OSCE Physical Examination 3 — Questions and Answers
Question 1: Which technique is used to distinguish ascites from a large ovarian cyst on abdominal examination?
- Shifting dullness (Correct answer)
- Fluid thrill
- Puddle sign
- Percussion note at the flanks
Correct answer: Shifting dullness
Shifting dullness demonstrates fluid that moves with gravity (ascites), while a cyst maintains its position; a cyst also produces resonance at the flanks.
Question 2: When testing cranial nerve VII (facial nerve), which movement specifically tests the upper motor neuron pathway?
- Puffing out cheeks
- Raising eyebrows (Correct answer)
- Showing teeth
- Closing eyes tightly
Correct answer: Raising eyebrows
Raising the eyebrows (forehead movement) is spared in upper motor neuron lesions because the forehead receives bilateral cortical input.
Question 3: During cardiovascular examination, which pulse character is described as a rapid upstroke and collapse, associated with aortic regurgitation?
- Pulsus paradoxus
- Collapsing (water-hammer) pulse (Correct answer)
- Pulsus alternans
- Plateau pulse
Correct answer: Collapsing (water-hammer) pulse
A collapsing (water-hammer) pulse has a rapid rise and sudden collapse, classically associated with aortic regurgitation due to high pulse pressure.
Question 4: A patient has decreased breath sounds, stony dull percussion, and decreased vocal fremitus at the right base. What is the most likely diagnosis?
- Right lower lobe consolidation
- Right-sided pleural effusion (Correct answer)
- Right-sided pneumothorax
- Right lower lobe collapse
Correct answer: Right-sided pleural effusion
Stony dull percussion with decreased breath sounds and decreased vocal fremitus at the lung base indicates fluid in the pleural space.
Question 5: When examining for hepatomegaly, percussion of the liver span reveals the upper border at the 5th intercostal space and lower border 6 cm below the right costal margin. This represents:
- Normal liver span
- Mild hepatomegaly (Correct answer)
- Moderate hepatomegaly
- Severe hepatomegaly
Correct answer: Mild hepatomegaly
Normal liver span is approximately 6-12 cm in the mid-clavicular line; extension 6 cm below the costal margin indicates mild hepatomegaly.
Question 6: Which clinical sign, elicited by passive dorsiflexion of the foot with the knee extended, suggests meningeal irritation?
- Brudzinski's sign
- Kernig's sign (Correct answer)
- Babinski's sign
- Chaddock's sign
Correct answer: Kernig's sign
Kernig's sign is positive when extension of the knee with the hip flexed to 90 degrees causes pain and resistance due to meningeal irritation.
Question 7: On otoscopic examination, a pearly white membrane with a cone of light at the 5 o'clock position in the right ear indicates:
- Acute otitis media
- Normal tympanic membrane (Correct answer)
- Tympanic membrane perforation
- Otitis externa
Correct answer: Normal tympanic membrane
A pearly white, translucent tympanic membrane with the light reflex at 5 o'clock (right ear) represents a normal finding on otoscopy.
OSCE Physical Examination 3
Which technique is used to distinguish ascites from a large ovarian cyst on abdominal examination?