NAC OSCE History Taking

Question 1

A 45-year-old patient presents with chest pain. Which of the following questions is MOST important to ask first?

Accepted Answer

Can you describe the pain — its location, character, onset, duration, and what makes it better or worse?

Answer

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?

Accepted Answer

Rigid abdomen with rebound tenderness and fever

Answer

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?

Accepted Answer

Questions about appetite changes, night sweats, fever, fatigue, bowel habit changes, and any lumps or masses

Answer

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?

Accepted Answer

Over-the-counter medications, herbal supplements, vitamins, and any recreational drug use

Answer

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?

Accepted Answer

Use of oral contraceptives, caffeine intake, stress levels, sleep patterns, and occupational exposures

Answer

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.

NAC OSCE Practice Test

NAC OSCE Practice Test

NAC OSCE History Taking