MBBS OSCE · General Medicine
OSCE — Paget Disease of Bone
Eight-minute OSCE station on Paget Disease of Bone: 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 Paget Disease of Bone.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Paget disease of bone (osteitis deformans) is a chronic, focal disorder of adult bone remodeling in which excessive, disorganised osteoclast activity is followed by chaotic osteoblast repair, producing bone that is thick and hypervascular but mechanically weak (a disordered woven/mosaic pattern). It is usually asymptomatic and found on incidental raised alkaline phosphatase with normal calcium and phosphate; symptoms include bone pain (often nocturnal), bony deformity (sabre tibia, enlarging skull, kyphosis), sensorineural deafness and, rarely, neurological or cardiac complications. Common sites are the pelvis, spine, femur, skull and tibia. Diagnosis rests on raised ALP with normal Ca/PO4,
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 | Sudden worsening bone pain in known Paget disease — osteosarcoma transformation; |
| Safety | Raised ALP with normal calcium and phosphate on routine bloods — consider Paget |
| Safety | Hearing loss with an enlarging skull — Paget disease of the skull base; audio an |
| 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.