‫اذكرونا بدعوة‬

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OSLER – Family Medicine
Group A
22-12-2021
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Azadi / Shadi PHC:-

Station -1- : - 30 years female with BP 150/80. How you manage the case.
Station -2- :- Female with dizziness. Take Hx and Dx? ( -- It was BPPV)
Station -3- :- A 18 months child with vomiting and diarrhoea and no dysentery.
There was a photo of real child and asking :
1- What are the signs in the phot : sunken eyes – Lethargic patient
2- What else would you look for : pinch the skin – Drinking water
3- Dx: severe Dehydration
4- Management:-
Station -4- : - Pregnant woman. Do antenatal care. What are the investigations
that would you send for her ( Dr wanted the investigations that are available in
Brayati PHC and not those in the lect !!! – which were : US – GUE – RBS - CBS).
Then she gave us the results of GUE, RBS, CBC to interpret them. And asked
what is next to confirm GDM and what are the parameters.
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Theory Exam – Family Medicine
Group A
23-12-2021
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1- A 52 years male who is completely asymptomatic with normal physical
examination presented for routine check up.
a. What are the routine CV test(s) you would send for?
b. What are the routine cancer screening you would send for?
c. What are the routine immunizations you would send for?

2- What are the indications for prophylactic therapy in migraine?

3- A 52 years old athletic male presented with acute lower back pain after
lifting heavy objects. How would advise the patient.

4- A 38 woman who is smoker with nother medical diseases. She had

miscarriage at 18 weeks and antoher one at 20 weeks. She had
spontaneous miscarriage at 38 weeks that required D&C to remove
retained pieces of gestations. She presents to you and afraid from
Preterm labor. ( Those are my own answers)
a. What are the risk factors in this lady for preterm labour?
Old age ( > 35)
Smoker
Recurrent miscarriages
b. What are the specific elements in antenatal care that you need to
address in this case?
TVUS for cervical incompetence
TAUS for congenital anomalies of uterus
Antibody titter for toxoplasmosis / rubella
Tests for thrombophilia disorders ( protein S C anti-phoopholipid
syndrome, SLE)
TSH
Progesterone ( contraversia)
Stop smoking
5- A 42-year-old woman comes to your office complaining of severe facial
pain in the region of her right maxilla, fever, and a purulent discharge
from the right side of her nose, all of which started after a recent upper
respiratory infection. She is taking no medications and has no known drug
allergies. Her temperature is elevated to 38.3° C. There is tenderness over
the right maxillary sinus and a greenish discharge in her right naris. The
rest of her examination is normal.
a. What is the most likely diagnosis in this patient?
Acute Rhinosinusitis
b. What are the most common types of this condition?
Allergic vs Viral
c. What organisms most commonly implicated in acute bacterial type of
this condition?
S. pneumoniae (the most common),
H. influenzae,
M. catarrhalis
d. what is the most predictive factor distinguishing viral and bacterial
type of the condition and how?
Acute bacterial sinusitis should be suspected when:-
1. symptoms last more than 10 days from the onset of upper
respiratory symptoms
2. symptoms of acute rhinosinusitis worsen after an initial
improvement.
e. what is the antibacterial drug of first choice for moderate to severe
acute bacterial type of the condition mentioned?
amoxicillin-clavulanate.

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THE END
 ‫اذﻛروﻧﺎ ﺑدﻋوة‬
Family Medicine End Course Exam.
OSCE & Theory - Group B

OSCE Exam - Wednesday 19/1/2022

3 subgroups in Azadi – 3 in Shadi. 4 stations + 4 rest.
Station 1:
• Contraception counseling
• Paper: A mother Gravity 5 Para 5 has been amenorrhea for 8 months, she
wants a type of contraception that she doesn’t need to remember daily,
wants to not get pregnant for 3-5 yeas.
1. Take history and discuss a suitable contraception for her.( from history you
discover that she has Vaginal discharge and her mens were irregular and heavy
before)
Station 2:

• Uncontrolled Diabetes Follow up

• Paper: A known case of Diabetes Female in 40s presents for follow up
complaining from Polyuria, Nocturia, Numbness in the legs. She has
been taking Metformin tab. 850mg 1*3. Her HbA1C was 8.9 and her
LDL was 122mg/dl
1. Manage Her
Station 3:

• Hx of Joint pain Gout

• Paper: A 34 years old man presented with swelling and redness of big
toe for 1 day duration, he is hypertensive and is on Thiazides.
• Task: take hx.
Station 4:
• Watch the Video and answer the questions: Video of Dr.Karwan and a UG-6
doing neck Examination

• Paper:A 4 year old boy presented with Repeated vomiting for 24 hours and has
no diarrhea cough. Watch the video and answer the following questions.

• What are the most important 2 signs you saw in the video?(Lethargy, Neck
stuffiness and +ve Brudzinski sign.)
• What is the classification of this condition?
• What is the diagnosis?
• What is the single most important investigation that you’ll order in PHC unit for
this case?
• How will you treat and manage this case at PHC?
Theory Exam Saturday 22/1/2022

5 clinical questions: short answers.

1. A 42 years old man newly diagnosed with T2DM presented with Paresthesia and
numbness of the feet for 3 months. His HbA1C is 7.He is hypertensive on
medication BP 130/80.Write about guidelines for diabetic foot care.

2. Mrs. Kamera is a 33 years old female has been newly diagnosed with Beta
thalassemia minor( carrier) her brother has Beta thalassemia Major. She is now
pregnant in 7th week of pregnancy and is concerned about her fetus having Beta
thalassemia.

• What are the chances of her baby having Beta thalassemia?

• What test is used for the diagnosis of thalassemia?
• What is the value of test suggestive that the person is affected?
• How will you mange this case?

3. A 40 years old man presents to your clinic wanting to stop smoking, he has
been smoking 20 cigarettes for the past 23 years.
• What are the 5As for cessation smoking?
• Mention 2 drugs used for smoking cessation

4. A 32 years old man presents to your clinic complaining from lesions on

his knees and elbows , on examination you find that the patient has
xanthoma.
• What further information would you obtain from the patient?
• What lab tests would you send for this patient?

5. A 14 months old child is brought by his mother complaining from 15 days of

diarrhea, his stool contained blood for the past 2 days. His initial visit was 5
days ago for his diarrhea. O/E he is eager to drink, no sunken eyes skin
turgor returned immediately, has no fever or any danger signs.
• What is(are) the classification(s) for his condition ?
• What are the criteria for a diarrhea >14 days to be considered as
severe ?
• What are the criteria for a dysentery to be considered severe?

By Group B students
 Group C

C1,2,3 @Azadi PHC

C4,5,6 @Brayati PHC

1. A 40-year-old shopkeeper presents to the PHC with elevated BP.

Q. What is the target BP for most of the population?
Q.What are the indications of ambulatory BPM?
Q. Why do we treat HTN?

2. A 13-month-old child brought by his mother for growth monitoring .

Q. What are the indications of growth monitoring in this child?
Q. What are the parameters used for growth monitoring in this child?

3. A 25-year-old multiparous lady who is in monogamous relationship,

desires a long term contraception. She had DVT with taking OCPs and she
is forgetful about taking the pills. She desires a contraception that allows
spontaneity. She had heavy mens. All examination was normal.
Q. What is the best contraceptive agent?
Q. Contraindications of the possible contraceptive agent?

4. A 50-year-old man with cough for years has his cough increased during
the last 4 months, he smoked a 1 & a half of packets of cigarettes per day.
He has been smoking for 10 years.
Q. What approach is used for those who are willing to quit?
Q. What is the first line treatment/substance used?
Q. Which type of dependence does Nicotine cause: Physical? Emotional? Or both?

5. A 33-year old man, 100 kg and 1.78 m tall, tried to lose weight on different
diets. He had lost 5 kg, but was unable to keep the new weight.
He says he has been obese since he was 25 years old.
Q. When are medications for obesity used?
Q. What are the main drug groups? Give example for each group?
 C1,2,3 @Shadi PHC
C4,5,6 @Azadi PHC

↔ : The different questions in group C4,5,6.

Paper: A 14-month-old boy presents to the PHC with shortness of breath.

*The doctor played a very short video of the child’s chest & abdomen. He
had chest indrawing and fast breathing.

1. What are the most 2 important signs in this child?

2. What is the cut-off point for fast breathing in this child?
3. What are 2 important investigations you should send for?
4. What is the diagnosis?
5. Would you manage this case at PHC or refer?

Paper: A 21-year-old lady came for ANC.

*The doctor asked for what investigations to be done and showed a CBC
report with findings of reduced Hb indices.

(From history: she is G1 P0 M0,

CC: had headache, dizziness and fatigue
Fx: Thalassemia).

1. Take a proper history.

2. What is the diagnosis?
Paper: A 30-year-old lady came to the PHC for her abdominal pain.

1. Take a proper history.

2. What is the diagnosis ?

↔ A lady with lower back pain.

1. Take complete history.

Paper: A 44-year-old lady came as she was worried she’d get a heart
attack because her sister died of a heart attack at 38 years.

*The doctor asked for what investigations to be done and showed a

fasting lipid profile report:
T.C: 242 mg/dL and HDL: 43 mg/dl and, Triglycerides & LDL were
abnormal too.

1. Do CV major risk assessment.

2. Assess her 10-year risk for ASCVD.

Amina
Family Medicine End Course Exam
OSCE & Theory - Group D
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OSCE Exam - Wednesday 17/9/2021
3 subgroups in Azadi – 3 in Shadi. 4 stations + 3 rest.
Station 1:
∑ Immunization
∑ Paper: A mother brings her 4 months old infant for immunization, he hasn’t
received any vaccine till now:
1. What is this type of immunization called?
2. What vaccines will you give in this visit and which one you don’t give (according
to WHO Recommendations) and why?
3. When should be the next visit for immunization and what more vaccines will you
give?
Station 2:
∑ Obstetrics
∑ Paper: 32 years old pregnant lady GA 24 weeks, Presented with tremor,
palpitation, weight loss...
1. Take focused hx from the lady.
2. What investigations will you send for?
3. Diagnosis and management.
Station 3:
∑ Hx of fatigue
∑ Paper: A 40 years old married lady presented with fatigue for 4 months
duration…
∑ Task: take hx.
Station 4:
∑ CVS Risk assessment
∑ Paper: a 44 years old lady visits the PHC for a regular checkup, her sister died
with an MI at age 44 and she’s afraid and concerned about her risk of developing
CVD.
∑ Task:
1. Take focused hx regarding the major CVD risk factors.
2. Assess 10 years risk of developing ASCVD.
Note// The other groups (D4,5,6) instead of hx of fatigue their station was to take a
headache history (Dr Muhammad).
_____________________

Theory Exam Thursday 18/9/2021

5 clinical questions: short answers.

1. A 40 years old man shopkeeper presented with raised BP.
∑ How do you record BP?
∑ Indications for ambulatory BP.
∑ What is the purpose of treating HTN.

2. What are the routine investigations in the 1st booking visit?

3. A 19 years old woman presents to the primary health care clinic complaining of
sore throat for 2 days duration and increased body temperature to 38.4
yesterday. She denies cough. On examination tender anterior cervical
lymphadenopathy + tonsils are enlarged and exudative. What are the salient
features in this condition, what is your dx and tx?

4. What is the most common symptom of acute appendicitis and how does it
progress?

5. Ahmad, a 28 days old infant 4kg and 54cm, temperature 37.5 this is his initial
visit. His mother is complaining that he’s hot for 2 days.
∑ What are the signs and symptoms that indicates very severe disease (possible
bacterial infection)?

Sariya Dler