Bangabandhu Sheikh Mujib Medical University

 

DISCIPLINE: PULMONOLOGY

PAPER: OSPE (Ten stations)

 

 

Q.1. How will you counsel a 28 years old male patient who will  receive  CAT-Il anti-TB drugs for smear positive PTB?

Checklist:

Greetings & self-introduction	0.5
Discussion about disease	1.0
Discussion about drug	1.0
Indication: why prescribed	1.0
Side effects	1.0
Assurance about side effects	1.0
Duration of treatment and time of follow up	1.0
Where will you get drugs/DOT	1.0
What will happen if there is incomplete treatment	1.0
Aware about use of mask	0.5
Feedback	1.0

 

 

 

 

 

                                                                                                                    

 

 

 

 

 

Bangabandhu Sheikh Mujib Medical University

 

DISCIPLINE: PULMONOLOGY

PAPER: OSPE (Ten stations)

 

 

 

Q.2. Show the procedure of correct use of metered dose inhaler (MDI) with and without spacer  and spacer with mask to an asthma patient?

 

1. Correct use of MDI…………………………………………………………….6

1. Shake and position of device in between thumb and index finger
2. Exhale
3. Place the mouth piece in between lips
4. Coordination in between deep inspiration and pressure over canester
5. Hold the breath for 10 sec, wash mouth after using device.
6. Repeat the procedure after 2 minutes interval

 

2. Correct use of spacer ………………………………………………………..3

1. Shake the device
2. Fixed with spacer
3. 1 puff and 5 times breathing in spacer.
4. Hold the breath 4 to 10 sec during inspiration.
5. Repeat it for next puff .

 

 

3. Use of spacer with mask …………………………………………………..1

 

 

 

 

 

 

 

 

Bangabandhu Sheikh Mujib Medical University

COURSE: DTCD

DISCIPLINE: PULMONOLOGY

PAPER: OSPE (Ten stations)

 

 

 

Q.3. A 30 year old man known case of right middle lobe bronchiectasis admitted in your unit with massive haemoptysis. Previously he was admitted in local hospital three times  for recurrent infective exacerbation . How will you manage him?

 

 

 

Checklist:

Initial management with A, B and C   (Air way , Breathing and Circulation : I/V channel open , Blood grouping )	2.0
Advice regarding posture of the patient	1.0
Discussion about medical management : 1) Control of infection 2) Postural drainage (contraindicated)	2.0
Discussion about surgical management	2.0
If surgical intervention not possible (eg. Bronchial artery embolization).	1.0
Vaccination	2.0

 

 

 

 

 

 

 

 

 

 

Bangabandhu Sheikh Mujib Medical University

 

DISCIPLINE: PULMONOLOGY

PAPER: OSPE (Ten stations)

 

 

Q.4. Look at the picture- This man came in OPD with the complain of cough , left sided chest pain and recurrent haemoptysis for two months .

 

1. What are the findings of the above pictorial?................................................................2

1. Partial ptosis
2. Miosis
3. Enopthalmus

 

2. Is there any name of this clinical presentation? What are the other components of this presentation ?................................................................................................................2

              Horner’s Syndrome .  Anhydrosis .

3. What may be the underlying cause?................................................................................3

              Left sided bronchial carcinoma .

4. What is the possible site of lesion?.................................................................................2

Involvement of left sided sympathetic chain .

5. Mention two important investigations for this patient. ..................................................1

CT scan of chest , CT guided FNAC and Fiber optic bronchoscope (FOB)

 

 

 

Bangabandhu Sheikh Mujib Medical University

 

DISCIPLINE: PULMONOLOGY

PAPER: OSPE (Ten stations)

                                                                                                                    

 

 

Q.5.This is an X-ray chest P-A view  of 35 years old man who presented with fever, cough and occasional scanty haemoptysis for one month.  There was a cavitary lesion in right upper  zone .

 

 

 

1. What is your diagnosis ? Describe the X-ray . .........................................................................3

PTB (Bilateral) . Bilateral patchy opacity involving upper zones with a cavitary lesion in right side.

 

2. What  are the other causes of cavitary lung lesion ?...............................................................2

 

Infective : MTB, NTM , bacterial, fungal . Vasculitis : WG, RA.  Neoplastic : bronchial carcinoma .     Non –hodgkins lymphoma .

 

3. What are the radiological signs of active pulmonary tuberculosis ?......................................2

Increasing patchy opacity /soft shadow in serial X-ray , cavitary lesion , pleural effusion etc.

 

 

 

4. How will you  differentiate malignant  cavity from tubercular cavity ?....................................3

 

Malignant cavity : Thick wall , acentric cavity , minimal fluid , surrounding inflammation absent , irregular inner and outer margin.

 

 

Bangabandhu Sheikh Mujib Medical University

 

DISCIPLINE: PULMONOLOGY

PAPER: OSPE (Ten stations)

                                                                                                                    

 

 

Q.6. Read CT scan of chest.

 

 

 

1. What are the findings?..................................................................5X2= 10

• A cavitary lesion with crescentic air shadow in right lung.

 

2. What is the likely diagnosis?

• Aspergilloma.

 

3. Mention the presenting feature.

• Asymptomatic
• Haemoptysis

 

4. What are the treatment options?

• If asymptomatic, no treatment is required.
• If massive/recurrent  haemoptysis, surgery.

 

5. Name two treatment options if surgery is not possible.

• Local instillation of Amphotericin B.
• Bronchial artery embolization.

 

 

 

 

Bangabandhu Sheikh Mujib Medical University

 

DISCIPLINE: PULMONOLOGY

PAPER: OSPE (Ten stations)

                                                                                                                    

 

 

Q.7. Look at the spirometric reading given below:

 

	Predicted	Test	% Predicted	Post-bronchodilator	% Test
FVC	3.91	3.59	92.0	4.61	+28.4
FEV1	3.14	1.42	45.2	2.01	+41.7
FEV1/FVC	77.3	39.5	51.1	43.6

 

1. What type of disease it is ?.........................................................................2X5 = 10

• Obstructive airway disease .

 

2. Is the reversibility test  positive ? If it is positive,  what are the criterias ?

• Positive , FEV1 increase > 200 ml and FEV1> 12 %

 

3. What is your diagnosis ?

    COPD with reversibility component (ACOS)

 

4. Draw   an  expiratory loop of flow volume curve  of  obstructive  air way disease and  a restrictive air way disease .

 

 

 

 

5. What is the basic component of management  of your  possible diagnosis ?

Inhaled corticosteroid (ICS) and bronchodilator.

 

 

 

Bangabandhu Sheikh Mujib Medical University

 

DISCIPLINE: PULMONOLOGY

PAPER: OSPE (Ten stations)

                                                                             

 

Q.8. Look at the picture.

 

 

1. What is your finding ?.................................................................................................. 5X2 =10

• Dilated veins in upper part of chest .

 

2. What is the most likely diagnosis?

• SVCO.

 

3. What may be the complains of the patient?

Swelling of face and neck , headache, dysphagia, stridor , shortness of breath etc.

4. What are the most likely causes of this  condition?

      Bronchial carcinoma , lymphoma , metastatic mediastina lymphadenopathy, retro-sternal goiter

 

5. How will you investigate the patient ?

• X-ray chest , CT scan of chest , Ct guided FNAC , FOB , EBUS-TBNA.
•  

 

 

 

 

 

 

 

 

 

 

 

 

 

Bangabandhu Sheikh Mujib Medical University

COURSE: MD (Pulmonology), Residency Phase-A

DISCIPLINE: PULMONOLOGY

PAPER: OSPE (Ten stations)

                                                                             

 

 

Q.9. A patient with very sever COPD  came with following ECG .

1. Mention three important findings...................................................................5X2 = 10

• Tall p wave in lead II
• Tall R wave in lead V₁
• Right axis deviation
• Asymmetrical T wave inversion (strain pattern) in II , III , aVF and V₁- V₄

 

2. What is the most possible cause?

• COPD with right ventricular hypertrophy due to pulmonary hypertension.

 

3. Patient may have right parasternal heave , what are the other impotant findings may present  in precordium ?

Palpable P2 , loud P2 , Pansystolicmurmurin tricuspid area , ejection systolic murmur in pulmonary area .

•  

 

4. How you will manage  the case ?

• Optimum management of COPD, LTOT, Diuretic etc .
•  

 

 

Bangabandhu Sheikh Mujib Medical University

 

DISCIPLINE: PULMONOLOGY

PAPER: OSPE (Ten stations)

 

                                                                                                                                                      

Q.10.  Look at the transverse section of HRCT of  Chest .

 

 

1. What are the findings of the above HRCT scan? ..........................................................  5X2 = 10
2.  

 

2. What is the likely diagnosis?

Bilateral bronchiectasis .

 

3. Mention two  important signs of this patient

Bilateral coarse crepitation , altered with cough and clubbing .

 

4. Mention four important presentation of this patient.

 

Asymptomatic , cough with profuse sputum , haemoptysis ,corpulmonale.

 

5. Mention treatment options of this patient

             Postural drainage, control of infection .

 

 

Bangabandhu Sheikh Mujib Medical University

                                                                

                                                         DISCIPLINE: PULMONOLOGY

PAPER: OSPE (Ten stations)

Q. 11) A 62 years old man presented to a pulmonologist with cough for 3 months, shortness of breath for 15 days and having  an X-ray chest P-A view , showing left sided opaque hemithorax .

 

 

 

 

1. Describe the bronchoscopic view of this picture ?..................................................5X2 =10

 

Left sided endobronchial mass lesion completely occluding the lumen of left principal      bronchus.

2. Is the carina  normal ?

Normal and sharp .

 

3. If it is a Non small cell carcinoma, is surgical treatment possible ?

           Not possible (as the mass lesion is within 2 cm of carina ) .

 

4. How will you give palliative management for shortness of breath ?

 

         Thermo plasty / Argon plasma coagulation (APC)  followed by stenting.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bangabandhu Sheikh Mujib Medical University

 

DISCIPLINE: PULMONOLOGY

PAPER: OSPE (Ten stations)

Q.12) A 60 years old man presented to pulmonologist with persistent  dry cough for six months and exortional shortness of breath for three months. The physician found following characteristics in HRCT of chest .

 

 

1. If there is no etiological factor , what type of ILD   it is ?......................................5X2=10

           IPF

2. Mention the characteristic features in HRCT of chest .

Reticular shadow , subpleural cyst , honey combing , peripheral distribution , less Ground glass opacity(GOO), traction bronchiectasis .

 

3. What physical findings you may get in this patient ?

          Cyanosis , clubbing , bilateral fine end inspiratory creps not altered with cough .

4. Mention the findings you may get in spirometry, DLCO and six minute walk test .

FEV1/FVC normal or increased , FVC – decreased , DLCO –decreased , SMWT-   desaturation