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 thumb the Linear hmg. Is parallel to the long axis of nailsCauses1. vasculitis trauma 2. Infective endocarditisa. the question was mcqs on the lesion's name? b. in which disease ? infective endocarditis

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hands with nodules at DIP joints (heberden's nodes)what's the Dx.? Osteoarthritiswhat's the best investigation ?(ESR , X-rays , ANA , CRP )

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Swan neck deformityDescribe 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 clubbingFattened appearance of distal phalynx with loss of angle between proximal edge of nail and skin. Associated with (but not pathognomonic for) COPD, cystic fibrosis, hypoxia, and a number of other disease states. Causes1. Infective endocarditis2. lung abscess 3. lung carcinoma 4. Bronchectaisis 5. chronic liver diseaseGrades 1. loss of angle 2. loss of angle + fluctuation 3. Drum stick appearanc 4.Hypertrophic pulmonary osteoarthropathyproliferation of tissue

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describe the abnormalities in the hand:Drum stick appearance (3rd degree clubbing of fingers).Loss of angle.Cyanosis.Differential diagnosis:Broncheictasis.Infective indocarditis.Liver failure (cirrhosis).IBD.Brochogenic CA.Congenital cyanotic heart disease.

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Ulnar deviationDescribe.Ulnar deviation of the fingers, wasting of the small muscles of the hands, swelling of the MCP jointsPicture 3.3 page 103 Color Atlas and Text of Clinical Medicine, 3rd edition.What is the most likely diagnosis?chronic rheumatoid arthritisacute gouty arthritischronic tophaceaous gout.

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Cyanosis

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nicotine staining

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onycholysis (separation of nail from underlying bed , often due to onychomycosis

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onychomycosis

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onychomycosis (fungal infection)

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paronychia Infection of skin adjacent to nail of middle finger

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Rt.upper extremity DVT

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Lower limb

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Erythema nodusaDescribe the abnormality on the projected lower limbs?Mention 4 causes?Sterptococcus b infection,TB and leprosyAnd associated with INFLAMMATORY BOWEL SYNDROME

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Thrombocytopenic purpurahmg into the skincauses: 1-increase platelets destruction as, in :a-immuno thrompocytopenic pupurab-loss of blood 2- decrease in platelet formation as Bone marrow Aplasia *found in liver diseases and hemophilia

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acute arterial insufficiency

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chronic arterial insufficiency with ulcers

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assymetric leg, swelling secondary to DVT in Rt.leg

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cellulitis

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Clinical Osteomyelitis

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gangrene of toes

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Lymphedema, Left Leg

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Massive pitting edemaSwelling in the limb and if you press the swelling there will be slor & RedillCauses:1. right sided heart failure 2. hepatic cirrhosis3. GI malabsorption 4-nephrotic syndromepitting unilateral: lower limb edema:DVT Compression on large vans by tumor or enlarged L.N

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Neuropathic Ulcer in Patient with diabetic neuropathy

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Head & neck

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ictersYellow discoloration of the sclera occurs in tissue containing elastin causes 1 . hemolysis 2. obstructive Jaundicewhen Billirubin level exceed 2-5 mg/dl

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butterfly rashdescribe the lesionwhat's the likely Dx? SLEFeatures:1.moon face 2.vasalitis4. Alopecia3. pallor

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upper anterior cervical lymphadenopathypatient with enlarged upper anterior cervical LN:describe the abnormality?Mention 3 imp. specific investigations?

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eyes in thyrotxicosisdescribe the abnormalities?1-Lid retraction or lid lag, allows the sclera to be seen above the cornea. 2-There is also soft tissue inflammation with forward displacement of the eye (proptosis) and myopathy of the extraocular muscles. which sign of the following can be found:(cold & dry skin , bradycardia , constipation , fine tremor)

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Exophthalmusprotrusion of the eye ball from the orbitsComplications: 1.chemosis 2. conjunctivitis 3. corneal ulcer 4.optic atrophy 5. opthalmoplegiaCauses: 2. Graves disease1. tumor of the orbit

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ErysipelasDescribe.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?ErysipelasCellulitisFrunculosis

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VITILIGO Face of female with depigmented areas a- describe what you see ( mention clinical diagnosis ) b- mention 4 associated diseases

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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 syndromeNoonan's syndromeDown's syndromeKlifenter's syndrome.

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Patient unable to completely close left upper eyelid due to peripheral CN 7 dysfunction3 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 palsyLMN OF LEFT 7TH CRANIAL NERVE

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Chest & abdomen

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Describe the abnormalities in the patient:Kyphosis at the thoracic region.Cachexia. Anteroposterior diameter (barrel chest).Differential diagnosis:COPD.Asthma.Ankylosing spondylitis.Investigations:CXR.ABG.Sputum analysis.ECG (corpulmonale).

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Patient with emphysema bending over in Tri-Pod Position

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Scoliosis , Condition where the 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 view a- describe what you see ( you have to write clinical term ) b- mention 5 related causes

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hepatomegaly

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Markedly enlarged gall bladder

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Gynecomastiapatient with bilateral gynecomastia:describe the abnormality?Give causes for the condition?give 3 related significant LAB investigations

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Caput MedusaeDilated, tortuous, superficial veins radiating upwards from the umbilicus. Portal hypertension has caused recanalization of the umbilical vein, 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 umbilicle a- write 6 findings b- give 3 related significant LAB investigations

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COMPLETE VILLOUS ATROPHY (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 )

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PA view of chest x-ray for 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, 3rd edition"

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Pansystolic (holosystolic) murmurIt can be: mitral regurgitation , tricuspid regrgitation , ventricular septal defect or aortopulmonary shunts.Increased its intesity by hand grip

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systolic ejection (crescendo-decrescendo or diamond shape) murmurIt can be: aortic stenosis , pulmonary stenosis or hypertrophic cardiomyopathy.

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Late systolic murmurIt can be : mitral valve prolapse

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Early diastolic murmurIt can be: aortic regurgitation or pulmonary regurgitation.

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Mid diastolic murmurIt can be: mitral stenosis , tricuspid stenosis or atrial myxomaincreased with exercise

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Late diastolic (presystolic) murmurIt 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 perianal erythematous 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 sarcomaLichen planusPsoriasis

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patient with acromegaly:

a-Select the appropriate diagnosis:I-Hyperthyroidism. II-Acromegaly.III-Hypopitutarisim. IV-Hypothyroidism.b-Mention 2 relevant investigations.

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Spider nevinumerous small vessels look like spider legs distributed over the chestfounding 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

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jaundice

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The endDont forget me from your prayingYour sister,Fatooma

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