NAC OSCE Exam — Questions and Answers

Question 1: When explaining a complex medical condition to a patient with limited health literacy, which communication technique is MOST effective?

Speak louder and more slowly
Use plain language, the 'teach-back' method (asking the patient to explain what they understood), visual aids, and limit information to 2-3 key points per visit (Correct answer)
Give the patient a medical textbook to read
Use medical terminology to be precise

Correct answer: Use plain language, the 'teach-back' method (asking the patient to explain what they understood), visual aids, and limit information to 2-3 key points per visit

Effective communication with patients who have limited health literacy requires plain language (avoiding or explaining medical jargon), the teach-back method (confirming understanding by asking patients to repeat the information in their own words), visual aids, and limiting key messages. Studies show that patients retain only 40-80% of medical information, and nearly half of what is recalled is incorrect.

Question 2: A 60-year-old man with COPD has an ABG on room air: pH 7.38, pCO2 52 mmHg, pO2 56 mmHg, HCO3 30 mEq/L, SaO2 87%. What is the most appropriate oxygen saturation target when initiating supplemental oxygen?

SaO2 94–98%
SaO2 ≥98%
No supplemental oxygen is needed
SaO2 88–92% (Correct answer)

Correct answer: SaO2 88–92%

In COPD patients with chronic hypercapnia, the target SaO2 is 88–92% to maintain adequate oxygenation without suppressing the hypoxic respiratory drive and worsening CO2 retention.

Question 3: In a NAC OSCE station assessing cranial nerves, which test assesses the function of cranial nerve V (trigeminal)?

Pupillary light reflex
Corneal reflex (afferent V1) and facial sensation in three divisions (Correct answer)
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.

Question 4: In a NAC OSCE abdominal examination station, which manoeuvre is used to distinguish a spleen from other left upper quadrant masses?

The mass is ballotable bimanually
It is palpable in both flank and midline
It resonates on percussion
The spleen moves towards the right iliac fossa on inspiration and has a notched medial border (Correct answer)

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: What is the 'Calgary-Cambridge model' and why is it relevant to the NAC OSCE?

A model for calculating medical school admissions scores
A model for surgical technique assessment
A model for hospital administration
A widely-used framework for structuring medical interviews that integrates clinical reasoning with effective communication, covering initiating the session, gathering information, physical examination, explanation/planning, and closing (Correct answer)

Correct answer: A widely-used framework for structuring medical interviews that integrates clinical reasoning with effective communication, covering initiating the session, gathering information, physical examination, explanation/planning, and closing

The Calgary-Cambridge model provides a comprehensive framework for the medical interview, widely taught in Canadian medical schools. It structures the encounter into five key tasks while emphasizing that relationship-building and communication skills run throughout. The NAC OSCE explicitly tests many of these skills, making familiarity with this model essential for exam preparation.

Question 6: A patient with known type 2 diabetes presents with confusion, rapid breathing, and fruity breath odour. Blood glucose is 28 mmol/L. What is the MOST likely diagnosis?

Diabetic ketoacidosis (DKA) — characterized by hyperglycemia, metabolic acidosis, and ketonemia/ketonuria (Correct answer)
Hypoglycemia
Alcohol intoxication
Hyperglycemic hyperosmolar state (HHS)

Correct answer: Diabetic ketoacidosis (DKA) — characterized by hyperglycemia, metabolic acidosis, and ketonemia/ketonuria

The triad of hyperglycemia (28 mmol/L), Kussmaul breathing (deep rapid breathing — respiratory compensation for metabolic acidosis), and fruity breath (acetone from ketone production) is classic for DKA. While more common in type 1 diabetes, DKA can occur in type 2 diabetes. Treatment priorities are IV fluids, insulin infusion, and electrolyte replacement (especially potassium).

Question 7: 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 8: In a diabetic patient presenting with fever, flank pain, and costovertebral angle tenderness, what complication must be urgently ruled out?

Simple cystitis treated with oral antibiotics
Diabetic nephropathy exacerbation
Renal calculus requiring urology referral only
Emphysematous pyelonephritis requiring urgent CT and possibly nephrectomy (Correct answer)

Correct answer: Emphysematous pyelonephritis requiring urgent CT and possibly nephrectomy

Emphysematous pyelonephritis is a life-threatening gas-forming infection of the renal parenchyma occurring predominantly in diabetics; CT abdomen is required urgently, and management may include percutaneous drainage or nephrectomy.

Question 9: A 28-year-old Indigenous woman presents for antenatal care. Which culturally safe practice is MOST important to incorporate at this first visit according to Canadian guidelines?

Ask about traditional practices and preferences without assumptions, and involve family or community supports if desired (Correct answer)
Assume she is high-risk due to Indigenous background
Order additional screening tests not ordered for other patients
Avoid discussing social determinants of health

Correct answer: Ask about traditional practices and preferences without assumptions, and involve family or community supports if desired

SOGC and the National Aboriginal Council of Midwives emphasise culturally safe care that avoids stereotyping, respects traditional practices, and incorporates patient-defined supports for Indigenous women.

Question 10: When interviewing a patient who is a poor historian, which technique is MOST effective?

Skip the history and proceed directly to investigations
Ask a colleague to take the history instead
Ask only yes/no questions to speed up the interview
Use open-ended questions initially, then focused closed questions, summarize frequently, and use collateral information from family or records (Correct answer)

Correct answer: Use open-ended questions initially, then focused closed questions, summarize frequently, and use collateral information from family or records

With poor historians, begin with open-ended questions to let them share what they can, then use focused questions to fill gaps. Summarize frequently to verify accuracy. Collateral information from family, caregivers, or medical records is invaluable. This structured approach maximizes information gathering while maintaining patient dignity.

Question 11: A patient presents with shortness of breath. Which question BEST helps differentiate between cardiac and pulmonary causes?

Have you travelled recently?
Is the shortness of breath worse when lying flat (orthopnea) and do you wake up at night gasping for air (paroxysmal nocturnal dyspnea)? (Correct answer)
What colour is your sputum?
Do you smoke cigarettes?

Correct answer: Is the shortness of breath worse when lying flat (orthopnea) and do you wake up at night gasping for air (paroxysmal nocturnal dyspnea)?

Orthopnea (breathlessness when lying flat) and paroxysmal nocturnal dyspnea (PND — waking from sleep with breathlessness) are classic features of heart failure. While they can occur in severe lung disease, these symptoms specifically suggest fluid redistribution when supine, pointing to a cardiac cause. This distinction is critical for guiding further investigation.

Question 12: A 60-year-old man presents with progressive dysphagia to solids more than liquids over 3 months, associated with weight loss. What is the MOST concerning diagnosis?

Globus pharyngeus
Achalasia
Gastroesophageal reflux disease
Esophageal carcinoma — progressive dysphagia to solids with weight loss in an older patient requires urgent endoscopy (Correct answer)

Correct answer: Esophageal carcinoma — progressive dysphagia to solids with weight loss in an older patient requires urgent endoscopy

Progressive dysphagia to solids more than liquids suggests a mechanical obstruction (unlike motility disorders which typically affect solids and liquids equally). Combined with weight loss and age, esophageal carcinoma must be excluded urgently. Upper GI endoscopy with biopsy is the investigation of choice. Risk factors include smoking, alcohol, Barrett's esophagus, and chronic reflux.

NAC OSCE Exam

The National Assessment Collaboration Objective Structured Clinical Examination (NAC OSCE) evaluates international medical graduates on clinical skills including history taking, physical examination, clinical reasoning, and communication skills required for Canadian medical licensure.

Questions

240 min

Time Limit

65%

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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

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