MBBS OSCE · General Medicine
OSCE — Thyroid Nodules & Thyroid Cancer
Eight-minute OSCE station on Thyroid Nodules & Thyroid Cancer: 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 Thyroid Nodules & Thyroid Cancer.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Thyroid nodules are very common but mostly benign — palpable in around 5 percent of adults and seen on ultrasound in 30 to 50 percent — yet only 5 to 10 percent are malignant. The clinical task is to identify that minority through ultrasound risk-stratification (ACR TI-RADS) and fine-needle aspiration cytology (Bethesda System), guided by clinical risk (neck radiation, family history, rapid growth, hoarseness, fixed nodule, lymphadenopathy). The four main thyroid cancers are papillary (commonest, around 80 percent; excellent prognosis; BRAF V600E, RET-PTC, psammoma bodies, orphan Annie-eye nuclei), follicular (10 percent; vascular and capsular invasion; haematogenous spread to bone and lung;
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 | Thyroid nodule with hoarseness, rapid growth or cervical lymphadenopathy — high |
| Safety | History of childhood neck radiation or family history of thyroid cancer — high r |
| Safety | Large nodule causing compressive symptoms (dysphagia, stridor) — surgical referr |
| 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.