MBBS OSCE · Neurology / Emergency
OSCE — hyperacute ischaemic stroke assessment and thrombolysis pathway
An 8-minute OSCE station on FAST/NIHSS-oriented assessment, time last known well, CT pathway, and IV alteplase decision-making with BP targets.
8 min stationVerification in progress
On this page
Study tools
Exam tags
NEET-PGINICETUSMLEPLAB
Brief (to candidate)
A 68-year-old man was last seen well at 08:00. At 09:10 his wife finds right-sided weakness and speech difficulty. He arrives at 09:40. BP 178/98, glucose 6.2 mmol/L, NIHSS appears moderate–severe. You have 8 minutes to assess, prioritise investigations, and outline reperfusion decisions.
Candidate instructions
- Take a focused history emphasising last known well and contraindications to thrombolysis.
- Perform structured neurological assessment (FAST/NIHSS domains).
- Order immediate non-contrast CT (± CTA) and state door-to-needle goals.
- Give alteplase dose if eligible and BP targets; mention thrombectomy if LVO.
Examiner checklist (mark each domain / 10)
| Domain | Key actions expected |
|---|---|
| Time metrics | Documents last known well 08:00; onset-to-door; activates stroke code |
| Mimics | Checks glucose; considers seizure Todd's, hypoglycaemia, migraine, conversion |
| ABCDE / monitoring | Airway risk if drowsy; NPO pending swallow screen; O2 only if hypoxic |
| Imaging | Immediate NCCT to exclude haemorrhage; CTA for LVO if candidate |
| Thrombolysis | Window <4.5 h; alteplase 0.9 mg/kg max 90 mg (10% bolus, rest over 1 h) |
| BP targets | <185/110 pre-tPA; <180/105 for 24 h post |
| Thrombectomy | If ICA/M1 LVO — endovascular within 6 h (or 6–24 h with mismatch imaging) |
| Communication | Explains ICH risk of tPA; consent/assent; secondary prevention plan later |
Model key actions
- Stroke clock starts now; CT before anything non-essential.
- Glucose already normal — not a mimic from hypo.
- If CT excludes blood and no absolute contraindication → IV alteplase.
- Parallel CTA; if LVO → thrombectomy centre activation.
- Aspirin deferred until 24 h post-tPA scan excludes haemorrhage.
Common errors
- Delaying CT for full laboratory panel in a non-anticoagulated patient.
- Lowering BP aggressively before deciding on tPA eligibility without indication.
- Using age alone to withhold reperfusion.
- Forgetting last known well vs discovery time in wake-up scenarios.
References1ShowHide
- [1]Powers WJ, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update. Stroke, 2019.PMID 31662037