You are on page 1of 15

To

The Controller of Examinations


University of Health Sciences
Lahore

Subject: Model OSPE (Objectively Structured Performance Evaluation) Questions of


Pharmacology for 2nd Professional MBBS Examination

With reference to your letter No. UHS/CE-08/801, dated 17-06-2008, the detailed list of
laboratory activities in the department of Pharmacology & Therapeutics that the students perform at
Lahore Medical & Dental College during the course of study, is attached along with 32 OSPE
questions.

Yours Sincerely,

Head of Department of
Pharmacology & Therapeutics
Lahore Medical & Dental College
Lahore
List of Experiments Performed by Students at LMDC

The following experimental pharmacology practicals are performed by students of 3rd Year MBBS
during the course of study:

1. To demonstrate the effects of drugs on Rabbit’s eyes (Parasympathomimetics, Anti-


cholinergics, sympathomimetics and local anesthetics)
2. To Identify the group of the unknown drug by demonstrating its effects on Rabbit’s eyes
3. To Draw a simple dose response curve of Acetylcholine’s effects on rabbit’s ileum
4. To demonstrate competitive antagonism between Acetylcholine and Atropine by observing
their actions on rabbit’s ileum
5. To demonstrate the effects of different drugs (Propranolol, Adrenaline, Acetylcholine and
Atropine) on frog’s heart
6. To determine effect on the reflex time of frog after application/administration of various
drugs (Caffeine, diazepam and Lignocaine)
7. To determine the effects of various drugs (Phenylephrine/Xylometazoline, Prazosin,
Adrenaline, Acetylcholine) on blood vessels of frog
8. To record and calculate biostatistical data including Mean, variance, Standard deviation,
Standard error of the Mean, t value and P values from T tables and its significance, by taking
readings of BP/Pulse from 6 subjects.
Model OSPE Questions with Key

OSPE Questions for Observed Stations

Q1. Determine the faults in the following experimental set-up

Requirements for Organizer/Student


Faulty experimental set-up of organ bath

Key for Examiner


Students shall be assessed whether they have checked the following on a faulty experimental set-up

S. No Assess Marks
1 Proper Oxygenation 1
2 Proper temperature of Organ Bath 1
3 Balanced lever with Plastocine etc 1
4 Proper placing of clamps 1
5 Tyroid’s Solution and writing pen (Present) 1
6 Proper Placement of Tissue 1

Q 2. Identify the group of the unknown drug by observing its effects on Rabbit’s eyes

Requirements for Organizer/Student


Unknown Drug
Rabbit (Unknown drug has already been instilled into one eye)
Torch
Cotton Wool
Scale

Key for Examiner


Students shall be assessed for performing the following:

S. No Assess/Perform Marks
1 Measure the size of the pupil of rabbit’s eyes (initial 1
size before drug was added will be told)
2 Perform light reflex on rabbit’s eyes 1
3 Perform corneal reflex on rabbit’s eyes 1
4 Note the colour of conjunctiva of rabbit’s eyes 1
5 Identify possible group of the unknown drug 1
6 Give specific examples of unknown drug 1
Q 3 Prepare Acetylcholine solutions of different strength and Prepare 1 Liter of Tyroid’s
Solution and 1 Liter of Ringer’s Solution

Requirements for Organizer/Student


Acetylcholine Solution of strength 10-3, 10-4, 10-5 and 10-6 solutions
Different reagents for preparation of Tyroid’s solution and Ringer’s solution
Apparatus (Flasks, beakers, test tubes etc)

Key for Examiner

S. No Assess/Perform Marks
1 Prepare 10-4 strength solution from 10-3 1
Acetylcholine
2 Take 1 μg of ACH from 10-5 and/or 10-6 solutions 1
3 Choose the correct chemicals for preparation of 1
Tyroid’s Solution
4 Prepare 1 Liter of Tyroid’s solution using correct 1
measurements of chemicals
5 Choose the correct chemicals for preparation of 1
Ringer’s solution
6 Prepare 1 Liter of Ringer’s solution using correct 1
measurements of chemicals

Q. 4 Record Contractions and Obtain Simple Dose Response Curve of Acetylcholine on


Rabbit’s Ileum

Requirements for Organizer/Student


Experimental setup of Organ Bath with Rabbit’s Ileum as tissue

Key for Examiners

S. No Assess/Perform Marks
1 Take Baseline Reading 1
2 Add next dose of Acetylcholine 1
3 Take reading after specific time 1
4 Wash the preparations after specific times 1
5 Know how to draw a dose response curve from a set 1
of readings
6 Give Significance of Log-dose response curve 1
Q. 5 Demonstrate the effects of the Given Drugs on Frog’s Heart

Requirements for Organizer/Student


Experimental setup of Frog’s Heart with Kymograph
Drugs to be administered (Adrenaline, Propranolol, Acetylcholine and Atropine)

Key for Examiners

S. No Assess/Perform Marks
1 Take a baseline reading 1
2 Add a dose of Given agonist drug 1
3 Record contractions 1
4 Wash, take baseline and add antagonist and record 1
contractions
5 Record contractions of antagonist followed by 1
agonist
6 Give explanation for above reading 1

Q. 6 Take Data of BP/Pulse of simulated subjects and Calculate Biostatistical Values

Requirements for Organizer/Student


BP apparatus
Simulated subjects
t table charts

Key for Examiners

S. No Assess/Perform Marks
1 Take the BP/Pulse of 6 subjects before and after 1
exercise
2 Calculate the means of observations 1
3 Calculate the standard deviations 1
4 Calculate the Standard error of the means 1
5 Calculate the t value 1
6 Find out the P Value from Given t table charts and 1
Give significance of its value
Q. 7 Determine reflex times of frog after application of various drugs

Requirements for Organizer/Student


Experimental setup for practical of Reflex time of frog
Injections Caffeine, Diazepam and Lignocaine

Key for Examiners

S. No Assess/Perform Marks
1 Take normal reflex time 1
2 Apply Lignocaine and note reflex time 1
3 Inject caffeine and note reflex time 1
4 Inject diazepam and note reflex time 1
5 Inference of above readings 1
6 Explain above inference 1

Q. 8 Demonstrate competitive antagonism between Acetylcholine and Atropine

Requirements for Organizer/Student


Experimental Setup of dose response curve of acetylcholine
Acetylcholine solutions of different strengths
Atropine solutions of different strengths

Key for examiners


A simple dose response curve has been obtained of Acetylcholine on isolated rabbit’s ileum.
Students will be asked to proceed to demonstrate competitive antagonism

S. No Assess/Perform Marks
1 Take submaximal dose or next dose of Acetylcholine 1
and a dose of atropine
2 Record contractions 1
3 Continue by increasing dose of Acetylcholine while 1
keeping dose of atropine constant
4 Students should know when to stop 1
5 Draw dose response curve of agonist in presence of 1
antagonist
6 Show effect of shift of curve (Right parallel shift) 1
OSPE Questions for Unobserved Stations (UOS)

UOS No. 1 Pharmacy Related Calculations

1. Give calculations for preparing and dispensing 120 ml of 10% Dextrose in Normal Saline

Key
a) Calculate the amount of NaCl required

For 100ml of distilled water NaCl required = 0.9 gm or 900mg

For 1ml of distilled water NaCl required = 900/100 mg

For 120 ml of distilled water, NaCl required = 900/100 X 120


= 1080mg
Thus 1080 mg of NaCl is required

b) Calculate the amount of dextrose required

For 100ml of distilled water dextrose required = 10gm

For 1ml of distilled water dextrose required = 10/100 gm

For 120 ml of distilled water dextrose required = 10/100 X 120


= 12 gm
Thus 12gm of Dextrose is required

2. Give calculations for preparing and dispensing 5 powders each containing 30mg of
Phenobarbitone

Key

We calculate for 6 powders, one for wastage


a) To calculate the amount of Phenobarbitone
For one powder, Phenobarbitone required = 30mg
For six powders, Phenobarbitone required = 30 x 6 = 180 mg
b) To calculate the amount of diluent (lactose)
The minimum weight of any powder should be 120 mg
To make 120 mg we add a diluent i.e. lactose
So minimum weight of one powder =120 mg
Minimum weight of six powders = 120 X 6
= 720mg
Amount of lactose required = Net weight of 6 powders Total weight of Phenobarbitone
= 720 180 = 540mg
UOS No. 2 Pharmacokinetic Related Calculations

3. First & Zero Order Kinetics

Drug A (Half-life 4 Hours) is undergoing first order kinetics


Drug B is undergoing zero order kinetics
Give presumptive calculations of their plasma concentrations after different times (initial plasma
concentration is 100mg/dl for both

Key

Time Drug A (mg/dl) Drug B (mg/dl)


0 Hours 100 100
4 Hours 50 80
8 Hours 25 60
12 Hours 12.5 40
16 Hours 6.25 20

4. Calculate the dose of a drug for


a) A child aged 2 years (Adult dose = 100 mg/day)
b) A child weighing 20 kg (Adult dose = 50mg/day)
c) A person with body surface area (BSA) of 2.1 m2 (Adult dose = 25mg/day)

Key

a) Young’s formula
Dose = Age X Adult dose
Age +12

Dose = 2/ 2+12 X 100


Dose = 2/14 X 100
Dose = 14. 28 mg/day
b) Formula for body weight:
Dose = Body weight in kg X Adult dose
70

Dose = 20/70 X 50
Dose = 14.28 mg/day

c) Formula for Body surface area (BSA) in m2:

Dose = BSA X Adult dose


1.7

Dose = 2.1/1.7 X 25
Dose = 30.88mg/day
UOS No. 3 Prescription for Systemic Disease
Q.5 Write prescription for management of hypertension in 50 year old male with BP 180/90.
The patient also has bronchial asthma
Key
Mr. Ali
50 Years
Township Lahore

Rx
Tablet Amlodipine 5mg
1 Tablet once a day

Tablet Aspirin 150mg


1 Tablet once a day

Q. 6 Write a prescription for a 40 year old female suffering from peptic ulcer associated with
H.Pylori
Key
Mrs. Nazia Inayat
30 Years
Garden Town, Lahore

Rx
Tablet Clarithromycin 500mg
One tablet 3 times a day for 10 days

Tablet Metronidazole 400mg


One tablet three times a day for 14 days

Capsule Omeprazole 40mg


One capsule once a day for 4 weeks

UOS No. 4 Prescription for Microbial Disease


Q. 7 Write a prescription for a 20 year old boy in emergency with high grade fever, chills and
rigors at night for 2 days. Now malarial parasite smear is positive on peripheral blood film
Key
Ali Naqvi
20 years
Model Town, Lahore

Rx
Chloroquine Sulphate 250 mg
4 tablets stat
2 tablets after 6 hours
1 Tablet 2 times a day for next 2 days
Tablet Paracetamol
Two tablets three times a day
Q. 8 Write a prescription for 30 year old male with enteric fever for last 10 days.

Key
Imtiaz Ahmed
30 years
Mughalpura, Lahore

Rx
Tablet ciprofloxacin 500 mg
One tablet 2 times a day for 14 days

Tablet Paracetamol
2 Tablets three times a day

UOS No. 5 P-Drug for Systemic Disease

Q. 9 An obese male known Hepatitis B positive patient is having symptoms of polyuria and
polydypsia uncontrolled by diet and exercise. Serum glucose is 300mg/dl. What is your P-
Drug? What are alternate drugs?

Key
a) Diagnosis: Non-Insulin Dependent Diabetes Mellitus
b) Objective: Control of Blood Glucose
c) Inventory of Group of Drugs for Treatment: Oral Hypoglycemics: Sulfonylureas, Biguanides,
Meglitinides, Thiazolidinediones and alpha glucosidase inhibitors
d) Choose subgroup: Biguanides because they cause anorexia and weight loss and they are cost
effective
Sulfonylureas cause weight gain; Thiazolidinediones avoided in patients with liver disease
e) P- Drug : Metformin
f) Alternate Drugs: Alpha Glucosidase Inhibitors: Acarbose

Q. 10 A 50 year old insulin dependent male patient presented with moderate retro-sternal pain
radiating to the left arm and left shoulder. It started when he was climbing the stairs. What is
your P-Drug? What are alternate drugs?

Key
a) Diagnosis: Classical Angina Pectoris
b) Objective: Relief of the Pain of Angina
c) Inventory of group of drugs for Treatment: Beta Blockers, Calcium channel blockers,
Nitrates and Nitrites and Potassium Channel Openers
d) Choose A Sub-group: Nitrates and Nitrites: Most rapidly acting (through sublingual route)
and cost effective
Beta Blockers not given in Insulin Dependent diabetics
e) Choose P Drug: Nitroglycerin (Again most cost-effective
f) Alternate Drugs: Isosorbide Dinitrate, Isosorbide Mononitrate, Calcium Channel Blocker
UOS No. 6 P-Drug for Microbial Disease

Q. 11 A young lady of 25 years reports to medical OPD with pain in the loins and dysuria.
Urine examination shows numerous pus cells. X-ray KUB reveals no abnormality or stone in
the urinary tract. What is your P Drug? What are alternate drugs?

Key
a) Diagnosis: Uncomplicated Urinary Tract Infection
b) Objective: Treat the infection
c) Inventory of Groups of drugs for treatment: Anti-folates, Quinolones, Cephalosporins and
Aminoglycosides
d) Choose a subgroup: Anti-folates: most cost effective
e) Choose P Drug: Cotrimoxazole
f) Alternate Drugs: A third generation cephalosporin or a fluoroquinolone like ciprofloxacin

Q. 12 A 30 year old male came to the doctors clinic with complaints of fever, abdominal pain
and loose stools for the last 2 days. Stools contained blood and mucus. There is also history of
cramps and tenesmus. What is your P Drug? What are alternate drugs?

Key
a) Diagnosis: Bacillary Dysentry
b) Objective: relief from the symptoms
c) Inventory of group of drugs: Penicillins, Cephalosporins, Fluoroquinolones, Anti-folates
d) Choose Subgroup: Anti-folates (most cost-effective)
e) Choose P Drug: Cotrimoxazole
f) Alternate Drugs: Cephalosporins (Ceftriaxone), Fluoroquinolones

UOS No. 7 General Pharmacology

Q. 13 Pharmacokinetics
A 30 year old woman is diagnosed with tuberculosis. She is started on anti-tuberculosis
treatment. After a few months, she becomes pregnant although she was taking oral
contraceptives.
Q. What happened? (1.5)
Q. Name 3 other drugs that may cause similar oral contraceptive failure (1.5)

Key

She most probably was taking rifampin as part of the anti-tuberculosis treatment. This drug causes
enzyme induction and hence increased the synthesis of enzymes responsible for metabolism of oral
contraceptives, especially the estrogen component

Other drugs that may cause similar oral contraceptive failure include Phenytoin, Barbiturates like
primidone and carbamazepine
Q. 14 Pharmacodynamics
A patient is given a drug A and a response occurs. Next day he is given a drug B and a response
occurs that is less than that of drug A.
Q. Drug A and Drug B are what type of drugs? (1)
Q. How will drug B behave in the presence of drug A? Explain (2)

Key
Drug A is a full agonist
Drug B is a partial agonist

Drug B will behave as an antagonist in the presence of Drug A as it will occupy many of the
receptors and not allow the agonist to produce its full effect, i.e. hence the full agonist’s action will
be antagonized

UOS No. 8 Autonomic Nervous System

Q. 15 Cholinergic System
A farmer presents to the emergency department with vomiting, diarrhea, miosis, excessive
salivation, excessive sweating, bronchial constriction, muscle weakness and convulsions

Q. What group of drug has the patient most probably taken? (1)
Q. What is the drug treatment of his condition? (1)
Q. What is ageing? (1)

Key
The patient most probably has taken or has been exposed to an organophosphorous compound
containing an irreversible cholinestrase inhibitor
Drug treatment includes Atropine to counter the muscarinic effects, diazepam to control the
convulsions and an Oxime like pralidoxime to regenerate the cholinestrase enzyme
The oximes have to be given before ageing starts otherwise, even they will be ineffective. Ageing is
the breaking of one of the Oxygen-Phosphorus bonds of inhibitor (and thus a loss of alkyl group)
which causes further strengthening of the Phosphorus-Enzyme bond.

Q. 16 Sympathetic System
An insulin dependent diabetic takes an anti-hypertensive drug and goes into hypoglycemic
shock a few hours later

Q. What anti-hypertensive drug did he most probably take? (1)


Q. Explain what happened (2)

Key
He most probably took a beta blocker especially a one that does not have ISA.
Such beta blockers are to be avoided in insulin dependent diabetics because:
• Glycogenolysis is inhibited by Beta Blockers
• So there is decreased response of the body to hypoglycemia
• Plus symptoms of Hypoglycemia are masked i.e. Tachycardia and Tremors
UOS No. 9 CVS, Diuretics and Blood

Q. 17 Diuretics
A patient who is taking medicine for bipolar disorder develops symptoms of polyuria and
polydypsia. He is given a diuretic for the symptoms

Q. What group of diuretic was he given? Give example (1)


Q. What is the rationale for using this diuretic in this condition? (2)

Key

He was given a thiazide diuretic for treatment of diabetes Insipidus caused by the drug lithium which
is used for bipolar disorder
Example is Hydrochlorothiazide
The rationale for their use in this condition is that Thiazides decrease plasma volume---Decreased
GFR------This causes enhanced Proximal reabsorption of NaCl and water—This Decreases delivery
of fluid to the diluting segments—thus maximum volume of dilute urine that can be produced is
decreased

Q. 18 CCF
A known patient of CCF taking medicine for the problem develops severe bradycardia.

Q. What drug is he most likely taking (1)


Q. What are the mechanisms of bradycardia caused by this drug? (2)

Key
He is most likely taking Digoxin

Heart Rate is decreased (Negative Chronotropic Effect) due to:


a) Vagal Action (Blocked by atropine)
• Direct stimulation of vagal nucleus
• Sensitization of the carotid baroreceptors
• Increased sensitivity of muscarinic receptors to Ach
b) Direct Action (Cannot be reversed by atropine)
• In CCF the sympathetic activity is increased due to compensatory mechanisms
• Digoxin, by improving the circulation decreases the sympathetic response and thus
decreases the heart rate
UOS No. 10 Respiratory System

Q. 19 A 30 year old male comes to the emergency department with complaint of cough,
dyspnoea and wheezing. He has history of similar episodes off and on.

Q. What is the most appropriate drug for the treatment of this patient? (1)

Q. What is the most common adverse effect caused by this drug during treatment? Explain
this adverse effect. (2)

Key

A beta 2 agonist like salbutamol given by nebuliser would be most appropriate


Tachycardia; although it is a beta 2 agonist, it is not absolutely selective like all drugs and will cause
some tachycardia and even more with higher doses

Q. 20 A 30 year old male is diagnosed to be HIV positive. He is receiving anti-viral therapy.

Q. Which drug is indicated to protect him against pneumonia due to pneumocystitis jiroveci?
(1)
Q. Enumerate the adverse effects of this drug (2)

Key
Cotrimoxazole
Hypersensitivity reactions, crystalluria, Hematopoietic disturbances like Agranulocytosis,
thrombocytopenia causing petechiae, hematuria and epistaxis and rarely aplastic anemia, Kernicterus
Other adverse effects include stomatitis, conjunctivitis, and rarely polyarteritis nodosa, confusion,
ataxia, tinnitus and psychosis

UOS No. 11 GIT

Q. 21 A patient with complaint of persistent vomiting was given a drug. After some time he
develops uncontrolled restlessness and spastic movements of parts of the body.

Q. What group of anti-emetic was he given? Give example of such a drug (1)

Q. What is the cause and treatment of these symptoms? (2)

Key
A D2 receptor blocker like metoclopramide
These are extrapyrimidal symptoms caused by the block of dopaminergic pathway Nigrostriatal
pathway involved in control of voluntary movement
These can be treated by giving a centrally acting anti-muscarinic like benztropine that will restore
the balance between acetylcholine and dopamine
Q. 22 A patient with chronic low back ache has been taking “pain killers” for long time. He
now complains of epigastric pain, vomiting and dyspepsia.

Q. Which type of drugs could have caused these complaints? (1)

Q. What is the treatment of the symptoms? (2)

Key
NSAIDS (Non-steroidal anti-inflammatory drugs)
Misoprostol is used for prevention of such ulcers; it has less role in treatment
Proton pump inhibitors are used for the treatment of such ulcers. H2 receptor blockers are also used

UOS No. 12 Autacoids

Q. 23 A patient with significant postpartum hemorrhage is given oxytocin but it is ineffective in


controlling the bleeding. Another drug was given which was effective but caused significant
nausea and vomiting.

Q. What drug was given to control the bleeding? (1)

Q. What is the cause of the nausea and vomiting by this drug? (1)

Q. What may be the complications of over dosage of this drug? (1)

Key

Ergonovine (ergometrine) was given


The nausea and vomiting are caused by stimulation of the vomiting center in CNS
Over dosage may cause severe prolonged vasoconstriction that may result in ischemia and gangrene

Q. 24 A patient is given a drug orally for the treatment of glaucoma that has no effects on
autonomic system and does not cause acid base disturbance.

Q. What group of drugs was he given? Name any drug of this group (1.5)

Q. What is the mechanism of action of this drug in treating glaucoma? (1.5)

Key
He was given Prostaglandin analog like Latanoprost

This drug increases the outflow of aqueous humor