OSCE Knowledge 4 — Questions and Answers
Question 1: During a respiratory examination, you find dull percussion, decreased breath sounds, and decreased vocal resonance over the left lower zone. What is the most likely finding?
- Consolidation
- Pleural effusion (Correct answer)
- Pneumothorax
- Lobar collapse
Correct answer: Pleural effusion
Pleural effusion causes stony dullness on percussion, reduced breath sounds, and decreased vocal resonance due to fluid attenuating sound transmission.
Question 2: A patient with type 2 diabetes has an eGFR of 45 mL/min/1.73m². Which medication adjustment is most important?
- Stop ACE inhibitor
- Stop metformin use (Correct answer)
- Reduce insulin dose by 50%
- Switch statin to a lower dose
Correct answer: Stop metformin use
Metformin is contraindicated when eGFR falls below 30 mL/min/1.73m² and should be used with caution below 45, often stopped to prevent lactic acidosis.
Question 3: In the OSCE consent station, which element is NOT a legal requirement for valid informed consent?
- Disclosure of material risks
- Capacity to consent
- Patient signature on a consent form (Correct answer)
- Voluntariness of decision
Correct answer: Patient signature on a consent form
A signed consent form is evidence of consent but is not legally required; verbal consent is valid if the other elements (capacity, voluntariness, information) are present.
Question 4: A 55-year-old man has a PSA of 12 ng/mL, and digital rectal examination reveals a hard irregular prostate. What is the next most appropriate step?
- Repeat PSA in 3 months
- Start empirical antibiotics
- Transrectal ultrasound-guided prostate biopsy (Correct answer)
- MRI prostate only
Correct answer: Transrectal ultrasound-guided prostate biopsy
An elevated PSA with a suspicious DRE finding requires histological confirmation via TRUS-guided biopsy to diagnose or exclude prostate cancer.
Question 5: Which physical sign, when positive, suggests ipsilateral cerebellar hemisphere disease?
- Romberg's sign
- Dysdiadochokinesia (Correct answer)
- Hoffmann's reflex
- Babinski's sign
Correct answer: Dysdiadochokinesia
Dysdiadochokinesia (inability to perform rapid alternating movements) indicates ipsilateral cerebellar hemisphere dysfunction.
Question 6: A 30-year-old pregnant woman at 32 weeks gestation presents with proteinuria 3+ and blood pressure 158/102 mmHg. What is the diagnosis?
- Gestational hypertension
- Preeclampsia (Correct answer)
- Chronic hypertension
- HELLP syndrome
Correct answer: Preeclampsia
Preeclampsia is defined as hypertension (≥140/90 mmHg) with proteinuria after 20 weeks gestation in a previously normotensive woman.
Question 7: Which immunoglobulin class is primarily responsible for the secondary (anamnestic) immune response?
- IgM
- IgA
- IgG (Correct answer)
- IgE
Correct answer: IgG
IgG is the predominant antibody in the secondary immune response, produced by memory B cells with higher affinity than the primary IgM response.
OSCE Knowledge 4
During a respiratory examination, you find dull percussion, decreased breath sounds, and decreased vocal resonance over the left lower zone.
What is the most likely finding?