medicine osce latest

8/17/2019 Medicine OSCE Latest

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MEDICINE OSCE

AL 2003 Batch2008


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Common areas

Haematology Anaemia Clotting disoders

Blood grouping CVS

ECG Mx of MI

RS CXR L! ABG


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Common areas

CNS CSF report

CT

GUT UFR

Imaging

RFT


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Common areas

Clinical signs Photo graphs-patients ,fundus,hand,eye,nail, Characteristic facies ermatological conditions Clinical features in te!t True " False

#thers Specimen collection $ %ottles e&uipments Clinical stations " clinical inter'ie(


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Haematology Slides

Niroshan_loku@ yahoo.com


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Anaemia


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Microcytic anaemia


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Sickle cell anaemia


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Hereditary Sherocytosis


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Hereditary sp"ero#ytosis

Autosomal dominant

Anaemia$%aundi#e$"epatomegaly

In#reased osmoti# fragility


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!sm. "ragility test


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Macrocytic anaemia


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Microangioathic Haemolytic Anaemia


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Leu&aemias


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ALL. Bone marrow.Complete replacement by small/medium sized blasts with scanty cytoplasm



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AML Myeloblast cells



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AML


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#LLNumerous Mature lymphocytes, few smear cells


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#LL


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#MLNiroshan_loku@ yahoo.com


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'umerous

granulo#yti# #ells

At different stages ofdifferentiation(


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MM $ %lasma cells


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MM $ Skull & 'ones


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Serum %rotein (lectrohoresis ) monoclonal gammoathy


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Salah BMA needle


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*amshidi BM +rehine Biosy needle


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,eed)Stern'erg cell ) HL



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,S cells ) HL


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Other Slides


A thi "il " 22 ld l h lid i i


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A thin "ilm "rom a 22)year)old male holidaying inAnuradhaura one month re-iously. ntermittent "e-ers

since returning.

/e-eloing and thick signet1 ring "orms(nlar ed red cells %- malaria


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Numerous "ine ring "orms


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%" malaria ring "orms sausage shaed gametocytes


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Malaria

)n#ompli#ated *ral C"loro+uine

Compli#ated IV +uinine


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Instruments



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A'rahams %leural Biosy needle


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%/ catheter


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/es"errio4amine n"usion %um)50mg & kg&d o-er 6hrs er day ara

um'ilically


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ECG



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http://upload.wikimedia.org/wikipedia/commons/9/96/ECG_Paper_v2.svg


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http://upload.wikimedia.org/wikipedia/commons/9/96/ECG_Paper_v2.svg


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ECG

RA!E

RH,!HM - REG)LAR . IRREG)LAR

CAR/IAC AXIS

C*'/)C!I*' I'!ERVALS - 0R$1RS

AB'*RMALI!, I' - 0$1RS$S!$!


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RA!E

Heart rate 2 344.R5R inter6al


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Heart rate

R5R I'!ERVAL 2 7 large s+uare

So HR 2344.7 2 37.min


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Normal (#7


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R"yt"m a8normalities


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V! 9 SV!

1RS #omplx : 4(;< s V!

1RS #omplx = 4(;< s SV!


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8+


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8+


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60


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Atrial fi8rillation - #auses>5 MV disease $ IH/ 9 #ardiomyopat"y$ !"yrotoxi#osis$ LA fi8rillationRx>5 /igoxin to #ontrol Ventri rate$ ?arfarin to pre6ent t"rom8oem8olism


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Atrial flutter


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@

HEAR! BL*C


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st degree HB


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Mo'it9 :enke'ach1


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Mo'it9


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68 2;< 'lock


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3rd

degree heart 'lock & comlete heart 'lock


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3rd degree heart 'lock & comlete heart 'lock

Atrio entricular dissociation. Atrium ! entricle hae

separate rhythms


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<

Bundle 8ran#" 8lo#&


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7"

RBBB

V; M Da6e . RSR

V@ deep S Da6e


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7#

LBBB

V@ M Da6e . RSR

V; deep S Da6e


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,BBB


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LBBB


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AM in the setting o" LBBB


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7

AXIS /EVIA!I*'


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7$

AXIS /EVIA!I*'

RA/ LIII : L II : LI

RVH$RBBB

LA/

LI : LII : LIII LVH$LBBB


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80

%A&


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8'

(A&


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LA/


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,A/


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8#


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86


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LA/


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7F

H,0ER!R*0H, * HEAR!


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$0

HEAR! CHAMBERS 5 H,0ER!R*0H,

LVH !all R Da6e in V@ 9 deep S Da6e in V;

V@ R Da6e :


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$'

HEAR! CHAMBERS 5 H,0ER!R*0H,

RVH !all R Da6e in V; 9 deep S Da6e in V@ RA/

RAH 0 Da6e : 3mm 0 pulmonale

LAH 0 mitrale


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$) (*+


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LVH


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RA H,0ER!R*0H, - 0 0)LM*'ALE


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RAH


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F

ISCHAEMIC CHA'GES I' ECG


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$8

Leads 9 is#"aemi# area

Anterior MI V; to V

Lateral MI V to V@ 9 aVL$ LI

Inferior MI LII$LIII(aV

Anterolateral V


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Anterior M


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Anterior M


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n"erior M


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;4

*!HER CHA'GES I' ECG


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Hyerkalaemia


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Hyerkalaemia


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Chest X-Rays



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'')


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L&leural e""usion&haemothora4


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,&%neumothora4


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,&+ension neumothra4


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L& yoneumothora4

http://www.brooksidepress.org/Products/OBGYN_101/MyDocuments4/Xray/Chest/CONSOLIDRULPA.JPG


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,&uer lo'e consolidation

http://www.brooksidepress.org/Products/OBGYN_101/MyDocuments4/Xray/Chest/CONSOLIDRULLAT.JPGhttp://www.brooksidepress.org/Products/OBGYN_101/MyDocuments4/Xray/Chest/CONSOLIDRULPA.JPG


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=i'rosis.


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Bronchiectasis


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,ome consolidation in the ri-ht upper lobe

with a caity arrowed typical o1

secondary tuberculosis


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#a-ity Lunga'scess1

A well2

de1ined

rounded in (

upper lobe

white

arrow.3'/)

o1 the caityis 1illed with

1luid and air

blac4

arrow.


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#a-ity Lung a'scess1

(ateral iew he

caity in the le1t

upper lobe isdepicted with the

air21luid inter1ace

arrow.


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ell2de1ined so1t

tissue mass in the

ri-ht upper zone anda smaller mass

medial to it. here is no bone destruction and no

mediastinal

lymphadenopathy.

coin & cannon 'allshado>s


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Multile lung mets

,eeral

di11erently2

sized mostly

round shadows

with the

intensity o1 so1t

tissue in both

lun-s. Most o1them are in the

lower lobes


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Milliary shado>s


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Milliary shado>s


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Hilar lyhadenoathy


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Lymhoma


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%ericardial calci"ication

,ead; causes "or cardiomegaly

http://www.aic.cuhk.edu.hk/web8/Hi%20res/0025%20Gas%20under%20diaphragm.jpg


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http://www.aic.cuhk.edu.hk/web8/Hi%20res/0025%20Gas%20under%20diaphragm.jpg


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C T SCNS



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(/H


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Acute S/H


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B&L chronic S/H

http://www.aic.cuhk.edu.hk/web8/Hi%20res/0256%20Chronic%20subdural.jpghttp://images.google.lk/imgres?imgurl=http://www.ne.jp/asahi/ueda/stroke/ct-hemo-put.jpg&imgrefurl=http://www.ne.jp/asahi/ueda/stroke/ich.html&h=593&w=465&sz=36&tbnid=FuRxC907f33GqM:&tbnh=133&tbnw=104&hl=en&start=1&prev=/images%3Fq%3DICH%2Bct%26svnum%3D10


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#H

http://images.google.lk/imgres?imgurl=http://www.ne.jp/asahi/ueda/stroke/ct-hemo-put.jpg&imgrefurl=http://www.ne.jp/asahi/ueda/stroke/ich.html&h=593&w=465&sz=36&tbnid=FuRxC907f33GqM:&tbnh=133&tbnw=104&hl=en&start=1&prev=/images%3Fq%3DICH%2Bct%26svnum%3D10


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SAH


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M#A in"arct


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,&Anterior middle cere'ralin"arct


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'#0


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#ere'ral a'scess%in- enhancement in capsule

o1 a bacterial abscess


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ntracranial other S!Ls eg; ,& Acoustic Neuroma

A round mass o1 mied si-nal in

%/C9 an-le. :t causes sli-ht

displacement o1 the brain stem

medially and etends into the

auditory canal on the ri-ht. he ed-e

o1 the mass ma4es an acute an-le

with the petrous bone.


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M(NN7!MA in #ontrast)enhanced #+


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Other In!esti"ations



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,ugger *ersy Sine


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8? ) Hydronehrosis


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Bone S#ans


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Bone S#ans


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M, scan $ 'rain


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#arotid angiogram


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8& scan ) %(

/!0A s#an&iethelene riamine 9enta Acetic acid


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&iethelene2riamine29enta2Acetic acid

Althou-h the 4idneys are the same sizethe center o1 the %/ 4idney has areas o1

decreased radioactiity; the hilum o1 the

%/4idney is li-hter -rey. his indicates that

the 4idney has hydronephrosis; the pelis

is so lar-e that the renal parenchyma is

stretched oer it.

(e1t 4idneys show pea4 concentration

computer -enerated cure at about 52

7min. (/4idney promptly drains cure

drops rapidly. he computer cure o1 theri-ht 4idney shows a much more -radual

rise and it continues to rise almost to the

end o1 the study. his shows that the ri-ht

4idney doesn?.


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Normal /MSA renal study.

Normal right kidney >ith ossi'le scar inuer ole and scarred le"t kidney at uer

ole middle and lo>er ole.


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/MSA ) HSC


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'56

rterial #loodGas analysis

ABG Reference Values


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@ p+ 7."5 2 7.#5

@ +C?" ))2)6 mmol/( )#

@ pC?) "52#5 mm+- #0 #.72649a

@ p?) 802''0 mm+- ''2'549a

@ ,a?) $72'00@ B ) to D)

@ AE F')2'8

ABG Reference Values

'. G now the p+; p+ determines whether theprimary disorder is an acidosis or an al4alosis


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'58

primary disorder is an acidosis or an al4alosis

). hat is the primary problem metabolic orrespiratory

". Any compensationH

Compensation tries to normalize the p+

Both C?) ! +C?" -oes to same direction

=nusual to oercompensate

%espiratory compensation is immediate while renalcompensation ta4es time

8. '"yr boy omitin- and diarrhea 1or "

d + l th i d l t


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'5$

days. +e appears lethar-ic and cool to

touch with a prolon-ed capillary re1illtime. ABE p+I7."# pC?)I)6

+C?"I')

9artially compensated metabolic acidosis

he prolon- history o1 1luid loss throu-h diarrhea has

caused a metabolic acidosis. lactic acid production

1rom the hypoolemia and tissue hypoper1usion D

bicarbonate losses in the stool. he body has

compensated by hyperentilation.

$ )"yr student Hdru- oerdose +e su11ers


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'60

$. )"yr student Hdru- oerdose. +e su11ers

a si-ni1icant depression o1 mental status andrespiration. %% 6. p+ I 7.'6 pC?) I 70

+C?" I ))

=ncompensated respiratory acidosis

here has not been time 1or metabolic compensation to

occur.

)6yr male abd. pain ! ,?B


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'6'

p+I7.) 9aC?)I)) +C?"I')

9a?) I $$. CB,I 5$0m-/dl

Met acidosis with partial resp. compensation

#5yr 1emale deeloped hypoentilation ! sli-ht

disorientation a1ter &) o1 peptic ulcer ,


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'6)

disorientation a1ter &) o1 peptic ulcer ,

?/ JE in situ

B9 pulse ! CE JA&

%esp. shallow ! %%I'0

p+I7.5# 9aC?)I#6 +C?"I") 9a?) I $$. B D$

9artially compensated met al4alosis

eD #auses(


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'6"

Resp )cidosis

!ype II Resp failure

Resp )l*alosis

Hyper6entilation

JC'S - stro&e$

meningitis$ anxiety$fe6er$ drugs5

sali#ilates(K

eD #auses(


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'6#

+et )cidosis

Renal failure

eto5a#idosis

La#ti# a#idosis

/iarr"ea

Illeostomy

Renal !A

+et )l*alosis

Vomiting

re+( 'G su#tion

Hyperaldosteronism

/iureti#s

Respiratory ailure


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'65

p y

HypoxiaJ0a*< = 7 &0a or =@4 mmHgK

Dit" normo#apnia J0aC*


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'66

,es. =unction +ests


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'67


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'68


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$undos%o&y



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/M retinoathy


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/M retinoathy %roli"erati-e1


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L(=+; Moderate hyertensi-e retinoathy >ith hemorrhages and e4udates.

,7H+; +his atient de-eloed central retinal -ein occlusion as a result o"

uncontrolled hyertension an-ry loo4in- eye


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Ht retinoathy grade 81 & %ailloedema $ ll de"ined disk margin enlarge disk cucant see -essel markings are reduce. %ulsations in-isi'le


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Macular star in Ht


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!tic atrohy


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'8#

AL! : @ !imes 9 AL0 =


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;7

!R)E . ALSE

1)ES!I*' ;


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'86

)rine Ix of a man during test for insuran#e

is gi6en 8eloD

B) 9 S(Cr 'A/

)R pus #ells 4."pf

protein

appearan#e - #lear urine #ulture 5 negati6e


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'87

List 3 #auses )rinary #al#uli

!B

)rinary tra#t malignan#y

#ystitis

1uestion


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'88

In a patient Dit" %aundi#e Biliru8in 5;< mg.dl J = ;(mg.dl K

AS! 5;44 I) J = 3 I) K

AL! - F4 I) AL0 - 744 I

?HA! IS !HE /IAG'*SIS

'AME ; Ix !* C*'IRM !HE /IAG'*SIS LIS! < AE!I*L*GICAL AC!*RS

1uestion 3

http://www.aic.cuhk.edu.hk/web8/Hi%20res/0256%20Chronic%20subdural.jpg


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'8$

!R)E . ALSE

http://www.aic.cuhk.edu.hk/web8/Hi%20res/0256%20Chronic%20subdural.jpghttp://www.aic.cuhk.edu.hk/web8/Hi%20res/0256%20Chronic%20subdural.jpg


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'$0

It is an E/H

/ue to 8leeding from middle meningeal

artery

CS Dill 8e xant"o#"romi#

Al#o"olism is a ris& fa#tor

0atient may "a6e #onfusion


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%hysical Signs



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Acromegaly "ace


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Hyothyroid "acies


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+hyroto4ic "acies


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L & 3rd #N alsy


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=acial N alsy


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Addison disease $ oral igmentation


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!ral candidasis


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,A ) HandNiroshan_loku@ yahoo.com


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?lnar ner-e alsy


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/uutrens contracture


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+endon Danthoma


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Sca'ies hands legs


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N=


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%laEue %soriasis


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E( nodosum


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E( multiforme



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!yp"us


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Snakes



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Miscellaneous



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Katty lier


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Macronodular cirrhosis


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+CC/ (ier ::ry


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Niyangala

7ood LuckF$eed'a%(s to niroshan)lo(u*yahoo+%om


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