OSCE — Phaeochromocytoma · MBBS OSCE

Brief (to candidate)

You will assess a patient with a presentation consistent with Phaeochromocytoma.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Phaeochromocytoma is a catecholamine-secreting tumour arising from chromaffin cells of the adrenal medulla; an identical tumour outside the adrenal (organ of Zuckerkandl, sympathetic chain, bladder) is a paraganglioma. About 80 to 85 percent are intra-adrenal and 15 to 20 percent extra-adrenal. It presents with the classic triad of episodic headache, sweating and palpitations with paroxysmal or sustained hypertension and striking pallor. The historical rule of 10 (about 10 percent each bilateral, malignant, extra-adrenal, familial and paediatric) is outdated for heritability: modern genotyping shows 30 to 40 percent carry a germline mutation (RET/MEN 2, VHL, NF1, SDHx, MAX, TMEM127). Diagnos

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	Episodic hypertension with headache, sweating and palpitations — screen metaneph
Safety	Hypertensive crisis on induction of anaesthesia or on a beta-blocker — undiagnos
Safety	Beta-blocker given before alpha-blockade in phaeochromocytoma — unopposed alpha
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.