MBBS OSCE · Nephrology
OSCE — Minimal Change Disease
Eight-minute OSCE station on Minimal Change Disease: 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 Minimal Change Disease.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Minimal change disease (MCD) is the leading cause of nephrotic syndrome in children and the prototype of steroid-responsive podocytopathy. It accounts for roughly 90 percent of childhood and 10-15 percent of adult nephrotic presentations, with selective albuminuria, normal light microscopy, no immune deposits on immunofluorescence, and diffuse foot process effacement on electron microscopy. High-dose corticosteroids induce remission in over 80 percent of cases, with cyclophosphamide, calcineurin inhibitors, mycophenolate, and rituximab reserved for frequent relapsers, steroid-dependent, and steroid-resistant disease.
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 | Sudden onset anasarca with breathlessness — suggests pulmonary oedema or pleural |
| Safety | Oliguria + rising creatinine + persistent heavy proteinuria — consider acute tub |
| Safety | Calf swelling, pleuritic chest pain, haemoptysis, or new atrial fibrillation — r |
| 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.