OSCE Procedural Skills 5 — Questions and Answers
Question 1: A patient requires intermittent self-catheterization. Which catheter type is most appropriate for this purpose?
- Foley catheter with 30 mL balloon
- Nelaton (straight-tip) catheter (Correct answer)
- Coude-tip catheter
- Three-way irrigation catheter
Correct answer: Nelaton (straight-tip) catheter
The Nelaton catheter is a simple straight-tip catheter designed for intermittent use without an inflatable balloon.
Question 2: During a blood transfusion, the patient develops fever, rigors, and back pain 15 minutes after commencement. What is the immediate first action?
- Slow the transfusion rate and give antipyretics
- Stop the transfusion immediately and maintain IV access with normal saline (Correct answer)
- Increase the transfusion rate to complete it quickly
- Administer IV antihistamines and continue
Correct answer: Stop the transfusion immediately and maintain IV access with normal saline
Stopping the transfusion immediately is the first priority to prevent worsening of a potentially life-threatening hemolytic reaction.
Question 3: When performing a digital rectal examination (DRE), a normal prostate in a young adult should feel:
- Hard and nodular
- Soft and fluctuant
- Firm and rubbery with a central sulcus (Correct answer)
- Asymmetric with obliteration of the median sulcus
Correct answer: Firm and rubbery with a central sulcus
A normal prostate is smooth, firm, and rubbery with a palpable midline groove (central sulcus) separating the two lobes.
Question 4: When using a defibrillator in synchronised cardioversion mode, why must the shock be synchronised with the QRS complex?
- To increase the energy delivered
- To avoid delivering the shock during the vulnerable T-wave period and inducing ventricular fibrillation (Correct answer)
- To allow the patient to breathe before the shock
- To reduce skin burns at the electrode site
Correct answer: To avoid delivering the shock during the vulnerable T-wave period and inducing ventricular fibrillation
Delivering a shock during the T-wave's relative refractory period can trigger ventricular fibrillation, so synchronisation to the R-wave is essential.
Question 5: A patient needs a suprapubic catheter. What is the most important preparatory step before insertion?
- Ensure the patient has an empty bladder confirmed by ultrasound
- Confirm the bladder is distended (filled with at least 300–400 mL of urine) using ultrasound (Correct answer)
- Position the patient in the lithotomy position
- Administer general anesthesia
Correct answer: Confirm the bladder is distended (filled with at least 300–400 mL of urine) using ultrasound
A distended bladder displaces the peritoneum superiorly, reducing the risk of bowel injury during suprapubic insertion.
Question 6: In a simulated OSCE suturing station, which suture material is most appropriate for closing a clean facial laceration in an adult?
- 2-0 polyglactin (Vicryl) interrupted sutures
- 6-0 monofilament non-absorbable suture (e.g., nylon or prolene) (Correct answer)
- 3-0 silk sutures
- 1-0 polypropylene sutures
Correct answer: 6-0 monofilament non-absorbable suture (e.g., nylon or prolene)
Fine 6-0 non-absorbable monofilament minimizes tissue reactivity and scarring in cosmetically important areas like the face.
Question 7: When performing peak flow measurement in an OSCE, which instruction is critical to give the patient before they blow?
- Breathe in slowly and gently before blowing
- Take a maximal deep breath in, seal lips tightly around the mouthpiece, then blow as hard and fast as possible (Correct answer)
- Breathe normally for 5 breaths then blow gently
- Hold the device vertically and blow upward
Correct answer: Take a maximal deep breath in, seal lips tightly around the mouthpiece, then blow as hard and fast as possible
Maximal inspiration followed by a forceful fast exhalation is required to measure peak expiratory flow rate accurately.
OSCE Procedural Skills 5
A patient requires intermittent self-catheterization.
Which catheter type is most appropriate for this purpose?