MBBS OSCE · General Surgery
OSCE — Neck Swellings
Eight-minute OSCE station on Neck Swellings: 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 Neck Swellings.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Neck swellings are classified by location: midline (thyroid goitre moves on swallowing; thyroglossal duct cyst moves on swallowing AND tongue protrusion; dermoid does not move) versus lateral (cervical lymphadenopathy is the commonest cause; also branchial cyst in young adults, salivary gland tumour, cystic hygroma). In an adult over 40, a new neck lump is malignancy until proven otherwise. Ultrasound plus FNA is the standard workup. Sistrunk procedure (excise cyst + tract + central hyoid) for thyroglossal cyst; surgical excision for branchial cyst; superficial parotidectomy with facial nerve preservation for pleomorphic adenoma; do NOT biopsy a carotid body tumour. Metastatic SCC node manda
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 | New painless neck lump in adult over 40 - malignancy until proven otherwise (urg |
| Safety | Hard, fixed, irregular cervical lymph node - metastatic carcinoma until proven o |
| Safety | Rapidly enlarging neck mass with stridor - airway compromise; emergency |
| 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.