OSCE OSCE Clinical Reasoning and Diagnosis 2 — Questions and Answers
Question 1: A patient presents with polyuria, polydipsia, and a random blood glucose of 280 mg/dL. In an OSCE reasoning station, which diagnosis is most consistent?
- Diabetes mellitus (Correct answer)
- Diabetes insipidus
- Addison's disease
- Hypothyroidism
Correct answer: Diabetes mellitus
The classic triad of polyuria, polydipsia, and hyperglycemia (≥200 mg/dL) meets the diagnostic criteria for diabetes mellitus.
Question 2: During an OSCE, you note a patient has unequal pupils (anisocoria) with ptosis on the right side. Which condition should your clinical reasoning prioritize?
- Horner syndrome (Correct answer)
- Third cranial nerve palsy only
- Migraine aura
- Benign positional vertigo
Correct answer: Horner syndrome
Anisocoria with ptosis and miosis on the same side is the classic triad of Horner syndrome, often indicating a serious underlying pathology.
Question 3: In an OSCE differential diagnosis station, a young athlete presents with sharp chest pain worsening with inspiration. Which diagnosis is most likely?
- Pleuritis or costochondritis (Correct answer)
- Acute myocardial infarction
- Pulmonary embolism
- Aortic dissection
Correct answer: Pleuritis or costochondritis
Sharp, inspiration-worsening chest pain in a young, otherwise healthy patient is most consistent with pleuritis or costochondritis rather than a vascular emergency.
Question 4: A patient in your OSCE station has a raised JVP, bilateral pitting edema, and bibasilar crackles. Which diagnosis fits this clinical picture?
- Congestive heart failure (Correct answer)
- Nephrotic syndrome only
- Liver cirrhosis without cardiac involvement
- Pneumonia
Correct answer: Congestive heart failure
Raised JVP, bilateral edema, and crackles form the classic triad of congestive heart failure due to fluid overload.
Question 5: An OSCE patient presents with sudden severe headache described as 'the worst headache of my life.' What should clinical reasoning prioritize immediately?
- Subarachnoid hemorrhage (Correct answer)
- Tension headache
- Cluster headache
- Medication overuse headache
Correct answer: Subarachnoid hemorrhage
A 'thunderclap' headache — sudden and maximally severe — is a red flag for subarachnoid hemorrhage until proven otherwise.
Question 6: During a clinical reasoning OSCE, a patient on warfarin presents with gum bleeding and an INR of 8.2. What is the most appropriate initial management step?
- Hold warfarin and administer vitamin K as directed by clinical protocol (Correct answer)
- Increase the warfarin dose to stabilize the INR
- Discharge with instructions to reduce dietary vitamin K
- Order a repeat INR in one week without intervention
Correct answer: Hold warfarin and administer vitamin K as directed by clinical protocol
A supratherapeutic INR with active bleeding requires withholding warfarin and reversing anticoagulation with vitamin K.
OSCE OSCE Clinical Reasoning and Diagnosis 2
A patient presents with polyuria, polydipsia, and a random blood glucose of 280 mg/dL.
In an OSCE reasoning station, which diagnosis is most consistent?