MBBS OSCE · Rheumatology
OSCE — Sjogren's Syndrome
Eight-minute OSCE station on Sjogren's Syndrome: 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 Sjogren's Syndrome.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Sjogren's syndrome is a chronic systemic autoimmune epithelitis characterised by focal lymphocytic infiltration of exocrine glands leading to sicca syndrome (dry eyes plus dry mouth), with variable extraglandular involvement. It is the second most common autoimmune rheumatic disease after rheumatoid arthritis, with a 9 to 1 female preponderance and peak onset at age 40 to 60. Anti-Ro/SSA is the key serological marker. Primary Sjogren's is classified by the ACR/EULAR 2016 weighted score of at least 4. Management is symptomatic first (artificial tears, saliva substitutes, secretagogues such as pilocarpine 5 mg four times daily), with immunosuppression reserved for organ-threatening disease. Li
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 | Persistent unilateral or progressive parotid enlargement, new lymphadenopathy or |
| Safety | Palpable purpura, leg ulcers or mononeuritis multiplex - cryoglobulinaemic or le |
| Safety | Hypokalaemia with metabolic acidosis and inappropriately high urine pH - distal |
| 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.