MBBS OSCE · General Medicine
OSCE — Lung Cancer
Eight-minute OSCE station on Lung Cancer: 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 Cancer.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Lung cancer is a malignant tumour arising from the bronchial or alveolar epithelium, the leading cause of cancer death worldwide. The fundamental divide is non-small cell lung cancer (NSCLC, ~85%) — adenocarcinoma (commonest, peripheral, never-smokers, EGFR/ALK-driven), squamous cell carcinoma (central, cavitates, PTHrP hypercalcaemia), large cell — versus small cell lung cancer (SCLC, ~15%) (central, smoker, neuroendocrine, paraneoplastic SIADH and Lambert-Eaton, early metastasis, chemo- and radio-sensitive). Risk is dominated by tobacco smoking (80 to 90%); also asbestos, radon, second-hand smoke. Presentation: persistent cough, haemoptysis, dyspnoea, weight loss, chest pain, plus paraneop
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 | Persistent cough, haemoptysis or weight loss in a smoker over 40 — suspect lung |
| Safety | New clubbing (hypertrophic pulmonary osteoarthropathy) in a smoker — squamous or |
| Safety | Superior vena cava obstruction (facial plethora, distended neck veins, arm swell |
| 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.