NAC OSCE Clinical Reasoning & Diagnosis 2

Question 1

A 68-year-old woman with atrial fibrillation presents with acute onset left-sided weakness and facial droop of 90 minutes' duration. Her CT head is normal. What is the MOST appropriate immediate management?

Accepted Answer

IV alteplase (tPA) if no contraindications, with consideration of thrombectomy if large vessel occlusion is confirmed

Answer

Heart and Stroke Foundation of Canada and Canadian Stroke Best Practices recommend IV tPA within 4.5 hours of symptom onset if there are no contraindications; CT angiography to identify LVO guides thrombectomy decision.

Question 2

A 50-year-old male with type 2 diabetes has a fasting glucose of 7.4 mmol/L and HbA1c of 6.8% on two separate occasions. According to Diabetes Canada guidelines, what is the diagnosis?

Accepted Answer

Type 2 diabetes mellitus (FPG ≥7.0 mmol/L or HbA1c ≥6.5% on two occasions)

Answer

Diabetes Canada 2023 guidelines define diabetes as FPG ≥7.0 mmol/L or HbA1c ≥6.5% on two separate occasions in asymptomatic individuals, both criteria met here.

Question 3

A 3-year-old child presents with a barking cough, stridor at rest, and subcostal retractions. Which clinical scoring system is used to assess severity in Canadian paediatric emergency departments?

Accepted Answer

Westley Croup Score

Answer

The Westley Croup Score assesses stridor, retractions, air entry, cyanosis, and level of consciousness to grade croup severity and guide dexamethasone dosing, as used in Canadian paediatric centres.

Question 4

A 22-year-old male university student presents with fever, neck stiffness, and a petechial rash. What is the MOST critical immediate action?

Accepted Answer

Administer IV ceftriaxone immediately without waiting for lumbar puncture results

Answer

Bacterial meningitis with purpuric or petechial rash (suggesting meningococcaemia) is a time-critical emergency; Canadian guidelines recommend immediate antibiotics (ceftriaxone) without delay for LP, as a 1-hour delay worsens mortality.

Question 5

A 55-year-old woman with rheumatoid arthritis on methotrexate presents with a new dry cough and dyspnoea. CXR shows bilateral interstitial infiltrates. What is the MOST important diagnosis to exclude?

Accepted Answer

Methotrexate-induced pneumonitis

Answer

Methotrexate pneumonitis is an idiosyncratic drug reaction causing interstitial lung disease; methotrexate must be stopped and the diagnosis confirmed with HRCT and possibly BAL, as continued use can be fatal.

NAC OSCE Practice Test

NAC OSCE Practice Test

NAC OSCE Clinical Reasoning & Diagnosis 2