MBBS OSCE · General Medicine
OSCE — Malabsorption
Eight-minute OSCE station on Malabsorption: 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 Malabsorption.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Malabsorption is impaired absorption of nutrients across the gut, divided into three mechanistic classes: luminal (defective digestion — pancreatic exocrine insufficiency, bile-salt deficiency, small-intestinal bacterial overgrowth, lactase deficiency), mucosal (defective uptake — coeliac disease, tropical sprue, Crohn's disease, radiation enteritis, Whipple disease) and transport/post-mucosal (short bowel syndrome, post-gastrectomy, intestinal lymphangiectasia). The hallmark is steatorrhoea (pale, bulky, greasy, foul-smelling, difficult-to-flush stool) with weight loss, bloating and deficiency signs (iron, B12, folate, calcium, and the fat-soluble vitamins A, D, E, K). Diagnosis combines bl
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 | Steatorrhoea with weight loss and low albumin — significant malabsorption; inves |
| Safety | Iron, folate or B12 deficiency with gastrointestinal symptoms — malabsorption wo |
| Safety | Osteomalacia or easy bruising (vitamin K) from fat-soluble vitamin deficiency — |
| 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.