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OSCE. Raika Jamali M.D. Gastroenterologist and hepatologist Sina hospital Tehran University of Medical Sciences. Case 56. A middle age woman with mild abdominal pain that tolerate food intake. You see the CT scan of patient in next slides. Vital signs are stable. No Icteric sclera, - PowerPoint PPT PresentationTRANSCRIPT
OSCE
Raika Jamali M.D.Gastroenterologist and hepatologist
Sina hospitalTehran University of Medical Sciences
Case 56
A middle age woman with mild A middle age woman with mild abdominal pain that tolerate food abdominal pain that tolerate food intake.intake.
You see the CT scan of patient in You see the CT scan of patient in next slides.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: Epigastric tenderness,No Morphy sign, Liver span=12 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 = 9100 , 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 = 79 U/L
ALT = 62 U/L
Alkaline phosphatase = 769 U/L
Viral markers = negative
Amylase = 100
T= 1.2 Bilirubin mg/dl D=0.8
What is your diagnosis?A)Pancreatic abscessB)Acute mild pancreatitisC)Pancreatic pseudocystD)Chronic pancreatitisE)Necrotizing pancreatitisF)Focal nodular hyperplasia
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
Case 57
A middle age man with RUQ pain and vomiting.
You see the CT scan of patient in 48 hours after the onset of pain.
Physical examination: Conscious, cooperative
80120BP min
95PR T (oral) = 37.5°c
Icteric sclera,He was pale ,No peripheral LNP, Heart and lung are normal.
Abdomen: Epigastric tenderness,No Morphy sign, Liver span=12 cm,Shifting dullness,
Lab findings Lab findings
Hb = 9.4 gr/dl, RBC = 5.1x10 6 , MCV=102,
MCH & MCHC = normal
PLT = 217000
WBC = 12100 , poly = 88% lymph = 12%
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 = 119 U/L
ALT = 122 U/L
Alkaline phosphatase = 769 U/L
Viral markers = negative
Amylase = 1000
T= 3.2 Bilirubin mg/dl D=1.8
What is your diagnosis?A)Pancreatic abscessB)Acute mild pancreatitisC)Pancreatic pseudocystD)Chronic pancreatitisE)Necrotizing pancreatitisF)Intra peritoneal metastasis
What is the best treatment? A) Prompt surgical consult for
resection B) Intraveous antibiotic plus
appropriate hydration C) A & B D) CT guided percutaneous
aspiration E) Angiographic
chemoembolization
Case 58
A middle age woman with chronic abdominal pain.
You see the CT scan of 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: Epigastric tenderness,No Morphy sign, Liver span=12 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 = 9100 , 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 = 49 U/L
ALT = 42 U/L
Alkaline phosphatase = 769 U/L
Tumor markers = negative
Amylase = 100
T= 1.2 Bilirubin mg/dl D=0.8
What is your diagnosis?A)Pancreatic abscessB)Acute mild pancreatitisC)Pancreatic pseudocystD)Chronic pancreatitisE)Necrotizing pancreatitisF)Intra peritoneal metastasis
What is the best treatment?What is the best treatment? A) Prompt surgical consult for
resection B) Intraveous antibiotic plus
appropriate hydration C) ERCP for drainage and pancreatic
stent placement D) CT guided percutaneous
aspiration E) Angiographic chemoembolization
Case 60
A middle age woman with chronic abdominal pain and weight loss.
You see the CT scan of 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: Epigastric tenderness,No Morphy sign, Liver span=12 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 = 9100 , 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 = 49 U/L
ALT = 42 U/L
Alkaline phosphatase = 769 U/L
CEA & CA 19-9 > 3 Upper limit normal range
Amylase = 100
T= 1.2 Bilirubin mg/dl D=0.8
What is your diagnosis?A)Pancreatic abscessB)Acute mild pancreatitisC)Pancreatic pseudocystD)Chronic pancreatitisE)Necrotizing pancreatitisF)Pancreatic cyst adenocarcinoma
What is the best treatment?What is the best treatment? A) Prompt surgical consult for
resection B) Intraveous antibiotic plus
appropriate hydration C) ERCP for drainage and pancreatic
stent placement D) CT guided percutaneous
aspiration E) Angiographic chemoembolization
Case 61
A middle age woman with epigastric pain.
You see the CT scan of patient in next slides.
Physical examination: Conscious, cooperative
80120BP min
95PR T (oral) = 39.5°c
Icteric sclera,She was not pale ,No peripheral LNP, Heart and lung are normal.
Abdomen: Epigastric tenderness,No Morphy sign, Liver span=12 cm,Shifting dullness,
Lab findings Lab findings
Hb = 11.4 gr/dl, RBC = 5.1x10 6 , MCV=102,
MCH & MCHC = normal
PLT = 217000
WBC = 12100 , poly = 88% lymph = 12%
ESR = 22 , PT = 12.5 sec. INR = 1.1,
Albumin = 3.4 g/dl / total protein = 5.7g/dl
BUN, Creatinine= normal
24 hour urinary protein= normal
AST = 119 U/L
ALT = 122 U/L
Alkaline phosphatase = 969 U/L
Tumor markers = negative
Amylase = 1000
T= 3.2 Bilirubin mg/dl D=1.8
What is your diagnosis?A)Pancreatic abscessB)Acute mild pancreatitisC)Pancreatic pseudocystD)Chronic pancreatitisE)Necrotizing pancreatitisF)Pancreatic cyst adenocarcinoma
What is the best treatment?What is the best treatment? A) Prompt surgical consult for
resection B) Intraveous antibiotic plus
appropriate hydration C) A & B D) ERCP for drainage and pancreatic
stent placement E) CT guided percutaneous
aspiration F) Angiographic chemoembolization
Case 62
A middle age woman with epigastric pain and shock.
You see the CT scan of patient in next slides.
Physical examination: Conscious, cooperative
pulse80BP min
115PR T (oral) = 37.5°c
Icteric sclera,She was pale,No peripheral LNP, Heart and lung are normal.
Abdomen: Epigastric tenderness,No Morphy sign, Liver span=12 cm,Shifting dullness,
Lab findings Lab findings
Hb = 6.4 gr/dl, RBC = 5.1x10 6 , MCV=102,
MCH & MCHC = normal
PLT = 217000
WBC = 12100 , poly = 88% lymph = 12%
ESR = 22 , PT = 12.5 sec. INR = 1.1,
Albumin = 3.4 g/dl / total protein = 5.7g/dl
AST = 119 U/L
ALT = 122 U/L
Alkaline phosphatase = 969 U/L
Tumor markers = negative
Amylase = 1000
T= 3.2 Bilirubin mg/dl D=1.8
What is your diagnosis?A)Pancreatic abscessB)Hemorrhagic pancreatic pseudocystC)Pancreatic pseudocystD)Chronic pancreatitisE)Necrotizing pancreatitisF)Pancreatic cyst adenocarcinoma
What is the best treatment?What is the best treatment? A) Prompt surgical consult for
hemostasis B) Blood transfusion plus
appropriate hydration C) A & B D) ERCP for drainage and pancreatic
stent placement E) CT guided percutaneous
aspiration F) Angiographic chemoembolization
Case 63
A middle age man with abdominal distention.
He had hepatosplenomegaly without shifting dullness in physical exam.
You see the CT scan of patient in next slides.
Physical examination: Conscious, cooperative
Blood pressure: 180/ 110 mm Hg.No Icteric sclera,She was not pale ,No peripheral LNP, Heart and lung are normal.
Abdomen: Hepatosplenomegaly was detected,No Morphy sign, No sign of portal hypertension,No shifting dullness,
Lab findings Lab findings
Hb = 14 gr/dl, RBC = 5.1x10 6 , MCV=102,
MCH & MCHC = normal
PLT = 217000
WBC = 6100 , poly = 45% lymph = 55%
ESR = 22 , PT = 12.5 sec. INR = 1.1,
Albumin = 3.4 g/dl / total protein = 5.7g/dl
Creatinine = 2.5 mg/dl U/A = normal
AST = 119 U/L
ALT = 122 U/L
Alkaline phosphatase = 969 U/L
Tumor markers = negative
Na = 145 mEq/l K= 4.5 mEq/L
T= 3.2 Bilirubin mg/dl D=1.8
What is your diagnosis?A)Primary amyloidosisB)Primary liver lymphomaC)Liver metastasisD)AD Polycystic kidney diseaseE)Intra peritoneal carcinomatosisF)Storage diseases
What is the best treatment?What is the best treatment? A) Prompt surgical consult for
resection B) Diagnostic laparoscopy C) Control of hypertension and
low salt diet D) liver and kidney
transplantation E) CT guided percutaneous
aspiration on
Case 64
An old man with lower abdominal pain.
He had tenderness in LLQ.
You see the abdominal sonography and CT scan of patient in the next slides.
What is your diagnosis?A)Pancreatic abscessB)Hemorrhagic pancreatic pseudocystC)Pancreatic pseudocystD)Chronic pancreatitisE)Necrotizing pancreatitisF)Pancreatic cyst adenocarcinoma
What is the best treatment?What is the best treatment? A) Prompt surgical consult for
hemostasis B) Blood transfusion plus
appropriate hydration C) A & B D) ERCP for drainage and pancreatic
stent placement E) CT guided percutaneous
aspiration F) Angiographic chemoembolization
Case 65
A young man with epigastric pain. She had hepatomegaly in physical
exam.
You see the CT scan of the patient in next slide.
What is your diagnosis?A)Pancreatic abscessB)Hemorrhagic pancreatic pseudocystC)Pancreatic pseudocystD)Chronic pancreatitisE)Necrotizing pancreatitisF)Pancreatic cyst adenocarcinoma
What is the best treatment?What is the best treatment? A) Prompt surgical consult for
hemostasis B) Blood transfusion plus
appropriate hydration C) A & B D) ERCP for drainage and pancreatic
stent placement E) CT guided percutaneous
aspiration F) Angiographic chemoembolization