OSCE Knowledge 3 — Questions and Answers
Question 1: During a clinical examination, you elicit Murphy's sign. Which condition does this finding suggest?
- Appendicitis
- Acute cholecystitis (Correct answer)
- Peptic ulcer perforation
- Pancreatitis
Correct answer: Acute cholecystitis
Murphy's sign — inspiratory arrest upon deep palpation of the right upper quadrant — is a classic sign of acute cholecystitis.
Question 2: Which cranial nerve is tested when asking a patient to shrug their shoulders against resistance?
- CN X (Vagus)
- CN XI (Spinal accessory) (Correct answer)
- CN XII (Hypoglossal)
- CN IX (Glossopharyngeal)
Correct answer: CN XI (Spinal accessory)
The spinal accessory nerve (CN XI) innervates the trapezius and sternocleidomastoid muscles, tested by shoulder shrug and head rotation against resistance.
Question 3: A 70-year-old man has a blood pressure of 180/110 mmHg, and fundoscopy reveals arteriovenous nipping and flame-shaped hemorrhages. What grade of hypertensive retinopathy is this?
- Grade 1
- Grade 2
- Grade 3 (Correct answer)
- Grade 4
Correct answer: Grade 3
Grade 3 hypertensive retinopathy is characterized by flame-shaped hemorrhages, soft exudates, and AV nipping, without papilledema.
Question 4: In a patient with suspected meningitis, which finding would contraindicate performing a lumbar puncture before CT scan?
- Neck stiffness
- Photophobia
- Papilledema on fundoscopy (Correct answer)
- Fever above 38.5°C
Correct answer: Papilledema on fundoscopy
Papilledema indicates raised intracranial pressure, and performing an LP before CT risks transtentorial herniation (coning).
Question 5: When interpreting an ABG showing pH 7.28, PaCO2 55 mmHg, and HCO3 24 mEq/L, what is the primary disorder?
- Metabolic acidosis
- Respiratory acidosis (Correct answer)
- Metabolic alkalosis
- Respiratory alkalosis
Correct answer: Respiratory acidosis
A low pH with elevated PaCO2 and normal bicarbonate indicates primary respiratory acidosis due to hypoventilation.
Question 6: A 45-year-old woman has a thyroid nodule on ultrasound. Which ultrasound feature is most suspicious for malignancy?
- Isoechoic texture
- Peripheral halo sign
- Microcalcifications (Correct answer)
- Smooth regular margins
Correct answer: Microcalcifications
Microcalcifications (punctate echogenic foci) within a thyroid nodule are highly associated with papillary thyroid carcinoma.
Question 7: Which medication is first-line for treating status epilepticus in an adult in the emergency setting?
- Phenytoin IV
- Levetiracetam IV
- Lorazepam IV (Correct answer)
- Sodium valproate IV
Correct answer: Lorazepam IV
Intravenous lorazepam (a benzodiazepine) is the first-line treatment for status epilepticus due to its rapid onset and efficacy.
OSCE Knowledge 3
During a clinical examination, you elicit Murphy's sign.
Which condition does this finding suggest?