OSCE Treatment Protocols & Interventions 2 — Questions and Answers
Question 1: A patient presents with anaphylaxis after a bee sting. What is the FIRST-line treatment?
- Diphenhydramine 50mg IV
- Epinephrine 0.3mg IM into the lateral thigh (Correct answer)
- Methylprednisolone 125mg IV
- Albuterol nebulizer treatment
Correct answer: Epinephrine 0.3mg IM into the lateral thigh
Epinephrine IM is the first-line treatment for anaphylaxis due to its rapid onset and ability to reverse bronchoconstriction and vasodilation.
Question 2: During a urinary catheterization, the patient reports significant pain and resistance is felt. What is the appropriate next step?
- Apply more lubrication and force the catheter through
- Withdraw the catheter and attempt a smaller size
- Stop the procedure and notify the supervising physician (Correct answer)
- Inflate the balloon to secure placement
Correct answer: Stop the procedure and notify the supervising physician
Resistance and pain during catheterization may indicate urethral stricture or false passage, requiring physician evaluation before proceeding.
Question 3: A child with febrile seizure has stopped convulsing. Temperature is 39.8°C. What is the priority intervention?
- Administer phenytoin prophylactically
- Reassure parents and monitor; administer antipyretics (Correct answer)
- Perform lumbar puncture immediately
- Start IV lorazepam to prevent recurrence
Correct answer: Reassure parents and monitor; administer antipyretics
Most simple febrile seizures are self-limiting; antipyretics and parental education are the mainstay of management.
Question 4: You are performing a wound irrigation. What is the recommended irrigation pressure for a contaminated wound?
- 1–5 psi using a bulb syringe
- 8–15 psi using a 35mL syringe with 19-gauge angiocath (Correct answer)
- 30–40 psi using a high-pressure jet device
- No pressure; gravity drip irrigation is preferred
Correct answer: 8–15 psi using a 35mL syringe with 19-gauge angiocath
8–15 psi is the optimal irrigation pressure to remove bacteria and debris without damaging tissue.
Question 5: A patient on warfarin presents with an INR of 8.5 and is actively bleeding. Which intervention is most appropriate?
- Hold warfarin and recheck INR in 24 hours
- Administer vitamin K 2.5mg orally
- Administer 4-factor PCC and IV vitamin K (Correct answer)
- Transfuse fresh frozen plasma only
Correct answer: Administer 4-factor PCC and IV vitamin K
For life-threatening bleeding with supratherapeutic INR, 4-factor prothrombin complex concentrate (PCC) with IV vitamin K provides the fastest reversal.
Question 6: When performing a nasogastric tube insertion, how do you confirm correct placement before use?
- Auscultate for air bubbling over the epigastrium after injecting air
- Obtain a chest X-ray to confirm tip position
- Test aspirate pH; a value below 5.5 confirms gastric placement
- Both B and C are acceptable confirmation methods (Correct answer)
Correct answer: Both B and C are acceptable confirmation methods
Chest X-ray and aspirate pH testing below 5.5 are both accepted methods to confirm NG tube placement; auscultation alone is unreliable.
Question 7: A patient in hypertensive emergency has a BP of 220/130 mmHg with signs of end-organ damage. What is the target BP reduction in the first hour?
- Reduce to normal range (120/80) within 60 minutes
- Reduce mean arterial pressure by no more than 25% within the first hour (Correct answer)
- Reduce systolic BP by 50 mmHg within 30 minutes
- Reduce diastolic BP below 90 mmHg within 15 minutes
Correct answer: Reduce mean arterial pressure by no more than 25% within the first hour
Reducing MAP by no more than 25% in the first hour prevents cerebral ischemia from autoregulatory failure.
OSCE Treatment Protocols & Interventions 2
A patient presents with anaphylaxis after a bee sting.
What is the FIRST-line treatment?