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Medicine Viva/OSPE/OSCE Questions by batch 2015


Ye Sir Irshad ne topics btai the for table viva: Rx of
Pul edema
Status Epilepticus
DKA
Honk
Upper GIT bleed
COPD& Asthma exacerbation
Acute MI

Imp topics for long case as per Dr.irshad hussain
CLD (ascites, upper gi bleed, enceph)
RESP
Pneumonia, tb, copd
CVS
Mi, cardiac failure, inf endocarditis
CNS
Meningoencaphitis
Stroke
DIABETES and complications

ECG( afib..STEMI) xplain ecg(rate..rythm.axis etc).diagnosis..traetmnt

instrumnt (ETT.double lumen cathetr.LP imp) sangstaken..NG tube..folleys..bone marrow biopsy needle.

counselling HTN..ischemic heart disease..diabetes..COPd asthma. epilepsy.
 brain(ischemic CVA..hemorrhagic..brain edema..brain atrophy .SOL)
CT abdomen..(hepatic mets)

x_ray chest pulmonary edema..pleural effusion..consolidation

xplain xray+ (PA view.trachea.soft tissue..heart..angles etc) .. diagnosis..treatmnt.

D/D(chest pain .upper git bleed..diarrhea acute..chronic.) neuropahy..myopathy k causes


Important Ward Questions

1) Why does edema first appear around eyes in Nephrotic
While in CCF it is on dependent parts?

(Pt.of Nephrotic can lie flat, so edema first appears around eyes, while pt. Of CCF cannot lie flat.. So on dependent parts)

MAP= diastolic pressure+1/3 of systolic

2) Causes of Ascites?
.Increase in Hydrostatic Pressure
.Dec in Oncotic Pressure
. Inflammation
.Blockade of Lymphatics

4) How do u differentiate b/w ascites of CCF n Cirrohsis?
(JVP raised in CCF while normal in cirrohsis)

5)Angina Equivalent.?
(Pt.presents wd SOB but no chest pain..as in old age, DM)

6): why S1loud in MS?
Incomplete filling of ventricles due to stenosis
So when ventricular systole starts
Come wd more force
More sound is produced

. If leaflets complete fuse..S1 decreases to absent

.Any young pt. Presenting wd CVA/TIA..must auscultate the heart

MS can present as Ortner Syndrome (Hoarseness
Bcz of RLN compression due to enlarged LA)


7):Clubbing in 2weeks time?
Infective Endocarditis
Lung Abscess

.If Apex beat horizontally displaced..Rt.Ventricular Hypertrophy
If downwards n outwards..LVH

8): MS murmer will be inc. In Exercise
While decreases that of HOCM

9): How to differentiate b/w JVP of RHF n vol.overload of CKD?
If JVP sustains for 30sec or more...RHF

If not...CKD

10):Define Cor-Pulmonale? Dr.Irshad

RHF secondary to Lung Dysfunction which may be
.Parenchymal (COPD)
.Vascular
.Musculoskeletal (myopathies)
Or
.CNS disease (pick- wickian syndrome)

11): Arterialization of JVP in which condition?

In Tricuspid Regurgitation
(Jugular Vein becomes palpable n got arterial charachter)

12):
Fine Crepts..not in all phases of respiration
Coarse.. Present in all phases

3Rules of Percussion
Dr.Sajid

1): Always percuss from resonant to dull area

2): Pleximeter should be placed horizontal to edge or border of organ to b percussed

3): line of percussion is perpendicular


Sir said is k elawa aur koi rule nae hae

Normal sa ho gya .east m tha pancytopenia long case tha .osce east m krwa d ti .shrt case ma lat. Rects ka paralysis tha aur heart k palpatn aur auscultatn krai

South ma ni krai osce .west east ma krai .north ka ni pta
sir irshad n shrt case m mjh s aortc regurg suna tha mainly us k peripheral sign ,precordial sign bki finding h sunte aur us s relatd aur b kuch ques kye the yad ni.
ext n findng ,bel phenomenon, hypoglycemia suna tha
.lng case ma kafi time tha help b kr dte
Short case ma koi help ni

Aik short case bilateral abducent palsy ka tha. Aik mitral stenosis ka. Sir irshad ko tricuspid regurg boht pasand. Us k peripheral signs!!!!! Status asthmatic. Epilepticus. Acute pul edema. Acute mi. Uper gi bleed. Ki managent. Hr bchay se aik question in me se.

Sir ko MS MR AR b bht psnd ha
TR ke peripheral signs i heard                      
N TR n MR ka diff on examintion

AR. splenomegaly. Pl effusion. Hemiplegia. Hr sys ka case rkha hua tha. Bahir cases bta diye thay. Dr sajid... Auscultate precordium. AR ki findings btain. Rhythm was irregular. Cause? Afib. Noncardiac causes of afib. Thyrotoxicosis most imp.
North extrnal short case. Palpate abd. Splenomegaly btai. Causes of nontender soft slightly enlarged spleen.

Long case dr tariq waseem. DVT.
PGs helped. DD cellulitis. Y this is nt cellulitis. Usme all signs of inflm r present. Complication: pul embolism. Hw prevent? IVC filter. Rx imobilize . Anticoag with heparin,  overlap wid warfarin. Then stop heparin continue warfarin. How long? 6 mo. Causes o dvt.
Osce north.. u had to ask PGs to come to u . Then they told ans.

South medicine.
Osce full help...they were really great.

Short case.external. examine 5th nerve.....conjunctival corneal reflex pathway?...in wich condition u test for pain n temperature in trigeminal? trigeminal neuralgia....aur? ....lateral medullary syndrome?. Weber syndrome? AS k peripheral signs? Causes of wide split of 2nd heart sound?

Inyernal . Examine liver...
Flapping tremors...
Dobutamine contra indications...indications of norepinephrine. 

Long case..infective exacerbation of asthma...external took viva..tell me about ur parient..brief history suni...gpe me kia hai? Wat is air hunger? Wat is nasal flaring? Respo me any finding?..wat investigations? . Can u diagnose asthma from sputum.? Ans apart from eosinophils, microscopically  charcot leyden crystals n curshman spirals...my patient was also thyrotoxic on carbimazole....shake her hand wat do u feel?  Warm dry hands...y warm? Ans was any of three causes Fever thyrotoxic co2 retention...metabolic tremors chek krain....if it was sweaty cold wid tremors? Anxiety...do u know the types of rhonchi? is stethoscope a misnomer? Y does she hav tachycardia? Fever, resp distress, thyrotoxic....cud it b iatrogenic? Salbutamol....aur kia dainge patient ko asthma me? In thyrotoxic u giv beta blockers....wud u in this case? No..carbimazole k side effects? Wat shud u tell the patient..ans to come immediately if theres any complaint of sore throat.

South:

Short1: AS peripheral signs. Other causes of Ej syst murmur? Pulm stenosis me apex beat kesi hoti h? Sign kya aata h RV hypertrophy pr? Check 3rd nerve of pt. Causes of constricted pupil. Argyll robertson pupil. Ek pta ni konsa pupil. Marcus gunn? Its Cause? 

Short2: palpate kidney.
Check jaundice.
Ye kya h. Indications contraindications (dobutamine thi ek just use poocha uska. Ek norepinephrine)

Long CVA. Diagnosis treatment pr viva

Osce total helped.

3Rules of Percussion
Dr.Sajid
1): Always percuss from resonant to dull area
2): Pleximeter should be placed horizontal to edge or border of organ to b percussed
3): line of percussion is perpendicular
Sir said is k elawa aur koi rule nae hae

 Osce in west med. Itni koi help nhi hoti. Bht basic level of cheating hoskta hai. Lekin apas me poochney wala koi scene nhi tha.
Counselling was for patient taking Warfarin.
Hypocalcemia scenario(pictures of carpal spasm was there)
Causes and conditions causing it.
Inf wall MI ki ECG thi (ye btaya tha mjhe PG ney)
NG tube. Indications
CT scan.ischemic CVA ka tha.
Ek scenario Anemia ka tha
Ek scenraio TBM ka tha

Medicine Viva.
You goto East ward and wahan per Batch parhi nikalti.
My batch got West Medicine.parchi: short case+osce in west med. Long case allotmnt bhi west mein but Viva.North waley lenge. (Dr Sajid ubaidaullah or external)
Drug was heparin.

Two short cases huye.
Ek Dr Tariq ney lia he looked at the card. Command was to examine 1-6 cranial nerves
And other short case was
Examine veins of neck. And palpate parasternal heave.
Long case was ITP (yes LOL)
But help ho hi gyi thi
But viva of long case was on pneumonia. (lol again)
East... as per i know
full help in osce
short cases were of hepatomegaly
consolidation
MS
Normal person
My batch got south medicine we had our short cases and osce there..
Osce.
Heparin,ng tube, ct scan ischemiac stroke, inf wall mi ecg, counseling diabetes
And warfarin intake after rheumatic heart disease,viral meningoencephalitis, upper gi bleed management, signs of hypocalcemia chovsteks trosseua tetany
Short case 1 dr. Khalid
Palpate upper border of liver u have to percuss also wd palpation on this command. He asked upper border percuss wd deep percussion or lite?? I said I have no idea answer is deep.. But he was really sweet doesnt say anythng
 Short case 2 external.. Bht sweet tha external
He asked to ascultate back and demarcated the area where to ascultate he asked for finding I said ronchi he asked causes doesn't matter u get the finding ritw or wrong he will ask question accordingly. Aortic stenosis ke findings kiya hti splittng knsi hti? Reverse splitting k air causes?
 Osce me heparin k moa bhe pucha tha.. Ng k complications, ischemiac strole k young me 2 causes,
They will say that no help in osce. But if u ask them they will tell..

Long case Dr. Irshad
He will ask about the history doesn't listen at all , in the end he asks any positive finding and ur diagnosis diff diagnosis, management.. And anyother relevant question..
Everyone all pgs are very helping everywhere.. No need to worry at all.. Dr. Irshad is askng question like lactulose k mode of action, prim sec arrythmias after sk administration.. But if u don't know he just tells u the answer no big deal
Normal sa ho gya .east m tha pancytopenia long case tha .osce east m krwa d ti .shrt case ma lat. Rects ka paralysis tha aur heart k palpatn aur auscultatn krai
South ma ni krai osce .west east ma krai .north ka ni pta
sir irshad n shrt case m mjh s aortc regurg suna tha mainly us k peripheral sign ,precordial sign bki finding h sunte aur us s relatd aur b kuch ques kye the yad ni.
ext n findng ,bel phenomenon, hypoglycemia suna tha
.lng case ma kafi time tha help b kr dte
Short case ma koi help ni
Aik short case bilateral abducent palsy ka tha. Aik mitral stenosis ka. Sir irshad ko tricuspid regurg boht pasand. Us k peripheral signs!!!!! Status asthmatic. Epilepticus. Acute pul edema. Acute mi. Uper gi bleed. Ki managent. Hr bchay se aik question in me se.

For 1st Cotton k uper koi perfume waghaira kr k
Sec k lie colours
Newspaper and color markers fr secnd  and koi bh smelly cheez fr frst like lemn
Sir ko MS MR AR b bht psnd ha
Wo b puchay thay
TRICUSPID?
 Pancytopenia k case mai kya Suna :-/
TR ke peripheral signs i heard
N TR n MR ka diff on examintion

North ki parchi nikli. Dr sajid n extrnal took short cases.
AR. splenomegaly. Pl effusion. Hemiplegia. Hr sys ka case rkha hua tha. Bahir cases bta diye thay. Dr sajid... Auscultate precordium. AR ki findings btain. Rhythm was irregular. Cause? Afib. Noncardiac causes of afib. Thyrotoxicosis most imp.
North extrnal short case. Palpate abd. Splenomegaly btai. Causes of nontender soft slightly enlarged spleen.
 Long case dr tariq waseem. DVT.
PGs helped. DD cellulitis. Y this is nt cellulitis. Usme all signs of inflm r present. Complication: pul embolism. Hw prevent? IVC filter. Rx imobilize . Anticoag with heparin,  overlap wid warfarin. Then stop heparin continue warfarin. How long? 6 mo. Causes o dvt.
Osce north.. u had to ask PGs to come to u . Then they told ans.

South medicine.
Osce full help...they were really great.
Short case.external. examine 5th nerve.....conjunctival corneal reflex pathway?...in wich condition u test for pain n temperature in trigeminal? trigeminal neuralgia....aur? ....lateral medullary syndrome?. Weber syndrome? AS k peripheral signs? Causes of wide split of 2nd heart sound?
Inyernal . Examine liver...
Flapping tremors...
Dobutamine contra indications...indications of norepinephrine.
Long case..infective exacerbation of asthma...external took viva..tell me about ur parient..brief history suni...gpe me kia hai? Wat is air hunger? Wat is nasal flaring? Respo me any finding?..wat investigations? . Can u diagnose asthma from sputum.? Ans apart from eosinophils, microscopically  charcot leyden crystals n curshman spirals...my patient was also thyrotoxic on carbimazole....shake her hand wat do u feel?  Warm dry hands...y warm? Ans was any of three causes Fever thyrotoxic co2 retention...metabolic tremors chek krain....if it was sweaty cold wid tremors? Anxiety...do u know the types of rhonchi? is stethoscope a misnomer? Y does she hav tachycardia? Fever, resp distress, thyrotoxic....cud it b iatrogenic? Salbutamol....aur kia dainge patient ko asthma me? In thyrotoxic u giv beta blockers....wud u in this case? No..carbimazole k side effects? Wat shud u tell the patient..ans to come immediately if theres any complaint of sore throat.

North medicine complete help in osce
Short case ki findings dey tell u nd commands unhi findings ki hoti like if its spleenomegaly den examine abdomen.
Long case main dey tell u keh yeh yeh isko hua dis is treatment yeh probable cause hai agay viva jo pooocha jayay woh xtrnal ki mrzi. dvt sa peripheral arterial disease sa beurger sa atrial fib sa embryo whtevr examiner wants

Short case ospe in east,full help in everything,mera long sir noman ny lia south say as internal and sahi hogya,focus on ur presenting complaints only,don't jump on to the diagnosis,baqi east k extrnl ka short case was weird for me gpe ki command di thi or phr sb kuch e pocha tha so focus on gpe ki findings and their causes too

South: Osce..dictated each n every word.
Short case: ext examine position sense. Its Tract n other sensation. Corticl sensations. Signs of TR. Int: palpate liver. Gave me a vial of dobutamine to identify n its side effects.
Long case: meningitis. Gpe. Where do u see pallor. causes of pallor other than anemia. What will happen if patient falls. Investigations. What will CT show. Signs of raised ICP n effect on pulse. Complications n Waterhouse Friedrichson syndrome

Position sense main kia krna
Us me 15 degrees tak up and down randomly move kro big toe ko.
Then stop
Patient say pocho k position "up" hai ya "down"

South Medicine
Short1: AS peripheral signs. Other causes of Ej syst murmur? Pulm stenosis me apex beat kesi hoti h? Sign kya aata h RV hypertrophy pr? Check 3rd nerve of pt. Causes of constricted pupil. Argyll robertson pupil. Ek pta ni konsa pupil. Marcus gunn? Its Cause?
Short2: palpate kidney.
Check jaundice.
Ye kya h. Indications contraindications (dobutamine thi ek just use poocha uska. Ek norepinephrine) Long CVA. Diagnosis treatment pr viva. Osce total helped.

South OSCE full help. Short case: examine tone of the lower limb. Knee jerk. Hypertonia ki types aur causes. Sir khalid asked crepts k causes. ETT ki indication
Long case. MI k investigations aur management. GPE ki findings

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