NAC OSCE Physical Examination

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?

Accepted Answer

Mitral valve prolapse

Answer

Aortic stenosis

Answer

Ventricular septal defect

Answer

Mitral regurgitation

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?

Accepted Answer

Elevated jugular venous pressure (JVP) above the sternal angle with the patient at 45°

Answer

Bilateral pitting oedema to the knees

Answer

Hepatomegaly on palpation

Answer

S3 gallop on auscultation

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?

Accepted Answer

Pleural effusion

Answer

Pneumothorax

Answer

Consolidation

Answer

Pleural thickening

Question 4

In a NAC OSCE abdominal examination station, which manoeuvre is used to distinguish a spleen from other left upper quadrant masses?

Accepted Answer

The spleen moves towards the right iliac fossa on inspiration and has a notched medial border

Answer

The mass is ballotable bimanually

Answer

It is palpable in both flank and midline

Answer

It resonates on percussion

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?

Accepted Answer

Homans' sign — however, it has low sensitivity (~50%) and is no longer recommended as reliable

Answer

Homan's sign — high sensitivity (>90%), confirms DVT

Answer

Thompson's test — tests for Achilles tendon rupture

Answer

McMurray's test — assesses for meniscal pathology

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?

Accepted Answer

Forehead sparing on the side of facial weakness

Answer

Complete unilateral facial paralysis including the forehead

Answer

Loss of taste on the anterior two-thirds of the tongue

Answer

Hyperacusis on the affected side