MBBS OSCE · General Medicine
OSCE — Multiple Myeloma
Eight-minute OSCE station on Multiple Myeloma: 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 Multiple Myeloma.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Multiple myeloma is a malignant clonal neoplasm of terminally differentiated B-cells (plasma cells) that accumulates in the bone marrow and secretes a monoclonal protein (paraprotein / M-band) and/or free light chains. End-organ damage is summarised by CRAB — hyperCalcaemia, Renal impairment (cast nephropathy), Anaemia, Bone lesions (lytic). Diagnosis (IMWG 2014) requires clonal marrow plasma cells at least 10 percent (or biopsy-proven plasmacytoma) plus a myeloma-defining event: CRAB features or a biomarker of malignancy (serum involved-to-uninvolved free light chain ratio at least 100, more than one focal lesion on MRI, or 60 percent or more clonal marrow plasma cells). Workup: SPEP + immu
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 | Older adult with bone pain, hypercalcaemia and renal impairment — multiple myelo |
| Safety | Pathological fracture (spine, rib) with anaemia — myeloma; urgent imaging and bl |
| Safety | Hypercalcaemia with AKI and anaemia (CRAB triad) — myeloma; treat hypercalcaemia |
| 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.