Phase 4 MEQ April 2012

1. SAH
-2 x differential diagnosis for the headache
-3 consecutive blood samples taken, why? Dural/traumatic tap?
-What would you want to see in CSF and after how long? Xanthochromia, after 12 hours.
-Label circle of willis
-2x management (1x medical, 1x surgical)

2. Addisons (same as 3b question!)
-Reasons for raised urea, creatinine, K+ and low Na+
-Investigation (short synacthen test)
-2 x treatments and class (Hydrocortisone glucocorticoid, and fludrocortisone
mineralcorticoid)
-Addisons Crisis 2 signs/symptoms

3. Primary Biliary Cirrhosis (LFTs given raised bilirubin, alk phosph, AST, patient c/o itch)
-Cause of itch
-Treatment of itch
-3x complications of PBC
-Reason for oesophageal varices? portal venous hypertension
-Management

4. Chest pain ECG given
-2x signs on ECG and which leads they are in (?ST elevation/depression/Q waves?)
-2x drug treatments for angina and Mechanism of Action
-2x advice to give patient re taking GTN

5. Small bowel obstruction - ABDO XR given
-4x signs on XR which indicates SBO
-Cause of SBO in this lady (adhesions - as she previously had pelvic surgery)
-Another cause which you would want to rule out in this lady

6. TB CXR given
-Describe lesion in right upper lobe (2 points wanted)
-4x treatment for TB (RIPE)
-Why TB high in the homeless
-Sputum another test microbiologist can do on sample to get cause

7. Mania/Bipolar Disorder
-4x symptoms of mania
-Lithium 2x side effects when dose within NORMAL limits
-Lithium 2x side effects in TOXIC dose
-2x CLASSES of meds that increase lithiums effects in the body (?enzyme inhibitors)

8. COPD - ABG given
-Interpret ABG - ?type 2 resp failure
-2x CLASSES (e.g. SABAg/Anti Cholinergic) of NEBULISED medication and name and
Mechanism of Action
- 2 common organisms that can lead to an exacerbation
-Management (with increasing CO2 and decreasing pH) -?BIPAP

9. Acute Asthma
-4x triggers
-3 things in history that points to an allergic cause (hayfever, eczema etc)
-??Something else in history that it runs in family (cant remember properly!)
-Initial treatment and route of administration (I said oxygen 15L/min via non-rebreath mask,
but think others might have put salbutamol via nebuliser)
-?4x things can ask her to see if she is receiving suboptimal treatment

10. Haemophilia A (2 year old boy bleeding into knee)
-pattern of inheritance (x-linked recessive)
-2x management (1x mechanical, 1x pharmacological)
-Treatment that GP can prescribe
-PT/APTT/Bleeding time: increased, decreased or normal

11. PV Bleed fibroid uterus
-3x differential diagnosis
-3x treatments GP can prescribe
-2x gynae Ix

12. Pregnancy and PV bleed
-3 x differential diagnosis
-2x things to ask in history to support diagnosis of pregnancy
-??3x reasons why fundal height and period timing not the same (really badly worded q!!)

13. Urinary Incontinence
-2x types of incontinence as described in history (Urge & Stress) and mechanism of these
-1 question you can ask patient to assess severity of incontinence
-4x NON-pharmacological management
-CLASS of drug to treat (anti cholinergic)
-NAME of that drug (oxybutinin)
-2x common side effects of that drug (blurred vision, dry mouth)

14. Stroke
-3x investigations
-Location of lesion ?Right MCA
-4x risk factors

15. SLE (some symptoms and signs already given)
-6x symptoms
-6 xsigns
-2x treatment CLASSES and NAME
-Cause for her miscarriages and reason why (Anti-phospholipid syndrome)

16. HUS (boy went on a farm then had diarrhoea)
-diagnosis (?HUS)
-organism species and genus
-Cause of the anaemia (?haemolysis)
-what would see on blood film that indicates cause of the anaemia

17. Epilepsy
-where lesion
-Type of seizure (2 marks)
-2x driving advice
-Treatment

18. Diabetes
-diagnosis (dont use abbreviations HONK)
-Calculate osmolality equation given
-Hypokalaemia 1x symptom and 1x sign o/e

19. Amurosis Fugax
-Artery affected
-reason why
-Treatment 1x pharmacological, 1x non-pharmacological

20. Bleeding oesophageal varices
-Reason why portal HTN
-Prophylactic treatment
-4x blood investigations

21. AF and stroke (syncope)
-SCORE - risk of AF stroke (CHAD-2)
-Treatment to reduce frequency of syncopal episodes
-4 reasons that predispose HIM of AF (from history)
-2x other investigations and reason

22. Acute confusional state/delirium
-diagnosis (above)
-4 things to predispose patient to this
-2x nurse interventions
-1x treatment for delirium if conservative measures havent worked

23. Haematemesis duodenal ulcer
-Artery ulcer has eroded into
-Species and genus of organism to have predisposed him to this (helicobactor pylori)
-Triple therapy
-Management 2x lifestyle changes ?from history

24. Prostate TURP
-4 complications of TURP
-4x differentials of low BP, high HR and bleeding etc post surgery
-2x complications that has happened (dont use abbreviations DIC [raised PT, raised d-
dimer, low fibrinogen] and ARDS)

25. Breast
- 3 differential diagnoses of breast lump
-Treatment (if ER +ve and HER-2 +ve)
-?Further investigations of breast lump - ?fine needle aspiration/core needle biopsy

OSCE April 2012

Histories:
1. Caeliac disease
-Qs explain dx to patient, plus prognosis and diet

2. Intermittent Claudication
-Qs diagnosis explain it, plus who hed be referred to (vascular surgeons) and what Ix and
mangement options they would tell him about

3. Urinary Incontinence
-Qs diagnosis: Multiple Sclerosis
- Imaging Ix: MRI
- behavioural management of incontinence

4. Sarcoidosis (SOB + eye symptoms + rash on leg erythema nodosum)
-Qs Diagnosis from CXR findings, what histopathological finding from biopsy, what would
monitor in blood (?ESR/ACE), CLASS of treatment (?NSAID/steroids)

5. Infertility
Qs: Dx prolactinoma/ pituitary adenoma, Management dopamine agonist, what 2 things
would you measure in blood?

6. Headache
Qs: Dx - Temporal Arteritis & Polymyalgia Rheumatica, diagnostic test temporal artery
biopsy, Treatment prednisolone, how would you monitor effectiveness of treatment ESR
levels and clinically (patients symptoms)

Examinations:
1. Both knees and hip on 1 side

2. Abdominal (full)
- patient had AV Fistula on left arm and scar and mass in Right Iliac Fossa
-Asked what think mass is: Transplanted kidney

3. Cardiac (full)
-Asked to summarise findings and Dx if the patient had an echo what would you find -
?Mitral regurgitation

4. Respiratory (full inc. back)
-Asked to summarise findings (widespread expiratory crackles and 2x scars on back) and
diagnosis and 2 more differentials

5. UMN and gait
-Parkinsons
-Qs asked to summarise and describe gait

6. Diabetic foot (peripheral neuropathy)
-Qs summarise findings, and 2x advice for foot care

Good Luck, you guys will be fine !!!!