MBBS OSCE · General Surgery
OSCE — Haemorrhoids
Eight-minute OSCE station on Haemorrhoids: focused history, examination priorities, investigations, emergency and definitive management.
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Study tools
Exam tags
Brief (to candidate)
You will assess a patient with a presentation consistent with Haemorrhoids.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Haemorrhoids (piles) are engorged, displaced anal vascular cushions at the anorectal junction. Internal (above dentate line, painless bleeding) vs external (below dentate line, painful thrombosis). Goligher grading: Grade I (bleed, no prolapse), II (prolapse, reduce spontaneously), III (prolapse, need manual reduction), IV (prolapsed, irreducible). Risk: constipation, straining, pregnancy, prolonged sitting. Present with painless bright red bleeding per rectum (on toilet paper, dripping), prolapse, pruritus ani. Thrombosed external haemorrhoid = acutely painful perianal lump. Always exclude colorectal cancer in patients over 40 with rectal bleeding. Manage: Grade I to II (dietary, topical, r
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 | Rectal bleeding over 40 years - colonoscopy to exclude colorectal cancer (never |
| Safety | Severe perianal pain with fever and systemic signs - perianal abscess or Fournie |
| Safety | Massive rectal bleeding causing haemodynamic instability - resuscitate, urgent e |
| 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.