How many stations are on the NAC OSCE?

The NAC Examination has 12 stations: 10 that count toward your score and 2 unscored pilot stations. Each station is 11 minutes long with 2 minutes between stations.

What disciplines does the NAC OSCE cover?

Stations are drawn from Medicine, Surgery, Pediatrics, Obstetrics and Gynecology, Psychiatry, and Preventive Medicine and Public Health, and you may be assessed on up to 7 competencies per station.

How is the NAC OSCE scored?

Physician examiners rate competencies such as history taking, physical examination, diagnosis, management, investigations, data interpretation, and communication. Results are reported as Fail, Pass, or Pass with Superior Performance; candidates do not receive a numeric score.

How much does the NAC Examination cost in 2026?

The 2026 application fee is CAD $3,320 and is non-refundable, with a CAD $538 withdrawal fee if you withdraw before the deadline. The exam is offered in spring and fall at designated centres across Canada.

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A 45-year-old woman presents with sudden severe epigastric pain radiating to the back, vomiting, and a history of gallstones. Serum lipase is markedly elevated. Which initial management is most appropriate for acute pancreatitis?

Aggressive IV fluid resuscitation, analgesia, and bowel rest with monitoring

Oral feeding with high-fat diet to maintain nutrition

Immediate ERCP for all patients regardless of cholangitis

Empiric broad-spectrum antibiotics for every case of pancreatitis

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Sample NAC OSCE Practice Questions

Try these sample questions to test your NAC OSCE exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 58-year-old man presents with crushing substernal chest pain radiating to the left arm for 40 minutes, with diaphoresis and nausea. His ECG shows 2 mm ST elevation in leads II, III, and aVF. In a NAC OSCE station, what is the single most time-critical management priority after confirming the diagnosis?

A.Arrange urgent reperfusion (primary PCI or thrombolysis) and give aspirin 160-325 mg chewed

B.Order a troponin and wait for the result before any treatment

C.Start an oral beta-blocker and discharge with cardiology follow-up

D.Obtain a CT pulmonary angiogram to exclude pulmonary embolism

Explanation: ST elevation in II, III, aVF indicates an inferior STEMI. Time-to-reperfusion drives mortality, so immediate aspirin and activation of primary PCI (or thrombolysis if PCI is unavailable within the recommended window) is the priority. Examiners reward decisive, guideline-based management here.

2During a focused history station, a 24-year-old woman reports a 3-week history of fatigue, polyuria, polydipsia, and 6 kg unintentional weight loss. Random capillary glucose is 19 mmol/L. Which finding on history would most strongly suggest she needs urgent assessment for diabetic ketoacidosis rather than routine clinic follow-up?

A.A family history of type 2 diabetes

B.Nausea, vomiting, and deep rapid breathing

C.Mild blurred vision that improves with rest

D.Increased appetite over the past month

Explanation: Vomiting, abdominal pain, and Kussmaul (deep, rapid) breathing signal the metabolic acidosis of DKA, a medical emergency in newly diagnosed type 1 diabetes. Recognizing these red flags and triaging to the emergency department demonstrates safe management to examiners.

3A 70-year-old woman with COPD presents with increased dyspnea, increased sputum volume, and new sputum purulence over 2 days. She is afebrile, alert, with SpO2 88% on room air. According to the Anthonisen criteria used in Canadian practice, this presentation most supports which management decision?

A.High-flow oxygen titrated to SpO2 100% and immediate intubation

B.Inhaled bronchodilators alone with no antibiotics or steroids

C.Antibiotics plus systemic corticosteroids and controlled oxygen titrated to SpO2 88-92%

D.Discharge home with reassurance and a follow-up appointment in 6 weeks

Explanation: All three cardinal Anthonisen symptoms (increased dyspnea, sputum volume, and purulence) define a severe COPD exacerbation warranting antibiotics and corticosteroids. In COPD, oxygen is titrated to a target of 88-92% to avoid CO2 retention. This integrated answer reflects safe management.

4A 65-year-old man presents with sudden right-sided weakness and slurred speech that began 90 minutes ago. CT head shows no hemorrhage. His blood pressure is 168/92 mmHg and capillary glucose is 6.2 mmol/L. What is the most appropriate next step?

A.Lower the blood pressure rapidly to below 120/80 mmHg with IV labetalol

B.Start aspirin immediately and admit for observation only

C.Give IV mannitol to reduce presumed cerebral edema

D.Assess eligibility for IV thrombolysis (tPA) and consider endovascular thrombectomy

Explanation: An acute ischemic stroke within the thrombolysis window and no hemorrhage on CT should be assessed urgently for tPA, with thrombectomy considered for large-vessel occlusion. Identifying the time window and the reperfusion pathway is the key safe action.

5In a focused history station, a 45-year-old man complains of episodic epigastric burning that worsens 2-3 hours after meals and at night, relieved by food and antacids. Which feature in the history is the most important alarm symptom that would change your management toward urgent endoscopy?

A.Progressive dysphagia and unintentional weight loss

B.Symptom relief with over-the-counter antacids

C.Burning that is worse when lying flat after meals

D.A history of occasional non-bloody belching

Explanation: Dysphagia, odynophagia, weight loss, anemia, GI bleeding, and persistent vomiting are alarm ('red flag') features in dyspepsia that mandate urgent endoscopy to exclude malignancy. Eliciting and acting on alarm symptoms is core to safe dyspepsia management.

6A 30-year-old woman presents with a 2-day history of dysuria, frequency, and urgency, no fever, no flank pain, and no vaginal discharge. She is not pregnant. What is the most appropriate management for this uncomplicated lower urinary tract infection in Canadian primary care?

A.Urgent renal ultrasound and intravenous antibiotics

B.A short course of a first-line oral antibiotic such as nitrofurantoin or TMP-SMX

C.A 2-week course of oral ciprofloxacin as first-line therapy

D.No antibiotics and reassessment only if symptoms persist beyond 2 weeks

Explanation: Uncomplicated cystitis in a non-pregnant woman is treated empirically with a short course of a first-line agent such as nitrofurantoin or TMP-SMX. Fluoroquinolones are reserved due to resistance and adverse-effect concerns. This reflects antimicrobial stewardship.

7A 55-year-old man with newly diagnosed hypertension has an office blood pressure of 158/96 mmHg confirmed on repeated measurement, no diabetes, and no target-organ damage. Per Hypertension Canada guidance, which is the most appropriate first step before committing to lifelong pharmacotherapy?

A.Start three antihypertensive agents simultaneously at maximum doses

B.Begin an ACE inhibitor only after a 6-month trial of no intervention

C.Confirm the diagnosis with out-of-office measurement (home or ambulatory BP monitoring)

D.Order a renal angiogram to exclude renal artery stenosis in all patients

Explanation: Hypertension Canada recommends confirming elevated office readings with ambulatory or home BP monitoring to exclude white-coat hypertension before labelling and treating. Lifestyle counselling proceeds in parallel. This avoids overtreatment and demonstrates evidence-based practice.

8A 68-year-old woman presents with acute monoarticular pain, swelling, warmth, and redness of the right first metatarsophalangeal joint. She cannot bear weight. What is the most important investigation to distinguish gout from septic arthritis?

A.Serum uric acid level alone

B.Plain radiograph of the foot only

C.Empiric colchicine trial without any joint sampling

D.Joint aspiration with synovial fluid analysis (crystals, cell count, Gram stain, culture)

Explanation: Acute monoarthritis requires arthrocentesis to differentiate crystal arthropathy (negatively birefringent urate crystals) from septic arthritis, which is a joint emergency. Serum uric acid can be normal during an acute gout flare, so it cannot exclude the diagnosis.

9A 26-year-old woman presents with palpitations, heat intolerance, weight loss despite good appetite, and a fine tremor. Examination reveals a diffuse goitre and lid lag. Which combination of investigations best confirms the most likely diagnosis?

A.Low TSH with elevated free T4 and positive TSH-receptor antibodies

B.High TSH with low free T4

C.Normal TSH with elevated cortisol

D.Low TSH with low free T4 and low free T3

Explanation: The picture is Graves disease (primary hyperthyroidism). A suppressed TSH with elevated free T4 confirms hyperthyroidism, and TSH-receptor (TRAb) antibodies support an autoimmune Graves etiology. Correctly ordering and interpreting thyroid function is a tested competency.

10A 72-year-old man presents with a 3-month history of progressive exertional dyspnea, orthopnea, and bilateral ankle edema. JVP is elevated and there are bibasilar crackles and an S3 gallop. Which initial investigation is most useful to confirm heart failure and assess systolic function?

A.Coronary angiography as the first test

B.Transthoracic echocardiogram

C.24-hour Holter monitor

D.Pulmonary function tests

Explanation: Echocardiography is the key test to confirm heart failure and characterize ejection fraction (HFrEF vs HFpEF), valvular and diastolic function. BNP/NT-proBNP supports the diagnosis, and ECG and chest X-ray are adjuncts, but echo defines structure and function.

About the NAC OSCE Practice Questions

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