faecaluria, recurrent UTI) — requires elective |
| 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.