MBBS OSCE · Rheumatology
OSCE — Giant Cell Arteritis
Eight-minute OSCE station on Giant Cell Arteritis: 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 Giant Cell Arteritis.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Giant cell arteritis (GCA, temporal arteritis) is the most common primary vasculitis in adults over 50, affecting large and medium arteries (especially the extracranial branches of the carotid, particularly the temporal arteries, and the aorta and its branches). Symptoms: new-onset headache, scalp tenderness, jaw claudication, visual disturbance (ischaemic optic neuropathy, amaurosis fugax, diplopia), constitutional symptoms, polymyalgia rheumatica. Diagnosis: ESR/CRP markedly elevated; temporal artery biopsy confirms. Treatment: high-dose corticosteroids started immediately on clinical suspicion (do not wait for biopsy); tocilizumab for relapse or steroid-sparing.
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 | Sudden visual loss in a patient over 50 with new headache, jaw claudication or s |
| Safety | Amaurosis fugax or transient diplopia in suspected GCA is impending permanent bl |
| Safety | Asymmetric arm blood pressure (more than 15 mmHg), absent radial pulse or upper- |
| 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.