slide1
Download
Skip this Video
Download Presentation
OSCE

Loading in 2 Seconds...

play fullscreen
1 / 31

OSCE - PowerPoint PPT Presentation


  • 214 Views
  • Uploaded on

OSCE. Raika Jamali M.D. Gastroenterologist and hepatologist Sina hospital Tehran University of Medical Sciences. Case 12. Old man with acute knee arthritis. You see the synovial fluid aspirate. . What is the diagnosis? Gouty arthritis Pseudogout arthritis Septic arthritis

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' OSCE' - libra


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

OSCE

Raika Jamali M.D.

Gastroenterologist and hepatologist

Sina hospital

Tehran University of Medical Sciences

case 12
Case 12
  • Old man with acute knee arthritis.
  • You see the synovial fluid aspirate.
slide3
What is the diagnosis?
    • Gouty arthritis
    • Pseudogout arthritis
    • Septic arthritis
    • Rheumatoid arthritis
  • What is the best treatment?
    • NSAID
    • Colshicin
    • Intraarticular steroid
    • Allopurinol
case 13
Case 13
  • A young boy with fever, dyspnea from 3 months ago. Anemia, splenomegaly, and systolic murmur in LSB.
slide5
What do you see?
    • Splintar hemorrhage
    • Blue toe
    • Reynaud disease
  • What is the treatment?
    • Intravenous antibiotic
    • Echocardiography and anticoagulation
    • Calcium channel blocker
case 14
Case 14
  • A young man with anemia and recurrent episodes of jaundice from childhood.
  • Mild splenomegaly was detected in ultrasonography. Hb: 12.5 mg /dl.
slide7
What is the diagnosis?
    • Crigler najjar syndrome
    • Gilbert disease
    • Favism
    • Spherocytosis
  • What is the best treatment?
    • Iron supplement
    • Folate supplement
    • Splenectomy and cholecystectomy
case 15
Case 15
  • Old man presented with severe anemia and huge splenomegaly.
slide9
What is the diagnosis?
    • Multiple myeloma
    • Acute leukemia
    • Aplastic anemia
    • Hairy cell leukemia
  • What is the best treatment?
    • Chemotherapy
    • Bone marrow transplant
    • plasmapheresis
case 16
Case 16
  • Old alcoholic man presented with severe anemia and dementia.
  • You see his PBS.
slide11
What is the diagnosis?
    • Sideroblastic anemia
    • Multiple myeloma
    • Megaloblastic anemia
  • What is the treatment?
    • B6 supplement
    • B12 supplement
    • B1 supplement
  • Which test is needed to discover the etiology?
    • Shilling test
    • Bone marrow biopsy
case 17
Case 17
  • Bedridden patient Presented with distention and vomiting. You see the MRI of abdomen and serum protein electrophoresis.
slide13
What is the diagnosis?
    • Carcinoid tumor
    • Adenocarcinoma of sigmoid
    • Fecal impaction
    • Adrenal mas
    • Inguinal hernia
case 18
CASE 18
  • A young girl with bulimia presented with abdominal pain.
slide15
What do you see?
    • Gastroparesis
    • Gastric outlet obstruction
    • Pancreas divisum
    • pancreatic pseudocyst
slide17
What diagnosis does not match with the patient?
    • Chollangitis
    • Typhoid fever
    • Leptospirosis
    • Acute viral hepatitis
    • Pancreatitis
case 20
CASE 20

A 27 yr pregnant woman admitted for evaluation of sustained RUQ pain.

She had bilious vomiting and skin rash.

There is recent history of coamoxiclave use for sinusitis.

physical examination conscious cooperative

T (oral) = 39.5°c

Icteric sclera.

She was not pale ,

No peripheral LNP,

Heart and lung are normal.

Abdomen:

Shifting dullness: positive,

Murphy sign positive

Liver span=14 cm,

Mild RUQ & epigastric tenderness,

No edema.

Physical examination:

Conscious, cooperative

slide20
What do you do for ascitis?
    • Diagnostic paracentesis
    • Diuretic therapy
    • Plain abdominal radiograph
    • Echocardiography
slide21
What diagnosis does not match the patient?
    • Acute collangitis
    • Budd chiari syndrome
    • Auto immune hepatitis
    • Acute fatty liver of pregnancy
    • Drug induced hepatitis
    • HELLP
    • Shock liver
case 21
Case21

A 27 yr pregnant woman admitted for evaluation of sustained RUQ pain.

Exam:

Ichteric sclera

Positive shifting dullness

Murphy sign negative

Liver span =14 cm,

Mild RUQ tenderness,

No edema.

lab findings
Lab findings:
  • Hb= 12.3 gr/dl, RBC=4x10 6 , MCV=84,

MCH, MCHC= normal

  • PLT=127000LDH: 1250
  • WBC= 10000 , poly=77% lymph=20%
  • PT=19, sec. INR=2.3, Ca=8.1
  • Alb=2.6 & total protein =3.9 g/dl
  • BUN, Creatinine = normal
  • U/A : normal
  • Viral markers: negative FANA : +
slide24
AST=194,1444 U/L

ALT= 328,1355 U/L

Alb ascitis: 0.6

WBC ascitis:80 (80% lymph)

T= 12,12.8

Bilirubin mg/dl , AlkPh = 769,623 U/L

D=5.8, 6.2

ultrasonography
Ultrasonography:
  • Liver with normal echo and size ,
  • Ascitis is seen in pelvic cavity,
  • Gall bladder wall thickness 6 mm,
  • Billiary ducts with normal diameter
  • normal portal and hepatic vein diameter ,
  • Spleen with normal echo and size .
  • No thrombosis in hepatic, splenic and portal veins
slide26
What is the best treatment strategy?

Termination of pregnancy

Ursodeoxycolic acid

B6 infusion

Steroid

case 22
Case22

A 37 yr woman admitted for evaluation of sustained RUQ pain and fatigue.

Exam:

Ichteric sclera

Positive shifting dullness

Murphy sign negative

Liver span =14 cm,

Mild RUQ tenderness,

No edema.

lab findings1
Labfindings
  • Hb= 9.4 gr/dl, RBC=5.1x10 6 , MCV=102,

MCH, MCHC= normal , PLT=117000 .

  • WBC= 7100 , poly=68% lymph=27%

ESR=22 , PT=32.5 , sec. INR=5.1, Ca=8.1

Albumin = 3.4 & total protein = 6.7 g/dl

  • BUN, Creatinine = normal

24hr Urinary protein= normal

slide29
AST=87 U/L

ALT= 123 U/L

T= 4.4

Bilirubin mg/dl , AlkPh = 215 (NL)

D=1.8

US: Heterogenous Liver 110mm , Mild

Ascites, normal GB, normal portal and hepatic vein , spleen=110mm.

slide31

What is your diagnosis ?

    • Autoimmune hepatitis
    • Amyloidosis
    • Multiple myeloma
    • Common variable immune deficiency
  • What is your treatment?
    • Steroid
    • Bone marrow transplant
    • Gamma globulin infusion monthly
ad