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OSPE Medicine Set 1 SurgicoMed.com

OSPE MEDICINE SET 1

Case 1

A 28 years old woman complains of low mood and frequent crying spells. This problem

started few days after the birth of normal baby boy. There is no past or family history of such

problem.

1. What is your diagnosis? 1

2. Discuss treatment plan. 4

Key

1. Post-partum depression

2. Treatment plan involves;

Counselling

A short course of anti-depressants (such as fluoxetine) and or anti-psychotics

(such as haloperidol) may be indicated.

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Case 2

Match the physical finding with the diagnosis. (5 marks)

Physical findings Diagnosis

1. Peri-orbital puffiness 1. Right heart failure

2. Left sternal heave 2. Appendicitis

3. Pulsating liver 3. Right ventricular hypertrophy

4. Tenderness right iliac fossa 4. Consolidation

5. Bronchial breath sounds 5. Nephrotic syndrome

Key


1. Peri-orbital puffiness 1. Nephrotic syndrome

2. Left sternal heave 2. Right ventricular hypertrophy

3. Pulsating liver 3. Right heart failure

4. Tenderness right iliac fossa 4. Appendicitis

5. Bronchial breath sounds 5. Consolidation





Case 3

1. What is the neurological abnormality? 1

2. Name two signs which are shown? 1

3. What is commonest cause of this condition? 1

4. If she has a vesicular rash on her ear, what will you call it? 2

Key 1. Left lower motor neuron palsy of VIIth nerve (must mention side)

2. Other signs:

Deviation of angle of mouth to normal (right)

Flattened nasolabial folds

Prominent palpebral fissure

3. Idiopathic called Bell’s palsy due to Herpes Simplex infection

4. Ramsey Hunt Syndrome





Case 4

1. Name the sign? 1

2. Name three other signs that may be present in this patient? 3

3. What is the commonest cause of this condition? 1

Key

1. Spider angioma

2. Other signs: (any three signs of cirrhosis)

Ascites

Splenomegaly

Gynecomastia

3. Cirrhosis of liver





Case 5

1. Describe the abnormality in the photographs? 1

2. What is the most likely diagnosis? 1

3. Name the diagnostic test? 1

4. What are the four treatment options? 2

Key 1. Bilateral ptosis and lack of facial expression

2. Myasthenia gravis

3. Edrophonium (Tensilon) test

4. Treatment:

Pyridostigmine (Anti-cholinesterase)

Corticosteroids

Immunosuppression

Thymectomy





Case 6 Match the physical finding with the diagnosis. (5 marks)


1. Ptosis 1. Myelofibrosis

2. Cyanosis 2. Emphysema

3. Murmur 3. Cardiac tamponade

4. Splenomegaly 4. Hyperthyroidism

5. Pulsus paradoxus 5. Myasthenia gravis

Key


1. Ptosis 1. Myasthenia gravis

2. Cyanosis 2. Emphysema

3. Murmur 3. Hyperthyroidism

4. Splenomegaly 4. Myelofibrosis

5. Pulsus paradoxus 5. Cardiac tamponade

6.





Case 7

1. Name two indications? 2

2. Name two side effects? 2

3. Name one substitute? 1

Key 1. Indications:

Cardiogenic shock (must)

Septicemic shock

Hypovolemic shock

2. Side effects:

Tachycardia or arrhythmia

Renal vasoconstriction due to excessive α-adrenergic effect

3. Dopamine or Nor-epinephrine





Case 8

1. What is the rhythm called? 1

2. What may be two abnormality in the examination of radial pulse? 2

3. Enumerate four causes? 2

Key 1. Atrial fibrillation

2. Irregularly irregular, pulse deficit

3. Causes:

Mitral stenosis

Thyrotoxicosis

Ischemic heart disease

Drugs (adrenaline, atropine)

Lung diseases

Idiopathic





Case 9

The gentle man sitting in front of you has been recently diagnosed to have positive anti-HCV.

Please council him regarding;

1. The prognosis of this condition. 2

2. Diet. 2

3. Advice to the family as a whole. 1

Key

1. Prognosis:

Slowly progressive disease

No need to panic

Prognosis is generally good except in advanced disease

2. The candidate must emphasize that no dietary restrictions are required.

3. Strict isolation is not required.





Case 10

1. Calculate the heart rate? 2

2. What is the rhythm? 1

3. Name four causes? 2

Key

1. 150 bpm (1500/RR interval i-e small boxes)

2. Sinus tachycardia

3. Causes:

Anxiety

Fever

Hyperthyroidism

Shock





Case 11 A 50 years old man presented with chronic productive cough.

1. What sign is shown in the photograph?

2. Write 4 possible diagnosis in this patient?

3. Name three specific investigations to find out the underlying cause?

Key 1. Clubbing grade 3

2. Differential Diagnosis: (only pulmonary causes are to described)

Bronchiectasis

Lung cancer

Pulmonary fibrosis

Emphysema

Cystic fibrosis

3. Investigations:

X-ray chest

High resolution CT chest

Bronchoscopy

Sputum examination





Case 12

A 15 years old boy has shortness of breath on exertion and palpitation. Physical examination

reveals parasternal heave and splitting of second heart sound. The following is the cardiac

catheterization of the patient;

Chamber Oxygen Saturation (%) Superior vena cave 69

Inferior vena cava 65 Right atrium 81

Right ventricle 82

1. What is the salient abnormality in this data? 2

2. What is the diagnosis? 2

3. What is the most important finding on cardiac auscultation? 1

Key

1. There is increase in oxygen saturation in the right atrium where oxygen saturation is

usually about 65%-70% in normal circumstances. This child has atrial septal defect

(ASD) with left to right shunt.

2. ASD (atrial septal defect)

3. Wide fixed splitting of second heart sound





Case 13

1. Two indications of its intravenous use? 2

2. When administered subcutaneously, what is its peak action time? 1

3. List two side effects? 2

Key 1. Indications:

Diabetic ketoacidosis

Hyperkalemia

Hyperosmolar non-ketosis

Diabetes and surgery

2. 2-4 hours

3. Side effects

Hypersensitivity reaction (urticarial, rash etc.)

Hypoglycemia

Fat hypertrophy/atrophy (at injection site)





Case 14

1. Identify the instrument? 1

2. Describe the instrument? 1

3. What is its most common use? 1

4. Demonstrate its use on an imaginary patient. 2

Key 1. Laryngoscope

2. Laryngoscope consists of:

A. Handle and battery case

B. Blade with light bulb

3. Description to the examiners satisfaction





Case 15

Observed Station

A 25 years old young man presented with sudden onset chest pain followed by dyspnea. He

used to smoke approximately 10 cigarette a day but was otherwise asymptomatic. On

examination, breath sounds are reduced on right side. Trachea and apex beat were felt at

normal position. Percussion note is resonant as compared to other side.

1. What is the most likely diagnosis? Give arguments. 2

2. What would you suspect if his condition becomes critical ? 1

3. What single therapeutic step is most to save his life from this complication? 2

Key

1. Spontaneous pneumothorax. Reduced VR and VF (to be counted 1) and cyanosis

2. Tension pneumothorax

3. Chest intubation





Case 16

Observed Station

A 22 years old girl presents with the history of palpitation, tremor and insomnia. This

problem started over few days before her final professional examination. There is no past

or family history of such problem. GPE reveals heart rate 114/min and BP 140/80 mmHg.

Thyroid examination is normal.

1. What is the most likely diagnosis? 1

2. Explain to her the nature of the problem and how to cope with it? 3

3. How can you control her symptoms? 1

Key

1. Acute anxiety

2. Examiners satisfaction

3. Psychotherapy and drugs like benzodiazepines and β-blockers etc.





Case 17

Observed Station

The gentle man sitting in front of you has recently been diagnosed as diabetic. Please council

him regarding diet and lifestyle changes.

Key

Following points should be emphasized;

Reduce food intake especially carbohydrates and fat

Restrict sugars

Reduce weight

Regular aerobic exercise

Quit smoking




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