OSCE — Xanthoma and xanthelasma

Brief (to candidate)

You will assess a patient with a presentation consistent with Xanthoma and xanthelasma.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Xanthomas are cutaneous, tendinous, and subcutaneous deposits of lipid-laden macrophages (foam cells) that act as visible markers of disordered lipoprotein metabolism. Six clinical types are recognised, each mapping to a specific lipoprotein defect: xanthelasma palpebrarum (eyelid plaques, about half normolipidaemic), tendinous xanthoma (Achilles and extensor tendons, pathognomonic for familial hypercholesterolaemia), tuberous xanthoma (elbows and knees, hypercholesterolaemia), eruptive xanthoma (crops of yellow papules in severe hypertriglyceridaemia, with pancreatitis risk), plane xanthoma (palmar creases in type III dysbetalipoproteinaemia), and diffuse plane xanthomatosis (widespread, si

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).

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.^[2]