MBBS OSCE · General Medicine
OSCE — Myeloproliferative Disorders (PV, ET, MF & CML)
Eight-minute OSCE station on Myeloproliferative Disorders (PV, ET, MF & CML): 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 Myeloproliferative Disorders (PV, ET, MF & CML).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Myeloproliferative neoplasms (MPN) are clonal disorders of haematopoietic stem cells causing overproduction of mature myeloid lineages. Polycythaemia vera (PV) = raised haematocrit (over 0.52 M / over 0.48 F) plus JAK2 V617F (~95%) and low serum erythropoietin; presents with hyperviscosity (headache, visual disturbance, thrombosis, aquagenic pruritus), splenomegaly, gout; treat with venesection to haematocrit under 0.45 plus low-dose aspirin plus cytoreduction (hydroxycarbamide 15 to 35 mg/kg/day). Essential thrombocythemia (ET) = sustained platelet count over 450 with megakaryocytic hyperplasia (JAK2 50 to 60 percent, CALR 25 percent, MPL 5 percent); risk of thrombosis and bleeding; treat w
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 | Markedly raised haematocrit (over 0.52 M / over 0.48 F) with low EPO and JAK2 mu |
| Safety | Sustained platelets over 450 with thrombosis or erythromelalgia — essential thro |
| Safety | Massive splenomegaly with tear-drop cells and leukoerythroblastic film — primary |
| 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.