Osce dr shawgi adugory

transcript

By dr\Shawgi

Adugory

طالب الي إهداء

الفاشرجامعة الطب كلية

5/1/2011 1dr\Shawgi Adugory

I hope that you gain the

acceptance and

illuminates the doctor will

have a significant

effect tomorrow5/1/2011 2dr\Shawgi Adugory

Angioedema

In the second image, the lesions of the patient's palm were painless (Janeway lesions). A way to differentiate Osler's node from Janeway lesions is that Osler's node is pain, Janeway lesion is painless

Select one of the following answers:

DiphenhydramineAdrenaline

HydrocortisoneOxygen

Adrenaline

5/1/2011 dr\Shawgi Adugory 6

Charcot joint----------

1-leprosy2-syringomyelia3-tabes dorsalis

4-Repeated intra-articular steroid

injection

Select one of the following answers: Heamaturia Elephentiasis Hemoptysis Heamatemesis Hematuria

Miliary T B______

Sputum for AAFB______CAT 1

Howell-jolly

bodies---

HYPOSPLENISM

Mariam is 68 year old . She presents with pains in her 'hand joints which tend to get worse as the day progresses. Her hands do get stiff particularly after use. She has never noticed her hands to be swollen but has noticed little 'swellings on the ends of her fingers'. What is the likely diagnosis?

Select one of the following answers: 1-Rheumatoid arthritis2-Osteoarthritis3-Psoariatic arthritis4-Gouty arthritis

>>>>>>>no 4

defibrillator5/1/2011 11dr\Shawgi Adugory

Acromegaly____________

Large spade like hand

Spacing apart of teeth

Tongue enlargeMyopathy

Cardiomegaly___________

HTNCarpal tunnel

syndromeVisual field defect

1-Epidural haematoma2-Subarachnoid haemorrhage3-Subdural haematoma4-Intracerebral haemorrhage

>>no 1

arachnodactyly

Sarcodosis because .. wide mediastinum

Diabetic Retinopathy

Hypertensive Retinopathy

Glaucoma5/1/2011 16dr\Shawgi Adugory

erythema nodosum

Ring stage plasmodio

m falciprum

HERPES SIMPLEX LABIALIS

Select one of the following answers: 1-Depression2-Type 2 diabetes3-Cushing's disease4-Hypothyroidism

This is a 76-year-old woman, who is complaining of fatigue and a 30-pound

weight gain occurring over several months. She is hypertensive and controlled on

hydrochlorothiazide. Her blood pressure today is 130/85 mmHg, and her heart rate is regular at 52 beats per minute. What is the

most likely diagnosis?

>>>no 4

Ophthalmic shingle(H sozter in

the eye)________

Acyclver tabs & ointment

___________-post herpetic

neuralgia

Myathenc snarl

Pectus

exacavatum

Cushing’s syndrome

1-24-hour urinary free cortisol level.2-Midnight plasma cortisol and late-

night salivary 3-cortisol

measurements Low-dose

dexamethasone suppression test

(LDDST).4-Dexamethasone-

corticotropin-releasing hormone

(CRH) test.

Kalazar_____________

Rx----admission

-pantostame 20mg\kg-iv_30

days_____________

Liver cirrhosiscancrum oris

Spleen ruptureAnemia

Skin pigmentationArrhythmia

(drug complication)

Anti Retroviral Drug

Nucleoside Reverse

Transcriptase Inhibitors(NRTI)

Use in the treatment of HIV pt

s\e– nausea-headache- insomnia –

damage the blood tiusse in BM

Trachoma-__________

Tetracycline eye ointment ( 2\d—6 wks)

Azithromycin caps 500mg \d-3 days

If not respond surgical removal

Stomach ulcer

____________

Eradication therapy

;-PPI(omeprazole)

+flagyl tabs

Necrobiosis lipoidica diabeticorum

Peroneal muscle atrophyPeripheral neuropathy

champagne bottle appearance

Lymphnode test to asses the group of

posterior triangle of the neck

bancroftia

n filariasis

1. Cytomegalovirus retinitis2. Roth spots3. Central retinal vein occlusion4. Hypertensive retinopathy5. Papilledema

5. Papilledema

Normal-disc_

--microfilariae__________

Onchocerca volvulus

Palmar erythemaascitesclubbing

dupuytren’s contracture jaundice gynaecomas

Liver cirrhosis

Pneumothorax-percutaneous aspiration & chest

tube drainageHemothorax_chest tube

drainge5/1/2011 36dr\Shawgi Adugory

Rt. Hypoglossal palsy

Peutz jegher syndrome5/1/2011 38dr\Shawgi Adugory

Sixth Left Cranial Nerve Palsy horner's

syndromes5/1/2011 39dr\Shawgi Adugory

HERPES ZOSTER (produced by reactivation of latent Varicella zoster virus VZV from the dorsal root ganglion of sensory nerves)Complication-- post-herpetic neuralgia: persistence of pain for 1-6 months or more following healing of the rash----Drug aciclovir 800 mg 5 times daily or valaciclovir 1 g 8-hourly

Foot with verrucous

skin change

Figure 13.15 Typical

Stevens-Johnson syndrome (SJS)

Causes Drugs(Anti-gout medications, NSAIDs,Sulfonamides &penicillins,Anticonvulsants)Infectious causes(herpes zoster,Influenza,HIV,Diphtheria,Typhoid,Hepatitis)&others (radiation therapy or

ultraviolet light).Complications:-

Secondary skin infection (cellulitis)Sepsis.Eye problems.

Damage to internal organs)- Permanent skin damage. Stopping

medication causesSupportive care (-Fluid replacement;Skin nursing _remove any dead skin.Medications Painkellar ,Antihistamines,Antibiotics,Topical steroids

Dx: air under

diaphragm(pneumope

ritoniu-perforating peptic (duednal ulcer)

Lipodystrophy1-infections

2-nephropathy3-neuropathy

4-D-foot5/1/2011 44dr\Shawgi Adugory

psoriasis

Sjogren's syndrome__Dryness of mause & eye ass-paroted gland enlargement5/1/2011 46dr\Shawgi Adugory

claw hand

Flattened “T”wave ,prominent “U”wave

hypokalemia

Tall tented “T”wave wide QRS

complex (sine wave)

hyperkalemia

Long “G-T”interval(eg –tetany)

hypocalcemia5/1/2011 48dr\Shawgi Adugory

ST-depression

myocardial ischemia

ST-elevation

acute myocardial infarction

saddle shaped ST-elevation

acute constrictive pericarditis

atrial fibrillationAbsent “P”wave

Sow-tooth patter with normal complexes—

Atrial flutter

Peaked “P”waveright atrial hypertrophy

eg(pulmonary HTN & tricuspid stenosis).

A biphasic P wave

left atrial enlargement

eg(mitral stenosis)5/1/2011 51dr\Shawgi Adugory

Hypertensive with angina &

Hyperthyroidism-pt bellow 35

yrs old &DM.

Fatigue & impotence

Give the names of these Different liver pathology---?

SecondariesCirrhosis fatty liver5/1/2011 53dr\Shawgi Adugory

Simple partial motor epilepsy

Complex partial motor epilepsy

Grandmal epilepsy____________

Gum hypertrophy Acine like

Increase vit D consumption

Visual acuityExamination of 2nd

CN For far vision with the snellen chart

burr cells---

uraemia

Rt side nasal hemianopia,

damage to the right optic chiasma ...

Extra-dural haematomaBiconvex (lenses)

Xanthelasma

Sign of hyper-lipideamia

-serum cholesterol

Spindling shape

--z-deformity

rheumatoid_nodules

Baker Cysts

Heberden’s nod’s—(SWELLING OF THE distal

interphalangelJoint)--- Osteoarthritis5/1/2011 60dr\Shawgi Adugory

caput medusaedInferior vena cava

obstructionPortal

hypertensioncirrhosis of the

liver.

Acanthosis_nigricans-causes:- hypothyroidism or

hyperthyroidism, acromegaly, polycystic ovary disease,& insulin-

resistant diabetes.

Cholera-- Vibrio cholerae

-call the emergency room in the menstery

of health

Stool sample5/1/2011 63dr\Shawgi Adugory

target cell -- liver disease

& iron deficiency anaemia

Butter fly_rashSystemic Lupus Erythematosus

(SLE)—Steroid Creams

malar flush occur with severe mitral

stenosis

Superior vena caval obstructio

Hirsutism-------

increased level of

androgens------

Spironolactone

What this sign call? if this pt with weakness of quadriceps (difficulty in walking) & fasciculation

also with hyperrflexia but no involvement of sensory system;

bladder or ocular muscles? Yr spot diagnosis? & one drug in this case?+ve planter

reflex__________

Amyotrophic lateral sclerosis

___________

Riluzole

Indication of this i-v fluide in pt admission with DKA ?

1-when the blood glucose level rech 250 mg

1-Lt facial and Lt occulomotor nerve palsy2-Lt facial nerve palsy3-Both Rt facial and Lt occulomotor nerve

palsy4-Rt facial nerve palsyLt facial nerve

palsy5/1/2011 70dr\Shawgi Adugory

1-Uremic Pericarditis or pleuritis - (urgent indication)-2-Progressive uremic encephalopathy or neuropathy, (with confusion, asterixis, myoclonus, 0r seizures (urgent indication)-A clinically significant bleeding diathesis attributable to uremia (urgent indication)-Fluid overload refractory to diuretics-Hypertension poorly responsive to antihypertensive medications-Persistent metabolic disturbances that are refractory to medical therapy; these include hyperkalemia, metabolic acidosis, hypercalcemia, hypocalcemia, and hyperphosphatemia-Persistent nausea and vomiting-Evidence of malnutrition

Select one of the following answers: 1-Slow relaxation phase of ankle jerk2-Collapsing pulse3-Pretibial myxoedema4-Lid lag

>>>No 1

Lid lag for case of hyper

Thyrodism (graves disease)

___________

-neumercazol______________

-heart failure5/1/2011 73dr\Shawgi Adugory

Investagation - x ray ,ECG&echo.

Treatment -bedrest in cardiac bed

-O2--lasix 40 mg iv

-digitalis-captrapil or atenalol

& follow up

Atrial Flutter5/1/2011 75dr\Shawgi Adugory

-dx Plain PA chest X-ray of a patient with mixed mitral valve disease.The left atrium is markedly enlarged Note the large bulge on the left heart border (left atrium)The ‘double shadow’ (border of the right and left atria) on the right side of the heart. There is cardiac (left ventricular) enlargement due to mitral regurgitation.

Kerning’s sign

-L P (CSF analysis)

-1-admission2-I v floud

3-analgesia (votrex inj &

tabs)4-benzyl

penicillin (iv 24 million U\24

hrs)& chloroamphencol

1 g\day- or samixon 2 g\day5/1/2011 77dr\Shawgi Adugory

Biomphalaria (water suitable intermediate for

schistosoma mansoni….)

Acute or chronic intestinal diseaseLiver involvement(

portal HTN & organomegaly)

AnaemiaPrazaquantel (single dose

40mg\kg)

Oral candidiasis

Seborrheic 0dermatitis0in

leukoplakia

Kaposi sarcoma Kaposi sarcoma of palate

aphthous ulcer

Hypocalcaemia5/1/2011 80dr\Shawgi Adugory

bilateral nodular

consolidation

Dx Left ventricular aneurysmon the left lateral border. This bulge is due toAneurysm formation of many years following a myocardial infarction. A thin line of calcification can be seen along the edge of this bulge.

Select one of the following answers: Lobar pneumonia Bronchopneumonia Lung cancer Pulmonary tuberculosis

Pulmonary

tuberculosis5/1/2011 83dr\Shawgi Adugory

Status epilepticus Tetany Acute severe asthma Depression

Status epilepticus

Pleural effusion

SUBDURAL HAEMATOM

Left-sided Horner's syndrome-

Right side facial nerve palsy--

Buruli ulcercaused by-----

Mycobacterium ulceransTreatment is by

surgical excision (removal) of the lesion,

Lower motor neuron Lt. hypoglossal nerve palsy5/1/2011 90dr\Shawgi Adugory

Estimation of arterial O2 saturation5/1/2011 91dr\Shawgi Adugory

pneumoniaasthma_ hyperinflation5/1/2011 92dr\Shawgi Adugory

7 differential diagnoses?

1-chronic liver disease

2-disseminated TB3-brucellosis

4- chronic anemia(megaloblas

tic;hemolytic)5-amyloidosis

6-CCF7-Gaucher’s syndrome.

rheumatoid nodules

evaluate the visual

fields via confrontati

on. For examin the optic nerve

(field of vision)

27 yrs old female from Almanagel area c\f---- fever headache\ 5days constipation \3days.. O\E ---- small spleen which is soft &

tender?Give 2 diff Dx? &Explain pathophysiology of this picture show ?

1-Malaria2-Entrica

________

Due to effection of the RBCs ---

thrombocytopenia---decrease platelate---

epistaxis

epidural heamatomaSubdural hematoma[5/1/2011 97dr\Shawgi Adugory

Biconvex epidural hematoma

subarachnoid hemorrhage 5/1/2011 98dr\Shawgi Adugory

SENEMET___ contains 250mg L-dopa

+ 25mg carbi-dopa .

Rx of parkinsonism

S\E incloude:- Confusion; drowsiness; dry mouth;

headache; increased sweating; loss of appetite;;

trouble sleeping; upset abd-; urinary tract infection; nausea&

vomiting.5/1/2011 99dr\Shawgi Adugory

DVTCelloliti

Abd- thrill

Vitiligo.

Lumbar Puncture

__________

Post puncture headache

herniation, Infections

Traumatic lumbar puncture

Left eye cataract

Intraocular lens

implantation

Hypo & hyper thyroidism

TFT_________

Thyroxine tabs or

Neo mercazole tabs

non-pulsatile vesselsthe vessels do not collapse with inspiration direction of flow in the vessels is downwards positive hepatojugular rflux

positive hepatojugul

ar rflux

Abd- paracentesis

-Therapeutic &diagnostic

studies( color; cell count ; SAAG & culture & gram

stain)-abd- ultrasound

Causes 1-portal HTN

2-Nephrotic syndrome3-Abd- TB

4-CCF5/1/2011 107dr\Shawgi Adugory

Finger nose test

For test sensory ataxia

1-Renal cysts2-Renal stones

3-Intersitial nephritis

4-Renal tumur

Severe malaria

_____________

Hypoglycemia

لعلني عبرت بعد جهد جهيد لعلني عبرت بعد جهد جهيد فأنا حيث أنتم قضيت شهد فأنا حيث أنتم قضيت شهد qسنين عمري بكيت كثيرا qسنين عمري بكيت كثيراوفرحت مرات أخري نمت وفرحت مرات أخري نمت

qوسهرت تألمت وسعدت وأخيرا qوسهرت تألمت وسعدت وأخيرا اغادر كلية الطب معقل اغادر كلية الطب معقل

اإلكتاب الي حيث ال أشتكي اال اإلكتاب الي حيث ال أشتكي اال من جهد العمل~ كخريج أحمل من جهد العمل~ كخريج أحمل راية كلية الطب جامعة الفاشر راية كلية الطب جامعة الفاشر

في سويدا قلبي وخارجه في سويدا قلبي وخارجه ولسوف اكن مدين لكم ولسوف اكن مدين لكم

وبصفة خاصة الي سنايري (وبرالمتي-- والي الذين

qعرفتهم ثم أثروا الذهاب بعيداعني

-- ) فرداq فرد --12الي الدفعة وسوف اكن مدين لكم بالكثير .....وفقكم الله وسدد خطاكم

dugory9@gmail.com د\ شوقي الدقوري

5/1/2011111

dr\Shawgi Adugory

يارب نستودعك ما

.....ودائعكتضيع علمتنا فإنه ال

سبحانك ال علم )

لنا اال ما علمتنا

انك انت العليم (الحكيم

Osce dr shawgi adugory

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