Derm Cases · Dermatology / Urology
OSCE — acquired phimosis and penile white plaques
OSCE: diagnose BXO, plan steroid ± circumcision, assess meatus, counsel on SCC surveillance and histology.
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Study tools
Target exams
NEET-PGINICETPLABMRCP
Prompt
OSCE: diagnose BXO, plan steroid ± circumcision, assess meatus, counsel on SCC surveillance and histology.
Brief (to candidate)
A 50-year-old uncircumcised man cannot fully retract the foreskin. White sclerotic glans/prepuce changes and meatal narrowing are described. Assess, diagnose, and outline medical/surgical management and counselling.
Candidate instructions
- Focused history including urinary stream and prior antifungals.
- State diagnosis and why circumcision status matters.
- Outline examination priorities (meatus, induration).
- Medical therapy choice.
- Surgical plan and histopathology.
- Safety-net for retention and cancer signs.
Examiner checklist
| Domain | Key actions expected |
|---|---|
| Diagnosis | BXO / male genital LS for adult-acquired phimosis + sclerosis[2] |
| Exam | Meatus, stream, induration, extragenital LS/LP clues |
| Medical | Ultra-potent topical steroid ointment when appropriate[4] |
| Surgical | Circumcision for refractory phimosis; send specimen |
| Risk | SCC field risk; biopsy non-healing lesions[1] |
| Communication | Not automatically an STI; follow-up plan |
Model key actions
- Name BXO/LS; stop endless antifungals as sole therapy.[2]
- Clobetasol pathway + urology for structural disease.[4]
- Counsel surveillance after treatment.[1]
Common errors
- Calling it only candida.
- Forcing retraction in tight phimosis.
- Circumcision without pathology request.
- Missing meatal stenosis.
References3ShowHide
- [2]Clouston D, et al. Penile lichen sclerosus (balanitis xerotica obliterans). BJU Int, 2011.PMID 22085120
- [4]Kirtschig G, et al. EuroGuiderm guideline on lichen sclerosus-Treatment of lichen sclerosus. JEADV, 2024.PMID 38822598
- [1]De Luca DA, et al. Lichen sclerosus 2023 update. Front Med, 2023.PMID 36873861