OSCE Clinical Reasoning 4

Question 1

A 72-year-old woman with osteoporosis falls and complains of hip pain. She cannot bear weight, and her left leg appears shortened and externally rotated. What is the most likely diagnosis?

Accepted Answer

Femoral neck fracture

Answer

Shortened, externally rotated leg after a fall in an elderly osteoporotic woman is the classic presentation of a femoral neck fracture.

Question 2

Which of the following best defines 'premature closure' as a diagnostic error?

Accepted Answer

Accepting the first plausible diagnosis without fully excluding alternatives

Answer

Premature closure is the failure to consider other diagnoses once a seemingly adequate explanation is found, and is one of the most common cognitive errors.

Question 3

A 28-year-old woman presents with pleuritic chest pain, dyspnea, and a swollen right calf after a long-haul flight. Wells score is calculated as high probability. What is the most appropriate next step?

Accepted Answer

Start anticoagulation and order CT pulmonary angiography

Answer

A high Wells score for PE warrants immediate anticoagulation and confirmatory CT-PA, not a D-dimer (which is only useful in low pretest probability).

Question 4

A 60-year-old male with a history of alcohol use disorder presents with confusion, ataxia, and ophthalmoplegia. What is the immediate treatment?

Accepted Answer

IV thiamine (Vitamin B1)

Answer

The triad of confusion, ataxia, and ophthalmoplegia is Wernicke's encephalopathy, and IV thiamine must be given immediately — before any glucose.

Question 5

In clinical reasoning, what is meant by 'diagnostic momentum'?

Accepted Answer

The tendency for a diagnosis made by one clinician to be accepted and perpetuated by subsequent clinicians without reassessment

Answer

Diagnostic momentum occurs when a label applied early in care propagates through the system unchallenged, even if incorrect.

OSCE Practice Test

OSCE Practice Test

OSCE Clinical Reasoning 4