MBBS OSCE · General Medicine
OSCE — Infectious Mononucleosis (Epstein-Barr Virus)
Eight-minute OSCE station on Infectious Mononucleosis (Epstein-Barr Virus): focused history, examination priorities, investigations, emergency and definitive management.
On this page
Study tools
Exam tags
Brief (to candidate)
You will assess a patient with a presentation consistent with Infectious Mononucleosis (Epstein-Barr Virus).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Infectious mononucleosis is the acute, self-limiting clinical syndrome of primary Epstein-Barr virus (EBV, human herpesvirus 4) infection, transmitted mainly by saliva ('kissing disease') and classically affecting adolescents and young adults. The classic triad is fever, exudative tonsillar pharyngitis and (especially posterior cervical) lymphadenopathy, with prolonged fatigue, palatal petechiae, splenomegaly, hepatitis and atypical lymphocytes on the blood film. EBV enters B lymphocytes via the CD21 (CR2) receptor; the atypical lymphocytes are reactive CD8+ cytotoxic T cells (Downey cells). Diagnosis is by heterophile antibody (Monospot) plus EBV-specific serology (VCA IgM = acute). Managem
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 | Young adult with fever, exudative tonsillitis, posterior cervical lymphadenopath |
| Safety | Diffuse maculopapular rash after ampicillin/amoxicillin for sore throat - classi |
| Safety | Left upper quadrant pain or shoulder-tip (Kehr sign) in mononucleosis - splenic |
| 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.