OSCE Treatment Protocols & Interventions 3 — Questions and Answers
Question 1: A patient with ST-elevation MI is being prepared for primary PCI. In addition to aspirin, which antiplatelet agent is recommended?
- Clopidogrel 75mg daily
- Ticagrelor 180mg loading dose (Correct answer)
- Dipyridamole 200mg
- Cilostazol 100mg
Correct answer: Ticagrelor 180mg loading dose
Ticagrelor 180mg loading dose (or prasugrel/clopidogrel) is added to aspirin as dual antiplatelet therapy for STEMI patients undergoing PCI.
Question 2: You are suturing a facial laceration. Which suture material is most appropriate for the skin closure?
- 2-0 Vicryl (absorbable)
- 5-0 Prolene (non-absorbable monofilament) (Correct answer)
- 3-0 Chromic gut
- 4-0 Silk
Correct answer: 5-0 Prolene (non-absorbable monofilament)
5-0 or 6-0 non-absorbable monofilament (Prolene/Nylon) is preferred for facial lacerations to minimize scarring and allow precise removal.
Question 3: During an OSCE station, a patient with asthma fails to respond to two back-to-back albuterol nebulizers. What is the next appropriate step?
- Discharge with a prescription for oral prednisone
- Add ipratropium bromide nebulizer and systemic corticosteroids (Correct answer)
- Intubate immediately for airway protection
- Administer IV aminophylline as first escalation
Correct answer: Add ipratropium bromide nebulizer and systemic corticosteroids
Ipratropium bromide combined with systemic corticosteroids is the next step for moderate-to-severe asthma not responding to initial bronchodilators.
Question 4: A patient requires procedural sedation. You administer midazolam and the patient becomes apneic. What reversal agent should you administer?
- Naloxone 0.4mg IV
- Flumazenil 0.2mg IV (Correct answer)
- Physostigmine 1mg IV
- Neostigmine 0.5mg IV
Correct answer: Flumazenil 0.2mg IV
Flumazenil competitively reverses benzodiazepine-induced sedation and respiratory depression.
Question 5: A 70-year-old patient is prescribed metformin for type 2 diabetes. Which condition would CONTRAINDICATE this medication?
- Mild hypertension (BP 140/90)
- eGFR of 25 mL/min/1.73m² (Correct answer)
- Obesity with BMI 32
- HbA1c of 8.5%
Correct answer: eGFR of 25 mL/min/1.73m²
Metformin is contraindicated when eGFR falls below 30 mL/min/1.73m² due to risk of lactic acidosis from drug accumulation.
Question 6: You are managing a patient with tension pneumothorax. After needle decompression, the patient deteriorates again. What is the definitive treatment?
- Repeat needle decompression on the same side
- Needle decompression on the opposite side
- Chest tube insertion (tube thoracostomy) (Correct answer)
- Pericardiocentesis
Correct answer: Chest tube insertion (tube thoracostomy)
Tube thoracostomy is the definitive treatment for tension pneumothorax; needle decompression is a temporizing measure.
Question 7: A patient with suspected meningitis requires a lumbar puncture. CSF opening pressure is elevated. Which finding in the CSF would MOST suggest bacterial meningitis?
- Glucose 60 mg/dL, protein 45 mg/dL, WBC 5 (lymphocyte predominant)
- Glucose 20 mg/dL, protein 280 mg/dL, WBC 1800 (neutrophil predominant) (Correct answer)
- Glucose 50 mg/dL, protein 80 mg/dL, WBC 200 (lymphocyte predominant)
- Xanthochromic fluid with RBC 10,000
Correct answer: Glucose 20 mg/dL, protein 280 mg/dL, WBC 1800 (neutrophil predominant)
Bacterial meningitis classically presents with very low CSF glucose, markedly elevated protein, and neutrophil-predominant pleocytosis.
OSCE Treatment Protocols & Interventions 3
A patient with ST-elevation MI is being prepared for primary PCI.
In addition to aspirin, which antiplatelet agent is recommended?