MBBS OSCE · General Medicine
OSCE — Variceal Haemorrhage
Eight-minute OSCE station on Variceal Haemorrhage: 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 Variceal Haemorrhage.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Variceal haemorrhage is massive upper gastrointestinal bleeding from ruptured oesophageal or gastric varices — dilated submucosal portosystemic collaterals that form when portal venous pressure rises. It is defined by a hepatic venous pressure gradient (HVPG) over 12 mmHg, and almost always occurs in cirrhosis. Each bleed carries 15 to 25 percent 6-week mortality. Acute management follows a four-step bundle: resuscitation with a restrictive transfusion strategy (Hb target 70 to 80), vasoactive drug (terlipressin or octreotide) plus prophylactic ceftriaxone (both proven to reduce mortality), urgent endoscopy within 12 hours for band ligation (or cyanoacrylate for gastric varices), and rescue
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 | Massive haematemesis or melaena in a patient with cirrhosis or stigmata of chron |
| Safety | Shock with tachycardia and low Hb at presentation — severe bleed; resuscitate bu |
| Safety | Child-Pugh C (7 to 13) or Child-Pugh B with active bleeding at endoscopy — high- |
| 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.