MBBS OSCE · Cardiology
OSCE — Non-ST-Elevation Acute Coronary Syndrome (NSTE-ACS)
Eight-minute OSCE station on Non-ST-Elevation Acute Coronary Syndrome (NSTE-ACS): 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 Non-ST-Elevation Acute Coronary Syndrome (NSTE-ACS).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Non-ST-elevation acute coronary syndrome (NSTE-ACS) is myocardial ischaemia at rest or on minimal exertion caused by a partially or intermittently occlusive intra-coronary thrombus over a disrupted atherosclerotic plaque, but without the ST elevation that mandates immediate reperfusion. It comprises NSTEMI (myocardial necrosis demonstrated by a rise and/or fall of high-sensitivity cardiac troponin with at least one value above the 99th centile) and unstable angina (ischaemia without troponin release). Diagnosis rests on the 12-lead ECG within 10 minutes plus serial high-sensitivity troponin (0-hour/1-hour or 0-hour/3-hour algorithms). Risk-stratify with the GRACE (death) and TIMI (composite
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 | Ischaemic chest pain at rest with dynamic ST depression over 0.5 mm or deep T-wa |
| Safety | NSTE-ACS with haemodynamic instability, cardiogenic shock, life-threatening arrh |
| Safety | A new pansystolic murmur days after an ACS with sudden pulmonary oedema = mechan |
| 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.