MBBS OSCE · Respiratory
OSCE — Haemoptysis
Eight-minute OSCE station on Haemoptysis: 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 Haemoptysis.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Haemoptysis is the coughing up of blood that originates from the lower respiratory tract (below the vocal cords). It ranges from blood-streaked sputum to massive, life-threatening haemoptysis. Worldwide the commonest cause is tuberculosis; in developed countries bronchial carcinoma, bronchiectasis and pneumonia predominate. Massive haemoptysis (any volume threatening the airway or gas exchange, classically over 100 to 240 mL/24h) kills by asphyxia, not exsanguination — because over 90 percent of such bleeds arise from the high-pressure bronchial arteries. Management is stepwise: protect the airway, oxygenate, put the BLEEDING LUNG DOWN, reverse anticoagulation, then rigid bronchoscopy with t
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 | Frank blood over 100 to 240 mL in 24 hours, or any volume threatening the airway |
| Safety | Stridor, falling SpO2, inability to clear blood, tachypnoea, shock - impending a |
| Safety | Smoker over 40 with weight loss and new haemoptysis - bronchial carcinoma until |
| 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.