NAC OSCE Physical Examination — Questions and Answers
Question 1: During a cardiovascular examination in a NAC OSCE station, auscultation reveals a mid-systolic click followed by a late systolic murmur at the apex. What is the MOST likely diagnosis?
- Mitral valve prolapse (Correct answer)
- Aortic stenosis
- Ventricular septal defect
- Mitral regurgitation
Correct answer: Mitral valve prolapse
A mid-systolic click followed by a late systolic murmur at the apex is the classic auscultatory finding of mitral valve prolapse, an important diagnosis in the MCCQE objectives.
Question 2: When examining a patient with suspected right heart failure, which physical finding is MOST specific for elevated central venous pressure in Canadian clinical practice?
- Elevated jugular venous pressure (JVP) above the sternal angle with the patient at 45° (Correct answer)
- Bilateral pitting oedema to the knees
- Hepatomegaly on palpation
- S3 gallop on auscultation
Correct answer: Elevated jugular venous pressure (JVP) above the sternal angle with the patient at 45°
JVP measured above the sternal angle at 45° is the standard Canadian method taught for estimating CVP; it is more specific for right heart failure than peripheral oedema.
Question 3: During a respiratory examination, you find dullness to percussion, reduced breath sounds, and absent tactile fremitus over the right lower zone. What is the MOST likely cause?
- Pleural effusion (Correct answer)
- Pneumothorax
- Consolidation
- Pleural thickening
Correct answer: Pleural effusion
Pleural effusion classically produces dullness to percussion, reduced breath sounds, and absent tactile fremitus; consolidation would preserve or increase fremitus and produce bronchial breath sounds.
Question 4: In a NAC OSCE abdominal examination station, which manoeuvre is used to distinguish a spleen from other left upper quadrant masses?
- The spleen moves towards the right iliac fossa on inspiration and has a notched medial border (Correct answer)
- The mass is ballotable bimanually
- It is palpable in both flank and midline
- It resonates on percussion
Correct answer: The spleen moves towards the right iliac fossa on inspiration and has a notched medial border
The spleen characteristically moves diagonally toward the right iliac fossa on inspiration and has a palpable medial notch, distinguishing it from renal or colonic masses.
Question 5: A 65-year-old male has asymmetric leg swelling and calf tenderness. Which bedside test is used to assess for deep vein thrombosis, and what is its sensitivity?
- Homans' sign — however, it has low sensitivity (~50%) and is no longer recommended as reliable (Correct answer)
- Homan's sign — high sensitivity (>90%), confirms DVT
- Thompson's test — tests for Achilles tendon rupture
- McMurray's test — assesses for meniscal pathology
Correct answer: Homans' sign — however, it has low sensitivity (~50%) and is no longer recommended as reliable
Homans' sign (pain on dorsiflexion) is historically taught but has poor sensitivity (~50%) and specificity; Canadian guidelines recommend clinical scoring (Wells score) combined with D-dimer or imaging instead.
Question 6: During a neurological examination, you test cranial nerve VII. Which finding would indicate an upper motor neuron (UMN) lesion rather than a lower motor neuron (LMN) lesion?
- Forehead sparing on the side of facial weakness (Correct answer)
- Complete unilateral facial paralysis including the forehead
- Loss of taste on the anterior two-thirds of the tongue
- Hyperacusis on the affected side
Correct answer: Forehead sparing on the side of facial weakness
UMN lesions spare the forehead due to bilateral cortical representation of the frontalis muscle, whereas LMN lesions (e.g., Bell's palsy) cause complete unilateral facial weakness including the forehead.
NAC OSCE Physical Examination
During a cardiovascular examination in a NAC OSCE station, auscultation reveals a mid-systolic click followed by a late systolic murmur at the apex.
What is the MOST likely diagnosis?