OSCE

1
• A 36 year old female presented with complaints of weight gain of 35
kilos over a period of 5 years and poorly controlled hypertension
since 2 years.
• On examination - BP-160/100 mm Hg
• Facial puffiness present
• Dorsocervical pad of fat+
• Proximal myopathy and easy bruisability
• Truncal obesity
• Striae present on lateral abdominal wall
1
• What is your clinical diagnosis?(1 mark)
• how do you confirm your diagnosis? (1 mark)
• How will you localise the adenoma? (1 mark)
• How will you manage this patient? (1 mark)
• What is the role of BIPPS in diagnosing the condition?(1 mark)
2
• 19 year old male came with alleged history of RTA , following which
he had neck pain. Neurologically he had no deficit.
• CT Cervical spine done showed
• What is your diagnosis(1 mark)

• Enumerate the classification used to classify this injury(1mark)

• What will you do next?(1 mark)
• Describe the MRI(1 mark)
• What approach will you choose, indication and contraindication for
them?(1 mark)
3
• 40 year old male with a/h/o RTA 3 hours back. On presentation, GCS
was E2 V1M5,pulse was 54 b/minute, BP- 120/80 mmhg, Pupils-b/l
2mm sluggish reacting.
• What are your next steps?(1 mark)
• Interpret CT (1 mark)
• What is your line of management? (1 mark)
• Indication for icp monitoring(1 mark)
• State any trials for decompressive craniectomy in traumatic brain
injury and their conclusion(1mark)
4
• 30 year old female presented with sudden weakness of right side of face
since 1 day. O/E angle of mouth is deviated to left at [Link] is unable to
completely close her eyes even on active [Link] is unable to raise
eyebrow on right [Link] is some movements of facial [Link]
weak compared to left side.
• What is your diagnosis? (1 mark)
• What is grading used ? (1 mark)
• what is the grade for this patient? (1 mark)
• Mention branches of the nerve during its intracranial course and their
supply (1 mark)
• How will you manage the case? (1 mark)
5
• 45 year old male had history of fall from height ,following which is
unable to move both lower limbs. O/E- power in both lower limbs is
0/5,no sensation below L1 . CT scan of spine done is as follows
Read the CT scan(1 mark)
• What will you do next?(1)
• What soring system is used to grade these injuries?(1 mark)
• What is the score for this system?(1mark)
• How will you manage this patient?(1 mark)
6
• Call is received from neonatal department for a just born newborn
regarding swelling in the back of child. Child is not moving both lower
limbs .There is no discharge from swelling.
• What is your diagnosis? (1 mark)
• What will you do next? (1 mark)
• Interpret the MRI (1 mark)
• How will manage it? (1 mark)
• What will you counsel the parents about? (1 mark)
7
• Identify neurosurgeon(1mark)
• Which institute did he work in?(1 mark)
3 contributions to field of neurosurgery
(3 marks)
8
• 35 year old female came with complains of sudden onset severe
headache .o/e she wasE4 V5 M5 with left sided [Link]
imaging was done
• What is your diagnosis?(1 mark)
• What is the clinical grade?(1 mark)
• How will you manage this case?(1 mark)
• Can you state any trial about treatment modalities of such cases and
their conclusion?(1 mark)
• What are the postop orders will you write for this case?(1 mark)
9
• Identify the lesion (1 mark)
• What is associated genetic condition and chromosome
(1 mark)
• What are the criteria's for diagnosis of this condition?
(1 mark)
• How will you manage the case?(1mark)
• What will you counsel the patient about? (1 mark)
10
• 1 year 1 month old child was brought to neurosurgery opd with
complains of increase in size of head since 2 [Link] Brain scan
done shows
• What is your diagnosis? (1 mark)
• How will you manage this case? (1 mark)
• What is ETV success score for this patient? (1 mark)
• Where will you do the ventriculostomy? (1 mark)
• Mention complications of ETV. (1 mark)
11
• 40 year old male presented with episodes of sharp,shooting pain on
right side of face trigerred by washing face,sharp breeze on face. On
examination ,there was no neurological deficit.
• What is your clinical diagnosis?(1 mark)
• What specific imaging sequence will you ask to confirm your
diagnosis?(1mark)
• What are different modalities of treatment?(1mark)
• What medical line of management will you start?(with starting doses
and maximum safe dose)?(1 mark)
• What are the common side effects of carbamazepine you will warn
the patient about?(1 mark)
12
• 75 year old male presented to opd with complains of headache since
2 [Link] with 2 episodes of vomiting. H/o trivial trauma to
head 1 month [Link] examination,he is conscious and oriented.
• What will you do next?(1 mark)
• What is your diagnosis?(1 mark)
• What are treatment modalities available? (1 mark)
• What will do you for this pt? (1 mark)
• What are the complications of this surgery? (1 mark)
13
• 24 year old female presented to the out patient department with
progressive loss of vision in right eye for 1 week and dropping of right
eyelid for 3 days. She also had retroorbital pain and redness in the
eye.
• O/E- She is PL positive in right eye. The visual acuity in left eye is
6/[Link] field in right eye could not be assessed. There are no visual
field defects in left eye.
• The right pupil is dilated and there is complete opthalmoplegia in the
right eye. She also has sensory loss over her forehead on the right
side.
• What is your diagnosis?(1 mark)
• What are substrates involved?(1mark)
• What is the distinguishing feature between SOF syndrome and orbital
apex syndrome?(1 mark)
• Identify blackened label in the diagram.(1 mark)
• What does it supply ?(1 mark)
14
• 65 year old female came with complains of headache associated with
vomiting. She complains of blurring of vision. MRI Brain was done
• Interpret the MRI(1 mark)
• What is your differential diagnosis? (1 mark)
• What field defect do you expect? (1 mark)
• What is your line of management? (1 mark)
• What are the post op complications which you can expect? (1 mark)
15
• 55 year old male operated case of right frontal GBM 8 months back,
presented with complains of headache,vomiting and had an episode of
Generalized tonic clonic seizures 2 hours back. He had undergone gross
total resection and completed his course of radiation and
[Link] brain was done
• Interpret the MRI(1 mark)
• What is your differential diagnosis? (1 mark)
• What other imaging can be done to arrive at diagnosis? (1 mark)
• How will you manage this case? (1 mark)
• What are indications for surgery? (1 mark)
16
• 75 year old man, k/c/o HTN came with complaints of sudden onset of
left sided weakness. O/E his GCS was E3V3M4. He had left
hemiplegia,
• CT scan was done
• Interpret the CT scan(1 mark)
• Enumerate causes of ICH(1 mark)
• What is the ICH score(volume =25ml) (1 mark)
• How will you manage this pt? (1 mark)
• Can you name recent trials regarding ICH and their result. (1 mark)