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MBBS VI Medicine > OSCE dead stations > Flashcards

OSCE dead stations Flashcards

1
Q
  1. What is dx?
  2. Name 2 features to support dx
  3. Name 1 immediate non pharmacological mx. based on ALS suggest 1 pharmacological tx
    Another ECG done after tx
  4. Name the most striking abnormality
  5. What is the vessel involved?
  6. Name 2 perfusion strategies
A
  1. Monomorphic Vtach
  2. Wide QRS complex tachycardia, extreme axis deviation, concordance
  3. DCCV, IV amiodarone, procainamide
  4. ST elevation over V1-4
  5. LAD
  6. TPA, PCI
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2
Q

50y male smoker left sided pleuritic chest pain, spO2 96%
1. most striking feature
2. 2 RF
3. Tx for this admission
PET CT showed hypermetabolic lesion
4. 1 striking feature
5. 3 complications
6. 1 Ix for dx

A
  1. left pneumothrax
  2. chronic smoking/emphysema, Marfan syndrome
  3. O2, analgesics, chest drain if large (symptomatic)
  4. Right apical hypermetabolic lesion
  5. SVCO, cardiac tamponade, SIADH, PTHrP, lung collapse
  6. CT guided percutaneous biopsy as peripheral lesio. If central would do for EBUS Transbronchial biopsy
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3
Q

M/70, presents with malaise, diarrhoea and nausea. HIstory of pancreatic cancer. PMH AF, HT, chronic renal impairment. DHx: diltiazem, losartan, apixaban
Pancytopenia
Given CBC with WBC differential count.
1. Blood test for pancytopenia
2. definitive Ix of pancytoepnia
3. 1 pharmacological tx of neutropenia
CBC 6 months ago was normal
Px had colchicine, forgot instruction from doctor, taking 4-5 times a day
1. Diagnosis of clinical presentation
2. Px morbidity
3. How does diltiazem contribute to this presentation

A
  1. Vit b12 and folate, PBS, reticulocyte count, liver function test
  2. Bone marrow aspiration and trephine biopsy (requires architectural examination)
  3. G-CSF
  4. Colchicine induced diarrhea and colchicine induced myelosuppression leading to pancytopenia
  5. Chronic renal impairment
  6. Diltiazem is CYP3A4 inhibitor, reduce metabolism of colchicine, increase colchicine level in blood
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4
Q

HyperCa (around 3), hypophosphataemia.
Low Cr (around 60), normal albumin.
1. Name ONE class of anti-hypertensive agent can cause the above abnormalities? (2)
2. Which other biochemical abnormality would this drug cause as well? (1)
3. Name TWO treatments for the biochemical abnormalities in the stem (NOT Q2) (2)
The patient did not take the anti-hypertensive name. The PTH returned to be 10 (increased).
4. What is the diagnosis (2)
Lumbar spine XR
5. What is the site of the lesion and what is the lesion
6. DEXA showing -1 to -2.5 what is dx

A
  1. Thiazide diuretics
  2. HypoK
  3. Fluid replacement, IV bisphosphonates, denosumab
  4. Primary hyperPTH
  5. T12/L1 vertebral body collapse
  6. Osteoporosis
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5
Q
  1. What is ECG dx
  2. 1 tx to stop arrhythmia
  3. Acute pharmacotherapy to prevent acute recurrence of arrhythmia
    Mum brings her med: levofloxacin, loperamide, metoclopramide. Biological father collapsed at 26yo, autopsy no obvious findings. K 2.4. Echo normal
    Another ECG
    Blood test result:
    HypoNa
    HypoK
    HypoCa
    TSH normal
    Bedside echo: normal
  4. 2 ECG features
  5. Precipitating factors
  6. 1 long term pharmacotherapy to prevent this arrhythmia
A
  1. polymorphic VT/ torsades de pointes
  2. AED (as pulseless VT)
  3. IV isoproterenol for refractory cases of recurrent TdP –> increases underlying heart rate (or use transvenous pacing. IgMgSO4 is 1st line pharmacologic therapy if VT has pulse.
  4. FHx of young onset sudden cardiac death, electrolytes (HypoCa, hypoK, HypoMg), antibiotics (clarithromycin), antipyschotics (haloperidol, SSRIs)
  5. BB
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6
Q
  1. Comment on XR
    19yo female non smoker SOB, distended face neck and UL veins
  2. 2 causes
  3. 1 immediate Mx
A
  1. Right hilar mass
  2. Lung tumor, lymphoma, thymoma, teratoma
  3. SVC stent and biopsy
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7
Q

LBP x 2 years, morning stiffness
1. Dx from XR
2. 2 blood test abnormalities that will confirm the dx
3. Initial tx
Failed conservative and developed 2nd pic
4. dx from clinical picture
5. Additional imaging to perform to ix for the low back pain
6. Heard about biologics, what are the viable options?

A
  1. Ankylosing spondylitis
  2. HLAB27, ESR/CRP
  3. NSAID
  4. Enthesitis of left achilles tendon
  5. MRI
  6. TNF inhibitor (adalimumab, entanercept, infliximab), JAK inhibitor (baricitinib, tofacitinib), IL17 inhibitor (secukinumab)
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8
Q

M/60 presented with 2 weeks hx of intact bulla
1. dx from picture
2. what dx test
3. What blood diagnostic test
4. What is 1st line systemic tx for this condition
5. 2 special precautions for this tx
6. 2 common complications of this tx

A
  1. Bullous pemphigoid
  2. Skin biopsy for histology and direct immunofluorescence test
  3. Anti skin Ab: anti BP180 and anti BP230
  4. Steroid for bullous
  5. Infection related: check TB and HBV status. Hyperglycemia and its complications esp with DM
  6. Hyperglycemia hypokalemia, infection
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9
Q

Old man, history of hypertension and non-valvular AF on warfarin presented with swollen L knee, INR 5.1

  1. 3 questions in history taking you will ask to swelling is due to over-warfarination (or ascertain the cause of overwarfanization?) (3M)
  2. MOA of warfarin (1M)
  3. Name one clinical score to assess need of anticoagulation in atrial fibrillation? (1M)
    Have TB and started a med, urine orange
  4. What is that med? (2M)
  5. How the med affects INR? (1M)
  6. What’s the drug drug interaction between the med and warfarin? (2M)
A
  1. Drug compliance, diet restriction, polypharmacy
  2. Vit K epoxidase reductase inhibtor –> reduce synthesis of coagulation F2,7,9,10
  3. CHADVASC score
  4. Rifampicin
  5. Decrease
  6. CYP inducer which increases the metabolism of warfarin
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10
Q

55/M, good past health, come to your clinic for muscle weakness and myalgia
a. Describe at least 1 lesion from each of the photos (2)
b. dx
c. 2 blood test to confirm dx
d. A long list of Ab) anti-TIF1g +ve, others all -ve One most important finding (1)
e. Significance
f. 3 more ix

A

a. V sign (shawl sign includes the back), gottron papules
b. dermatomyositis
c. Serum CK, LDH. Anti-Jo1, Mi2, MDA5
d. Anti-TIF1g +ve
e. Cancer associated myositis
f. EMG, skin/muscle bx, CXR, nasoendoscopy (NPC), colonoscopy

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11
Q

a. What are some suspicious features? (1)
b. 3 DDx (3)
c. dermoscopy features?
d. sun related?
e. groin LNcm, FNAC malignant cells, one Ix
f. Drug tx

A

a. irregular, hyperpigmentation
b. malignant melanoma, BCC, SCC
c. heterogenous hyperpigmentation, irregular
d. No
e. PET CT (lymphatic mapping with lymphosctinigraphy (for sentinal lymph node biopsy if there wasnt any palpable LN)
f. anti PD1 (nivolumab)

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12
Q
  1. ECG
  2. dx
  3. One more Ix
A
  1. RAD, RBBB, S1Q3T3
  2. PE
  3. CTPA
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13
Q
  1. CT findings
  2. 1 more ix
  3. Immediate tx
A
  1. Right ICH, sulcal effacement
  2. CTA, INR
  3. Anti hypertensives, tranexamic acid, reverse coagulopathy (IV vit K, PCC, FFP (takes time), control ICP (mannitol, do not hyperventilate)
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14
Q
A

a. hydropneumothorax, pleural effusion
b. IV Abx, O2, chest drain
c. neutropenia
d. Piperacillin (B lactam), tazobactam: B lactamase inhibitor
e. Date, drug: piperacillin-tazobactam, dosage: 4.0g/0.5g, route: IVI, frequency: q6h, prescribed by: name
f. penicillin allergy

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15
Q
A

a. cushing syndrome
b. late night salivary cortisol, low dose dexamethasone suppression test
c. hypoK
d. R adrenal mass
e. R adrenalectomy
f. DM, osteoporosis, AVN, proximal myopathy

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16
Q
  1. Name 2 abnormalities
  2. Name 1 biochemical test
  3. Name an Ix to rule out septic arthritis
  4. X ray feature
  5. Dx
  6. 2 acute tx
A
  1. swollen erythematous DIp, MCPJ, tophi
  2. Serum uric acid, inflammatory markers: ESR, CRP
  3. Joint fluid analysis for cell count, smear x C/ST
  4. Juxtaarticular erosion
  5. Acute gouty attack
  6. NSAID, colchicine, intraarticular steroid
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17
Q

86yo elderly lady with mostly intact blisters, some ulcerated
1. dx
2. Name 3 Ix that can help with your dx
3. Pathophysio of hte disease
4. Finding in skin biopsy below
5. dosing frequency of methotrexate
6. MoA of methotrexate

A
  1. Bullous pemphigoid
  2. Skin biopsy wth direct IF staining, anti skin antibodies (antihemidesmosome), CBC for eosinophilia
  3. Autoantibody against dermal-epidermal junction
  4. Skin biopsy with direct immunofluorescence staining
  5. weekly
  6. Dihydrofolate reductase inhibitor that inhibits purine synthesis
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18
Q
  1. 2 features of bradycardia in the ECG
  2. dx
  3. 2 blood tests
A
  1. AV dissociation, rSR’ pattern in V1, poor R wave progression
  2. Complete heart block
  3. Cardiac biomarkers, electrolytes, NTproBNP (heart failure)
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19
Q
  1. cause of headache
  2. 2 anatomical pathologies that cause such
  3. Immediate mx before definitve tx
A
  1. Subarachnoid hemorrhage
  2. Berry aneurysm, AVM
  3. Antihypertensive, mannitol (reduce ICP)
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20
Q

25/M, Low back pain x 6 months, Improves with Exercise, Worsens with Rest
(AP Pelvic XR)
1. 2 Ix (2 marks)
2. 2 tx options
3. 1 biochemical test for disease activity?
4. Name 2 findings osn the XR
5. Likely dx
6. Eye Cx of the dx

A
  1. HLAB27, inflammatory markers (ESR, CRP)
  2. NSAID, DMARD (sulfasalazine), biologics (TNFa inhibitors: infliximab), IL17 inhibitors (secukinumab)
  3. ESR/CRP
  4. Marginal syndesmophytes, fusion of SIJ, squaring of vertebral bodies
  5. AS
  6. Anterior uveitis
21
Q
  1. Rash found in body, chest, back, limbs. Name 3 other sites would you look for in the skin? (3 marks)’
  2. What drug was started? (1 mark)
  3. What gene
  4. Skin sliding away, what is this?
  5. 2 more causes of this sign
  6. Name another drug and the gene that can cause this condition
A
  1. Palms, soles, face
  2. Allopurinol
  3. HLA B5801
  4. Nikolsky sign
  5. Staph scalded skin syndrome, pemphigus vulgaris
  6. Carbamezapine and HLA-B 1502
22
Q

Palpitation, SOB, no chest pain with high random BG
1. 2 features of tachycardia
2. 2 ddx of ECG
3. Most appropriate Mx

A
  1. Wide QRS, right axis deviation
  2. VT, SVT with aberrancy
  3. Vagal maneuvre, amiodarone
23
Q
  1. most striking feature on ECG
  2. 2 most likely ddx of the sx
  3. 2 Ix to confirm the dx
A
  1. T wave inversion of leads V2-6, lead I and aVL
  2. Wellen type B, GERD
  3. CXR, echocardiogram, cardiac enzymes
24
Q

Patient with T2DM, HT on losartan, no chest pain. Complains of nausea and ankle edema
1. what abnormalities
2. What ix
3. Drug tx

A
  1. Peaked T wave, loss of P wave (QRS wide)
  2. Serum K, RFT
  3. 10% IV calcium gluconate, DI drop, sodium bicarbonate
25
Q

PRP scars for PDR (In real photo -> not much neovascularization) Same patient taking Metformin, Pioglitazone, Sitagliptin for his DM. eGFR is 30ml/min; ECHO done with LVEF 40%…
1. most important abnormality
2. What is the dx
3. Which 2 drugs would you withdraw and why?
4. Additional measure to help slow down progression of the renal failure

A
  1. PRP scars
  2. Proliferative diabetic retinopathy
  3. Metformin: GFR low –> risk of lactic acidosis
    Pioglitazone –> LVEF low –> risk of congestive heart failure
  4. ACEI
26
Q
  1. Describe CXR
  2. Cause
  3. 2 radiological Ix
  4. Ix to look for underlying cause
A
  1. Pleural effusion
  2. CA lung
  3. CT thorax, PET CT
  4. Bronchoscopy or CT guided percutaneous biopsy of lesion
27
Q
  1. What is ecg dx
  2. name 2 biochemical blood tests
  3. Name 3 effective mx modalities
A
  1. Aflutter
  2. TFT, electrolytes, cardiac enzyme
  3. Antiarrhythmic e.g. amiodarone, anticoagulant
    Synchronized DC cardioversion
28
Q
  1. Name 3 abnormalities on CTB
  2. What is the cause of this condition
  3. Name 1 immediate mx
A
  1. ICH, midline shift, blood in lateral ventricles
  2. Hemorrhagic stroke
  3. Antihypertensive (keep MAP < 130) e.g. CCB
29
Q
  1. what is dx
  2. Name 1 immediate test for disease
  3. name 2 other RF for this disease
  4. Name 1 important blood test for Mx
A
  1. TB
  2. Sputum culture (ziehl neelson stain), PCR, AFP sbear
  3. Immunocompromised, old age
  4. HbA1c, BG
30
Q
  1. ECG abnormalities
  2. Most likely dx
  3. Site of lesion
  4. 3 mx
A
  1. ST elevation in V2-4
  2. Acute aneroseptal STEMI
  3. LAD
  4. Anti thrombotic: aspirin and clopidogrel, LMWH, anti ischemic BB, ACEI, statin, PCI if < 12 hours
31
Q
  1. what is dx
  2. 2 non pharm maneuvres you can do
  3. What is drug tx
  4. What is the definitive tx
A
  1. SVT
  2. Vagal manouvres (carotid sinus pressure, ice water immersion)
  3. ATP 10mg iv push
  4. Catheter ablation of accessory pathway
32
Q
  1. 2 ecg abnormalities
  2. dx
  3. 2 drug contraindicated
  4. definitive tx
A
  1. delta wave, short PR interval
  2. WPW
  3. AVN blocking agent: adenosine, BB, CCB, digoxin
  4. Catheter ablation of accessory pathway
33
Q

Hypertension on atenolol
1. dx
2. 2 factors contributing to this condition
3. 2 mx

A
  1. AV dissociation, wide QRS complex –> complete heart block
  2. AMI, degenerative
  3. Atropine, temporary cardiac pacing
34
Q
  1. dx
  2. Immediate mx
  3. 2 conditions
  4. 2 drugs used
A
  1. monomorphic VT
  2. DC cardioversion
  3. AMI, valvular heart disease
  4. Amiodarone, procainamide
35
Q
  1. dx
  2. underlying pathology
  3. Ix
  4. 2 immediate mx
A
  1. SAH
  2. aneurysm, or AVM
  3. DSA, MRA
  4. ABC, CCB (nimodipine to prevent vasospasm), tranexamic acid (withint 48h), neurosurgical consultation for microsurgical clipping/ endovascualr coiling
36
Q
  1. dx
  2. 2 drugs for patient
  3. 1 electrophysiological problem associated with this problem
  4. Which arrhythmia associated with this condition
  5. What is definitve tx for this condition
  6. 1 mechanical complication
A
  1. Inferior STEMI
  2. Immediate tx: triple therapy (aspirin + ticagrelor + LMWH), rosuvastatin, pain relief (nitrate, morphine)
    Post PCI: statins, ACEI (prevent LV remodelling), BB (decrease cardiac workload), sublingual nitrate, tx of cardiovascular RF
  3. Arrhythmia
  4. AV block (AMI involve AVN): inferior STEMI means RCA blocked and RCA supplies the AVN through AV nodal branch before going down to inferior walls. Other arrhythmias of inferior/anterior STEMI: VT/ VF.
    If AMI affect SAN, it will cause sinus arrest
  5. Emergency PCI, thrombolytic therapy with tenecteplase
  6. VSD from rupture of interventricular septum due to weakening
37
Q
  1. describe abnormality
  2. dx
  3. 2 pharma tx
A
  1. bradycardia HR 40bpm, ST elevation in lead II, III, aVF. TWI in anterior leads
  2. Inferior STEMI with 3rd degree heart block
  3. Acute tx of STEMI + pacemaker implant for complete heart block
38
Q
  1. Name 2 ECG features
  2. dx
  3. 2 Mx
A
  1. STE elevation in V4R, ST elevation in leads III > lead II (that means coming from RCA), RV infarct usually occurs in the setting of inferior infarct (due to proximal RCA occlusion)
  2. STEMI likely right ventricular
  3. Aspirin + clopidogrel (avoid nitrate as decreases preload –> decreases cardiac output), LMWH
39
Q
  1. dx
  2. 2 causes of condition
  3. immediate Mx
  4. Give 1 drug to control condition
A
  1. VT. (regular, tachcyardiac, wide QRS)
  2. With structural heart diseases: IHD, dilated cardiomyopathy, HOCM, RCM, ARVD
    Without structural heart disease:
    Congenital: brugada, long QT, short QT
    Acquire: hypoK, hypoCa, hypoxia, aacidosis, drugs that prolong QT interval
  3. Defibrillation if pulseless VT, direct current cardioversion
  4. Acute: class 1 fast Na channel blockers (IV lignocaine, IV procainamide), class 3 K channel blockers (IV amiodarone)
    Long term: PO class 1 and 3 OAA (true AA)
40
Q

Lady with thyrotoxic symptoms
1. dx
2. 2 predisposing causes
3. 1 blood Ix
4. 1 immediate ix
5. 1 medical mx that has long term survival benefit
6. 1 complication of drug
7. 1 complication

A
  1. AF due to hyperthyroidism
  2. degenerative, ischemic heart disease, valvular heart disease, hyperthyroidism, rheumatic heart disease
  3. TFT
  4. IV digoxin, IV class 2 and 4 OAA (BB: esmolol and diltiazem), PTU
  5. NOAC (rivaroxaban), warfarin (valvular AF)
  6. Increase bleeding tendency (risk of intracranial hemorrhage)
  7. Acute heart failure
41
Q
  1. What is the ecg abnormality
  2. 2 Ix
  3. Why SOB
  4. Name 1 immedaite Mx tx for the above abnormality
  5. Non pharmacological
  6. Complication
A
  1. Atrial flutter, 4:1 block
  2. CXR, echocardiogram, troponin I, electrolytes, CBC, TFT
  3. Heart failure causing acute pulmonary edema (arrhythmia can cause heart failuure)
  4. IV digoxin, IV class 2 and 4 OAA (BB: esmolol and slow Ca channel blocker: diltiazem)
  5. Acute: DCCV. Long term: catheter ablation, pacing, surgery
  6. Acute pulmonary edema, AFlu has thromboembolic risk but lower than AF
42
Q
  1. Most likely dx
  2. 2 non pharmacological maneuvers
  3. immediate Tx
  4. Name 1 Ix
  5. 1 definitive tx
A
  1. Narrow complex tachycardia (SVT)
  2. Carotid sinus massage, vagal maneuvres (increase vagal tone to slow AVN conduction and termination of SVT), valsalva maneouvre (gagging, drinking ice water, cold water immersion of face)
  3. IV ATP, IV class II (esmolol) and class 4 slow CCB (diltiazem)
  4. Holter ECG, electrophysiolgoy study
  5. RF catheter ablation, PO immediate tx
43
Q
  1. Name 2 ecg abnormalities
  2. 2 causes
  3. ECG dx
  4. drug to give
  5. what tx if drug fails
  6. long term tx
A
  1. bradycardia, AV dissocation (QRS 120ms), slow ventricular rhythm (ventricular escape rhythm is the intrinsic beating of the ventricle because signal blocked from AVN)
  2. AMI, hypothyroidism, drugs (AVN blockers), hyperK
    Drugs ABCD: antiarrhythmics, BB, CCB, digoxin
  3. Complete heart block
  4. IV atropine, IV isoproterenol
  5. Temporary transvenous/ transcutaneous pacing
  6. Permanent pacemaker implant
44
Q
  1. dx
  2. Ix
  3. Tx
A
  1. J wave amplitude or an ST segment elevation of >2mm
    Negative T wave
    RBBB
  2. Ix: procainamide to unmask a brugada syndrome (however can trigger a polymorphic VT), electrophysiological study
  3. ICD
45
Q
  1. dx
  2. Risk
  3. Tx
A
  1. Long QT syndrome (calculated from beginning of q wave to end of T wave. QTc >450ms (adult male)
  2. Torsades de pointes
  3. Avoid strenuous excercise, avoid LQT drugs (macrolides, antiepileptics, 1st gen antihistamines), give BB, ICD

If hypocalcemia –> calcium gluconate

46
Q
A

Hypercalcemia (shortened ST segment and QT interval)

47
Q
  1. ECG features
  2. risk
  3. tx
A
  1. epsilon wave (tick after QRS), T wave inversion in V1-3, localized QRS widening and prolonged S wave upstroke in V1-3
  2. Ventricular arrhythmia, heart failure
  3. BB (sotalol), amiodarone
    ICD, avoid strenuous excercise
48
Q
  1. ECG features
  2. Ix
  3. Tx
  4. Long term tx
A
  1. LVH, q waves in lateral and inferior leads (due to septal hypertrophy)
  2. Echo, cardiac MRI
  3. Tx: BB, CCB, dispyramide
  4. Long term tx: myomectomy, septal ablation. ICD
49
Q
  1. ecg features
  2. causes
  3. tx
A
  1. 35bpm (bradycardia), prominent U wave in precordial leads (becomes more prominent below 65bpm)
  2. Anorexia nervosa, hyperK, MI, hypothyroidism. BB, CCB, digoxin.
  3. IV atropoine, IV isoproterenol (B agonist), temporary/transvenous/transcutaneous pacing

MBBS VI Medicine (99 decks)

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