ESTUDYR
Yale School of Medicine OSCE: Elite Physical Examination
Mastery & Diagnostic Performance Assessment
(Comprehensive Honors Simulation 1–75)
1.
A student begins a cardiovascular exam on a 65-year-old man with exertional chest pain. Which
action must be performed before auscultation to properly assess venous pressure?
A. Palpate carotid arteries simultaneously
B. Lay patient flat at 0°
C. Position patient at 30–45° and inspect the internal jugular vein
D. Ask patient to hold breath
E. Percuss the precordium
Correct Answer: C. Position patient at 30–45° and inspect the internal jugular vein
Rationale:
JVP assessment requires proper positioning (30–45°). Flat positioning obscures venous
pulsations. Simultaneous carotid palpation is unsafe.
2.
A crescendo-decrescendo systolic murmur radiates to the carotids. Which maneuver strengthens
suspicion for aortic stenosis?
A. Listening with bell at apex in left lateral position
B. Auscultating while patient leans forward
C. Palpating for delayed carotid upstroke
D. Asking patient to squat
E. Checking for S3
Correct Answer: C. Palpating for delayed carotid upstroke
Rationale:
Aortic stenosis produces pulsus parvus et tardus (weak, delayed carotid pulse). Radiation to
carotids is classic.
,ESTUDYR
3.
Failure to assess which of the following is considered a major scoring deduction in a Yale-style
OSCE cardiovascular station?
A. PMI location
B. Radial pulse
C. Jugular venous pressure
D. Capillary refill
E. Blood pressure
Correct Answer: C. Jugular venous pressure
Rationale:
JVP is essential in dyspnea/cardiac scenarios. Omission suggests incomplete volume assessment.
2. Respiratory Examination
4.
A student percusses a patient with sudden dyspnea and finds hyperresonance with absent breath
sounds on one side. Most likely finding?
A. Pleural effusion
B. Lobar pneumonia
C. Pneumothorax
D. Pulmonary edema
E. Asthma exacerbation
Correct Answer: C. Pneumothorax
Rationale:
Hyperresonance + absent sounds = air in pleural space.
5.
Which technique is required to accurately assess tactile fremitus?
A. Use fingertips
B. Use ulnar edge of hand
C. Ask patient to whisper
, ESTUDYR
D. Percuss during exhalation
E. Press deeply with thumbs
Correct Answer: B. Use ulnar edge of hand
Rationale:
Ulnar edge or palmar base detects vibratory transmission best.
6.
Which finding suggests pleural effusion?
A. Hyperresonance
B. Increased fremitus
C. Bronchial breath sounds
D. Dullness to percussion with decreased breath sounds
E. Crackles only
Correct Answer: D. Dullness to percussion with decreased breath sounds
Rationale:
Fluid dampens vibration and sound transmission.
3. Abdominal Examination
7.
Correct sequence of abdominal exam?
A. Inspection → Palpation → Percussion → Auscultation
B. Auscultation → Inspection → Palpation → Percussion
C. Inspection → Auscultation → Percussion → Palpation
D. Palpation → Inspection → Auscultation → Percussion
E. Percussion → Auscultation → Inspection → Palpation
Correct Answer: C. Inspection → Auscultation → Percussion → Palpation
Rationale:
Palpation before auscultation may alter bowel sounds.
Yale School of Medicine OSCE: Elite Physical Examination
Mastery & Diagnostic Performance Assessment
(Comprehensive Honors Simulation 1–75)
1.
A student begins a cardiovascular exam on a 65-year-old man with exertional chest pain. Which
action must be performed before auscultation to properly assess venous pressure?
A. Palpate carotid arteries simultaneously
B. Lay patient flat at 0°
C. Position patient at 30–45° and inspect the internal jugular vein
D. Ask patient to hold breath
E. Percuss the precordium
Correct Answer: C. Position patient at 30–45° and inspect the internal jugular vein
Rationale:
JVP assessment requires proper positioning (30–45°). Flat positioning obscures venous
pulsations. Simultaneous carotid palpation is unsafe.
2.
A crescendo-decrescendo systolic murmur radiates to the carotids. Which maneuver strengthens
suspicion for aortic stenosis?
A. Listening with bell at apex in left lateral position
B. Auscultating while patient leans forward
C. Palpating for delayed carotid upstroke
D. Asking patient to squat
E. Checking for S3
Correct Answer: C. Palpating for delayed carotid upstroke
Rationale:
Aortic stenosis produces pulsus parvus et tardus (weak, delayed carotid pulse). Radiation to
carotids is classic.
,ESTUDYR
3.
Failure to assess which of the following is considered a major scoring deduction in a Yale-style
OSCE cardiovascular station?
A. PMI location
B. Radial pulse
C. Jugular venous pressure
D. Capillary refill
E. Blood pressure
Correct Answer: C. Jugular venous pressure
Rationale:
JVP is essential in dyspnea/cardiac scenarios. Omission suggests incomplete volume assessment.
2. Respiratory Examination
4.
A student percusses a patient with sudden dyspnea and finds hyperresonance with absent breath
sounds on one side. Most likely finding?
A. Pleural effusion
B. Lobar pneumonia
C. Pneumothorax
D. Pulmonary edema
E. Asthma exacerbation
Correct Answer: C. Pneumothorax
Rationale:
Hyperresonance + absent sounds = air in pleural space.
5.
Which technique is required to accurately assess tactile fremitus?
A. Use fingertips
B. Use ulnar edge of hand
C. Ask patient to whisper
, ESTUDYR
D. Percuss during exhalation
E. Press deeply with thumbs
Correct Answer: B. Use ulnar edge of hand
Rationale:
Ulnar edge or palmar base detects vibratory transmission best.
6.
Which finding suggests pleural effusion?
A. Hyperresonance
B. Increased fremitus
C. Bronchial breath sounds
D. Dullness to percussion with decreased breath sounds
E. Crackles only
Correct Answer: D. Dullness to percussion with decreased breath sounds
Rationale:
Fluid dampens vibration and sound transmission.
3. Abdominal Examination
7.
Correct sequence of abdominal exam?
A. Inspection → Palpation → Percussion → Auscultation
B. Auscultation → Inspection → Palpation → Percussion
C. Inspection → Auscultation → Percussion → Palpation
D. Palpation → Inspection → Auscultation → Percussion
E. Percussion → Auscultation → Inspection → Palpation
Correct Answer: C. Inspection → Auscultation → Percussion → Palpation
Rationale:
Palpation before auscultation may alter bowel sounds.
