OSCE History Taking 5

Question 1

A patient presents with jaundice. Which combination of historical features most suggests obstructive (cholestatic) jaundice?

Accepted Answer

Pale stools, dark urine, and pruritus

Answer

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?

Accepted Answer

Is the joint stiffness worse in the morning and for how long?

Answer

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?

Accepted Answer

Syncope during exertion or without any prodrome

Answer

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?

Accepted Answer

What were you exposed to in the 30 minutes before the reaction?

Answer

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?

Accepted Answer

Cardiovascular risk factors and medication history

Answer

Erectile dysfunction is often an early marker of cardiovascular disease, and medications (antihypertensives, antidepressants) are common reversible causes.

OSCE Practice Test

OSCE Practice Test

OSCE History Taking 5