MBBS OSCE · General Medicine
OSCE — Typhoid & Enteric Fever (Salmonella Typhi)
Eight-minute OSCE station on Typhoid & Enteric Fever (Salmonella Typhi): 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 Typhoid & Enteric Fever (Salmonella Typhi).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Enteric (typhoid) fever is a prolonged systemic bacteraemic illness caused by Salmonella enterica serovars Typhi and Paratyphi A, B, C, transmitted faecal-orally through contaminated food and water. It is endemic in South Asia (India, Pakistan, Bangladesh), sub-Saharan Africa and parts of SE Asia, with an incubation of 7 to 14 days. The clinical signature is a step-ladder (stepwise-rising) fever with relative bradycardia (Faget sign), dull headache, constipation then 'pea-soup' diarrhoea, rose spots, splenomegaly and a coated tongue. Untreated it progresses over weeks to intestinal perforation and haemorrhage (Peyer's patch necrosis, week 3 to 4), severe typhoid with encephalopathy, myocar
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 | Step-ladder fever with relative bradycardia, rose spots and splenomegaly in a tr |
| Safety | Typhoid with sudden severe abdominal pain, rigid abdomen or melaena in week 3 to |
| Safety | Severe typhoid with delirium, obtundation or shock - severe typhoid; add dexamet |
| 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.