OSCE — vulval itch with white plaques and scarring

Brief (to candidate)

A 60-year-old woman has severe vulval itch for years treated as thrush. Exam card shows ivory-white atrophic plaques with purpura and labial resorption. You have 8 minutes to diagnose, explain, treat, and safety-net.

Candidate instructions

1. Take a focused history (itch vs pain, products, sexual function, prior treatments).
2. Interpret the examination findings.
3. State the most likely diagnosis and two differentials.
4. Prescribe first-line therapy with drug, vehicle, and schedule.
5. Explain surveillance and red flags for biopsy.
6. Give clear follow-up advice.

Examiner checklist (mark each domain / 10)

Model key actions

• Name genital LS from morphology.^[2]
• Stop unconfirmed thrush cycles; examine properly.^[1]
• Prescribe clobetasol 0.05% ointment correctly, not mild hydrocortisone alone.^[3]
• Teach red-flag biopsy symptoms.

Common errors

• Another empirical antifungal course only.
• Mild steroid under-treatment of genital LS.
• Forgetting SCC surveillance.
• Missing architectural scarring significance.