MBBS OSCE · General Medicine
OSCE — Low Back Pain (Approach & Red Flags)
Eight-minute OSCE station on Low Back Pain (Approach & Red Flags): 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 Low Back Pain (Approach & Red Flags).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Low back pain is the leading cause of disability worldwide; the vast majority is non-specific (mechanical) and self-limiting (over 90 percent recover within 6 weeks). The central clinical skill is identifying red flags (serious pathology — fracture, infection, malignancy, cauda equina, inflammatory) that mandate imaging and referral, while reassuring and mobilising the remainder. Red flags: significant trauma; age over 50 with new pain; history of cancer; fever/weight loss/night sweats; immunosuppression, IV drug use; night pain or pain unrelieved by rest; recent bacterial infection; corticosteroid use; cauda equina (saddle anaesthesia, urinary retention/incontinence, bilateral neurology, pr
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 | Cauda equina syndrome - saddle anaesthesia, urinary/faecal retention or incontin |
| Safety | Back pain with fever, weight loss, night sweats or immunosuppression/IVDU - spin |
| Safety | History of cancer with new progressive back pain, especially night pain - spinal |
| 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.