MBBS OSCE · General Medicine
OSCE — Spinal Cord Compression
Eight-minute OSCE station on Spinal Cord Compression: 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 Spinal Cord Compression.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Spinal cord compression is a neurological emergency in which the spinal cord, conus medullaris or cauda equina is compressed by metastatic cancer (commonest: breast, prostate, lung, myeloma, kidney), intervertebral disc herniation, epidural abscess, epidural haematoma or vertebral collapse. Presentation: progressive, often nocturnal back pain, a sensory level, weakness, and — late and ominous — bladder and bowel dysfunction. Cauda equina syndrome adds saddle anaesthesia, bilateral sciatica, urinary retention and erectile dysfunction. Diagnosis is urgent whole-spine MRI. Malignant spinal cord compression: dexamethasone 16 mg immediately, then radiotherapy or surgical decompression within 24 t
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 | Back pain with new neurological symptoms (weakness, numbness, urinary retention) |
| Safety | Known cancer with new back pain — metastatic spinal cord compression until prove |
| Safety | Saddle anaesthesia with urinary retention — cauda equina syndrome; emergency MRI |
| 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.