Family Medicine OSCE

Doctor of this course

Dr. Duaa Hiasat
Dr.Latifa Mari’e

OSCE:
1) Pt. with chronic cough ,his FEV1 is 0.7 ,after taking a vasodilator drug it
becomes 0.72 /CXR &blood test are normal.

A) What is your diagnosis? COPD

B) What is the first line therapy? Inhaled bronchodilators

C) After years ,he notice clubbing / What is the best imaging to detect the
cause?? High resolution chest CT scan

2) 55 y/o pt. with epigastric discomfort

A) What is the first line of therapy &for how long? PPI ,4 weeks

B) Which is the best test can do here? if it is positive ,what can you do??

Stool antigen test /eradication therapy

3)

A) What is you diagnosis? Tinea versicolor

B) What is the causative microorganism?

Malassezia furfur

C) How could you treat this?

Antifungal shampoo, creams & tablets in severe cases

 4) A woman with suspected RT breast mass came to you asking about the
best method of contraception that can be last at least 3 years. what is your
opinion?

IUD (copper)

5) 65 y/o pt came to you complaining of several attacks of loss of balance

that lasting for minutes associated with nausea ,he said that the last week
he suffered from viral infection

A) What is your differential diagnosis? BPPV

B) Which test can be done in this case? DIix-Hallpike maneuver

C) What is the treatment? Epley's maneuver

6)

What is this? Central DEXA

Mention other bone could be assessed? Vertebrae

7) A mother came to you with her child of 9 months old who’s born outside
of Jordan.

A) She asks you if her child can take a Rota vaccine?

No need (>8months)

B) Mention the vaccines can be taken at this age?

Measles & OPV

 8) A mother came to your clinic complaining that her child experienced fever
for the lasting 3 days, after that a rash start to appear on his trunk.

A) What is your diagnosis?

Roseola infantum

B) What is the cause of this disease?

HSV-6

C) How could you manage this pt.?

Control fever with paracetamol

9) Pt. complaining of cough (8 weeks duration)

A) Mention 3 differential diagnosis (from the most common to lest common)?

UACS, asthma, GERD.

B) What is the first line therapy?

Antihistamines-decongestant

10) Regarding IBS.

A) Mention the Name of diagnostic criteria of IBS? Rome criteria

B) Mention the criteria of IBS

Recurrent abdominal pain on average at least 1 day/week in the last 3 months,

+ two or more of the following:

1. Related to defecation

2. Associated with a change in the frequency of stool

3. Associated with a change in the form (appearance) of stool

_________________________
Q1) pic of pterygium

Diagnosis, cause, treatment? (The answer is in the slide)

Q2) pic of seborrhic dermatitis

Dianosis, DDx, treatment?

(the answer is in the slide)

Q3) patient 65 years smoker 35 pack year with cough for 3 months

What 2 investigations very important and must be done for his cough?
Spirometry and high resolution ct

Mention 3 screening? Colon cancer, lung cancer, AAA

What is the most important advise you have to tell him? Smoking cessation

Q4) patient with peptic ulcer and "4 symptoms of depression" and is on oral
hypoglycemic agent, weight gain despite anorexia, Hb=11, mcv=105, rdw normal

Mention 3 ddx?

B12 anemia, depression, hypothyroid

What other symptom you have to ask about to diagnose depression and what is
the duration?

Anhydonia for 2 weeks

If he has dyspepsia for 2 months what investigation you have to do? Endoscopy

What drugs he takes can be the cause of his anemia? Metformin, ppi
Q5) baby with bilateral conjunctivitis and unilateral lymphadenopathy with
eeythema on his lips and rash

What is the diagnosis? Kawasaki

What is the next step? Do echo

What is the treatment? Aspirine, IVIg, cortecosteroids

Q6) patient 18 months old with cochlear implants

What vaccines you should give him according to Jordanian schedule? Dtp
booster +opv booster +mmr2

What other vaccines should you give him according to his case?

Pneumococcal

His mother has uncotrolled htn and she wants a contraceptive method for 1
year what is the best choice? Mini pills

Q7) patient with "symptoms of graves"

What can you find in her ligs? Hyperreflixia and tibial myxedema

What is the most important investigation "other than TSH"? Antibodies test

What is the first step of treatment? B blocker

Her baby has enuresis, at ehat age he has to start desmoprsssin? 6 years

Q8) case about IBS and Rome criteria

Q9) pic of kopliks spot

What is in the picture?

Diagnosis? Measles

Causitive agent? Paramyxovirus

_________________________

Dx?

2 DDx?

Tx?

*According to Jordan vaccine table ...

what vaccine should give at this age,?

* Additional vaccine suggest for this case

Next step?

Best type of tx,?...ecv

Percentage of recurrence of his

Condition?
Dx?

2 findings on examination?

2 complications of disease?

** Dx?

** Caustive pathogen?

** Mention 6 screening test advise for this patient?

** If patient develop hemolytic anemia during hospitalazation...what do except

to this investigation...just low or high

Haptoglobin

Retic count

Mcv

** if concerned about copd ... investigation??

70 y/o male known htn on enalpril 10 mg daily... complaint of dizziness 2 days

** Mention 2 findings on ecg?

** further history... dizziness is felt as spinning around.. nausea...tinnitus...

sometimes is just lightheadedness..what important point physical examination
would you do... mention 2??

55 y/o female, smoker, thin, ....when examination find thia mass

** How would you approach?....tsh and ultrasound

** Indications of radioiodine uptake in this case,.?.... Low tsh

**If the patient mother's died from hip fracture and the patient take steroids
for 6 months due to RA without history of personal fracture.... Mention 4 risk
factors in this case for osteoporosis other than white postmenopausal female??

** If the dexa scan done and T score was -1.5,... Diagnosis??.... Whats the best
management to prevent future fractures??

_________________________
1) What's DDx of resistance hypertension?

 Secondary cause
 Drug (NSAID ; steroid)
 Improper measurement
 Not compliant with drugs
 Not avoid risk factors

- What's drug used in HTN with kidney disease? ACEI

- In asthma? B blockers

- Gold standred treatment in copd ? Long acting bronchodilator

2) Case for 60y female with copds and smoker & depression ; dyspepsia ;
diarrhia more than 4w.

* counseling to give SSRI

* what to do for dyspepsia? Upper endoscopy ( 60y age is alarm sign)

* what to do for diarrhia? Colonoscopy ( age 60y is alarm)

3) 4 screening for 45y age female

4) Contraception method for women in lactation 6w postpartum.? Mini pill

Instructions? Taking daily at same time

_________________________

.. Kwazaki case .. Iron deficency anemia

.. Metabolic syndrome .. COPD tx.

.. Investigation chronic diarrhea .. Pterygium pic

.. Osteoporosis case... Tx. .. Risk factors.. Side effect for alendronate

.. Implanion contraindication and mechanism of action

Oral exam:
ENT:
- Types of otitis media (causes, treatment)

Note: we treat pt. with OM with effusion after a trial of 3 months with
conservative Tx.

- What are the differences between labryrinthitis &vestibular neuritis ??

- mention 5 differences between BPPV &labyrinthitis

Vaccinations:
- What is the type of MMR vaccine? Live attenuated

- What is the route of administration of it? SC

- How much doses?? 2doses (1year/1.5years)

- Is it contraindicated in person with egg allergy? No (precaution )

(It is contraindicated only in influenza vaccine)

Diarrhea & constipation:

- Treatment of IBS

IBS-C :

1. Psyllium ..osmotic laxative ..stimulant

2. Antispasmotic if associated with abdominal pain

3. Antidepressant

4. 2-weeks trial of rifaximin

IBS-D :

Antidiarrheal

History& physical examination

Mention 2 signs occur in OA !!

heberden /bouchard nodules

- Would you give antibiotic for pt. with shiga toxin diarrhea? Why?! No, cause it’s
not bacterial infection it’s a toxin & if treated with antibiotic it will lead to HUS

COPD:
- Indication of oxygen therapy:

severe cases & hypoxia

- Indications of ICS:

1) eosinophils >300

2) More than 2 exacerbations ,one of them need admission -

3)severe frequent exacerbations

DM:
- What do you looking for in physical examination ??

Anemia:
- What to ask about in anemia Hx.?

Nutrition, GI ( melena, diarrhea), Post menstrual bleeding, Family Hx., Drug Hx. (
such as: Aspirin, NSAIDs, Neomycin, Metformin, Anit-convalsion), Surgical Hx.

Common Pediatric diseases:

- What do you know about Measles?

1) Causictive aggent? Paramyxovirus, RNA virus

2) Incubation period? 7-14 days incubation

3) How they present? prodromal fever, Coryza, hacking cough, conjunctivitis,
Koplik’s spots 2-4 days later, Rash.

4) How does the rash distribution? Retroauriculartemporal region face 

maculo-papulous exanthemes

5) Where do you see Koplik’s spots? in buccal mucosa opposite the 1st and 2nd
upper molars.

6) Possible Complications? bacterial super- infections,encephalitis, cerebellitis,

subacute sclerotizing panencephalitis.

Contraception:
What do you know about Implanon? How it works? The percent of its
effectiveness? For how long? Where it implant? 5 or 6 advantages?

About 5 Side effects? 4 to 5 contraindications?

_________________________

- These 3 slides

"the rapport - - > mention 5"

and what is the meaning of paraverbal?

 - Take a history of a diabetic patient
- About Counseling stages

_________________________

**Time of chickenbox vaccine

**Name the virus responsable for chickenbox

**Describe the chickenbox rash

**Complications of chickenbox

**Examples of live attenuated vaccine...viral and bacterial...all examples in lec

9.1

**cause of resistant htn

**Age to diagnosis enuresis... percentage of family history

**All modalities of treatment for enuresis

_________________________

1. Type of lesions in acne..

2. Pathophysiology of acne formation..
3. What is the bacteria ..
4. How to treat it ?
5. Tests for chronic diahrreha
6. When we use electronic convulsive therapy in depression?
7. What is the age of secreening for dyslipidemia?

_________________________

Otitis media

Roseola infantuim

Vb12 deficency anemia tr

Enuresis history
_________________________

Primary and sec preventive screenings for dyslipidemia

DTap vaccine ..

“Nothing will work unless you do””

Collected by: Ahmad Al-Masri

Good Luck