GENERAL MEDICINE SOLVED OSPE 9 & 10 SEMESTER

STATION NO: 01 (CCF)

- SCENARIO:
 A 60-years old male has presented with shortness of breath & chest pain. He has history of
myocardial infarction 02 year back. On examination he has raised JVP, tender hepatomegaly
& heaving apex beat.

1. What is your diagnosis?

 Congestive cardiac failure

2. Give any 02 causes of left heart failure.

 AR, MR, CMP, hypertension

3. Give any 02 causes of right heart failure.

 ASD, PH, TR, LVF

4. What is the most common cause of diastolic failure?

 Hypertension.

5. Name any 02 mechanisms which help in compensation.

 Remodeling, retention of sodium & fluid due to raas, sympathetic stimulation.

6. Give 03 signs specific for left heart failure.

 Basal crepts, heaving apex & loud p2

7. Give 03 signs specific for right heart failure.

 Tachycardia, increased JVP, pitting edema & hepatomegaly

8. Give any 03 investigations.

 ECG, X-ray chest, serum BNP, echocardiography, etc.

9. Name the drug used for CCF with arrhythmias.

 Digoxin.

10. Name any 02 drugs used in severe cases of CCF.

 Furosemide, nitrates, digoxin
 STATION NO: 02 (HYP: ENCEPHALOPATHY)
- SCENARIO:
 A 40-years old smoker has presented with vomiting, visual disturbances, confusion &
tachycardia in emergency department. He takes alcohol for the last 10 years. On
examination face is plethoric & B.P is 180/120 mmHg.

1. What is your diagnosis?

 Hypertensive encephalopathy

2. What risk factors in this scenario favor your diagnosis?

 Alcohol, smoking.

3. Give any 04 complications of this condition.

 SAH, stroke, retinopathy, visual loss, heart failure.

4. Give any 04 signs you will look for in this patient during examination.
 Facial congestion, prominent left ventricular heave, loud S2, basal crepts, renal bruit, pedal
edema etc.

5. Give any 04 investigations of this condition.

 Chest X-ray, echo, lipid profile, serum urea creatinine, ECG.

6. Give any 03 drugs used as treatment option.

 Diuretics, ACE inhibitors, beta blockers, nitrates.

7. If patient has migraine which antihypertensive drug will you recommend?

 Nonspecific beta blockers like propranolol.

8. How will you differentiate hypertensive urgency from hypertensive emergency?

 By end organ damage (seen in emergency not in urgency).

STATION NO: 03 (M.I)

- SCENARIO:
 A 55-year old male known case of hypertension, has presented with severe chest pain &
shortness of breath in OPD. His pain radiates towards left arm & jaw & is not relieved
by taking nitrates.

1. What is your diagnosis?

 Myocardial infarction.

2. Give any 02 precipitating factors of this condition.

 Hypertension, exercise, heavy meals, violent dreams, etc.

3. Give any 03 investigations of this condition.

 Cardiac enzymes, ECG, isotope scanning, coronary angiography, etc.
4. Name the drugs used as treatment option.
 Nitrates, beta blockers, ACE inhibitors, aspirin, etc.

5. Give any 04 complications of this condition.

 Heart failure, arrhythmias, pericarditis, heart block, thromboembolism.

6. What will be the immediate steps to do?

 I/V line maintaining, morphine & aspirin, oxygen.

7. Give any 03 differential diagnosis of ST segment depression.

 Left ventricular hypertrophy, severe hypertension, CMP.

8. How will you differentiate pericarditis from myocardial infarction on ECG?

 In pericarditis ST elevation is with upward concavity which is not in myocardial infarction.

STATION NO: 04 (INFEC: ENDOCARDITIS)

- SCENARIO:
 A 35-years old male has presented with shortness of breath & tachycardia. On
examination he is febrile with splinter hemorrhages on nails & marks of cannula over the
arms.

1. What is the most likely diagnosis?

 Infective endocarditis

2. What is the most common cause of this condition in this patient?

 Staphylococcus aureus.

3. Give any 03 important investigations of this condition.

 Blood culture, echo, Blood CP/ESR.

4. What are the major components of Ducke's criteria?

 Positive blood culture & echo consistent with endocarditis or new murmur.

5. Give any 04 cardiac complications of this condition.

 Congestive heart failure, valvular stenosis, valvular regurgitation, ring abscess, etc.

6. Name any 03 drugs which are used in this condition.

 Benzyl penicillin, vancomycin, gentamicin.
 STATION NO: 05 (MITRAL STENOSIS)
- SCENARIO:
 A 45-year old lady has presented with shortness of breath, chest pain & malar flush. Her
pulse is irregularly irregular. On auscultation a mdm is heard in mitral area.

1. What is the most likely diagnosis?

 Mitral stenosis

2. Give any 03 clinical features by which you can differentiate your

diagnosis from aortic stenosis recurrent syncope in as systolic murmur
in as reversed splitting of 2nd heart sound in as Heaving apex beat in as.

3. Give any 03 signs & 03 causes of pulmonary hypertension.

 Signs: loud P2, right ventricular heave, pulmonary valve regurgitation causing frahan steel
 Murmur causes: mitral stenosis, mitral regurgitation, chronic bronchitis, etc.

4. Give any 03 investigations for confirming your diagnosis.

 Echo, X-ray chest, ECG.

5. What complications can be developed in this patient?

 Atrial fibrillation.

6. Give any 02 treatment options for this condition.

 Drugs like beta blocker, digoxin & surgery like MVR.

STATION NO: 06 (IRON DEF: ANEMIA)

- LOOK AT THIS CBC AND ANSWER THE FOLLOWING QUESTIONS.

1. What is your diagnosis?

 Iron deficiency anemia.

2. Give any 03 investigations for confirming your diagnosis.

 Serum ferritin, TIBC, bone marrow studies.

3. What oral treatment will you suggest in this patient?

 Tablet ferrous sulphate (Iberet) or capsule ferrous gluconate (Sangobian).

4. For how long oral therapy should be given in this condition?

 03 to 06 months.

5. Give any 03 differential diagnosis of this condition.

 Thalassemia, sideroblastic anemia, lead poisoning.

6. Give any 02 dietary causes of megaloblastic anemia.

 Vitamin B12 deficiency & folic acid deficiency.
7. How will you differentiate your diagnosis from thalassemia? (Any 03)
 Hb electrophoresis, ferritin levels & reticulocyte count.

STATION NO: 07 (CML)

- SCENARIO:
 A 42-years old woman presented with exertional dyspnea & fatigue for past 01 year. Past
medical history is unremarkable. Examination revealed conjunctival pallor with
splenomegaly of 14 cm. In blood CP hemoglobin is 10.2%, WBC 300x109/l, neutrophils
44%, metamyelocytes & promyelocytes seen & platelets count 638x109/l.

1. What is your diagnosis?

 Chronic myeloid leukemia (CML).

2. Give any 03 differential diagnosis of this condition.

 Leukemia, lymphoma, aplastic anemia.

3. Give any 03 investigations of this condition.

 Blood CP, bone marrow biopsy, peripheral smear, lap score, chromosomal studies.

4. Give any 03 treatment options of this condition.

 Bone marrow transplantation, chemotherapy by immunosuppressive, other drugs like
hydroxyurea, alpha interferon, etc.

5. Mention any 03 drugs used in induction phase.

 Methotrexate, dounorubicin, prednisolone.

6. Give any 04 causes of pancytopenia.

 Aplastic anemia, Hodgkin lymphoma, acute leukemia, multiple myeloma, etc.

STATION NO: 08 (HEMOPHILIA)

- SCENARIO:
 A young male had excessive bleeding episode after undergoing tonsillectomy. He has
been suffering from joint pain & swelling in knee since last 02 years & this time has
presented with hematoma over the calf muscles after a mild trauma.

1. What is the most likely diagnosis?

 Hemophilia

2. Give any 03 differential diagnosis of this condition.

 Von-willebrand, ITP, DIC.

3. Give 01 difference between hemophilia & von-willebrand disease.

 Hemophilia is X-linked whereas von-willebrand is autosomal dominant, there is increased BT in
von-willebrand disease which is normal in hemophilia, etc.
4. Give the management of this condition.
 Factor-VIII, concentrate by I/V infusion, synthetic vasopressin.

5. Give any 03 complications of this condition.

 Arthropathy mono-neuropathy, muscle atrophy, etc.

STATION NO: 09 (ACUTE RENAL FAILURE)

- SCENARIO:
 A patient has presented with dyspnea & pain in right lumbar region. He has oliguria
since many days and hypotension. On urine analysis urea is more than 200 mg/dl.

1. What is your most likely diagnosis?

 Acute renal failure

2. What is the most common renal cause of this?

 ATN

3. Give any 03 other causes of this condition.

 Renal stones, glomerulonephritis, nephrotic syndrome etc.

4. Give any 03 investigations of this condition.

 Serum urea & creatinine, urine D/R, urine electrolytes, ABGs, serum electrolytes, CBC,
ultrasound kidney, etc.

5. Give any 02 differences between acute renal failure & chronic renal failure.
 Anemia is frequently present in chronic renal failure, kidney size is small in chronic renal failure,
renal osteodystrophy is seen in chronic renal failure.

6. Give any 03 indications for dialysis in this condition.

 Severe hyperkalemia, uremic pericarditis, uremic pleural effusion, pulmonary edema, blood urea
above 200 mg/dl.

7. Give any 04 complications of this condition.

 Fluid overload, hyponatremia, hyperkalemia, anemia, etc.

8. What is the most common cause in chronic renal failure?

 Diabetes mellitus.

9. When creatinine clearance decreases to 10 ml/min it is called as?

 Renal insufficiency.

10. Name any 02 drugs that should be avoided in renal failure?

 Chloroquine, metformin, methotrexate, etc.
 STATION NO: 10 (NEPHROTIC SYNDROME)
- SCENARIO:
 A young girl has presented with swelling all over the body for the last 02 weeks. On
examination pulse is 90 beats/min & B.P is 140/90 mmHg, edema over the feet & face is
positive.

1. What is the most likely diagnosis?

 Nephrotic syndrome

2. Give any 03 causes of proteinuria.

 IgA nephropathy, MPGN, FSGN, etc.

3. What is the most common cause of this condition in adults?

 Membranous glomerulonephritis.

4. Which type of this condition has best prognosis?

 Minimal change disease.

5. Give any 03 causes of hematuria.

 Renal stones, renal cell carcinoma, renal cysts, acute glomerulonephritis, etc.

6. Which glomerular disease is seen most commonly in heroine abusers?

 Focal segmental glomerulosclerosis (FSGS)

7. Which group of drug is most commonly used in these diseases?

 Corticosteroids.

STATION NO: 11 (HEADACHE)

- SCENARIO:
 Coma, headache syndromes and epilepsy.

1. What is the definition of coma based on Glasgow coma scale (GCS)?

 GCS 8 or less is said to be a coma.

2. What is the most common type of headache?

 Tension headache.

3. A 30-years old female using oral contraception presented with complain of severe headache
with vomiting, irritability with bright light, abnormal visual perceptions during the attack
that lasts few hours. What is the likely diagnosis?
 Migraine with aura (classical migraine)

4. Name any 03 drugs that can be used in this patient?

 Aspirin, paracetamol, NSAID, metoclopramide, domperidone, sumitriptan.
5. A 22-years old boy medical student presented with complain of severe headache at noon for
last 04 days with nasal congestion, wetting of eyes & agitation during the spell lasting about
30 minutes. What is most likely diagnosis?
 Cluster headache

6. What are the possible treatment options for this condition?

 Subcutaneous sumitriptan, 100% oxygen.

STATION NO: 12 (EPILEPSY)

1. What is the drug of choice in childhood absence seizures?
 Ethosuximide.

2. Name first line drugs used for generalized tonic clonic seizures.
 Sodium valproate, levetiracetam.

3. Mention any 04 infective causes of seizures.

 Pyogenic brain abscess, toxoplasmosis, cysticercosis, meningitis, encephalitis, HIV.

4. Name any 02 inflammatory causes of focal seizures.

 Sarcoidosis, vasculitis.

5. Name any 02 inflammatory causes of generalized tonic clonic seizures.

 Multiple sclerosis, systemic lupus erythematous (SLE).

6. What is the first line drug in focal epilepsy / secondary generalized tonic clonic seizures?
 Lamotrigine

STATION NO: 13 (MULTIPLE SCLEROSIS)

- SCENARIO:
 A 45-years old lady presented in OPD with weakness of both lower limbs with subacute
onset of bladder & bowel involvement for last 07 days. She also noticed decreased vision
from one eye for past few days. In past history same weakness happened one year back &
was treated in a hospital. On examination visual acuity decreased, upper limbs normal,
lower limb power 3/5 in all joints, exaggerated reflexes, planters upgoing & sensory level
at T10.

1. What is anatomical localization of the lesion?

 T10 & below.

2. What type of lesion do you suspect in this condition?

 Autoimmune, inflammatory, demyelinating lesion.

3. What is the most likely diagnosis?

 Multiple sclerosis.
4. Give any 04 differential diagnosis of this condition.
 Vitamin B12 deficiency, transverse myelitis, neuromyelitis optica, spinal cord compression.

5. How will you investigate in this condition?

 MRI, VEP, CSF examination & oligoclonal bands

6. How will you treat this acute episode?

 High dose steroid orally or I/V for 3-5 days.

STATION NO: 14 (PARKINSON’S DISEASE)

- SCENARIO:
 A 65-years old male retired school teacher presented in neurology clinic with complaint
of progressively small handwriting, difficulty doing routine tasks, slowness in movements,
anxiety & speech problems.

1. What is the most likely diagnosis?

 Parkinsonism (Parkinson’s disease).

2. What signs will you look for in this patient?

 Resting tremors (pin rolling), cogwheel or lead pipe rigidity, loss of postural
reflexes, festination gait.

3. Which drug regimen is most commonly used to treat the symptoms?

 Levodopa + carbidopa (sinemet).

4. What are other drugs used as treatment option?

 MAOi b inhibitors: Selegline
 COMT inhibitors: entacapone amantadine
 Anticholinergic: Rivastigmine
 Dopamine agonist: apomorphine, pramipexole

STATION NO: 15 (BACTERIAL MENINGITIS)

- SCENARIO:
 A 20-years old boy presented with headache, photophobia & stiff neck. Examination
shows generalized purpuric rashes on the limbs & altered conscious level. CSF shows
turbid appearance with marked neutrophilic pleocytosis, glucose 30 mg/dl & elevated
protein level.

1. What is the most likely diagnosis?

 Bacterial meningitis

2. Which organism is most likely involved in this condition?

 Neisseria meningitides (meningococcus).
3. Which other organism is commonly involved in adults?
 Streptococcus pneumonia.

4. Name any 02 organisms which are more common in neonate.

 E. coli, Proteus, group B streptococci.

5. What immediate treatment should be administered while waiting for organism’s

identification?
 I/V benzyl penicillin

6. Which drug can be used to prevent this disease in the contacts?

 Oral rifampicin

7. What are the possible complications of this disease?

 Seizures, brain abscess, septicemia, cranial nerve palsies.

STATION NO: 16 (MND)

- SCENARIO:
 A 60-years old male presented with weakness of lower limbs. Examination shows marked
wasting of proximal & distal lower limb muscles, fasciculations, hyper-reflexia, upgoing
planters. There is no sensory loss, extra-ocular involvement or bladder & bowel
involvement.

1. What is the most likely diagnosis?

 MND (ALS)

2. Which investigations will you perform in this condition?

 Conduction block, EMG, mildly raised CK level

3. Name any other 03 variants of this disease.

 Progressive muscular atrophy, progressive bulbar palsy, progressive lateral sclerosis

4. Which drug can be useful in this patient?

 Riluzole

5. What other advises will you give to this patient & his attendant?
 Physiotherapy, speech & occupation therapy, ventilatory support, dietary support
 STATION NO: 17 (RHEUMATOID ARTHRITIS)
- SCENARIO:
 A 50-years old female presented with complaint of pain, stiffness & swelling in the joints
of both hands & wrists for more than 02 months. She also complains of fatigue, weight
loss & fever.

1. What is the most likely diagnosis?

 Rheumatoid arthritis

2. What signs will you look for in the hands of this patient?
 Button hole, swan neck, deformities, synovial swelling at joints,
ulnar deviation of fingers.

3. What is the most common ocular symptom in this disease?

 Kerato-conjunctivitis / dry eye

4. Which investigations will you advise to confirm the diagnosis?

 acpa, rf, X-rays

5. Name any 03 disease modifying drugs in this case?

 Methotrexate, sulfasalazine, hydroxylchloroquine, gold salt, penicillamine, leflunomide.

6. Name any 03 biological therapies in this condition.

 Etanercept, adalimumab, abatacept, anakinra, rituximab

7. Which analgesic is best during pregnancy in this disease?

 Paracetamol

STATION NO: 18 (SLE)

- SCENARIO:
 On SLE, scleroderma.

1. Name antibodies that can be found in a patient of SLE?

 Anti-Ds DNA, anti-SM, ANA

2. What is the characteristics of rash in SLE (shown in picture)?

 Butterfly rash / malar rash

3. What is the most common cardiac manifestation of SLE?

 Pericarditis

4. Name any 04 clinical criteria used for diagnosis of SLE?

 ANA, anti-DNA & anti-Sm, oral ulcers, photophobia, discoid rash, malar rash, arthritis etc.
5. Name monoclonal antibody used in SLE.
 Belimumab.

6. Which antibodies can be found in a patient with scleroderma / systemic sclerosis?

 SC l70, anti-centromere, ANA.

7. What are the forms of scleroderma?

 Diffuse cutaneous (DCSS) & limited cutaneous (LCSS)

8. What are the features of crest syndrome?

 Calcinosis, Raynaud’s phenomenon, esophageal involvement, sclerodactyly, telangiectasia.

9. Raynaud’s phenomenon is a universal finding in scleroderma. Which drugs can be used to

treat it?
 Prostacyclin, bosenton, antibiotics if infected.

STATION NO: 19 (RHEUMATOLOGY)

- LOOK AT THE PICTURE AND ANSWER THE QUESTIONS.

1. What findings can you see in this picture?

 Podagra, swelling & erythema at 1st MTP joint.

2. What is the most likely diagnosis?

 Gout.

3. What are the risk factors for this condition?

 Beer, metabolic syndrome, osteoarthritis, high red meat in diet, low vitamin C, high seafood diet,
renal failure, psoriasis etc.

4. What is the biological treatment for this disease?

 Pegloticase

5. What are the enzyme inhibitors used to treat this disease?

 Xanthine oxidase inhibitors: allopurinol, febuxostat.

6. What is the best treatment for acute attacks in old age?

 Aspiration & intra-articular corticosteroids

7. Which investigations can be helpful in diagnosis?

 Joint aspirate microscopy for urate crystals, blood counts, serum uric acid, ESR, CRP

8. Which lifestyle change can be helpful?

 Weight loss, avoiding alcohol specially beer, decrease intake of seafood, offal, high purine diets.
 STATION NO: 20 (MEASLES)
- SCENARIO:
 A 4-years old boy presented with history of flu like illness & pink eyes for past 03 days &
has now developed maculopapular rash on face, trunk & upper limbs. Mother also gives
history of frequent soft stools. She also reports lack of immunization facility in her
village.

1. What is the most likely diagnosis? (picture)

 Measles

2. How this disease can be prevented?

 Measles vaccine

3. What is the pathognomonic sign of this disease?

 Koplik’s spots

4. What are the complications of this disease?

 Otitis media, pneumonia, transient hepatitis, encephalitis, SSPE

5. A 08-years old girl presented with crops of vesicular rashes & pustules on her trunk with
itching. What is the most likely diagnosis?
 Chicken pox

6. Which investigations can be done to confirm the diagnosis?

 Direct immunofluorescence or PCR of vesicular fluid

7. A 07-years old girl presented with swelling & redness over the right cheek & jaw. On
examination her temperature is 37˚C & swelling is tender. What is the most likely
diagnosis?


8. What are the complications of this disease in both male & females?
 Mumps

9. How this disease can be prevented?

 MMR vaccine
 STATION NO: 21 (TYPHOID FEVER)
- SCENARIO:
 A 30-years old labor presented with fever, headache & altered bowel habits for last 10
days. On examination, temperature is 103˚F, pulse is 100/min, spleen is palpable 02 cm
below costal margin.

1. What is the most likely diagnosis?

 Typhoid fever

2. What are the complications of this disease?

 Hemorrhage, perforation, meningitis, arthritis, cholecystitis,
myocarditis, pneumonia, nephritis.

3. Name the organism responsible for this condition.

 Salmonella typhi.

4. How this disease can be prevented?

 Improving sanitation & living conditions, vaccination

5. What is the drug of choice for this condition?

 Fluoroquinolones e.g. ciprofloxacin

6. What is the most important diagnostic test?

 Blood culture

7. What is the route of transmission of disease?

 Fecal oral

STATION NO: 22 (AIDS)

- SCENARIO:
 A 35-years old homeless I/V drug abuser presented with marked weight loss, fever,
diarrhea, malaise, dysphagia & oral ulcers. On examination cervical nodes are enlarged,
there is hepatosplenomegaly & tachypnea.

1. What is the most likely diagnosis?

 AIDS.

2. How will you investigate in this condition?

 Serological tests i.e. ELISA, western blot, PCR for viral load, absolute
CD4 count, blood CP.

3. Name any 03 malignancies which are common in this disease.

 Kaposi's sarcoma, non-Hodgkin lymphoma, carcinoma of cervix.
4. What are the respiratory complications of this disease?
 Tuberculosis, histoplasmosis, cryptococcal pneumonia, etc.

5. Name any 03 drugs used in this disease?

 Zidovudine, efanavir, lamivudine.

6. Give any 03 preventive measures of this condition.

 Screening of the blood used for transfusion, instrument sterilization, safe sexual contact.

STATION NO: 23 (MALARIA)

1. Name the causative organism which causes most severe disease.
 Plasmodium falciparum

2. Name two organisms that have a latent hepatic stage & can cause
relapses up to two years.
 Plasmodium ovale & plasmodium vivax

3. Which organism is involved in cerebral malaria?

 Plasmodium falciparum

4. Give any 03 clinical features of cerebral malaria.

 Coma, headache, seizures, confusion, fever.

5. Give any 03 complications related to this organism.

 Black water fever, cerebral malaria, algid malaria, septicemic malaria.

6. What are the diagnostic tests in malaria?

 Thick & thin film for MP, immunochromatography (parasight f and optimal), QBC test

7. What is the treatment of choice for complicated falciparum malaria?

 I/V artesunate

8. Which drug is used in non-resistant species of other organisms?

 Chloroquine
 STATION NO: 24 (PEPTIC ULCER)
- SCENARIO:
 A middle aged male presented with burning pain in epigastrium that relieves on taking
food & milk & is more severe at midnight. He has a history of frequently taking pain
killers for mild headache. He is a chronic smoker.

1. What is the most likely diagnosis?

 Peptic ulcer

2. Give any 03 risk factors of this condition.

 NSAIDs, blood group O, smoking, large parietal cell mass.

3. Give any 02 differences between gastric & peptic ulcers.

 Pain increases on taking meals in gastric ulcer, while it is relieved in peptic.
 Vomiting relieves pain of gastric ulcer not of peptic ulcer.

4. Give any 03 complications of this condition.

 Hemorrhage, penetration, perforation, pyloric obstruction.

5. What investigations will you carry out for this condition?

 Stool antigen test, endoscopy & biopsy, urea breath test, serological tests etc.

6. What is triple therapy?

 1 PPI + 2 antibiotics used for helicobacter pylori eradication (see drugs from book )

7. Give any 04 differential diagnosis of epigastric pain.

 GERD, biliary tract disease, acute pancreatitis, acute cholecystitis, acute myocardial infarction.

STATION NO: 25 (CROHN’S DISEASE)

- SCENARIO:
 A 30-years old cigarette smoker has complaint of altered bowel habits since 06 months &
abdominal pain which is crampy. He also complains of sticky stools & has pain in
perianal region. He has lost weight since last 03 months & has ulcerations in mouth.

1. What is the most likely diagnosis?

 Crohn’s disease

2. What other signs you will look for in this patient?

 Aphthous ulcers, signs of ureteric obstruction, local tenderness in
right iliac fossa, bloody diarrhea

3. Give any 04 differential diagnosis of this condition.

 Pelvic inflammatory disease, appendicular abscess, TB intestine, ulcerative colitis, amoebiasis,
etc.
4. Give any 03 investigations of this condition.
 Blood CP, stool analysis, serum albumin, P-ANCA and ASCA, colonoscopy

5. What is the drug therapy for its remission?

 Mesalamine + azathioprine

6. Give any 04 extra-intestinal manifestations of this condition.

 Pyoderma gangrenosum, fatty liver, gallstones, DVT, portal vein thrombosis, erythema
nodosum, etc.

7. Give any 03 complications of this condition.

 Abscess, fistula, intestinal perforation, etc.

STATION NO: 26 (ACUTE PANCREATITIS)

- SCENARIO:
 An alcoholic male has presented with sudden epigastric pain radiating to the back.
Which relieves when he leans forward.

1. What is the most likely diagnosis?

 Acute pancreatitis

2. What is the most common cause of this condition in a patient?

 Alcohol

3. Name any 03 factors which indicate its worsening prognosis?

 Ca <8mg, fluid deficit more than 4 l, fall in hematocrit by 10%.

4. Give any 03 complications of this condition.

 Shock, renal failure, hyperglycemia, hypoxia, pseudocyst, etc.

5. Give any 03 investigations of this condition.

 Serum amylase & lipase, ultrasound & X-ray of abdomen, CT scan abdomen

6. Give any 03 differential diagnosis of this condition.

 Perforated peptic ulcer, acute cholecystitis, acute intestinal obstruction, etc.

7. What is grey turner's sign?

 Bruising & discoloration in the left flank.

8. Which antibiotics will you suggest to this patient & why?

 Broad spectrum antibiotics like imipenum
 For prophylaxis against infections
 STATION NO: 27 (LIVER ABSCESS)
- SCENARIO:
 A young man presented with swinging pyrexia & dysentery for last 01 week. He has
tenderness in right hypochondriac region.

1. What is the most likely diagnosis?

 Liver abscess

2. Give any 04 complications of this condition.

 Basal pneumonia, pleural effusion, hepatobiliary fistula, rupture in
peritoneum, etc.

3. Give any 03 differential diagnosis of this condition.

 Typhoid, cholecystitis, hepatitis.

4. Give any 03 important investigations of this condition.

 Ultrasound abdomen, blood CP, serology for amoeba.

5. Which drugs would you prescribe in this condition?

 Metronidazole & diloxanide furoate.

6. Give any 02 differences between pyogenic & amoebic forms.

 Amoebic is single & in pyogenic multiple abscesses are seen
 In amoebic aspiration is usually not required.

STATION NO: 28 (CLD)

- SCENARIO:
 A 65-years old alcoholic male has presented with distended abdomen & drowsiness. He
has dilated veins over the abdomen in which flow is away from umbilicus.

1. What is the most likely diagnosis?

 Chronic liver disease

2. What are the complications of this condition?

 Variceal bleeding, ascites, hepatic encephalopathy, hepato-renal failure, etc.

3. Give any 03 hepatic causes of this condition.

 Hemochromatosis, Wilson’s disease, hepatitis B & C etc.

4. Give any 05 causes of portal hypertension.

 Cirrhosis, CCF, alcoholic hepatitis, constrictive pericarditis, hepatic failure.

5. Give any 03 investigations for this condition.

 Blood CP, ascitic fluid analysis, LFTs, serum albumin, prothrombin time.
6. Give any 03 poor prognostic factors for this condition.
 Low albumin, low serum sodium & prolonged PT.

7. What treatment would you suggest for ascites?

 Spironolactone, or leven shunt (if refractory)

8. If the patient takes high protein diet, what complication he is going to develop?
 Hepatic encephalopathy

9. What signs can you find in hand in this patient?

 Asterixes, Dupuytren's contracture.

STATION NO: 29 (ACUTE HEPATITIS)

- SCENARIO:
 A young female has presented with low grade fever & vomiting, she has enlarged liver 02
cm below costal margin & jaundice in eyes.

1. What is the most likely cause?

 Acute hepatitis

2. Give any 03 acute complications of this condition.

 Fulminant hepatic failure, post-hepatic syndrome, pancreatitis,
atypical pneumonia.

3. Name any 02 serological markers indicating chronicity.

 Anti-HbC, IgG, anti-HbS IgG

4. Name any 02 serological markers indicating infectivity.

 PCR showing increased viral load & HbeAg

5. In case of accidental pin prick with HBsAg contaminated needle. What next step would you
recommend to do?
 Go for viral load, PCR, if it is more than 10 then prescribe immunoglobulins & vaccine. If it is
less than 10 then only vaccine is recommended.
 STATION NO: 30 (CUSHING SYNDROME)
- SCENARIO:
 A patient presents with complains of fatigue & obesity. She has thin skin, purplish striae
& rounded face. She is also hyperglycemic.

1. What is the most likely diagnosis?

 Cushing syndrome

2. Give any 03 differential diagnosis of this condition.

 Hypothyroidism, obesity, PCOS

3. Give any 04 investigations of this condition.

 24 hour dexamethasone test, 48 dexamethasone test, urinary cortisol,
circadian plasma levels of cortisol.

4. What is the most common symptom of this condition?

 Weight gain

5. What complications can be develop in this lady?

 Hypertension, diabetes mellitus, increased risk of infections, etc.

6. What is Nelson's syndrome?

 Following bilateral adrenelectomy for Cushing disease, there is enlargement of pituitary
adenoma causing visual symptoms & hyperpigmentation.

7. What signs in CNS can be present in this patient?

 Psychosis & depression.

STATION NO: 31 (GRAVE’S DISEASE)

- SCENARIO:
 A 40-years old female has presented with high grade fever, tachycardia & tremors. On
examination, she has proptosis & a mass in front of the neck.

1. What is the most likely diagnosis?

 Grave's disease

2. Give any 03 investigations of this condition.

 T3, T4 & TSH levels, anti-thyroglobulin & anti-microsomal antibodies,
thyroid scan.

3. How will you manage this condition?

 Methyl cellulose eye drops, lateral tarsorrhaphy, steroids, low dose radiation, orbital
decompression.
4. Which complications can be caused by this disease?
 Atrial fibrillation, periodic paralysis, osteoporosis.

5. Give any 04 differential diagnosis of this condition.

 Acute psychiatry disorder, pheochromocytoma, orbital tumor, acromegaly

6. Name any 02 drugs which can be specifically used in this condition.

 PTU, carbimazole.

STATION NO: 32 (DIABETIC KETOACIDOSIS)

- SCENARIO:
 An 18-years old male has presented with abdominal pain, vomiting & altered level of
consciousness. His RBs is 300 gm/dl. Her ABGs shows pH less than 07 & bicarbonate
less than 20.

1. What is the most likely diagnosis?

 Diabetic ketoacidosis.

2. Give any 03 additional investigations of this condition.

 Electrolytes, anion gap, urinary ketones, X-ray chest, ECG, plasma osmolality.

3. What is the most important step in management of this condition?

 Insulin & fluids.

4. At what osmolality will consciousness be altered?

 Greater than 320mosm/L

5. Give any 03 complications of this condition.

 Hypotension, cerebral edema, ARDS, DIC, hypothermia.

6. Give any 02 differences between hyperosmolar coma & diabetic ketoacidosis.

 There is no hyperventilation in the former
 Former presents with stupor & coma with hyperglycemia greater than 600 gm/dl
 STATION NO: 33 (COPD)
- SCENARIO:
 A 60-years old male smoker has presented with productive cough & shortness of breath
since 02 months. His pulse is 105 beats/min and B.P is 90/50 mmHg and R/R is 30
breaths/min. He is using accessory muscles of respiration. His chest is barrel shaped &
hyper-resonant.

1. What is the most likely diagnosis?

 COPD

2. What are the findings on X-ray (see the picture)?

 Hyper-inflated lungs, flattening of diaphragm, tubular heart.

3. What other signs on physical examination you will look for?

 Hyper-resonant lungs, tripod posture, pursing of lips, use of accessory muscles,
peripheral edema, cyanosis.

4. Give any 02 investigations for confirming your diagnosis.

 ABGs, PFTs.

5. Give the first line treatment for this condition.

 Inhaled ipratropium.

6. Give any 03 differential diagnosis of this condition.

 Bronchial asthma, bronchiectasis, cystic fibrosis, etc.

7. What are its stages on the basis of severity?

 Mild when FEV1 is between 60 to 79
 Moderate when FEV1 is between 40 to 59
 Severe when in between 20 to 39.

8. Which complications this condition can lead to?

 Respiratory failure, secondary polycythemia, spontaneous pneumothorax, Cor-pulmonale, etc.

9. How will you differentiate this condition from asthma?

 On the basis of reversibility.
 STATION NO: 34 (PNEUMOTHORAX)
- SCENARIO:
 A patient who was on ATT has suddenly presented with dyspnea with central cyanosis
since 01 hour. On examination he had decreased breath sounds & hyper-resonant right
lung (see X-ray).

1. What is the most likely diagnosis?

 Pneumothorax on right side.

2. What are the findings on X-ray?

 Hyper-inflated right lung, mediastinal shift towards left, absent lung
markings in right lung

3. Give any 02 differential diagnosis of this condition.

 Flial chest, COPD.

4. Which further investigation is done for this condition?

 CT scan.

5. Give any 02 other clinical signs that you can find in this patient.
 Decreased chest movements on affected side, decreased breath sounds, tracheal shift, cyanosis,
tachycardia, etc.

6. What is the urgent management of this condition?

 Chest tube intubation

STATION NO: 35 (PLEURAL EFFUSION)

- Read this X-ray & answer the following questions.

1. What are the findings on this X-ray?

 Obliteration of costo-phrenic & cardio-phrenic angles on left side,
homogenous opacity in left lower half of lung, menicus sign

2. What is your diagnosis?

 Pleural effusion

3. What clinical signs you will see in this patient?

 Dyspnea, dry cough, pleuritis pain, etc.

4. According to Light's criteria, how much protein should be present in the fluid in case of
CCF?
 Less than 03 gm/dl & fluid serum ratio of less than 0.5

5. What is Meig's syndrome?

 Right sided pleural effusion due to ovarian tumor.
6. Give any 03 causes of exudative effusion.
 Pneumonia, tuberculosis, Ca bronchus, rheumatoid, etc.

STATION NO: 36 (TUBERCULOSIS)

- SCENARIO:
 A 48-years old male has presented with low grade fever & weight loss since 06 months.
On examination B.P is 90/50 mmHg & pulse is 98 beats/min & weight is 39 kg &
temperature is 99.4˚F.

1. What is the most likely diagnosis?

 Tuberculosis

2. Give any 03 investigations of this condition.

 Sputum culture, mantoux test, PCR, etc.

3. Give any 03 extra-pulmonary complications of this condition.

 Enteritis, ano-rectal disease, poncet's polyarthritis, etc.

4. Name the 2nd line drugs used in this condition.

 Amikacin, cycloserine, capreomycin, kanamycin, ofloxacin, ethionamide, etc.

5. Name the drugs used in initiation phase.

 INH, rifampicin, ethambutol, pyrazinamide.

6. What findings you will get on X-ray of this patient?

 Hilar lymph node shadowing, miliary mottling, cavitation.

7. Name few common side effects of ATT.

 Rashes, hepatotoxicity, neuropathy, etc.

8. What is she therapy?

 Streptomycin, INH & ethambutol used in pregnancy.

9. Give any 03 causes of wheezing.

 Asthma, chronic bronchitis, emphysema, bronchiolitis, etc.

10. Give any 03 causes of crepts.

 Pulmonary edema, pneumonia, bronchiectasis, alveolitis, etc.

11. Give any 03 causes of tracheal shift.

 Collapse. Fibrosis, pleural effusion & pneumothorax.

12. Give any 03 causes of decreased breath sounds.

 Collapse, pneumonia, pleural effusion pneumothorax, etc.
 STATION NO: 37 (L.P NEEDLE)
1. Identify the instrument shown in the picture.
 Lumbar puncture needle.

2. Give any 02 diagnostic uses of this instrument.

 Meningitis, SAH, neurosyphilis.

3. Give any 02 therapeutic uses of this instrument.

 To lower CSF pressure, intrathecal chemotherapy.

4. What is the site of lumbar puncture?

 Between 3rd & 4th lumbar vertebrae.

5. Give any 04 contraindications of this procedure.

 Raised ICP/shock, septicemia, bleeding disorder, etc.

6. Give any 04 complications of this procedure.

 Spinal cord compression, congenital lumbosacral lesion of meningo-myelocele, local infection

STATION NO: 38 (TRUCUT BIOPSY NEEDLE)

1. Identify the instrument shown in the picture.
 Trucut biopsy needle

2. Give any 04 indications of this instrument.

 Liver biopsy
 To evaluate unexplained jaundice
 Suspected hepatic neoplasm
 Diagnosis of cholestatic liver disease.

3. Give any 04 complications of this procedure.

 Hemorrhage, pleural pain, bile peritonitis, bacteremia, sepsis.

4. Give any 04 contraindications of this procedure.

 Uncooperative patient, severe ascites, thrombocytopenia, prolong prothrombin time.

5. What is the site for this procedure?



6. Give any 05 causes of liver cirrhosis.

 Alcohol, hepatitis B ,hepatitis C, hepatitis D, Wilson’s disease