MBBS OSCE · General Surgery
OSCE — Hepatocellular Carcinoma
Eight-minute OSCE station on Hepatocellular Carcinoma: 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 Hepatocellular Carcinoma.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Hepatocellular carcinoma (HCC) is the 6th most common cancer and 3rd leading cause of cancer death worldwide. Most cases arise in the setting of cirrhosis (HBV, HCV, alcohol, NASH). Surveillance: 6-monthly USS +/- AFP in at-risk patients. Diagnosis: non-invasive (LI-RADS) by typical arterial enhancement + portal venous washout on CT/MRI. BCLC staging guides treatment: resection (early), transplant (Milan criteria), TACE (intermediate), sorafenib/atezolizumab+bevacizumab (advanced).
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 | New liver mass in a patient with known cirrhosis - HCC until proven otherwise; u |
| Safety | Cirrhotic nodule over 1 cm with arterial phase hyperenhancement and portal venou |
| Safety | Sudden decompensation of cirrhosis (rapid ascites, weight loss, pain) - suspect |
| 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.