MBBS OSCE · Cardiology
OSCE — Pulmonary Hypertension
Eight-minute OSCE station on Pulmonary Hypertension: 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 Pulmonary Hypertension.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Pulmonary hypertension (PH) is a haemodynamic and pathophysiological syndrome defined as a mean pulmonary arterial pressure (mPAP) above 20 mmHg at rest measured by right heart catheterisation (RHC), confirmed by a pulmonary arterial wedge pressure (PAWP) of 15 mmHg or less in pre-capillary disease and pulmonary vascular resistance (PVR) above 2 Wood units (WU) in pulmonary arterial hypertension (PAH). The 2022 ESC/ERS Guidelines classify PH into five groups by aetiology: Group 1 — pulmonary arterial hypertension (PAH) (idiopathic, heritable, drug- and toxin-induced, and associated with connective tissue disease, HIV, portal hypertension, congenital heart disease); Group 2 — PH due to left h
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 | Syncope or pre-syncope on exertion in a previously well young or middle-aged adu |
| Safety | Peripheral oedema, ascites, tender hepatomegaly and raised JVP with clear lungs |
| Safety | Mismatched perfusion defects on V/Q scan in a patient with persistent dyspnoea 6 |
| 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.