OSCE Practical/Clinical Examination
Target Audience: Medical students, postgraduate trainees, and
healthcare professionals preparing for Objective Structured Clinical
Examinations (OSCEs)
Difficulty Level: Mixed (ranging from foundational to advanced clinical
reasoning)
180 questions&answers
1. A 65-year-old male presents with acute onset of severe, tearing
chest pain radiating to the back. His blood pressure is 160/90
mmHg in the right arm and 110/70 mmHg in the left arm. Which
of the following is the most appropriate initial investigation to
confirm the suspected diagnosis?
A. Computed tomography angiography (CTA) of the chest
B. Standard 12-lead electrocardiogram (ECG)
C. Chest X-ray
D. Transthoracic echocardiogram
Correct answer: A
Rationale:: The clinical presentation of tearing chest pain with a
differential in blood pressure between arms is highly suggestive of
acute aortic dissection. CTA of the chest is the gold-standard
investigation with high sensitivity and specificity for confirming aortic
dissection. ECG (B) may show non-specific changes but is not
diagnostic. Chest X-ray (C) may show a widened mediastinum but is
insensitive. Transthoracic echocardiogram (D) can visualise the aortic
1
,root but is operator-dependent and less reliable for the entire thoracic
aorta.
2. During a respiratory examination, a 72-year-old female with a
history of smoking presents with progressive dyspnoea. On
auscultation, you note diminished breath sounds, prolonged
expiration, and end-expiratory wheezes. Percussion note is
resonant. Which of the following is the most likely diagnosis?
A. Pulmonary fibrosis
B. Chronic obstructive pulmonary disease (COPD)
C. Pleural effusion
D. Lobar pneumonia
Correct answer: B
Rationale:: The combination of diminished breath sounds, prolonged
expiration, and end-expiratory wheezes in a smoker with progressive
dyspnoea is characteristic of COPD. Pulmonary fibrosis (A) would
present with fine end-inspiratory crackles. Pleural effusion (C) would
demonstrate dullness to percussion. Lobar pneumonia (D) would
present with bronchial breathing and crackles over the affected area.
3. A 45-year-old female presents with a 3-month history of
progressive weakness in her proximal muscles, a heliotrope rash
over her eyelids, and Gottron's papules over her knuckles. She
also reports difficulty swallowing. Which of the following
investigations is most specific for diagnosing this condition?
2
,A. Serum creatine kinase (CK) level
B. Anti-Jo-1 antibody
C. Antinuclear antibody (ANA)
D. Electromyography (EMG)
Correct answer: B
Rationale:: The clinical presentation is classic for dermatomyositis.
Anti-Jo-1 antibody is highly specific for dermatomyositis and
polymyositis, particularly when associated with interstitial lung
disease. Serum CK (A) is elevated but non-specific. ANA (C) is positive
in many connective tissue diseases. EMG (D) shows characteristic
myopathic changes but is not specific to dermatomyositis.
4. A 28-year-old male presents with acute-onset right lower
quadrant abdominal pain, nausea, and anorexia. On
examination, he has tenderness at McBurney's point with
rebound tenderness. Which of the following signs would most
strongly support the diagnosis of acute appendicitis?
A. Psoas sign
B. Obturator sign
C. Rovsing's sign
D. Murphy's sign
Correct answer: C
Rationale:: Rovsing's sign—pain in the right lower quadrant upon
palpation of the left lower quadrant—is a classic sign of peritoneal
irritation and strongly supports acute appendicitis. Psoas sign (A) and
obturator sign (B) are suggestive but less specific. Murphy's sign (D) is
associated with cholecystitis, not appendicitis.
3
, 5. A 55-year-old male with a history of hypertension and diabetes
presents with sudden-onset, painless loss of vision in his left eye.
Fundoscopic examination reveals a pale retina with a cherry-red
spot at the fovea. Which of the following is the most likely
diagnosis?
A. Central retinal vein occlusion (CRVO)
B. Central retinal artery occlusion (CRAO)
C. Acute angle-closure glaucoma
D. Optic neuritis
Correct answer: B
Rationale:: The classic finding of a pale retina with a cherry-red spot at
the fovea is pathognomonic for CRAO. CRVO (A) presents with retinal
haemorrhages and venous tortuosity. Acute angle-closure glaucoma
(C) presents with pain, redness, and a hazy cornea. Optic neuritis (D)
presents with painful eye movement and decreased visual acuity, but
the fundus is often normal initially.
6. A 32-year-old female presents with episodes of palpitations,
sweating, and anxiety. During one episode, her blood pressure is
180/110 mmHg and heart rate is 120 bpm. Between episodes,
she is normotensive. Which of the following is the most
appropriate next step in diagnosis?
A. 24-hour ambulatory blood pressure monitoring
B. Plasma metanephrines and urinary catecholamines
4
Target Audience: Medical students, postgraduate trainees, and
healthcare professionals preparing for Objective Structured Clinical
Examinations (OSCEs)
Difficulty Level: Mixed (ranging from foundational to advanced clinical
reasoning)
180 questions&answers
1. A 65-year-old male presents with acute onset of severe, tearing
chest pain radiating to the back. His blood pressure is 160/90
mmHg in the right arm and 110/70 mmHg in the left arm. Which
of the following is the most appropriate initial investigation to
confirm the suspected diagnosis?
A. Computed tomography angiography (CTA) of the chest
B. Standard 12-lead electrocardiogram (ECG)
C. Chest X-ray
D. Transthoracic echocardiogram
Correct answer: A
Rationale:: The clinical presentation of tearing chest pain with a
differential in blood pressure between arms is highly suggestive of
acute aortic dissection. CTA of the chest is the gold-standard
investigation with high sensitivity and specificity for confirming aortic
dissection. ECG (B) may show non-specific changes but is not
diagnostic. Chest X-ray (C) may show a widened mediastinum but is
insensitive. Transthoracic echocardiogram (D) can visualise the aortic
1
,root but is operator-dependent and less reliable for the entire thoracic
aorta.
2. During a respiratory examination, a 72-year-old female with a
history of smoking presents with progressive dyspnoea. On
auscultation, you note diminished breath sounds, prolonged
expiration, and end-expiratory wheezes. Percussion note is
resonant. Which of the following is the most likely diagnosis?
A. Pulmonary fibrosis
B. Chronic obstructive pulmonary disease (COPD)
C. Pleural effusion
D. Lobar pneumonia
Correct answer: B
Rationale:: The combination of diminished breath sounds, prolonged
expiration, and end-expiratory wheezes in a smoker with progressive
dyspnoea is characteristic of COPD. Pulmonary fibrosis (A) would
present with fine end-inspiratory crackles. Pleural effusion (C) would
demonstrate dullness to percussion. Lobar pneumonia (D) would
present with bronchial breathing and crackles over the affected area.
3. A 45-year-old female presents with a 3-month history of
progressive weakness in her proximal muscles, a heliotrope rash
over her eyelids, and Gottron's papules over her knuckles. She
also reports difficulty swallowing. Which of the following
investigations is most specific for diagnosing this condition?
2
,A. Serum creatine kinase (CK) level
B. Anti-Jo-1 antibody
C. Antinuclear antibody (ANA)
D. Electromyography (EMG)
Correct answer: B
Rationale:: The clinical presentation is classic for dermatomyositis.
Anti-Jo-1 antibody is highly specific for dermatomyositis and
polymyositis, particularly when associated with interstitial lung
disease. Serum CK (A) is elevated but non-specific. ANA (C) is positive
in many connective tissue diseases. EMG (D) shows characteristic
myopathic changes but is not specific to dermatomyositis.
4. A 28-year-old male presents with acute-onset right lower
quadrant abdominal pain, nausea, and anorexia. On
examination, he has tenderness at McBurney's point with
rebound tenderness. Which of the following signs would most
strongly support the diagnosis of acute appendicitis?
A. Psoas sign
B. Obturator sign
C. Rovsing's sign
D. Murphy's sign
Correct answer: C
Rationale:: Rovsing's sign—pain in the right lower quadrant upon
palpation of the left lower quadrant—is a classic sign of peritoneal
irritation and strongly supports acute appendicitis. Psoas sign (A) and
obturator sign (B) are suggestive but less specific. Murphy's sign (D) is
associated with cholecystitis, not appendicitis.
3
, 5. A 55-year-old male with a history of hypertension and diabetes
presents with sudden-onset, painless loss of vision in his left eye.
Fundoscopic examination reveals a pale retina with a cherry-red
spot at the fovea. Which of the following is the most likely
diagnosis?
A. Central retinal vein occlusion (CRVO)
B. Central retinal artery occlusion (CRAO)
C. Acute angle-closure glaucoma
D. Optic neuritis
Correct answer: B
Rationale:: The classic finding of a pale retina with a cherry-red spot at
the fovea is pathognomonic for CRAO. CRVO (A) presents with retinal
haemorrhages and venous tortuosity. Acute angle-closure glaucoma
(C) presents with pain, redness, and a hazy cornea. Optic neuritis (D)
presents with painful eye movement and decreased visual acuity, but
the fundus is often normal initially.
6. A 32-year-old female presents with episodes of palpitations,
sweating, and anxiety. During one episode, her blood pressure is
180/110 mmHg and heart rate is 120 bpm. Between episodes,
she is normotensive. Which of the following is the most
appropriate next step in diagnosis?
A. 24-hour ambulatory blood pressure monitoring
B. Plasma metanephrines and urinary catecholamines
4
