OSCE — Transient neonatal pustular melanosis (TNPM)

Brief (to candidate)

You will assess a patient with a presentation consistent with Transient neonatal pustular melanosis (TNPM).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Transient neonatal pustular melanosis (TNPM) is a benign, self-limiting, vesiculopustular dermatosis of the newborn that is PRESENT AT BIRTH. It predominantly affects Black infants (4 to 5 percent) and is rare in Caucasian infants (0.1 to 0.6 percent). Each lesion evolves through three morphological stages — a superficial vesiculopustule, rupture leaving a collarette of scale, and a residual hyperpigmented macule — over days to weeks. Distribution includes the trunk, proximal limbs, face, neck and crucially the PALMS AND SOLES (which distinguishes it from erythema toxicum). The baby is otherwise entirely well. Wright stain of pustule contents shows NEUTROPHILS with no organisms. No treatment

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. Name complications and disposition (ward / HDU / theatre / discharge safety-net).
9. 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]