NAC OSCE History Taking 2

Question 1

A patient presents with shortness of breath. Which question BEST helps differentiate between cardiac and pulmonary causes?

Accepted Answer

Is the shortness of breath worse when lying flat (orthopnea) and do you wake up at night gasping for air (paroxysmal nocturnal dyspnea)?

Answer

Orthopnea (breathlessness when lying flat) and paroxysmal nocturnal dyspnea (PND — waking from sleep with breathlessness) are classic features of heart failure. While they can occur in severe lung disease, these symptoms specifically suggest fluid redistribution when supine, pointing to a cardiac cause. This distinction is critical for guiding further investigation.

Question 2

When interviewing a patient who is a poor historian, which technique is MOST effective?

Accepted Answer

Use open-ended questions initially, then focused closed questions, summarize frequently, and use collateral information from family or records

Answer

With poor historians, begin with open-ended questions to let them share what they can, then use focused questions to fill gaps. Summarize frequently to verify accuracy. Collateral information from family, caregivers, or medical records is invaluable. This structured approach maximizes information gathering while maintaining patient dignity.

Question 3

A patient mentions they have been feeling 'down.' Which screening questions are part of the PHQ-2 for depression?

Accepted Answer

Over the past 2 weeks, have you had little interest or pleasure in doing things? Have you been feeling down, depressed, or hopeless?

Answer

The PHQ-2 consists of two screening questions about the core symptoms of depression over the past 2 weeks: (1) loss of interest or pleasure (anhedonia) and (2) feeling down, depressed, or hopeless (low mood). A positive screen should prompt the full PHQ-9 assessment. These two questions have high sensitivity for major depressive disorder.

Question 4

When taking a sexual history in the NAC OSCE, which approach is considered BEST practice?

Accepted Answer

Normalize the questions, use non-judgemental language, ask about gender of partners, contraception, STI history, and ensure confidentiality

Answer

A sexual history is a routine part of a complete medical assessment. Best practice includes normalizing ('I ask all my patients these questions'), using non-judgemental inclusive language, asking about the gender of sexual partners, number of partners, contraception use, STI testing and history, and ensuring confidentiality. The NAC OSCE assesses comfort and competence in this area.

Question 5

A 65-year-old patient presents with confusion. Which elements of the history are MOST important to obtain from a collateral source?

Accepted Answer

The timeline of confusion onset (acute vs gradual), baseline cognitive function, recent medication changes, recent falls, and new symptoms such as fever or urinary symptoms

Answer

In acute confusion (delirium), collateral history is essential because the patient may be unable to provide reliable information. The most critical elements are: baseline cognition (is this new?), timeline (acute suggests delirium vs gradual suggests dementia), recent medication changes (common cause), recent infections, falls, and functional decline. This information guides the workup for reversible causes.

NAC OSCE Practice Test

NAC OSCE Practice Test

NAC OSCE History Taking 2