Lymphadenopathy and organomegaly: diagnostic approach — OSCE

Station brief (candidate)

• Explain that enlarged nodes are common after infection and usually reactive. [1] [2]
• Take focused history: duration, growth of lump, fever, night sweats, weight loss, bruising, animal scratches, TB risk, sore throat, fatigue. [1] [5]
• Outline examination priorities: all node stations, ENT/skin source, liver and spleen. [1]
• Agree observation versus investigation criteria and a review time. [4]
• If EBV/spleen cue appears, counsel activity restriction principles. [3]
• Use teach-back; avoid false reassurance and avoid catastrophic language.

Role-player notes

You are worried about cancer after reading online. You become more anxious if the doctor lists rare diseases first. You calm if they explain common reactive nodes, what they checked, and clear return precautions. If asked, your child plays contact sport and has been very tired. [1] [3]

Expected candidate performance

• Opens with plain-language explanation of lymph nodes.
• Screens red flags explicitly.
• Mentions mapping nodes and checking liver/spleen.
• Gives a timed plan (not “come back sometime”).
• Safety-nets enlarging mass, bruising, breathing difficulty, night sweats, weight loss.
• Handles sport/spleen cue safely if introduced. [1] [3] [4]

Examiner checklist

Mark against the counselling standard for reactive base rate, red-flag screen, organomegaly check, timed plan and teach-back. [1] [3] [4]

• Base rate of reactive disease stated without dismissing concern [1] [2]
• Red-flag screen complete
• Organomegaly considered
• Clear follow-up and ownership
• Shared decision language and teach-back