OSCE Clinical Reasoning 2

Question 1

A 68-year-old man presents with sudden onset of severe tearing chest pain radiating to his back. Blood pressure is 160/90 mmHg in the right arm and 130/75 mmHg in the left arm. What is the most likely diagnosis?

Accepted Answer

Aortic dissection

Answer

Unequal blood pressures between arms combined with tearing back pain is the classic presentation of aortic dissection.

Question 2

During an OSCE station, a patient's history reveals fatigue, cold intolerance, constipation, and weight gain. Which single test is most appropriate to order first?

Accepted Answer

TSH level

Answer

TSH is the single best screening test for thyroid dysfunction, which explains all four symptoms in this clinical picture.

Question 3

A 25-year-old woman presents with right lower quadrant pain, nausea, and a positive urine hCG. Her last menstrual period was 7 weeks ago. Vital signs show HR 110, BP 90/60. What is the priority action?

Accepted Answer

Start IV fluids and prepare for emergency management of ectopic pregnancy

Answer

Hemodynamic instability with a positive pregnancy test and pelvic pain indicates likely ruptured ectopic pregnancy requiring immediate resuscitation.

Question 4

Which cognitive bias occurs when a clinician anchors on the first diagnosis made and fails to consider alternatives as new information emerges?

Accepted Answer

Anchoring bias

Answer

Anchoring bias is the tendency to rely too heavily on the initial diagnosis despite subsequent contradictory information.

Question 5

A 55-year-old male smoker presents with hemoptysis, weight loss, and a new persistent cough. Chest X-ray shows a hilar mass. What is the most important next step in the diagnostic workup?

Accepted Answer

CT chest with contrast

Answer

CT chest with contrast is the next step to characterize the mass, assess mediastinal involvement, and plan biopsy approach before tissue diagnosis.

OSCE Practice Test

OSCE Practice Test

OSCE Clinical Reasoning 2