MBBS OSCE · General Medicine
OSCE — Subarachnoid Haemorrhage
Eight-minute OSCE station on Subarachnoid Haemorrhage: focused history, examination priorities, investigations, emergency and definitive management.
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Exam tags
Brief (to candidate)
You will assess a patient with a presentation consistent with Subarachnoid Haemorrhage.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Subarachnoid haemorrhage (SAH) is bleeding into the subarachnoid space, usually from a ruptured intracranial aneurysm (85 percent), presenting with a sudden, severe 'thunderclap' headache (maximum intensity within 1 minute) — often described as 'the worst headache of my life' — with neck stiffness, photophobia, nausea, vomiting, altered consciousness and sometimes seizures. Non-contrast CT brain (sensitivity about 100 percent within 6 hours on a modern scanner) is the first investigation; if the CT is negative or performed later than 6 hours, lumbar puncture for xanthochromia (yellow CSF supernatant from bilirubin) confirms the diagnosis. Management includes securing the aneurysm (endovascul
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 | Thunderclap headache (max intensity within 1 minute) — SAH until proven otherwis |
| Safety | Sudden severe headache with neck stiffness and photophobia — SAH; CT then LP if |
| Safety | Deteriorating consciousness after initial SAH — rebleeding, hydrocephalus or vas |
| 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.