OSCE Diagnostic Skills 3 — Questions and Answers
Question 1: A patient with diabetes presents with a foot ulcer, reduced vibration sense, and absent ankle reflexes. Which diagnostic tool best quantifies the degree of peripheral neuropathy?
- 10g monofilament test (Correct answer)
- Ankle-brachial pressure index
- Nerve conduction study
- Doppler ultrasound
Correct answer: 10g monofilament test
The 10g Semmes-Weinstein monofilament test is the standard bedside tool to screen and quantify loss of protective sensation in diabetic neuropathy.
Question 2: When examining a patient with suspected Horner's syndrome, which triad of signs would you expect?
- Ptosis, miosis, anhidrosis (Correct answer)
- Ptosis, mydriasis, anhidrosis
- Ptosis, miosis, hyperhidrosis
- Exophthalmos, mydriasis, ptosis
Correct answer: Ptosis, miosis, anhidrosis
Horner's syndrome results from sympathetic chain disruption and classically presents with ptosis, miosis, and anhidrosis on the affected side.
Question 3: Which auscultatory finding is most consistent with aortic stenosis?
- Harsh ejection systolic murmur at the right second intercostal space radiating to the carotids (Correct answer)
- Pan-systolic murmur loudest at the apex radiating to the axilla
- Early diastolic murmur at the left sternal edge
- Mid-diastolic rumble at the apex
Correct answer: Harsh ejection systolic murmur at the right second intercostal space radiating to the carotids
Aortic stenosis produces a harsh ejection systolic murmur heard best at the right second intercostal space with radiation to the carotids.
Question 4: A 30-year-old woman presents with weight gain, cold intolerance, and constipation. Which single blood test is most appropriate first?
- TSH (Correct answer)
- Free T4
- Total T3
- Anti-TPO antibodies
Correct answer: TSH
TSH is the most sensitive screening test for thyroid dysfunction and is the recommended first-line investigation.
Question 5: Which sign, elicited by extending the knee with the hip flexed, suggests meningeal irritation?
- Kernig's sign (Correct answer)
- Brudzinski's sign
- Babinski's sign
- Lhermitte's sign
Correct answer: Kernig's sign
Kernig's sign is positive when the patient resists or has pain on passive knee extension after hip flexion to 90°, indicating meningeal irritation.
Question 6: A 45-year-old with jaundice has pale stools and dark urine. This pattern most likely indicates:
- Obstructive jaundice (Correct answer)
- Haemolytic jaundice
- Hepatocellular jaundice
- Gilbert's syndrome
Correct answer: Obstructive jaundice
Pale stools and dark urine with jaundice indicate conjugated hyperbilirubinaemia due to biliary obstruction preventing bile from reaching the gut.
Question 7: During a respiratory examination, which finding would indicate consolidation rather than pleural effusion?
- Increased vocal resonance (Correct answer)
- Stony dull percussion note
- Absent breath sounds
- Tracheal deviation away from the lesion
Correct answer: Increased vocal resonance
Consolidation transmits sound better through solid lung, producing increased vocal resonance (and bronchial breathing), unlike effusion which reduces all sounds.
OSCE Diagnostic Skills 3
A patient with diabetes presents with a foot ulcer, reduced vibration sense, and absent ankle reflexes.
Which diagnostic tool best quantifies the degree of peripheral neuropathy?