OSCE — Dyslipidaemia

Brief (to candidate)

You will assess a patient with a presentation consistent with Dyslipidaemia.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags. ^[15]

Clinical context

Dyslipidaemia is an abnormality of circulating lipids or lipoproteins. LDL-C is the primary atherogenic particle. Clinical ASCVD: maximally tolerated statin to cut LDL-C by at least 50 percent (2018 AHA/ACC); European post-ACS goals LDL-C under 1.4 mmol/L (under 1.0 mmol/L after a second event within 2 years). Add ezetimibe then a PCSK9 inhibitor while LDL-C is 70 mg/dL (1.8 mmol/L) or above in very-high-risk ASCVD. Triglycerides greater than 10 mmol/L confer pancreatitis risk. ^[15][32]

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). ^[15]

Examiner checklist

^{[15] [32] [35] [19]}

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. ^[15]

References14ShowHide

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2. [10]Sabatine MS, Giugliano RP, Keech AC, et al. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease N Engl J Med, 2017.PMID 28304224
3. [12]Bhatt DL, Steg PG, Miller M, et al. Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia N Engl J Med, 2019.PMID 30415628
4. [15]Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC Guideline on the Management of Blood Cholesterol Circulation, 2019.PMID 30586774
5. [16]Nissen SE, Lincoff AM, Brennan D, et al. Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients N Engl J Med, 2023.PMID 36876740
6. [27]Nordestgaard BG, Chapman MJ, Ray K, et al. Lipoprotein(a) as a cardiovascular risk factor: current status Eur Heart J, 2010.PMID 20965889
7. [32]Landmesser U, McGinniss J, Steg PG, et al. Achievement of ESC/EAS LDL-C treatment goals after an acute coronary syndrome with statin and alirocumab Eur J Prev Cardiol, 2022.PMID 35708715
8. [34]Krishnamurthy A, Bradley C, Ascunce R, et al. SAMSON and the Nocebo Effect: Management of Statin Intolerance Curr Cardiol Rep, 2022.PMID 35759168
9. [35]Dalugama C, Pathirage M, Kularatne SAM Delayed presentation of severe rhabdomyolysis leading to acute kidney injury following atorvastatin-gemfibrozil combination therapy: a case report J Med Case Rep, 2018.PMID 29784023
10. [38]National Institute for Health and Care Excellence Cardiovascular disease: risk assessment and reduction, including lipid modification NICE NG238, 2023.Source
11. [13]Baigent C, Landray MJ, Reith C, et al. The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial Lancet, 2011.PMID 21663949
12. [17]Ray KK, Wright RS, Kallend D, et al. Two Phase 3 Trials of Inclisiran in Patients with Elevated LDL Cholesterol N Engl J Med, 2020.PMID 32187462
13. [19]Nordestgaard BG, Chapman MJ, Humphries SE, et al. Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population Eur Heart J, 2013.PMID 23956253
14. [37]Patel AM, Shariff S, Bailey DG, et al. Statin toxicity from macrolide antibiotic coprescription: a population-based cohort study Ann Intern Med, 2013.PMID 23778904