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Question 1
A 25 years old male presented with X was temporarily put on exhibit Y 1. State 3 characteristic of X (3 marks) 2. What is the most likely nerve affected? (2 marks) 3. State the location of lesion and give 2 reasons (3 marks) 4. Name exhibit Y (2 marks)
Question 1
State 3 characteristic of X (3 marks)
There is wrist and finger drops of the right upper limbs The right triceps muscle is intact No evidence of other nerve injury such as claw hands and pointing finger
Question 1
Other spotted PRO question (Clinical short case or OSCE)
Ulnar paradox (FDP and lumbricals) Pointing finger (Extensor indices) Carpal tunnel syndrome (median nerve palsy)
Question 2
A 5 years old came to you with vomiting and diarrhoea for 1 day duration. Initial assessment found out that the child was lethargy, dry mucous membrane and pulse rate was 152 beats/minute. Outline the fluid resuscitation in this patient (10 marks)
Dehydration
Answer question 2
25 years old - unable to tolerate orally (no ORS, give intravenous fluids) Fluid requirement = Maintenance + Deficit + Ongoing loss Set 2 intravenous line = one for deficit, one for maintenance Deficit
Lethargy, dry mucous membrane and tachycardia moderate dehydration (~5.1 9.9 %) Took halfway in between 5.1 9.9% = 7.5 % Calculate the fluid requirement
o 7.5/100 x (patients bodyweight = 60,000 g) = 4500 mls of fluid deficit o Replace 4500 ml in 24 hours
First 8 hours (1/2 of total deficit) = 2250 mls (4.5 pint) Second 8 hours (1/4 of total deficit) = 1125 mls (2.25 pint) Final 8 hours (1/4 of total deficit) = 1125 mls (2.25 pint)
Answer question 2
Maintenance
40 mls per kilogram in adult 60 kg patient needs = 60 x 40 = 2400 mls per day (~ 5 pint per day) Choice of fluids depending upon the sodium requirement in this patient
Assuming sodium requirement is normal Na+ requirement = 2 4 mmol/ kg/ day Thus, 60 kg patient needs = 120 240 mmols per day 1 pint of normal saline 0.9 % contains 75 mmols of sodium (150 mmols/liter) Thus, this patient needs = 2 3 pint of normal saline 0.9% Another 2 pint = Dextrose 5% So, this patient need 2 pints of NS 0.9% with 3 pints of Dextrose 5% or 3 pints of NS 0.9% with 2 pints of D5%
Question 2
Other spotted PRO question (Clinical short case or OSCE) Fluid requirement in paediatric patient
1st 10 kg = 100 mls/kg/ day 2nd 10 kg = 50 mls/kg/day Remaining kg = 20 mls/kg/day Fluid for resuscitation = Na 0.18 Fluid for maintenance = Na 0.18 Dextrose 4.3%
Question 3
An 18 years old male with visual disturbance and deafness came to see you for follow up 1. State 4 findings in the above picture (4 marks) 2. State 1 provisional diagnosis (2 marks) 3. State 3 visual disturbances experienced by the patient (3 marks) 4. State 1 pharmacological treatment in this patient (1 mark)
Answer Question 3
State 4 findings in the above picture (4 marks)
Bony spicules appearance at all 4 quadrant of retina Waxy pallor of the optic disc Attenuation of retinal artery Preservation of the macula with peripheral ring of depigmentation
Answer Question 3
State 3 visual disturbances experienced by the patient (3 marks)
Nyctalopia Tunnel vision Poor colour separation Photopsia Visual loss
Question 3
Other spotted PRO question (Clinical short case or OSCE)
Diabetic retinopathy (last year PRO question) Corneal ulcer Orbital cellulitis vs Periorbital cellulitis
Question 4
A 56 years old female with underlying diabetes mellitus came to see you at dermatology clinic 1. Describe 3 characteristics of the lesion (3 marks) 2. State the most likely diagnosis (1 mark) 3. Name 4 other skin lesions seen in diabetic patient (4 marks) 4. Outline your treatment (2 marks)
Answer Question 4
Describe 3 characteristics of the lesion (3 marks)
Presence of well-defined rashes at anterior shins Erythematous border with central yellowish tint Multiple dilated veins
Answer Question 4
Name 4 other skin lesions seen in diabetic patient (4 marks)
Eruptive xanthomata Lipoatrophy or lipohypertrophy Diabetic foot ulcer Acanthosis nigricans Peripheral anhidrosis Granuloma annulare
Question 4
Other spotted PRO question (Clinical short case or OSCE)
Lipoatrophy Scabies (last year PRO) Erythema multiforme Linchen planus Livedo reticularis
Question 5
A 35 years old gentleman were called to infertility clinic for Seminal fluid analysis. Explain to the patient regarding the procedure (10 marks)
Answer Question 5
Greet the patient, maintain privacy (1 mark) Explanation of the procedure (2 marks)
collect seminal fluid analyzed under microscope and laboratory to detect the quantity and the quality of sperms
Answer Question 5
Explanation on how to collect the sample (3 marks)
Wash hands and genital area before masturbating Ejaculate directly into the sterile container provided (avoid contaminating the container by touching inside it) Store the sample at body temperature (in pockets) before delivering it to the hospital) Do not use condoms to collect the samples
Question 6
Other spotted PRO question (Clinical short case or OSCE)
Breastfeeding counselling Partogram charting
Question 6
A 56 years old gentleman who suffered from loss of consciousness was brought to a accident and emergency clinic. Cardiac monitoring found was done and revealed the above diagram 1. State your diagnosis (1 mark) 2. Outline your management (4 marks)
Subsequently, after 5 minutes of resuscitation, the rhythm change to the above diagram 1. State your diagnosis (1 mark) 2. Outline your management (4 marks)
Answer Question 6
State your diagnosis (1 mark)
Ventricular fibrillation
Answer Question 6
State your diagnosis (1 mark)
Asystole
Question 6
Other spotted PRO question (Clinical short case or OSCE)
5H and 5T treatment Acute management of stroke Acute management of increase ICP
Question 7
A 50 years old female with mental retardation and seizure 1. Name exhibit G and H (2 marks) 2. Name the triad of mental retardation, seizure and exhibit G (2 marks) 3. State your diagnosis (2 marks) 4. State 4 other lesion cause by the disease you stated above (2 marks) 5. Outline your treatment (2 marks)
Answer - Question 7
Name exhibit G and H (2 marks)
G Adenoma Sebaceum H Ash leaf macules
Answer Question 7
Answer Question 7
State 4 other lesion cause by the disease you stated above (2 marks)
CNS hamartomas (cortical tubers, subependymal hamartomas) Renal angiomyolipomas Cardiac rhabdomyomas and pulmonary myomas Liver, renal and pancreatic cyst
Question 7
Other spotted PRO question (Clinical short case or OSCE)
Neurofibromatosis I and II Dystrophia myotonica
Question 8
Regarding exhibit Y and Z 1. Name exhibit Y (2 marks) 2. State 1 indication and 1 contraindication of exhibit Y (2 marks) 3. Name exhibit Z (1 mark) 4. State 2 uses of Z (2 marks) 5. Name 3 ways to detect the correct placement of Z (3 marks)
Answer Question 8
Name exhibit Y (2 marks)
Sengstaken Blakemore Tube
Answer Question 8
State 2 uses of Z (2 marks)
Feeding in unconscious patient Gastric decompression
Question 8
Other spotted PRO question (Clinical short case or OSCE)
Chest tube and its placement Diathermy (unipolar and bipolar) Scalpel, needle holder, artery forceps
Question 9
D
C B
Regarding picture above 1. Name exhibit A and B (2 marks) 2. State 2 uses of exhibit A (3 marks) 3. Name exhibit C and D (2 marks) 4. List 2 complications of insertion of C and D (3 marks)
Answer Question 9
Name exhibit A (2 marks)
A is Balkans frame B is Monkey bar
Answer Question 9
1.Name exhibit C and D (2 marks)
- Steinmen pin - Stirrup
Question 9
Other spotted PRO question (Clinical short case or OSCE)
Thomas splint (complete and incomplete ring) Skin traction Bohler-Braun frame Cast, figure of 8
Question 10
An 8 years old patient with known case of thalassaemia came for blood transfusion. His current haemoglobin was 10 g/dL and he was currently on desferoxamine 1. State 2 abnormalities in this patient skull radiograph (2 marks) 2. Calculate the amount of blood to transfuse in this patient (8 marks)
Answer Question 10
State 2 abnormalities in this patient skull radiograph (2 marks)
Hair on end appearance Frontal bossing
Answer Question 10
Calculate the amount of blood to transfuse in this patient (8 marks)
Estimate bodyweight in this patient
(Age + 4) x 2 = (8 +4) x 2 = 24 kg
Question 10
Other spotted PRO question (Clinical short case or OSCE)
Remember the formula for packed cell transfusion
On iron chelation
(14 current Hb level) x BW x 3.5 to 4
Question 11
A 56 years old female with underlying psychiatric illness and on antipsychotic 1. State your diagnosis (2 marks) 2. Name 1 drug which is commonly associated with above diagnosis (2 marks) 3. Name 4 other complications of antipsychotic (4 marks) 4. State one pharmacological treatment (2 marks)
Answer Question 11
State your diagnosis (2 marks)
Acute dystonia secondary to antipsychotic ingestion
Answer Question 11
State one pharmacological treatment (2 marks)
Dopamine agonist Bromocriptine Dopamine Levo-Dopa
Question 11
Other spotted PRO question (Clinical short case or OSCE)
Interview technique video Phenomenology based on MSE DSM IV classification
Axis I Psychiatric illness Axis II Mental retardation/ Personality disorder Axis III GMC Axis IV Social problem Axis V Activity of daily living
Question 12
A 2 days old neonate was born with respiratory distress syndrome. Examination reveals a fasciculation at upper limbs and tongue 1. State 3 features of the patient (3 marks) 2. State the most possible diagnosis (2 marks) 3. State 1 blood investigation for diagnosis (2 marks) 4. State the prognosis for this child (2 marks)
Answer - Question 12
State 3 features of the patient (3 marks)
Patient is on opisthothonic posture Bilateral CTEV, left knee is hyperextended Patient was on nasogastric tube and nasal prong
State 1 blood investigation for diagnosis and the expected findings (2 marks)
Genetic testing show bi-allelic deletion of exon 7 of the SMN 1 gene
Question 12
Other spotted PRO question (Clinical short case or OSCE)
Spinal muscular atrophy types Approach to floppy infant (muscle, NMJ, Peripheral nerve, Anterior Horn Cell)
Question 13
A 65 years old patient with bilateral knee pain for 3 months duration 1. State 2 findings in the knee radiograph (2 marks) 2. State your diagnosis (1 mark) 3. State 1 other view of radiograph you would like to order in this patient to asses the patellofemoral joint (1 mark) 4. State 2 pharmacological treatment in this patient (2 marks) 5. State 1 surgical intervention you would like to offer the patient (1 mark) 6. State 3 complications of the operation you stated above (3 marks)
Answer Question 13
State 2 findings in the knee radiograph (2 marks)
Narrowing of medial joint space of bilateral knee joint Marginal osteophytes
State 1 other view of radiograph you would like to order in this patient to asses the patellofemoral joint (1 mark)
Skyline view, Lateral view
Answer Question 13
State 2 pharmacological treatment in this patient (2 marks)
Tablet NSAIDs T Glucosamine Sulphate
State 1 surgical intervention you would like to offer the patient (1 mark)
Bilateral knee arthroplasty
Question 13
Other spotted PRO question (Clinical short case or OSCE)
Hip osteoarthritis Hip avascular necrosis total hip arthroplasty
Question 14
Picture above showing the medication used in the labour room. Explain how would you titrate and calculate how would you give the patient with this medication (10 marks)
Answer Question 14
Induction
4g of MgSO4 over 10 - 15 minutes 10 mls vial contains 5 g of MgSO4
Thus, 1 ml solution contains 0.5 g of MgSO4 Use, 8 ml solution (4 g of MgSO4) add dilute in 12 mls of Normal Saline 0.9% or Dextrose 5% Total of 20 mls with 4g of MgSO4 given in 10-15 minutes
Answer Question 14
Maintenance
Aim = 1 g per hour with a rate of 5mls per hour Take 20 mls vial (contains 10 g of MgSO4) dilute in 30 mls of Normal Saline 0.9% or Dextrose 5% Total of 50 mls of solution with 10 g of MgSO4 So, 5mls contains 1 g of MgSO4 Infuse the patient with 5 mls per hour
Question 14
Other spotted PRO question (Clinical short case or OSCE)
Titration of Pitocin Drugs MgSo4, Antihypertensive in pregnancy, Tocolytics (side effects and precautions)
Question 15
Mr S, a 36 years old Malay man with newly diagnosed hypertension since 1 year ago, came to your clinic for 3rd follow up. He is a businessman who is busy travelling, and thus always forgot to take his medication. He is currently on nifedipine 10mg TDS. His latest BP was 160/90mmHg. Please counsel him on compliance towards medication
Answer Question 15
Greet the patient, build rapport Explain the hypertension control in this patient
Not controlled Aim is systolic <140mmHg and diastolic <85 mmHg Complications which may arise in the patient
Question 15
Other spotted PRO question (Clinical short case or OSCE)
Pap smear counseling and performing the procedures Prescription drugs Short history and diagnosis Contraception counselling
Question 16
A 34 years old gentleman was referred to you with palpitations 1. State 4 features in the ECG (4 marks) 2. State your diagnosis (2 marks) 3. Outline the treatment in this patient (3 marks)
Answer Question 16
State 4 features in the ECG (4 marks)
Absent of P wave in all leads Widened QRS complex Tall T wave Evidence of sine wave
Question 16
Other spotted PRO question (Clinical short case or OSCE)
Hypokalaemia (tall P wave, ST segment depression, U wave) Acute myocardial infarction and PCI
Question 17
A newborn with syndromic features 1. State 3 features of the patient (3 marks) 2. State your diagnosis (2 marks) 3. State 3 other system that can be involved in the disease you stated above (3 marks)
Answer Question 17
State 3 features of the patient (3 marks)
Cleft lip and palate Polydactyly Omphalocele
State 3 other system that can be involved in the disease you stated above (3 marks)
Central nervous system myelomeningocele, microcephaly, mental retardation Cardiovascular system VSD, ASD and PDA Skin Cutis aplasia Urogenitalia Undescended testis
Question 17
Other spotted PRO question (Clinical short case or OSCE)
Downs syndrome Marfans syndrome Turner syndrome Congenital Adrenal Hyperplasia
Question 18
Mdm K, a 43 years old Para 7 just underwent emergency C-section due to macrocosmic baby. Her last child birth was 1 year ago. Counsel the patient prior to discharge
Answer Question 18
Greet the patient, build rapport Wound care avoid water contact, came to hospital if bleeding and any discharge Breasfeeding exclusive breastfeeding until 6 months and continue up to 2 years of babys age Importance of spacing give at least 2 years Advise on contraception
Risk of grand multipara Risk of advance age pregnancy Choice of contraception
Discharge the patient with letter to local public health nurse (follow up at 6 weeks) Sexual intercourse wait until 4 weeks Any symptoms of pervaginal discharge, fever please came to hospital immediately