1 / 31

OSCE

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

libra
Download Presentation

OSCE

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. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. OSCE Raika Jamali M.D. Gastroenterologist and hepatologist Sina hospital Tehran University of Medical Sciences

  2. Case 12 • Old man with acute knee arthritis. • You see the synovial fluid aspirate.

  3. What is the diagnosis? • Gouty arthritis • Pseudogout arthritis • Septic arthritis • Rheumatoid arthritis • What is the best treatment? • NSAID • Colshicin • Intraarticular steroid • Allopurinol

  4. Case 13 • A young boy with fever, dyspnea from 3 months ago. Anemia, splenomegaly, and systolic murmur in LSB.

  5. What do you see? • Splintar hemorrhage • Blue toe • Reynaud disease • What is the treatment? • Intravenous antibiotic • Echocardiography and anticoagulation • Calcium channel blocker

  6. 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.

  7. What is the diagnosis? • Crigler najjar syndrome • Gilbert disease • Favism • Spherocytosis • What is the best treatment? • Iron supplement • Folate supplement • Splenectomy and cholecystectomy

  8. Case 15 • Old man presented with severe anemia and huge splenomegaly.

  9. What is the diagnosis? • Multiple myeloma • Acute leukemia • Aplastic anemia • Hairy cell leukemia • What is the best treatment? • Chemotherapy • Bone marrow transplant • plasmapheresis

  10. Case 16 • Old alcoholic man presented with severe anemia and dementia. • You see his PBS.

  11. 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

  12. Case 17 • Bedridden patient Presented with distention and vomiting. You see the MRI of abdomen and serum protein electrophoresis.

  13. What is the diagnosis? • Carcinoid tumor • Adenocarcinoma of sigmoid • Fecal impaction • Adrenal mas • Inguinal hernia

  14. CASE 18 • A young girl with bulimia presented with abdominal pain.

  15. What do you see? • Gastroparesis • Gastric outlet obstruction • Pancreas divisum • pancreatic pseudocyst

  16. CASE 19

  17. What diagnosis does not match with the patient? • Chollangitis • Typhoid fever • Leptospirosis • Acute viral hepatitis • Pancreatitis

  18. 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.

  19. 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

  20. What do you do for ascitis? • Diagnostic paracentesis • Diuretic therapy • Plain abdominal radiograph • Echocardiography

  21. 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

  22. 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.

  23. 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 : +

  24. 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

  25. 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

  26. What is the best treatment strategy? Termination of pregnancy Ursodeoxycolic acid B6 infusion Steroid

  27. 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.

  28. 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

  29. 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.

  30. You see the serum protein electrophoresis in this patient.

  31. 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

More Related