OSCE — Umbilical and Epigastric Hernia

Brief (to candidate)

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

Clinical context

Umbilical hernias occur through the umbilical ring and are common in infants (95% close spontaneously by 5 years) and adults (associated with obesity, pregnancy, ascites). Epigastric hernias occur through the linea alba between the umbilicus and xiphisternum and always contain preperitoneal fat (often no peritoneal sac). Management: infantile — observe until age 4-5; adult — surgical repair (open or laparoscopic mesh). Richter's hernia (only anti-mesenteric border of bowel in sac) is a particular risk in small umbilical/epigastric hernias.

Candidate tasks

1. Clarify onset, severity, associated features, and red-flag symptoms.
2. State focused examination priorities.
3. List first-line investigations and any named score/criteria.
4. Give immediate resuscitation steps.
5. Outline definitive management with doses/routes where standard.
6. Name complications and disposition (ward / HDU / theatre / discharge safety-net).
7. Mention one special-population modifier (pregnancy, child, elderly, CKD).

Examiner checklist

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.