OSCE Series Set 1 ( Questions & Answers ).pdf

Q1.
A patient presented with history of fever , diffuse abdominal pain and abdominal distension
with past history of hematemesis and melena. On examination , jaundice + ; tenderness + in
the abdomen ; shifting dullness +.
1. What is the likely diagnosis and complication which the patient has presented with ? 1
2. What investigation will you do to confirm the diagnosis ? 1
3. What is the criteria to make the diagnosis based on the above investigation ? 1
4. What is the first line drug to treat this complication ? 1
5. Name two drugs for prophylaxis of this complication. 1

Answers
1. Chronic liver disease with portal hypertension ; Spontaneous
bacterial peritonitis
2. Ascitic fluid analysis
3. Ascitic fluid neutrophil count > 250 / mm3
4. A 3rd generation cephalosporin ( for community acquired
SBP )
5. Norfloxacin ; Cotrimoxazole

Q2.
A 21 year old male presented with
complaints of fatigability , abdominal
pain , nausea and postural dizziness for
the last 6 months. A picture of his hands
is shown below.
1. What is the most likely diagnosis ? 1
2. Name at least two classic electrolyte
abnormalities seen in this condition. 2
3. What investigations will you do in
order to prove your diagnosis ? 2

Answers
1. Chronic primary adrenal insufficiency
2. Hyponatremia , Hyperkalemia
3.
○ ACTH stimulation test ( to confirm the diagnosis of adrenal
insufficiency )
○ Plasma ACTH ,Plasma renin , serum aldosterone ( to differentiate
primary vs secondary adrenal insufficiency )
○ Investigations for etiologic diagnosis ( like adrenal autoantibodies ,
adrenal CT , MRI pituitary etc )

Q3.
An 82 year old male was brought to the
emergency department with recurrent
episodes of syncope. On examination , he
easily found to have bradycardia. The image
shown is that of his ECG.
1. What is the ECG diagnosis ? 1
2. Mention any 4 causes for the this ECG
finding. 2
3. Mention the various treatment options. 2

Answers
1. Third degree AV block ( Complete heart block )
2.
● Fibrosis / sclerosis / calcification of the conduction system
● Iatrogenic ( like cardiac surgery , medications like beta blockers )
● Ischemia
● Infectious causes ( like Lyme carditis , viral myocarditis )
3.
● Eliminate reversible causes of complete heart block
● Pacing ( Temporary / Permanent )

Q4.
A 28-year-old non-pregnant lady presented with fever, cough and
weight loss for two months. She weighs 38 kg. Her HIV report came as
positive.
1. Name the drugs to be given as per current guidelines. 2
2. Give the basic principles of initiation of treatment in this patient. 3

Answers
1.Tenofovir ( TDF ), Lamivudine ( 3TC ) , Dolutegravir ( DTG )
TDF - 300 mg + 3TC 300 mg + DTG 50 mg , as FDC in a single pill once a day at a fixed
time every day
2.
● A comprehensive clinical assessment to obtain the baseline clinical status and to
rule out opportunistic infections
● Rule out active pulmonary TB. If the patient has TB , start ATT. Start antiretroviral
therapy as soon as possible within 2 weeks of initiation of ATT. If the patient does
not have TB, start the patient on TB preventive therapy.
● If the CD4 count is < 350 cells/mm3 , start the patient on cotrimoxazole prophylaxis

Q5.
A 40 year old female presented with fever and throat pain. She gave history of an
upper respiratory tract infection 2 weeks ago. On examination , she had a tender
goitre. Investigations showed an ESR of 105 , TSH of 0.01 mIU/ml and free T4 of 2.7
ng / dL.
1. What is the likely diagnosis ? 1
2. List any two causes for this condition 1
3. What will be the radioactive iodine uptake status in this patient at present ? 1
4. How will you treat this condition ? 2

Answers
1.Subacute thyroiditis ( thyrotoxic phase )
2.Viral infections , Drug induced ( Amiodarone )
3. Low uptake
4.
● NSAIDs
● Beta blockers to control thyrotoxic symptoms
● If no symptom relief with NSAIDs, glucocorticoids
● Monitor thyroid function every 2 -4 weeks using TSH & Free T4

Q6.
A 65 year old male , who is a known case of DM of 25
years duration and systemic hypertension of 20 years
duration , presented with complaints of frothing of
urine and edema of lower extremities. On
examination , he was found to have pallor and
bilateral grade 3 pedal edema. There were no
crepitations on chest auscultation. The investigation
results were as follows :
Hb - 8.5 g / dL ; S.Cr - 3.5 g / dL ; Urine albumin - 3 +
RBS - 200 mg / dL ; S.Na - 132 meq/L ;S.K - 4.8 meq/L
1.What is nephrotic range proteinuria ?
Mention any two causes. 2
2. How is chronic kidney disease classified ? 1
3. Mention any two causes of chronic kidney
disease. 1
4. What is the most important cause of
anemia in chronic kidney disease ? 1

Answers
1.
● 24 hour urinary protein excretion > 3.5 g
● Diabetes , Amyloidosis
2. Chronic kidney disease is staged based on
the cause of CKD , estimated GFR and
albuminuria ( CGA staging )
3.
● Diabetes
● Glomerulonephritis
4. Insufficient production of
EPO by the diseased kidneys

Q7.
You are the infectious diseases consultant at your hospital. Your ENT colleague
asked you to see a patient admitted in their department with suspected
mucormycosis.
1. Mention any two species of fungi that cause mucormycosis ? 1
2.Which are the risk factors for mucormycosis ? 1
3.Which is the most common form of mucormycosis ? 1
4.What is the investigation required for a definitive diagnosis ? 1
5.Which are the antifungals that can be used to treat mucormycosis ? 1

Answers
1. Rhizopus oryzae , Rhizopus delemar
2.
● Diabetes mellitus
● Solid organ or hematopoietic stem cell
transplantation
● Prolonged neutropenia
● Corticosteroid use
● Malignancy
3. Rhino orbital cerebral form of
mucormycosis
4. Definitive diagnosis requires a
positive culture from a sterile site
(e.g., a needle aspirate, a tissue
biopsy specimen, or pleural fluid) or
histopathologic evidence of invasive
mucormycosis.
5. Amphotericin B , Isavuconazole ,
Posaconazole

Q8.
A 70 year old lady fell on her outstretched hands and sustained fracture of her
forearm. The doctor informed the patient that she has severe osteoporosis and
hence the fracture.
1. Mention any 4 risk factors for osteoporosis related fractures ? 1
2. Mention any two indications for bone mineral density testing. 1
3. Mention any two biomarkers of bone formation and bone resorption. 2
4. Mention any two pharmacologic agents approved for the treatment of
osteoporosis. 1

Answers
1. Female gender , Advanced age ,
Current cigarette smoking ,
Alcoholism , Estrogen deficiency
2.
● Women aged more than or equal to
65 years and men aged more than
or equal to 70 years
● Adults who have a fracture at or
after age 50
3.
● Markers of bone formation -
Serum bone specific alkaline
phosphatase , Serum osteocalcin
● Markers of bone resorption -
Urine & serum cross linked N
telopeptide , Serum & Urine
cross linked C telopeptide
4. Raloxifene , Zoledronate

Q9.
A 30 year old male presented to the OPD with fever and myalgia. He is a farmer by profession. On examination , he had
icterus , subconjunctival hemorrhage and calf muscle tenderness.
Blood investigations showed
Hb - 15.4 ; TC - 15,000 ; DC - N 70 L 30 ; PLC - 70 ,000 ; Total bilirubin - 2.3 ; Direct bilirubin - 1.4 SGOT - 70 ; SGPT - 80 ;
ALP - 140 ; S.Cr - 2.0
The physician suspected leptospirosis.
1. What are the complications in this patient ? Mention any 4 other complications. 2
2. What is modified Faine's criteria ? 1.5
3. Mention any 3 antibiotics useful in this condition , with dose and duration. 1.5

Answers
1. Hepatitis , Renal dysfunction ; Pulmonary hemorrhage ,
Pancreatitis , Aseptic meningitis , Rhabdomyolysis
2. The diagnostic criteria for leptospirosis, introduced by WHO ,
which takes into account clinical , epidemiologic and laboratory
data.
3. Doxycycline ( 100 mg PO BD x 7 days ) ; Ceftriaxone ( 1 g IV BD x 7
days ) ; Crystalline penicillin 1.5 MU Q6H x 7 days

Q10.
A 55 year old lady presented with complaints of heaviness in the left upper
abdomen and weight loss of around 4 kg in the last 2 months. Her examination
revealed a palpable spleen of 14 cm. Her peripheral smear is shown below.
1.What is your diagnosis ? 1
2.Which chromosomal abnormality is most commonly observed in this
hematological condition ? 1
3. Name two drugs used in the treatment of this condition. 2
4. What is the definitive treatment ? 1

OSCE Series Set 1 ( Questions & Answers ).pdf

Answers
1. Chronic myeloid leukemia
2. Philadelphia chromosome - t(9;22) (q34.1;q11.2)
3. Imatinib mesylate , Dasatinib
4. Allogeneic stem cell transplantation

Q11.
A 60 year old man was brought to the OPD by his wife with history of forgetfulness for the
past 5 years. The wife also informed the doctor that he was finding it difficult to drive and
has lost way on a few occasions after going out for shopping. After examination , the doctor
concluded that the patient likely has dementia.
1. Which is the most common cause of dementia ? 1
2. Mention any 4 potentially reversible causes of dementia. 1
3. Give an example of a rapidly progressing dementia. 1
4. Mention the routine lab tests that should be done in a patient with dementia. 2

Answers
1.Alzheimer’s disease
2. Vitamin B12 deficiency ,
Alcoholism , Drug / medication
intoxication , Hypothyroidism
3. Creutzfeldt-Jakob disease
4.
● Complete blood count
● Electrolytes
● Thyroid function tests
● Vitamin B12
● CT / MRI

Q12.
A patient who was admitted in the medical ICU following gangrene of the left foot due to
uncontrolled DM developed hypotension and decreased urine output. The critical care
physician diagnosed him to have septic shock with acute kidney injury.
1. What is current definition of sepsis ? 1
2. What is the recommendation regarding the fluid resuscitation in a patient with septic
shock ? 1.5
3.What is the vasopressor of choice in a patient with septic shock ? 1
4. What is the KDIGO definition of AKI ? 1.5

Answers
1. Sepsis : Life threatening organ dysfunction due to dysregulated host response to
infection
2. For patients with sepsis induced hypoperfusion or septic shock , at least 30 mL/kg
of IV crystalloid fluid should be given within the first 3hr of resuscitation.
Balanced crystalloids are preferred. Use dynamic measures to guide fluid
resuscitation.
3. Norepinephrine
4. AKI ( KDIGO 2012 ) : An increase in serum cre atinine of 0.3 mg/dl or more within
48 hours of observation or 1.5 times baseline or greater, which is known or
presumed to have occurred within 7 days, or a reduction in urine volume below
0.5 ml/kg/h for 6 hours.

Q13.
1.Identify these snakes A & B 1
2.What is the classic toxicity produced by these snakes ? 1
3.Which are the species of snakes against which ASV is effective ? 1
4.In toxicity produced by snake A , what are the treatment options ? 2

Answers
1. A - Common spectacled Cobra , B - Russel’s Viper
2. Cobra : Neurotoxicity ; Russell's Viper - Vasculotoxicity
3. Spectacled Cobra , Common Krait , Russell's Viper , Saw
scaled Viper
4. Anti snake venom , Atropine - Neostigmine , Assisted
ventilation

Q14.
A 75 year old diabetic patient presented with fever and altered mental status.
Suspecting meningoencephalitis , a CSF study was done. CSF showed
polymorphonuclear pleocytosis with elevated protein and low glucose levels.
The wet mount of CSF showed organisms with tumbling motility.
1. The probable pathogen is ? 1
2. Which are the risk factors for the disease ? 1.5
3. What are the treatment options ? 1.5
4. Mention any two causes of hypoglycorrhachia. 1

Answers
1. Listeria monocytogenes
2. Neonates , pregnant women, individuals >60 years, and immunocompromised
individuals of all ages.
3. Ampicillin + Gentamicin , for at least 3 weeks
Ampicillin : total daily dose required is 12 g/ day ;
Gentamicin is added in critically ill patients (2 mg/kg loading dose, then 7.5
mg/kg per day given every 8 h and adjusted for serum levels and renal function)
4. Bacterial meningitis , TB Meningitis

Q15.
A 30 year old pilgrim was taken to a temporary health camp in the Himalayas with
complaints of headache , vomiting and lightheadedness. He travelled by car and
reached at a 1950 m above sea level by morning, and by late afternoon the same day ,
reached at a height of 3000 m sea above the sea level where he started experiencing
symptoms.
1. What is the likely diagnosis ? 1
2. What are the risk factors for this condition ? 1
3. List any two differential diagnoses. 1
4. What are the approved pharmacologic agents for treating this condition ? 2

Answers
1. Acute mountain sickness
2. The rate of ascent , A prior history of high altitude illness ,
Exertion , Respiratory tract infections , Dehydration
3. Alcoholic hangover , Hyponatremia
4. Acetazolamide , Oxygen , Dexamethasone

Q16.
1. What does size of the ET tube mean ? What is the size of
the ET tube shown below ? 1.5
2. What is the purpose of the cuff ? 1
3. What is the significance of Murphy’s eye ? 1
4. How to confirm the position of the ET tube after
intubation ? 1.5

Answers
1. The internal diameter of the tube in millimeters ; 8
2. The inflated cuff produces a seal against the tracheal wall; this prevents
gastric contents from entering the trachea and facilitates the execution of
positive pressure ventilation.
3. If the distal end of the ETT should become obstructed by the wall of the
trachea or by touching the carina, gas flow can still occur via Murphy's
eye. This prevents complete obstruction of the tube
4. Auscultation of bilateral breath sounds ; Monitoring of end tidal CO2 ,
Chest X ray

Q17.
A 40 year old male presented with pain in the 1st MTP joint of right foot. On
examination , he had features of inflammation at the joint. The doctor suspected
gouty arthritis.
1. What investigation/s may be done to confirm the diagnosis ? 1
2. Mention the treatment options for this patient. 2
3. If a patient has asymptomatic hyperuricemia , does he require urate lowering
therapy ? 1
4. Mention any 4 causes of hyperuricemia other than gout. 1

Answers
1. Synovial fluid analysis - check for needle shaped monosodium urate crystals .
2.
● Anti inflammatory measures : NSAIDs / Colchicine /Glucocorticoids
● Rest
● Ice pack application
Urate lowering therapy later , during the resolution phase / after the attack ,
together with anti inflammatory prophylaxis.
3. No
4. Myeloproliferative diseases , Rhabdomyolysis , Renal insufficiency , Tumour
lysis syndrome

Q18.
1.Describe the CT findings - A & B 2
2.What is the difference in the pathophysiology of these two
cases ? 2
3.What is the recommended BP target in these situations ? 1

A. Sudden onset of right hemiparesis B. Sudden decrease in consciousness

Answers
1. A - A hyperdensity involving the left putamen , suggestive of hemorrhage
B - A hyperdensity in the right frontal lobe , suggestive of hemorrhage
with mass effect
2. A - Hypertensive hemorrhage
B - Cerebral amyloid angiopathy is likely to be the pathology responsible
for hemorrhage
3. Reduce the systolic BP to < 140 mm of Hg

Q19.
1. The reflex tested is ? 0.5
2. Which is the peripheral nerve
responsible for this reflex ? 0.5
3. Which are the spinal levels tested in this
reflex ? 1
4. Mention any 2 causes of generalised
hyporeflexia. 2
5. Mention any two electrolyte
abnormalities causing generalised
hyperreflexia. 1

Answers
1. Biceps jerk
2. Musculocutaneous nerve
3. C5 , C6
4. Hypothyroidism , Guialline Barre syndrome
5. Hypocalcemia , Hypomagnesemia

Q20.
You are the resident doctor on duty in the ICU. You have a patient with metastatic
liver disease who is critically ill.
A. The patient’s son , who was abroad , came to the ICU and has requested to see
the doctor. What communication model will you use while breaking this bad
news ? 3
B. At the request of the relatives , the consultant has decided to transfer the
patient to a local hospital. You are asked to call the doctor at the local hospital
and describe the details of the patient. The department is using the ISBAR
model during communication. What is the ISBAR model ? 2

Answers
1. P SPIKES
P - Preparation
S - Setting of the interaction
P - Patient’s perception and
preparation
I -Invitation & information
needs
K - Knowledge of the
condition
E - Empathy & exploration
S - Summary and planning

2. ISBAR clinical handover
I - Introduction
S - Situation
B - Background
A - Assessment
R - Recommendation

OSCE Series Set 1 ( Questions & Answers ).pdf

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