MBBS OSCE · General Medicine
OSCE — Waldenström Macroglobulinaemia, MGUS & Hyperviscosity Syndrome
Eight-minute OSCE station on Waldenström Macroglobulinaemia, MGUS & Hyperviscosity 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 Waldenström Macroglobulinaemia, MGUS & Hyperviscosity Syndrome.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic clonal plasma-cell or B-cell disorder defined by a serum monoclonal protein (M-protein) under 30 g/L, bone-marrow plasma cells under 10 percent, and absence of end-organ damage (CRAB); it is common in older adults (over 3 percent of those over 50) and carries a roughly 1 percent per year lifelong progression risk, so requires lifelong monitoring. Waldenstrom macroglobulinaemia is an indolent B-cell lymphoma (lymphoplasmacytic lymphoma) of post-germinal-centre B cells driven in over 90 percent of cases by the MYD88 L265P mutation, secreting a monoclonal IgM paraprotein. Its signature emergency is hyperviscosity syndr
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 | Raised serum viscosity with mucosal bleeding, visual disturbance and neurologica |
| Safety | Fundoscopy showing sausage-string retinal veins, haemorrhages and papilloedema — |
| Safety | IgM paraprotein over 30 g/L with symptoms — Waldenstrom macroglobulinaemia; bone |
| 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.