MBBS OSCE · General Medicine
OSCE — Status Epilepticus
Eight-minute OSCE station on Status Epilepticus: 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 Status Epilepticus.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Status epilepticus (SE) is a continuous seizure lasting over 5 minutes, or recurrent seizures without recovery between them — a neurological emergency with mortality over 20 percent. The protocol is staged and time-critical: (1) IV lorazepam 4 mg (repeat once at 10 min); (2) IV levetiracetam 60 mg/kg or fosphenytoin 20 mg PE/kg or valproate 40 mg/kg; (3) refractory — ICU, intubation, anaesthetic infusion (propofol or midazolam) with continuous EEG. Always secure the airway, give oxygen, check and treat glucose and electrolytes, and find and treat the precipitant (AED non-adherence, infection, alcohol withdrawal, metabolic disturbance, stroke, tumour).
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 | Seizure lasting over 5 minutes — status epilepticus; give IV lorazepam NOW |
| Safety | Recurrent seizures without full recovery between — status; protocolised treatmen |
| Safety | Refractory after benzodiazepine plus a second-line agent — ICU, anaesthesia, con |
| 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.