OSCE — Solitary Pulmonary Nodule · MBBS OSCE

Brief (to candidate)

You will assess a patient with a presentation consistent with Solitary Pulmonary Nodule.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

A solitary pulmonary nodule (SPN) is a single, well-defined, roughly spherical opacity 3 cm or less in diameter, surrounded by aerated lung, with no associated atelectasis, adenopathy or pleural effusion — most often found incidentally on CT or on low-dose CT lung cancer screening. The clinical task is to distinguish benign from malignant using size, density (solid, part-solid, ground-glass), border (smooth vs spiculated), growth rate, calcification, and patient risk (age, smoking, prior cancer). Benign features favour a smooth border, dense central/popcorn calcification, and no growth over two years; malignant features are a spiculated or part-solid nodule that grows in an older smoker. A v

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	A growing nodule, or a spiculated/part-solid nodule over 8 mm — high cancer risk
Safety	A nodule over 3 cm is a mass, not a nodule — likely malignant until proven other
Safety	Nodule in a smoker or patient with prior cancer — higher malignant probability;
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.