Medicine OSPE

For Prof. under Dhaka University

Collected & Edited by : S. M. Musabbir Alam (Pallab)

(ShSMC-7, Session: 2011-12)

For any Query / To give any Suggestion:

Facebook ID: Musabbir Alam
WhatsApp / Viber account No.: 01521579945,
Table of Contents
Curriculum (New) .....................................................3
Bonus ........................................................................4
Lumbar puncture needle ...........................................5
Bone marrow aspiration needle ................................6
X-Ray of Haemolytic anaemia..................................8
Normal Chest X-Ray...............................................10
Chest X-Ray Made easy..........................................12
Pictures for OSPE ...................................................19
Previous OSPE Questions.......................................24
November 2019..............................................................................24
May 2019 .......................................................................................34
July 2019........................................................................................41
January 2019 (List) ........................................................................49
July 2018........................................................................................49
July 2017........................................................................................55
January 2017 ..................................................................................64
January 2016 (St-6)........................................................................78
July 2015........................................................................................79
January 2013 ..................................................................................92
July 2010 (St-3)............................................................................101
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Curriculum
OSPE
1. Fifty (50) marks will be allocated for OSPE.
2. There will be ten (10) stations in OSPE.
3. Each station shall carry five (5) marks.
4. Topic of OSPE station number one to eight (no.1-8) will be given from Internal
Medicine.
Four (4) examiners (Board I & II) of Internal Medicine & allied subjects will examine the
answer scripts of these (1-8) OSPE stations.
5. Topic of OSPE station number nine & ten (no.9&10) will be given from
Paediatrics.
Two (2) examiners (Board III) of Paediatrics will examine the answer scripts of these
(9&10) OSPE stations.
6. Time allocation for each station shall be five (5) minutes.

Probable stations:
1. ECG.
2. X-ray/ Radiology.
3. Instruments.
4. Data interpretation/ Scenario.
5. Pictorial diagnosis/ Picture scenario.
6. Pediatrics (Instruments).
7. Pediatrics (Data/ Photograph).
8. Skin-VD (Photograph/ Data).
9. Psychiatry (Data/ Scenario).
10. Pedigree/ Family tree.
 Prescriptions.
 Procedures.
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Bonus
(Click to see/download)

X-ray & ECG for OSPE

By Prof. Khan Abul Kalam Azad
Principal (DMC), Dean (Faculty of Medicine, DU)

Paediatrics OSPE for MBBS by Prof. Iffat Ara Shamsad

Medicine OSPE Instruments

ECG Video Collection

ECG notes by Dr. Shamol

Other ebooks of ECG

Chest X-ray Interpretation video

Chest X-ray by Dr. Shamol

Basics of Reading Chest X ray

Anatomy in Diagnostic Imaging (3rd Edition)

Radiology in Medical Practice by ABM Abdullah sir (5th Edition)

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Lumbar puncture needle

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• Bone marrow aspiration needle

Salah Bone marrow aspiration needle

Parts of the needle:

• Trocar
• Cannula
• Adjustable side guard: This is important part, which helps in adjusting the depth of penetration of
the needle.
The common indications of the bone marrow aspiration:
a. Red cell disorders : Megaloblastic anemia,Pure red cell aplasia.
b. WBC disorders: leukemia and subleukemic leukemias,
c. Platelet disorders: Idiopathic thrombocytopenic purpuras
d. Myeloproliferative disorders and myelodysplatic syndroms
e. Storage disorders like Gauchers disease and Neimannpick disorders,
f. In evaluation of fever of unknown origin,
g. Assessment of iron stores can also be done,
h. Any suspicion of metastasis.
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The therapeutic indication of bone marrow aspiration:

Bone marrow transplantation
The preferred sites for bone marrow aspiration:
a. Posterior superior iliac spine/crest- most preferred.
b. Anterior superior iliac crest- Obese individual,history of previous radiation or surgery.
c. Sternum,
d. Upper 3rd (most commonly antero-medial aspect) of Tibia in infants and children ( less than 2
years)
The contraindications for Bone marrow aspiration:
There are no absolute contraindications. In thrombocytopenia and hemophilia, BMA can be done
with skilled technician and the aspiration site should be kept compressed for 5 to 10 min.
The different types bone marrow aspiration needles:
a. Klima Bone marrow aspiration needle: here, the adjustable guard is present along the length of
the needle. This is more secure than the side side guard present in Salah BMA needle.
b. Jemshedi disposable BMA needle
c. Illinois sternal/iliac aspiration needle
What is dry tap?
The bone marrow is not obtained on aspiration. Seen in aplastic anemia and myelofibrosis. Faulty technique
also results in dry tap. Other causes include compactly cellular marrow as in acute leukemia and lymphomas
where, it may be difficult to aspirate.
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Notes on X-Ray of Hereditary Haemolytic Anaemia

Figure 1
Hair-on-end appearance—lateral view.

Figure 2
Hair-on-end appearance—frontal view.
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Description

The hair-on-end sign is a finding seen in the diploic space on skull radiographs and has the appearance of long,
thin vertical striations of calcified spicules perpendicular to bone surface that look like hair standing on end. It
is classically seen in children/adolescents with haemolytic anaemias, in particular, thalassemia major.
A 24-year-oldman, born out of consanguinous marriage with history of splenectomy done at the age of four
and history of requiring frequent blood transfusions, that is, every 5–6 months, came with complaints of
breathlessness on exertion, generalised fatiguability and weakness. On examination the patient had frontal
bossing, haemolytic facies and hepatomegaly. His haemoglobin (Hb) was 5.6 g/dl and peripheral smear
revealed hypochromic, microcytic red blood cells with target cells. Serum iron studies revealed serum iron of
300 mg/dl (200–400 mg/dl) and serum ferritin of 1500 ng/ml (20–300 ng/ml). Haemoglobin electrophoresis
showed fetal haemoglobin F of 7 g/dl and adult haemoglobin A of 8.8 g/dl. A skeletal survey was done which
revealed evidence of extra medullary haematopoiesis with a classical hair–on-end appearance seen on x-ray
skull (Figures 1 and 2). The patient was given three packed cell transfusions. The patient was advised tablet
folic acid daily and iron chelation therapy. The patient was discharged on a Hb of 9 g/dl.
Cooley and Lee described skeletal changes associated with haemolytic anaemias, more than 80 years
ago.1 Hair–on-end appearance refers to the skull abnormalities seen predominantly in patients with
haemolytic anaemias that is, thalassemia, major, sickle cell anaemia, pyruvate kinase deficiency—hereditary
elliptocytosis and spherocytosis.2 It is due to periosteal reaction with neo-osteogenesis of the outer cranial
table which results in marked calvarial thickening, external displacement and thinning of the inner table. The
changes are due to marrow hyperplasia. Hair–on-end appearance is also seen in congenital syphilis—syphilitic
periostitis of tibia, metastatic neuroblastoma, iron-deficiency anaemia, cyanotic—right-to-left shunt—
congenital heart disease, osteomyelitis, polycythaemia vera, thyroid acropachy and haemangiomas. 3 ,4
It is debatable whether the hair-on-end sign may be reversed following treatment of anaemia. The classical
presentation is rarely seen these days. Hair-on-end is uncommon in the milder thalassemia intermedia. Similar
appearance in facial bones is rare and suggests an extreme degree of medullary erythropoiesis. Our patient
had facial involvement as well.
Normal X-ray
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Normal Chest X-Ray

It is important to know the normal chest radiograph and common landmarks so that you can
recognize what is abnormal.

Cardiac Silhouette
On an antero-posterior (AP) or postero-anterior (PA) view of the chest, the borders of the heart have
common landmarks:
• Right Border: Formed by the right atrium which is in between the SVC and IVC
• Left Border: Formed by the left ventricle & portion of the left auricle
• Anterior Surface or Sternocostal Surface: Mainly the right ventricle (not seen on AP view)
• Inferior Border: Combination of the right & left ventricles

Aortic Knob
The aortic knob should be visualized in the normal chest radiograph around the level of T3 to T4 or
just lateral to the carina. In patients with aortic aneurysm, this can be the area contributing to the
"widened mediastinum".
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Costocardiac & Costophrenic Angles

The costocardiac angles (as well as the costophrenic angles) should fairly sharp and well defined if
the patient does not have significant effusions or pulmonary edema.
 If they are blunted or lost, you should be concerned for the presence of fluid in the lung or a
mass obstructing the view. Additional imaging with a chest CT may sometimes be warranted
if the etiology is not clear from the patient's presentation.

Carina
The carina is the point or level at which the trachea divides into the right and left main bronchi. This
is usually midline with the spinous process being behind it. The carina is also the location that is
used by healthcare providers when assessing the proper position of an endotracheal tube (ET) after
intubation. Typically, the tip of the ET tube should be 3-4 centimeters above the carina so that both
lungs are properly oxygenated.

Clavicle
The head of the clavicle is attached to the lateral surface of the sternum. The location of the
clavicular heads in relation to the trachea can help determine proper positioning of the patient at
the time the chest radiograph was taken. The two clavicular heads should be on either side of the
trachea and with the spinous processes being in the middle.

Hemidiaphragms
The right hemidiaphragm normally sits slightly higher than the left due to the presence of the liver
under the diaphragm which prevents the right hemidiaphragm from going down further with
inspiration. Important clinical pearls include:
 Each dome of the diaphragm is innervated by its own nerve supply from the phrenic
nerve. Therefore, damage to the nerves for one side will not affect the other. On chest
radiograph you would see the the paralyzed hemidiaphragm as being higher than the other
hemidiaphragm during inspiration (creating a paradoxical pattern of movement with
respiration).
 You should also not see free air under the hemidiaphragm. If free air is found you will see a
black line under the hemidiaphragm which would be concerning for a bowel perforation. This
requires emergent evaluation with a CT scan and surgical consult. Do not confuse the normal
gastric bubble seem on many chest radiographs with free air.

Trachea
The trachea should sit midline and be in between the right and left clavicular heads. Any deviation
from the midline could suggest that the patient was either rotated at the time of the chest
radiograph, the presence of a mediastinal mass, or presence of a tension pneumothorax.
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Chest X-Ray [Made Easy]

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Pulmonary TB
Figure: Chest x-ray demonstrates extensive patchy reticulonodular opacities particularly on the left. Peripherally at
the junction of mid and upper zones a parenchymal cavity can be identified.
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Both lungs are markedly hyper-inflated with 11 posterior ribs easily visible above the diaphragmatic
domes (yellow dotted lines). The diaphragms are depressed and flattened (best seen on lateral
projection, with loss of the normal acute angle formed by the costophrenic pleural reflection (dotted
blue line).The lungs appear very radiolucent with some areas devoid of lung markings ( * ) suggesting
bullous formation.On lateral projection the retrosternal air space (RS) is markedly widened (aorta
outlined in red).
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Bronchial carcinoma

Diffuse increased interstitial markings throughout both lungs, without a zonal

distribution.
'Shaggy' outline to the heart.
Tracheomegaly.

Case Discussion
Moderate to severe pulmonary fibrosis. The 'shaggy' appearance to the heart results from adjacenet
lung fibrosis so the outline of the heart is less well delineated.
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Some pictures for OSPE

Acne vulgaris
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These photographs are from a pregnant patient with lower motor neuron facial palsy and syndrome of hemolysis,
elevated liver enzyme levels, and low platelet levels [HELLP].

Top left image: The nasolabial fold is flat on the right side of the face. At the same time, the patient was also
unable to wrinkle her forehead on the same side (not shown).

Top right image: She was unable to show all her teeth on the right side.

Bottom left image: The patient could not purse her lips on the right side.

Bottom right image: She exhibited Bell phenomenon (upward rolling of the eye on the affected side with partial
closure of the eyelid when asked to close both eyes).
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Previous OSPE Questions

November, 2019
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May, 2019

Question 1: Write important radiological findings.

Question 2: What is the most likely diagnosis?
Question 3: Mention 4 (four) important physical sings you expect during
percussion and auscultation of the chest.
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Instructions: A 50-year-old man presented with blood report showing

S. bilirubin 22mg/dl, SGPT 70 U/L, alkaline phosphatase-1100 U/L
and prothrombin time: patient-22 sec, Control-12 sec.

Answer the following questions.

Time: 05 minutes

Question 1: What is your clinical diagnosis?

Question 2: Mention 4 (four) important clinical history you will take to

support your diagnosis.

Question 3: Mention 4 (four) important causes of this condition.

Question 4: Write 2 (two) other important investigations you will do in this

case.
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July,2019

Question 4: Mention 2 (two) abnormalities in this x-ray.

Question 5: What is your diagnosis? (HHA/Thalassemia)
Question 6: Write 3 (three) investigations to support your diagnosis.
Question 7: Write 3 (three) principles in management of this case.

Answers of station 1: Radiology in Medical Practice by ABM Abdullah sir,5th edition,(page:258-260)

(pdf page:871)
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Station: 2 Total marks: 10

Instructions: Study the ECG Tracing and answer the following questions.
Time: 05 minutes

Question 1: Write down the 2 (two) important abnormal ECG findings. (MI)
Question 2: Write 5 (five) investigations necessary for this patient.
Question 3: Mention 4 (four) immediate complications of this condition.
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Station: 3
Instructions: A 35 year old male (weight-45 kg) diagnosed as a case of smear +ve
pulmonary tuberculosis. You are asked to prescribe Category-1 anti tubercular
therapy. Write down a prescription for him.

Time: 05 minutes

Station: 4

Question 1: Identify the instrument.

Question 2: Write down 4 (four) important indications of using this
instrument.
Question 3: What are the advantages of using this instrument?
Question 4: Write down 2 (two) complications of using this instrument.
Question 5: Mention 2 (two) infections which may be introduced by using
this instrument.
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Station: 5

Instruction: A 45 year old female presented with fever for 2 months and
abdominal examination revealed hepatosplenomegaly.

Question 1: Write down 3 (three) important differential diagnosis.

Question 2: Mention 4 (four) other important physical signs which may be
found.
Question 3: Write 4 (four) important investigations to reach a diagnosis.

Station: 6

Instructions: A 50 year old male presents in emergency with massive

haematemesis and malaena. On examination,he was found to be
jaundice,gynaecomastia and spider naevi.

Question 1: What is the most likely diagnosis?

Question 2: What is the likely source of bleeding?
Question 3: Mention 3 (three) signs you may get on examination of hand of
this patient.
Question 4: Mention 6 (six) investigations necessary for him.
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Station: 7

Question 1: What is your possible diagnosis?

Question 2: Mention some points in favour of your diagnosis.
Question 3: Give two differential diagnosis.
Question 4: What is the causative organism?
Question 5: Mention 2 local and 2 systemic drugs which are used in this
condition.
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Station: 8

Instructions: A 35 year old male presented with fever for 1 week and
disorientation for 2 days. His CSF study is as follows:
Cytology-
Total leukocyte- 2000/Cu mm, neutrophil- 90%, lymphocyte- 10%
Biochemistry- protein-150mg/dl, sugar-25mg/dl

Question 1: What is the most likely diagnosis?

Question 2: Write down 2 (two) important physical signs.
Question 3: Write down the name of 2 (two) drugs you will start empirically
to initiate therapy.
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Station: 9

Question 1: Identify the supplied instrument.

Question 2: Mention 3 (three) indications of its use.
Question 3: Mention 2 (two) contraindications of its use.
Question 4: Mention 2 (two) complications.
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Station: 10

Instructions: A 10 months old child, weighing 7 kg has been suffering from acute
watery diarrhea for 3 days. On examination, the baby is lethargic and drinking poorly.

Question 1: What is your interpretation?

Question 2: Mention the name of fluids will you select to manage the child.
Question 3: How will you measure the amount of fluid required for
rehydration?
Question 4: Mention the duration of rehydration in this case.
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January,2019
Station list
1. Instrument: Lumbar puncture needle,
2. Instrument: Bone marrow aspiration needle,
3. Prescription: Enteric fever,
4. X-Ray: Pleural effusion,
5. ECG: LVH ē strain,
6. Data: Rheumatoid arthritis,
7. Photograph: Psoriasis,
8. Photograph: AGN,
9. Data: Hypoglycaemic coma,
10. Case: Acute viral hepatitis.
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Station: 2

ECG Tracing: “Atrial fibrillation”

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Station: 3

Instructions: Write down a prescription for a 30 year old pregnant female

who has been suffering from uncomplicated urinary tract infection.
(Only one drug is to be prescribed)

Station: 4
Instruction: Please see the supplied instrument and answer the following
questions-

(Lumbar puncture needle/ Bone marrow aspiration needle)

Question 1: Identify the instrument.

Question 2: Mention its parts.
Question 3: Write down 4 (four) important indications of using this
instrument.
Question 4: Mention the common site of introduction of this instrument (in
adult).
Question 5: Write down the contraindications of using this instrument.
Question 6: Mention 2 (two) complications of using this instrument.

Station: 5

Instructions: A 50-year-male presented with blood report showing S. Bilirubin

15 mg/dl, SGPT 60 U/L, Alkaline phosphatase- 900 U/L. Prothrombin time:
patient-20 sec, Control- 12sec.

Question 1: What is your clinical diagnosis?

Question 2: Mention 3 (three) important clinical history you will take to
reach a diagnosis.
Question 3: Write 2 (two) other important investigations you will advice in
this case.
Question 4: Mention 6 (six) important causes of this condition.
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Station: 6
Instructions: A 20-year-old male, known diabetic, presented to emergency
department in semiconscious state. On query his attendant told that he is having
fever for 1 week and stopped insulin doses. Now his blood sugar is 32 mmol/L and
urine for ketone body is present.

Question 1: What is your clinical diagnosis?

Question 2: Mention 5 (five) additional important signs you may get.
Question 3: Write 5 (five) important investigations you will suggest in
this case?
Question 4: Mention four (4) principles of management.

Station: 7
Instructions: Look at the picture and answer the following questions-

Question 1: What is the most likely diagnosis?

Question 2: Mention 2 (two) points in favour of your diagnosis.
Question 3: Name the causative organism.
Question 4: Mention 2(two) topical and 1(one) systemic drug used
in this condition.
Question 5: Write down 1 local and 1 systemic complications in
this condition.
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Scabies-of-the-hand-with-secondary-infection
Station: 8
Instructions: A 35 year-old woman presented with progressive generalized
weakness and palpitation for 3 months. She had H/O menorrhagia for 5 months.
On examination, she had koilonychia, anaemia and no organomegaly.

Question 1: What is the most likely diagnosis?

Question 2: Mention 3(three) points in favour of your diagnosis in this
scenario.
Question 3: Write 3 (three) investigations to confirm your diagnosis with
findings.
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Station: 9

(Lumbar puncture needle/ Bone marrow aspiration needle)

Question 1: Identify the instrument with parts.

Question 2: Write down 3 (three) important use of this instrument.
Question 3: Mention 2 (two) contraindications.
Question 4: Mention 2 (two) complications.
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July,2017
Station: 1 (Q+Answer key)
Instructions: Look at the X-ray and answer the following questions-

Chest X-ray showing the features of pneumothorax on the left side of the person
(right in image)
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Question 1: Write important radiological findings. Max-2.5

i) Increased translucency + in left lung (0.25+0.25)
ii) Absence of bronchovascular marking (0.5)
iii) Trachea shifted + to right side (0.25+0.25)
iv) Mediastinum shifted + to right side (0.25+0.25)
v) Collapse lung margin (0.5)
Question 2: What is the most likely diagnosis?
Left sided + Pneumothorax (0.5+1)
Question 3: Write down 4 important underlying causes when it occurs
spontaneously. 1x4=4
Primary :
i. Ruptured subpleural emphysematous bulla,
ii. Subpleural bleb,
iii. Pulmonay or pleural adhesion.
Secondary:
i. COPD,
ii. Pulmonary TB,
iii. Asthma,
iv. Lung abscess,
v. Bronchogenic carcinoma,
vi. All cystic or fibrotic diseases.
Question 4: Mention 3 important physical sings you expect during percussion
and auscultation of the chest. Max-2
Percussion note-
i. Hyperresonance (1)
ii. Upper border of liver dullness-low in position (0.5)
Auscultation-
i. Breath sound- Diminished/Absence (0.5)
ii. Vocal resonance- Diminished/Absence (0.5)
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Station: 2
(ECG tracing)
Question 1: Write down the 3 important abnormal ECG findings.
Question 2: What is your ECG diagnosis?
Question 3: Mention 4 important causes of this ECG change.
Question 4: What are the clinical findings as palpation of precordium?

Station: 3 (Q+Answer key)

Instructions: Write down a prescription for a 30 year old pregnant female who
has been suffering from uncomplicated Urinary tract infection.
(Only one drug is to be prescribed)

i. Particulars of the patient

a. Name (0.5)
b. Age (0.5)
c. Date (0.5)
ii. Drugs : Amoxicillin/ Cephalexin/ Amoxi-Clav/ Cefixime/ Ceftriaxone (2)
iii. Formulation (Tab/Cap) (0.5)
iv. Dose (1)
v. Frequency of administration (1)
vi. Duration of treatment Max- 1.5
a. 7 days (1.5)
b. Less than 7 days (0.5)
vii. Advice
a. Reassurance (0.5)
b. Plenty of fluid (0.5)
viii. Doctor’s name, registration number, Signature 0.5x3
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Station: 4 (Q+Answer key)

Question 1: Identify the instrument. 1.5
Lumbar puncture needle
Question 2: Mention its parts.
i. Trocar (0.5)
ii. Cannula (0.5)
Question 3: Write down 4 important indications of using this instrument.
Max-4
i. Meningitis (1)
ii. Encephalitis (1)
iii. Subarachnoid hemorrhage (1)
iv. Guillain Barre Syndrome/ Acute infective polyneuropathy (1)
v. Neurosyphilis (0.5)
vi. Multiple sclerosis (0.5)
vii. Part of procedure of mylography/diagnostic procedure (0.5)
viii. Intrathecal injection of drugs/Therapeutic procedure (0.5)
ix. Spinal anaesthesia (0.5)
Question 4: Mention the common site of introduction of this instrument
(in adults). 1
Between L3 and L4
Question 5: Write down the contraindications of using this instrument.
i. Papilloedema/Evidence of raised ICP (1)
ii. Local infection/Local bed sore (0.5)
Question 6: Mention 1 complication of using this instrument Max-1
i. Coning/Herniation (1)
ii. Introduction of infection (1)
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Station: 5 (Q+Answer key)

Instructions: A 30-year-female presented with the complaints of malaise

for 10 days followed by profound anorexia, vomiting and upper
abdominal discomfort with high color urine for 5 days.

Question 1: What is your clinical diagnosis? Max-2

a. Acute hepatitis (2)
b. Acute viral hepatitis (1.5)
Question 2: Write 4 important physical signs you may get in this case.
Max-3.5
a. Jaundice (1)
b. Tender+ hepatomegaly (0.5+0.5)
c. Flapping tremor (1)
d. Level of consciousness/Orientation (0.5)
Question 3: Write 4 important investigations you will do in this case?
Max-3
a. Serum bilirubin (1)
b. SGOT/SGPT/ALT/AST (1)
c. Prothrombin time (1)
d. Viral markers (0.5)
e. USG of IBS (0.5)
Question 4: Write down one important acute complication. 1.5
Acute fulminant hepatic failure/ Hepatic encephalopathy/ Fulminant hepatic
failure.
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Station: 7 (Q+Answer key)

Instructions: Look at the picture and answer the following questions-

(See above)

Question 1: what is the most likely diagnosis? Max-1.5

i. Scabies (1)
ii. Scabies with complication/Infected scabies (1.5)
Question 2: Mention 2 points in favor of your diagnosis. 1x2=2
i. Papule
ii. Pustule
iii. Interdigital/web space involvement
iv. Eczematization
Question 3: Name the causative organism. 1.5
Sarcoptes scabiei hominis
Question 4: Mention 2 topical and 1 systemic drug used in this condition.
1x3=3
i. Topical- Benzyl benzoate
lotion/Permethrin/Crotamiton/Monosulfiram/Sulphur
ii. Systemic- Ivermectin
Question 5: Write down 1 local and 1 systemic complications in this
condition. 1x2=2
i. Local- Infection/Eczematization
ii. Systemic-AGN/Post-streptococcal glomerulonephritis
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Station: 8 (Q+Answer key)

Instructions: A 35-year-female presented with polyarthritis involving small

and large joints of both upper and lower limbs for 1 year. She gave H/O
morning stiffness for 1 hour.

Question 1: What is the most likely diagnosis? 1

Rheumatoid arthritis
Question 2: Mention 3 deformities which may be found in the hand.
1x3=3
i. Swan neck deformity
ii. Boutonniere deformity
iii. Z deformity
iv. Ulnar deviation
v. Dorsal subluxation
Question 3: Write 4 important investigations used to support your diagnosis.
0.5x4=2
i. ESR
ii. CRP
iii. RA test
iv. Anti CCP Antibody
v. Xray hand/involved joint.
Question 4: What are the groups of drugs used in this condition?
1x4=4
i. Analgesic/NSAID
ii. DMRD
iii. Biologics
iv. Steroid
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Station: 9 (Q+Answer key)

Instructions: A 9-year-old boy came with the complaints of gradual

pallor and history of repeated blood transfusion since 2 years of age.
On examination he had pallor and hepatosplenomegaly. X ray of the
skull was done. Study the X ray of the skull of this child and answer the
following questions:

(See notes on HHA)

Question 1: Mention 2 abnormalities in this X ray. 2x2=4

i. Thinning of the outer table
ii. Widening of the diploic space
iii. Hair on end appearance
Question 2: What is your diagnosis? 3
Thalassemia/Hereditary Haemolytic Anaemia/Thalassemia major/Hb E β
Thalassemia
Question 3: Write 2 investigations to confirm the diagnosis. 1.5x2=3
i. CBC with PBF
ii. Hb electrophoresis
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Station: 10

Instructions: Read the scenario and answer the following questions-

A 10-month-old girl presented with fever for 3 days followed by convulsion
for 2 days. On examination, she had neck stiffness and bulged fontanelle.
Her CSF study showed the following findings :
Color-hazy,Protein-138 mg/dl, Cells-209/cumm, 96% Neutrophil

Question 1: What is your diagnosis?

Question 2: Name 2 common organisms responsible for the illness.
Question 3: Name 2 complications if not treated properly.

Ans:
1. Bacterial meningitis/Pyogenic meningitis.
2. Group B streptococcus, Neisseria meningitidis.
3. Hydrocephalus, Death.
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Medicine OSPE

January,2017
Station: 1 (Q+Answer key)
Instructions: A 25 year old male presents with fever and cough for 5 days.
Study at the X-ray and answer following questions-

(see above)

Question 1: Write important radiological findings. 2

Homogenous opacity (1) at middle and partly lower zone (0.5) of right lung
field (0.5)
Question 2: What is the most likely diagnosis? 1
Pneumonia/Consolidation/Pneumonic consolidation
Question 3: Mention three (3) important physical sings you expect during
auscultation of the chest. Max-1.5
a. Bronchial breath sound (0.5)
b. Increased vocal resonance (0.5)
c. Crepitation (0.5)
d. Pleural rub (0.25)
Question 4: Write five (5) investigations for this patient. 0.5x5=2.5
(Any five)
a. CBC with ESR,
b. Sputum for Gram staining,
c. Sputum for C/S,
d. Blood for C/S,
e. S. electrolyte,
f. Blood urea,
g. Arterial Blood Gas analysis (ABG).
Question 5: Mention four (4) common complications that may occur.
Max-3
(Any four)
a. Pleural effusion (1)
b. Lung abscess (1)
c. Septicemia (0.5)
d. Myocarditis (0.5)
e. Atrial fibrillation (0.5)
f. Respiratory failure (0.5)
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Station: 2 (Q+Answer key)

Instructions: Study the ECG Tracing and answer the following

questions--
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Question 1: Write down the three (3) important abnormal ECG findings.
a. ST segment elevation in II, III, aVF (0.5) and V1 to V6 (0.5) 1
b. Pathological Q wave in II, III, aVF (0.5) and V1 to V6 (0.5) 1
c. T inversion in V1 to V6 (0.5) 0.5
Question 2: What is your ECG diagnosis? 2
a. Acute (0.5)
b. Anterior (0.5) & Inferior (0.5) MI (0.5)
Question 3: Write five (5) investigations necessary for this patient.
(Any five) 0.5x5=2.5
a. Cardiac enzyme- Troponin I/CPK MB/CPK
b. Echocardiogram
c. CAG (Coronary Angiogram)
d. Blood sugar
e. Lipid profile
f. S. creatinine (0.5)
g. S. electrolyte
h. CBC with ESR
Question 4: Mention three (3) immediate complication of this patient.
Max-3
a. Cardiogenic shock (1)
b. Acute circulatory failure (1)
c. Arrhythmia/Heart block/AF/VF/Bradycardia (1)
d. Mechanical-rupture of Papillary muscle/rupture of inter-ventricular
septum (0.5)
e. Thromboembolism/embolism (0.5)
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Station: 3 (Q+Answer key)

Instructions: A 45 year-old-male (weight-45kg) diagnosed as a case of

smear +ve pulmonary tuberculosis. He is on oral hypoglycemic agent and
his postprandial blood sugar is 15mmol/L. You have decided to give
Category-1 anti tubercular therapy.
Write down a prescription for him.

1. Particulars of the patient 1.5

Name (0.5), Age (0.5), Date (0.5)
2. Drugs: 2
Rifampicin-R (0.5), Isoniazid-INH (0.5), Ethambutol-E (0.5),
Pyrazinamide-PZA (0.5)

3. Formulation-Separate or fixed dose both are acceptable 0.5

4. Dose- 1
R: 450mg (0.25), INH: 300 mg (0.25), E: 750-1000mg (0.25),
PZA: 1500mg (0.25)
5. Frequency of administration- Daily 0.5
6. Duration of treatment- 1
HRZE- 2 months (0.5) then HR- 4 months (0.5)
7. Switch over to insulin for glycemic control 1
8. Advice Max-2
a. Reassurance (0.5)
b. Reddish coloration of urine/stool/sweat (0.5)
c. Regular intake of drugs (0.5)
d. Regular follow up (0.5)
e. Immediate contact with doctor if any adverse effect like
hepatitis/visual disturbance (0.5)
9. Signature 0.5
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Station: 4 (Q+Answer key)

Question 1: Identify the device. 2

Metered dose (1) inhaler (1)
Question 2: Mention two (2) important diseases where this device is used.
3
a. Bronchial asthma (1.5)
b. COPD (1.5)
Question 3: Name four (4) important drugs which can be used through this
device. Max-5
a. Salbutamol (1.5),
b. Salmeterol (1),
c. Steroid/Fluticasone/Budesonide/Beclomethasone (1.5)
d. Ipratropium bromide (1)
e. Na chromoglycate (0.5)
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Medicine OSPE

Station: 5 (Q+Answer key)

Instructions: A 50-year-old male presented with blood report showing

S. bilirubin 15mg/dl, SGPT 60 U/L, Alkaline phosphatase 1200 U/L.
Prothrombin time: Patient: 20 sec, Control: 12 sec.

Question 1: What is your clinical diagnosis? 1.5

Obstructive jaundice
Question 2: Mention three (3) important clinical history you will take to
reach a diagnosis. (Any three) 1x3=3
a. Itching
b. Color of stool/steatorrhoea
c. Abdonal pain
d. Progressive/Increasing Jaundice
e. Fever
Question 3: Write three (3) other important investigations you will advice to
do in this case. (Any three) 0.5x3=1.5
a. USG of whole abdomen
b. CT scan of Hepatobiliary system/abdomen
c. MRCP
d. ERCP
Question 4: Mention four (4) important underlying causes of this condition.
(Any four) 1x4=4
a. Ca head of pancreas,
b. Choledocolithiasis,
c. Cholangiocarcinoma,
d. Biliary ascariasis,
e. Intrahapatic cholestasis,
f. Biliary stricture,
g. Compression by lymph node,
h. Periampullary carcinoma.
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Medicine OSPE

Station: 6 (Q+Answer key)

Instructions: A 20-year-old male,known diabetic, presented to

emergency department in semiconscious state. On query his attendant
told that he is having a fever for 1 week and stopped insulin doses. Now
his blood sugar is 32 mmol/L. Urine for ketone body is present.

Question 1: What is your clinical diagnosis? 2

DKA/ Diabetic ketoacidosis
Question 2: Mention four (4) additional important signs you may get.
(Any four) 0.5x4=2
a. Dehydration
b. Hypotension
c. Tachycardia
d. Air hunger/Kussmaul’s breathing
e. Smell of acetone
f. Hypothermia
g. Cold extremities
Question 3: Write four (4) important investigations you will suggest in this
case? Max-2
a. CBC with ESR/CRP (0.5)
b. Electrolyte (0.5)
c. Arterial Blood Gas analysis (ABG) (0.5)
d. S. creatinine/urea (0.5)
e. Urinary R/M/E or C/S (0.5)
f. ECG (0.25)
g. CXR (0.25)
Question 4: Mention four (4) principles of management. 1x4=4
a. Control of blood sugar by short acting insulin
b. Maintenance of fluid balance/Normal saline
c. Electrolyte correction/potassium replacement
d. Administration of antibiotic if infection is present.
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Medicine OSPE

Station: 7 (Q+Answer key)

Instructions: Study the picture and answer the following questions:
(see above)

Question 1: What is the most likely diagnosis? 1

Psoriasis /plaque type psoriasis
Question 2: Mention three (3) points in favour of your diagnosis. 1x3=3
a. Erythematous
b. White/silvery scale
c. Well defined edge
Question 3: Write five (5) common sites of involvement of this type of lesion.
0.5x5=2.5
a. Elbow
b. Knee
c. Lower back
d. Scalp
e. Nail
f. Natal cleft
g. Sub-mammary area
h. Axillary folds
Question 4: Mention two (2) topical and two (2) systemic drugs used in this
condition. 0.5x4= 2
Topical:
a. Steroid,
b. Salicylic acid ointment,
c. Vitamin D analogue,
d. Coal tar,
e. UVA light.
Systemic:
a. Methotrexate
b. Retinoids
c. Biologics
d. Psoralen
Question 5: Mention two (2) drugs which may exacerbate this condition.
0.75x2=1.5
a. Antimalarials
b. Beta-blockers
c. Lithium
d. Lipid lowering agent
e. ACE inhibitors.
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Answer of Q 1: (1x4=4)
a. Kala-azar,
b. Chronic myeloid myeloma,
c. Malaria,
d. Lymphoma.
Answer of Q 2: (0.75x4=3)
a. Bleeding manifestation/purpura/gum bleeding,
b. Anaemia,
c. Jaundice,
d. Lymphadenopathy,
e. Bony tenderness.
Answer of Q 3: (Max-4)
a. CBC with ESR (1)
b. PBF (1)
c. Bone marrow (1)
d. Rk39/DAT/Serology for kala-azar (0.5)
e. Splenic puncture/Splenic puncture for LD bodies (0.5)
f. CXR (0.5)
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Medicine OSPE

Station: 9 (Q+Answer key)

Instructions: Study the photograph and answer the following

questions:

Question 1: What is the name of the condition of the eye visible in the
photograph? 2
Bitot’s spot/Xerophthalmia/ocular manifestation of Vit-A deficiency
Question 2: Write down the WHO Staging of this condition. 5
WHO staging are:
XN- Night blindness
XIA- Bitot’s spot
XIB- Conjunctival Xerosis
XII- Corneal Xerosis
XIIIA- Keratomalacia ˂1/3rd of the corneal surface
XIIIB- Keratomalacia ˃1/3rd of the corneal surface
XS- Corneal scar
XF- Xerophthalmic fundus
(Examinee will get full marks even if they write the name of the stages)
Question 3: Mention the specific treatment. 3
Vit-A (1) three doses (1) on day 1, day 2 and day 14 (1)
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Medicine OSPE

Station: 10 (Q+Answer key)

Instructions: Study at the X-ray of hands of a 3 years old child and

answer the following questions:

Question 1: Identify three (3) radiological abnormalities. Max-3

a. Widening of lower end of radius and ulna (1)
b. Cupping and fraying of metaphysis/lower end of radius and ulna (1)
c. Increased gap between the metaphysis and epiphysis (1)
d. Osteopenia of radius and ulna (0.5)

Question 2: What is the diagnosis? 1

Rickets
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Question 3: Mention three (3) findings on physical examination. Max-3

a. Bowing legs (1)
b. Knock-knee (1)
c. Rachitic rosary (1)
d. Harrison sulcus (1)
e. Short stature (1)
f. Chest deformity (1)
g. Craniotabes (1)
Question 4: Write down three (3) important investigations. Max-3
a. S.calcium (1)
b. S. phosphate (1)
c. S. alkaline phosphatase (1)
d. Parathyroid hormone (1)
e. 25-OH vitamin D assay (1)

To know more about Rickets-radiology

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Medicine OSPE

January,2016
Station: 6 (Q+Answer key)

Instructions: A 35-year-old male presented to you with following

investigation report-
S. TSH: 0.002 mU/L, T3: 10nmol/L and T4: 480 nmol/L.
(Normal value—S. TSH: 0.34-6.2 mU/L, T3: 1.2-3 nmol/L and T4: 51-142
nmol/L.

Question 1: What is the most likely diagnosis? 2.5

Hyperthyroidism/Thyrotoxicosis
Question 2: Write 5 important physical signs you will look for. 0.5x5=2.5
a. Anxious face/staring look,
b. Warm sweaty hands,
c. Tremor/fine tremor,
d. Pulse-tachycardia/atrial fibrillation,
e. Lid retraction,
f. Lid lag,
g. Goiter/thyromegaly,
h. Exophthalmos,
i. Reflex exaggerated,
j. Proximal myopathy.
Question 3: Write 3 other important investigations you can do in this case.
Max-2
a. Radioiodine uptake (1)
b. Thyroid scan (1)
c. USG of thyroid gland (0.5)
d. Antithyroid antibody/TRAb (0.5)
e. ECG (0.5)
Question 4: Mention modalities of treatment. 1x3=3
a. Anti thyroid drugs- Carbimazole/Propylthiouracil
b. Radioiodine therapy
c. Thyroid surgery
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Medicine OSPE

(See above)

Question 1: Write important radiological findings.

Question 2: What is the most likely diagnosis?
Question 3: Write down 4 important underlying causes when it occurs spontaneously.
Question 4: Mention 3 important physical sings you expect during percussion and
auscultation of the chest.
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Instructions: A 30-year-male presented to you with a history of fever for 5 days.

He had a history of travel to Rangamati 26 days ago. His blood picture shows
malarial parasite (Plasmodium falciparum). Write down a prescription for this
patient.
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Medicine OSPE

Station: 4 July: 2015

Instructions: Please see the supplied instrument and answer the
following questions-

Question 1: Identify the instrument.

Question 2: Mention its parts.
Question 3: Write down 4 important indications of using this instrument.
Question 4: Mention the common site of introduction of this instrument (in adults).
Question 5: Write down the contraindication of using this instrument.
Question 6: Mention 1 complication of using this instrument
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Station: 5 July: 2015

Instructions: A 50-year-male presented with blood report showing S.
bilirubin 25mg/dl, SGPT 60 U/L, Alkaline phosphatase- 1200 U/L.
Prothrombin time- Patient: 20 sec, Control: 12 sec.
Question 1: What is your clinical diagnosis?
Question 2: Mention 3 important clinical history you will take to
reach a diagnosis.
Question 3: Write 2 other important investigations you will do in this
case.
Question 4: Mention 4 important causes of this condition.

Station: 6 July: 2015

Instructions: A 20-year-old male, known diabetic, presented to emergency
department in semiconscious state. On query, his attendant told that he had a
fever for 1 week and missed insulin doses. Now his blood sugar is 32 mmol/L,
Urine for ketone body is present.
Question 1: What is your clinical diagnosis?
Question 2: Mention 4 other important signs you may get.
Question 3: Write 4 important investigations you will do in this case.
Question 4: Mention 4 principles of management.
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Medicine OSPE

Station: 7 July: 2015

Look at the picture & answer the following questions-

Question 1: What is the most likely diagnosis?

Question 2: Mention 2 points in favour of your diagnosis.
Question 3: Name the causative organism.
Question 4: Mention 2 topical and 1 systemic drug used in this condition.
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Medicine OSPE

Station: 8 July: 2015

Instructions: A 25-year-female presented with polyarthritis involving small and
large joints of both upper and lower limbs for 1 year. She gave H/O morning
stiffness for 2 hours.
Question 1: What is your clinical diagnosis?
Question 2: Mention 3 deformities which may be found in the hand.
Question 3: Write 4 important investigations used to support your
diagnosis.
Question 4: What are the groups of drugs used in this condition?
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Station: 3 January: 2013

Instructions: A 30 year old woman (weight 45 kg) is diagnosed as a

case of Kala-azar. Write down a prescription for her with an oral drug.
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Station: 4 January: 2013

Question 1: Identify the instrument.

Question 2: Mention its parts.
Question 3: Write down 4 important indications of using this instrument.
Question 4: Write down the common site of introduction of this instrument.
Question 5: Write down the contraindications of using this instrument.
Question 6: Write down one complication of using this instrument.

Station: 5 January: 2013

Instructions: A 40 yrs old male presented in Emergency room with haematemesis
and melaena. On examination, he had leuconychia, spiders in his chest and
splenomegaly.
Question 1: What is the likely cause of haematemesis and melaena?
Question 2: Mention one investigation to confirm your clinical diagnosis.
Question 3: Mention 3 important investigations to assess prognosis.
Question 4: Mention 5 emergency steps to be taken for his management.
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Medicine OSPE

Station: 6 January: 2013

Instructions: A 30-yr-old female presented with generalized weakness and pallor.
On clinical examination, she had moderate anaemia and koilonychia.
Question 1: What is the likely diagnosis?
Question 2: Mention 3 investigations to confirm your clinical diagnosis.
Question 3: Name the oral drug with duration of treatment.
Question 4: Write down the 3 common causes of the above condition in
Bangladesh.
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Medicine OSPE

Station: 8 January: 2013

Instructions: A 18-year-old known diabetic boy who was on insulin for 6 months,
presented to emergency department in a semiconscious state. On query his
mother told that he has fever for 1 week and has missed insulin doses. His reports
showed
RBS: 33 mmol/L, Urine for ketone body: Present.
Serum electrolyte: Na: 128 mmol/L, K: 5.3 mmol/L, Cl: 99 mmol/L, CO2: 14 mmol/L
Question 1: What is your clinical diagnosis?
Question 2: Write down 4 important signs you may get.
Question 3: Mention 4 most important investigations for monitoring this
patient.
Question 4: Write down the outline of 4 management steps.
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Medicine OSPE

Station: 10 January: 2013

Instructions: A 10 month old boy is admitted with high fever and recurrent
convulsions. The finding of his CSF study is as follows:
Colour- Hazy
Cells- 560/mm3
(Polymorph-95%, Lymphocyte-5%)
Protein- 125 mg/dl Glucose- 26 mg/dl Chloride- 98 mg/dl
Question 1: What do you think about the probable diagnosis?
Question 2: Name 2 important organisms responsible for this.
Question 3: Name 2 important complications.
Question 4: Name 4 important principles of treatment.
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Medicine OSPE

July,2010
Station: 3 (Q+Answer key)
Instructions: Write down a prescription for a patient who has been
suffering from typhoid fever.

…Answer Key….
1. Name of the patient 0.5
2. Age 0.5
3. Date 0.5
4. Name of the drug - 2
Quinolone/Azithromycin/Cefixim/Co-trimoxazole/Ceftriaxone
5. Route of administration- oraly 1
6. Dose of drug- 1
7. Frequency of administration- 1
8. Duration of treatment- 7 days 1
9. Advice to the patient 1
10.The doctor’s name, registration number and signature 0.5x3=1.5