OSCE History Taking 3 — Questions and Answers
Question 1: When taking a psychiatric history in an OSCE, after establishing the presenting complaint, what should be specifically explored regarding suicidality?
- Intent, plan, means, and timeline (Correct answer)
- Duration of depressive symptoms only
- Family history of mental illness
- Current medication compliance
Correct answer: Intent, plan, means, and timeline
A full suicide risk assessment must include exploring ideation, intent, specific plan, available means, and any intended timeline.
Question 2: A 62-year-old woman presents with weight loss. Which combination of symptoms in the history would most raise suspicion for malignancy?
- Night sweats, fatigue, and anorexia (Correct answer)
- Increased appetite and diarrhea
- Weight loss with increased activity
- Seasonal variation and mood changes
Correct answer: Night sweats, fatigue, and anorexia
Constitutional symptoms including night sweats, profound fatigue, and anorexia alongside unexplained weight loss are classic 'red flag' features for malignancy.
Question 3: When taking a gynaecological history, which information about menstruation is least relevant to the current presenting complaint of intermenstrual bleeding?
- Age at menarche (Correct answer)
- Cycle length and regularity
- Last menstrual period
- Contraceptive use
Correct answer: Age at menarche
While age at menarche is part of a complete menstrual history, it is least directly relevant to investigating intermenstrual bleeding compared to current cycle patterns and contraception.
Question 4: In a history of headache, which feature is the most important 'red flag' requiring urgent investigation?
- Thunderclap onset reaching maximum intensity within seconds (Correct answer)
- Gradual onset over several hours
- Associated with stress and tension
- Relieved by over-the-counter analgesia
Correct answer: Thunderclap onset reaching maximum intensity within seconds
A thunderclap headache reaching maximum severity within seconds is the classic presentation of subarachnoid haemorrhage and requires immediate CT head.
Question 5: When taking a history from an elderly patient with confusion, what is the most appropriate additional source of collateral history?
- A family member or regular carer (Correct answer)
- The patient's GP records only
- A neighbour
- Emergency department triage nurse
Correct answer: A family member or regular carer
A family member or regular carer who knows the patient's baseline cognition and recent changes provides the most reliable collateral history for a confused patient.
Question 6: A patient discloses they are taking St. John's Wort. Why is this clinically significant in the drug history?
- It induces CYP450 enzymes and interacts with many prescription drugs (Correct answer)
- It causes direct hepatotoxicity at standard doses
- It is associated with agranulocytosis
- It causes hypertensive crisis when combined with food
Correct answer: It induces CYP450 enzymes and interacts with many prescription drugs
St. John's Wort is a potent CYP450 inducer that reduces plasma levels of drugs like warfarin, contraceptive pills, and antiretrovirals.
Question 7: When establishing a patient's social history in the OSCE, which domain is most relevant for a patient presenting with chronic lower back pain?
- Occupational duties and ergonomics (Correct answer)
- Smoking pack-year history
- Alcohol consumption frequency
- Living situation and support network
Correct answer: Occupational duties and ergonomics
For chronic back pain, the patient's occupation and daily ergonomic demands are critical to understanding causative and perpetuating factors.
OSCE History Taking 3
When taking a psychiatric history in an OSCE, after establishing the presenting complaint, what should be specifically explored regarding suicidality?