FINAL MBBS MEDICINE

OSCE
( 2014 CLASS)
By Ken ORAZULIKE [K3sH]
 STATION 1

 Examine the patient’s precordium and note your

findings (mitral regurgitation)

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 STATION 2

1. What are the obvious physical examination findings?

2. What is the likely diagnosis?
3. What is the most likely valve affected?
4. What is the definitive treatment option for the
patient?
5. What investigation can help in your diagnosis

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Inspection
 Inspect for visible heave or active precordium.
 For visible veins, scarification marks.

Palpation
 Locate the apex beat with the palm and use a finger to localize it. Determine location
in relation with the ribs and mid clavicular line. Look out for heave at the apex – left
ventricular heave, it relates to the left ventricular hypertrophy.
 Palpate the left lower sternal border for right ventricular heave, it relates to the right
ventricular hypertrophy.
 Palpate the pulmonary area(2nd intercoastal space to the left of the sternum) and the
aortic area (2nd intercoatal space to the right of the sternum) for thrill – palpable
murmur.
 Turn the patient to left with your palm covering the precordial area to also check for
thrill. Sit the patient up and with patient bending forward and your palm still at the
precordial area, the same thrill is also checked.

Ascultation
 Ascultate the apex with the bell first then the diaphragm, then auscultate the left lower
sternal border, the pulmonary area and the aortic area.
 STATION 3

 Look at this ECG tracing and note your findings.

(ST segment elevation, widened PR complexe and P mitrale)

1. What are the two obvious ECG findings?

2. state 2 causes of each
3. treatment

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 STATION 4

1. Identify the Instrument (upper GI endoscope)

2. List 3 therapeutic indications
3. List 3 diagnostic indications
4. List the contraindications of its use
5. List the complications associated with its use

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 STATION 5

1. Identify the Instrument (bag valve mask device/ ambu

bag)
2. list the indications
3. list 3 parts of the instruments

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 STATION 6

 Take a focused history from this patient who presented

with an anterior neck swelling and protrusion of the
eyeball

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 STATION 7

(vitiligo)

 Examine and Take a focused history from this patient,

then discuss your diagnosis and mode of treatment.

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 STATION 8

 
 Do a mental state examination on this patient who
presented with symptoms suggestive of schizophrenia to
elicit 3 negative symptoms and 3 positive symptoms 

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 STATION 9

 Examine the tone, power and reflex of the lower limb

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 STATION 10
From the lower limb examined in the previous station:
1. What are the obvious physical examination findings?
2. List 5 differentials

List 5 causes of Paraplegia?

Answer: I-CAST
T-Trauma – Broken neck, broken back
S-Spinal cord injury
I-Infection – Transverse myelitis, HZV, HIV
T-Tumours
S-Stroke
C-Congenital
Vitamin B12 Deficiency
A-Autoimmune Disease
12 Genetic disorder (Hereditary spastic paraplegia) 09/07/2022
 STATION 11

 Examine the patient’s posterior chest wall and note

your findings

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 STATION 12

1. What are the obvious physical examination findings?

2. What is the likely diagnosis?
3. What is the treatment option?

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Examine the Posterior chest wall
Consent
Inspection – Scarification marks, visible or dilated veins,
Shape of the posterior chest for scoliosis, Kyphosis, cutaneous
swellings (fractures, osteomyelitis)
Palpation – Centrality of trachea, Chest expansion, Tactile
vocal fremitus.
Percussion – Percussion notes.
Auscultation – Breath sounds (Present or absent, normal-
vesicular or bronchial, increase or decreased intensity,
presence or absence of added sounds), Vocal Resonance
List 5 causes of Pleural Effusion?
Answer:
Tuberculosis
 Lung abscess (subphrenic abscess)
 Lobar Pneumonia
 Bronchogenic Ca.
 Pulmonary infarction
 Pulmonary emboli
 Congestive Cardiac failure
 Rheumatoid disease
 SLE and other collagen vascular diseases
 Acute pancreatitis
 Hepatic failure
 Nephrotic syndrome
 Obstruction of thoracic duct
 Malignant diseases
 STATION 13

 The HIV screening test of the above patient who came

with her roommate was positive; as the medical officer
on duty, you are told to tell her the result and offer a
post screening conselling. 

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 STATION 14
 The below prescription was done by a medical personnel with a
dubious reputation for a patient diagnosed recently with
congestive cardiac failure, all are meant to be taken for a
duration of 1 month except the zentel; comment on the
prescription.
Lisinopril
Furosemide
Spironolactone
Propranolol
Valsartan
Zentel
Vitamin c
Paracetamol
etc
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 STATION 15

 A patient presented with facial puffiness and leg

swelling, with malar rash and alopecia

1. What is the likely diagnosis

2. list 6 specific investigations

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 STATION 16

 Look at this photograph and note your findings

1. identify the above procedure (abdominal paracentesis)
2. list 3 complications
3. what 2 investigation each would you do to avoid
each complication
4. what are the indication of the procedure

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 STATION 17

 Look at this laboratory result and note your findings

potassium = 5.5mmol/L
creatinine = 200
calcium = 0.8mmol/L
sodium = 134mmol/L
bicarbonate = 15mmol/L
chloride = 98mmol/L
 
1. list 5 abnormal biochemical findings
2. what is the likely diagnosis
3. list 5 mode of treatment
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 STATION 18

 A patient presented to MOP with a history of bone

pains, swellings on the fingers, malar rash
 
1. whats your likely diagnosis
2. what 6 specific investigation would you do.
 

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 Miscellaneous

ken orazulike@facebook.com
Take a history from a male patient who has DM for
20yrs.Take history of the complications
Biodata
 Any feeling of abdominal
Are you compliant with your drugs and
fullness or easy satiety?
check ups?
Any vomiting, constipation or
What drugs are you on?
Any dietary control?
diarrhea?
Any facial swelling while
Any blurring of vision or double vision?
Any decrease in the frequency or volume of
eating?
Any erectile dysfunction in
urine?
Any ankle swelling? male?
Any numbness or burning or painful
sensation on the limb?
Any feeling of walking on pebbles or foams?
Any slipping off of shoes without knowing?
Any ulcer in any part of the body?
Any boil or body itching?
Any difficulty in swallowing?
Chronic Complications Acute complications
• Diabetic Retinopathy
• Diabetic nephropathy Hypoglycemia
• Diabetic foots Hypergycemic emergencies
• Microangiopathies Hyperosmolar Hyperglycemic
• Macroangiopathies non ketotic state (HHNKS)
• Peripheral neuropathy Infections
• Autonomic neuropathy Diabetic keto acidiosis (DKA)
• Mononeuritis Lactic acidiosis
• Diabetic amyotrophy
• Charcot’s arthropathy
• Necrobiosis lipodica
diabeticorum
 Examine the abdomen of this patient?

List 5 causes of hepatosplenomegally?

Answer: MALTS
Infections/infestations;
 Bacteria – T-Tuberculosis, Brucellosis
 Parasite – M-Malaria, T-Toxoplasmosis, Kala-azar, Hydatid disease, S-
Schistosomiasis.
 Spirochetes – Relapsing fever.

Infilterations;
 T-Tumours
 A-Amyloidosis
 S-Sarcoidosis
 L-Lipoidosis
Take a history from this 30yr old male patient who presented
to the clinic with the history that he is JESUS CHRIST, that
has lasted for 2weeks.

Answer:
Biodata
PC
HPC – DABC (in that order)
 Delusional Perception – D
 What happened that made you know that you are Jesus Christ?
 When did it start? incase onset and duration were not given
 How long has it lasted?
 Have you ever had the experience of being something else in the past?
 Do you suddenly become sad or happy at different times?
 Any crawling sensation on the body?
 Auditory Hallucination – A
 Feeling that someone is giving patient instruction
 Feeling that someone is discussing patient with a third person
 Feeling that someone is running commentary on patients’ activity
  Broadcasting – B
 Thought insertion – Someone adding thought to your flow of thought?
 Thought withdrawal – Someone takes away what you are thinking about?
 Thought broadcasting – Saying aloud what you are thinking about?
 Echo la-lia – Repeating what is said around you
 Echo praxia – Repeating what is done around you?
 Looseness of associations esp. in telling stories.
 Controlled feeling – C
 Excessive depression – Being excessively unhappy and sad.
 Hyperactivity – Having excessive energy to engage in activities.

Rule out Causes:

Infections/Infestations;
 Typhoid fever
 Cerebral malaria Severe fever
 Encephalitis
Liver failure – Jaundice
Renal failure – Uremic symptoms
 Mania;
 Elevated mood – Excessively happy
 Talkativeness
 Gross behavioral disinhibition – Going naked, picking from dust bin?
 Restlessness
Any family history?
Have you been jilted in the past
Do you take hallucinogens – igboo, or recreational drugs – cocain?
Any apathy or loss of drive?
Social isolation? Signs of chronicity
Poverty of speech?
Poor self care – Being unkempt and dirty in dressing?
PMHX
FSHX
D/AHX
RS.