MBBS OSCE · Neurology
OSCE — Parkinson Disease
Eight-minute OSCE station on Parkinson Disease: 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 Parkinson Disease.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Parkinson disease (PD) is a progressive neurodegenerative disorder characterised by loss of dopaminergic neurons of the substantia nigra pars compacta, with intracellular alpha-synuclein Lewy bodies. The cardinal motor features are TRAP: resting Tremor, Rigidity, Akinesia/bradykinesia (obligatory), and Postural instability. Diagnosis is clinical (MDS 2015 criteria); investigations exclude mimics. Treatment is symptomatic — levodopa combined with a peripheral decarboxylase inhibitor (carbidopa or benserazide) is the gold-standard and most effective therapy. Dopamine agonists, MAO-B inhibitors, COMT inhibitors and amantadine have defined roles; advanced disease uses apomorphine, levodopa-carbi
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 | Asymmetric rest tremor plus bradykinesia or rigidity in an older adult - think P |
| Safety | Early falls, vertical gaze palsy, symmetrical onset, early dementia or poor levo |
| Safety | Young-onset parkinsonism (under 50) - exclude Wilson disease (ceruloplasmin, uri |
| 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.