MBBS OSCE · General Medicine
OSCE — Heat Stroke
Eight-minute OSCE station on Heat Stroke: 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 Heat Stroke.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Heat stroke is a life-threatening hyperthermic emergency defined by a core body temperature above 40 degrees C (104 F) with central nervous system dysfunction (confusion, agitation, seizures, ataxia, coma) and, in many cases, multi-organ failure. It is the severe end of the heat-illness spectrum (heat cramps, heat exhaustion, heat stroke). Two forms: (1) Classic (non-exertional, epidemic) — elderly and chronically ill patients during heatwaves, with impaired thermoregulation, polypharmacy and hot dry skin; (2) Exertional — young, fit individuals (athletes, military, firefighters, labourers) during strenuous exercise in heat, in whom sweating is often still present. The mechanism is thermoreg
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 | Core temperature over 40 C with CNS dysfunction (confusion, seizures, coma) - he |
| Safety | Athlete or military recruit collapsing during exertion in heat with altered ment |
| Safety | Elderly or chronically ill, hot dry skin during a heatwave, confusion - classic |
| 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.