NAC OSCE Physical Examination 2 — Questions and Answers
Question 1: In a NAC OSCE thyroid examination station, which technique is used to auscultate for a thyroid bruit and what does it indicate?
- Use the bell of the stethoscope over the thyroid lobes; a bruit indicates increased vascularity, classically seen in Graves' disease (Correct answer)
- Use the diaphragm; a bruit indicates malignancy
- Auscultate over the carotid arteries and attribute any bruit to the thyroid
- A thyroid bruit is normal in all patients
Correct answer: Use the bell of the stethoscope over the thyroid lobes; a bruit indicates increased vascularity, classically seen in Graves' disease
A thyroid bruit detected with the bell of the stethoscope indicates hypervascular thyroid tissue, classically associated with Graves' disease due to TSH receptor stimulation.
Question 2: When performing a fundoscopic examination in a Canadian OSCE station, which finding is MOST associated with hypertensive emergency?
- Papilloedema (disc swelling with blurred margins) (Correct answer)
- Arteriovenous nicking alone
- Hard exudates without disc changes
- Dot haemorrhages only
Correct answer: Papilloedema (disc swelling with blurred margins)
Papilloedema on fundoscopy indicates raised intracranial pressure from hypertensive emergency and requires immediate blood pressure management per Canadian Hypertension Education Program (CHEP) guidelines.
Question 3: During a musculoskeletal examination, the Lachman test is performed and found to be positive. What does this indicate?
- Anterior cruciate ligament (ACL) injury (Correct answer)
- Posterior cruciate ligament (PCL) injury
- Medial collateral ligament (MCL) injury
- Meniscal tear
Correct answer: Anterior cruciate ligament (ACL) injury
The Lachman test (anterior tibial displacement on a flexed knee) is the most sensitive bedside test for ACL rupture, with sensitivity >80%, and is a key OSCE manoeuvre.
Question 4: A 4-year-old child is brought in with a limp. On examination, the hip is held in flexion, abduction, and external rotation. What is the MOST likely diagnosis?
- Septic arthritis of the hip (Correct answer)
- Transient synovitis
- Developmental dysplasia of the hip
- Legg-Calvé-Perthes disease
Correct answer: Septic arthritis of the hip
Septic arthritis presents with the hip held in the position of maximum capsular volume (flexion, abduction, external rotation) and is a surgical emergency; fever and elevated inflammatory markers distinguish it from transient synovitis.
Question 5: During a breast examination in a Canadian NAC OSCE station, which feature of a palpable mass is MOST associated with malignancy?
- Hard, irregular, non-tender, fixed mass with skin dimpling (Correct answer)
- Soft, mobile, tender, smooth-bordered mass
- Bilateral tender nodularity worse premenstrually
- A fluctuant mass with overlying erythema
Correct answer: Hard, irregular, non-tender, fixed mass with skin dimpling
Malignant breast masses are typically hard, irregular, non-tender, and fixed to surrounding tissue, with skin dimpling (peau d'orange) from Cooper's ligament involvement.
Question 6: In a NAC OSCE station assessing cranial nerves, which test assesses the function of cranial nerve V (trigeminal)?
- Corneal reflex (afferent V1) and facial sensation in three divisions (Correct answer)
- Pupillary light reflex
- Gag reflex alone
- Hearing with the Weber and Rinne tests
Correct answer: Corneal reflex (afferent V1) and facial sensation in three divisions
CN V is assessed by testing facial sensation in the ophthalmic, maxillary, and mandibular divisions and by the corneal reflex (afferent limb via V1); motor function is tested by jaw clenching.
NAC OSCE Physical Examination 2
In a NAC OSCE thyroid examination station, which technique is used to auscultate for a thyroid bruit and what does it indicate?