Transcript OSCE (Part one) Answers - Tehran University of Medical

OSCE (Part one)
Answers
Raika Jamali M.D.
Gastroenterologist and hepatologist
Sina hospital
Tehran University of Medical Sciences
CASE 1
• Mention to the air and the leak of contrast material in the
mediastinum.
• The diagnosis is esophageal rupture.
• First step in the management of patient is the evaluation of
patient oxygenation and blood pressure.
• Then the patient should be NPO.
• Wide spectrum antibiotic administration and urgent
surgical consult is needed.
• Nasogastric tube insertion and endoscopy is not
recommended in this case.
• The best management strategy is early surgical
intervention.
Case 2
• The typical esophageal web in the upper third
of esophagus.
• It is frequently seen in middle age woman
with iron deficiency anemia.
Case 3
• The tall T wave with ST segment elevation in
inferior leads are in favor of acute inferior wall
MI.
• The best management strategy that increases
the patients survival is coronary reperfusion
by PCI method.
Case 4
• Mention to the mediastinal widening in the
first CXR.
• Pulmonary edema is seen in the second CXR,
most probably due to the extension of
dissection to the base of coronary arteries
causing ischemia and concomitant heart
failure.
• The best strategy is reducing the risk of
further ischemia by surgical intervantion.
Case 5
• Tall T wave in leads V1 and V2 are clues to true
posterior wall MI.
• Notice to the clear lung fields and shock in this patient.
• The patient may have right ventricular ischemia as
well.
• Evaluation of right pericordial and posterior leads are
recommended.
• Diuretic therapy and nitroglycerin is not
recommended.
• The best initial management is adequate hydration.
Case 6
• Mention to the stenotic areas in left common
carotid and brachiocephalic arteries.
• The typical signs of takayaso vasculitis (pulseless
syndrome) is seen in the CT angiography of
patient.
• The best treatment is steroid administration.
• Surgical interventions and angioplastic methods
for management of the stenotic areas are
recommended if the initial treatment with steroid
fails.
Case 7
• Mention to the thrombosis in right renal vein.
• The best treatment is anticoagulation therapy.
• The duration of treatment depends on the
etiology of hypercoagulability state.
Case 8
• Mention to the schistocyte in the PBS
indicative of microangiopatic hemolytic
anemia.
• This might be seen in all of the below
conditions:
– Hemolytic uremic syndrome
– Disseminated intravascular coagulation
– Thrombotic thrombocytopenic purpura
Case 9
• The patient has pneumonia. Mention to the
increase of acute phase reactants in serum
protein electrophoresis.
• Toxic granulation is seen in neutrophils.
Case 10
• You see sickle cell in PBS.
• In hemolytic crisis all of the below treatment
options might be considered:
– Hydration
– Blood exchange
– Control of infection and hypoxia
• The best treatment strategy is bone marrow
transplantation
Case 11
• Mention to the mass in the superior
mediastinum (above the level of carina).
• Ectopic thyroid, Thymus, Teratoma are the
differential diagnosis of the mass in superior
mediastinum.