OSCE Physical Examination 4 — Questions and Answers
Question 1: A patient presents with a small, round, painless ulcer with indurated edges on the penis. The most appropriate next examination step is:
- Biopsy the lesion immediately
- Examine the inguinal lymph nodes (Correct answer)
- Palpate the prostate
- Inspect the urethral meatus
Correct answer: Examine the inguinal lymph nodes
A painless indurated penile ulcer (chancre) requires inguinal lymph node examination, which typically shows non-tender lymphadenopathy in primary syphilis.
Question 2: When assessing ankle clonus, how many beats of sustained clonus is considered pathological?
- 1 beat
- 2 beats
- 3 or more beats (Correct answer)
- Any clonus is always normal
Correct answer: 3 or more beats
Sustained clonus (3 or more rhythmic beats) is pathological and indicates an upper motor neuron lesion; 1-2 beats can be normal.
Question 3: During thyroid examination, which maneuver best confirms that a midline neck swelling is the thyroid gland?
- Transillumination
- Asking the patient to swallow (Correct answer)
- Auscultating for bruit
- Asking the patient to protrude the tongue
Correct answer: Asking the patient to swallow
The thyroid gland moves upward on swallowing because it is enclosed in the pretracheal fascia, distinguishing it from other neck masses.
Question 4: On ophthalmoscopy, arteriovenous (AV) nipping at arteriovenous crossings is most associated with:
- Diabetic retinopathy
- Hypertensive retinopathy (Correct answer)
- Papilledema
- Central retinal vein occlusion
Correct answer: Hypertensive retinopathy
AV nipping occurs when hardened, thickened retinal arteries compress the veins at crossing points, a hallmark of hypertensive retinopathy.
Question 5: When performing the finger-nose test in a patient with cerebellar disease, the characteristic finding is:
- Past-pointing that worsens with eyes closed
- Intention tremor increasing as finger approaches target (Correct answer)
- Resting tremor that improves with movement
- Cogwheel rigidity on passive movement
Correct answer: Intention tremor increasing as finger approaches target
Intention tremor that worsens as the finger approaches the target (dysmetria) is the hallmark of cerebellar dysfunction on the finger-nose test.
Question 6: Which physical examination finding would suggest cardiac tamponade as part of Beck's triad?
- Hypertension, tachycardia, and JVD
- Hypotension, muffled heart sounds, and raised JVP (Correct answer)
- Bradycardia, hypotension, and peripheral edema
- Tachycardia, wide pulse pressure, and bounding pulse
Correct answer: Hypotension, muffled heart sounds, and raised JVP
Beck's triad of cardiac tamponade consists of hypotension, muffled heart sounds, and raised jugular venous pressure (JVD).
Question 7: When testing light touch sensation in the dermatome over the lateral aspect of the forearm, which nerve root is being assessed?
- C5
- C6 (Correct answer)
- C7
- C8
Correct answer: C6
The lateral forearm (including thumb and index finger) is supplied by C6 via the musculocutaneous nerve's lateral cutaneous branch.
OSCE Physical Examination 4
A patient presents with a small, round, painless ulcer with indurated edges on the penis.
The most appropriate next examination step is: