MRCEM CDU OSCE 

  These cases mirror real CDU reviews you might encounter in the MRCEM OSCE. They test your ability to make safe and justified admission or discharge decisions, communicate clearly, and apply sound clinical judgement.

Case 1 – Back Pain 

Scenario

A 35-year-old male presented earlier with lower back pain and some numbness around the groin area. He had urinary hesitancy but no incontinence. An MRI spine has been completed and shows no acute findings. You are reviewing him in the Clinical Decision Unit (CDU).

Case 2 – Shortness of Breath and Wheeze

Scenario

A 22-year-old woman was admitted overnight with shortness of breath and wheeze. She was treated with nebulisers and oral medication. This morning, she feels well, is speaking in complete sentences, and her peak flow is 95% of predicted. You are asked to review and decide the next step.

Case 3 – Palpitations

Scenario

A 70-year-old man presented earlier with palpitations that started yesterday afternoon. He denies chest pain or shortness of breath. ECG shows an irregularly irregular rhythm with a rate of 110 bpm. Blood pressure is stable, and there are no signs of heart failure. He has no known cardiac history.

 

 

Case 4 – Fever and Cough

Scenario

A 75-year-old woman was admitted earlier today with fever, cough, and shortness of breath. She has received 12 hours of IV antibiotics and fluids. She reports feeling slightly better but still has a temperature of 38.2°C and a respiratory rate of 25/min. Her blood pressure and oxygen saturations remain stable.

 

 

Case 5 – Confusion and Low Sodium

Scenario

A 55-year-old woman presented with mild confusion and lethargy. Her initial blood tests showed sodium 118 mmol/L. She was given slow IV fluids, and repeat sodium is now 121 mmol/L. She feels slightly improved but remains drowsy.

 

Exam Focus

Each of these CDU cases tests key MRCEM OSCE competencies:

• • Safe decision-making: admit vs discharge

• • Focused reassessment: Are they truly stable?

• • Communication skills: explaining results, providing reassurance, safety-netting

• • Clinical reasoning: applying guidelines and recognising red flags

  The correct answer isn’t just “admit” or “discharge” — it’s about demonstrating safety, logic, and patient understanding. Always reassess, explain, and plan  

What Examiners Expect from Candidates

Case 1: Back Pain 

Diagnosis: Mechanical or radicular back pain (no cauda equina  Discharge from CDU with safety-net and GP follow-up

What Examiners Expect

• • Reassess red flag symptoms (urinary retention, saddle anaesthesia, leg weakness).

• • Explain MRI findings clearly — no compression or emergency findings.

• • Reassure patient but emphasise the importance of returning if symptoms worsen.

• • Provide analgesia advice and recommend early mobilisation and physio.

• • Document assessment, explanation, and safety-net advice comprehensively.

Core Skills Tested: Safe discharge | Communication | Documentation

Case 2 – Asthma Exacerbation (Now Resolved)

Diagnosis: Resolved acute asthma attack Disposition: Discharge home with education and follow-up

What Examiners Expect

• • Confirm full recovery: PEF >75% predicted, no wheeze, normal observations.

• • Prescribe oral steroids (e.g., prednisolone 40 mg for 5 days).

• • Check and correct inhaler technique.

• • Provide a written asthma action plan.

• • Arrange GP/asthma nurse follow-up within 48 hours.

• • Give clear safety-net advice for recurrence.

• • Record all advice and follow-up arrangements.

Core Skills Tested: Patient education | Safe discharge | Continuity of care

Case 3 – New Atrial Fibrillation

Diagnosis: New onset atrial fibrillation, uncertain duration Disposition: Admit under the medical/cardiology team

What Examiners Expect

• • Review ECG and confirm AF (irregularly irregular rhythm, no P waves).

• • Clarify onset/duration and exclude reversible causes (thyroid, sepsis, ACS).

• • Control rate (e.g., bisoprolol or diltiazem if appropriate).

• • Calculate CHA₂DS₂-VASc and HAS-BLED scores.

• • Discuss with the senior medical team regarding anticoagulation and echocardiogram.

• • Explain to the patient why admission is necessary (monitoring and stroke risk).

• • Document ECG findings, risk scores, and management plan clearly.

Core Skills Tested: Clinical reasoning | Escalation | Communication

Case 4 – Community-Acquired Pneumonia

Diagnosis: CAP with partial response to initial IV antibiotics Disposition: Admit for continued inpatient management

What Examiners Expect

• • Review progress: still febrile and tachypneic → not ready for discharge.

• • Continue IV antibiotics and reassess in 12–24 hours.

• • Ensure oxygen therapy, fluids, and regular observations.

• • Review cultures and consider escalation if no improvement.

• • Communicate clearly that ongoing hospital care is required.

• • Document progress, plan, and review schedule.

Core Skills Tested: Clinical judgement | Safe admission | Communication

Case 5 – Hyponatraemia

Diagnosis: Symptomatic hyponatraemia (Na⁺ 121 mmol/L, partial correction) Disposition:Admit under medical/renal team for controlled correction and monitoring

What Examiners Expect

• • Review symptoms and the trend of sodium correction.

• • Avoid rapid correction (>8–10 mmol/L/24h).

• • Investigate underlying cause (SIADH, medications, hypothyroidism, etc.).

• • Discuss with the senior/medical team for ongoing management.

• • Explain to the patient why hospital monitoring is required.

• • Document findings, correction plan, and referral details.

Core Skills Tested: Clinical safety | Fluid/electrolyte management | Documentation