Adolescent PCOS OSCE — diagnostic reasoning, lifestyle counselling and management planning

Station objectives

1. Reason through adolescent PCOS diagnosis using Rotterdam criteria with developmental modification. [4] [2]
2. Explain why ultrasound alone does not establish the diagnosis in adolescents. [2] [1]
3. Deliver lifestyle-first counselling without weight-centric messaging that risks disordered eating. [5]
4. Integrate mental health screening into the PCOS management plan. [6]
5. Co-create a symptom-directed, follow-up-aware plan with transition planning. [3] [1]

Candidate brief

You are the paediatric doctor in adolescent clinic. You have 10 minutes for Station A (diagnostic reasoning with the family) and 12 minutes for Station B (private assessment and management planning). Examiners score diagnostic reasoning, communication, lifestyle counselling quality, and safety awareness. [1] [3]

Station A — Premature label and diagnostic reasoning

Setup: 16-year-old with her mother. A referral letter from the GP states "PCOS based on ultrasound." The mother asks whether her daughter needs fertility treatment. [2]

Expected actions:

• Acknowledge the concern without confirming the label prematurely. [2]
• Take a precise menstrual history: menarche age, cycle pattern, duration of irregularity. [2] [4]
• Explain that Rotterdam requires two of three criteria and that ultrasound alone is insufficient in adolescents. [4] [2]
• Outline the investigations needed: testosterone panels, TSH, prolactin, 17-OHP, metabolic screen. [3]
• Avoid alarming the family about fertility while being honest about the need for assessment. [1]

Station B — Private disclosure and management planning

Setup: Once alone, the adolescent discloses low mood, body image distress, and worry that she will "never be normal." She has gained 8 kg this year and has tried restrictive dieting. [6]

Expected actions:

• Assess mood and suicide risk in detail (ideation, plan, intent, protective factors). [6]
• Screen for disordered eating given the restrictive dieting history. [5]
• Deliver lifestyle counselling framed around health behaviours and function, not weight. [5]
• Explain the management plan: lifestyle first, COCP for menstrual regulation and endometrial protection, mental health pathway. [3] [5]
• Address metformin as a potential adjunct if metabolic dysfunction is confirmed on testing. [7]
• Agree a follow-up plan and what the adolescent wants shared with her mother. [1] [6]

Marking anchors

Clear pass: correct Rotterdam criteria with adolescent modification, explains why ultrasound alone is insufficient, lifestyle-first counselling without weight-centric language, same-visit mental health assessment and plan, shared follow-up with confidentiality awareness. [2] [4] [5] [6] Borderline: knows the criteria but cannot explain the adolescent modification, or delivers good diagnostic reasoning but neglects mental health screening. [1] Fail: confirms PCOS from the ultrasound alone without further assessment; prescribes metformin as first-line without lifestyle; ignores mood disclosure; or alarms the family about infertility without context. [2] [3] [6]

Debrief pearls

• The ultrasound report is a finding, not a diagnosis, in adolescents. [2]
• Lifestyle framing around weight loss can harm; frame around health behaviours instead. [5]
• Mental health screening is core management, not optional add-on. [6]
• Transition planning begins now, not at age 18. [1]