MBBS OSCE · General Medicine
OSCE — Nephrolithiasis (Kidney & Ureteric Stones)
Eight-minute OSCE station on Nephrolithiasis (Kidney & Ureteric Stones): 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 Nephrolithiasis (Kidney & Ureteric Stones).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Nephrolithiasis (renal and ureteric stones) is the formation of crystalline calculi within the urinary tract, driven by urinary supersaturation of stone-forming salts, and presenting classically as acute, severe colicky flank pain radiating from loin to groin with nausea, restlessness and haematuria. Calcium oxalate is the commonest stone type (~75%, radio-opaque); the other three pillars are uric acid (radio-lucent, acidic urine, gout, dissolvable with alkalinisation), struvite (urease-producing Proteus infection, alkaline urine, staghorn calculi) and cystine (autosomal-recessive cystinuria, hexagonal crystals). Risk factors cluster around low fluid intake, high sodium/animal-protein/fructo
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 | Obstructing stone with fever/sepsis (pyonephrosis) — urological emergency; IV an |
| Safety | Solitary kidney with obstruction — emergency drainage to preserve renal function |
| Safety | Bilateral obstructing stones or renal colic with acute kidney injury — urgent de |
| 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.