5 medicine OSCE

th

Collection
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 X-
ray:
• 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 (crescendo-
decrescendo 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
– describe main
abnormality in
perianal region:
• Multiple perianal
erythematous
lesions surrounded
by rash.
– 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
• Don’t forget me from
your praying
• Your sister,
Fatooma
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