MBBS OSCE · General Medicine
OSCE — Raynaud Phenomenon
Eight-minute OSCE station on Raynaud Phenomenon: 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 Raynaud Phenomenon.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Raynaud phenomenon is episodic reversible vasospasm of the digital arteries and cutaneous arterioles, classically producing the triphasic colour change: white (pallor / ischaemia), blue (cyanosis) and red (reperfusion hyperaemia) of the fingers and toes on cold exposure or emotional stress. Two forms: primary (benign, idiopathic, young women, symmetric, no tissue loss, normal nailfold capillaries, negative autoantibodies) and secondary (associated with connective tissue disease — systemic sclerosis above all, plus SLE, MCTD; occupational vibration; drugs such as beta-blockers, bleomycin, cisplatin, ergotamine; thromboembolic and hyperviscosity states; older onset, asymmetric, abnormal nailfo
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 | Raynaud with abnormal nailfold capillaries or positive ANA - secondary Raynaud; |
| Safety | Onset of Raynaud over age 30, asymmetric, or with digital ulcers/ischaemia - sec |
| Safety | Critical digital ischaemia (severe pain, tissue loss) in secondary Raynaud - urg |
| 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.