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OSCE (Part one) Answers. Raika Jamali M.D. Gastroenterologist and hepatologist Sina hospital Tehran University of Medical Sciences. CASE 1. Mention to the air and the leak of contrast material in the mediastinum . The diagnosis is esophageal rupture.
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OSCE (Part one)Answers RaikaJamali M.D. Gastroenterologist and hepatologist Sina hospital Tehran University of Medical Sciences
CASE 1 • Mention to the air and the leak of contrast material in the mediastinum. • The diagnosis is esophageal rupture. • First step in the management of patient is the evaluation of patient oxygenation and blood pressure. • Then the patient should be NPO. • Wide spectrum antibiotic administration and urgent surgical consult is needed. • Nasogastric tube insertion and endoscopy is not recommended in this case. • The best management strategy is early surgical intervention.
Case 2 • The typical esophageal web in the upper third of esophagus. • It is frequently seen in middle age woman with iron deficiency anemia.
Case 3 • The tall T wave with ST segment elevation in inferior leads are in favor of acute inferior wall MI. • The best management strategy that increases the patients survival is coronary reperfusion by PCI method.
Case 4 • Mention to the mediastinal widening in the first CXR. • Pulmonary edema is seen in the second CXR, most probably due to the extension of dissection to the base of coronary arteries causing ischemia and concomitant heart failure. • The best strategy is reducing the risk of further ischemia by surgical intervantion.
Case 5 • Tall T wave in leads V1 and V2 are clues to true posterior wall MI. • Notice to the clear lung fields and shock in this patient. • The patient may have right ventricular ischemia as well. • Evaluation of right pericordial and posterior leads are recommended. • Diuretic therapy and nitroglycerin is not recommended. • The best initial management is adequate hydration.
Case 6 • Mention to the stenotic areas in left common carotid and brachiocephalic arteries. • The typical signs of takayasovasculitis (pulseless syndrome) is seen in the CT angiography of patient. • The best treatment is steroid administration. • Surgical interventions and angioplastic methods for management of the stenotic areas are recommended if the initial treatment with steroid fails.
Case 7 • Mention to the thrombosis in right renal vein. • The best treatment is anticoagulation therapy. • The duration of treatment depends on the etiology of hypercoagulability state.
Case 8 • Mention to the schistocyte in the PBS indicative of microangiopatic hemolytic anemia. • This might be seen in all of the below conditions: • Hemolytic uremic syndrome • Disseminated intravascular coagulation • Thrombotic thrombocytopenic purpura
Case 9 • The patient has pneumonia. Mention to the increase of acute phase reactants in serum protein electrophoresis. • Toxic granulation is seen in neutrophils.
Case 10 • You see sickle cell in PBS. • In hemolytic crisis all of the below treatment options might be considered: • Hydration • Blood exchange • Control of infection and hypoxia • The best treatment strategy is bone marrow transplantation
Case 11 • Mention to the mass in the superior mediastinum (above the level of carina). • Ectopic thyroid, Thymus, Teratoma are the differential diagnosis of the mass in superior mediastinum.