NAC OSCE History Taking — Questions and Answers
Question 1: A 45-year-old patient presents with chest pain. Which of the following questions is MOST important to ask first?
- Have you had any recent surgery?
- Can you describe the pain — its location, character, onset, duration, and what makes it better or worse? (Correct answer)
- Do you have a family history of heart disease?
- Are you currently taking any medications?
Correct answer: Can you describe the pain — its location, character, onset, duration, and what makes it better or worse?
Characterizing the chest pain using OPQRST (Onset, Provocation, Quality, Radiation, Severity, Time) is the most important initial step. This helps differentiate between cardiac, pulmonary, musculoskeletal, and gastrointestinal causes. While family history and medications are relevant, understanding the pain characteristics guides the immediate differential diagnosis.
Question 2: When taking a history from a patient with abdominal pain, which associated symptom is MOST suggestive of a surgical emergency?
- Bloating after meals
- Rigid abdomen with rebound tenderness and fever (Correct answer)
- Occasional heartburn
- Mild constipation for the past week
Correct answer: Rigid abdomen with rebound tenderness and fever
A rigid abdomen with rebound tenderness and fever suggests peritonitis, which may indicate a perforated viscus, appendicitis, or other surgical emergency. These findings indicate peritoneal irritation and require urgent surgical consultation. The other symptoms, while relevant, suggest less acute conditions.
Question 3: A patient reports a 3-month history of unintentional weight loss. Which set of additional questions is MOST appropriate for the review of systems?
- Questions about diet preferences and exercise routine only
- Questions about appetite changes, night sweats, fever, fatigue, bowel habit changes, and any lumps or masses (Correct answer)
- Questions about recent travel only
- Questions about stress at work only
Correct answer: Questions about appetite changes, night sweats, fever, fatigue, bowel habit changes, and any lumps or masses
Unintentional weight loss requires a broad systematic review because it can indicate malignancy, chronic infection (e.g., tuberculosis), endocrine disorders (e.g., hyperthyroidism, diabetes), or gastrointestinal disease. Asking about constitutional symptoms (night sweats, fever, fatigue) and organ-specific symptoms helps narrow the differential diagnosis.
Question 4: When taking a medication history, which of the following is MOST important to document in addition to prescribed medications?
- The colour of each medication
- Over-the-counter medications, herbal supplements, vitamins, and any recreational drug use (Correct answer)
- The pharmacy where prescriptions are filled
- Whether the patient prefers brand-name or generic medications
Correct answer: Over-the-counter medications, herbal supplements, vitamins, and any recreational drug use
A complete medication history must include over-the-counter medications (which can interact with prescribed drugs), herbal supplements (e.g., St. John's wort affects many medications), vitamins, and recreational drug use. These are frequently overlooked but can cause significant drug interactions and affect the clinical picture.
Question 5: A 28-year-old woman presents with headache. Which element of the social history is MOST relevant to explore?
- Her favourite hobbies
- Use of oral contraceptives, caffeine intake, stress levels, sleep patterns, and occupational exposures (Correct answer)
- Her pet ownership
- Her favourite foods
Correct answer: Use of oral contraceptives, caffeine intake, stress levels, sleep patterns, and occupational exposures
For headache in a young woman, oral contraceptive use is relevant (associated with migraine with aura and cerebral venous thrombosis), caffeine intake (excess or withdrawal causes headache), stress and sleep patterns (common triggers), and occupational exposures (screen time, ergonomics). The social history often reveals modifiable triggers.
Question 6: When obtaining a family history, which pattern of disease is MOST suggestive of a hereditary condition requiring further investigation?
- One grandparent with type 2 diabetes diagnosed at age 80
- Multiple first-degree relatives with the same type of cancer diagnosed before age 50 (Correct answer)
- A distant cousin with asthma
- An uncle with a sports injury
Correct answer: Multiple first-degree relatives with the same type of cancer diagnosed before age 50
Multiple first-degree relatives with the same cancer type diagnosed at a young age strongly suggests a hereditary cancer syndrome (e.g., Lynch syndrome, BRCA mutations). This pattern warrants genetic counselling and potentially genetic testing. The key red flags are: multiple affected relatives, young age at diagnosis, and the same or related cancers.
NAC OSCE History Taking
A 45-year-old patient presents with chest pain.
Which of the following questions is MOST important to ask first?