OSCE History Taking 4 — Questions and Answers
Question 1: A 30-year-old woman presents with recurrent urinary tract infections. Which aspect of the sexual history is most relevant to elicit?
- Frequency of intercourse and contraceptive method (Correct answer)
- Number of lifetime partners
- Age of sexual debut
- History of sexually transmitted infections only
Correct answer: Frequency of intercourse and contraceptive method
Post-coital UTIs are common, and certain contraceptives like diaphragms or spermicides increase UTI risk, making sexual frequency and contraception key history points.
Question 2: When taking a travel history from a patient with fever, which combination of questions is most important?
- Destination, duration, malaria prophylaxis, and vaccinations taken (Correct answer)
- Airline and hotel accommodation only
- Whether food and water were of good quality
- Whether the patient used insect repellent
Correct answer: Destination, duration, malaria prophylaxis, and vaccinations taken
Destination determines endemic diseases, duration affects exposure risk, and prophylaxis/vaccination status indicates degree of protection the patient had.
Question 3: In an OSCE station, a patient presents with haemoptysis. Which historical feature would most urgently point to lung cancer as the diagnosis?
- 40 pack-year smoking history with weight loss and hoarse voice (Correct answer)
- Recent upper respiratory tract infection
- History of bronchiectasis since childhood
- Use of ACE inhibitors
Correct answer: 40 pack-year smoking history with weight loss and hoarse voice
Heavy smoking history combined with constitutional weight loss and hoarseness (recurrent laryngeal nerve involvement) are classic red flag features for lung cancer.
Question 4: When taking a history of altered bowel habits, which change pattern would most urgently indicate a need to rule out colorectal cancer?
- Persistent change to looser stools for more than 6 weeks in a patient over 50 (Correct answer)
- Constipation lasting 3 days in a young adult
- Alternating bowel habit since adolescence
- Diarrhea after eating dairy products
Correct answer: Persistent change to looser stools for more than 6 weeks in a patient over 50
NICE guidelines classify persistent change in bowel habit lasting over 6 weeks in patients over 50 as a red flag symptom requiring urgent colorectal cancer investigation.
Question 5: A patient with type 2 diabetes presents for a routine review. Which systems review question is most important to include in the history?
- Any vision changes, foot numbness, or chest pain on exertion (Correct answer)
- Changes in hair texture or weight gain
- Sleep quality and snoring history
- Recent dental procedures
Correct answer: Any vision changes, foot numbness, or chest pain on exertion
Diabetes causes micro- and macrovascular complications affecting eyes (retinopathy), peripheral nerves (neuropathy), and coronary arteries (ischemic heart disease).
Question 6: In a history of loss of consciousness, which feature best distinguishes an epileptic seizure from a vasovagal syncope?
- Prolonged post-ictal confusion and tongue biting (Correct answer)
- Prodrome of nausea and tunnel vision
- Recovery within seconds of lying flat
- Occurrence in hot crowded environments
Correct answer: Prolonged post-ictal confusion and tongue biting
Post-ictal confusion lasting minutes to hours and lateral tongue biting are specific features of tonic-clonic seizures not seen in vasovagal syncope.
Question 7: When taking a history of dysphagia (difficulty swallowing), which question best differentiates oropharyngeal from oesophageal dysphagia?
- Does the difficulty occur immediately on initiating the swallow or after? (Correct answer)
- Is solid food or liquid harder to swallow?
- Is there associated heartburn?
- Has there been recent weight loss?
Correct answer: Does the difficulty occur immediately on initiating the swallow or after?
Oropharyngeal dysphagia causes difficulty initiating the swallow (immediately), while oesophageal dysphagia causes sensation of food sticking after the swallow has been initiated.
OSCE History Taking 4
A 30-year-old woman presents with recurrent urinary tract infections.
Which aspect of the sexual history is most relevant to elicit?