MBBS OSCE · Cardiology
OSCE — Syncope
Eight-minute OSCE station on Syncope: 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 Syncope.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Syncope is a transient loss of consciousness (TLoC) due to transient global cerebral hypoperfusion, characterised by rapid onset, short duration, and spontaneous complete recovery without electrical brain injury. It must be separated from seizures and psychogenic collapse. The three mechanism-based categories are reflex (neurally-mediated, commonest in the young), orthostatic hypotension (drugs, volume depletion, autonomic failure), and cardiac (arrhythmic or structural — highest mortality). The initial evaluation — a focused history, eyewitness account, examination and a 12-lead ECG in every patient — yields a diagnosis in the majority. Reproduce the San Francisco Syncope Rule (CHEAT) and 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 | Syncope DURING EXERTION or while SUPINE — high-risk cardiac cause until proven o |
| Safety | Palpitations immediately before collapse, chest pain, or breathlessness — cardia |
| Safety | Family history of sudden cardiac death under age 40, or known long QT / Brugada |
| 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.