Bangabandhu Sheikh Mujib Medical University

COURSE: DTCD

DISCIPLINE: PULMONOLOGY

PAPER: OSPE (Ten stations)

 

 

Q.1. How will you counsel a 48 years old diabetic patient who will  received  CAT-II anti-TB drugs for smear positive PTB?

Checklist:

Greetings & self-introduction	0.5
Discussion about disease and DM	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

COURSE: DTCD

DISCIPLINE: PULMONOLOGY

PAPER: OSPE (Ten stations)

 

 

 

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

 

1. Correct use of MDI…………………………………………………………….5

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.

 

2. Correct use of spacer ………………………………………………………..5

1. Shake the device
2. Fixed with spacer
3. Place it in between lip
4. 1 puff and 5 times breathing in spacer.
5. Hold each breath for 10 sec .(If possible).

 

 

 

 

 

 

 

 

 

Bangabandhu Sheikh Mujib Medical University

COURSE: DTCD

DISCIPLINE: PULMONOLOGY

PAPER: OSPE (Ten stations)

 

 

 

Q.3. A 45 years old man was diagnosed as a case of right middle lobe bronchiectasis and aspergilloma in right upper lobe. Previously he was admitted in local hospital three times  for recurrent infective exacerbation . He also received blood transfusion for massive haemoptysis . How will you counsel him?

 

 

 

Checklist:

Greetings & self-introduction	0.5
Discussion about disease and its present complications	1.0
Advice regarding posture and physiotherapy	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, if it is not adequately managed	1.0
Feedback	0.5

 

 

 

 

 

 

 

 

 

 

Bangabandhu Sheikh Mujib Medical University

COURSE: DTCD

DISCIPLINE: PULMONOLOGY

PAPER: OSPE (Ten stations)

 

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

 

 

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

1. Partial ptosis
2. Miosis
3. Enopthalmus

 

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

              Horner’s Syndrome . Anhydrosis .

4. What may be the underlying cause in this patient?What may be the other causes…….3

              Left sided bronchial carcinoma . Stroke , tumour or trauma in the neck .

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

Involvement of left sided sympathetic chain .

6. Mention two important investigations for this patient. ..................................................1CT scan of chest and Fiber optic bronchoscope (FOB)

 

5. A 65 years male, smoker  admitted in hospital with right sided chest pain . He had following chest X-ray with him .(5x2)

 

1. Mention  the characteristics features of the cavitary lesion ?

1. Thick wall cavity
2. Minimum amount of fluid
3. Ecentic cavity
4. Absence of surrounding inflammation .

 

2. What is the cause of this cavitary lesion ?

Bronchial carcinoma . Histological type more likely squamous cell carcinoma .

 

 

3. What are the other causes of cavitary lesion ?

1. Pyogenic lung abscess
2. Tubercular cavity
3. Weigner’s granulomatosis
4. Fungal infection

4. What other findings you want to look at during physical examination ?

Digital clubbing , metastatic lymphnode

 

5. What investigations you should perform ?

CT scan of chest and CT guided FNAC , FOB

Bangabandhu Sheikh Mujib Medical University

                                                                 COURSE: DTCD

                                                         DISCIPLINE: PULMONOLOGY

PAPER: OSPE (Ten stations)

Q. 6 ) 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 .

 

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

Not possible .

 

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

 

Thermo plasty with stenting.

5. What may be the histological type of bronchial carcinoma ?

Squamous cell carcinoma , small cell carcinoma , carcinoid tumour .

 

 

 

 

 

 

 

 

 

 

 

 

 

 7) Look at the following arterial blood gas and serum electrolytes of a patient .

 

pH : 7.15               Pa CO_{2 :} 50                 Pa O₂ :  75

 

Na ⁺ : 140              K⁺  : 5                 Cl⁺ : 103          HCO_{3 :  17}

 

1. What type of acid base disorder present ?------------------------------------------------3

Metabolic acidosis with respiratory acidosis .

2. Whether is it acute or chronic disorder ?..................................................................3

It is acute disorder.

3. What is the anion gap ,either high or low ?..............................................................2

Anion gap :20 . It is high anion gap .

4. What may be the underlying cause ?.........................................................................2

1. COPD with hypoxia with lactic acidosis.
2. COPD with diabetic Ketoacidosis .

 

 

 

 

8. Look at the following  ECG :

 

1. What is your diagnosis ? Describe the characteristics features of this ECG .

Palpitation , Atrial fibrillation . Absence of P wave and QRS complexes are in irregular interval .Rapid ventricular rate .

 

2. What clinical findings will you get in this case ?

Pulse : irregularly irregular , pulsus deficit present ,features associated with underlying cause .

 

3. What are the preferable investigations in this case ?

X-ray chest P/A view , Echocardiography.

4. Write some respiratory causes of this ECG findings .

Pneumonia , COPD, pulmonary embolism etc

 

5. What  are the other causes of this ECG findings ?

Mitral valvular disease (MS,MR) , Hyper thyroidism , cardiomyopathy , Lone atrial fibrillation .

 

 

 

 

9. Look at the picture :

 

 

 

 

 a) Write the name of the device . Write the characteristic features of it .

IntrathoracicTube . It has two ends . One end is introduced within thoracic cavity another end is connected to water seal drainage . There are multiple lateral opening near the first end . The tube is marked in cm . There is a radio opaque line in the tube .

 

  b) Write the utilities of the device .

Evacuation of unwanted air (pneumothorax) , pleural fluid (pleural effusion) , pus (empyema thoracis) , blood (haemothorax in trauma , post surgical).

  c) Describe the insertion site .

In 4^th and 5^th intercostal space within triangle of safety (between anterior and posterior axillary fold)

  d) How will you follow up the cases ?

Daily amount of fluid is evacuated, movement of fluid column in tube (for presence of fistula), clinical examination of chest , chest X-ray.

e)Write complications of the procedure .

Haemorrhage (trauma to intercostal vessel), vasovagal attack , lung injury , trauma to underlying structure according to insertion site (diaphragm , spleen , liver etc) , infection (eg. Empyema).

 

Q 10)  A  71 years ,  male   Wt :88kg ,  Ht :175cm  and BMI 28.7 kg/m², comes to you with the following spirometry tracing .

 

   

 

	Normal	Observed	%predicted	Post-dilator
Spirometry FVC(l) FEV1(l) FEV1/ FVC(%) FEF25-75(L/s) MVV(L/min) Volumes TLC(L) RV/TLC(%) DLCO(mL/min per mm Hg)	4.29 3.29 77 2.8 125   6.61 35 25	1.94* 1.03* 53* 0.4* 51*   9.37* 75* 10*	45 31   15 41   142 214 40	2.76 1.25   0.5

 

This patient had a smoking history of 74 pack-years and was still smoking. He complained of progressive breathlessness and wheezing on mild exertion. He had a family history of pulmonary disease.

 

1. How would you interpret test?

1. Interpretation of Data .

1. FEV₁/FVC ratio = 53 ,so it is obstructive
2. FEV₁ = 31% , very severe obstruction
3. Gestal method : scooping/concavity upwards indicate obstructive air way disease.

 

2. Is the test is reversible ?

Reversibility positive .

FEV₁ >200ml and >12% increased .

 

3. Can you make a statement as to the patient’s underlying lung disease?

 

COPD with reversibility component

 

4. Does the reduced D_LCO suggest anything?

 

                   Significantly decreased , indicate presence of emphysema ,

 

5. What is your management plan ?

      LABA ,LAMA , ICS