Troy Kampira - Osce of Internal Medicine Across Years

TABLE OF CONTENTS
LIST OF FIGURES
AUTHOR:
Figure 1-Satelite map of Kalang'oma village.............................................. Error! Bookmark not defined.
Figure 2- A small marsh near Nankhaka river .......................................... Error! Bookmark not defined.
Figure 3- Sketch of village profile................................................................ Error! Bookmark not defined.
Figure 4- Gule Wamkulu.............................................................................. Error! Bookmark not defined.
INTERNAL MEDICINE
Figure 5-Jehovah's witness church and the village cemetery ................... Error! Bookmark not defined.
Figure 6- Earth road and ox-drawn cart .................................................... Error! Bookmark not defined.
Figure 7-Grass thatched house .................................................................... Error! Bookmark not defined.
OSCE
Figure 8- Boys playing soccer and pool table ............................................. Error! Bookmark not defined.
Figure 9- Community members drawing water from a borehole ............. Error! Bookmark not defined.
ACROSS YEARS
Figure 10-Ablution facilities......................................................................... Error! Bookmark not defined.
Figure 11-Inside the ablution facilities and improper waste disposal in the village ... Error! Bookmark
not defined.
Figure 12- Women preparing vegetables for sale and men doing piece work ....... Error! Bookmark not
defined.
SUBMITTED
Figure 13- A manTO MBBS
on his way to sale 3 maize
STUDENTS and a food stand.................... Error! Bookmark not defined.
END OF 2ND COMHE ROTATIO TROY

KAMPIRA
2022 END OF INTERNAL MEDICINE 4th ROTATION OSCE
1. STATION 1
Study the picture below and use it to answer the questions

below
1|Page ...TROY KAMPIRA...

a. What is your diagnosis?
Rheumatoid Arthritis
b. Which phalangeal joints are spared in the picture?
Distal interphalangeal (DIP) joints
c. Mention three findings upon performing physical exam
i. Inflammation of Metacarpal phalangeal (MCP)

and Proximal Interphalangeal (PIP) joints
ii. Ulnar drift
iii. Subluxation of proximal phalanges
d. Which autoantibody is usually positive in these patients

to support the diagnosis in 1(a)?
Rheumatoid factor
e. Apart from the condition above, mention other three

conditions in which the autoantibody mentioned in 1(c) is
also positive

i. SBE
ii. TB
iii. Hep C
iv. Sarcoidosis
v. Infectious Mononucleosis
f. Mention three second line drugs used to treat this

condition
i. Chloroquine
ii. Methotrexate, gold, azathioprine
iii. Sulfasalazine, Leflunomide, Etanercept
2. STATION 2
Read the ECG and use it to answer the questions below

a. What is your diagnosis?
Left Ventricular Hypertrophy
b. Support your diagnosis in 2 (a)
Adding the larger S wave of V1 or V2 in mm, to the

larger R wave of V5 or V6, the Sum is greater than
35mm, which is the ECG finding suggestive of Left
Ventricular Hypertrophy
c. Explain how would the following conditions

lead to a picture similar to the ECG above
i. Hypertension
Long- term high blood pressure strains the

left side of the heart and makes the heart
work harder than normal. The extra work
it takes to pump blood can cause the
cardiomyocytes in the left ventricle to get
larger and thicker.

ii. Pheochromocytoma
Chronic elevated levels of circulating

plasma norepinephrine in
pheochromocytoma patients leads to high
blood pressure which causes LVH
d. Mention three signs of a patient with Aortic

regurgitation
• Quincke’s sign
• Corrigan sign
• De Musset’s sign
• Hill’s sign
• Water hammer or Collapsing pulse
• Duroziez’s sign
• Traube’s sign
• Mayne’s sign
• Rosenbach’s sign
• Austin Flint Murmur
• Becker’s sign

• Gerhard’s sign
• Landolfi’s signs
• Lincoln sign
3. STATION 3
Physical Examination
A patient lying supine on the examination bed with paralysis

in both lower limbs. Perform the full Neurological
Examination of the patient and present your findings.
4. STATION 4
A patient lying supine on the examination bed with a

distended abdomen with ascites. Perform the full Gastro-
Intestinal System Examination of the patient and present
your findings.
Note: Each student meets different patients in Physical

examination Stations hence others met Respiratory,
Cardiovascular, Cranial nerve examination, etc.

2022 END OF INTERNAL MEDICINE 1ST & 3RD ROTATION OSCE
1. STATION 1
Read the Chest X-ray below and use it to answer questions that
follow

a. Describe in detail the abnormality you see on this X-ray
i. There is an irregularly shaped thick-walled cavity with

an air-fluid level in the anterior segment of the left
upper lobe which is consistent with unilateral lung
abscess
b. Mention one causative organism
i. Staphylococcus aureus
ii. Klebsiella pneumoniae
c. What are the other investigations you would do?
i. Bronchoscopy
ii. Pleural fluid and blood culture
iii. Sputum culture
d. State three components of the Lights criteria
In light criteria ≥ One of these favors an Exudate pleural fluid
i. Ratio of Pleural fluid protein to Serum protein >

0.5
ii. Ratio of Pleural fluid LDH to Serum LDH > 0.6
iii. Pleural fluid LDH is more than two-thirds of

normal serum LDH

e. Give two complications of a pleural tap
i. Infections: Empyema
ii. Bleeding: Hemothorax
iii. Pneumothorax- tension/non-tension
iv. Damage to long thoracic nerve: Winged scapula
v. Reperfusion pulmonary oedema
2. STATION 2
A woman comes in with a 3-day history of shortness of breath. She

experiences chest pain when lying down but is relieved by leaning forward.
She is also been having intermittent heart palpitations. An ECG was done as
shown below.
a. What abnormality is the ECG showing?
The ECG strip is demonstrating low electrical

voltage with QRS complexes of less than 5mV and
electrical alternans
b. What is the diagnosis from the ECG?
Pericardial effusion / Cardiac tamponade

c. What are the 3 things that you are likely to find on
examination?
i. Hypotension
ii. Elevated Jugular Venous Pressure
iii. Muffled heart sounds
iv. Tachycardia
v. Narrow arterial pulse pressure
vi. Pulsus paradoxus greater than 10 mmHg
d. What investigations would you do to confirm this

condition?
i. Chest X ray
ii. Cardiac Echo
3. STATION 3 (PHYSICAL EXAM): GIT, Neuro, Resp and Cardio.
4. STATION 4 (PHYSICAL EXAM): GIT, Neuro, Resp and Cardio.
10 | P a g e ...TROY KAMPIRA...
SOME ECGs AND CHEST-XRAYs FOR PRACTICE
2021 END OF YEAR (SUPPLIMENTARY)- INTERNAL
MEDICINE OSCE STATIONS
STATION 1
Read the following Six ECG strips below and use them to cross-match
with the following conditions: Atrial fibrillation, ST elevation myocardial
infarction, Ventricular tachycardia, Heart block, Sinus bradycardia and
Hyperkalemia effects
ECG strip labelled 1
ECG strip Labelled 2
b. Mention three causes of diagnosis of ECG strip number 2
c. Explain how would you manage the diagnosis in ECG strip number 2
STATION 2
MBBS 3 students were given a Chest X-ray to interpret. (Missing picture)
STATION 3
Cranial Nerve Examination on an active station
STATION 1
Cross matching Six ECG strips (as in 2021 paper above)
STATION 2
There was a Chest X-ray. MBBS 3 Students were asked to:
a. comment on the following from the X-ray
i. Quality
ii. Penetration
iii. Inspiration
iv. Number of libs
v. Position
vi. Exposure
b. Systemically Interpret the Chest X-ray
c. Comment on the Pulmonary findings
STATION 3
a. Outline steps used in measuring Blood

pressure (10m)
b. Explain the grading of Hypertension (4m)
c. Which population should be screened for

HTN (6)
2020 END OF YEAR-INTERNAL MEDICINE OSCE STATIONS
STATION 1
Gastro-Intestinal System Examination on a live patient lying on the
examination bed.
STATION 2
Read the ECG strip below and use it to answer questions that follow
a. What is your diagnosis

b. Comment on the following: Rate, Rhythm, QRS and Axis
STATION 3
Concerning FASH
a. Which Windows do you look at?
b. Describe what do you see in each Window
STATION 1
(The same Question as in 2021 and 2020 papers above)
Read the following Six ECGs below and use them to cross-match with the
following conditions: Atrial fibrillation, ST elevation myocardial
infarction, Ventricular tachycardia, Heart block, Sinus bradycardia and
Hyperkalemia effects
STATION 2
A 40 years old man, who has history of night sweats and weight loss. On
examination had a spleen 20cm below costal margin.
a. What is the classification of the condition of the spleen? 2m
b. Mention 3 differential diagnosis of the condition answered above? 3m
A blood was done and showed the following, neutrophils 40%,

lymphocytes 20%, eosinophils 2%, basophils 3%
c. What is your diagnosis? 2m
d. Mention other investigation you would do? 3m
STATION 3
You are a doctor at a certain clinic, some two clients came for assessment.
They asked you to weigh them and measure the height. Both clients are
1.65m tall. Mr. X has 90kgs and Mrs. Y has 49kgs.They also asked you to
assess their child who had several episodes of diarrhea and looked wasted.
You found the MUAC to be 12.3cm.
a. What are the parameters used to assess the two client and the child? 2m
b. Using evidence, how do you classify their nutritional status? 3m
c. What is the general nutrition advice would you give to each of the adults
and the child? 3m
d. To which nutritional body in Malawi would you refer Mr. X and Mrs. Y?
2m
2018 END OF YEAR- INTERNAL MEDICINE OSCE
STATIONS
STATION 1
MBBS 3 students were asked to Interpret an ECG (Missing ECG strip)
STATION 2
Performing a full Abdominal examination on a live patient
STATION 3
MBBS 3 students were asked to Interpret a Chest X-ray (Missing Image)
STATIONS
STATIONS
STATION 1
a. Outline Questions you can ask in History taking of an Asthmatic
patient
b. Explain to an Asthmatic patient on how he/she can use the Salbutamol
inhaler with a spacer device
STATION 2
Performing a full Abdominal examination on a live patient
STATION 3
Interpretation of a Chest X-Ray
2011 END OF YEAR- INTERNAL MEDICINE OSCE STATIONS
STATION 1
System examination
▪ Cardio.
▪ Resp.
▪ GIT.
▪ Neuro.
STATION 2
ECG interpretation
STATION 3
Chest X-ray Interpretation
OTHER INTERNAL MEDICINE OSCE STATIONS
STATION 1
1. An HIV patient who was on 5A and cotrimoxazole prophylactic
therapy (CPT). She later developed anaemia and jaundice. She had MCV
of 76 and other parameters were also given
(a) List 2 causes of anaemia in this patient
I. Drugs: CPT and 5A
Concerning HIV infection

(b) Which ART drug has jaundice as a side effect.
❖ Protease inhibitors (Tenofovir)
(c) Which ART drug has anaemia as a side effect

❖ Efavirenz
(d) If a peripheral blood smear of this patient was done, what

would you see…. give 2 features
i. Hypochromic
ii. Microcytosis
iii. Target Cells
iv. Tear Drops
STATION 2
(2) There was an ECG of a patient who presented with palpitations
a) List 4 differentials of palpitations
i. Cardiovascular e.g., CCF, Atrial fibrillation, Severe
anaemia
ii. Endocrine e.g., Thyrotoxicosis
iii. Renal e.g., Nephrotic syndrome
iv. Respiratory e.g., Pulmonary oedema
v. Nervous system e.g., Anxiety
b) What investigation was done

❖ 12-lead electrocardiogram
c) Based on the ECG what’s your diagnosis

❖ Myocardial Infarction
d) How could the patient be managed?

i. Digoxin
ii. Verapamil
iii. Beta-blocker
STATION 3
Explain how to use a metered dose inhaler (MDI) with spacer device
i. Cut a small hole in the bottom of the plastic bottle
ii. Fit the inhaler mouthpiece with an airtight seal
iii. Shake the inhaler before each puff
iv. Shake the canister
v. Exhale functional residual capacity
vi. Place the spacer device nozzle to open mouth
vii. Inhale slowly but deeply
viii. Close the mouth then hold breathe for 10 seconds then exhale
ix. Repeat the process.

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TABLE OF CONTENTS

END OF 2ND COMHE ROTATIO TROY

Study the picture below and use it to answer the questions

1|Page ...TROY KAMPIRA...

b. Which phalangeal joints are spared in the picture?

Distal interphalangeal (DIP) joints

c. Mention three findings upon performing physical exam

i. Inflammation of Metacarpal phalangeal (MCP)

ii. Ulnar drift

iii. Subluxation of proximal phalanges

d. Which autoantibody is usually positive in these patients

e. Apart from the condition above, mention other three

2|Page ...TROY KAMPIRA...

f. Mention three second line drugs used to treat this

ii. Methotrexate, gold, azathioprine

iii. Sulfasalazine, Leflunomide, Etanercept

Read the ECG and use it to answer the questions below

3|Page ...TROY KAMPIRA...

Left Ventricular Hypertrophy

b. Support your diagnosis in 2 (a)

Adding the larger S wave of V1 or V2 in mm, to the

c. Explain how would the following conditions

Long- term high blood pressure strains the

4|Page ...TROY KAMPIRA...

Chronic elevated levels of circulating

d. Mention three signs of a patient with Aortic

• Water hammer or Collapsing pulse

• Austin Flint Murmur

5|Page ...TROY KAMPIRA...

A patient lying supine on the examination bed with paralysis

A patient lying supine on the examination bed with a

Note: Each student meets different patients in Physical

6|Page ...TROY KAMPIRA...

7|Page ...TROY KAMPIRA...

i. There is an irregularly shaped thick-walled cavity with

b. Mention one causative organism

ii. Klebsiella pneumoniae

c. What are the other investigations you would do?

ii. Pleural fluid and blood culture

iii. Sputum culture

d. State three components of the Lights criteria

In light criteria ≥ One of these favors an Exudate pleural fluid

i. Ratio of Pleural fluid protein to Serum protein >

ii. Ratio of Pleural fluid LDH to Serum LDH > 0.6

iii. Pleural fluid LDH is more than two-thirds of

8|Page ...TROY KAMPIRA...

ii. Bleeding: Hemothorax

iii. Pneumothorax- tension/non-tension

iv. Damage to long thoracic nerve: Winged scapula

v. Reperfusion pulmonary oedema

A woman comes in with a 3-day history of shortness of breath. She

a. What abnormality is the ECG showing?

The ECG strip is demonstrating low electrical

b. What is the diagnosis from the ECG?

Pericardial effusion / Cardiac tamponade

9|Page ...TROY KAMPIRA...

ii. Elevated Jugular Venous Pressure

iii. Muffled heart sounds

v. Narrow arterial pulse pressure

vi. Pulsus paradoxus greater than 10 mmHg

d. What investigations would you do to confirm this

ii. Cardiac Echo

3. STATION 3 (PHYSICAL EXAM): GIT, Neuro, Resp and Cardio.