OSCE Knowledge 2 — Questions and Answers
Question 1: A patient presents with sudden-onset severe headache described as 'the worst headache of my life.' What is the most critical diagnosis to rule out?
- Migraine with aura
- Subarachnoid hemorrhage (Correct answer)
- Cluster headache
- Tension-type headache
Correct answer: Subarachnoid hemorrhage
A thunderclap headache reaching maximum intensity within seconds is the classic presentation of subarachnoid hemorrhage, a life-threatening emergency.
Question 2: During an OSCE station, you are asked to interpret a 12-lead ECG showing ST elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
- Left anterior descending artery
- Left circumflex artery
- Right coronary artery (Correct answer)
- Left main coronary artery
Correct answer: Right coronary artery
ST elevation in the inferior leads (II, III, aVF) indicates an inferior STEMI most commonly caused by right coronary artery occlusion.
Question 3: A 60-year-old patient has a serum potassium of 6.8 mEq/L. Which ECG finding would you expect to see first?
- Widened QRS complex
- Peaked T waves (Correct answer)
- Sine wave pattern
- Flattened P waves
Correct answer: Peaked T waves
Tall, peaked (tented) T waves are the earliest ECG manifestation of hyperkalemia, appearing before P wave changes or QRS widening.
Question 4: Which spirometry pattern is consistent with obstructive lung disease such as COPD?
- Reduced FVC with normal FEV1/FVC ratio
- Reduced FEV1/FVC ratio below 0.70 (Correct answer)
- Proportionally reduced FEV1 and FVC
- Normal FEV1 with reduced FVC
Correct answer: Reduced FEV1/FVC ratio below 0.70
Obstructive disease is defined by an FEV1/FVC ratio below 0.70 post-bronchodilator, reflecting impaired airflow due to airway narrowing.
Question 5: A 25-year-old female presents with unilateral lower quadrant pain, vaginal bleeding, and a positive pregnancy test. What is the most important diagnosis to exclude?
- Ovarian cyst rupture
- Ectopic pregnancy (Correct answer)
- Threatened miscarriage
- Appendicitis
Correct answer: Ectopic pregnancy
Ectopic pregnancy is life-threatening and must be excluded first in any woman of reproductive age with pelvic pain and a positive pregnancy test.
Question 6: When performing a Glasgow Coma Scale assessment, a patient opens their eyes to pain, makes incomprehensible sounds, and shows abnormal flexion. What is the GCS score?
- 7 (Correct answer)
- 8
- 6
- 9
Correct answer: 7
Eye opening to pain = 2, incomprehensible sounds = 2, abnormal flexion (decorticate) = 3, totaling a GCS of 7.
Question 7: A patient is brought in with symptoms of opioid overdose. Which triad of findings is classic?
- Hyperthermia, tachycardia, dilated pupils
- Miosis, respiratory depression, decreased consciousness (Correct answer)
- Mydriasis, hypertension, agitation
- Hyperthermia, seizures, muscle rigidity
Correct answer: Miosis, respiratory depression, decreased consciousness
The opioid toxidrome classically presents with the triad of pinpoint pupils (miosis), respiratory depression, and decreased level of consciousness.
OSCE Knowledge 2
A patient presents with sudden-onset severe headache described as 'the worst headache of my life.' What is the most critical diagnosis to rule out?