OSCE-4th yr

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Mahesh Chaudhary, MBBS-2006, ::::::::::::::::::::::::::::::::::::::::::::Updated version of Dr. Amits Edition

Dental:

1. X-ray (skull)

1. Which view

2. 3 uses

3. Dx.: # of mandible

4. Le-forte classification

2. OPG dentigerous cyst 1. View

2. Findings

1. Unerrupted 3rd molar in maxillary teeth.

2. Multiloculated lesion on the left side on the mandibular body (radiolucency) extending

from 4th, 6th to sigmoid nthc??

3. Normal condylar and coronoid process

3. d/d

3. Mouth gag- Acralic, se 1. Identify

2. Uses

4. Dental floss 1. Identify

2. Uses

3. types

5. INTRA-ORAL PERIAPICAL RADIOGRAPH (IOPAR)

1. Molars

2. Radiolucency suggesting carries

6. OCCLUSAL RADIOGRAPH

1. Radiolucency line suggesting

2. # of maxilla

3. # of incisor teeth

7. Impacted Tooth:

1. Occlusal radiograph showing

8. Radiopaque shadows showing bone plating in # of mandible or maxilla.

9. Chisel Malleate

10. Periosteal Elevator (WOODLANDS)

11. Forceps MANDIBLE MAXILLARY

12. LOCAL ANAESTHETIC SOLUTION 2% xylocaine with adrenaline 1: 2 Lac

13. OPG

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Indications Dental cysts Dental tumours

Abnormality in x ray - # mandible

14. Dental cast of maxilla A/c to FDI, name the teeth present

What may be the D/D for the defect?

15. Toothbrush Types A/c to bristle, hard, medium, soft A/c to handle, fixed & flexible Manual & electric Ultrasonic When to replace & why?

16. Removable partial denture Teeth present Upper left and right central incisors (11, 21) Composition Poly Methyl Methacrylate

17.

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Anesthesia 1. Aqmour? Shesel? Metallic tube

1) Advantage: can be bent in any direction

2) There is a stainless steel spring inside

3) Latex tube, Silico latex, Slicon

4) Disadv:

- becomes soft with autoclaving

- low vol, high pressure cuff

- may get disloged

5) Use:

- Risk of kinking tube?

- Oral surgery

- Head surgery

6) Cannot be kept for a long time

7) Spring valve in PVC | Not in Flexo-

metallic.

2. Red Rubber tube 1) Type of cuff: High Pressure variety 2) Disavd.:

- Eliminates toxic gases on autoclaving

- To test toxicity place tube in muscles of rabbit, inflammation

seen microscopically. 3) asdfa

3. PREFORMED tube 1) RAE tubes

2) Oral and head and neck surgery

4. Double lumen tube: 1) 1 tube with 2 tubes inside

2) Thoracic surgery lobectomy,

pneumectomy

Separating the lungs in cases of

hemorrhage and infection

3) 2 inflating lumens

4) C/I: Pts in whom you cannot change

tubes.

5. Tracheostomy tube:

1) Patient on ventilator for more than 2

weeks

D/t changes of

Failed ventilation/

2) Cuff

3) Radiopaque line

4) Mass in oral cavity?

6. LMA BRAIN MASK 1) Oral cuff (silicon)

2) Airway tube (PVC)

3) Airway bars prevent epiglottis

4) Herniation into airway tube

5) Indications

1. As an alternative to intubation

where difficult intubations

anticipated.

2. Securing airway in emergency

where intubation and mask

ventilation is not possible.

3. As a elective method for minor

surgeries where anaesthetist wants

to avoid intubation.

4. As a conduit for bronchoscope,

small size tubes gum elastic

bougies.

5. Tip goes to oesophagus

6. Aperture pass at vocal cords.

6) What are the contraindications?

1. Full stomach patient

2. Hiatus hernia, pregnancy

3. Oropharyngeal abscess or mass

4. Patient who are vulnerable to go in

bronchospasm.

7) What are the advantages?

1. It is easy to perform

2. Does not require any laryngoscope

and muscle relaxant

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3. Does not require any specific

position of cervical spine so can be

used in cervical injuries.

8) What are the disadvantages?

1. Does not prevent aspiration so

should not be used in full stomach

patients.

2. High incidence of laryngospasm and

bronchospasm.

9) Types:

1) Classic LMA

2) Intubating LMA

3) Proseal LMA

4) Short Handle LMA

10) How to select LMA?

Decided upon the body wt of pt.

1. 1 - 5-10 kg

2. 2 10-15 kg

3. 2 - 15 -20 kg

4. 3 20-30 kg

5. 4 30-50 kg

6. 5 50-70 kg

11) How much air to inflate the cuff in fixed

in an LMA?

12) Not used for lung surgeries

13) Black line should face incubator?

14) Complications:

1. Dental trauma

2. Mucosa, lips

3. Sore throat.

15)

7. I.V cannula: 1) Sizes:

1. Or 14

2. Br 16

3. Gr 18

4. Pn 20

5. B 22

6. Y 24

7. W 26

2) I.V cannula

8.

9. Endotracheal Tube: 1. What are the types?

Mainly 2 types

Red rubber and PVC

2. Secure airway

3. PVC quality: Non-toxic, on autoclaving

does not eliminate toxic gases or

become soft.

4. Write down the Parts.

a. Two ends patients end machine

end

b. Patient end is BEVELLED

(45o in case of oral and 30o in

case of nasal)

c. Murphy eye serves as an alternate

coat for ventilation and sucking out

secretion even when main lumen is

blocked.

d. Cuff-

i. Pedeatric non cuffed

ii. Help in ventilation

iii. Prevent leak of gas

iv. Preventing aspiration

v. CO2 monitoring.

e. Pilot balloon

f. Inflating tube

g. Tube connector

5. Black mark at level of vocal cord

6. Standard 15 mm

7. How to decide the size of ETT?

Ascertaining DIAMETER

Age Size

Premature 2.5 mm ID

0-6 months 3- 3.5 mm

6-1 year 3.5 4 mm

1-6 years

> 6 years

Healthy male 9 mm

Healthy female 8 mm

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ID = internal diameter

Ascertainign LENGTH

Male = 23 cm

Females = 21 cm

Children = Age in years/2 + 12 cm.

For NASAL intubation, add 3 cm is

added to oral length.

8. How do ascertain that the tube has

reached its position?

1. Auscultation of chest for air entry

2. Characteristic feel of bag

3. Chest inflation on positive pressure

4. X-ray radiopaque line in PVC

5. CAPNOGRAPHY.

9. What are the complications of

intubation?

1. Reflex disturbances

2. May go into oesophagus

3. Ischemia, edema and necrosis by

cuff.

4. Aspiration

5. Bronchial intubation and collapse of

other lung

6. Sore throat most common post-

op complication

7. Laryngeal aodema

8. Palsies

9. Infections

10. Vocal cord granuloma.

11.

10. What are the reflex that can be caused

and how to handle them?

Reflex reactions

1. Laryngospasm

2. Bronchospasm

3. Severe hypertension

4. Tachycardia

5. Cardia arrhythmias.

How to manage?

1. Adequate depth of anesthesia

2. Opiodis (SULFENTANIL) is DOC

3. i.v xylocard 2% 1mg/kg 2-3 minutes

before intubation

4. local xylocaine spray

5. -blocker (ESMOLOL)

6. CCB

11. How long ETTC can be kept?

1. Max is 7 days.

12. How much pressure should be thre to

prevent ischemia?

< 30 cm of H2O

Prefer non-cuffed in children

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Reduced dead space by 70 mL as

1. Nasal passage is bypassed and

2. Lumen of ETT is less than that of

airway.

17. When and how to extubate?

18. Diff between Red rubber and PVC ETT?

Red rubber PVC

1. Costelier Cheap

2. Reusable Disposable

3. Cuff type: High pressure, low volume

Low pressure and high volume

4. Tracheal injuries chance high so no to prolong surgeries

Less and so can be safely for prolonged surgeries

5. Radiolucent Radioapque line can be visualized in x-ray

6. Non-transparent

Transparent, so secretions can be visualized

7. No Murphy eye present

Present

8. Slightly more rigid and so does not conform to anatomy of airways

Easily conforms to anatomy of airways

9. Less incidence of sore throat

Increased due to large cuff

10. Has preservative LEAD

no

19. What are the conditions

contraindicationg to both oral and

nasal intubation?

1. Laryngeal odema

2. Epiglottis

3. Laryngotracheaobronchitis.

20. What are the indications of Nasal

intubation?

1. Obstructive mass in oral cavity

2. Oral surgery

3. Fracture mandible

4. Inadequate mouth opening due to

TMJ dysfunction

5. Neck injury

6. For awake intubation, it is

preferred.

21. Contraindications for nasal intubation?

1. Basal cell fractures and CSF

rhinorrhoea

2. Bleeding disorders

3. Nasal polyp, abscess, foreign body.

4. Previous nasal surgery

5. Adenoids

6. And that applying to both.

22.

23.

10. LMA: 1. Types flexometallic, intubating,

standard, prosseal

2. Use/indications

1. To protect the airway without the

anesthesist hands to support a

mask

2. To avoid the use of tracheal

intubation

3. In cases of difficult intubation

4. In case of short surgeries

3. C/I

1. Pt is on full stomach

2. When regurgitation is likely

3. When surgical access is impeded by

the cuff of the LMA

4.

4. Disavd.

1. Aspiration

2. Aerophagia

3. Laryngospasm

4. Injury

5. Parts tube, eye, cuff, pilot, connector.

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11. Intubating LMA (Fastrach) 1. 3, 4, 5 sizes

2. Diff- preformed, rigid, stainless steel

airway tube

3. Used

a. alternate for laryngoscopy to

intubate

b. Controlled ventilation

c. Easy to use (paramedical staff)

4. Stabilizaer of ILMA

5. Disavd

a. More airway damage than LMA

b. Dental trauma

c. Sore throat

d. Cannot be kept for long term

6.

12. Masks:

1. Anatomical mask - Fixed to anatomy of tissue

- Cuff, body, connector

- hook

2. What are the parts?

1. Connector

2. Hook

3. Filling tube

4. Body

5. Air filled cuff (has soft cushioning

effect)

3. The pyramidal area that the face mask

can occupy air equivalent to DEAD

space so increased dead space.

4. What is the main indications?

1. To maintain airway

2. And oxygenation

5. What are the Disadv

a. It is very tiring.

b. Cannot prevent regurgitation

and vomiting

c. Cannot secure airway

d. Uncomfortable for tissue

e. Significant air can go into

oesophagus and thus increases

intragastric pressure (>28 cm

H2O) leading to aspiration.

6. Why Black? Antistatic

7. Childred dead space of 200-300 mL

8. REINDEL BAKER MASK

a. low dead space

b. for neonates

All masks:

- Causes damage to skin, mucosa, small

nerves for long time

13. Simple Face Mask 1. Nose is clipped so that mask is in place

2. Istoles For air entrapment

3. Used to supplement O2 (this is the only

use)

14. Nasal Cannula

1. Low flow oxygen delivery device

2. No high flow O2 (upto 4L)

3. FiO2 (4%)

15. Venturi Mask: 1. Based on BERNOULLis LAW or VENTURI

PRINCIPLE.

when a fluid or gas passed through a

tube of varying diameter, the pressure

exerted by fluid (lateral pressure) is

minimum where velocity is maximum

(pressure energy drops where kinetic

energy increase; BERNOULLISs law).

2. What is the advantage?

By increasing flow rate (velocity),

through narrow constriction, we can

create subatmoshpheric pressure.

3. What are the uses?

1. Venture mask

2. Jet ventilation

3. Suction apparatus.

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4. What do you mean by Venturi mask is

FIXEED PERFORMANCE oxygen

delivering devices?

Meaning that performance not

affected by changes in patients tidal

volume and respiratory rate.

5. What is the maximum oxygen that can

be achieved by venture mask?

60%

6. What can kind of delivery system is it?

it is a high flow oxygen system

- 3 to 4 times Minute volume.

7. What are other low flow oxygen

delivery systems?

Also called VARIABLE performance

device.

1. Nasal cannula

2. Simple mask

3. Oxygen tents

4. Non-rebreathing mask

5. Rebreathing mask

6. polymask

8.

- Achieve 80% FiO2

- Venturi yellow, blue, red (depending

upon % of O2)

- 35% - 8L of O2

- ICU use

16. Spinal needle (18-32 G) 1. In BPKIHS, 25G is used

2. Cutting/Non-cutting

3. Opening at distal tip

4. Cut an angle

5. Length 10 cm needle +

6. 5% bupivacaine heavy

It is made heavy by adding 25%

dextrose

7. Parts pierced: Skin, s.c tissue,

supraspinous lig., interspinous lig., lig.

Of flavum,

In Epidural, Lig. Of Flavum is not

pierced.

8.

17. Epidural Needle (TOUHYs) 1. 16-18G

2. Puncture chances more if pierced in

subarachanoid,

3. Loss of resitance technique

4. Air/saline can be used for technique

5. Normal depth of epidural 4-6 cm

6. Catheter epidural threaded

7. 8-9 at skin length

8. Needle 10 cm

9. Cutting of epidural needle stability,

direction of hub

10. The dye used here is plain and not

heavy

11. Walking epidurals only analgesia, no

motor block, pt can walk without pain

12. Bupivacaine

13. Lignocaine.

14. Indications

15. Contraindications

Epidural set:

1. Components:

1. Epidural catheter

2. Loss of resistance syringe

3. Microfilter

4. Touchy needle

2. Indications

1. Surgery below waist

2. Post-op analgesia

3. Cancer pain relief

4. Administration of corticosteroid

5. Caeseraian section

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3. 2 methods to know you have reached

the epidural space?

1. On piercing the ligamentum flavum,

there is loss of reistance

2. Hanging drop method: a drop of

water placed on the needle tip of

epidural needle is soaked in.

18. Guedels Airway: 1. 3 parts:

1. Curved part

2. Bite guard

3. flange

2. 2 uses/Indications

1. To prevent backward displacement

of tongue

2. To prevent biting of tongue

3. Assisted ventilation

4. Oropharyngeal suction

5. Maintenance of airway

3. 2 disadvantages

1. Cannot prevent aspiration

2. Cannot be used in tenesmus

4.

19. CVP catheter: 1. Identify

2. Indications

3. Route of admission

Route of admission

20. B.T packs: 1. Filter for micro particles, wider pore

21. Burete I.V. set

22. McGills Foreceps: 1. Endotracheal intubation

- (Guiding) in cases of Nasal intubation

- Throat packing

- Insertion of NG tube

2. Adv: does not have a hinge no trauma

3. Disadv: tend to slip

23. Bupivacaine: 1. 20 mL vials

2. Max dose 2-3 mL/kg

3. Cardiotoxic

4. 4 mL ampoules for spinal

24. Thiopentone 1. How do you recognize?

Yellow hygroscopic powder.

2. Indications:

1. i.v induction

3. 1 week of self-life after making into

solution

4. What is its half life?

5. What is its pH?

- 10.5-10.8

6. Why pH is important?

25. Propofol 1. Color: Milky white in color (only white)

2. Contents:

Egg phosphate, neuroprotection

3. TIVA: Total Intravenous sedation?

26. Adrenaline

27. Midazolam 1. Dose:

0.01mg/kg 2. Uses:

1. uasdf 3. Asdf 4. asdf

28. VECURONIUM/ITRACURONIUM

29. SUXAMETHONIUM 1. What precaution to keep in children?

Give atropine 1st in paedeatric d/t

bradycardia

2.

30. Fluids 1.

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OtoRhinoLaryngology:

1. X-ray mastoid

1. View

2. Identify

A dural plant

B Lat sinus plate

C sinodural angle

D mastoid air cells

3. 6 other views

4. 6 indications of cortical

mastoidectomy

2. LAWs view (lateral oblique view)

1. Findings

3. Indirect Laryngoscopy mirror

1. Identify

2. How to use before patient and why

3. Structures seen with diagram

4. Adult larynx vs child larynx

4. X-ray of neck

1. View

2. Finding

3. Management

4. complication

5. Foreign body neck

1. Identify

2. Normal length of oesophagus

3. Narrow constriction of oesophagus

4. What FB?

6. Peritonsilar abscess foreceps

1. Identify

2. Use

3. Waldeyers ring?

4. Arterial supply of tonsil

7. Audiogram SNHL

1. Type of hearing loss

2. Average threshold

3. Pre-requisities

4. Causes of mixed H/L metabolic,

noise trauma, otosclerosis, drugs

5. Principles of Gelles test.

8. Tympanogram:

1. Name of graph

2. Type of curve

3. Provisional dx.

4. ET tube: adult vs. padiatric

9. PTA: Karharts notch

10. Tracheostomy:

1. Steps

2. Complications

3. Indications

4.

11. Tracheal dilator

12. Jaegers B type graph of OME

1. Signs

2. Symptoms

3. Management

13.

14. Hartmans Foreceps:

1. Identify

2. 2 uses

3. Nerve supply of pinna

4. Predisposing factors of wax

formation

1. Genetic secrete more

ceruminous gland

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2. Narrow and torturous canal

3. Stiff hair

4. Obstruction in canal e.g.,

exostosis.

5. What are the contents of wax?

1. Secretions of sebaceous gland

2. Ceruminous gland

3. Hair

4. Desquamated epithelial debris

5. Kerain

6. dirt

6. what are the ceruminolytics?

1. 5% HCO3 in equal volume of

glycerine and H2O

2. H2O2

3. Olive oil

4. Liquid paraffin

5. Paradichlobenzene 2%

7.

15. St. Clair Thompson adenoid curette

1. Identify

2. Parts:

1. Curette: shaves off the adenoid

mass

2. Guard holds the tissue and

prevent the slipping.

3. Operations where used

4. Contraindications:

1. Cleft palate and submucous

palate

2. Hemorrhagic diasthesis

3. Acute infection

5. Syndrome associated with

operation

6. c/f of the syndrome

16. Photo of tracheostomy tubes

1. PVC cuffed 2. Flexometallic

2. 3 adv & 1 disadv of 1 over 2

3. Which of these is used immediately

postop.

4. Diameter of adult and infant

trachea

5. Adductors of vocal cord

6. Nerve supply to post.

Cricoarytenoid.

17. asf

18. Identify the view Occipitomental (Waters) view

Findings

Haziness in the maxillary sinuses B/L

Mucosal thickness

How would you treat?

Decongestants

Antibiotics

Mastoidectomy !!

19. Identify the instrument Trachial dilator

Advantages of this?

4 most important indications of

Tracheostomy

4 postop complications of

tracheostomy.

20. Pure tone audiogram SensoriNeural Hearing Loss

Causes

21. Pure tone Audiogram- Tympanogram

B-type graph (flat curve)

Probable diagnosis-

22. X-ray soft tissue neck and chest lateral view

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Abnormality

Radio-opaque shadow in C5, 6, 7

levels

Probable diagnosis

FB in Oesophagus

T/t-

Removal of FB with Rigid

esophagoscope under GA

23. Identify Tongue depressor Uses

Which part of the tongue will you

depress ?

If posterior third is depressed, what will

happen?

24. Identify Posterior rhinoscopy mirror How do you use it? Write method.

Draw a labeled diagram of PR view.

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OPTHALMOLOGY:

1. IOL

1. Identify

2. Draw parts

3. 2 contraindications

2. Atropine

1. MOA

2. 4 uses

3. 2 contraindications

3. Photo corneal ulcer staining

1. Staining techniques

2. Finding

3. Management

4. Photo Graves opthalmopathy

1. Findings

2. 2 ocular signs

3. 2 investigations

5. CT Scan rt. Eye proptosis

1. Findings

2. Dx.

3. Mng.

6. Perimetry

1. Defect

2. Other Ix.

3. Mx.

7. PinHole:

1. Identify

2. M-O.A

3. Uses

8. Lacrimal syringe and punctuate dilator

1. Identify

2. indications

9. Leukocoria photo

1. Identify

2. d/d

3. dx

4. t/t modalities

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10. Pilocarpine eye drops

1. M.O.A

2. 3 indications

3. ADR

11. Hertels exompthamoter

1. Identify

2. Indications

3. Normal value

12. Maddox rod

1. Identify

2. Used

3. Why macular function not in cataract

13. Photo: Congenital glaucoma

1. Identify

2. Common problems as seen in photo

3. Mx

4. 4 causes of epiphora in child

14. Severe ptosis

1. Identify

2. hx

3. Inv.

15. Convex lens:

1. Identify convex lens

2. How will you recognize?

3. Conditions

4. disadvantages

16. Spectacle with concave lens

1. Identify

2. Uses in correction of myopia

3. 5 other modalities of treatment

1. Contact lens

2. Radial keratotomy

3. Photorefractive keratomy

4. LASIK

5. Extraction of lens

4. 3 complications of this condition

1. Complicated cataract

2. Retinal detachment

3. Vitreous hemorrhage

4. Choroidal hemorrhage

5. Clinical varieties of myopia

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1. Congenital

2. Developmental

3. Pathological

4. Acquired

17. CT scan

1. Proptosis of left eye

2. Describe lesion

1. Forward protrusion of left eyeball

2. Mass behind the left eye ball

3. Name the view: Axial view

4. Causes:

1. Orbital abscess/cellulitis

2. Tumours of the orbit

3. Cysts of orbit

4.

5. Management:

18.

19. RAF rule

1. RAF rule

2. Uses to examine convergence of the eye

3.

20. Malignant melanoma

1. Identify malignant melanoma of upper lid

2. Management surgical excision with reconstruction of lid

3. d/d Naevus, pigmented basal call ca.

21. Schiotz tonometer:

1. Identify schiotz tonometer

2. Principle plunger will indent a soft eye more than hard eye (INDENTATIOn tonomtery)

3. Parts with diagram

4. Falls readings high/low

22. FMN gel

1. Group steroid

2. Other drugs prednisolone, dexamethasone, betamethasone, hydrocortisone

3. M.O.A anti-inflammatory, anto-allergic, anti-fribrotic, decreases inflammation by

1. Maintain cellular membrane integrity

2. Decreases lymphocytes

3. Decreases lysosomal release

4. Decreases tissue swelling.

4. ADR complication

1. Glaucoma

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2. Cataract

3. Activation of infection

4. Delayed wound healing

5. Dry eye

6. ptosis

5.

23. Corneal ulcer:

1. Identify

2. Investigations

1. Ocular examination

2. Lab investigation

Routine

Microbiology

3. Treatment:

1. Local antibiotics topical, subconjunctival

2. Systemic antibiotis

3. Cycloplegics

4. Analgesics

5. Hot formentation

6. Pad and bandage

4. Advice:

1. Rest

2. Do not strain.

5.

24. Na-Flourescein stain

1. Identify Na Flourescin stain stripes

2. Principle

3. Conditions of use

1. corneal ulcer

2. tear film test (break up time)

3. applanation tonometry

4. Jones test

5. Floursecin dye displacement test

25. Kelman McPhersons forceps

1. Identify

2. Use

1. To tear off the anterior capsular flap

2. Sutures

3. IOL implantation

3.

26. Chalazion clamp:

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1. Use: to fix the chalazion and achieve hemostasis during incision and curettage

2. Describe the process

27. Mebomian cell ca:

1. Dx.: Meibomian cell ca

2. Lesion: reddish, irregular, solid mass on inner aspect of upper lid

3. Management

28. Foreign body in eye eye is red and watery examination

29. A

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Family Medicine

1. Anaphylactic shock: Management

2. Diabetic Ketoacidosis: findings given, discuss on them

3. X-ray Pleural effusion (Mng. Of Dx)

1. Nursing care

2. Investigation

3. Emergency treatment

4. Discharge plan

4. Consult on

1. Anxiety

2. Depression,

3. Consult on dry cough

4. Stroke

5. Post MI

5. H/O crushing chest pain X-ray (?) Pulmonary odema clinical co-relation with condition

6. Advice for 24/F on contraception

7. Abstract and its questions

8. Write LFT readings for Hep.A

9. Primary survey of RTA (Demon on model)

10. Shoulder examination and exerceise

11. Fluid charting:

1) 50/F for cholecystectomy, NPO-12 hrs

2) 4/M, 15 kg NPO 12 hrs

12. ECG reporting, Ant. Wall MI

13. MI counseling

14. Headache counseling

15. Migraine counseling

16. CAGE questions Alcohol counseling

17. HEADS questions Adolescent Health

18. PV discharge

19. Counsel on :

pregnancy, STDs, LBP, Infertility, child with seizure and fever, gout, tubal ligation,

20. Adrenaline + saline dilution

21. TRIAGE

22. OP poisoining

23. Measuring visual acquity

24. How to use PEFR

25. How to use MDI + spacer?

26. IMCI

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27. Broncial asthma

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Orthopaedics: Instruments

1. Periosteum Elevator

2. Bone Lever

3. Bone Nibbler

4. Bone Cutter

5. Osteotome

6. Bone Chisel

7. Mallet

8. Bone Curette

9. Bone Gouge

10. Bone Awl

11. Bone Holding Forceps

12. Plate Holding Forceps

13.

Traction Instruments

1) KIRSHNER WIRE

2) GUIDE WIRE

3) SANZ PIN ???

4) Used in external fixation (for open #)

Femur 4.5 mm

Upper limb 6 mm

Hip 6mm

Hand 2.5 mm

5) STEINMANN PIN

6) BOHLER STIRRUP

7) K-WIRESTIRRUP WITH TENSIONER

8) SKULL TRACTION TONGS

IMPLANTS

1) KUNTSCHERS NAIL

2) SMITH-PETERSEN NAIL

3) V NAIL

4) INTERLOCKING NAIL

5) TALWALKAR NAIL

6) RUSH NAIL

7) ENDERS NAIL

PLATES AND SCREWS

P a g e | 22


1. Heavy duty Plate

2. Cortical screw

3. Malleolar Screw

4. Cancellous Screw

5. HARTSHILL RECTANGLE

6.

PROSTHESES

1. AUSTIN MOORE PROSTHESIS

2. THOMPOSN PROSTHESIS

3. CHARNLEYs TOTAL HIP PROSTHESIS

4. MULLERS TOTAL HIP PROSTEHESIS.

SPLINTS and Tractions

1. Crammer-wire splint

2. Thomas Splint

3. Bohler-Braun Splint

4.

1) KUNTSCHNERs CLOVERLEAF

INTRAMEDULLARY NAIL

1. Common use:

Intramedullary nail for fixation of

femoral fractures.

2. What are the parts:

1. Hollow tube

2. Slot on one side

3. Eye on both the ends.

3. What is the principle of fixation?

Based on three point fixation i.e. when

a straight rod passes through curved

medullary cavity o f the femur, it fixes

the bone at three points at either

ends and at the isthmus.

4. Why is there eye on its either end?

Hook of extractor goes there while

removing the nail.

5. How do you estimate the size of K-nail

for a particular case?

- Length is found by tip of greater

trochanter to the lateral joint line of the

knee and subtracting 2 cm from it.

- Diameter is determined by X-ray, from

width of the medullary cavity at the

ISTHMUS.

6. What are the techniques of insertion?

1. Inserted from fracture-site and

hammered proximally till it comes

out of the trochanter. The # is

reduced and nail driven back into

the distal fragment. Called

Retrograde Nailing.

P a g e | 23


2. Other is introduced from greater

trochanter over a guide wide

passed from the fracture-site.

Once the nail comes upto the

fracture-site, the guide wire is

removed, the fracture reduced

under the vision, and the nail driven

home. About 2 cm is left protruding

at the trochanter to facilitate

removal.

7. When is it removed?

Usually 2 years after the operation.

8. What are the complications?

1. Nail getting stuck

2. Splintering of the cortex while

hammering the nail

3. Proximal migration of the nail

leading to bursitis over its

protruding end

4. Distal migration of the nail leading

to stiffness of the knee

5. Infection.

9.

2) Ulnar nerve injury and deformities

3) Colles fracture, Dx and complications

4) Supracondylar # - dx. And 3 complications

5) What are the objectives of tractions?

1. Reduction of # and their maintenance.

2. For immobilizing a painful, inflamed

joint

3. For the prevention of deformity by

counteracting the muscle spasm with

painful joint conditions

4. For the correction of soft-tissue

contractures by pulling them out.

5.

6) How to care for patient in traction?

1. The traction should be comfortable as

possible

2. Proper functioning of the traction-unit

must be ensured.

3. Traction weight should not touching the

ground.

4. Ropes should be in groove.

5. The foot of the patient or the end of

traction device should be touching the

pulley.

6. Terminal part of limb in traction must

be warm and of normal color,

sensations should be normal.

7. Any new arise of swelling may point

tight bandage.

8. A pin-tract infection must be noted.

9. The proper position of the # should be

ensured bytaking x-rays in traction.

10. A watch must be kept on general

complications bed sores, chest

congestion, UTI, constipation.

11. Physiotherapy of the limb in traction

should be continued to minimize

muscle wasting.

7) Contradict SKIN and SKELETON traction.

SKIN SKELETON

Required for Mild-moderate force

Moderate-severe force

Age used for Children Adults

Applied with Adhesive plaster

Pin, K-wire

Applied On skin Through bone

Common site Below knee Upper tibial pin traction

Weight permitted

Upto 3-4 kg Upto 20 kg

Used for Short duration

Long duration.

8) How to prepare for SKIN Traction?

1. Logic is to provide traction in skin that is

transmitted from through deep fascia

and intermuscular septae to the bone.

P a g e | 24


2. Prepare the skin by plucking hair,

washing and drying the area.

3. Avoid placing adhesive straps over

bony prominences.

4. If bony prominences are in way, cover

them well with cast padding.

5. Make the adhesive straps.

6. Place longitudinally on opposite sites

with the skin left between the straps to

prevent tourniquet effect.

7. Attach the free ends of these straps to

the spreader bar.

8. Hold the straps in place by encircling

them with adhesive tapes.

9. Now apply the traction rope to

spreader bar.

10. Support the leg in traction with pillows

.

9) How to prepare for SKELETAL Traction?

1. Establish thestatus of

NEUROVASCULAR structures before

proceeding.

2. General rule: always start from the

place where vital structures are

situated. This gives more control and

better avoidance. E.g. start from medial

side for olecranon pin to avoid ulnar

nerve.

3. Prepare skin. It should be free from

active infection.

4. Giving anesthesia:

Inject 1% xylocaine in skin, s.c tissue

and go down to periosteum. 1st do for

that side from where drilling with start.

Once the drilling reaches middle or

cavity, give anesthesia from other side.

5. SKIN INCISION

6. Pins and wires better inserted with

Hand drill than power tool.

7. Best placed in metaphysic

8. Avoid epiphyseal plate damage,

muscles and tendons piercing.

9. Do not violate fracture hematoma.

10. Do not penetrate joints

10)

11) KIRSCHNER WIRE:

1. What are the uses?

1. For internal fixation of small bones

2. For giving traction e.g., for applying

traction through the olecranon

3. For fixing fractures in children

4. For Ilizarovs fixating system.

2.

12) Steinmanns pin Identify and 2 uses

1. For skeletal traction

1. Upper end of tibia

2. Supracondylar region of the femur

3. calcaneum

2. Places for insertion:

a. Metacarpals. Place the wire through the metaphyseal diaphysed junction of the index and middle metacarpals. To facilitate insertion, push the first dorsal interosseous muscle in a volar direction and palpate the subcutaneous portion of the bone. Angle the wire to pass through the index and middle metacarpals and to come out the dorsum of the hand, so as to preserve the natural arch.

b. Distal radius and ulna. Usually place the wire or pin through both the radius and the ulna. This site is rarely used.

c. Olecranon. Take care to avoid an open epiphysis. Do not place the pin too far distally because this causes elbow extension, and it is more comfortable to pull through a flexed elbow than an extended elbow. Use a moderate-sized wire or pin and insert from the medial side to avoid the ulnar nerve. Use a very small traction bow.

P a g e | 25


d. Distal femur. Start on the medial side, anterior enough to avoid the neurovascular structures. This insertion is best accomplished by placing the pin 1 in. inferior to the abductor tubercle. If the pin will be used for traction on a fracture table for delayed intramedullary nailing, make sure it is placed far anterior, off the coronal midline to avoid incarceration by the intramedullary nail. Fluoroscopy should be used to help the surgeon avoid an open physis.

e. Proximal tibia. Place the wire or pin 1 in. inferior and 1/2 in. posterior to the tibial tubercle, starting on the lateral side to avoid the peroneal nerve. Take extreme care to avoid an open epiphysis; if the anterior portion of the proximal tibial epiphyseal plate is violated, genu recurvatum can occur.

f. Distal tibia and fibula. Start the pin 1 to 1 1/2 fingerbreadths above the most prominent portion of the lateral malleolus to avoid the ankle mortise. Insert it parallel to the ankle joint and angulate it slightly anteriorly. The surgeon should feel the pin pass through the two fibular cortices and then the two tibial cortices. Pass the pin through both bones to avoid the tendons and neurovascular structures. If the pin is placed too far proximally, the foot rests on the bow, and a pressure sore may occur.

g. Calcaneus. Generally select a large diamond-point pin. The preferred insertion site is 1 in. inferior and posterior from the lateral malleolus or 1 3/4 in. inferior and 1 1/2 in. posterior from the medial malleolus. Because of the position of the tibial nerve, the medial starting site is preferred. If the pin is placed too far posteriorly, it causes a calcaneal position of the foot. If the pin is

placed too far inferiorly, it may cut out of the bone. If the pin is placed too far superiorly, it can enter the subtalar joint and also spear the flexor tendons or tibial nerve and/or artery. Infections that are difficult to treat often occur when the calcaneus is used for long-term traction.

3. What are the complications?

1. Infection (treat by removing, Abs)

2. Distraction of bone fragments

3. Heavy traction may lead to nerve

palsy

4. Pin breakage

4.

13) Crammer wire splint identify and 2 uses

1. What is its use?

For temporary splintage of fractures

during transportation.

2. What is the advantage?

It can be bent into different shapes in

order to immobise different parts of the

body.

3.

14) Thomas Splint:

1. What is it?

Thomas Knee-Bed Splint

2. What are its uses?

1. Immobilsation

2. Definite treatment for fracture

femur

3. What are its parts?

1. Ring

2. Two side bars joined distally

3. Ring has angle of 120o

4. Outer bar has a curvature near its

junction with the ring to

accommodate the greater

trochanter.

4. How to measure its size?

P a g e | 26


1. Ring size: thigh circumference at

the highest point of groin + 2

inches.

2. Length: highest point on the medial

side of the groin upto heel + 6

inches

5. What are its disadvantage?

1. Ring is discomfort.

6.

15) BOHLER-BRAWN Splint:

1. What is its use?

Fracture-femur

2. What are its parts?

Multiple pulleys (1-3)

3. What is disadvantage and advantage

over Thomas splint?

Adv.

More convenient than Thomas splint as

has no ring.

Disadv:

No Inbuilt system for counter-traction,

so not suitable for transportation.

4.

16) How do you care for a patient in a splint?

1. The splint should be properly applied,

well-padded at BONY PROMINENCE

and at the fracture site.

2. The bandage of the splint should not be

too tight as it may produce sores; or too

loose it be ineffective.

3. The patient should be encouraged to

actively exercise muscle and joints

inside the splint as much as permitted.

4. Any compression of nerve or vessel s

usually due to too tight bandage, should

be detected early and managed

accordingly.

5. Daily checking and adjustments, if

requirement should be made.

17) Femur parts and attachments (Lesser

trochanter)

18) Tibia parts shown and attachment (Tibial

tuberosity)

19) POP setting time, use, complication of

tight cast.

20) Posterior dislocation of Hip

21) CTEV photo

22) Fixed Flexion deformity

23) DCP

1. What is this?

Dynamic Hip Screw

2. Why is it called Dynamic

3. What the use?

For fixation of trochanteric fractures.

4. What are the parts?

1. Lag screw

2. Barrel

5.

24) Ankylosing spondylitis X-ray:

25) Austin Moore Prosthesis:

1. What is this? Austin Moore prostehsis.

2. What it it use?

- Replacement of femoral head in case of

fracture neck of femur in elderly

persons.

3. What are its part?

1. Head

2. Small neck with a hole

3. 2 fenestration

4. Stem

4. What are its sizes?

- 35 mm to 59 mm (ODD sizes)

5. Why there is small hole at the top of

stem?

P a g e | 27


- For the hook of extractor used while

removing the prosthesis

6. Why fenestration in midline?

- Through which bone supposedly grows

and helps in fixation of prosthesis.

7. Can cement be used?

- No as use of cement make its removal if

required, difficult.

8. What are other advantageous Prothesis

for # neck of femur than Austin MOORE?

THOMPSONs PROSTHESIS:

Advantages;

1. In older fracturs of femoral head

where neck of femur is absorbed.

2. It can be used with or without

cement.

3.

1. CHARNLEYS TOTAL HIP

PROSTHESIS:

2. MULLERS TOTAL HIP

PROSTHESIS.

For replacement of both

Acetabulum and Head of femur.

9.

26) PLASTER OF PARIS?

1. What is the chemical formula?

[CaSO4)2H2O

2. What is the reaction?

(CaSO4)2H2O + 3H2O

Anhydrous calcium sulfate: plaster of

paris

2(CaSO4 2H2O) + heat

Hydrated calcium sulfate: Gypsum.

3. Forms:

1. Slab

Only 2/3rd of the circumference

covered

Remaining by cotton and bandage

Indications:

1) Soft-tissue injury

2) Massive swelling (may increase

so before definitive treatment)

3) Supracondylar #

2. Cast

4. What are the basic principle before

apply?

1. 2 joints

2. Immobilize the joints in functional

position (collaterals are maximally

stressed after physiotherapy, so

length and activity easily achieved)

3. Physiotherapy of all the joints that

are not incorporated in the cast

4. Adequately padded

5. (distal to proximal as venous

return distal to proximal so swelling

subsides early)

5. Advantages:

1. Cheap

2. Easily available

3. Easy to apply

4. Not allergic

5. Moulds to the shape of limp

6. Disadvantages:

1. Doesnt protect from water

2. Hold for longer time till setting

3. Heavy

7. What is setting time? What is its clinical

importance?

- Time taken from conversion of

Amorphous form to Crystalline from.

- 2-7 min.

- One has to hold the limb in position for

this time.

8. What is Drying time? What is its clinical

importance?

- Change of crystalline from into

anhydrous form.

- It is 24-72 hours

- Ask the patient to avoid weight bearing

till this time.

P a g e | 28


9. How to decrease the setting time?

1. Warm the H2O

2. Salt

3. Boric acid

4. resin

10. How to increase?

1. Cold H2O

2. Mobilization of joints.

11. What are the after care instructions?

12. Complications?

1. 5Ps pain in passive movement,

parasthesia, p

2. Compartment syndrome.

3. Pressure sores

4. stiffness

13. How to cut the plaster?

- Manual saw

- Electrically powered oscillating (Antero-

postero-movement)

14. Recent advancements:

1. Synthetic cast Beni Cast, Articast

1. Light

2. H2O resistant

3. Strong

4. Radiolucent

2. Disadv: Allergy and costly.

15. Special casts:

1. PTB cast patella tendon bearing

cast e.g. # both bone of legs

2. SPICA involves the part of trunk

and limbs. e.g., # of femur

3. THUMB SPICA for scapoid #

16. What will be the extent of plaster of

paris in case of colles #?

17. What should be the extent of PoP cast

for lower tibial #?

27)

P a g e | 29


Lab Medicine: 1. DM

- Draw unctonrolled DM graph

- Serum C-peptide

- Tests for insulin

2. Wintrobe tube:

1. Uses:

1. PCV

2. ESR

2. Normal values:

Males

Females

PCV

40-54%

37-47% Increases: 1. Polycythemia

vera 2. High altitude

Decreases: 1. Aplastic

anemia 2. Thalasemia

ESR (at the end of 1st hr)

0-10 mm

0-20 mm

Increases: 1. TB 2. Rheumatoid

arthritis Decreases:

1. Polycythemia vera

2. Leukemia

3.

3. Calculate VLDL

1.

2. LDL = Total Cholesterol VLDL

HDL

3. Normal values

HDL >30

VLDL >30

LDL

P a g e | 30


1. Glomerular Function tests:

Clearance tests (Urea, inulin,

creatinine)

2. Tubular function test:

1. Urine concentration or

dilution test

2. Urine acidification test

3. Analysis of blood/serum:

1. Estimation of blood urea

2. Serum creatinine

3. Protein and electrolyte

4. Urine examination:

1. Volume

2. pH

3. specific gravity: 1.020 in the early morning

4. abnormal contents

(proteins, blood, glucose)

3. Formula for Urea:

Process Formula Normal value

If V is >2 mL/min Maximum Urea Clearance

75 mL/min

If V1.5 10

P a g e | 31


5. Protein in urine

Uncommon Present on dipstick testing

5. How do you measure the Blood

Urea?

- Urease method

- Diacetyl Monoaxime (DAM) method

6. What is Azotemia?

- Condition in which elevation in blood

urea/or other nitrogen metabolites

which may or may not be associated

with renal diseases.

7. What is Uremia?

- Indicate increased blood urea levels due

to renal failure

8.

9. Asd

10. Asdf

11.

P a g e | 32


6. Jaundice

7. SAHLIs Haemoglobinometer

1. What is the principle?

Blood -> add 0.1 nomrla HCL acid

Hematin (brown in color)

Dilute with distilled water

Compare in sunglight

2. 2 savles g/dL and % concentration

3. Precautions

1. Thick prick as free flow of blood

is needed

2. Wipe 1st 2-3 drops of blood to

decrease tissue fluid

interference

3. Wipe the pipette before putting

the blood into the tube.

4.

8. Rubella H/o given

9. BHI: 1. Brain Heart Infusion

2. Principle:

Enrichment media

Bacterial Growth is inhibited by

many chemicals in the blood. By

dilution and enriching the media

with blood, bacteria growth can be

made to proliferate.

3. Constituents:

Beef Heart, Calf Brain, Peptone

Water, Phosphate buffer, Glucose

4. Use: IE

5. What is the ratio of blood to broth?

1:10

6. What is the anticoagunt used?

Sulpho-Polyethamol-sulphate

(0.02%) ??

7. Precautions:

1. Draw blood before starting

antibiotics

2. Send sample immediately

3. Aseptic precautions.

10. How to collect Sputum sample?

Take deep breath

Regurgitate

>25 epithelial cells or >10 pus cells

rejected

11. Asdf

12. Asdf

13. Asdf

14. BHI:

15.

16. CML

17. AML

1. Features of slide:

1. Blast cells

2. Increased WBC

3. NC/

4. Anemia

5. Thrombocytopenia

2. Dx AML

3. Other investigation:

1. Hb, TLC, DLC

2. Bone marrow aspirate

3. CXR

4. ECG

5. Serum URATE

6. RFT, LFT

4.

18. LD Bodies

19. Widal test

1) Antigen present O and H

2) Name of test (type) widal (Tube

agglutionation test)

3) For which disease duodenal

aspirate typhoid

4) Name of organism:

P a g e | 33


S. typhi, S. paratyphi A

5) Vaccination:

TAB vaccination

6) What is the significant value?

7) Anamestic reaction

Low rise:

8)

20. N. Gonorrhoea:

1. Name of the stain: Gram stain

2. What are the features?

1. Gram negative diplococci

2. Present both intracellular and

extracellularly

3. Kidney-shaped in shape

4. Polymorphs present.

3. Draw diagram

4. Culture medium:

1. Non selective chocolate agar

2. Selective

Thayer martin,

Chacko-Nair medium

5. d/t that organ can cause

Gonorrhoea

6. Name of another organism of same

genre N. Meningitis

7. Any specific test:

Oxidase test

8. What are the specimen that can be

used?

Sites

Male URETHRA, Littres and cowpers glands, prostrate, seminal vesicles and epididymis

Females Urethra, Bartholins and skenes glands

Extragenital sites Rectum and pharynx

So SPECIMEN taken from:

1. Urethral discharge

2. Endocervical discharge

3. Pharyngeal

4. And Rectal Swabs

9. What are the presenting symptoms

in male and females?

Males Females

1. Painful micturition 2. Urethral discharge

which is purulent, profuse, thick and creamy

3. Redness and edema of urethral meatus

4. The infection may spread to posterior urethra

1. Often ASYMPTOMATIC.

2. Primary site is ENDOCERVICAL CANAL.

3. Vaginal discharge which be scanty or profuse

4. Dysuria, frequency and urgency of micturition.

10. What can be the complications in

male and female?

Males Females

Acute

1. Infection of glands (tysonitis, littritis)

2. Ascending infections (Prostatitis, Cystitis, Epididymitis)

3. Infection of adjoining structures (periurethral abscess and infection of median raphe)

1. Bartholinitis 2. Skenitis 3. Proctitis 4. PID

Chronic

1. Urethral stricture 2. Infertility

1. Ectopic pregnancy

2. Tubal factor infertility.

11. How do you treat?

1. Sexual abstinence

2. Treatment of sexual partners

3. Avoidance of heavy work

P a g e | 34


4. Avoidance of alcohol intake

5. Uncomplicated:

1. Azithromycin 2g single oral

dose.

or

CEFTRIAXONE 250 mg i.m

single dose

6. COMPLICATED:

1. CEFTRIAXONE 1g i.m o.d. x

7 days.

7.

12.

21. ELISA

22. Stain: SUPRAVITAL STAIN 1) Other name: METHYL CRESYL BLUE

2) Staining for: reticulocyte

3) Increased in:

4) Its counterpart cell in peripheral

smear: RBC

as

23. P. Falciparum 1. Describe the findings.

RBC size similar - smaller (cf. p vivax

reticulocyte etc.)

Two chromatin dots can be seen

Multiple rings

2. How to report?

1-10 parasites /100 oil immersion field

+

11-100/100 field ++

1-10/ field +++

>10 /field

++++

3. QBC Quantification:

100 parasite /QBC field

4|

4. What investigation is this?

Thick smear: chances of finding is

high as small place, more density

Thin smear: structure and

morphology more well visualized.

5. What is an ideal smear?

1. From head to tail, RBC decrease

in number

2. Newspaper can be read through

the smear thickness

3. Tongue shaped 2 cm

4. 30 times more concentrated

blood in thick than in thin

smear

5. Blood not angi-coagulated,

clotted.

6.

24. WUCHERIA BRANCROFTI: 1. What is this? Microfilariae larvae

2. Describe morphology.

1. Large, measuring 275-300 x 8-

10 m

2. Body curves are few, nuclei are

distinct

3. Sheath stains pink with giemsa

and palely with Hematoxylin

4. Tail: no nuclei in the tip

3. When to test:

Test night blood 16-18 h PACIFIC

Strain

4. What disease it causes?

Lymphatic filariasis

5. What are the d/d?

1. Brugia and L.Loa

2. Mansonella.

6.

25. Amastigotes: LD bodies

P a g e | 35


1. Describe findings:

1. Small, round to oval bodies

measuring 2-4 m

2. Can be seen in group inside

blood macrophages, in

aspirates or skin smears or lying

free between cells.

3. Nucleus and rod shaped

kinetoplast in each amastigote

stain dark reddish curve

4. Cytoplasm stains palely.

2. How to grade?

6+ >1000 /hpf

5+ 100-1000/field

4+ 10-100/field

3+ 1-10/10 field

2+ 1-10/10 field

1+ 1-10/100 field

3. What is the disease caused?

4. What is the vector?

26.

P a g e | 36


Radiology:

1. Consolidation

2. Collapse

3. COPD (emphysema)

4. Pleural effusion

5. Pneumothorax

6. Mitral stenosis

7. Rickets

8. Scurvy

9. Osteochondroma

10. GCT

11. Osteosarcoma

12. Ewings

13. Osteoarthritis

14. R.A

15. Cholelithiasias

16. IVU

17. IVP: dx hydronephrosis; horse-shoe kidney

18. Stone in urinary bladder

19. Horse-shoe kidney

20. Hysterosalphingography

21. Ulcerative colitis

1. Horse Shoe Kidney

a) What is the investigation

b) Radiological features?

2. Pneumothorax

a) Radiological feature

b) Dx.

c) cause

3. Osteochondroma

a) Feature

b) Dx

c) Disability/complication

4. Ulcerative colltiis

a) Type of x-ray

b) Radiological feature

c) Dx

5. Mitral stenosis

P a g e | 37


1) Feature

2) Cause

3) Further investigation.

6.

P a g e | 38


Psychiatry: Drugs:

1) Antipsychotics

2) Antidepressants

3) Mood Stabilizing drugs

4) Anti-Anxiety and Hypnosedatives

5) Anti-Epileptics

6) Alcohol and drugs of dependence

1. Classification of AntiDepressants 1. Cyclic

antidepressants

1. Imipramine 2. Amitrytptiline 3. Clomipramine 4. Nortryptiline 5. Amoxapine 6. Mianserin

2. SSRIs 1. Fluoxetine 2. Paroxetine 3. Fluvoxamine 4. Sertraline 5. Cialopram

3. SNRIs Venlafxaine

4. NSREs Tianeptin

5. NaSSA Mirtazapine

6. NDRIs Bupropion

7. SARIs Trazodone Nefazonone

8. NARIs Reboxetine

9. MAOIs Selegelline

10. MAOI-A Moclobemide

1) SSRIs Selective Serotonin Reuptake

Inhibitors

2) SNRIs- SEROTONIN NOREPINEPHRINE

REUPTAKE INHIBITOR

3) NSREs NOREPINEPHRINE SEROTONIN

REUPTAKE INHIBITOR

4) NaSSA NORADERENERGIC AND

SPECIFIC SEROTONERGIC

ANTIDEPRESSANTs

5) NDRIS NOREPINEPHRINE DOPAMINE

REUPTAKE INHIBITORS

6) SARIs SEROTONIN ANTAGONISTS AND

REUPTAKE INHIBITORS

7) NARIs- NORADRENERGIC REUPTAKE

INHIBITORS

8) MAOI Monoamine Oxidase Inhibtors.

2. Mania 1) Treatment

2) Distractibility

3) Euphoria

3. Fluoxetine 1. Category : SSRI

2. Uses:

1. Depression

2. Panic attack

3.

3. Side effects

Refer to Amitryptiline, Less side effects

and CVs effects.

4. Dosage:

10-60 mg/day

5.

4. Verbigeration

5. Catatonia

1. Features:

1) Mutism

2) Negativisim

3) Rigidity

4) Posturing

5) Stupor

6) Echolalia

7) Echopraxia

8)

2. T/t

3. Conditions in which catatonia occurs

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6. Depression: Photo; Depressed old woman

photo

1. Describe appearance:

Low mood-

2. Lack of interest of surroundings

3. Loss of sleep

4. D/d

5. 5 types of drugs for T/t.

7. Q: Where do you live?

A: Live, Live Live

1. What is the disorder ECHOLALIA

2. Condition

3. What if action is repeated -

ECHOPRAXIA

8. Hey doctor, I have come from KTM. Im a

contractor, I will soon be PM.

1. Comment on MSE

a) Behavior

b) Thought

c) Speech

d) Affect

e) Insignt

2.

9. Alcohol:

1. Amount increase ->tolerance

2. Control not possible

3. Physiological dependence

4. T/t- Alcohol dependence

syndrome.

10. Lithium carbonate 1. Drug category

2. Use

3. What are the different levels?

Level Value

Therapeutic 0.8 1.2 mEq/L

Prophylactic 0.6 1.2 mEq/L

For relapse prevention in bipolar disorder

Toxic lithium levels >2.0 mEq/L

4. What are the side effects?

1. Neurological TREMOR, muscular

weakness, seizures, neurotoxicity

(seizure, celebellar signs, coma)

2. Renal: Polyuria, Polydipsia, tubular

changes, Nephrotic syndrome.

3. CVS: hypokalemia like changes.

4. Endocrine: Goitre, Hypothyroidism

5. Gastro-intestinal: - nausea,

vomiting, diarrhea

6. Dermatological: acneiform

eruptions, popular eruptions.

So all tests are to be done

before starting the dose

Generally for ACUTE MANIA

initial starting dose 900-2100

mg/day

5. What is its effect on pregnancy?

1. Teratogenic

2. Increased incidence of Ebsteins

anomaly (distortion and

downward displacement of

tricuspid valve in right ventricle)

when taken in 1st trimester.

3. Secreted in milk can cause

toxicity in infant.

6. What are other mood-stabilizing drugs

that can be given?

1. VALPROATE

2. CARBAMAZEPINE

3.

7. What are the INDICATIONS of Lithium?

1. Treatment of acute mania

2. Prophylaxis of bipolar mood

disorder

3. Treatment of shizo-affective

disorder

4. Prophylaxis of unipolar mood

disorder

5. Treatment of Cyclothymia

6. Treatmentof acute depression.

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7. Treatment of medical disorders.

cluster headace, Huntingtons

chorea.

8.

11. Amitryptilline 1) Generic name:

2) Category belongs:

ANTIDEPRESSANT Drugs

3) What is the mechanism of action?

Tricyclic antidepressants are also called

MARIs Mono-Amine reuptake

Inhibitors

1. Blocking the reuptake of nor-

epinephrine (NE), Serotonin (5HT)

and or Dopamine (DA) at the nerve

terminals, thus increasing the NE,

5HT, or DA levels at receptor site

2. Down-regulation of the -adrenergic

receptors.

4) Indication

1. Depression

2. Child Psychiatric disorders

3. Other psychiatric disorders

4. Medical disorders

5) Contraindications:

6) ADR:

1. Autonomic side effects

1) Dry mouth

2) Constipation

3) Cyclopegia

4) Mydriasis

5) Urinary retension

6) Delirium

7) Aggravation of glaucoma

8) Orthostatic hypotension

2. Sexual-side effects:

1. Impotence

2. Impoaired/retarded ejaculation.

3. CNS effects

1. Sedation

2. Tremor

3.

4. Cardiac side effects

1. Tachycardia

2. ECKG changes

7)

12. ANTIPSYCHOTIC DRUGS:

1. Asdf

2. Side effects:

A. Autonomic Side effects

B. Extra-pyramidal side effects

C. Other CNS effects

D. Metabolic and Endrocrine effects

E. Allergic side effects

F. Cardiac side effects

G. Ocular side effects

H. Dermatological side effects.

3. Autonomic dry mouth, constipation,

cyclopegia, mydriasis, urinary

retiontion, orthostatic hypotension,

impotence, impaired ejaculation

4. Extra-pyramidal Parkinsoniian

syndrome, Akathasia (motor

restlessness), Acute Dystonia, Rabbit

Syndrome (Peri-oral syndrome), Tardive

Dyskinesia (Late onset Oro-facial

dyskinesia), Neuroepileptic malignant

Syndrome (Fever, EPS, High CPK),

5. Other CNS seizures, sedation,

depresseion or pseudo-depression

6. Metabolic wt gain, diabetes,

galactorrhea

7. Allergic Cholestatic jaundice

8. Cardiac EKG changes

9. Write the names of TYPICAL

ANTIPSYCOTICS.

1. CHLORPORMINE

2. THIORIDAZINE

3. HALOPERIDONE

4. PIMOZIDE

5. LOXAPINE

P a g e | 41


6. PROCHLORPERAZINE.

10. Write the names of ATYPICAL

ANTIPSYCHOTICS.

1. Clozapine

2. Risperidone

3. Olanzepine

4. QUETIAPINE

5. SULPIRIDE

6.

11. What is the mechanism of action?

Anti-Dopaminergic activity?

12. What are the indications?

1. Organic psychiatric disorders

2. Non-organic psychotic disorders

3. Child Psychiatric Disroders

4. Neurotic and Other psychiatric

disorders

5. Medical disorders

13. ORGANIC (D4) 1. Delirium

2. Dementia

3. Delirium tremens

4. Drug induced psychosis

14. Non-Organic

1. Schizophrenia

2. Schizo-affective disorder

3. Acute Psychoses

4. Mania

5. Major depression

6. Delusional disorder

15. CHILD-PSYCHIATRIC DISORDERS

1. Attention Deficit disorder with

hyperactivity

2. Infantile autism

3. Conduct disorders in Children.

16. NEUROTIC and other PSYCHIATRIC

DISORDERS

1. Severe intractable and disabling

anxiety

2. Treatment refractory OCD

3. Anorexia Nervosa

17. Medical Disorders

1. HUNTINGTONs CHOREA

2. INTRACTABLE HICCUPS

18.

13.

P a g e | 42


Dermatology: 1. G. auricular nerve thickening

1) Dx

2) Bed side test

3) Lab test

4) Treatment

2. TB chancre

3. PSORIASIS:

1. What is your dx? Psoriasis

2. Describe the lesion

1. Well defined

2. Erythematous

3. Have large, silvery, loose

scales

3. What are the histological changes

seen?

1. Epidermal:

1) Increased epidermal cell

proliferation. Why?

Increased growth fraction

100% of basal cells are

multiplying

Shortened epidermal

turnover time 45 days

to 70 days.

2) Retention of nuclei in stratum

corneum parakeratosis

2. Dermal:

1) Dilated and torturous capillary

loops

2) Proliferation of fibroblasts.

4. What are the bed side tests you can

do?

1. Grattage test

2. Auspitz sign

5. What is the basic pathogenesis of

psoriasis?

6. What are the sites of Predilection?

7. What are the morphological variants?

8. What are the investigations?

9. How do you treat?

1.

10. What are d/d?

1. Seborrhoeic dermatitis

2. Discoid eczema

3. Hyperkeratotic hand eczema

4. Pityriasis rosea

5. Candida intertrigo

11.

4.

5. Chancroid: 1. Causative organism:

H. Ducrei

2. d/d:

1. herpes group of infection

2.

3. Ulcer:

1. Bleeding on manipulation

2. Friable and soft

3. Can pick granulation tissue from

Base

LN:

1. Inguinal unilateral

lymphadenopathy

2. May show groove sign (if inguinal

and femoral LN)

4. Ix:

1. Gram staining

2. Culture

3. PCR

4. School of fish/Railtrack sign

5. T.t

1. Erythromycin 500 mg q.i.d x 7

days

P a g e | 43


2. Ciprox 500 mg b.d. x 3-7 days

3. Azithromycin

4. Ceftroaxone.

6.

6. BHC: 1) Generic name: Lindane

2) Mechanism of action:

By invading chitimous layer and

affects CNS of lice

3) Concentration used

1%

4) Contraindication:

1. Pregnant lady or breastfeeding

mother

2. Young children

3. History of convulsion

4. Body weight 72 hrs)

2. Eosinophilic vasculitis (mimic

urticaria)

No skin changes or

pigmentation left in urticaria

but secondary changes in

vasculitis.

4.

8. T. Capitis (Tinea of Scalp) 1. Common group: Epidemic in school

children

2. What are the patterns in hair?

1. Non-inflammatory tinea capitis

1) Caused by ANTHROPHILIC

2) Gray patch

(multiple, erythematous

patches, mild scaling, patchy,

parital alopecia)

3) Block dot

( hair broken at the surface, mild

erythema and scales)

4) Seborrhoic dermatitis like lesion

5) Alopecia areata like lesion

(tinea complete patchy loss of

lesion)

2. Inflammatory tinea capitis

(KERION)

P a g e | 44


(caused by ZOOPHILIC, Painful,

boggy swelling with

pustulations

Reactive occipital

Lymphadenopathy)

3. AGMINATE folliculitis: well

defined, dull red plaques, follicular

pustules.

4. FAVUS:

T. Schoenleinii

(presence of foul-smelling,

yellowish cup-shaped, cicatrical

alopecia)

3. Antifungal used:

1) Griseofulvin 10 mg/kg daily

after food, 4-6 weeks

Minimum 6 wks in T. capitis

2) TERBINAFINE 250 mg daily x 2

weeks

4.

9. T. Unguium: 1. Describe the lesion

1) Assymetrical nail infected (cf.

psoriasis)

2) Yellowish brown discoloration

and crumbling of the nail plate

3) TUNNELING of the nail plate.

(cf. psoriasis, no crumbling, as

debris is firm)

4) Nail plate thickened

5) No pitting (cf. psoriasis)

6) Collection of friable debris

under the nail SUBUNGUAL

HYPERKERATOSIS.

7) Separation of nail plate from

nail bed ONYCHOLYSIS.

2. d/d

1. psoriasis of nail

2. yeast and mould infections of

nails.

3. Causative organism?

1. Trichophyton rubrum

(commonest)

2. Epidemophyton floccosum

4. bedside test: KOH of nail clippings

fungal hyphae

WOOD LAMPS examination.

5. confirmatory test: culture in SDA

6. dx/

7. t/t

1. Finger nails:

Griseofuvin x 6 months

Terbinafine x 6 weeks

Itraconazole pulse therapy (3-5

mg/kg daily for 1 week every 4

week)

2. Toe nails:

Griseofulvin x 9 months

Terbinafine x 12 weeks

Itraconazole pulse therapy

8.

10. Leprosy? 1. Lupus vulgaris: d/d of BT

2. Investigation:

1. Go for FNA before biopsy

2. Only sensory fibre providing nerve

is biopsied not motor fibre proving

nerve

3. Sural nerve: purely sensory nerve,

Area supplied by sural nerve?

4. Biopsy features:

1. Tuberculoid (epitheloid) type

of granuloma

2. Few lymphocytes along with

Langhans giant cell- horse

shoe shaped

3. Compact type of granuloma

4. Foamy macrophages

5. Spongios (inter-cellular

oedema) in tuberculoid pole

6. No differentiation between

dermis and epidermis

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5. Type I reaction

6. Type ii reaction

3.

11. Satellite lesion 2-5 mm from main lesion

12. Bubo Formation (Primary syphilis/LGV)??

1. Groove Sign

2. D/D

3. Dx.

4. Serological test

5. treatment

13. LGV: 1. Causative organism:

Chlamydia trachomatis (organism)

2. Site:

1. Glans, prepuce

2. Post. Wall, vulva

3. Other: Eye, lip, Rectum, anal

mucosa

3. What are the clinical features?

1. Primary

1) Small papule after 3-4 days

enlarge and ulcerate

Painless ulcer, base covered

with white solugh

2. Inguinal syndrome:

1) 30-40 days later

2) Inguinal lymphadenopathy

3) True Bubo (Multinodular, soft)

4) Groove sign +ve

3. Lymphatic obstruction

1) Anogenital rectal syndrome

2) Proctocolitis (Female)

3) Tenesemus, Low abdominal

pain.

4.

4. Complications:

1. Ram Rod Penis, Saxophone

penis

2. Chronic induration of vulva

3. Vaginal fistula

4. Stricture of anus

5. PID

6. Ritters dz: Arthritis, Urethretis,

Uveitis

Delayed complication

5. Treatment:

Ceftriaxone: 125 mg i.m

Azithro: 2 g stat

Cipro 500 mg stat

Doxy 100 mg (if not treated)

6.

14. Molluscum contagiosum 1. Describe the lesion:

1) Pearly white, dome-shaped papules

which are umbilicated.

Cheesey material oozes out

when pierced through

umbilication.

2) Pseudo-Isomorphic phenomenon: due

to autoinoculation can give rise to

lesions arranged linearly along line of

trauma.

2. Complication:

Secondary infection.

3. t/t:

1. children: few lesions may resolve

spontaneously

several lesions WART PAINT,

MECHANICAL REMOVAL after

using EMLA

2. Adult Few lesions Mechanical

expression followed by chemical

cautery

Several lesions Cryotherapy ,

WART PAINT.

4. 2 conditions in adult where it is seen

1. Anogenital region: Sexually

transmitted MC

2. In HIV patients.

5. Investigation:

P a g e | 46


1. Cytology shows large

eosinophilic cytoplasmic

inclusion bodies.

6. Causative organism: pox virus

7.

14. TB (Cutaneous)

1. D/d

1. Sclofuroderma

2. Orofacial TB

3. TB gumma

4. Lupus vulgaris

5. TB chancre

2. Lesion: undermined edges on

unclear base

3. Investigation

4. T/t:

15. Asfasfas

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OSCE Final

13th July 06, Thursday

Opthal, ENT, Anaes, Oral

Opthalmology

1. Do Confrontation test in the pt. 2. Name the procedure - Indirect ophthalmoscopys 2 advantages & 2 disadvantages.

Adv large area of retina can be examined

Can examine even in hazy media

Disadv less magnification

Mastered only after hours of practice

3. Desxribe the lesion Black pigmented mass in the upper lid of left eye

Irregular border, no ulceration, bleeding

Lower lid is also involved

D/D

Malignant melanoma

Pigmented basal cell carcinoma

T/t

Exenteration

Chemotherapy, Laser therapy

4. Name the operation. Exenteration

Indications for the above operation

Malignant melanoma

Perforated injury to eyeball

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Retinoblastoma

5. Write the condition Facial nerve palsy

Surgical and non surgical methods

Tarsorraphy Tear drops

Eye padding

Importance of Bells phenomenon.???

6. signs in the given photo Lid retraction

Staring gaze

Other 6 signs seen in this condition.

7. write 4 causes of epiphora in child Congenital glaucoma

Atresia of lacrimal draining system

Signs in this patient

Blue sclera

Strabismus

Treatment for congenital glaucoma

Goniotomy

Trabecuectomy

8. diagnosis of the photo Membranous keratitis

Signs

Conjunctival chemosis, congestion

Keratitis

P a g e | 49


Complications

Perforation

Iris prolapse

ENT

1. Identify Mollisons self retaining haemostatic mastoid retractor

Used in

Mastoidectomy

Types of mastoidectomy

Cortical, Radical, Modified radical

2. Identify Boyle-Davis mouth gag

Used in

Tonsillectomy, Adenoidectomy

4 Indications of tonsillectomy

Recurrent tonsillitis, chronic tonsillitis, enlarged tonsils, tonsillitis refractory to medical

therapy

C/I of tonsillitis

Active tonsillitis

3. Name the graph Pure tone audiogram

Abnormality

Conductive hearing loss

4 causes of CHL wax , FB in EAM,

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4. Abnormality in PTA High frequency hearing loss in air bone conduction

Diagnosis

Presbycusis

5. Name the type of curve B type

Probable diag. Serous OM

Mgt Myringotomy with Grommet insertion

Decongestants

T/t of throat infections

6. Name the view Laws view of mastoids

Abnormalities in xray haziness in the mastoid air cells

Irregular outline of air cells

Normal appearance of mastoid in xray, draw a diagram.

7. view Waters view of maxillary, sphenoid, frontal sinuses with open mouth

Abnormalities

Diagnosis Chronic maxillary sinusitis

Mgt.

8.

Anaesthesia

1. drug Thiopentone sodium 2 indications

Induction & maintenance of anaesthesia

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In Status epilepticus

Major ADRs

2. Identify Guedels airway

Draw and label the parts.

Uses

Complications

3. LMA 2 Uses

2 advantages & 2 disadvantages

4. Tuohys needle

how to know it has gone to accurate place?

Uses

Oral

1. OPG Indications orthodontic diagnosis, impacted third molar, Mandibular fracture,

unerupted/impacted tooth.

Dental cysts : Dentegerous, OKC, Radicular, eruption cyst.

Dental tumours : Adenomatoid odontogenic tumor, ameloblastoma, Calcifing odontogenic

tumor,

Abnormality in x ray - # mandible

2. Dental cast of maxilla A/c to FDI, name the teeth present

What may be the D/D for the defect?

3. Toothbrush Types

A/c to bristle, hard, medium, soft

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A/c to handle, fixed & flexible

Manual & electric

Ultrasonic

When to replace & why?

4. Removable partial denture Teeth present

Upper left and right central incisors (11, 21)

Composition

Poly Methyl Methacrylate

5. Station 1: Asthma patient. 80% PEFR!

6. Criteria?

7. Management?

8. Station 2: ECG.. report..! MI?

9. Station 3: Acute sob in 55/m diabetes, hypertension. jvp raised. no edema.

10. immediate resusitation? d/d? inv?

11. St. 4: X-ray Gas under diaphragm. Management

12. St. 5: Haloperidol. from the CIMS.

13. St. 6: Primary Survey in Head trauma

14. St 7: Spacer and Meter dose in haler. how to use?

15. st. 8: IMCI of pneumonia. management?

16. st.9 : Hypertension councelling.

17. st.10: Shoulder Examination

18. st.11: Severe dehydration and fluid management acc. to iMCI.

19. st.12: Councelling in depression.

20. st.13: 17/M. RBS: 433 and ketoneurea with UTI. further investigations?

21. st.14:

22. st.15: anterior d/l shoulder.which nerve injury? reduction technique. names? x-ray

23. st.16: POP. colles' cast till where? fracture tibia cast till where?

24. st.17: Steinmann's pin. uses in detail!!

25. st.18: supracondylar fracture. what type? deformity?

26. st.19: pneumatic torniquet. advantage? disadvantage?

27. st.20: K-nail: where eye? principle? use?

28. st.21: 70/F with external rotation, adduction and swelling of the lower limb. shortening.

29. inter-trochanteric fracture? management? (Russell traction, DCP screw!!)

30. st.22: deformity at hip with fixed flexion deformity. apparent lengething/shortening?

31. adduction deformity? abduction deformity? examination of hip.

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32. st.23: principle of management of open fracture. x-ray photo

33. st.24: lateral mastoid view(??): features? d/d? diag? mc. evans triangle?

34. st.25: water's view? structure passing thru infra-orbital foramen.? AC polyp vs. ethmoidal.

35. st.26: Boyle Davis mouth gag. other instrument? commonest operation? indication?

contraindication? causes of reactive bleeding??

36. st.27: Posterior rhinoscopy mirror. diagram? importance of rossenmuller fossa?

37. st.28: 3/M unable to speak since birth, most likely diagnosis? risk factors prenatal?

objective test? management?

38. st.29: h/o 2 years ear discharge. now with fever, neck rigidity, facial deformity. d/d??

39. difference between supra nuclear and infra nuclear lesions.

40. parts of facial nerve and topographical test for intratemporal lesion.

41. st.30: myringotome. used for? serous otitis media predisposing factors and complications?

42. st.31: conductive hearing loss b/l in PTA. causes?

43. st.32: B type impedence tympanograph. other types? causes of B type.

44. st.33: maddox rod. uses? principle for any one use.

45. st.34: schiotz tonometer. parts and principle. advantage and disadvantage.

46. st.35: convex lens. uses. disadvantages.

47. st.36: snellen's chart. angle at nodal point? alternative for children.

48. st.37: pin hole. principle and condition in which VA worsens?

49. st.38: perimetry. bitemporal hemi anopia. lesion where? investigations? machine used?

50. st.39: fluorescin dye. 2 uses? principles.

51. st.40: pilocarpine. what class of drug? principle. ADR? Use?

52. st.41: Photo of exopthalmos. systemic condition associated? investigation to confirm?

53. other signs in eyes.

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OSCE 2008:

Orthopaedics and GP:

GP

1. Get the history from a person suffering from enlargement of thyroid.

2. A person otherwise fine. Get history on drug and Alcohol and advice him on safe limits.

3. Draw adrenaline for paediatric dose. (Dont forget to throw, dont inject again into via if you

have taken in excess).

4. Dr. J is new Resident in Emergency. Advice him on preventing transmission of infection to and

from him.

1. Follow universal precaution

2. Hand washing

3. Wearing gloves, aprons, spectacles

4. Proper disposal

5. Needle prick injury, prevent, authority, prophylaxis HepB, HIV

6. Get prophylaxis of most common diseases

7. Treat your infectious disease, avoid contact to patient during so

5. A newborn baby 7 days old, diagnose HIRSCHPRUNGs disease. Discuss with his father who is

also a Resident, about care to be done in EMERGENCY medicine.

Hypothermia, Hypoglycaemia, NG, electrolytes, fluids

6. Burn in hand and face, How to manage? Fluids

7. Do snake bite bandaging along with patient explanation.

8. Sinus bradycarida, Rhythm discussion, causes and symptoms.

9. TB spondylitis: describe, causes, late complications.

10. IMCI, what to look for in Pneumonia, danger signs, severe pneumonia signs.

11. Vertigo: causes and treatment.

12. An alcoholic with fever, pain abdomen, distended, peritoneal lavage was done with serous fluid

high TLC count, neutrophils more, - dx and treatment bacteria

OSCE-4th yr

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Transcript of OSCE-4th yr