OSCE Mental Health Assessment 2 — Questions and Answers
Question 1: When using the PHQ-9 to screen for depression in a primary care OSCE station, a score of 15 indicates which severity level?
- Mild depression
- Moderate depression
- Moderately severe depression (Correct answer)
- Severe depression
Correct answer: Moderately severe depression
PHQ-9 scores of 15–19 indicate moderately severe depression, while scores ≥20 indicate severe depression.
Question 2: A patient presents with pressured speech, decreased need for sleep, grandiosity, and impulsivity lasting 1 week. The most appropriate next step in the mental health assessment is to:
- Administer the GAD-7
- Screen for hypomanic episodes in the past
- Obtain a urine drug screen (Correct answer)
- Assess for command auditory hallucinations
Correct answer: Obtain a urine drug screen
Stimulant or substance intoxication can mimic mania and must be excluded before diagnosing bipolar disorder.
Question 3: During an OSCE mental status exam, a patient describes seeing the room spin while stationary and feeling as though objects are unreal. This perception is best described as:
- Derealization (Correct answer)
- Depersonalization
- Illusion
- Pseudohallucination
Correct answer: Derealization
Derealization is the feeling that the external environment is unreal or detached; depersonalization refers to the self feeling unreal.
Question 4: In an OSCE suicide risk assessment, which of the following factors most significantly elevates short-term risk?
- Family history of depression
- Chronic low self-esteem
- A specific, lethal, and accessible plan (Correct answer)
- Passive death wishes without intent
Correct answer: A specific, lethal, and accessible plan
A specific, lethal, and accessible plan is the strongest predictor of imminent suicide attempt compared to ideation alone.
Question 5: A patient scores 26/30 on the Montreal Cognitive Assessment (MoCA). The clinician should interpret this as:
- Severe cognitive impairment
- Mild cognitive impairment
- Within normal limits (Correct answer)
- Consistent with dementia
Correct answer: Within normal limits
A MoCA score of ≥26 out of 30 is considered within normal limits for cognitive function.
Question 6: During a mental health OSCE station, the examiner expects the student to elicit 'flight of ideas.' This thought process is characterized by:
- Sudden interruption of a train of thought
- Rapid shifting between loosely connected ideas driven by word sounds or chance associations (Correct answer)
- Repetitive, stereotyped phrases lacking meaning
- Inability to reach a goal despite many associations
Correct answer: Rapid shifting between loosely connected ideas driven by word sounds or chance associations
Flight of ideas is rapid thought with connections that can be followed but are driven by distractibility, rhymes, or puns, classically seen in mania.
Question 7: A 22-year-old student reports recurrent, intrusive thoughts of harming her infant niece, which she finds distressing and ego-dystonic. She performs checking rituals to neutralize anxiety. The primary diagnosis to consider is:
- Postpartum depression
- Antisocial personality disorder
- Obsessive-compulsive disorder (Correct answer)
- Schizophrenia, paranoid type
Correct answer: Obsessive-compulsive disorder
Ego-dystonic intrusive thoughts paired with compulsive rituals to reduce anxiety are the hallmark presentation of OCD.
OSCE Mental Health Assessment 2
When using the PHQ-9 to screen for depression in a primary care OSCE station, a score of 15 indicates which severity level?