MBBS OSCE · General Medicine
OSCE — Myelodysplastic Syndromes
Eight-minute OSCE station on Myelodysplastic Syndromes: 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 Myelodysplastic Syndromes.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal haematopoietic stem-cell neoplasms defined by dysplastic, ineffective haematopoiesis, peripheral cytopenia(s) and a variable risk of transformation to acute myeloid leukaemia. Diagnosis requires dysplasia of at least 10 percent in one or more myeloid lineages (or an MDS-defining cytogenetic lesion) plus a persistent unexplained cytopenia after excluding secondary causes (B12, folate, copper deficiency, alcohol, infection). The 20 percent blast threshold separates MDS from AML. Risk is stratified by the IPSS-R and, increasingly, the molecular IPSS-M (blast percentage, cytogenetics, haemoglobin, platelets, plus TP53, SF3B1, FL
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 persistent macrocytic cytopenia and dysplastic film — MDS; send |
| Safety | Marrow or blood blasts at least 20 percent — this is AML, not MDS; urgent haemat |
| Safety | Chronic transfusion with ferritin over 1000 microg/L — start iron chelation to p |
| 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.