MBBS OSCE · General Medicine
OSCE — Polyarteritis Nodosa (PAN)
Eight-minute OSCE station on Polyarteritis Nodosa (PAN): 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 Polyarteritis Nodosa (PAN).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Polyarteritis nodosa (PAN) is a necrotising vasculitis of medium-sized muscular arteries characterised by transmural inflammation, fibrinoid necrosis, disruption of the internal elastic lamina and microaneurysm formation. It is defined by what it is NOT: it does not involve glomeruli or capillaries, does not involve the lungs (no pulmonary capillaritis), and is not ANCA-associated — the three findings that distinguish it from the ANCA-associated vasculitides (especially microscopic polyangiitis). Presentation: constitutional symptoms, mononeuritis multiplex (wrist/foot drop from nerve infarction), mesenteric ischaemia (abdominal angina), renovascular hypertension with bland urinalysis, lived
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 | Mononeuritis multiplex (wrist/foot drop) with constitutional symptoms and livedo |
| Safety | Abdominal pain after eating (abdominal angina), weight loss and new hypertension |
| Safety | PAN with hepatitis B surface antigen positive - HBV-associated PAN; treat with a |
| 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.