MBBS OSCE · General Medicine
OSCE — Hypertensive Nephrosclerosis
Eight-minute OSCE station on Hypertensive Nephrosclerosis: 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 Hypertensive Nephrosclerosis.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Hypertensive nephrosclerosis is chronic kidney injury caused by long-standing systemic hypertension — after diabetic kidney disease, the commonest cause of CKD and ESKD worldwide. Benign (chronic) nephrosclerosis produces hyaline arteriolosclerosis of the afferent arteriole, small granular kidneys and slowly progressive CKD with sub-nephrotic proteinuria. Malignant-phase (accelerated) hypertension — severe BP (typically over 180 over 120 mmHg) with acute target-organ damage (retinopathy grade III-IV, encephalopathy, AKI, microangiopathic haemolysis) — is a medical emergency whose histology is fibrinoid necrosis of arterioles and onion-skinning of interlobular arteries. Chronic management is
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 | Severe BP with retinopathy (flame haemorrhages, papilloedema), AKI or haemolysis |
| Safety | Uncontrolled chronic hypertension with falling eGFR and proteinuria — hypertensi |
| Safety | Resistant or early-onset hypertension (under 30, abrupt onset, hypokalaemia, abd |
| 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.