Medicine OSCE

A 56-year-old man comes to the ER complaining of chest discomfort. He describes the discomfort as a
severe, retrosternal pressure sensation that had awakened him from sleep 3 hours earlier. He
previously had been well but has a medical history of hypercholesterolemia and a 40-pack-year history
of smoking. On examination, he appears uncomfortable and diaphoretic, with a heart rate of 116 bpm,
blood pressure of 166/102 mm Hg, respiratory rate of 22 breaths per minute, and oxygen saturation of
96% on room air. Jugular venous pressure appears normal. Auscultation of the chest reveals clear lung
fields, a regular rhythm with an S4 gallop, and no murmurs or rubs. A chest radiograph shows clear
lungs and a normal cardiac silhouette.

1. What is the most likely diagnosis?

2. Mention 4 drugs with their dose to be administered in this patient.
A 62-year-old man is brought to the clinic for a 3-month history of unintentional weight loss (12 lb). His appetite
has diminished, but he reports no vomiting or diarrhea. He does report some depressive symptoms since the
death of his wife a year ago, at which time he moved from Hong Kong to the United States to live with his
daughter. He denies a smoking history. He complains of a 3-month his- tory of productive cough with greenish
sputum. He has not felt feverish. He takes no medications regularly. On examination, his temperature is 100.4°F
and respiratory rate is 16 breaths per minute. His neck has a normal thyroid gland and no cervical or
supraclavicular lymphadenopathy. His chest has few scattered rales in the left mid-lung fields and a faint
expiratory wheeze on the right. His heart rhythm is regular with no gallops or murmurs. His abdominal
examination is benign, his rectal examination shows no masses, and his stool is negative for occult blood.
1. What is the most likely diagnosis?
2. Mention any 4 complications of this disease.
1. Mention the findings observed.
2. What is the likely diagnosis?
3. Mention any 2 differential diagnosis.
1. What’s this test called?
2. Mention conditions where
(a) there is absence of resonance on performing this test
(b) the liver dullness is shifted down
A 20-year-old college student is your next patient in the emergency room. When you walk into the room, he is
lying on the examination table, on his side, with his arm covering his eyes. The light in the room is off. You
look at his chart and see that the nurse recorded his temperature as 102.3°F, heart rate 110 bpm, and blood
pressure 120/80 mm Hg. When you gently ask how he has been feeling, he says that for the past 3 days he has
had fever, body aches, and a progressively worsening headache. The light hurts his eyes and he is nauseated,
but he has not vomited. He has had some rhinorrhea, but no diarrhea, cough, or nasal congestion. He has no
known ill contacts. On examination, he has no skin rash, but his pupils are difficult to assess because of
photophobia. Ears and oropharynx are normal. Heart, lung, and abdomen examinations are normal.
Neurologic examination reveals no focal neurologic deficits, but passive flexion of his neck worsens his
headache, and he is unable to touch his chin to his chest.
1. What is the most likely diagnosis?
2. Name the sign that was elicited in this patient
3. Mention any other 2 signs relevant in this patient.
1. Mention the test being performed.
2. What is the prerequisite for this test to be positive?
3. What’re the other tests for the same condition?
A patient presents to triage with acute onset of severe breathlessness & on
examination you find that the chest movements are reduced, vocal fremitus &
resonance are also reduced.
1. What are the two most likely diagnosis?
2. How will you differentiate between the two diagnosis?
 1 2

1. Correlate images 1 & 2 and mention the most probable diagnosis.

2. Drug of choice in this disease and the dosage.
A 70 year old male has following findings on investigations:
RBC count- 3 million/mm3
Hb- 12g%
Total Luecocyte count- 50,000/mm3
Absolute lymphocyte count- >5000/mm3

1 What is the likely diagnosis?

2. What will be his clinical features?
A 5 year old child has following investigation findings:
Proteinuria - 3+
Serum Albumin - <2.5g%
Serum lipids - >200mg%

1. What is this syndrome called?

2. Most common cause of this syndrome.
3. Management of this condition.
1. What is the diagnosis ?
2. Mention 2 symptoms and 2 signs of this condition.
1. What is the diagnosis?
2. Mention 2 causes of this condition.
3. Treatment of choice for this condition.
1. What’s the likely diagnosis?
2. Mention any 4 causes.
1. Identify the instrument
2. Site of insertion
3. Two contraindications
1. Identify.
2. Mention the size of this instrument used for adult males and females.
3. 2 complications associated with this instrument.
1. Identify.
2. Mention two drugs that can be given via this device
3. Mention any one condition where this device can be used.
1. Identify the lesion
2. Mention 4 causes of this lesion.
Fred, aged 45, is a locksmith. He has longstanding and persistent worries that he has not
done his job properly and that someone might get burgled as a result. He worries he might
have given customers the wrong change whenever they have paid him in cash. Fred
informs you that he worries about many things in his life, and his most common thought is
‘what if’? He often imagines the worst happening and states that when he worries, he
often feels sick, has headaches, feels butterflies in his stomach and is aware of his heart
pounding. Fred often gets hot and sweaty and says his anxiety makes it difficult to
concentrate and do his job or play with his children. He is very distressed by his constant
worrying and feelings of anxiety, and regards it as a sign of weakness. At the beginning of
the consultation with his GP, Fred states he is attending because of problems with sleeping.
But after questioning about how things have been for him recently, Fred discloses to his
GP that he is feeling under considerable stress.
1. What’s the likely diagnosis?
2. Name any 4 drugs used in this condition.
A patient presents to the emergency with diarrhoea & severe muscle
cramps. On examination he is hypotensive and investigations reveal
hyponatremia and hyperkalemia.
1. What’s your diagnosis?
2. Write the management protocol for this patient.
A 28 year old man is diagnosed to have HIV infection.
How will you counsel this patient?