5th medicine OSCE Collection

By: 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 nails Causes 1. vasculitis trauma 2. Infective endocarditis a. the question was mcqs on the lesion's name? b. in which disease ? infective endocarditis www.wss4m.com

hands with nodules at DIP joints (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 nail and skin. Associated with (but not pathognomonic for) COPD, cystic fibrosis, hypoxia, and a number of other disease states.

Causes 1. Infective endocarditis 2. lung abscess 3. lung carcinoma 4. 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 the abnormalities in the hand:

Drum stick appearance (3rd degree clubbing of fingers). Loss of angle. Cyanosis. Broncheictasis. Infective indocarditis. Liver failure (cirrhosis). IBD. Brochogenic CA. Congenital cyanotic heart disease.

Differential diagnosis:

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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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Cyanosis
Blue discolariation of skin & mucus membrane, Due to Deoxygenated Hb in blood vessels Prephral All causes of central will cause prephral Cold Dec cardiac output Vessels obstruction Central COPD Pulmonary Embolism Cyanotic congenital Heart disease

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nicotine staining

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

Anemia (iron deficient) Bronchiectasis - Diabetes mellitus

- lichen plannus - psoriasis

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caused by fungal inf (dermatophytes)

Onychomycosis

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onychomycosis (fungal infection)

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paronychia Infection of skin adjacent to nail of middle finger

caused by biting, either bacterial,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,EBV And associated with INFLAMMATORY BOWEL SYNDROME
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Thrombocytopenic purpura

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 diseaseswww.wss4m.com and hemophilia

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
localized or diffuse inflammation of connective tissue red, hot, and tender Caused Group A Streptococcus and Staphylococcus Ddx: Gas Gangrene- Insect Bites burn

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Clinical Osteomyelitis

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gangrene of toes

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Lymphedema, Left Leg

Caused by: Infections with filariasis Injury Radiation therapy cellulitis Surgery Tumors

blockage of the lymph vessels that drain fluid from tissues throughout the body and allow immune cells to travel where they are needed

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Massive pitting edema

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 www.wss4m.com

Neuropathic Ulcer in Patient with diabetic neuropathy

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Head & neck

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icters

Yellow discoloration of the sclera occurs in tissue containing elastin causes 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 cervical lymphadenopathy

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, 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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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 www.wss4m.com

VITILIGO

Face of female with depigmented areas a- describe what you see ( mention clinical diagnosis ) b- mention 4 associated diseases
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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. www.wss4m.com

High arched palate.

Patient unable to completely close left upper eyelid 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 www.wss4m.com

Chest & abdomen

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Describe the abnormalities in the patient:

Kyphosis at the thoracic region. Cachexia. Anteroposterior diameter (barrel chest). COPD. Asthma. Ankylosing spondylitis. CXR. ABG. Sputum analysis.

Differential diagnosis:

Investigations:

www.wss4m.com ECG (corpulmonale).

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 Xray:

Opacification in the left side. Obliteration of costodiaphragmatic recess. Collapse of left lung. TB. Pleural effusion. Pneumonia. www.wss4m.com Bronchogenic CA.

Differential diagnosis:

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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Gynecomastia

patient with bilateral gynecomastia:

describe the abnormality? Give causes for the condition? give 3 related significant LAB investigations 1- mamographyCA www.wss4m.com

Caput Medusae

Dilated, 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) murmur

It can be: mitral regurgitation , tricuspid regrgitation , ventricular septal defect or aortopulmonary shunts. Increased its intesity by hand grip
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systolic ejection (crescendodecrescendo 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
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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 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 sarcoma Lichen planus Psoriasis
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patient with acromegaly:

a-Select the appropriate diagnosis: I-Hyperthyroidism. III-Hypopitutarisim. II-Acromegaly. IV-Hypothyroidism.

b-Mention 2 relevant investigations.

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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 www.wss4m.com

syphilitic ulcer

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jaundice

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The end
Dont forget me from your praying Your sister, Fatooma

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