NAC OSCE Diagnostic Investigations & Data Interpretation 2

Question 1

A 62-year-old man with acute chest pain has an ECG showing ST elevation in leads II, III, and aVF with reciprocal ST depression in leads I and aVL. Which coronary artery is most likely occluded?

Accepted Answer

Right coronary artery

Answer

Left anterior descending artery

Answer

Left circumflex artery

Answer

Left main coronary artery

Question 2

A 70-year-old woman presents with palpitations. ECG shows an irregularly irregular rhythm, no identifiable discrete P waves, and a ventricular rate of 118 bpm. What is the diagnosis?

Accepted Answer

Atrial fibrillation

Answer

Atrial flutter with variable block

Answer

Ventricular tachycardia

Answer

Multifocal atrial tachycardia

Question 3

A 55-year-old man's ECG shows a PR interval of 240 ms with every P wave followed by a QRS complex and no dropped beats. What is the correct interpretation?

Accepted Answer

First-degree AV block

Answer

Mobitz Type I (Wenckebach) second-degree AV block

Answer

Mobitz Type II second-degree AV block

Answer

Complete (third-degree) AV block

Question 4

A 30-year-old man presents with sudden onset dyspnea and right-sided pleuritic chest pain. CXR shows a hyperlucent right hemithorax with absent lung markings and tracheal deviation to the left. What is the most appropriate immediate intervention?

Accepted Answer

Needle decompression at the right 2nd intercostal space, midclavicular line

Answer

CT chest to confirm diagnosis

Answer

Chest tube at 5th intercostal space, midaxillary line

Answer

High-flow oxygen and observation

Question 5

A 65-year-old woman with dyspnea has a CXR showing bilateral perihilar infiltrates in a 'bat-wing' pattern, Kerley B lines, and cardiomegaly. What is the most likely diagnosis?

Accepted Answer

Cardiogenic pulmonary edema

Answer

Community-acquired pneumonia

Answer

ARDS

Answer

Pulmonary sarcoidosis

Question 6

A 70-year-old woman with hip pain undergoes X-ray showing loss of joint space, subchondral sclerosis, osteophyte formation, and subchondral cysts of the right hip. What is the most likely diagnosis?

Accepted Answer

Osteoarthritis

Answer

Rheumatoid arthritis

Answer

Septic arthritis

Answer

Avascular necrosis

Question 7

A chest X-ray shows complete opacification (white-out) of the right hemithorax with tracheal deviation to the left and no air bronchograms. What is the most likely diagnosis?

Accepted Answer

Massive pleural effusion

Answer

Tension pneumothorax

Answer

Lobar consolidation

Answer

Right-sided hemothorax with consolidation