OBJECTIVE STRUCTURED KNOWLEDGE EXAMINATION
(OSKE) COMPREHENSIVE MEDICAL KNOWLEDGE
ASSESSMENT QUESTIONS
Exam Instructions
Format: This is a paper-based test consisting of 75 multiple-choice questions.
Time Allowed: 2 hours and 30 minutes (approximately 2 minutes per question).
Question Style: Each question presents a clinical vignette followed by several
possible answers. Select the one best answer.
Answer Sheet: Indicate your choice on a separate answer sheet by filling in the
corresponding bubble.
OSKE Practice Exam
1. A 65-year-old man with a history of hypertension and type 2 diabetes presents
to the emergency department with sudden, severe chest pain that radiates to his
back. His blood pressure is 210/120 mmHg in the right arm and 110/60 mmHg in
the left arm. A chest X-ray shows a widened mediastinum. What is the most
appropriate initial management step?
A. Administer sublingual nitroglycerin
B. Start an intravenous infusion of sodium nitroprusside
C. Order a high-resolution CT angiogram of the chest
D. Administer intravenous thrombolytics
E. Perform a pericardiocentesis
<br> <hr> <br>
,2. A 28-year-old woman presents with fatigue, weight gain, and constipation. On
physical examination, she has a delayed relaxation phase of deep tendon reflexes.
Laboratory studies show an elevated thyroid-stimulating hormone (TSH) and a low
free T4. Which of the following is the most likely finding on further physical
examination?
A. Exophthalmos
B. Fine resting tremor
C. Pretibial myxedema
D. Lid lag
E. Warm, moist skin
<br> <hr> <br>
3. A 45-year-old male with a history of alcohol use disorder presents with
confusion, ataxia, and ophthalmoplegia. Which of the following medications
should be administered immediately before any glucose-containing solutions?
A. Naloxone
B. Flumazenil
C. Thiamine
D. Glucose
E. Folate
<br> <hr> <br>
4. A 60-year-old woman is evaluated for a chronic cough. She reports that the
cough is sometimes productive of small amounts of mucus and has been present
for over a year. She denies fever, night sweats, or weight loss. She has never
smoked. A chest X-ray is unremarkable. Which of the following is the most
appropriate next step in management?
A. Prescribe a course of oral corticosteroids
B. Perform a high-resolution CT scan of the chest
C. Order pulmonary function tests with bronchodilator challenge
,D. Prescribe a proton-pump inhibitor (PPI) for a suspected trial of therapy
E. Refer for bronchoscopy
<br> <hr> <br>
5. A 3-year-old boy is brought to the clinic by his mother due to a limp. He is
afebrile and appears well. On examination, he holds his left leg in flexion and
external rotation, and range of motion of the hip is limited. Which of the
following is the most likely diagnosis?
A. Septic arthritis of the hip
B. Legg-Calvé-Perthes disease
C. Slipped capital femoral epiphysis (SCFE)
D. Transient synovitis of the hip
E. Developmental dysplasia of the hip (DDH)
<br> <hr> <br>
6. A patient with a history of opioid use disorder is brought to the emergency
department unresponsive. Respirations are 4 breaths per minute. After supporting
the airway, what is the next most appropriate intervention?
A. Administer oral naltrexone
B. Administer intravenous naloxone
C. Administer intramuscular epinephrine
D. Start a continuous infusion of propofol
E. Administer activated charcoal
<br> <hr> <br>
7. A 52-year-old man with cirrhosis secondary to hepatitis C is admitted with
confusion and asterixis. His family reports he has been acting strangely for the
past two days. Which of the following is a known precipitating factor for his
current condition?
A. Hyperkalemia
, B. Metabolic alkalosis
C. Hypernatremia
D. Constipation
E. Hyperoxia
<br> <hr> <br>
8. A 70-year-old man presents with a tremor in his right hand. He notes the tremor
is most prominent when his hand is resting in his lap. On examination, he has
rigidity in his right arm and a slow, shuffling gait. Which of the following is the
most likely diagnosis?
A. Essential tremor
B. Parkinson's disease
C. Huntington's disease
D. Cerebellar tremor
E. Wilson's disease
<br> <hr> <br>
9. A 25-year-old woman with systemic lupus erythematosus (SLE) presents with
acute onset of shortness of breath and pleuritic chest pain. A CT pulmonary
angiogram confirms a pulmonary embolism. Which of the following laboratory
abnormalities is most likely associated with her underlying condition?
A. Positive rheumatoid factor
B. Elevated creatine kinase
C. Antiphospholipid antibodies (lupus anticoagulant)
D. Anti-SSA (Ro) antibodies
E. Cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA)
<br> <hr> <br>
10. A newborn is noted to have cyanosis shortly after birth. A hyperoxia test is
performed, and the infant's arterial oxygen saturation fails to rise above 50%
(OSKE) COMPREHENSIVE MEDICAL KNOWLEDGE
ASSESSMENT QUESTIONS
Exam Instructions
Format: This is a paper-based test consisting of 75 multiple-choice questions.
Time Allowed: 2 hours and 30 minutes (approximately 2 minutes per question).
Question Style: Each question presents a clinical vignette followed by several
possible answers. Select the one best answer.
Answer Sheet: Indicate your choice on a separate answer sheet by filling in the
corresponding bubble.
OSKE Practice Exam
1. A 65-year-old man with a history of hypertension and type 2 diabetes presents
to the emergency department with sudden, severe chest pain that radiates to his
back. His blood pressure is 210/120 mmHg in the right arm and 110/60 mmHg in
the left arm. A chest X-ray shows a widened mediastinum. What is the most
appropriate initial management step?
A. Administer sublingual nitroglycerin
B. Start an intravenous infusion of sodium nitroprusside
C. Order a high-resolution CT angiogram of the chest
D. Administer intravenous thrombolytics
E. Perform a pericardiocentesis
<br> <hr> <br>
,2. A 28-year-old woman presents with fatigue, weight gain, and constipation. On
physical examination, she has a delayed relaxation phase of deep tendon reflexes.
Laboratory studies show an elevated thyroid-stimulating hormone (TSH) and a low
free T4. Which of the following is the most likely finding on further physical
examination?
A. Exophthalmos
B. Fine resting tremor
C. Pretibial myxedema
D. Lid lag
E. Warm, moist skin
<br> <hr> <br>
3. A 45-year-old male with a history of alcohol use disorder presents with
confusion, ataxia, and ophthalmoplegia. Which of the following medications
should be administered immediately before any glucose-containing solutions?
A. Naloxone
B. Flumazenil
C. Thiamine
D. Glucose
E. Folate
<br> <hr> <br>
4. A 60-year-old woman is evaluated for a chronic cough. She reports that the
cough is sometimes productive of small amounts of mucus and has been present
for over a year. She denies fever, night sweats, or weight loss. She has never
smoked. A chest X-ray is unremarkable. Which of the following is the most
appropriate next step in management?
A. Prescribe a course of oral corticosteroids
B. Perform a high-resolution CT scan of the chest
C. Order pulmonary function tests with bronchodilator challenge
,D. Prescribe a proton-pump inhibitor (PPI) for a suspected trial of therapy
E. Refer for bronchoscopy
<br> <hr> <br>
5. A 3-year-old boy is brought to the clinic by his mother due to a limp. He is
afebrile and appears well. On examination, he holds his left leg in flexion and
external rotation, and range of motion of the hip is limited. Which of the
following is the most likely diagnosis?
A. Septic arthritis of the hip
B. Legg-Calvé-Perthes disease
C. Slipped capital femoral epiphysis (SCFE)
D. Transient synovitis of the hip
E. Developmental dysplasia of the hip (DDH)
<br> <hr> <br>
6. A patient with a history of opioid use disorder is brought to the emergency
department unresponsive. Respirations are 4 breaths per minute. After supporting
the airway, what is the next most appropriate intervention?
A. Administer oral naltrexone
B. Administer intravenous naloxone
C. Administer intramuscular epinephrine
D. Start a continuous infusion of propofol
E. Administer activated charcoal
<br> <hr> <br>
7. A 52-year-old man with cirrhosis secondary to hepatitis C is admitted with
confusion and asterixis. His family reports he has been acting strangely for the
past two days. Which of the following is a known precipitating factor for his
current condition?
A. Hyperkalemia
, B. Metabolic alkalosis
C. Hypernatremia
D. Constipation
E. Hyperoxia
<br> <hr> <br>
8. A 70-year-old man presents with a tremor in his right hand. He notes the tremor
is most prominent when his hand is resting in his lap. On examination, he has
rigidity in his right arm and a slow, shuffling gait. Which of the following is the
most likely diagnosis?
A. Essential tremor
B. Parkinson's disease
C. Huntington's disease
D. Cerebellar tremor
E. Wilson's disease
<br> <hr> <br>
9. A 25-year-old woman with systemic lupus erythematosus (SLE) presents with
acute onset of shortness of breath and pleuritic chest pain. A CT pulmonary
angiogram confirms a pulmonary embolism. Which of the following laboratory
abnormalities is most likely associated with her underlying condition?
A. Positive rheumatoid factor
B. Elevated creatine kinase
C. Antiphospholipid antibodies (lupus anticoagulant)
D. Anti-SSA (Ro) antibodies
E. Cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA)
<br> <hr> <br>
10. A newborn is noted to have cyanosis shortly after birth. A hyperoxia test is
performed, and the infant's arterial oxygen saturation fails to rise above 50%
