SELECTION EXAMINATION OF MD GENERAL & GERIATRIC MEDICINEOCT 2017

OSCE PART 1

01. A 88yr old lady had forgetfulness for 01 yr and presented with acute confusional state ( a
history suggestive of delirium)she has taken medications for cough and fever from a GP.

1. List three findings of her chest x ray .(lobar pneumonia with pleural effusion )
2. What is the immediate management of her condition.
3. What are the predisposing factors for her condition according to history?
4. What are the precipitating factors for Q 3?
5. Patient was deteriorated in the ward. List two causes for her deterioration.

02. A 30 yrold man presented with shortness of breath (ABG given – metabolic acidosis with
respiratory alkalosis )

1. Calculate anion gap

2. List three points that you want to ask in history?
3. What is the management of this patient?

03. ECG given.. (widespread concave ST elevations)

1. List three findings of this ECG. (Pericarditis)

2. After 01 week the patient came with following ECG. Interpret the ECG.
(Electrical Alternans)
3. What is the condition that patient developed? ( pericardial effusion)
4. What are the features you would look for in clinical examination?

04. A 20 yr old girl presented to medical ward following ingestion of unknown seed of a plant.
ECG was given.(Atrial flutter with variable block)

1. What is the possible cause for this clinical picture?

2. What is the probable plant of that seed?
3. Pictures of three plantsgiven.( atthana/ endaru/ yellow oleander)
4. On discharge write a referral to a relevant authority?

05. A 50 yr old gentleman who is a known Diabetic , Hypertensive presented with headache.

1. List three abnormalities in fundoscopy. ( grade 2 hypertensive retinopathy )

2. List three findings of this chest x-ray. ( cardiomegaly with pulmonary oedema)
3. List three findings in ECG. ( LVH with strain pattern)
 06. A patient presented with hemiplegia.

1. List 2 abnormalities of the NCCT brain. ( LS middle cerebral arterial territory

infarction)
2. What is the abnormality seen in MRI brain? ( dense MCA sign)
3. What is the management?
4. The patient’s ECG was given. ( atrial fibrillation )
5. What is the unifying diagnosis? ( atrial fibrillation+ ischaemic stroke of MCA territory
following thromboembolism)

07. X ray of a arthritis mutilansgiven.

1. List three abnormalities of the x ray.

2. What is the diagnosis?
3. What are theclinical featuresyou would look in hands?
4. What are the characteristic skin changes you would look for?
5. The patient developed painful swollen knee joints. Knee joint aspiration done. Joint
fluid report showed high WBC count. Name 2 clinical signs you would elicit in this
patient.
6. List two differential diagnosis.
7. Name two tests to differentiate above mentioned conditions.

OSCE PART 1

01. A 88yr old lady had forgetfulness for 01 yr and presented with acute confusional state ( a
history suggestive of delirium)she has taken medications for cough and fever from a GP.

1. List three findings of her chest x ray .(lobar pneumonia with pleural effusion )
2. What is the immediate management of her condition.
3. What are the predisposing factors for her condition according to history?
4. What are the precipitating factors for Q 3?
5. Patient was deteriorated in the ward. List two causes for her deterioration.

02. A 30 yrold man presented with shortness of breath (ABG given – metabolic acidosis with
respiratory alkalosis )

1. Calculate anion gap

2. List three points that you want to ask in history?
3. What is the management of this patient?
03. ECG given.. (widespread concave ST elevations)

1. List three findings of this ECG. (Pericarditis)

2. After 01 week the patient came with following ECG. Interpret the ECG.
(Electrical Alternans)
3. What is the condition that patient developed? ( pericardial effusion)
4. What are the features you would look for in clinical examination?

04. A 20 yr old girl presented to medical ward following ingestion of unknown seed of a plant.
ECG was given.(Atrial flutter with variable block)

1. What is the possible cause for this clinical picture?

2. What is the probable plant of that seed?
3. Pictures of three plantsgiven.( atthana/ endaru/ yellow oleander)
4. On discharge write a referral to a relevant authority?

05. A 50 yr old gentleman who is a known Diabetic , Hypertensive presented with headache.

1. List three abnormalities in fundoscopy. ( grade 2 hypertensive retinopathy )

2. List three findings of this chest x-ray. ( cardiomegaly with pulmonary oedema)
3. List three findings in ECG. ( LVH with strain pattern)

06. A patient presented with hemiplegia.

1. List 2 abnormalities of the NCCT brain. ( LS middle cerebral arterial territory

infarction)
2. What is the abnormality seen in MRI brain? ( dense MCA sign)
3. What is the management?
4. The patient’s ECG was given. ( atrial fibrillation )
5. What is the unifying diagnosis? ( atrial fibrillation+ ischaemic stroke of MCA territory
following thromboembolism)

07. X ray of a arthritis mutilansgiven.

1. List three abnormalities of the x ray.

2. What is the diagnosis?
3. What are theclinical featuresyou would look in hands?
4. What are the characteristic skin changes you would look for?
5. The patient developed painful swollen knee joints. Knee joint aspiration done. Joint
fluid report showed high WBC count. Name 2 clinical signs you would elicit in this
patient.
6. List two differential diagnosis.
7. Name two tests to differentiate above mentioned conditions.
OSCE PART 2

8. Observe this patient’ s face and proceed with relevant cranial nerves examination.

1. Take brief history from the patient.

2. Examine the patient.

3. Tell findings to the examiners.

4. Interpret your findings.

5. Take brief history from the patient to come to a diagnosis.

9.1. Examine this patient’s radial pulse.

2. Tel findings to the examiners.

3. Examine the patient’s precordium. ( palpation &auscultation only. Don’t change patient’s
positionwithout examiners’ consent.)

4. Tel findings to the examiners.

5. Take brief history from the patient to come to a diagnosis.

6. Tel your diagnosis to the examiners.

10.A 50yr old gentleman presented with progressive worsening of cough for 06 months.

1. Take briefhistory from the patient.

2. Auscultate this patient’s respiratory system posteriorly.

3. Tel findings to the examiners.

4. Interpret your findings.

5. Take brief history for arriving at a diagnosis.

11. 16 year old boy was admitted to the medical ward with bodyches ,fever for 3 days. His dengue
NS 1 antigen positive. On admission you have done a uss abdomen. It shows thickened gall
bladder.His mother Mrs perera is worring about her son’s condition. Counsel mother regarding his
current condition. She prefers to continue conversation in english.

In this station following domains are assessed..

1. Communication skills
2. Data interpretation

12. Basic life support (examiners said no need to confirm cardiac arrest.Your are alone. Show the
technique of cardiac compressions and ambu ventilation using oral airway.)