MBBS OSCE · General Medicine
OSCE — Lung Abscess
Eight-minute OSCE station on Lung Abscess: 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 Lung Abscess.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
A lung abscess is a localised collection of pus within a cavitating area of lung parenchyma, classically produced by aspiration of oropharyngeal contents (a mixed anaerobic inoculum) in a host with impaired consciousness or swallowing — alcoholism, seizures, poor dentition, dysphagia, stroke. Other mechanisms are necrotising pneumonia (Staphylococcus aureus, Klebsiella, Pseudomonas), septic emboli (right-sided endocarditis in intravenous drug use, Lemierre syndrome), and abscess distal to an obstructing tumour or foreign body. The presentation is insidious over weeks with fever, foul-smelling (fetid) sputum, cough, weight loss and night sweats, and imaging shows a thick-walled cavity with an
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 | Foul-smelling sputum + a cavity with air-fluid level on imaging — lung abscess; |
| Safety | A lung abscess that fails to resolve on antibiotics — bronchoscopy to exclude an |
| Safety | Multiple peripheral cavitating nodules — septic emboli; look for right-sided end |
| 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.