MBBS OSCE · Rheumatology
OSCE — Gout
Eight-minute OSCE station on Gout: 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 Gout.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.[1]
Clinical context
Gout is a common and treatable disease caused by deposition of monosodium urate crystals in articular and non-articular structures, driven by hyperuricaemia. The diagnostic gold standard is MSU crystals in synovial fluid or a tophus. Acute flares are treated with colchicine, an NSAID or a glucocorticoid; long-term allopurinol is first-line urate-lowering therapy, started low and titrated to a serum-urate target below 6 mg/dL, with anti-inflammatory prophylaxis for at least 3 to 6 months. Always aspirate an acutely hot joint to exclude sepsis. [1][2]
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).[1]
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 | Explosive-onset severe monoarthritis — aspirate to exclude sepsis |
| Safety | Any acutely hot swollen joint — aspirate for crystals AND culture; sepsis can coexist |
| Safety | Serum urate can be NORMAL during an acute attack — do not use it to exclude gout |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Aspirate any hot joint. Use ACR-standard flare therapy (colchicine, NSAID or glucocorticoid) and treat-to-target allopurinol. A safe candidate never delays sepsis care for non-urgent imaging.[1][2]
References2ShowHide
- [1]FitzGerald JD, Dalbeth N, Mikuls T, et al. 2020 American College of Rheumatology Guideline for the Management of Gout Arthritis Rheumatol, 2020.PMID 32390306
- [2]Dalbeth N, Gosling AL, Gaffo A, Abhishek A. Gout Lancet, 2021.PMID 33798500