5 medicine OSCE

Collection
th

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

vasculitis trauma. 1
Infective endocarditis. 2
a. the question was mcqs on the lesion's name?
b. in which disease ? infective endocarditis
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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.

Differential diagnosis:

Broncheictasis.
Infective indocarditis.
Liver failure (cirrhosis).
IBD.
Brochogenic CA.
Congenital cyanotic
heart disease.
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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

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nicotine staining

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

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onychomycosis

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onychomycosis
(fungal infection)

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paronychia Infection of skin

adjacent to nail of middle
finger

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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
And associated with
INFLAMMATORY BOWEL
SYNDROME

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Thrombocytopenic
purpura

hmg into the skin

: causes
:increase platelets destruction as, in -1
a-immuno thrompocytopenic pupura
b-loss of blood
decrease in platelet formation as Bone marrow Aplasia - 2
found in liver diseases and hemophilia *
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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

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Clinical
Osteomyelitis

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gangrene of toes

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Lymphedema, Left
Leg

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Massive pitting
edema

Swelling in the limb and if you press the swelling there will be slor & Redill
:Causes
right sided heart failure 2. hepatic cirrhosis . 1
GI malabsorption

4-nephrotic syndrome . 3

:pitting unilateral: lower limb edema

DVT Compression on large vans by tumor or enlarged L.N

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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
moon face 2.vasalitis.1
3. pallorAlopecia. 4
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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
chemosis 2. conjunctivitis 3. corneal ulcer.1
optic atrophy 5. opthalmoplegia.4
: Causes
1. tumor of the orbitGraves disease. 2
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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

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VITILIGO

Face of female with depigmented areas

a- describe what you see ( mention clinical
diagnosis )
b- mention 4 associated diseases
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High arched
.palate

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.

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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

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Chest &
abdomen
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 Describe the abnormalities

in the patient:

Kyphosis at the thoracic

region.
Cachexia.
Anteroposterior diameter
(barrel chest).

Differential diagnosis:

COPD.
Asthma.
Ankylosing spondylitis.

Investigations:

CXR.
ABG.
Sputum analysis.
ECG (corpulmonale).

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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.

Differential diagnosis:

TB.
Pleural effusion.
Pneumonia.
Bronchogenic CA.

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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
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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

Multiple perianal
erythematous
lesions surrounded
by rash.

describe main
abnormality in
perianal region:

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.
II-Acromegaly.
III-Hypopitutarisim.
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*

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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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