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PM&DC Step-3/OSCE For Foreign Medical Graduates (Solved )
7-DEC-2103 (Morning-Session)
Exam was in Margala hotel,Islamabad and professors were from LUMHS,Jamshoro
(199 FMGs appeared this time for step-3)
Total Stations=25 ( Active Stations = 15 Rest Stations=10)
Active Stations=15 (Interactive Stations=4 Static Stations=11)
Time for each Station= 5 minutes
Marks for each station= 20
Total Marks= 15 x 20 = 300
Distribution of stations:
Medicine: 3 stations ,,,,,,,,,,,,,, (1 interactive + 2 static)
Surgery: 3 stations ,,,,,,,,,,,,,,,, (1 interactive + 2 static)
Gyne/Obs: 2 Stations ,,,,,,,,,,,, (1 interactive + 1 static)
Paeds: 2 stations ,,,,,,,,,,,,,,,,, (1 interactive + 1 Static)
E.N.T: 1 station ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, (static)
Optha: 1 station ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, (static)
Derma: 1 station ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, (static)
Psychiatry/Beh.Science: 1 station ,,,,,,,, (static)
Instruments/ECG/X-Ray: 1 station ,,,,,,, (static)
Medicine (interactive station)
A patient (young male) was laying on bed , professor sahib give command to exam the back of patient’s chest.
Approach towards right side of bed
Always introduce yourself first
Take patient introduction
Perform an exam on back of patient chest that involves following steps; (Inspection,Palpation,Percussion,Ausscultation)
Then Professor Sahib asked me about my findings …
Inspection: normal shape,no visible scars,deformity, reduced chest movements
Palpation: decreased chest expension, decreased vocal fremitus
Percussion: dull percussion note
Auscultation: decreased breath sounds, decreased vocal resonance, bronchial breath sounds (equal inspiration and expiration with an air gap in between)
Diagnosis: Pleural effusion
Causes:
Exudative: (malignancy,tb)
Transdative: (CCF,nephrotic syndrome,liver cirrhosis,myxodema)
Investigations to conform: (Lat/decubitus X-ray, USG, Aspiration of fluid)
Treatment: (Causes specific, chest tube drainage, antibiots)
Surgery (Interactive station)
See the picture paste on table and ask following question asked by professor sahib;
What is this: (Gynecomastia)
Causes:
Endocrine abnormalities:hypogonadism,hyperthyroidism,hyperprolactinemia
Systemic disorders:chronic kidney disease,chronic liver disease, obesity
Neoplasm’s:adrenal,brest,liver,lung,testicular
Drug side effects:oral antifungals,H2 receptor blockers,antiandrogens,anticancer drugs etc…
Treatment options:
Cause specific
subcutaneous mastectomy
liposuction-assisted mastectomy
laser-assisted liposuction and laser-lipolysis without liposuction
Radiotherapy
Gynecology/Obstetrics (Interactive station)
There was a dummy on table, professor sahiba command perform the delivery of baby on it with all cardinal movement of labor.
Paediatrics (Interactive station)
There were 5 vials in front of a professor sahiba, command was pick a vial which is used for the treatment of tuberculosis.
(BCG vial)
When this vaccination scheduled in children:
(at birth)
Dose this prevent tuberculosis in adulthood:
(Its is only used for primary prevention not for secondary prevention)
Correct place of its introduction and route of administration:
(I/M right deltoid)
How you conform this vaccination is done:
(wheel shape spot on right deltoid when this vaccination is done at birth and left a life long SCAR there)
Ophthalmology (static station)
Diagnosis:
Dacrocystitis
Clinical features:
Tender, red, swelling at medial canthus,tearing,crushing,fever,
Digital pressure over the lacrimal sac may extrude pus through the punctum
Treatment options:
Topical warm compressors + systemic antibiotics + systemic analgesics
Syringing, Probing, incision & drainage
DCR (dacryocystorhinostomy)
Complications:
Chronic dacrocystitis
orbital cellulitis, which may lead to optic neuritis, proptosis, motility abnormalities, blindness
E.N.T (Static station):
Diagnosis:
Daviated nasal septum (DNS)
Causes:
Trauma nose
Development errors
Clinical Features:
(Nasal obstruction,headache,sinusitis,epistaxis,ansomnia,extrnal nasal deformity)
Treatment of nasal bleed :
Ant. & post. nasal packing, cauterization, SMR, Ligation of vessels,
general measures after bleeding control (sitting position,mild sedations,pulse,bp & respiration monitored, blood transfusion>>>if required)
Compications of DNS surgery:
Nasal septum perforation, Septal haematoma & septal abscess, Saddle nose, Adhesions, Dropped nasal tip
Dermatology (static station):
Picture of foot of a lady who developed rash and intense itching at night and after hot showers:
Diagnosis:
Scabies (Sarcoptes scabiei)
What advise You will give her :
Improve hygeigic conditions
Adoid close contct with others because risk of transmission of infection
Treatment options:
Topical Permethrin, Topical benzyl alcohol, Topical calamine lotion
Oral antihistamines (loratadine) >>> for itching
Differential Diagnosis:
Atopic dermatitis
Contact dermatitis
Bedbug bites
Chicken pox
Paediatrics (Static Station)
Picture of a child with maculopapular rash;
Diagnosis:
Measles
Common complications:
Pneumonia
Encephalitis
Hemorrhagic measles
Gastroentiritis
Myocarditis
Immunosuppression
EPI strategies to cope with this disease:
Measles vaccination at 9 months of age and booster at 15 months of age
Long term complication of this disease:
respiratory illness, diarrhoea, conjunctival dryness
Instrument / ECG / X-ray station:
Name the instrument:
Babcock’s forceps
Uses:
It is used to hold the delicate structures such as;
Intestine,
Appendix,
Mesentery
How to sterilize this instrument:
Autoclave
Surgery (Static station):
Findings:
Radio-opaque rounded opacities in left kidney
Investigations for this condition:
Plain abdominal KUB X-ray, helical CT-scan, Intravenous pyelogram, Abdominal Ultrasound
Clinical features associated with this condition:
Sever pain radiating from flank to the groin and genital area or inner thigh
Urinary urgency,restlessness,haematuria,sweating,nausea & vomitting
Diagnosis:
Renal stones leading to hydronephrosis
Surgery (Static Station):
A case scenario of a 40 years old male complaining of fresh bleeding per rectum after bowel movements which is bright red in colour since last 2 years,also there is a history of mass protruding out from anus and no pain associated with it.
Diagnosis:
Haemorrhoids
Treatment options:
Rest
Fiber diet
Oral fluids to maintain hydration
Sitz baths
Laxatives (lactulose, basacodyl)
Rubber band ligation
Sclerotherapy
Electrocautery/infrarad radiation/laser surgery/cryosurgery
Hemorrhoidectomy (sever cases)
Complications associated with this:
Anemia
Strangulated haemorrhoids
Gynecology/obstetrics (static station)
A case scenario of a 35 yers old nulliparous female complaints of distended abdomen with menorrhagia:
Diagnosis:
Uterine fibroids
Investigation:
Bimannual examination
Ultrasonography
Hysterosalpingography
Treatment options:
“Medical”
NSAIDs
OCPs
Danazol
GnRH analogues
“Surgical”
Myomectomy
Hystrectomy
Uterine artery embolization
Pyschiatry (Static Station)
A case scenario of 30 years old females complaints of recurrent attacks of chocking , chest pain, Palpitations and dizziness .Her lab reports and ECG is normal.
Diagnosis:
Panic Attack/Disorder
What are other features of this disorder:
Periods of intense fear or discomfort ,Tachypnea, Diaphoresis
Hot flushes,Trembling,Fear of dying
Treatment options:
Short term therapy: (Benzodiazepines)
Long term thepapy: SSRIs (Fluoxetine) ,TCAs
(Amitriptyline >>> with strong sedative properties)
(Imipramine >>> with weak sedative properties)
Psychotherapy (Cognitive behavioral therapy,Interpersonal therapy)
Patient Education
Differential Diagnosis:
Medical conditions:
(Angina,MI,arryhythmias,Hyperthyrodism)
Psychiatric Conditions:
(Substanced Induced anxiety, generalized anxiety disorders, PTSD)
Medicine (Static Station)
A case scenario of 19 years old boy comes to you with fever,headache, nausea and vomitting with positive neck regidity on clinical exam. There is a history of drowsiness.
Diagnosis:
Meningitis
Investigations:
LP
Viral PCRs
CT/MRI brain (to rule out other diagnoses)
CBC with ESR
Treatment Options:
Supportive care and close follow up (in case of viral meningitis)
Antibiotics (in case of bacterial meningitis)
(I/V) Vancomycin + Ceftriaxone / Cefotaxime (Empiric treatment)
To decrease cerebral pressure >>> Dexamethasone/Mannitol (I/v)
>>> more beneficial if given 15-20 minutes before antibiotics
Treat close contects of patient with Rifampin
Second line prophylactic regimens include Ciprofloxacin/Ceftriaxone/Azithromycin
Medicine (Static Station):
A case scenario of a 35 years old female comes to you with routine check up. There is a history of contipation and nausea and vomitting before.There is no history of Jaundice and her lab reports are as following:
HBsAg: -ve HCV: +VE Serum Biliubin: 1.5 mg/dl
ALT: 45 U/L AST: 22 U/L Serum Phosphate: 180 U/L
Diagnosis:
Chronic Hepatitis C leading to CLD
Treatment options:
Intake of protein reduction
Lactulose for constipation
H2 receptor blocker (ranitidine)/PPI(omeprazole) for nausea and vomitting
Give I/V fluids (5% DW) for the correction of electrolyte imbalance
Interferons,Ribavirin >>> specific for the treatment of chronic Hepatitis-C
Mention side effects of the drug used to treat this condition:
Fatigue,Flu ike symptoms,mild anxity, skin rash,depression,GI symptoms
Common Complications of cirrhosis of liver:
GI bleeding Ascites Infection ( SBP)
Hepatic Coma Hepto-renal syndrome Electrolyte Imbalance
