MBBS OSCE · General Medicine
OSCE — Thrombocytopenia & Immune Thrombocytopenia (ITP)
Eight-minute OSCE station on Thrombocytopenia & Immune Thrombocytopenia (ITP): 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 Thrombocytopenia & Immune Thrombocytopenia (ITP).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Thrombocytopenia (platelets under 150 x 10^9/L) is classified by MECHANISM: decreased production (marrow failure, leukaemia, chemo, B12/folate, alcohol, viruses), increased destruction (immune — ITP; microangiopathic — TTP/HUS; DIC; drugs; HIT) and sequestration (hypersplenism). Immune thrombocytopenia (ITP) is isolated thrombocytopenia (platelets under 100 x 10^9/L) with a normal marrow (normal or increased megakaryocytes) and no other cause. Presentation is mucocutaneous bleeding (petechiae, purpura, epistaxis, menorrhagia) or an asymptomatic incidental FBC finding. First-line: prednisolone 1 mg/kg (or dexamethasone 40 mg for 4 days); IVIg for rapid response, children, bleeding and pregnan
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 | Platelets under 10 with bleeding, or any suspected intracranial bleed - emergenc |
| Safety | Thrombocytopenia with fever, neurology, renal impairment and schistocytes on fil |
| Safety | Thrombocytopenia with prolonged PT and APTT, low fibrinogen, high D-dimer - DIC; |
| 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.