MBBS OSCE · General Surgery
OSCE — Urinary Tract Stones
Eight-minute OSCE station on Urinary Tract Stones: 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 Urinary Tract Stones.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Urinary tract stones (urolithiasis) are crystalline formations arising anywhere from the renal collecting system to the urethra when urine becomes supersaturated with stone-forming solutes. They present with renal colic — sudden, severe pain radiating from loin to groin that makes the patient writhe and roll (unlike the stillness of peritonitis). CT KUB is the gold standard (97% sensitive, sees all stone types). Calcium oxalate is the commonest (75%); uric acid stones are radiolucent and dissolvable; struvite stones form staghorn calculi with urease-producing infection. Stones under 5 mm pass spontaneously in 80%; over 10 mm need intervention (ESWL, ureteroscopy + laser, or PCNL). NSAIDs are
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 + rigors + obstructing stone - infected obstructed system; emergency decom |
| Safety | AKI with bilateral ureteric stones or a single functioning kidney - urgent urolo |
| Safety | Anuria in a renal transplant patient or single kidney - obstructing stone; emerg |
| 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.