OSCE Physical Examination 5 — Questions and Answers
Question 1: A patient has an ulcer at the medial malleolus with surrounding lipodermatosclerosis and hemosiderin deposits. The most likely underlying cause is:
- Arterial insufficiency
- Diabetic neuropathy
- Venous insufficiency (Correct answer)
- Pressure sore
Correct answer: Venous insufficiency
Medial malleolus ulcers with lipodermatosclerosis and hemosiderin staining are classic features of chronic venous insufficiency.
Question 2: When performing Phalen's test for carpal tunnel syndrome, the test is positive if symptoms are reproduced within:
- 10 seconds
- 30 seconds
- 60 seconds (Correct answer)
- 120 seconds
Correct answer: 60 seconds
Phalen's test is considered positive if tingling or numbness in the median nerve distribution is reproduced within 60 seconds of maximal wrist flexion.
Question 3: During breast examination, which finding is most suggestive of malignancy rather than a benign cyst?
- Smooth, mobile, well-defined lump
- Tender lump that varies with the menstrual cycle
- Hard, irregular, non-tender, fixed lump with skin tethering (Correct answer)
- Bilateral breast pain with no discrete lump
Correct answer: Hard, irregular, non-tender, fixed lump with skin tethering
Malignant breast lumps are characteristically hard, irregular, non-tender, and fixed to surrounding structures, with possible skin tethering or nipple inversion.
Question 4: When assessing peripheral arterial disease, an ankle-brachial pressure index (ABPI) of 0.6 indicates:
- Normal perfusion
- Mild arterial disease
- Moderate arterial disease with claudication (Correct answer)
- Critical ischemia requiring urgent intervention
Correct answer: Moderate arterial disease with claudication
An ABPI of 0.5-0.8 indicates moderate peripheral arterial disease associated with intermittent claudication.
Question 5: When testing the Achilles tendon reflex, which nerve roots are being assessed?
- L3-L4
- L4-L5
- L5-S1 (Correct answer)
- S1-S2
Correct answer: L5-S1
The Achilles (ankle jerk) reflex tests the S1-L5 nerve roots primarily via the tibial nerve, with S1 being the dominant root.
Question 6: A patient with suspected deep vein thrombosis (DVT) has calf tenderness and swelling. Homans' sign is tested by:
- Compressing the calf with the knee flexed
- Dorsiflexing the foot with the knee extended to elicit calf pain (Correct answer)
- Palpating the popliteal fossa for a cord-like structure
- Measuring calf circumference bilaterally
Correct answer: Dorsiflexing the foot with the knee extended to elicit calf pain
Homans' sign involves passive dorsiflexion of the foot with the knee extended; calf pain suggests DVT, though this sign has poor sensitivity and specificity.
Question 7: On examination of the hand in rheumatoid arthritis, which deformity results from rupture of the central slip of the extensor tendon?
- Swan neck deformity
- Boutonniere deformity (Correct answer)
- Mallet finger
- Trigger finger
Correct answer: Boutonniere deformity
Boutonniere deformity (PIP flexion with DIP hyperextension) results from rupture of the central slip of the extensor tendon allowing the lateral bands to slip volarly.
OSCE Physical Examination 5
A patient has an ulcer at the medial malleolus with surrounding lipodermatosclerosis and hemosiderin deposits.
The most likely underlying cause is: