OSCE Diagnostic Skills 5

Question 1

A patient is found to have shifting dullness and a fluid thrill on abdominal examination. These signs indicate:

Accepted Answer

Ascites

Answer

Shifting dullness and a fluid thrill are classic signs of free peritoneal fluid (ascites), especially when greater than 1500 mL.

Question 2

Which bedside test is used to differentiate central from peripheral vertigo?

Accepted Answer

Head impulse test

Answer

The head impulse (thrust) test is positive in peripheral vertigo (compensatory saccade seen) and typically negative in central causes, helping differentiate the two.

Question 3

A 25-year-old athlete presents with a painful, swollen knee after twisting injury. A positive anterior drawer test suggests injury to which structure?

Accepted Answer

Anterior cruciate ligament

Answer

Anterior drawer test assesses ACL integrity; anterior tibial displacement on the femur indicates ACL rupture.

Question 4

On auscultation of the abdomen, which finding would suggest bowel obstruction rather than paralytic ileus?

Accepted Answer

High-pitched tinkling bowel sounds

Answer

Mechanical bowel obstruction produces hyperactive, high-pitched tinkling sounds from peristalsis against obstructed bowel, whereas paralytic ileus produces absent sounds.

Question 5

A patient's urine dipstick shows 3+ protein and 3+ blood. Which investigation should follow to evaluate for glomerulonephritis?

Accepted Answer

Urine microscopy for red cell casts

Answer

Red cell casts on urine microscopy are pathognomonic of glomerulonephritis, confirming that bleeding originates from the glomerulus.

OSCE Practice Test

OSCE Practice Test

OSCE Diagnostic Skills 5