MBBS Final Professional Examination (For all affiliated Medical Colleges)

Theory
Sub Oral and Int. Sub Grand
S.No. Subject Int. Clinical
SEQs MCQs Total Practical Ass Total Total
Assessment
5 1
9 45
45 marks 45 marks
1. Medicine - I SEQs MCQs
marks each marks each
2 hours 1 hour
25 200 210 65 25 300 500
5 1
9 40
45 marks 40 marks
2. Medicine - II SEQs MCQs
marks each marks each
2 hours 1 hour
5 1
10 50
50 marks 50 marks
3. Surgery - I SEQs MCQs
marks each marks each
2 hours 1 hour

5 1 25 250 170 55 25 250 500

13 60
65 marks 60 mark
4. Surgery - II SEQs MCQs
marks each marks each

2 hour 1 hour 5 min

5 1
7 35
35 marks 35 mark
5. Obstetrics SEQs MCQs
marks each marks each
2 hours 45 min
15 150 100 35 15 150 300
3 1
10 35
30 marks 35 mark
6. Gynaecology SEQs MCQs
marks each marks each
2 hours 15 min 45 min
5 1
10 40
Paediatric 50 marks 40 marks 10 100
7. SEQs MCQs 65 25 10 100 200
Medicine marks each marks each
2 hours 15 min 45 min

BY: MEHTAB ZAFAR N65

 MBBS FINAL PROFESSIONAL EXAMINATION 2007
MEDICINE I

Table of Specifications

SEQs

Maximum Marks: 45
Time: 2 Hours
All questions carry equal marks
Attempt all questions

Sr No: Topic :No of SEQs

1 : Cardiovascular System :02

2 : Pulmonary Medicine :01
3 : Central Nervous System :01
4 : Gastroitestinal System :02
5 : Liver, Pancrease, Gallbladder :01
6 : Blood :01
7 : Rheumatology :01

MCQs

Total Mark 45
Time: 1 hour
Mark for each MCQ: 01
Type of MCQ: One best of five

Sr No: Topic :No of MCQs

1 : Cardiovascular System :07

2 : Pulmonary Medicine :07
3 : Central Nervous System :07
4 : Gastroitestinal System :07
5 : Liver, Pancrease, Gallbladder :06
6 : Blood :05
7 : Rheumatology :06
 MBBS FINAL PROFESSIONL EXAMINATION 2007
MEDICINE-II
Table of Specifications
SEQs
Maximum marks: 45
Time: 2 hours
All questions carry equal marks.
Attempt all questions.
Sl.
Topic Specification SEQs
No.
1. Endocrines 02
2. Renal / Kidneys, Water, Acid Base / Electrolyte; 02
Metabolism
3. Infection / Tropical Diseases 02
4. Neuro-Psychiatry 02
5. Dermatology 01
Total 09

MCQs
Total MCQs 40
Time: 60 minutes
Time for each MCQ: 1½ minutes
Marks for each MCQ: one
Type of MCQ: One Best of Five
Sl.
Topic Spe cification MCQs
No.
1. Endocrines: 05
(Breakup of
MCQs as follows)
a) Diabetes Mellitus. 01
b) Thyroid. 01
c) Adrenals. 01
Misc. / others. 02
2. Renal / Kidneys ; Water, Acid Base / Electrolyte; 10
Metabolism
3. Infection / Tropical Diseases 07
4. Neuro-Psychiatry : 10
a) Signs and Symptoms in Psychiatric patients. (Breakup of 10
b) Patients presenting with fear and panic. MCQs)
c) Persistent complainer and somatization. One MCQ
d) The depressed patient. from each
e) Patients brought with features of psychosis (odd, Topic.
excited, aggressive).
f) Conversion States.
g) Mental Handicap.
h) Confused and disoriented patients.
i) Substance abuse disorder.
j) Obsessional states.
5. Dermatology: 06
a) Eczema. (06 MCQs
b) Papulosquamous Dermatoses. from the topics
c) Drug Eruptions. given)
d) Bullous Dermatoses.
e) Bacterial Infections of Skin.
f) Cuta- neous Infestations.
g) Sexually Transmitted Infections.
h) Skin Manifestations of Systemic Disorder.
6. Nutrition; Data / Photo. 02
 MBBS FINAL PROFESSIONAL
Surgery Paper-I (Multiple Choice Questions)

Table of Specifications

50 MCQs of one mark each Time Allowed 01 hour

Sl.
Topic No. of Questions
No.
1.
Surgical Anatomy 3
2.
Wounds, Tissue Repair and Scars 3
3.
Accident and Emergency Surgery, Warfare Injuries 3
4.
Fluid, Electrolyte and Acid-Base Balance 3
5.
Blood Transfusion and Shock 3
6.
Nutrition 3
7.
Wound Infection 3
8.
Special Infection; AIDS; Sterile Precautions 3
9.
Tumours, Cysts, Ulcers and Sinuses 3
10.
Burns 3
11.
Skin lesions; Skin Grafts and Flaps 3
12.
Arterial Disorders 3
13.
Venous Disorders 3
14.
Lymphatic Disorders 3
15.
Principles of Anaesthesia and Pain Management 3
16.
Principles of Radiology 3
17.
Principles of Radiotherapy and Chemotherapy 2
 MBBS FINAL PROFESSIONAL
Surgery Paper-I (Short Essay Questions)

Table of Specifications

10 SEQs of five marks each Time Allowed 02 hours

Question
Content
No.
Surgical Anatomy
1
Wounds, Tissue Repair and Scars; Accident and Emergency Surgery;
2
Warfare Injuries

Fluid, Electrolyte and Acid-Base Balance; Blood Transfusion and Shock

3
Nutrition
4
Wound Infection; Special Infections; AIDS; Sterile Precautions
5
Tumours, Cysts, Ulcers and Sinuses; Burns; Skin Lesions, Skin Grafts
6
and Flaps

Arterial, Venous and Lymphatic Disorders

7
Principles of Anaesthesia and Pain Management
8
Principles of Radiology
9
Principles Of Radiotherapy and Chemotherapy
10
 MBBS FINAL PROFESSIONAL
Surgery Paper-II (Multiple Choice Questions)

Table of Specifications

60 MCQs of one mark each Time Allowed 01 hour and 5 minutes

I. Musculoskeletal System (6)

No. of
S. No. Contents
Questions
1. Fractures and Dislocations – General Principles 1
2. Fractures and Dislocations – Upper Limb 1
3. Fractures and Dislocations – Lower Limb 1
4. Other Diseases of Bones, Joints and related tissues 2
5. Hand and Foot 1

II. Upper GIT (14)

No. of
S. No. Contents
Questions
6. Oesophagus 2
7. Stomach and Duodenum 2
8. Liver 2
9. Spleen 2
10. Gall Bladder and Bile Ducts 2
11. Pancreas 2
12. Peritoneum, Omentum, Mesentery and Retroperitoneal Space 2

III. Lower GIT (12)

No. of
S. No. Contents
Questions
13. Small and Large Intestine 2
14. Intestinal Obstruction 2
15. Vermiform Appendix 2
16. Rectum 2
17. Anus and Anal Canal 2
18. Hernia, Umbilicus and Abdominal Wall 2

IV. Urogenital System (10)

No. of
S. No. Contents
Questions
19. Kidney and Ureter 2
20. Urinary Bladder 2
21. Prostate and Seminal Vesicles 2
22. Urethera and Penis 2
23. Testes and Scrotum 2
V. Head and Neck (4)
No. of
S. No. Contents
Questions
24. Thyroid Gland and Thyroglossal Tract 1
25. Parathyroid and Adrenal Glands 1
26. Salivary Glands 1
27. Others 1

VI. Thorax (4)

No. of
S. No. Contents
Questions
28. Chest Trauma 2
29. Others 2

VII. Breast (4)

No. of
S. No. Contents
Questions
30. Malignant Diseases 2
31. Benign Diseases 2

VIII. Nervous System (2)

No. of
S. No. Contents
Questions
32. Head, Spine and Nerve Injuries 1
33. Others 1

IX. Heart and Great Vessels (2)

No. of
S. No. Contents
Questions
34. Heart 1
35. Great Vessels 1

X. Orodontal (2)
No. of
S. No. Contents
Questions
36. Maxillofacial Injuries 1
37. Others 1

Note: At least Five Questions from S.No.II to VII will be of

Operative Surgery.
 MBBS FINAL PROFESSIONAL
Surgery Paper-II (Short Essay Questions)

Table of Specifications

13 SEQs of five marks each Time Allowed 02 hours

No. of
S. No. Contents
Questions
Musculoskeletal System 1
1.
Upper GIT 2
2.
Lower GIT 2
3.
Urogenital System 2
4.
Head and Neck 1
5.
Thorax 1
6.
Breast 1
7.
Nervous System 1
8.
Heart and Great Vessels 1
9.
Orodental 1
10.

Note: At least One Question from S.No.2 to 7 will be of

Operative Surgery.
 MBBS FINAL PROFESSIONAL
Gynaecology
(Multiple Choice Questions)

Table of Specifications

35 MCQs of one mark each Time Allowed 45 minutes

Sl. No. of
Contents
No. Questions
1.
Anatomy and embryology of genital tract 2
2.
Disorders of puberty and ovulation. 2
3.
Disorders of menstruation. 4
4.
Abortions. 2
5.
Ectopic gestation. 1
6.
Infertility. 2
7.
Endometriosis and adenomyosis. 1
8.
Infections of the genital tract. 3
9.
Uterovaginal prolapse. 1
10.
Urogynecology and fistulae. 1
11.
Benign diseases of genital tract. 4
12.
Malignant diseases of genital tract. 4
13.
Contraception. 2
14.
Menopause and HRT. 2
15.
Common gynecological procedures. 2
16.
Pre-intra and post-operative care. 1

Total MCQs 35
 MBBS FINAL PROFESSIONAL
Gynaecology
(Short Essay Questions)

Table of Specifications

10 SEQs of 03 marks each Time Allowed 2 hours and 15 minutes

Sl. No. of
Contents
No. Questions
1.
Anatomy and development of the genital tract 1
2.
Disorders of menstruation. 1
3.
Abortions including ectopic gestation. 1
4.
Infertility and Endometriosis. 1
5.
Infections of genital tract. 1
6.
Benign tumours of genital tract. 1
7.
Malignancies of the genital tract. 1
8. Displacements of the uterus and urinary
1
problems.
9.
Contraception. 1
10.
Common gynecological procedures. 1

Total SEQs 10
 MBBS FINAL PROFESSIONAL
Obstetrics
(Multiple Choice Questions)

Table of Specifications

35 MCQs of one mark each Time Allowed 45 minutes

Sl. No. of
Contents
No. Questions
1.
Physiological changes in Pregnancy. 2
2.
Normal Fetal Development. 2
3.
Abnormal Fetal Development. 2
4.
Assessment of Fetal Well Being. 3
5.
Role of Investigations. 1
6.
Antenatal Care. 4
7.
Pain relief in Labour. 1
8.
Normal Labour. 4
9.
Abnormal Labour. 4
10.
Puerperal Disorders. 3
11.
Medical Disorders in Pregnancy. 4
12.
Role of Imaging and Radiology. 2
13.
Statistics. 2
14.
Neonatology. 1

Total MCQs 35
 MBBS FINAL PROFESSIONAL
Obstetrics
(Short Essay Questions)

Table of Specifications

07 SEQs of 05 marks each Time Allowed 2 hours

Sl. No. of
Contents
No. Questions
1.
Physiology of Pregnancy. 1
2.
Antenatal care including investigations. 1
3.
Assessment of Fetal Well Being. 1
4.
Intrapartum Care – Normal Labour. 1
5.
Abnormal Labour. 1
6.
Post – Partum Disorders. 1
7.
Medical Disorders in Pregnancy. 1

Total SEQs 07
 Page 1 of 2

MBBS FINAL PROFESSIONAL EXAMINATION 2007

PAEDIATRIC MEDICINE

Table of Specifications

MULTIPLE CHOICE QUESTIONS

Total Marks: 40 Time Allowed: 45 Minutes

No. of MCQs: 40
Note: One best answer to be chosen from 5 options

Sl. No. of
Contents
No. MCQs
1. Disorders of Blood 4
2. Heart Diseases 4
3. Infectious Diseases 5
4. Neurological Diseases 4
Diseases of Gastrointestinal Tract
5. 5
and Liver
6. Respiratory Tract Diseases 1
7. Oncological Diseases in Children 1
8. Renal Disorders 1
9. Rheumatic Diseases 1
10. Endocrine Problems 2
11. Neonatology 5
12. Immune Diseases 2
13. Genetics 1
14. Miscellaneous Diseases 4
Total MCQs 40
 Page 2 of 2

MBBS FINAL PROFESSIONAL EXAMINATION 2007

PAEDIATRIC MEDICINE

Table of Specifications
SHORT ESSAY QUESTIONS

50
Total Marks : 30 Time Allowed: 2 hours and 15 min.

No. of SEQs: 10
05
03 marks for each question.

Sl. No. of
Contents
No. SEQs
1. Endocrinology 1
2. Cardiology 2
3. Respiratory Diseases (ARI) 1
4. Gastrointestinal Tract Diseases (AWD) 1
5. Meningitis 1
6. Vaccinology – EPI Schedule 1
7. Oncology 1
8. Neurology 1
9. Nephrology 1
Total SEQs 10
 Format of OSPE
MBBS Final Professional

MEDICINE

OSPE Total Marks 65

Total Stations 15 (02 Rest Stations)
05 Marks at Each Station
04 Minutes at Each Station

¾ Static Stations 11
09 Internal Medicine according to the Curriculum
01 each for the two sub-specialties
(Dermatology, Psychiatry)

¾ Interactive / 02
Observed Stations Internal Medicine and Trauma Only

Short Cases Total Marks 120

At least 04

Long Case Total Marks 90

Grand Total 275

 OSPE Model Paper
M.B; B.S.
Final Professional Examination 2008

MEDICINE

University of Health Sciences, Lahore

 INSTRUCTIONS
(This page is to be given to the students when they enter the
examination area of OSPE)

1. Please read the questions carefully and answer ONLY what is

asked.
2. Use specific terms where possible.
3. Be precise and to the point.
4. All stations carry equal marks
5. Leave the answer sheet on the table/ Fold and put it in the box or
carry to the next station (to be decided in the meeting)
6. Once OSPE starts you will not
1. Look at the pictures of a 25 year old woman complaining of
difficulty in closing one eye:

a) What condition does she have?

b) What is the neurological deficit?
c) On which side is the lesion?

TOPIC SPECIFICATION: NEUROLOGY

2. This 45 year old hypertensive male was brought to the
emergency with sudden excruciating headache and loss of
consciousness.

a) What is the abnormality seen on CT scan of the

brain?
b) Name two common causes.
c) List 2 steps in management.
TOPIC SPECIFICATION: NEUROLOGY
3. This forty five year old female has had pain and stiffness of
several joints in the body for a decade.

a) What is the diagnosis

b) Name two drugs used to modify the disease
c) Name one physical abnormality seen in the picture

TOPIC SPECIFICATION: RHEUMATOLOGY

4. Look at this instrument/picture (the actual instrument
should be shown)

a) What is this instrument called?

b) Give three important indications.
c) Give three important contraindications.

TOPIC SPECIFICATION: INSTRUMENT

IDENTIFICATION
5. Drug identification: (the actual drug should be pre be

provided)
a) List three important side effects of the given drugs.
b) List three important indications.
c) What will happen to serum cortisol level after its
administration?

TOPIC SPECIFICATION: DRUG IDENTIFICATION

6. Look at the picture of a 25 year old man complaining of a
painful and itchy rash on the chest.
a) Identify the lesion.
b) What is the causative microorganism.
c) Name one specific therapy.

TOPIC SPECIFICATION: DERMATOLOGY

7. This chest X-ray is of a 27 year old lady who presented with
dyspnoea. On examination there is irregular pulse and a
murmur on the mitral area.

a) Name two X-ray abnormalities.

b) What is the most likely underlying valvular lesion?
c) What is the commonest cause of this lesion in
Pakistan?
TOPIC SPECIFICATION: CARDIOLOGY
8. A 35 year old female presents with weight loss and tremors.
On examination she is looking extremely agitated and has
fine tremors of the fingers.

a) What is the most likely diagnosis?

b) Name three physical signs which are present in this
patient.
c) List two investigations.

TOPIC SPECIFICATION: ENDOCRINOLOGY

9. Counseling station interactive station.
This 45 year old obese lady who is a known diabetic has
presented to you with a fasting blood sugar level of 220 mg/dl.
Please counsel her regarding her illness.

TOPIC SPECIFICATION: COUNSELLING/ DIABETES

10. The X-ray shown is of a 40 years old man who presented
with chest pain and dyspnoea.

a) What is the abnormality on this x-ray.

b) Name two physical findings you would expect in this
patient.
c) What is the emergency management?
TOPIC SPECIFICATION: PULMONOLOGY
11.(Observed station)
SIMULATED PATIENT
Examiner’s opening statement. “This 30 year old gentleman
has presented to the emergency with haematemesis. How
would you proceed to manage this patient?”

TOPIC SPECIFICATION: GASTROENTROLOGY

12. This is the laboratory report of a 55 year old man who had
poorly controlled diabetes and hypertension for the last 20
years.
• pH 7.1
• pCO2 20 mmHg
• pO2 90 mmHg
• HCO3 10 mEq/l
• Blood glucose 176 mg/dl
• Potassium 6.1 mEq/l
• Sodium 132 mEq/l
• Blood urea 210 mg/dl

a) What acid base disorder is present?

b) What is the underlying cause of these metabolic
abnormalities?
c) List two definitive treatments for the underlying
condition.

TOPIC SPECIFICATION: NEPHROLOGY

13. A 20 year old woman has presented to the psychiatry
outpatients department accompanied by her mother. She
complains of hearing voices in her head threatening to poison
her, and commenting upon her every move. She has had these
complaints for last 7 months and her family believes that she
is possessed by jins.
a) What is the most likely diagnosis?
b) Name 2 drugs used in treatment?

TOPIC SPECIFICATION: PSYCHIATRY

14. A 17 year old boy has presented with a febrile illness
which recurs every third day. The fever is high grade and
accompanied by chills and rigors. This is the peripheral blood
smear of this patient.

a) What abnormality is seen in this blood smear?

b) Name 2 drugs used in its treatment.
c) Name one important complication.

TOPIC SPECIFICATION: INFECTIOUS DISEASES

15. A 40 year old mother of 6 children has had menorrhagia
for several months. This is her peripheral blood smear.

a) What does this peripheral smear show?

b) What is the most likely cause in this patient?
c) What laboratory tests you will perform to confirm the
diagnosis?

TOPIC SPECIFICATION: HEMATOLOGY

 KEY/Typical answer
Q Answer
1 a) Right sided facial palsy
b) Flattened nasolabial fold on right side and shifting of
angle of mouth toward unaffected side
2 a) Hyperdense opacity in temporal lobe
b) Hypertension and congenital arteriovenous
malformations/aneurisms
c) Manitol, NG tube and Foley’s catheterization
3 a) Rheumatoid arthritis
b) Methotrexate, leflunomide, quinine, sulphasalazine
etc.
c) Ulnar deviation
4 a) Lumbar puncture or spinal puncture needle
b) Meningitis, encephalitis, subarachanoid haemorrhage
c) Raised ICP, local sepsis and extremely restless patient
5 a) Water retention, hyperglycaemia and osteoporosis
b) Severe attack of bronchial asthma, raised ICP due to
tumor and anaphylaxis
6 a) Typical lesion of Herpes Zoster
b) Herpes Zoster Virus/ chicken pox virus
c) Acyclovir
7 a) Enlarged cardiac shadow and convexity in left upper
border (mitralization)
b) Mitral stenosis/regurgitation
c) Rheumatic heart disease/rheumatic fever in childhood
8 a) Hyperthyroidism due to Grave’s disease
b) Tachycardia, diffuse enlargement of thyroid gland and
a bruit over thyroid
c) TFTs i.e. T4, T3, TSH and Iodine uptake test or
thyroid USG
9 a) Explains about the normal fasting sugar value and
significance of exercise, diet and proper medication
10 b) Pneumothorax
c) Intubation or chest puncture with any needle suspicion
of tension pneumothorax
d) Decreased breath sounds and resonant percussion
11 a) History, physical examination
b) I/V line, blood transfusion, coterie infusion.
c) When stable USG, endoscopy and sclerotherapy or
banding if varicies
12 a) Metabolic acidosis
b) Renal failure
c) Dialysis (peritoneal followed by haemodialysis), renal
transplant
13 a) Schizophrenia
b) Haloperidol, phenothiazines or atypical anti
psychotics
14 a) RBCs containing malarial parasites
b) Chloroquine, quinine, halofantrine or artemether (any
two should be accepted correct)
15 a) Severely hypochromic and microcytic picture
b) Chronic iron deficiency
c) Pallor, koilonychia and atrophic tongue
 Format of OSPE
MBBS Final Professional

SURGERY

OSPE Total Marks 55

Total Stations 13 (02 Rest Stations)
05 Marks at Each Station
05 Minutes at Each Station

¾ Static Stations 09
05 General Surgery
01 each of the four sub-specialties
(Anaesthesia, Urology, Neurosurgery, Orthopaedics)

¾ Interactive / 02
Observed Stations General Surgery and Trauma Only

Short Cases Total Marks 100

At least 03

Long Case Total Marks 70

 MODEL QUESTIONS
OSPE FOR FINAL YEAR M.B.B.S.
SUBJECT: SURGERY
UNIVERSITY OF HEALTH SCIENCES, LHR

Time allowed: 05 minutes

Static Station

Instruction to Candidates:

Carefully observe the provided object and answer the following questions.

™ Name the object. 0.5

™ Name its different parts. 01, 01

™ Give three indications for use. 1.5 (0.5 each)

™ Give two indications for supra pubic cystostomy. 01(0.5 each)

 Key

a Foley catheter. 0.5

b Balloon at the tip. 01, 01

™ Part for injecting fluid in balloon.
™ Part for urine bag application.

c Bladder out flow obstruction (BPH, CA-prostate) 1.5 (0.5 each)

™ After TURP
™ After TVP
™ For supra-pubic cystostomy
™ For measurement of urine out in hypovolemia or shocked patient.

d Stricture urethra 01 (0.5 each)

Urethral injury
 OSPE FOR FINAL YEAR M.B.B.S.
SUBJECT: SURGERY
UNIVERSITY OF HEALTH SCIENCES, LHR

Time allowed: 05 minutes

Static Station

Instruction to Candidates:

Carefully observe the provided object and answer the following questions.

™ Name these objects. 1.5 (0.5 each)

™ One indication of use of each object. 1.5 (0.5 each)

™ Mechanism of action of each. 1.5 (0.5 each)

™ Which drain is used after thyroidectomy? 0.5

 Key

a CRD, Nealeton Drain, Redivac Suction Drain. 1.5 (0.5 each)

b CRD=placed in abdomen after purulent peritonitis.

Nealetion Drain= After Laparatomy placed abdomen. 1.5 (0.5 each)

Redivac Suction Drain (R.S.D) = after thyroidectomy, after Mastectomy.

c CRD= Multi channel drain.

Nealeton= Gravity/ Dependent Drainage 1.5 (0.5 each)

R.S.D.= vacuum drain

d R.S.D 0.5
 OSPE FINAL YEAR M.B.B.S.
SUBJECT: SURGERY
UNIVERSITY OF HEALTH SCIENCES, LHR

Time allowed: 05 minutes

Static Station

Instruction to Candidates:

Carefully observe the provided object and answer the following questions.

™ Identify. 01

™ Name the different parts. 01

™ Give three indications for the use of this equipment. 1.5 (0.5 each)

™ Give three indications of thoracotomy. 1.5 (0.5 each)

 Key

a) Chest tube with under water seal bottle. 01

b) Chest tube.
™ Under water seal bottle with tubing. 01

c) Pneumothorax – Haemothorax- Haemopnemotharax

---Pyothorax---flail chest---Post thoracotomy etc. 1.5 (0.5 each)

d) Indications for thoracotomy after blunt trauma

™ 1000ml blood drained at insertion of chest tube.
™ Continuous brisk bleeding > 100ml per 15 min.
™ Continued bleeding > 200ml per hr for three or more hrs.
™ Rupture of bronchus, aorta, oesophagus, and diaphragm.
™ Cardiac tamponade. 1.5 (0.5 each)
 OSPE FOR FINAL YEAR M.B.B.S.
SUBJECT: SURGERY
UNIVERSITY OF HEALTH SCIENCES, LHR

Time allowed: 05 minutes

Static Station

Instruction to Candidates:

Carefully observe the provided radiological study and answer the following
questions.

™ What is this investigation? 0.5

™ What are the findings? 2 (0.5 each)

™ One indication for CBD exploration. 0.5

™ What is residential stone? 0.5

™ Name three different methods of residential stone removal? 1.5 (0.5 each)
 Key

a. T. tube Cholangiogram 0.5

b. T-tube in place 0.5

Dilated extrahepatic biliary Channels. 0.5

Dye is Visible going into the duodenum. 0.5

One negative shadow at the lower and of CBD. 0.5

c. Choledocholithiasis 0.5

d. A stone that remains in Common bile duct after CBD exploration.

0.5

e. ERCP (sphincterotomy) 1.5 (0.5 each)

Burhennes technique

Tans Duodenal Sphincterotomy

 OSPE FOR FINAL YEAR M.B.B.S.
SUBJECT: SURGERY
UNIVERSITY OF HEALTH SCIENCES, LHR

Time allowed: 05 minutes

Static Station

Instruction to Candidates:

Carefully observe the provided radiological study and answer the following
questions.

™ What is this investigation? 01

™ What are the findings? 02

™ Give three causes of these findings? 1.5 (0.5 each)

™ Which part of duodenum usually perforates after ulceration? 0.5

 Key

a Plain X-Ray Abdomen. Errect posture 01

b Free gas (crescent shaped) under diaphragm (Bilaterally). 02

c Any hollow viscous perforation in abdomen 1.5 (0.5 each)

After Laparotomy

Penetrating injury to abdomen.

d. Second part. 0.5

 OSPE FOR FINAL YEAR M.B.B.S.
SUBJECT : SURGERY
UNIVERSITY OF HEALTH SCIENCES, LHR

Time allowed: 05 minutes

Static Station

Instruction to Candidates:

Carefully observe the provided radiological study and answer the following
questions.

™ Name this investigation? 0.5

™ What are the findings? 01

™ Name different types of intra-cranial hemorrhage. 1.5 (0.5 each)

™ What is emergency management of this patient? 01 (0.25 each)

™ Which operation is done for extra-dural hemorrhage? 01

 Key

a CT-Scan Brain. 0.5

b Sub dural hematoma…..midline shift. 01

c Extra dural haematoma. 0.5

Sub-dural Haematoma. 0.5
Intra cerebral Bleeding 0.5

d According to ABC of traumatology.

™ Maintain airway & I.V line. 0.25

™ Tetanus toxoid 0.25

™ Pain killer 0.25

™ Monitor vitals 0.25

e Burr hole craniotomy. 1

 OSPE FOR FINAL YEAR M.B.B.S.
SUBJECT : SURGERY
UNIVERSITY OF HEALTH SCIENCES, LHR

Time allowed: 05 minutes

Static Station

Instruction to Candidates:

Carefully observe the provided radiological study and answer the following
questions.

™ What is this investigation? 0.5

™ What are the findings? 0.5

™ What types of fracture is this? 0.5

™ What is emergency management of this patient? 03 (0.5 each)

™ What is definite management of this fracture, if it is not compound? 0.5

 Key

a. X-Ray Arm. AP view. 0.5

b. Transverse fracture of shaft of Humerus. 0.5

With a small piece of bone visible.

c. Transverse fracture 0.5

d. According to ABC of traumatology

™ Tetanus toxoid 0.5

™ Pain killer 0.5

™ Immobilization of fracture 0.5

™ Antibiotics if open wound 0.5

™ U-slab application 0.5

™ 2-Hanging cast application 0.5

e. Application of a hanging cast or internal fixation by plating 0.5

 OSPE FOR FINAL YEAR M.B.B.S.
SUBJECT: SURGERY
UNIVERSITY OF HEALTH SCIENCES, LHR

Time allowed: 05 minutes

Static Station

Instruction to Candidates:

Carefully observe the provided radiological study and answer the following
questions.

™ What is this investigation? 0.5

™ What are the findings? 1.5 (0.5 each)

™ What are indications of this investigation? 02 (0.5 each)

™ What are the causes of bilateral hydronephrosis? 0.5 (0.25 each)

™ What is surgical treatment of stone in renal pelvis? 0.5

 Key

a. Intravenous urogram 0.5

b. Dilated left renal pelvis and major calyxes 1.5 (0.5 each)
Normal right intra and extra renal excretory system.

c. 1. Renal/ ureteric stone 02 (0.5 each)

2. Vesicoureteric reflux

3. pelviureteric junction obstruction

4. Obstruction due to retroperitoneal tumor.

d. 1. Obstruction of urethra due to stone or stricture 0.25

2. Retro peritoneal fibrosis. 0.25

e. Pyelolithotomy 0.5
 OSPE FOR FINAL YEAR M.B.B.S.
SUBJECT: SURGERY
UNIVERSITY OF HEALTH SCIENCES, LHR

Time allowed: 05 minutes

Static Station

Instruction to Candidates:

Carefully observe the provided Photgraph and answer the following questions.

™ What is this? 01

™ What Type of gangrene usually develops in diabetic patients? 0.5

™ What are three important points for pathogenesis of diabetic? 0.75

™ How will you manage diabetic foot? 1.25

™ Name the levels of amputation in lower limb. 1.5

 Key

a. Diabetic foot, ulcer of foot. 01

b. Wet gangrene. 0.5

c. Hyperglycemia……..Ischemia…..Neuropathy 0.75 (0.25 each)

d. Routine investigations 0.25

X-Ray foot to see for osteomoyelitis 0.25

Control of BSL 0.25

Wound debridement 0.25

Amputation if bone involved 0.25

e.

Trans meta tarsal 0.25

Syme’s amputation 0.25

Below knee 0.25

Through knee 0.25

Gritti-Stokes 0.25

Above knee 0.25

 OSPE FOR FINAL YEAR M.B.B.S.
SUBJECT: SURGERY
UNIVERSITY OF HEALTH SCIENCES, LHR

Time allowed: 05 minutes

Static Station

Instruction to Candidates:

Carefully observe the provided object and answer the following questions.

™ What is this object? 0.25

™ What is it number/ size? 0.25

™ Name three methods of maintaining IV line. 1.5

™ Name three I-V fluids used routinely. 1.5

™ Give two Complications of this object. 1.5

 Key

a. Branula/ I.V canula 0.25

b. Number 20 0.25

c. IV Branula, central venous line venous cut 1.5

Down / vene section.

d. Normal saline, Ringer’s Lactate, 5% D/W 1.5

D/S solution-10/% D/W.

e. Thrombophlebitis, thrombo-embolism fracture and embolism of canula.

1.5
 OSPE FOR FINAL YEAR M.B.B.S.
SUBJECT: SURGERY
UNIVERSITY OF HEALTH SCIENCES, LHR

Time allowed: 05 minutes

Interactive Station

Instruction to Candidates:

Carefully observe the provided objects, identify and explain their uses.
 Key
CHECK LIST FOR THE EXAMINER

Sr.# Questions Marks

1 Curved artery forceps
uses:
For haemostasis. For holding 1
thread. For holding
Sub-cutaneouss tissue and
aponeurosis.
2 Allis’s forceps
Uses:

For holding
Sub-cutaneouss tissue, 1
Aponeurosis, deep fascia, sac of
hydrocele, for holding fibrous
capsule of some sac during
dissection.
3 Sponge holding forceps uses:

For holding sponge for painting. 1

For holding gall bladder during
Cholecystectomy.
4 Babcock’s tissue forceps.

Uses:
For holding appendix, 1
Ureter, fallopian tube.
For holdling gut wall.
5 Scalpel (knife handle)
Holding positions:
™ Dinner knife position. 1
™ Writing (pen holding) position.
™ Fiddle bow position
™ Grasping position.
TOTAL 5
 OSPE FOR FINAL YEAR M.B.B.S.
SUBJECT: SURGERY
UNIVERSITY OF HEALTH SCIENCES, LHR

Time allowed: 05 minutes

Interactive Station

Instruction to Candidates:

Carefully observe the provided objects and Illustrate their usage in everyday life
of a medical practitioner.
 Key

CHECK LIST FOR THE EXAMINER

Sr.# Questions Marks

What are these instruments?

1
1 Endotracheal tube and
Laryngoscope.

Type of anaesthesia required for

2 usage of these instruments? 1
General Anaesthesia

Indication for their use?

General Anaesthesia.
3 1
Unconscious patient after
Trauma

Other methods of maintaining

airway?

Head tilt, chin lift maneuver.

Oropharyngeal
4 1
Airway. Cricothyroidotomy.
Mini tracheostomy.
Tracheostomy.

5 Complications? 1
Tracheal injury.
Blockage of tube.

TOTAL 5
 Format of OSPE
MBBS Final Professional

OBSTETRICS AND GYNAECOLOGY

OSPE Total Marks 75
Total Stations 20 (05 Rest Stations)
05 Minutes at Each Station
05 Marks at Each Station

Out of 15, 08 stations will be of Obstetrics and 07

stations will be of Gynaecology. In these 15 stations, 05
stations will have to be interactive stations.

Long Case x 2 60 (30 Internal + 30 External)

One Long case of Obstetrics and One of Gynaecology
(Compulsory Requirement)

Internal 15
Assessment

Total Marks 150

15 Stations (05 marks for each station)

08 Stations 07 Stations
(Obstetrics) (Gynaecology)

5 3 5 2
(Non-Interactive) (Interactive) (Non-Interactive) (Interactive)
 Instructions to Examiners for OSPE
Introduction to OSPE
Objective structured practical examination will replace table viva. OSPE will consist of twelve stations, six of
Obstetrics and six of Gynecology. There will be ten static non observed stations and two observed stations.
Each subject, Obstetrics and Gynaecology, has been divided into sections, as shown in the table. The objective
is to cover the entire subject matter. The examiner preparing the OSPE will prepare, one OSPE from each
section. The time allocated to each station will be 5 minutes. Out of the 5 Interactive Stations at least 1 station
should be structured on “Counseling”.

no. Obstetrics Stations 06 Gynecology Stations 06

1 Anatomy of pelvis & fetal skull and 1 Anatomy &Physiology of female 1
physiological changes in pregnancy genital tract
2 Antenatal care, malpresentation and 1 Benign tumours of the genital 1
malposition and demographic tract
indicators of Pakistan
3 Labour (mechanism, management, 1 Reproductive endocrinology 2
stages, normal, abnormal) (infertility, endometriosis, PCOS)
& other Gynecological conditions
such as Urognecology,
Uterovaginal prolapsed, Fistulas.
4 Medical disorders in pregnancy and 2 Malignant tumours of the genital 1
tests for fetal wellbeing and newborn tract
care
5 Maternal mortality and its causes - 2 Contraception 1
Obstetrical hemorrhage (APH, PPH),
Eclampsia, obstructed labour,
abortion, puerperal sepsis)
6 Operative obstetrics 1 Operative Gynecology 1
Resources used in each station can be selected from the resource list. It can also be increased according to the
availability of further resources.
Resource list
• Counseling
• Scenario
• Lab report
• Instrument
• Specimen
• Picture
• Traces CTG
• Partogram
• Contraceptives
• Graphs
• USG pictures
• X-rays
• Dummies
• Operation
• Movie clip
• Endoscopic findings
• Antenatal card
• Operative notes
 OSPE Model Paper
Obstetrics & Gynecology

Time 5 mins at each station

STATION 1 - Static
Q1. This is a picture of a 30 year old G5P4+0
presenting at 34 weeks with painless vaginal
bleeding. What is the diagnosis? (0.5)
 Q2. Enumerate and define its different
types? (2)

Q3. What are the maternal risks associated

with it? Enumerate any three. (1.5)

Q4. How will you deliver this patient?(0.5)

Q5. Will you do a pelvic examination in this

patient? (0.5)

Key : STATION 1 Placenta previa

A1. Placenta previa
A2. Grade 1: The placenta is in the lower segment but the lower edge does not
reach the internal os.
os.
Grade 2: The lower edge of the low lying placenta reaches but does
does not
cover the internal os
Grade 3: The placenta covers the internal os asymmetrically
Grade 4: The placenta covers the internal os symmetrically
A3. Maternal mortality 0.1%
Postpartum haemorrhage
Anaesthesia & Surgical complications
Air embolism
Postpartum sepsis
Pl. accreta
Recurrence rate 4-
4-8%
A4. By C/S
A5. No
 STATION 2 - Static

Q1. Identify the following specimen. (1)

Q2. What are its uses? Enumerate any three

(1.5)

Q3. What are the steps of diagnostic D&C?

Briefly outline them (2.5)
 Key: STATION 2 - Sim’s speculum
A1. Sim’
Sim’s speculum
A2. 1.DIAGNOSTIC:
a) Inspection of vaginal walls and cervix
b) Diagnostic D&C
c) VVF
2.THARAPEUTIC:
a) E&C
b) Minor vaginal and cervical surgical indications
c) Vaginal hysterectomy
A3. 1. G/A
2. Lithotomy position
3. Cleaning and draping
4. EUA
5. Retract posterior vaginal wall with Sim’
Sim’s speculum
6. Hold anterior lip of cervix with volsellum forceps
7. Pass uterine sound
8. Dilate cervix with Hegar’
Hegar’s dilator
9. Explore uterine cavity with sponge holding forceps
10. Curette with sharp curette
11. Send specimen for H/P

STATION 3 - Static

Q1. A 24 year old P0+0 presents with

oligomenorrhea for 4 years. Her USG report
shows polycystic ovaries. What are the other
symptoms with which this condition can
present? Name three
(1.5)

Q2. How will you treat her menstrual irregularity?

(1.5)
Q3. How will you treat her primary infertility? (2)
 Key: STATION 3 - PCOD

A1. Hirsutism
Weight gain
Infertility
A2. Weight reduction
OCP’
OCP’s/Diane 35 or
Progestogens alone
A3. Baseline investigations of infertility
Weight reduction/ Metformin
Ovulation induction for 6 months
If fails…
fails…IUI 6 cycles
If fails…
fails…IVF/ICSI

STATION 4 - Static
Q1. A G2P1+0 presents with hyperemesis
gravidarum.
gravidarum. Her USG at 7 and 10 weeks shows
the following reports. What is the diagnosis?
(1)
7 wks 10wks
 Q2. What are the antepartum maternal
complications of this condition?
Enumerate three
(1.5)

Q3. What are the antepartum fetal

complications of this condition?
Enumerate three
(1.5)

Q4. What are the features on abdominal

examination suggestive of this condition?

Key: STATION 4 - Twin pregnancy

A1. Twin pregnancy
A2. Hyperemesis gravidarum
PIH
Gestational diabetes
Anemia
APH
Increased chances of hospitalization
A3. Congenital anomalies
Single fetal death
TTTS
TRAP
IUGR
A4. INSPECTION: Excessive abdominal distension
PALPATION: FH larger than expected for duration of gestation
Multiple fetal parts palpable
Two fetal poles/ Two fetal heart beats
 STATION 5 - Static
Q1. A 35 year old P4+2 presented to OPD with foul smelling vaginal
vaginal
discharge and postcoital bleeding. What is the D/D? (1.5)

Q2.On examination you observe the following finding. How will you
you
investigate her? (1)

Q3. If H/P turns out to be squamous cell

carcinoma of cervix, outline treatment
plan? (1.5)

Q4. What is the name of surgery for cervical

carcinoma? (0.5)

Q5. Will you remove ovaries during this

surgery? (0.5)
 Key: STATION 5 - Cervical CA
A1. Infections
Benign / malignant growth of cervix
Benign/malignant growth of endometrium
A2. EUA
Cervical biopsy
A3. Staging
Treatment according to stage:
Sugery
Chemoradiotherapy
A4. Wertheim’
Wertheim’s hysterectomy
A5. No

STATION 6 - Static
Q1. A 24 year old woman presented with
amenorrhea of 6 weeks and lower abdominal
pain for 2 days. The following procedure is being
done on her. What is the likely diagnosis? (1)
Q2. What are the risk factors for this
condition? Enumerate any three (1.5)

Q3. What are the common sites of location

of this condition? Enumerate three (1.5)

Q4. Give two investigations helpful for

diagnosis of ectopic pregnancy? (1)

Key: STATION 6 - Ectopic pregnancy

A1. Ectopic pregnancy
A2. Maternal age
Previous ectopic pregnancy
Pelvic surgery
PID
IUCD
A3. Fallopian tube
Ovary
Broad ligament
Uterosacral ligament
Pouch of douglas
Abdomen
A4. B-
B-hCG
Transvaginal USG
Laparoscopy
 STATION 7 - Static

Q1. A PG presents at 20 weeks gestation

with the following GTT report. What is the
medical problem the patient is suffering
from? (1)

Fasting BSL 130

mg/dl
1 hr postprandial BSL 200 mg/dl
2 hr postprandial BSL 165 mg/dl

Q2. What are the risk factors for the

development of this condition in
pregnancy? Name two (1)

Q3. What are the maternal complications of

this pregnancy? Enumerate any three
(1.5)

Q4. What are the neonatal complications of

this pregnancy? Enumerate any three
(1.5)
 Key: STATION 7 - Diabetes in pregnancy
A1. Gestational diabetes
A2. Obesity
Family history
Previous baby > 4.5 kg
Previous unexplained stillbirth
Previous congenital abnormality
A3. Nephropathy (temporary worsening)
Retinopathy (progression)
Hyperglycemia/ hypoglycemia/ ketoacidosis
Infections
Pre-
Pre-eclampsia
Polyhydramnios/
Polyhydramnios/ preterm labour
Increased chances of operative delivery/ C/S
A4. Macrosomia:
Macrosomia:
birth asphyxia
traumatic birth injury
RDS
Hypoglycemia
Hypomagnesemia
Hypocalcemia
Hyperbilirubinemia
Polycythemia

STATION 8 - Static
Q1. What is the procedure being done in the
picture below? (1)
 Q2. Define this procedure? (0.5)

Q3. When is this procedure done? (1)

Q4. What is the main risk associated with

this procedure? (1)

Q5. In whom should this procedure be

done? Enumerate any three (1.5)

Key: STATION 8 - Amniocentesis

A1. Amniocentesis
A2. Amniocentesis is a procedure in which a small amount of the amniotic fluid
surrounding the fetus is removed by passing a fine needle through
through the mother's
abdomen
A3. After 15 weeks gestation
A4. Risk of miscarriage..1%
A5. Women who:
1-have received a high-
high-risk screening result from a blood test for Down syndrome.
2-have missed screening for Down syndrome and they are over a certain certain age
(typically over 35 years). This is because the risk of having a baby with Down
syndrome increases as a woman gets older.
3-have received a result from a scan which shows certain features, such as fluid
collection at the back of the baby's neck (nuchal
(nuchal translucency), or a heart defect
which indicates the baby may have a chromosomal abnormality. This This may be found
on a scan at 20 weeks.
4-have had a previous pregnancy affected with a disorder.
5-have one or more relatives affected with a genetic disorder.
6-want to know for certain whether the baby has a disorder
 STATION 9 - Static
Q1. Identify the following components of the
placenta (1 each)

Key: STATION 9 - Placenta

A. Amnion
B. Umbilical cord
C. Chorionic plate
D. Chorionic vessels
E. Cotyledon
 STATION 10 - Static
Q1. This is a picture of a 30 year old P0+0 who presents with
the complain of dysmenorrhea,
dysmenorrhea, dyspareunia and chronic
pelvic pain for last 5 years. What is the most likely
diagnosis? (1)

Q2. What is the gold standard investigation

for diagnosis of this condition? (1)

Q3. What are the treatment options for this

patient? (3)
 Key: STATION 10 - Endometriosis
A1. Endometriosis
A2. Laparoscopy
A3. Medical:
GnRH analogues
Progestogens alone
Danazol/
Danazol/ Gestrinone
Surgical:
Adhesiolysis
Ablation of endometriotic spots
Enucleation of endometriotic cysts
For infertility:
Ovulation induction
IUI/ IVF/ ICSI

STATION 11 (Interactive)

Q. Perform General Physical Examination on

this patient. (05)
 Key: Station-11 (Interactive)

Key:
1. Introduction ¼
2. Explanation ¼
3. Stand on R side of patient ¼
4. Privacy (ask for screen) if not present ¼
5. Pulse ½
6. B. p. ½
7. Temp ¼
8. Look for pallor (palm of hand, conjunctiva) ½
9. Look for jaundice (sclera of eyes) ¼
10. Clubbing, Koilonychias ¼
11. Thyroid (asking the patient to swallow) ½
12. Palpation of cervical lymph nodes ½
13. Feel the spine ¼
14. Pitting edema (2cm above ankle) ½

STATION 12 (Interactive)

Q1. This is a patient who has delivered a

baby 6 hours back. Now you are going
to discharge her. Counsel her about
postnatal care. 05
 Key: Station-12 (Interactive)
Key:
1. Introduction ½
2. Sympathetic approach ½
3. Explanation about
- Procedure done ½
- Care of episiotomy ½
4. Advice about nutrition ½
5. Explanation of medicines ½
6. Care of baby ½
7. Breastfeeding ½
8. Counselling about vaccination ½
9. Contraception 1
 Format of OSPE
MBBS Final Professional

PAEDIATRICS
OSPE Total Marks 70
Total Stations 15 (03 Rest Stations)
05 Minutes at Each Station

¾ Static Stations 08 (5 Marks at Each Stations)

08 Paediatrics according to the Breakup Provided Below
1. Neonatology (compulsory)
2. Respiratory (compulsory)
3. GIT (compulsory)
4. Nutrition (compulsory)
5. CVS / Hematology (either one or both in combination)
6. Nephrology / Endocrinology
(either one or both in combination)
7. CNS / Musculoskeletal / Genetics
(either one or both / all three in combination)
8. Preventive / Infectious Diseases
(either one or both in combination)

The 08 Static Stations will further be divided as:

1. Lab data x 2
2. Radiographs x 2
3. Pictures x 2
4. Instruments / Procedures x 2

¾ Interactive / 04 (Short Cases; at least TWO)

Observed Stations 02 stations on Clinical Skills
(08 Marks at each Station)
02 stations on Viva Voce based on Clinical Cases
(07 Marks at each Station)

Long Case Total Marks 20

10 Internal
10 External

Grand Total 90
 MODEL PAPER
OSPE (PAEDIATRICS)
FOR FINAL YEAR M.B.B.S.

Q1.

• Identify 3 physical signs in these pictures? [3]

• What is the diagnosis? [2]

Key
• Signs [3]
– Epicanthic folds
– Low set ears
– Simian crease
– Increased distance between 1st and 2nd toe
• Down syndrome [2]
 Q2.

• Give 3 radiological
findings? [3]
• What is the
diagnosis [2]

Key

• Radiological findings [3]

– Cupping
– Fraying
– Flaring
– Osteopenia
• Rickets [2]
 Q3

• Identify 2
radiological
abnormalities. [2]
• What is the
diagnosis? [1]
• Give 2 causes. [2]

Key

• 2 abnormalities [2]
– Bilateral opacities
– Obliteration of costophrenic angles
• Bilateral pleural effusion [1]
• Causes [2]
– Nephrotic syndrome
– CLD
– Connective tissue disorders
– CCF
– Tuberculosis
 Q4

This 5 year old boy

presented with easy
fatigability for the
last 2 years.
• Identify the physical
sign. [3]
• What is the likely
diagnosis? [2]

Key

• Bilateral ptosis [3]

• Myasthenia gravis [2]
 Q5

• What is the
diagnosis? [2]
• Give 3
complications. [3]

Key

• Meningomyelocele [2]
• Complications [3]
– Infections / meningitis
– Hydrocephalus
– Paralysis of lower limbs
– Bowel and bladder dysfunction
– Hip dislocation, foot deformities
 Q6

• Name the physical sign shown in these pictures? [3]

• What is the most likely diagnosis? [2]

Key

• Gower’s sign [3]

• Duchene muscular dystrophy [2]
 Q7
A 4 year old girl presents
with a 4 day history of • What is the most
increasing puffiness likely diagnosis? [2]
around the eye. • Give 3 further
Investigations are as investigations. [3]
follows:
– Hb 12.6 g/dl
– WBC 10,290/cumm
– Na 136 mmol/l
– K 4.7 mmol/l
– S/albumin 2.6 g%
– Urine
• pH 6.5

Key

• Nephrotic syndrome [2]

• Investigations [3]
– 24 hr urinary proteins
– Urinary protein creatinine ratio
– Serum cholestrol
– Serum C3 level
– Urea and creatinine
 Q8
A previously well child with one week history
of febrile illness, treated with injectable
ampicillin, presents with mild neck stiffness
and hemiplegia. CSF results are as follows:
– Proteins 80 mg/dl
– Sugar 40 mg/dl
– WBCs 300/cumm, lymphocyte 68%
– Gram staining and culture – ve
• What is the diagnosis? [2]
• Give 3 other complications. [3]

Key
• Partially treated bacterial meningitis [2]
• Complications: [3]
– Subdural effusion
– Brain abscess
– Cranial nerve palsies
– Seizures
– SIADH