NAC OSCE Physical Examination

Question 1

During a cardiovascular examination in a NAC OSCE station, auscultation reveals a mid-systolic click followed by a late systolic murmur at the apex. What is the MOST likely diagnosis?

Accepted Answer

Mitral valve prolapse

Answer

A mid-systolic click followed by a late systolic murmur at the apex is the classic auscultatory finding of mitral valve prolapse, an important diagnosis in the MCCQE objectives.

Question 2

When examining a patient with suspected right heart failure, which physical finding is MOST specific for elevated central venous pressure in Canadian clinical practice?

Accepted Answer

Elevated jugular venous pressure (JVP) above the sternal angle with the patient at 45°

Answer

JVP measured above the sternal angle at 45° is the standard Canadian method taught for estimating CVP; it is more specific for right heart failure than peripheral oedema.

Question 3

During a respiratory examination, you find dullness to percussion, reduced breath sounds, and absent tactile fremitus over the right lower zone. What is the MOST likely cause?

Accepted Answer

Pleural effusion

Answer

Pleural effusion classically produces dullness to percussion, reduced breath sounds, and absent tactile fremitus; consolidation would preserve or increase fremitus and produce bronchial breath sounds.

Question 4

In a NAC OSCE abdominal examination station, which manoeuvre is used to distinguish a spleen from other left upper quadrant masses?

Accepted Answer

The spleen moves towards the right iliac fossa on inspiration and has a notched medial border

Answer

The spleen characteristically moves diagonally toward the right iliac fossa on inspiration and has a palpable medial notch, distinguishing it from renal or colonic masses.

Question 5

A 65-year-old male has asymmetric leg swelling and calf tenderness. Which bedside test is used to assess for deep vein thrombosis, and what is its sensitivity?

Accepted Answer

Homans' sign — however, it has low sensitivity (~50%) and is no longer recommended as reliable

Answer

Homans' sign (pain on dorsiflexion) is historically taught but has poor sensitivity (~50%) and specificity; Canadian guidelines recommend clinical scoring (Wells score) combined with D-dimer or imaging instead.

NAC OSCE Practice Test

NAC OSCE Practice Test

NAC OSCE Physical Examination