OSCE — Syphilis (cutaneous manifestations)

Brief (to candidate)

You will assess a patient with a presentation consistent with Syphilis (cutaneous manifestations).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Syphilis is a chronic systemic sexually transmitted infection caused by Treponema pallidum subsp. pallidum (a spirochaete), characterised by distinct clinical stages: primary (painless chancre with clean base and regional lymphadenopathy), secondary (polymorphic rash on palms and soles, condylomata lata, mucous patches, moth-eaten alopecia, generalised lymphadenopathy), latent (asymptomatic with positive serology), and tertiary (gummas, cardiovascular and neurosyphilis). Cutaneous manifestations are the hallmark of secondary and tertiary disease and earned syphilis the epithet 'the great imitator'. Serology: non-treponemal tests (RPR/VDRL) for screening and treatment monitoring; treponemal t

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).
8. Give immediate resuscitation steps.
9. Outline definitive management with doses/routes where standard.
10. Name complications and disposition (ward / HDU / theatre / discharge safety-net).
11. 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.^[1]