OSCE Diagnostic Skills 2 — Questions and Answers
Question 1: A 55-year-old man presents with exertional chest pain radiating to the left arm. Which initial diagnostic test is most appropriate?
- 12-lead ECG (Correct answer)
- Chest X-ray
- Serum troponin only
- CT pulmonary angiography
Correct answer: 12-lead ECG
A 12-lead ECG is the first-line test in suspected acute coronary syndrome to detect ischemic changes rapidly.
Question 2: When percussing the chest, dullness over the lower lung fields bilaterally most likely indicates:
- Pleural effusion (Correct answer)
- Pneumothorax
- Emphysema
- Pulmonary fibrosis
Correct answer: Pleural effusion
Bilateral basal dullness on percussion is a classic sign of pleural effusion due to fluid replacing air-filled lung.
Question 3: A patient has a positive Murphy's sign. Which condition does this most strongly suggest?
- Acute cholecystitis (Correct answer)
- Appendicitis
- Peptic ulcer disease
- Hepatitis
Correct answer: Acute cholecystitis
Murphy's sign (inspiratory arrest on RUQ palpation) is a specific indicator of acute cholecystitis.
Question 4: Which finding on fundoscopy is pathognomonic of hypertensive retinopathy grade IV?
- Papilloedema (Correct answer)
- AV nipping
- Flame haemorrhages
- Silver wiring
Correct answer: Papilloedema
Grade IV hypertensive retinopathy is defined by papilloedema in addition to other hypertensive changes.
Question 5: A 70-year-old presents with sudden painless loss of vision in one eye described as 'a curtain falling.' The most likely diagnosis is:
- Retinal detachment (Correct answer)
- Acute angle-closure glaucoma
- Vitreous haemorrhage
- Central retinal artery occlusion
Correct answer: Retinal detachment
Painless unilateral visual loss described as a descending curtain is the classic presentation of retinal detachment.
Question 6: Which reflex tests the integrity of the S1 nerve root?
- Ankle jerk (Correct answer)
- Knee jerk
- Biceps reflex
- Triceps reflex
Correct answer: Ankle jerk
The ankle jerk (Achilles tendon reflex) is mediated by the S1 nerve root and its absence suggests S1 pathology.
Question 7: In a patient with suspected deep vein thrombosis, which clinical scoring system guides the pre-test probability assessment?
- Wells score (Correct answer)
- CURB-65
- Glasgow Coma Scale
- Rockall score
Correct answer: Wells score
The Wells DVT score combines clinical features to stratify patients into low, moderate, or high pre-test probability for DVT.
OSCE Diagnostic Skills 2
A 55-year-old man presents with exertional chest pain radiating to the left arm.
Which initial diagnostic test is most appropriate?