MBBS OSCE · cardiology
OSCE — Pericardial Disease
Eight-minute OSCE station on Pericardial Disease: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Pericardial Disease. [1] You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Pericardial disease spans three overlapping syndromes: acute pericarditis (inflammation of the pericardium with pleuritic chest pain, pericardial rub and diffuse ST elevation with PR depression), pericardial effusion with cardiac tamponade (fluid under pressure impairing diastolic filling; Beck triad, pulsus paradoxus), and constrictive pericarditis (chronic thickening producing Kussmaul sign and a pericardial knock). Commonest cause is idiopathic/viral; in India TB pericarditis is a major differential. Diagnose clinically plus ECG; echocardiography is the key imaging. Treat acute pericarditis with NSAIDs (ibuprofen 600 to 800 mg TID) plus colchicine 0.5 mg BD for 3 months; corticosteroids are reserved for specific indications (autoimmune, uraemic, pregnancy, refractory disease) and are never first-line.[1][2]
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Clarify onset, severity, associated features, and red-flag symptoms. [2]
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State focused examination priorities.
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List first-line investigations and any named score/criteria.
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Give immediate resuscitation steps.
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Outline definitive management with doses/routes where standard.
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Name complications and disposition (ward / HDU / theatre / discharge safety-net).
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Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Pleuritic chest pain worse on lying back, relieved sitting forward, with diffuse |
| Safety | Hypotension, raised JVP and muffled heart sounds (Beck triad) with pulsus parado |
| Safety | Raised JVP that RISES on inspiration (Kussmaul sign) with a pericardial knock an |
| Communication | Clear plan and safety-netting |
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][2]
References2ShowHide
- [1]Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases Eur Heart J, 2015.PMID 26320112
- [2]Cremer PC, Klein AL, Imazio M Diagnosis, Risk Stratification, and Treatment of Pericarditis: A Review JAMA, 2024.PMID 39235771