NMC OSCE Clinical Assessment Skills 2 — Questions and Answers
Question 1: You are performing a 12-lead ECG. Where should the V4 electrode be placed?
- Fifth intercostal space, mid-clavicular line (Correct answer)
- Fourth intercostal space, right sternal edge
- Fourth intercostal space, left sternal edge
- Fifth intercostal space, anterior axillary line
Correct answer: Fifth intercostal space, mid-clavicular line
V4 is placed in the fifth intercostal space at the mid-clavicular line (left side). Correct placement is essential for accurate ECG interpretation. V1 and V2 are at the fourth intercostal space at the right and left sternal edges respectively. V3 is between V2 and V4. V5 and V6 are at the anterior and mid-axillary lines.
Question 2: When assessing fluid balance, which clinical sign most reliably indicates dehydration in an adult patient?
- Reduced skin turgor when pinching the skin over the sternum or clavicle (Correct answer)
- Feeling thirsty
- Dark-coloured urine only
- Dry lips
Correct answer: Reduced skin turgor when pinching the skin over the sternum or clavicle
Reduced skin turgor assessed over the sternum or clavicle (where age-related skin changes are less pronounced) is one of the most reliable clinical signs of dehydration. Other important signs include tachycardia, postural hypotension, dry mucous membranes, reduced urine output, and prolonged capillary refill time.
Question 3: A patient has a respiratory rate of 28 breaths per minute, is using accessory muscles, and has intercostal recession. Using the ABCDE framework, what does this assessment indicate?
- The patient has significant respiratory distress requiring immediate intervention at the 'B' (Breathing) stage (Correct answer)
- The patient has a normal respiratory rate and no intervention is needed
- This is an airway problem requiring suctioning
- This indicates a circulatory problem
Correct answer: The patient has significant respiratory distress requiring immediate intervention at the 'B' (Breathing) stage
A respiratory rate of 28, accessory muscle use, and intercostal recession are signs of significant respiratory distress identified during the 'B' (Breathing) assessment. Normal adult respiratory rate is 12-20 breaths per minute. These findings require immediate oxygen therapy, positioning (sit upright), and urgent medical review.
Question 4: When performing a pain assessment, which validated tool should be used for a patient who is unable to communicate verbally?
- Abbey Pain Scale or FLACC scale (observational behavioural tools) (Correct answer)
- Visual Analogue Scale (VAS)
- Numerical Rating Scale (0-10)
- Wong-Baker FACES scale
Correct answer: Abbey Pain Scale or FLACC scale (observational behavioural tools)
For patients who cannot self-report pain (unconscious, severe cognitive impairment, intubated), observational behavioural tools like the Abbey Pain Scale or FLACC scale assess pain through facial expressions, body movements, vocalisations, and physiological changes. Self-report tools like VAS and numerical scales require verbal communication.
Question 5: You are performing a peak expiratory flow rate (PEFR) measurement. What instructions should you give the patient?
- Stand or sit upright, take a deep breath in, seal lips around the mouthpiece, and blow out as hard and fast as possible in one short sharp blast (Correct answer)
- Breathe in and out normally through the mouthpiece for 30 seconds
- Blow gently and steadily for as long as possible
- Take three quick breaths in succession through the mouthpiece
Correct answer: Stand or sit upright, take a deep breath in, seal lips around the mouthpiece, and blow out as hard and fast as possible in one short sharp blast
PEFR measures the maximum speed of expiration. The patient should stand or sit upright, inhale fully, form a tight seal around the mouthpiece, and blow out as hard and fast as possible in a short, sharp blast. Three readings are taken and the best value recorded. It is not a measure of sustained expiratory flow.
Question 6: When assessing peripheral circulation, what is the normal capillary refill time and where should it be assessed?
- Less than 2 seconds, assessed by pressing on the sternum or fingertip for 5 seconds then releasing (Correct answer)
- Less than 5 seconds, assessed on the ear lobe
- Less than 10 seconds, assessed on the toe
- Less than 1 second, assessed on the palm
Correct answer: Less than 2 seconds, assessed by pressing on the sternum or fingertip for 5 seconds then releasing
Normal capillary refill time (CRT) is less than 2 seconds. It is assessed by pressing firmly on the sternum or fingertip for 5 seconds and then releasing. Prolonged CRT (>2 seconds) suggests poor peripheral perfusion and may indicate dehydration, shock, or peripheral vascular disease. Central CRT (sternum) is more reliable than peripheral.
NMC OSCE Clinical Assessment Skills 2
You are performing a 12-lead ECG.
Where should the V4 electrode be placed?