Medicine Ospe

Batch:2013 to 2018
 Total 13 stations
• 4 interactive stations
1 BLS
1 instrument
1 drug
1 counseling /1 scenario
• 9 static stations
1 ECG
1 X-ray
1 Ct scan
1 Derma
1 psychiatry
1 clinical history base scenario
1 disease picture base scenario
1 data interpretation (lab report reading)
1 repeat from upper 8 topic
• A 50 years person is found unconscious on roadside. You reach the spot.
What steps you will take for his resuscitations?
 BLS
• 1. Move to the safe place
• 2. Check consciousness(gently shake shoulder/ shout “are
you ok?”)
• 3. Check nostril and carotid for 10 sec(not <5 sec or >10sec)
• 4. Call for help
• 5. Do oral clearance
• 6. Start chest compression @ 100 compression/min
(30 compression followed by 2 mouth breaths for 1 person
15 compression followed by 1 mouth breath for 2 persons )
• 7. Chin lift + jaw thurst
• 8. Give 2 breaths
• 9. Again 30 compressions (upto 20 minutes if patient comes
in emergency /upto 40 min if sudden cardiac arrest in
hospital )
•Instruments
• Name the instrument?
foleys catheter (1)
• Write its uses/indications?
Bph,urinary retention,CA prostate, unconscious patient
(2)
• Enumerate complications associated with it?
infection,injury to urethra,perforation,trauma (2)
• Steps to use it?
Intro, consent , expain the procedure , drape with pyiodine solution , xylocain gel introduce in urethra , pass
foleys , check its placement , inflate its balloon
• Name the instrument? (2)
NG TUBE[BOYL’S TUBE]
• Write its uses? (3)
FEEDING,DRUG DELIVERY,BULBAR PALSY,GASTRIC
LAVAGE..
• S/E..TEAR,INFECTION,ASPIRATION PNUEMONIA..
• What is this instrument? (2)
LP NEEDLE
• Write its uses? (3)
LUMBER PUNCTURE,ANESTHESIA,CSF EXAM..
• S/E
HMG,INFECTION,HEADACHE.
• 1.Names the methods to check the blood pressure and check the BP in this
patient?
Palpatory and auscultatory method.
• 2.what is silent gap?
An ausculttory gap/silent gap is a period of diminish or absent korotkoff sound
duing manual mesurement of B.P
• 3.Names the stages of hypertension?
Prehypertension
stage 1 HTN
stage 2 HTN
hypertensive emergency
•Drugs
• Identify the drug? (1)
Adrenaline injecion
• Write its uses? (3)
Cardiac arrest ,severe bradycardia,local anesthetic,anaphylactic shock,
cardiogenic shock
• Write one fatal complication associated with this drug?
Tremors, palpitations, weakness, arrythmias (1)
 Kcl 25ml
USES= hypokalemia..DKA.. Excessive diarrhea.. Metabolic acidosis.. Vomitng..
S/E= cardiac arest if fast infusion…hyperkalemia,, renal failure,,muscle breakdown..
T/M OF HYPERKALEMIA…= insulin+glucose+ ca gluconate..
Sodium bicarbonate… hemodialysis
 Adernaline..moa= non selective adernergic agonist…. Route im n sc
Uses= asthma… cardiogenic shock.. Anaphylactic reaction… copd…. Cpr… to gain less blood field during
surgery
s/e= arrythmia… skin gangrene..
• Identify the drug? (1)
ATROPINE SULFATE
• Write its uses? (4)
MYDRIASIS,
IN GA TO DEC SECRETIONS,
ORGANOPHOSPHATE POISONING,
BRADYCARDIA..
• S/E..FLUSHING,HIGH GRADE
FEVER,ARRYTHMIAS,CONSTIPATION,BRONCHOSPASM..
• Streptokinase
uses..ST segment elevation M.I
massive pulmonary edema and SVT
C.I…CVA, h/o CPR, bleeding disorder, liver disease
• Ca gluconate
uses… Hyperkalemia, hyperparathyroidism,
tetany and renal failure
•Counseling
•ECG
• What is your diagnosis?
Inf wall MI and ST ELEVATION IN II,III,avf
(2)
• Enumerate the steps in management of this patient.
Opiods,cachannelblocker,antiplatelets,anticoagulants,nitrates

• complication..dreselar syndrome.,arrhythmia,embolism (3)

• What is the condition shown in this ECG? (2)
ATRIAL FIB,P WAVE ABSENT,NORMAL QRS
COMPLEXES,IRREGULARLY IRREGULAR RHYTHM..
• Name the drugs to treat this condition?(3)
DIGOXIN,VERAPAMIL,BETA BLOCKER,AMIODRONE,ELECTRO
CARDIOVERSIAN..
• What is shown in this ECG? (2)
SVT,P WAVE ABSENT,R-RINTERVAL REGULAR,RATE
INC.
• How will you manage this condition?(3)
ADENOSINE,VERAPAMIL,CAROTID MASSAGE,BETA
BLOCKER,DIGOXIN..
IF DRUGS INEFFECTIVE THEN DEFIBRILLATORS..
Inferior wall Myocardial infraction and lateral wall ischemia
Anterio-septo-lateral wall Myocardial infraction
•X-Rays
• What is the radiological diagnosis? hydropneumothorax
(2)
• List likely conditions which can cause this picture on this X-Ray?
Tb,empyema,pneumonia,ccf(3)
• List abnormal findings in this X-Ray? Cardiomegaly , cp
angle obliterated , hilar congestion , pacemaker present , kerly
b line, upper lobe divergent (5)
• List abnormal findings in this X-Ray? (3)

CARDIOMEGALY,HILAR CONGEATION,PACEMAKER,FLUID AT THE BASE,AORTIC KNUCKLE.

• What further investigations you would do?
(2)ECHOCARDIOGRAM,ECG,CARDIAC ENZYMES.
• CAUSE,
ANURYSMS,PERICARDIAL EFFUSION,CCF,PIL EDEMA,VAVULAR DISEASE..
• TREATMENT..
FRUSAMIDE,O2,NITRATE TO DEC PRE LOAD,ACE INHIBITORS TO DEC AFTER LOAD
• List abnormal findings in this X-Ray? (2)
CAVITY AND LUNG FIBROSIS LEFT SIDE
• What is your diagnosis? (3)
TB…OTHER SARCCOIDOSIS,KAPLAN
SYNDROME,ASPERGILLOSIS..
 Pleural effusion
Findings…Non hemogenous, radio opaque shadow of left side
causes… T.B pneumonia, fibrosis and consolidation
t/m Thoracentisis..
•CT-Scans
• What is your finding on this CT Scan Brain plain?
HYPODENSE AREA LEFT SIDED INFARCT
,MIDLINE SHIFT (3)
• What is the territory of circulation involved in this condition?
TEMPOROPARIETAL AREA
MIDDLE CEREBRAL ARTERY INVOLVED,
EMBOLI (2)
• What are the abnormal findings on this CT Scan Brain?
Hyperdense area on the Rt side of brain (2)
• What medical conditions can cause this picture on CT Scan Brain? (3)
…hmgic stroke,meningioma abcess
• symptomatic treatment
…mannitol,control bp give nitrates,craniotomy if accessible,dispirin
containdicated
1. Dilated ventricles leading to hydrocephalous
2. Manitol(diuretics) ,VP shunt
•Derma
• What is the lesion? (3)
• Name two drugs to treat this condition? (2)
•Psychiatry
• You are a House Officer and your junior comes up to
you for help. Your friend tells you she failed in her
Professional examination. For the past 3 weeks she
has been crying nonstop about failing and has no
motivation to study for her upcoming supplementary
examinations. She doesn’t feel like eating her favorite
foods anymore and has dark circles under her
eyes.She feels worthless and tells you she has
thoughts about ending her life because becoming a
Doctor just isn’t worth it anymore.
• What is your diagnosis? (2)
DEPRESSION
• How will you treat her? (3)
ANTIDEP,
BENZODIAZEPINES,
SSRIS..
• A 23 year old Male student is brought to you by his parents after
he strangled the house cat and hung it in front of his door. On
further inquiry, his parents tell you that their child had been
acting very odd for the past 6 months. He wouldn’t eat any food
that was cooked in the house out of fear that his mother was
poisoning him. 2 months ago he started to tell his family to call
him Nawaz Sharif . You ask the patient the reason for strangling
the cat, to which he simply replies: “The voices inside my head
told me to do it so that the poison in the food doesn’t kill me”

• 1) What is your diagnosis?

SCHIZOPHRENIA (1)
• 2) Name 2 symptoms in this history which leads you to the
diagnosis
HALLUCINATIONS,FEAR (2)
• 3) Mention the appropriate treatment you would give him
(2)
ANTIPSYCHOTICS,ANTIDEPRESSANTS,PYSCHOTHERAPY,BENZODIA
ZIPINES…
• A survivor of Army Public School massacre comes to you in a very
anxious and agitated state. He jumps at loud sounds, he isn’t
doing well in his studies due to lack of concentration. When he is
sitting in class he feels as if he is reliving the 16th December
massacre all over again and runs out of class crying. His mother
tells you he doesn’t want to go to his school anymore. When
inquired about his mental state, the student tells you he feels
guilty about surviving while his best friends couldn’t.

• What is the diagnosis?

Post traumatic stress disorder (1)
• What are the clues in the scenario which lead you to this
diagnosis?
Flash backs , guilt(2)
• How would you help treat this child?
Counselling , ssris, anxiolytics , Antip\depressants, cognitive
behavioural therapy (2)
Clinical history
base scenario
• A fifty five year old nonsmoker man presents with
increasing dyspnea on exertion and dry irritating cough
from several months.
• On examination, he has dyspnea, cyanosis and clubbing
of fingers. He has loud P2 and fine inspiratory crackles
at the bases of both lungs

• What is the most likely diagnosis?

Interstitial lung disease (2)
• What are the steps in management of this patient?
O2,nebulize,steroids,
immunosupressants[ cyclosporins],med to dec
pulmonary HTN (3)
• A young boy with history of increased urination from last few
weeks has now presented with altered state of consciousness.On
examination, patient is drowsy and looks wasted and dehydrated.
His investigations show the following results:
• Blood glucose level 463 mg/dl,
urinary ketones 3+,
complete blood counts; HB 13g/dl, WBC 14x103/uL, Platelets
count 200x103 /uL.
Blood urea 40mg/dl,
Creatinine 0.9mg/dl.
Diabetic ketoacidosis

• Management for this patient?

Give insulin,fluid,sodium bicarbonate..maintain sugar level btw 200
to 250md/dl
Treat the underlying cause
• A thirty six year old lady who is on oral contraceptives pills,
presented with pain and swelling over right leg which started soon
after returning home on a long flight from Canada.
• On examination the right leg is red, swollen and tender to touch.
There are prominent veins over the leg.

• What is the most likely diagnosis?

DVT OF RT LEG.. (1)
• How you will investigate the case?
ANTITHROMIN III,PROTEIN C,S LEVELS, DOPPLER USG OF
LEGS,D.DIMERS.. (2)
• What treatment will you offer once the diagnosis is established?
IV HEPARIN AND ORAL WARFARIN..VENA-CAVAL FILTERS.CAUSES OF
DVT..IMMOBILITY,PREGNANCY,OCPS,ANTIPHOPHOLIPID
SYNDROME,DEC PROTEIN C,S LEVELS.,POLYCYTHEMIA,NEPHROTIC
SYNDROME
• A 40 year old lady has presented to the Medical
Outpatient clinic with generalized itching all over the
body from the last 3 months. On examination there
are prominent xanthelasma of face, deep jaundice
and enlarged, firm liver with smooth margins.
• Labs:
Total Bilirubin 6.8 mg/dl.
ALT 73 U/L,
AST 85 U/L,
ALP 736 U/L.
• 1.PBC
• 2.T/M
STERIODS,ANTI HITAMINES,IMMUNOSUPRESSIVES..
• A 53 years old chronic smoker with history of chronic
cough and shortness of breath has now presented
with rapid deterioration of health. There is history of
significant weight loss. On examination there is
cyanosis, clubbing of fingers and engorged veins in
the neck with facial edema. There is percussion
dullness & bronchial breath sounds over Rt. upper
zone.

• What is the likely diagnosis?

BRONCHOGENIC CA (2)
• Write 3 further relevant investigations? (3)
CBC WITH ESR,
XRAY CHEST,
CT CHEST
• A 77 years old type 2 diabetic on oral hypoglycemic has presented to
emergency ward with altered state of consciousness. On examination he
has low grade fever; BP is 100/90, Pulse 110 per minute. He is
dehydrated and comatose with no focal neurologic sign and there is no
neck stiffness.
• Laboratory Investigations show
S.glucose 536 mg/dl,
S. Sodium 155 mmol/l,
S. Potassium 4.1 mmol/l,
Urea 65 mg/dl,
Creatinine 1.1 mg/dl.
Arterial blood gases are normal,
urine examination shows glucose 4+,
Ketones nil,
Pus Cells 25-30 PHF.

• What is your diagnosis? (2)

HYPEROSMOTIC NONKETOTIC COMA(HONK)
• Outline the steps in the management of this patient?(3)
REHYDRYATE WITH ½ SALINE,
INSULIN,
ANTIBIOTICS..
• A 30 years old boy is brought to the emergency
department with two days of fever, headache,
vomiting and altered state of consciousness. On
physical examinations, he is found to have neck
stiffness and petichial rash on the legs. His TLC is
16,000/cmm, with 80% polymorphs in DLC.

• What is your diagnosis? (1)

MENINGITIS
• What further tests would perform ? (2)
LUMBAR PUNCTURE,CSF EXAM,CT BRAIN
• Name the drugs to treat this condition? (2)
BENZYL PEN,CEFTRIXONE,CEFOTEXIME..
• A thirty five year old man presents with malaise, poor
appetite and vomiting from last one week. On
examination, he is pale and right hypochondrial
tenderness.
• Laboratory results show:
T.bilrubin 3.1 mg/dl.
ALT 60 U/L (range 16-40)
AST 80 U/L (range 20-45).
ALP; 478 (range 86-310),
CBC; Hb 12.5 g/dl,
TLC 10.5x103/L,
Platelets count 200x1003/L.
• What is your diagnosis?
• Management plan?
• Dietry advice?
•Disease picture
base scenario
Identify the skin lesion? (1)
What is diagnosis? (2)
Name two relevant investigations to diagnose this condition? (2)

1.Malar rash butterfly rash

2. SLE
3. dsDNA, ANA ,COMPLEMENT LEVEL
4.T/M…
What abnormality is shown in this picture?
Clubbing (2)
What are the causes of this condition? (3)
Resp causes..tb,BROCHIACTESIS,empyema,malignancy,LUNG FIBROSIS
Git causes,crohn,uc,celiac disease
Cardiac causes,IE,TOF,cYANOTIC heart diseases..
Liver causes.. CLD,CA LIVER
1. What is your diagnosis?
SYSTEMIC SCLEROSIS[SCLERODERMA]
CREST SYNDROME
C=CALCINOSIS,R=RAYNAODS,E=ESOPHAGEAL
DYSMOTILITY,S=SCLERDYCTILITY,T=TALENGECTASIA (2)

2. Name the relevant investigations to diagnose this condition? (3)

SCL 70 ANTIBODIES,ANA,ANTI TOPOMERASE ANTIBODIES,CBC,ESR..
FEATURES..TIGHT FACIAL MUSCLES,BEAK NOSE,FISSURING OF MOUTH ANGLE
What is your diagnosis?
EXOSPHTHALMOS..GRAVES DISEASE (2)

Name the relevant investigations and their results? (3)

T3 INC,T4 INC,TSH DEC..
What is shown in the picture? (2)
DVT
List the causes of this condition?(3)
IMMOBILITY,PREGNANCY,OCPS,NEPHROTIC
SYNDROME,ANTIPHOPHLIPID SYNDROME,DECPROTEIN
C,SLEVELS,POLYCYTHEMIAS..
1.What is your diagnosis?(1)
RA(rhematoid hand)..ULNAR DEVIATION,Z-DEFORMITY,SWAN NECK
DEFORMITY,MUSCLE WASTING.
2.INVESTIGATION..
RA FACTOR,XRAY HANDS,ANTI CCP ANTIBODIES,ESR
3.Name the four specific drugs to manage this condition?,
STEROIDS,DMARDS(METHO,GOLD),NSAIDS.
1.Exopthalmos
2.Graves disease
3. Propyl thiouracil,methimazol,propanolol
1. Raynaud’s phenomenon
2. Causes.. Athrosclerosis, RA, SLE, smoking
3. stop smoking ,avoid caffine , warm hands , nifedipine,nitroglycerine
1.Koilonychias or spooning of nails
2. Iron deficiency anemia, GI bleed, malignancy,acid peptic disease
3.serum iron, feritin, TIBC
Herpes zooster
1st and 2nd trigeminal root involvement
•Data interpretation (lab
report reading)