MBBS OSCE · General Medicine
OSCE — Toxic Shock Syndrome
Eight-minute OSCE station on Toxic Shock Syndrome: 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 Toxic Shock Syndrome.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Toxic shock syndrome (TSS) is an acute, life-threatening, toxin-mediated multisystem illness caused by bacterial superantigen exotoxins that bypass normal MHC-restricted antigen presentation, activating up to 20 to 30 percent of all T-cells simultaneously (versus ~0.01 percent normally) and producing a massive cytokine storm (IL-1, IL-2, TNF-alpha, IFN-gamma) that drives capillary leak, systemic vasodilation, hypotension and multi-organ failure. Two forms: staphylococcal TSS (Staphylococcus aureus producing TSST-1, staphylococcal enterotoxins B and C — classically associated with tampons/menstruation but now more often non-menstrual — surgical wounds, postpartum, burns, skin infection, nas
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 | Fever over 38.9 deg C + diffuse sunburn-like rash + hypotension + multi-organ in |
| Safety | Menstruating woman with tampon + fever + rash + hypotension - staphylococcal TSS |
| Safety | Severe soft-tissue infection / necrotising fasciitis with shock - streptococcal |
| 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.