5th Medicine O0SCE Collection 5

7/31/2019 5th Medicine O0SCE Collection 5

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5th medicine OSCE

CollectionBy: Fatimah Al-Ibrahim


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Upper limb


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splinter hemorrhage

small linear splinter hemorrhage is seen here subungually on the left thumbthe Linear hmg. Is parallel to the long axis of nails

Causes1. vasculitis trauma

2. Infective endocarditis a. the question was mcqs on the lesion's name? b. in which disease ? infective endocarditis


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hands with nodules at DIPjoints (heberden's

nodes)

what's the Dx.? Osteoarthritis

what's the best investigation ? (ESR , X-rays , ANA , CRP )


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Swan neck deformity Describe the

abnormalities of the

fingers:

Swan neck deformity(flexion of the distal &

extension of the

proximal

interphalangeal joints). Diagnosis:

Rheumatoid arthritis.


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Fingers clubbing Fattened appearance of distal phalynx with loss of angle between proximal

edge of nailand skin. Associated with (but not pathognomonic for) COPD, cysticfibrosis, hypoxia, and a numberof other disease states.

Causes1. Infective endocarditis2. lung abscess 3. lung carcinoma4. Bronchectaisis 5. chronic liver disease Grades 1. loss of angle

2. loss of angle + fluctuation 3. Drum stick appearanc 4.Hypertrophic pulmonary osteoarthropathy proliferation of tissue


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describe theabnormalities in thehand: Drum stick appearance

(3rd degree clubbing offingers).

Loss of angle. Cyanosis.

Differential diagnosis: Broncheictasis. Infective indocarditis. Liver failure (cirrhosis). IBD. Brochogenic CA. Congenital cyanotic

heart disease.



Ulnar deviation

Describe. Ulnar deviation of the fingers, wasting of the small muscles of the hands, swelling of

the MCP joints

Picture 3.3 page 103 Color Atlas and Text of Clinical Medicine, 3rd edition. What is the most likely diagnosis? chronic rheumatoid arthritis acute gouty arthritis chronic tophaceaous gout.



CyanosisBlue discolariation of skin & mucus membrane, Due

to Deoxygenated Hb in blood vessels

Prephral Central

All causes of central will cause prephralCold

Dec cardiac outputVessels obstruction

COPDPulmonary Embolism

Cyanotic congenital Heart disease


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nicotine staining


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nail from underlying bed ,

often due to onychomycosis

Anemia (iron deficient) Bronchiectasis - Diabetes mellitus- lichen plannus - psoriasis


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Onychomycosiscaused by fungal inf (dermatophytes)


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onychomycosis

(fungal infection)


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adjacent to nail of middlefinger

causedby biting, eitherbacterial,fungal, candida


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Rt.upper extremity

DVT


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Lower limb


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Erythema nodusa

Describe the

abnormality on the

projected lower

limbs? Mention 4 causes?Sterptococcus b infection,TB

and leprosy,EBVAnd associated with

INFLAMMATORY BOWEL

SYNDROME


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Thrombocytopenicpurpura

hmg into the skin

causes:

1-increase platelets destruction as, in :a-immuno thrompocytopenic pupura

b-loss of blood

2- decrease in platelet formation as Bone marrow Aplasia

*found in liver diseases and hemophilia


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acute arterialinsufficiency


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chronic arterialinsufficiency with ulcers


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assymetric leg, swellingsecondary to DVT in Rt.leg


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cellulitis

localized or diffuse inflammation ofconnectivetissue

red, hot, and tender

Caused Group AStreptococcus andStaphylococcus

Ddx: GasGangrene- InsectBites burn

li i l
http://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Connective_tissuehttp://en.wikipedia.org/wiki/Connective_tissuehttp://en.wikipedia.org/wiki/Group_A_streptococcal_infectionhttp://en.wikipedia.org/wiki/Streptococcushttp://en.wikipedia.org/wiki/Staphylococcushttp://emedicine.medscape.com/article/782709-overviewhttp://emedicine.medscape.com/article/782709-overviewhttp://emedicine.medscape.com/article/769067-overviewhttp://emedicine.medscape.com/article/769067-overviewhttp://emedicine.medscape.com/article/769067-overviewhttp://emedicine.medscape.com/article/769067-overviewhttp://emedicine.medscape.com/article/782709-overviewhttp://emedicine.medscape.com/article/782709-overviewhttp://en.wikipedia.org/wiki/Staphylococcushttp://en.wikipedia.org/wiki/Streptococcushttp://en.wikipedia.org/wiki/Group_A_streptococcal_infectionhttp://en.wikipedia.org/wiki/Connective_tissuehttp://en.wikipedia.org/wiki/Connective_tissuehttp://en.wikipedia.org/wiki/Inflammation


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ClinicalOsteomyelitis


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gangrene of toes

L h d L f


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Lymphedema, LeftLeg

blockage of the lymph vessels that drainfluid from tissues throughout the body andallow immune cells to travel where they areneeded

Caused by: Infections with filariasis

InjuryRadiation therapycellulitisSurgeryTumors

M i i i
http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A001918/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000855/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A001310/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A001310/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A000855/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A001918/


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Massive pittingedema

Swelling in the limb and if you press the swelling there will be slor &Redill

Causes:1. right sided heart failure 2. hepatic cirrhosis

3. GI malabsorption 4-nephrotic syndrome

pitting unilateral: lower limb edema:

DVT Compression on large vans by tumor or enlarged L.N

europa c cer n


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europa c cer nPatient with diabetic

neuropathy


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Head &

neck


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icters

Yellow discoloration of the sclera

occurs in tissue containing elastincauses 1 . hemolysis 2. obstructive Jaundice

when Billirubin level exceed 2-5 mg/dl


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butterfly rash

describe the lesion what's the likely Dx? SLE

Features:

1.Artheritis 2.vasalitis

4. Alopecia 5.photosensitivity 3. oral ulcers


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upper anterior cervicallymphadenopathy

patient with enlarged upper anterior cervical

LN: describe the abnormality? Mention 3 imp. specific investigations?


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eyes in thyrotxicosis describe the abnormalities?

1-Lid retraction or lid lag, allowsthe sclera to be seen abovethe cornea.

2-There is also soft tissue

inflammation with forwarddisplacement of the eye(proptosis) and myopathy ofthe extraocular muscles.

which sign of the following

can be found:(cold & dry skin , bradycardia ,

constipation , fine tremor)


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Exophthalmus

protrusion of the eye ball from the orbits

Complications:

1.chemosis 2. conjunctivitis 3. corneal ulcer

4.optic atrophy 5. opthalmoplegia

Causes:

2. Graves disease 1. tumor of the orbit


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Erysipelas

Describe. Well demarcated, raised erythematous lesion on the right side of the face.

Picture 1.85 page 26 Color Atlas and Text

of Clinical Medicine, 3rd edition. What is the diagnosis? Erysipelas Cellulitis Frunculosis


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VITILIGO

Face of female with depigmented areas

a- describe what you see ( mention clinicaldiagnosis )

b- mention 4 associated diseases

High arched


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High arched

palate. Describe the

abnormality. High arched palate. Picture 3.115 page 134 Color Atlas and Text

of Clinical Medicine,3rd edition.

What is the diagnosis? Marfan's syndrome Noonan's syndrome Down's syndrome Klifenter's syndrome.


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completely close left uppereyelid due to peripheral CN

7 dysfunction

3 ABNORMALITIES: 1-loss of forehead wrinkle

2-LOSS ability to close eye 3-decreased naso-labial fold prominence on left 4-LOSS ability to raise corner of mouth CLINICAL IMPRESSION: facial palsy

LMN OF LEFT 7TH CRANIAL NERVE


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Chest &

abdomen


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Describe the abnormalitiesin the patient:

Kyphosis at the thoracicregion.

Cachexia.

Anteroposterior diameter(barrel chest).

Differential diagnosis: COPD. Asthma.

Ankylosing spondylitis. Investigations:

CXR. ABG. Sputum analysis.

ECG (corpulmonale).

Patient with emphysema


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Patient with emphysemabending over in Tri-Pod

Position

Scoliosis Condition where


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Scoliosis , Condition wherethe spine is curved to

either the left or right


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describe the

abnormalities in the X-

ray: Opacification in the

left side. Obliteration of

costodiaphragmatic

recess.

Collapse of left lung.

Differential diagnosis: TB.

Pleural effusion.

Pneumonia.

Bronchogenic CA.


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Describe: PA chest X-ray with white opacity in the right

middle zone. What is the most likely diagnosis? a-Lung cancer of the middle lobe.? b- bronchoneumonia of the middle lobe ?


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opacity at the left upper lobe on PA CXR: describe the abnormality? Give 3 D.D.s ? Give 3 investigations?


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ASCITIS

( from lecture of progressive liver dis. , 6th yr )Thin African man , standing , with severe

distended abdomen, lateral side viewa- describe what you see ( you have to writeclinical term )b- mention 5 related causes


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hepatomegaly

M k dl l d ll


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Markedly enlarged gallbladder


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Gynecomastia

patient with bilateral gynecomastia:

describe the abnormality? Give causes for the condition? give 3 related significant LAB investigations

1- mamographyCA

-


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Caput Medusae

Dilated, tortuous, superficial veins radiating upwardsfrom the umbilicus. Portal

hypertension has caused recanalization of the umbilicalvein, allowing the formation of this collateral

DDx :inferior vena cava obstruction


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Gynacomestia

, Bandage for liver biopsy , wt. loss ......etc( from lecture of progressive liver dis. , 6th yr )

2 men exposed to the level of the umbiliclea- write 6 findingsb- give 3 related significant LAB investigations

COMPLETE VILLOUS


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COMPLETE VILLOUSATROPHY

(lecture of malabsorption , 5th yr )

2 histological slidses of intestin villi one is normal

& the other there is atrophy

a- describe what you see .

b- give the most common diagnosis ( Ceoliac dis )

v ew o c es x-ray


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v ew o c es x-rayfor bronchogenic

carcinoma

a-Describe the abnormalities.

b-Give differential diagnosis.

c-mention relevant investigations.

This Picture is NO. 4.30 page 155 from" Color

Atlas and Text of Clinical Medicine, 3rdedition"


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Pansystolic (holosystolic) murmur

It can be: mitral regurgitation , tricuspid

regrgitation , ventricular septal defect oraortopulmonary shunts. Increased its intesity by hand grip

sys o c e ec on crescen o-


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sys o c e ec on crescen odecrescendo or diamond shape)

murmur

It can be: aortic stenosis , pulmonary stenosis

or hypertrophic cardiomyopathy.


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Late systolic murmur

It can be : mitral valve prolapse


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Early diastolic murmur

It can be: aortic regurgitation or pulmonary

regurgitation.


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Mid diastolic murmur

It can be: mitral stenosis , tricuspid stenosis

or atrial myxoma increased with exercise

Late diastolic (presystolic)


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Late diastolic (presystolic)

murmur

It can be: mitral stenosis , tricuspid stenosis

or atrial myxoma.


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Others


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Herpes simplex.

describe main

abnormality in

perianal region:

Multiple perianalerythematous

lesions surrounded

by rash. Diagnosis:

Herpes simplex.


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Describe the lesion. Picture 1.26 page 8 Color Atlas and Text of Clinical Medicine, 3rd

edition.

What is the diagnosis? Kaposi's sarcoma Lichen planus Psoriasis


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acromegaly:

a-Select the appropriate diagnosis:

I-Hyperthyroidism. II-Acromegaly.

III-Hypopitutarisim. IV-Hypothyroidism. b-Mention 2 relevant investigations.

id i


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Spider nevi

numerous small vessels look like spider legs distributed over the chest

founding Neck, arm, chest.

causes 1. liver cirrhosis 2. viral hepatitis 3. pregnancy

DDX1. Campbell de Morgan bodies 2. hereditary Hmg telangectaisia

*spider nevi opposite venous stars


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syphilitic ulcer

j di


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jaundice


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Th d


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The end Dont forget mefrom your praying

Your sister,

Fatooma

5th Medicine O0SCE Collection 5

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