OSCE — Tetanus · MBBS OSCE

Brief (to candidate)

You will assess a patient with a presentation consistent with Tetanus.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Tetanus is an acute, toxin-mediated neurological disease caused by Clostridium tetani tetanospasmin released from spores germinating in anaerobic, necrotic wounds. The toxin travels retrogradely in motor nerves to the spinal cord and brainstem, cleaves synaptobrevin (VAMP), and blocks release of the inhibitory neurotransmitters glycine and GABA, producing unopposed sustained muscle contraction and reflex spasms with a preserved sensorium. The classic phenotype is trismus (lockjaw), risus sardonicus, opisthotonos and stimulus-triggered spasms, progressing to autonomic instability and respiratory failure. Diagnosis is clinical — there is no useful laboratory test. Management rests on three p

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	Trismus (lockjaw) with muscle rigidity and stimulus-triggered spasms, preserved
Safety	Risus sardonicus, opisthotonos, or board-like abdominal rigidity - generalised t
Safety	Tetanus with autonomic instability (labile BP, tachycardia, arrhythmia) - severe
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.