Palestinian Medical School AL – AZHAR UNIVERSITY

6 Year Final Clinical Examination ( 2009 ) - INTERNAL MEDICINE

th

Station No. ………. / History Taking

INSTRUCTIONS TO THE SIMULATED PATIENT

Please read carefully the instructions to the student and to the examiner prior to the
start of the examination.

Answer questions based on the following scenario.

Do not volunteer information unless asked.

This station tests the student ability to take a history from a patient.

One week ago you experienced an episodes of passing red urine 24 hours of an
episode of URTI.The urine was uniformly red but there was no clots of blood.Not
associated with burning urination ,abdominal pain , joint pain ,no skin rash , no GIT
Bleeding.

You have recurrent episode most of them related to URTI.

General health : You are otherwise fit and well.

Family history : No family history of deafness or ESRD.

Drug history : Not on any medications

Social history : Not smoker

Occupation : Student
Palestinian Medical School AL – AZHAR UNIVERSITY
6 Year Final Clinical Examination ( 2009 ) - INTERNAL MEDICINE
th

Station No. ………. / History Taking

INSTRUCTIONS TO THE STUDENT

This young patient has been referred by the GP complaining of blood

in the urine.

Please take a focused history and attempt to make a diagnosis.

After 4 minutes you will be asked what you think is the most likely
diagnosis and what would be the most useful diagnostic
investigations.
 Station No. ………. / History Taking

INSTRUCTIONS TO THE EXAMINER

EXAMINERS NAME…………………...…STUDENT NAME……………………
Greet the student and give him/her the written instructions.
Please circle the appropriate mark for each criteria.

Performed Performed but Not performed or

competently not fully incompetent
competent

Initial approach to the patient (introduces him- 2 1 0

herself, explains what he/she will be doing)

Relation to URTI/ Joint pain/ dysuria /Skin 7 4-6 1-3

rash/GIT BLEEDING /Deafness / Family History

D.Diagnosis
4 2 0
Ig A Nephropathy (Beurgers )
1 0 – 0.5 0
Post Streptovoccal GN
1 0 – 0.5 0
Henoch Shonleien Purpura
1 0 – 0.5 0
Alports Syndrome

Investigations
2 1 0
Urine analysis for casts &protein
2 1 0
RFT / Elctrolytes / ASOT /Complement/ Renal
Biopsy

Total (max 20)

Name Signature Date

Palestinian Medical School AL – AZHAR UNIVERSITY
6 Year Final Clinical Examination ( 2009 ) - INTERNAL MEDICINE
th

Station No. ………………………

PATIENT COMMUNICATION

INSTRUCTIONS TO THE STUDENT

This single young patient referred by the GP with HBsAg

Positive during routine medical checkup for employement.
The patient would like to ask you some questions about this
disaster finding from his point of view .
You can ask the patient some questions to clarify some points
related to the patient concerns and questions.
Please clarify his concerns and reassure him .
Finally give to the patiet the plan fo the future.
 Palestinian Medical School AL – AZHAR UNIVERSITY
6 Year Final Clinical Examination ( 2009 ) - INTERNAL MEDICINE
th

Station No. ………………………

PATIENT COMMUNICATION

INSTRUCTIONS TO THE SIMULATED PATIENT

Please read carefully the instructions to the student and to the examiner prior to the start of
the examination.Ask and Answer questions based on the following scenario.

Do not volunteer information unless asked.

This station tests the student ability to communicate with the patient.

You was informed by the GP that during routine investigatios for your new job ,that you
have a positive test fof HbsAg.You are completely asymptomatic.No history of blood
transfusion, no any surgery done before.Your family was screened and all your family are
ok except your mother foud to be positive for HbsAg ,but she is asymptomatic.

You was ordered to do LFTs & ultra sound abdomen ,the results obtained all normal.

Q.1- What is the meaning of positive HbsAg ?

Q.2-How the infection come to me ?

Q.3-What is my future and what complicatins can occure with me ?

Q.4- Is there any hope for me to be cured and whether any treatment available ?

Q.5-What I will do if I want marry and if there is any danger for my future wife and
children
 Station No. ………. / COMMUNICATION
STUDENT NAME…………………………EXAMINERS NAME ……………….
INSTRUCTIONS TO THE EXAMINER

Greet the student and give him/her the written instructions.

Please circle the appropriate mark for each criteria

Performed Performed but Not performed or

competently not fully incompetent
competent

Initial approach to the patient 2 1 0

(introduces him-herself, explains
what he/she will be doing)

Explanation of Positive HBsAg 2 1 0

Explanation mode of infection
2 1 0

Explanation the out come of the 2 1 0

carrier state
Explain the possible complications 5 3 -4 0-2
and how to detect early

Explain the available treatment

Interferon
1 0 0
Lamivudine
1 0 0
Any one of the new drugs availble
1 0 0

Explain how to protect the others.

Vaccination ,avoid exposure to blood ,
family and spouse screening , No blood 4 1-3 0
donation, new borne vaccination and
immunoglobulin within 12 hours from
delivery

Total (max 20)

Name Signature Date

 OSCE STATION No ……………

PHYSICAL EXAMINATION

INSTRUCTIONS TO THE STUDENT

This 12- year – old boy presented to OPD with increasing shortness of
breath for last few months. .No history of fever ,surgery , no family
history of cardiac diseases or any syndromic disorders.
Please examine this patient cardiovascular system.
All blood works are normal including serum calcium.
Please provide a commentary on what you are examining for as you go
along and describe any abnormal findings you identify as you proceed.
 STATION No………….. PHYSICAL EXAMINATION

STUDENT NAME………………………..EXAMINERS NAME ……….………

Greet the student and give him/her the written instructions.

Please circle the appropriate mark for each criteria.

Performed Performed but not Not performed or

competently competent incompetent

Initial approach to the patient (introduces him-

herself, explains what he/she will be doing)
2 1 0

Looking for syndromic features

1 0.5 0
Examination of pulse including carotd pulse
Slow rising, low volume pulse , narrow pulse
pressure
2 1 0

Heart Inspection and palpation

Apex beat : Sustained , Not Displaced. 2 1 0

Looking for thrill

Auscultation :

Ejection systolic murmur in A2 Area ,radiating 2 1 0

to carotd
 Diagnosis : Aortic stenosis subvalvular 2 1 0
Differential diagnosis :VSD , HOCM ,Aortic
sclerosis 2 1 0

Association and aetiology 2 1 0

Coarctation of aorta. Bicuspid aortic valve ,
angiodysplasia

Age , bicuspid aortic valve.congenital ( valvular ,

subaortic bembrane & supravalvular) rheumatic
fever 2 1 0

Prognosis : 50 % mortality

Chest pain 5 years 1 0 0

1 0 0
Syncope 3 years

1 0 0
Heart failure 2 years

Total (max 20)

NAME…………………… SIGNATURE…………………DATE…………………..
 OSCE STATION No ……………

PHYSICAL EXAMINATION

INSTRUCTIONS TO THE STUDENT

This patient is 39 – year – old presented with jaundice , ascites , elevated aminotransferases
& hyperbilirubinaemia..No history of alcoholics , blood transfusion , not known drug addict.
No previous history of viral hepatitis. No family history of chronic liver diseases.
Blood works : CBC : Normal , elevated liver enzymes , VIRAL HEPATITIS SCREEN
NEGATIVE.
SAAG > 1.1
Please look for stigmatas of chronic liver disease and demonstrste how you will do shifting
dullness.

Please provide a commentary on what you are examining for as you go

along and describe any abnormal findings you identify as you proceed.
 STATION No………….. PHYSICAL EXAMINATION

STUDENT NAME………………………..EXAMINERS NAME ……….………

Greet the student and give him/her the written instructions.
Please circle the appropriate mark for each criteria.

Performed Performed but Not performed or

competently not competent incompetent

Initial approach to the patient (introduces

him-herself, explains what he/she will be
doing) 2 1 0

Inspection of the face & Eyes for

jaundice , pallor xanthelesmata ,parotid 2 1 0
swelling.:
Inspection for gynaecomastia and spider 1 0.5 0
naevi
1
Inspection of the abdomen for distention,
umblicusdilated veins ,fullness of 2 0
flanks ,scratch marks.
1
Inspection of hands and nails for
2 0
clubbing . leukonychia ,Duputryen
contracture ,flpping tremors 0.5

Examination of genetalia and lower limb 1 0

for oedema

Demonstrate shifting dullne

.3 2 1

What is the most likely diagnisis : 2 1 0

Autoimmune hepatitis.
What are the typrs of autoimmune
hepatitis
2 1 0.5
What are the investigations:
0- 0.5
ASMA. LKMA .sol Liver antigen
2 1
Liver biopsy
1 0 0

Total (max 20)

NAME…………………… SIGNATURE…………………DATE…………………..
 OSCE STATION No ……………

PHYSICAL EXAMINATION

INSTRUCTIONS TO THE STUDENT

This patient is 47 – year – old presented with fever , cough and left sided chest pain
increase with breathing for last 3 days.
The patient is smoker and diabetic for long time . Not known Hypertension.
No history of previous similar attacks .
No family history of chest diseases.
Random Blood Sugar 158 mg / dl
Serum electrolytes , urea and creatinine normal
Liver Function Tests Normal
Please examine this patient ( Do General examination and examine this patient chest from
posterior position only .

Please provide a commentary on what you are examining for as you go

along and describe any abnormal findings you identify as you proceed.
 STATION No………….. PHYSICAL EXAMINATION

STUDENT NAME………………………..EXAMINERS NAME ……….………

Greet the student and give him/her the written instructions.

Please circle the appropriate mark for each criteria.

Performed Performed but Not performed or

competently not competent incompetent

Initial approach to the patient (introduces him-herself,

explains what he/she will be doing)
2 1 0

General Examination : Obese , Not in respiratory 3 1-2 0

distress, No cyanosis or clubbing., not using
accessory muscles , Nicotine stain , tremors

Posterior Chest & Axilla area Examination

Inspection : Decrease movement on left side 1 0.5 0

Palpation & Chest expansion :Decrease expansion 2 0.5 0

on left side
1 0.5 0
Percussion : Stony dullness on left lung base and
axilla

Auscultation : Decrease on left base and normal in 1 0.5 0

character .

Differential diagnosis of lung base dullness:

Pleural effusion ,Stony dull note ,trachea may be 1 1/2 0.5-1 0

deviated

Pleural thickening ,Trachea not deviated , Breath

sounds will be heard. 1 1 /2 0.5-1 0

Consolidation : Bronchial brating 1 1/2 0.5-1 0

Collapse of the lung : Trachea deviated and absent 1 / 12 0.5-1 0

breath sounds

How you will differentiate between an exudates and 2 1 0

transudate : Lights Criteria
What is the most likely diagnosis in this patient and how
you will treat
1 0.5 0
CAP with mild pleural effusion

Cephalosporine and Macrolide

1 0.5 0

Total (max 20)

NAME…………………… SIGNATURE…………………DATE…………………..