Month and year of exam. July-2015			New Curriculum
Course	:	Diploma (DTCD)	Time            : 5 minutes Total marks: 10 Pass marks  : 06   Roll/Code No.:  .......................
Discipline	:	CHEST DISEASES
Paper	:	OSPE
Station No.	:	01 (One)

 

 

Q.1.	This 30 year old man was diagnosed as a case of right middle lobe bronchiectasis in your unit. How will you counsel him?

 

 

 

Checklist:

Greetings & self-introduction	0.5
Discussion about disease	1.0
Discussion about treatment options	1.0
Discussion about medical management	2.0
Discussion about surgical management	2.0
Cyclical/long term antibiotic therapy	1.0
Vaccination	1.0
Complications	1.0
Feedback	0.5

 

 

Month and year of exam. July-2015			New Curriculum
Course	:	Diploma (DTCD)	Time            : 5 minutes Total marks: 10 Pass marks  : 06   Roll/Code No.:  .......................
Discipline	:	CHEST DISEASES
Paper	:	OSPE
Station No.	:	02 (Two)

 

Q.2.This is an X-ray of 35 years old man who presented with fever, cough and scanty haemoptysis for one month. He took anti TB drugs two times but could not show any document.

 

 

 

 

1. What are the findings of X-ray above?                                                                        Marks- 02

• Cavitary lesion in right  upper zone
• Patchy opacities on both apices

 

2. What may be the possible diagnosis of this patient?                                                   Marks- 02

• PTB (relapsed)

 

3. How will you manage him before getting microbiological report?                              Marks- 02

• Antibiotic
• Control of haemoptysis
• Antipyretic
• General management

 

4. Name two important investigation for this patient                                                      Marks- 1+1

• Sputum for AFB
• Sputum for geneXpert

 

5. What is the next step if sputum AFB is 2⁺ and 3⁺ but geneXpert is negative?           Marks- 02

• Sputum AFB culture for both typical and atypical mycobacteria.

 

 

 

Month and year of exam. July-2015			New Curriculum
Course	:	Diploma (DTCD)	Time            : 5 minutes Total marks: 10 Pass marks  : 06   Roll/Code No.:  .......................
Discipline	:	CHEST DISEASES
Paper	:	OSPE
Station No.	:	03 (Three)

 

Q.3. 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. Interpret the report                                                                                                Marks- 02

• Severe obstructive airway disease with significant bronchodilation.

 

2. What is the most likely diagnosis                                                                         Marks- 02

• Bronchial asthma.

 

3. Name four cardinal symptoms of this patient                                                       Marks-0.5x4

• Dry cough
• SOB
• Wheeze
• Chest tightness

 

4. What is the most important inflammatory cell for pathogenesis of the condition?    Marks- 02

• Eosinophil

 

5. What are the treatment options for this patient if he present with dyspnoea?     Marks- 02

• Corticosteroid
• Nebulized bronchodilator
• Inhaled/nebulized  corticosteroid
• Montelukast
• High flow O₂ inhalation

Month and year of exam. July-2015			New Curriculum
Course	:	Diploma (DTCD)	Time            : 5 minutes Total marks: 10 Pass marks  : 06   Roll/Code No.:  .......................
Discipline	:	CHEST DISEASES
Paper	:	OSPE
Station No.	:	04 (Four)

 

 

Q.4. Read the X-ray.

 

 

 

 

1. What are the findings?                                                                                                Marks- 02

• A cavitary lesion with crescentic air shadow in the upper lobe of left lung.

 

2. What is the likely diagnosis?                                                                                      Marks- 02

• Aspergilloma.

 

3. Mention the presenting feature.                                                                                  Marks- 02

• Asymptomatic
• Haemoptysis

 

4. What are the treatment options?                                                                                 Marks- 02

• If asymptomatic, no treatment is required.
• If haemoptysis, surgery.

 

5. Name two treatment options if surgery is not possible.                                              Marks- 02

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

 

 

 

Month and year of exam. July-2015			New Curriculum
Course	:	Diploma (DTCD)	Time            : 5 minutes Total marks: 10 Pass marks  : 06   Roll/Code No.:  .......................
Discipline	:	CHEST DISEASES
Paper	:	OSPE
Station No.	:	05 (Five)

 

 

Q.5. This is a CT scan of a 60 years age woman who presented with cough with occasional haemoptysis for 1 month.

 

 

 

 

1. What are the CT findings?                                                                                          Marks- 02

• A dense shadow in peripheral part of left lung.
• Mediastinal lymphadenopathy.
• Focal emphysematous changes.
• Fibrotic band in right lung.

 

2. What is the likely diagnosis?                                                                                      Marks- 02

• Left sided bronchial carcinoma with mediastinal lymphadenopathy.

 

3. What is the most likely histopathological type?                                                         Marks- 02

            Adenocarcinoma

 

4. What is the single most investigation you will do next?                                            Marks- 02

• CT guided FNAC from the left lung lesion.

 

5. Name two newer drugs for this patient along with conventional chemotherapy.      Marks- 02

• Crizotinib
• Erlotinib

 

 

 

 

Month and year of exam. July-2015			New Curriculum
Course	:	Diploma (DTCD)	Time            : 5 minutes Total marks: 10 Pass marks  : 06   Roll/Code No.:  .......................
Discipline	:	CHEST DISEASES
Paper	:	OSPE
Station No.	:	06 (Six)

 

Q.6. This 67 years old man developed progressive dyspnoea for 6 months.

 

 

 

1. What is the HRCT finding?                                                                                        Marks- 02

• Reticulonodular shadowing with ground glass opacity involving peripheral part of both lungs.

 

2. What is the most likely diagnosis?                                                                              Marks- 02

• DPLD (IPF variety)

 

3. What is the histopathological/radiological pattern of this variety of your diagnosis? Marks- 02

• Usual interstitial pneumonia (UIP)

 

4. Name four cardinal features of this patient.                                                               Marks- 0.5x4

• Exertional dyspnea
• Cyanosis
• Clubbing
• Bibasal end inspiratory crepitation

 

5. Mention the lung function findings of this patient.                                                    Marks- 02

• Restrictive abnormality in spirometry
• Reduced DLC_o
• Reduced exercise capacity with desaturation on walking in 6MWT

 

 

 

 

 

 

Month and year of exam. July-2015			New Curriculum
Course	:	Diploma (DTCD)	Time            : 5 minutes Total marks: 10 Pass marks  : 06   Roll/Code No.:  .......................
Discipline	:	CHEST DISEASES
Paper	:	OSPE
Station No.	:	07 (Seven)

 

Q. 7. This 16 years old boy presented with low grade fever for 1 month and dry cough.

 

 

 

1. What is the radiological finding?                                                                                Marks- 02

• Miliary mottling involving the both lungs.

 

2. Name four radiological D/D.                                                                                      Marks- 0.5x4

1. Chicken pox pneumonitis
2. Histoplasmosis
3. Cryptococcosis
4. Tropical pulmonary eosionophilia
5. Lymphangitis Carcinomatosis
6. ILD

(Any four of above six answer is correct)

 

3. What is the auscultatory finding in advanced stage?                                                 Marks- 02

• Widespread crepitations

 

4. What will be your diagnosis if this patient develop severe headache?                       Marks- 02

• Tuberculous meningitis.

 

5. Name two haematological features that indicate bone marrow involvement.            Marks- 1+1

• Anaemia
• Leukopenia

 

 

 

Month and year of exam. July-2015			New Curriculum
Course	:	Diploma (DTCD)	Time            : 5 minutes Total marks: 10 Pass marks  : 06   Roll/Code No.:  .......................
Discipline	:	CHEST DISEASES
Paper	:	OSPE
Station No.	:	08 (Eight)

 

Q.8. Look at the picture.

 

 

 

1. What is your finding?                                                                                                 Marks- 02

• Vesicular lesion around mouth.

 

2. What is the most likely diagnosis?                                                                              Marks- 02

• Herpes simplex virus-1 infection.

 

3. This patient have concomitant cough with rusty sputum, fever and chest pain for 5 days. Auscultatory finding reveals bronchial breath sound and coarse crepts in right base. What is your impression?                                                                                                                Marks- 02

• Community acquired pneumonia (right lung)

 

4. What is the most likely organism for lungs findings of this disease condition?         Marks- 02

• Streptococcus pneumoniae

 

5. Mention four indications for which you will refer this patient to ICU.                     Marks- 0.5x4

1. CURB score of 4-5, failing to respond rapidly to initial management
2. Persisting hypoxaemia PaO₂<8 kPa, despite high concentration O₂
3. Progressive hypercapnoea
4. Severe acidosis
5. Circulatory shock
6. Reduced conscious level

(Any four of above six answer is correct)

Month and year of exam. July-2015			New Curriculum
Course	:	Diploma (DTCD)	Time            : 5 minutes Total marks: 10 Pass marks  : 06   Roll/Code No.:  .......................
Discipline	:	CHEST DISEASES
Paper	:	OSPE
Station No.	:	09 (Nine)

Q.9. Look at the ECG

 

1. Mention four important findings                                                                                              Marks- 0.5x4

1. Tall p wave in lead II
2. Tall R wave in lead V₁
3. Right axis deviation
4. Tachycardia with multiple atrial ectopics

2. What is the most important possible cause?                                                                 Marks- 02

• COPD with right ventricular hypertrophy due to cor-pulmonalae

3. Name four important investigations for this patient.                                                    Marks- 0.5x4

• Spirometry with reversibility.
• Chest  X-Ray P/A view
• Dopplar echocardiography
• Body box
• CEPT
• CBC with hematocrit

(Any four of above six answer is correct)

4. Mention four important complications of COPD.                                                                    Marks- 0.5x4

• Pulmonary hypertension
• Cor-pulmonalae
• Respiratory failure
• Policythemia
• Pneumothorax
• Pneumonia
• (Any four of above six answer is correct)

5. Mention three important principle of management of patient with this ECG?            Marks- 1+0.5+0.5

• Management of etiology.
• Management of Co-morbidities
• Management of Complications of etiology. 

Month and year of exam. July-2015			New Curriculum
Course	:	Diploma (DTCD)	Time            : 5 minutes Total marks: 10 Pass marks  : 06   Roll/Code No.:  .......................
Discipline	:	CHEST DISEASES
Paper	:	OSPE
Station No.	:	10 (Ten)

 

Q.10. Look at the FOB picture.

 

 

 

1. What is your finding?                                                                                                 Marks- 02

• A fleshy mass at the lower end of trachea.

 

2. What is the most important presentation for this patient?                                          Marks- 02

• Stridor
• Breathlessness

 

3. What is the next step for diagnosis of this patient?                                                    Marks- 02

• Rigid bronchoscopy and biopsy

 

4. Write four differential diagnosis of bronchoscopic findings.                                     Marks- 0.5x4

1. Bronchial carcinoma
2. Bronchial hemangioma
3. Bronchial adenoma
4. Wegner’s granulomatosis
5. Endobronchial tuberculosis
6. Adenocystic carcinoma

(any four of above six answer is correct)

 

5. Mention three bronchoscopic modality of treatment for palliation with bronchoscopic findings above.                                                                                                                                Marks- 1+0.5+0.5

• Endobronchial laser therapy
• Cryotherapy
• Stenting