OSCE History Taking 5 — Questions and Answers
Question 1: A patient presents with jaundice. Which combination of historical features most suggests obstructive (cholestatic) jaundice?
- Pale stools, dark urine, and pruritus (Correct answer)
- Dark stools and splenomegaly
- Fever, rigors, and right upper quadrant pain only
- Gradual onset over years with fatigue
Correct answer: Pale stools, dark urine, and pruritus
Obstructive jaundice prevents bile reaching the gut (pale stools) and causes bilirubin to spill into urine (dark urine) and accumulate in skin causing itch.
Question 2: When taking a history from a patient with joint pain, which question distinguishes inflammatory from mechanical arthritis?
- Is the joint stiffness worse in the morning and for how long? (Correct answer)
- Which specific joint is affected?
- How long have you had the pain?
- Does the pain affect your sleep?
Correct answer: Is the joint stiffness worse in the morning and for how long?
Morning stiffness lasting more than 30–60 minutes is characteristic of inflammatory arthritis (e.g., rheumatoid arthritis), while mechanical pain worsens with activity.
Question 3: In a history of syncope, which feature most suggests a cardiac arrhythmic cause rather than a structural or vasovagal cause?
- Syncope during exertion or without any prodrome (Correct answer)
- Prodrome of nausea, sweating, and tunnel vision
- Syncope when standing from a sitting position
- Syncope in a hot, crowded room
Correct answer: Syncope during exertion or without any prodrome
Exertional syncope or sudden collapse without warning strongly suggests a cardiac arrhythmia or structural heart defect, which can be life-threatening.
Question 4: When taking a history in a suspected case of anaphylaxis, which question is most critical for guiding future management?
- What were you exposed to in the 30 minutes before the reaction? (Correct answer)
- Have you had allergies before?
- Did you take any medication during the episode?
- Where were you when the reaction happened?
Correct answer: What were you exposed to in the 30 minutes before the reaction?
Identifying the trigger within the 30-minute exposure window is essential for diagnosing the allergen and prescribing an appropriate avoidance plan and emergency action plan.
Question 5: A 45-year-old man presents with erectile dysfunction. Which aspect of the history is most important to explore first?
- Cardiovascular risk factors and medication history (Correct answer)
- Relationship satisfaction and stress levels
- Testosterone level measurement history
- Sleep quality and fatigue
Correct answer: Cardiovascular risk factors and medication history
Erectile dysfunction is often an early marker of cardiovascular disease, and medications (antihypertensives, antidepressants) are common reversible causes.
Question 6: When taking a neonatal history from a mother with a jaundiced newborn, which maternal factor is most critical to establish?
- Maternal blood group and Rhesus status (Correct answer)
- Mode of delivery
- Duration of labour
- Maternal age at delivery
Correct answer: Maternal blood group and Rhesus status
Rhesus incompatibility (Rh-negative mother with Rh-positive fetus) can cause haemolytic disease of the newborn, a serious cause of neonatal jaundice.
Question 7: In an OSCE breaking bad news station, after delivering the diagnosis, what is the most appropriate immediate next step?
- Pause, allow silence, and acknowledge the patient's emotional response (Correct answer)
- Immediately outline the treatment plan
- Provide written information leaflets
- Ask if the patient has questions about prognosis
Correct answer: Pause, allow silence, and acknowledge the patient's emotional response
After delivering bad news, allowing silence and empathically acknowledging the patient's emotional reaction is crucial before proceeding with further information.
OSCE History Taking 5
A patient presents with jaundice.
Which combination of historical features most suggests obstructive (cholestatic) jaundice?