MBBS OSCE · General Medicine
OSCE — IgG4-Related Disease
Eight-minute OSCE station on IgG4-Related Disease: focused history, examination priorities, investigations, emergency and definitive management.
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Exam tags
Brief (to candidate)
You will assess a patient with a presentation consistent with IgG4-Related Disease.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
IgG4-related disease (IgG4-RD) is a fibro-inflammatory immune-mediated disorder characterised by tumefactive (mass-like) lesions, a dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, storiform fibrosis and obliterative phlebitis, and often elevated serum IgG4. It can affect nearly any organ — type 1 autoimmune pancreatitis, IgG4-related sclerosing cholangitis, sialadenitis (Mikulicz syndrome), dacryoadenitis, retroperitoneal fibrosis, tubulointerstitial nephritis, aortitis, Riedel thyroiditis and hypertrophic pachymeningitis. It predominantly affects older men and often presents as painless organ enlargement or a mass that mimics malignancy. Diagnosis rests on histology (
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 | Painless mass or organ enlargement (pancreas, salivary/lacrimal gland, bile duct |
| Safety | Type 1 autoimmune pancreatitis with a sausage-shaped pancreas and raised serum I |
| Safety | Retroperitoneal fibrosis with hydronephrosis and renal failure - IgG4-RD; reliev |
| 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.