MBBS OSCE · General Medicine
OSCE — Restless Legs Syndrome & Sleep Disorders
Eight-minute OSCE station on Restless Legs Syndrome & Sleep Disorders: 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 Restless Legs Syndrome & Sleep Disorders.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Restless legs syndrome (RLS) is an irresistible urge to move the legs, worse at rest and in the evening, relieved by movement, and tightly linked to brain-iron deficiency — so check ferritin and replace it if under 75 ug/L before anything else. First-line drug therapy is an alpha-2-delta ligand (gabapentin, pregabalin) or, alternatively, a non-ergot dopamine agonist (pramipexole 0.125 to 0.5 mg, ropinirole 0.25 to 4 mg, rotigotine patch) — but beware augmentation with long-term dopamine agonists. Obstructive sleep apnoea (OSA) is recurrent upper-airway obstruction during sleep producing snoring, witnessed apnoeas and daytime somnolence; screen with STOP-BANG, confirm with polysomnography (Ap
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 | Daytime somnolence with witnessed apnoeas and loud snoring — OSA; polysomnograph |
| Safety | RLS with ferritin under 75 ug/L — iron deficiency; replace first |
| Safety | RLS worsening, earlier onset and spread to arms on a dopamine agonist — augmenta |
| 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.