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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.
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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.
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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/Inflammation7/31/2019 5th Medicine O0SCE Collection 5
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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/A001918/7/31/2019 5th Medicine O0SCE Collection 5
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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