OSCE

Raika Jamali M.D.Gastroenterologist and hepatologist

Sina hospitalTehran University of Medical Sciences

Case 47 An old man presented with mild

RUQ pain without jaundice.

What is your diagnosis? Porcelin gall bladder Gall bladder abcess Acute cholecystitis Hydatid cyst

What is the best initial therapeutic strategy?

Metronidazole and ciprofloxacin Cholecystectomy Albendazole

Case 48 A young man presented with

jaundice, fever and RUQ pain.

What is your diagnosis? Porcelin gall bladder Gall bladder abcess Biliary leak Primary sclerosing colangitis

What is the best initial therapeutic strategy?

Metronidazole and ciprofloxacin Steroid and azathioprine Ursodeoxycholic acid

Case 49 A young man presented with

generalized edema.

What is your diagnosis? Celiac disease MALTOMA Intestinal lymphangiectasis

What is the best initial therapeutic strategy?

Metronidazole and ciprofloxacin Steroid and azathioprine MCT oil

Case 50 A middle age woman with RUQ pain

from 6 months ago and normal findings in physical examination.

Hx of OCP use for 7 years.

You see the hepatic angiography of the patient in next slide.

What is your diagnosis? Focal nodular hyperplasia Hemangioma Adenoma Hepatocellular carcinoma

What is the best initial therapeutic strategy?

Metronidazole and ciprofloxacin Steroid and azathioprine Discontinuation of OCP Surgical removal

Case 51 A middle age man presented with

abdominal pain, weight loss and depression.

Tenderness in epigastrium was detected.

You see the CT scan of abdomen in next slide.

What is your diagnosis? Focal nodular hyperplasia Hemangioma Adenoma Metastatic carcinoma

What is the best initial therapeutic strategy?

CT guided biopsy of the lesion Steroid and azathioprine Chemoembolization Surgical removal

Case 52 A young man with fever, RUQ

pain and ichterus.

History of diarrhea in 3 weeks ago.

Physical examination: Conscious, cooperative

80120BP min

95PR T (oral) = 39.5°c

Icteric sclera,She was pale ,No peripheral LNP, Heart and lung are normal.

Abdomen: RUQ & epigastric tenderness,No Morphy sign, Liver span=16 cm,No shifting dullness,

Lab findings Lab findings Hb = 9.4 gr/dl, RBC = 5.1x10 6 , MCV=102, MCH & MCHC = normal PLT = 217000

WBC = 11100 , poly = 80% lymph = 20% ESR = 22 , PT = 32.5 sec. INR = 5.1,

Albumin = 3.4 g/dl / total protein = 6.7g/dl BUN, Creatinine= normal 24 hour urinary protein= normal

AST = 194 U/LALT = 328 U/L

Alkaline phosphatase = 769 U/LViral markers = negativeAlpha feto protein = normal

T= 12 Bilirubin mg/dl D=5.8

What is your diagnosis?A)Liver metastasisB)Liver abcessC)Liver hemangiomaD)Liver cystE)Focal nodular hyperplasiaF)Liver adenomaG)Hepatocellular carcinoma

What is the best treatment? A) Prompt surgical consult for

resection B) Intraveous antibiotic plus

appropriate hydration C) Emergent percutaneous drainage D) Angiographic chemoembolization E) Follow up visits with oral

antibiotics

Case 54 A middle young woman with RUQ

pain.

You see the Dynamic CT scan of the patient in next slides.

Physical examination: Conscious, cooperative

Vital signs are stable.No Icteric sclera,She was not pale ,No peripheral LNP, Heart and lung are normal.

Abdomen: RUQ tenderness,No Morphy sign, Liver span=15 cm,No shifting dullness,,

Lab findings Lab findings Hb = 12.4 gr/dl, RBC = 5.1x10 6 , MCV=102, MCH & MCHC = normal PLT = 217000

WBC = 7100 , poly = 68% lymph = 27% ESR = 22 , PT = 12.5 sec. INR = 1.1,

Albumin = 4.4 g/dl / total protein = 5.7g/dl BUN, Creatinine= normal 24 hour urinary protein= normal

AST = 19 U/LALT = 32 U/L

Alkaline phosphatase = 769 U/LViral markers = negativeAlpha feto protein = normal

T= 1.2 Bilirubin mg/dl D=0.8

What is your diagnosis?A)Liver metastasisB)Liver abcessC)Liver hemangiomaD)Liver cystE)Focal nodular hyperplasiaF)Liver adenomaG)Hepatocellular carcinoma

What is the best treatment?What is the best treatment? A) Prompt surgical consult for

resection B) Intraveous antibiotic plus

appropriate hydration C) Emergent percutaneous

drainage D) Angiographic

chemoembolization E) Follow up visits

Case 55 A middle young woman with RUQ

pain and the history of OCP use.

You see the CT scan of patient in next slide.

Physical examination: Conscious, cooperative

Vital signs are stable.No Icteric sclera,She was not pale ,No peripheral LNP, Heart and lung are normal.

Abdomen: RUQ tenderness,No Morphy sign, Liver span=17 cm,No shifting dullness,

Lab findings Lab findings Hb = 13.4 gr/dl, RBC = 5.1x10 6 , MCV=102, MCH & MCHC = normal PLT = 217000

WBC = 7100 , poly = 68% lymph = 27% ESR = 22 , PT = 12.5 sec. INR = 1.1,

Albumin = 4.4 g/dl / total protein = 5.7g/dl BUN, Creatinine= normal 24 hour urinary protein= normal

AST = 19 U/LALT = 32 U/L

Alkaline phosphatase = 769 U/LViral markers = negativeAlpha feto protein = normal

T= 1.2 Bilirubin mg/dl D=0.8

What is your diagnosis?A)Polycystic kidney diseaseB)Liver abcessC)Liver hemangiomaD)Liver simple cyst (congenital)E)Focal nodular hyperplasiaF)Liver adenomaG)Hydatid cyst versus cystadenocarcinomaH)Hepatocellular carcinoma

What is the best treatment?What is the best treatment? A) Prompt surgical consult for

resection B) Intraveous antibiotic plus

appropriate hydration C) CT guided percutaneous

aspiration D) Angiographic

chemoembolization E) Follow up visits