OSCE Patient Assessment and Evaluation 3 — Questions and Answers
Question 1: When performing the Romberg test, the examiner asks the patient to stand with feet together and eyes closed. A positive result indicates dysfunction of which system?
- Cerebellar
- Proprioceptive/Vestibular (Correct answer)
- Upper motor neuron
- Corticospinal tract
Correct answer: Proprioceptive/Vestibular
A positive Romberg test (increased sway with eyes closed) indicates impaired proprioception or vestibular function, as the patient loses compensatory visual input.
Question 2: A 45-year-old woman presents with heat intolerance, weight loss, palpitations, and a fine tremor. On inspection, her eyes appear to protrude. What is the most likely diagnosis?
- Hypothyroidism
- Hyperthyroidism with Graves' disease (Correct answer)
- Cushing's syndrome
- Acromegaly
Correct answer: Hyperthyroidism with Graves' disease
Exophthalmos (proptosis) combined with hypermetabolic symptoms is classic for Graves' disease, an autoimmune cause of hyperthyroidism.
Question 3: During a respiratory examination, you note that the trachea is deviated to the left. Which finding on the right side would most suggest a tension pneumothorax?
- Dullness to percussion and absent breath sounds
- Resonance to percussion and absent breath sounds (Correct answer)
- Dullness to percussion and bronchial breath sounds
- Resonance to percussion and increased vocal resonance
Correct answer: Resonance to percussion and absent breath sounds
Tension pneumothorax causes hyperresonance (resonance) and absent breath sounds on the affected side, with tracheal deviation away from the lesion.
Question 4: When assessing deep tendon reflexes, a grade of 2+ indicates:
- Absent reflex
- Normal reflex (Correct answer)
- Brisk reflex without clonus
- Sustained clonus
Correct answer: Normal reflex
On the standard 0–4 scale, 2+ represents a normal reflex response.
Question 5: A patient with a history of peptic ulcer disease presents with sudden-onset severe epigastric pain radiating to the back. His abdomen is board-like rigid. What is the most likely diagnosis?
- Acute pancreatitis
- Perforated peptic ulcer (Correct answer)
- Acute mesenteric ischemia
- Ruptured abdominal aortic aneurysm
Correct answer: Perforated peptic ulcer
Sudden-onset severe epigastric pain with generalized peritonism (board-like rigidity) in a patient with PUD history is classic for a perforated peptic ulcer.
Question 6: In a patient with suspected deep vein thrombosis (DVT), which clinical sign involves calf pain on dorsiflexion of the foot?
- Homans' sign (Correct answer)
- McMurray's sign
- Lachman's sign
- Thompson's sign
Correct answer: Homans' sign
Homans' sign is pain in the calf on dorsiflexion of the foot, classically associated with DVT, though it has low sensitivity and specificity.
Question 7: During a paediatric OSCE, you assess a 2-year-old child's developmental milestones. Which of the following is an expected gross motor milestone at this age?
- Walking independently
- Running and kicking a ball (Correct answer)
- Climbing stairs with alternating feet
- Riding a tricycle
Correct answer: Running and kicking a ball
Running and kicking a ball are expected gross motor skills by 2 years of age, while stair-alternating and tricycle riding develop later.
OSCE Patient Assessment and Evaluation 3
When performing the Romberg test, the examiner asks the patient to stand with feet together and eyes closed.
A positive result indicates dysfunction of which system?