MBBS OSCE · General Medicine
OSCE — Substance Use Disorders (Alcohol & Opioids)
Eight-minute OSCE station on Substance Use Disorders (Alcohol & Opioids): 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 Substance Use Disorders (Alcohol & Opioids).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Substance use disorders (SUD) are chronic relapsing brain diseases defined by pathological substance use despite harm, with tolerance, withdrawal, craving, loss of control, and continued use despite consequences (DSM-5: 2+ of 11 criteria over 12 months — mild 2 to 3, moderate 4 to 5, severe 6+). The two highest-yield subtypes are alcohol use disorder (AUD) and opioid use disorder (OUD). Alcohol withdrawal ranges from tremor to generalised seizures (24 to 48 h) to delirium tremens (48 to 72 h, mortality 5 percent untreated); treated with benzodiazepines via CIWA-Ar scoring (chlordiazepoxide preferred; lorazepam if liver disease) plus IV thiamine BEFORE any glucose (Wernicke encephalopathy). O
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 | Alcohol withdrawal with tremor, agitation, autonomic hyperactivity (CIWA-Ar 8 or |
| Safety | Delirium tremens (confusion, vivid hallucinations, fever, severe autonomic insta |
| Safety | Alcohol withdrawal seizure at 24 to 48 h - IV benzodiazepine; investigate and ex |
| 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.