OSCE Knowledge 5 — Questions and Answers
Question 1: A 28-year-old man presents with acute monoarthritis of the first metatarsophalangeal joint, erythema, and extreme tenderness. Serum uric acid is 9.2 mg/dL. What is the first-line treatment for the acute attack?
- Allopurinol
- Colchicine or NSAIDs (Correct answer)
- Probenecid
- Corticosteroids only
Correct answer: Colchicine or NSAIDs
Colchicine or NSAIDs are first-line for acute gout flares; allopurinol is for long-term urate lowering and should not be started during an acute attack.
Question 2: In a history-taking OSCE station, which question best assesses the severity of a patient's chest pain using the SOCRATES framework?
- 'Does the pain radiate anywhere?'
- 'What makes the pain better or worse?'
- 'On a scale of 1 to 10, how bad is the pain?' (Correct answer)
- 'When did the pain start?'
Correct answer: 'On a scale of 1 to 10, how bad is the pain?'
A numeric pain scale directly assesses severity (S in SOCRATES), giving a standardized measure of pain intensity.
Question 3: A child presents with inspiratory stridor, a barking cough, and low-grade fever. What is the most likely diagnosis?
- Epiglottitis
- Croup (laryngotracheobronchitis) (Correct answer)
- Foreign body aspiration
- Bacterial tracheitis
Correct answer: Croup (laryngotracheobronchitis)
Croup (viral laryngotracheobronchitis) classically presents with a barking 'seal-like' cough, inspiratory stridor, and low-grade fever, typically in children aged 6 months to 3 years.
Question 4: During fundoscopy, which finding is pathognomonic of diabetic retinopathy and not seen in hypertensive retinopathy?
- Arteriovenous nipping
- Hard exudates
- Microaneurysms (Correct answer)
- Cotton wool spots
Correct answer: Microaneurysms
Microaneurysms are the earliest finding in diabetic retinopathy and result from capillary wall weakness; they are not a feature of hypertensive retinopathy.
Question 5: A patient is prescribed warfarin and starts taking ibuprofen regularly. What is the most concerning drug interaction?
- Reduced warfarin absorption
- Increased bleeding risk due to CYP2C9 inhibition and antiplatelet effect (Correct answer)
- Reduced anti-inflammatory effect of ibuprofen
- Increased warfarin clearance
Correct answer: Increased bleeding risk due to CYP2C9 inhibition and antiplatelet effect
NSAIDs like ibuprofen inhibit CYP2C9 (reducing warfarin metabolism) and inhibit platelet aggregation, significantly increasing hemorrhagic risk.
Question 6: In a hand washing OSCE station, which area of the hand is most commonly missed during routine hand washing?
- Palm of the hand
- Dorsum of the hand
- Fingertips and thumbs (Correct answer)
- Wrist
Correct answer: Fingertips and thumbs
Studies consistently show that fingertips, thumbs, and interdigital spaces are the most commonly missed areas during hand hygiene.
Question 7: A 65-year-old woman has a serum calcium of 11.8 mg/dL, low phosphate, and elevated PTH. What is the most likely underlying cause?
- Malignancy-related hypercalcemia
- Primary hyperparathyroidism (Correct answer)
- Vitamin D toxicity
- Sarcoidosis
Correct answer: Primary hyperparathyroidism
Elevated PTH with hypercalcemia and hypophosphatemia is the classic biochemical profile of primary hyperparathyroidism, most commonly caused by a parathyroid adenoma.
OSCE Knowledge 5
A 28-year-old man presents with acute monoarthritis of the first metatarsophalangeal joint, erythema, and extreme tenderness.
Serum uric acid is 9.2 mg/dL.
What is the first-line treatment for the acute attack?