Osce dr shawgi adugory

By drShawgi Adugory
‫ب‬‫ل‬‫ط‬ ‫ل‬‫ا‬ ‫ء‬‫ا‬‫د‬‫ه‬‫إ‬
‫ر‬‫ش‬‫ا‬‫ف‬‫ل‬‫ا‬ ‫ة‬‫ع‬‫م‬‫ا‬‫ج‬ ‫ب‬‫ط‬‫ل‬‫ا‬ ‫ة‬‫ي‬‫ل‬‫ك‬
5/1/2011 1drShawgi Adugory

I hope that you
gain the
acceptance and
illuminates the
doctor will have
a significant
effect tomorrow

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:



Diphenhydramine
Adrenaline
Hydrocortisone
Oxygen



Adrenaline

5/1/2011 drShawgi Adugory 6
CharCot joint
----------
1-leprosy
2-syringomyelia
3-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 15/1/2011 8drShawgi Adugory

Howell-jolly
bodies
---
HYPOSPLE
NISM

 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?
1-Rheumatoid arthritis
2-Osteoarthritis
3-Psoariatic arthritis
4-Gouty arthritis



>>>>>>>no 4

defibrillator5/1/2011 11drShawgi Adugory

Acromegaly
____________
Large spade like hand
Spacing apart of teeth
Tongue enlarge
Myopathy
Cardiomegaly
___________
HTN
Carpal tunnel syndrome
Visual field defect


1-Epidural haematoma
2-Subarachnoid haemorrhage
3-Subdural haematoma
4-Intracerebral haemorrhage


 >>no 1

arachnodactyly

Sarcodosis because .. wide mediastinum

Diabetic Retinopathy
Hypertensive Retinopathy
Glaucoma

erythema
nodosum

Ring stage
plasmodiom
falciprum

HERPES
SIMPLEX
LABIALIS




1-Depression
2-Type 2 diabetes
3-Cushing's disease
4-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
20mgkg-iv_30 days
_____________
Liver cirrhosis
cancrum oris
Spleen rupture
Anemia
Skin pigmentation
Arrhythmia (drug
complication)5/1/2011 25drShawgi Adugory

Anti Retroviral Drug
Nucleoside Reverse
Transcriptase
Inhibitors(NRTI) group
Use in the treatment of HIV
pt
se– nausea-headache-
insomnia –damage the
blood tiusse in BM

Trachoma
-__________
Tetracycline eye ointment ( 2d—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 atrophy
Peripheral neuropathy
champagne bottle appearance

Lymphnode test
to asses the
group of
posterior
triangle of the
neck

bancroftian
filariasis

1. Cytomegalovirus retinitis
2. Roth spots
3. Central retinal vein occlusion
4. Hypertensive retinopathy
5. Papilledema
5. Papilledema
Normal-disc_

--microfilariae
__________
Onchocerca
volvulus

Palmar erythemaascitesclubbing
dupuytren’s
contracture
jaundice gynaecomastia
Liver cirrhosis

Pneumothorax
-percutaneous aspiration & chest tube
drainage
Hemothorax_chest tube drainge5/1/2011 36drShawgi Adugory

Rt. Hypoglossal palsy

Peutz jegher syndrome

Sixth Left Cranial Nerve Palsy horner's syndromes

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 causes
Supportive care (-Fluid replacement;Skin
nursing _remove any dead skin.
Medications Painkellar

Dx: air under
diaphragm(pneumoperitoniu
-perforating peptic (duednal
ulcer)

Lipodystrophy
1-infections
2-nephropathy
3-neuropathy
4-D-foot

psoriasis

Sjogren's syndrome__
Dryness of mause & eye
ass-paroted gland
enlargement

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)
hypocalcemia

ST-depression
myocardial
ischemia
ST-elevation
acute myocardial
infarction
saddle shaped
ST-elevation
acute constrictive
pericarditis

atrial fibrillation
Absent “P”wave
Sow-tooth patter with normal complexes—
Atrial flutter

Peaked “P”wave
right atrial hypertrophy
eg(pulmonary HTN & tricuspid
stenosis).
A biphasic P wave
left atrial enlargement
eg(mitral stenosis)

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 53drShawgi Adugory

Simple partial motor epilepsy
Complex partial motor epilepsy
Grandmal epilepsy
____________
Gum hypertrophy
Acine like
Increase vit D consumption

Visual acuity
Examination 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 haematoma
Biconvex (lenses)5/1/2011 58drShawgi Adugory

-
Xanthelasma
Sign of hyper-
lipideamia
-serum
cholesterol


Spindling shape
--z-deformity
rheumatoid_nodules
Baker Cysts
Heberden’s nod’s—(SWELLING OF
THE distal interphalangel
Joint)--- Osteoarthritis5/1/2011 60drShawgi Adugory

caput medusaed
Inferior vena cava
obstruction
Portal hypertension
cirrhosis 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 63drShawgi Adugory

target cell --
liver disease &
iron deficiency
anaemia

Butter fly_rash
Systemic Lupus Erythematosus (SLE)—
Steroid Creams
malar flush
occur with severe mitral stenosis

Superior vena
caval
obstruction

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 palsy
2-Lt facial nerve palsy
3-Both Rt facial and Lt occulomotor nerve palsy
4-Rt facial nerve palsy
Lt facial nerve palsy

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 malnutrition5/1/2011 71drShawgi Adugory

1-Slow relaxation phase of ankle jerk
2-Collapsing pulse
3-Pretibial myxoedema
4-Lid lag
>>>No 1

Lid lag for case of
hyper
Thyrodism
(graves disease)
___________
-neumercazol
______________
-heart failure

Investagation - x ray
,ECG&echo.
Treatment -bedrest in cardiac
bed
-O2
--lasix 40 mg iv
-digitalis
-captrapil or atenalol
& follow up

Atrial Flutter

-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 to5/1/2011 76drShawgi Adugory

Kerning’s
sign
-L P (CSF analysis)
-1-admission
2-I v floud
3-analgesia (votrex inj
& tabs)
4-benzyl penicillin (iv
24 million U24 hrs)&
chloroamphencol 1
gday- or samixon 2
gday

Biomphalaria (water
suitable intermediate
for schistosoma
mansoni….)
Acute or chronic
intestinal disease
Liver
involvement( portal
HTN & organomegaly)
Anaemia
Prazaquantel (single
dose 40mgkg)

Oral candidiasis
Seborrheic 0dermatitis0in
leukoplakia
Kaposi sarcomaKaposi sarcoma of palate
aphthous ulcer5/1/2011 79drShawgi Adugory

Hypocalcaemia5/1/2011 80drShawgi Adugory

bilateral
nodular
consolidation

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




 Lobar pneumonia
 Bronchopneumonia
 Lung cancer
 Pulmonary tuberculosis



Pulmonary tuberculosis

 Status epilepticus
 Tetany
 Acute severe asthma
 Depression
Status epilepticus

Pleural
effusion

SUBDURAL
HAEMATOMA

Left-sided Horner's syndrome-

Right side facial nerve palsy
--

Buruli ulcer
caused by-----
Mycobacterium ulcerans
Treatment is by surgical
excision (removal)
of the lesion,

Lower motor neuron Lt. hypoglossal nerve palsy5/1/2011 90drShawgi Adugory

Estimation of arterial O2
saturation5/1/2011 91drShawgi Adugory

pneumoniaasthma_ hyperinflation

7 differential
diagnoses?
1-chronic liver disease
2-disseminated TB
3-brucellosis
4- chronic
anemia(megaloblastic;he
molytic)
5-amyloidosis
6-CCF
7-Gaucher’s syndrome.

rheumatoid nodules

evaluate the
visual fields via
confrontation.
For examin the optic
nerve (field of
vision)

 27 yrs old female from Almanagel area
 cf---- fever headache 5days
 constipation 3days..
 OE ---- small spleen which is soft & tender?
Give 2 diff Dx? &Explain pathophysiology of
this picture show ?
1-Malaria
2-Entrica
________
Due to effection of the
RBCs
---thrombocytopenia---
decrease platelate---
epistaxis

epidural heamatomaSubdural hematoma[

Biconvex epidural
hematoma
subarachnoid
hemorrhage5/1/2011 98drShawgi Adugory

SENEMET___
cont ai ns 250mg L-dopa
+ 25mg carbi -dopa .
Rx of
parki ns oni s m
SE incloude:- Confusion; drowsiness;
dry mouth; headache; increased
sweating; loss of appetite;; trouble
sleeping; upset abd-; urinary tract
infection; nausea& vomiting.

DVT
Cellolitis

Abd- thrill

Vitiligo.

Lumbar Puncture
__________
Post puncture headache
herniation,
Infections
Traumatic lumbar
puncture

Left eye
cataract.
IOL-
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
hepatojugular
rflux

Abd- paracentesis
-Therapeutic
&diagnostic
studies( color; cell
count ; SAAG & culture
& gram stain)
-abd- ultrasound
Causes 1-portal HTN
2-Nephrotic syndrome
3-Abd- TB
4-CCF

Finger nose test
For test sensory
ataxia

1-Renal cysts
2-Renal stones
3-Intersitial nephritis
4-Renal tumur

Severe malaria
_____________
Hypoglycemia

‫تألمت‬ ‫وسهرت‬ ‫نمت‬ ‫أخري‬‫تألمت‬ ‫وسهرت‬ ‫نمت‬ ‫أخري‬
‫الطب‬ ‫كلية‬ ‫اغادر‬ ‫وأخيرا‬ ‫وسعدت‬‫الطب‬ ‫كلية‬ ‫اغادر‬ ‫وأخيرا‬ ‫وسعدت‬
‫ل‬ ‫حيث‬ ‫الي‬ ‫الكتاب‬ ‫معقل‬‫ل‬ ‫حيث‬ ‫الي‬ ‫الكتاب‬ ‫معقل‬
~‫العمل‬ ‫جهد‬ ‫من‬ ‫ال‬ ‫أشتكي‬~‫العمل‬ ‫جهد‬ ‫من‬ ‫ال‬ ‫أشتكي‬
‫الطب‬ ‫كلية‬ ‫راية‬ ‫أحمل‬ ‫كخريج‬‫الطب‬ ‫كلية‬ ‫راية‬ ‫أحمل‬ ‫كخريج‬
‫قلبي‬ ‫سويدا‬ ‫في‬ ‫الفاشر‬ ‫جامعة‬‫قلبي‬ ‫سويدا‬ ‫في‬ ‫الفاشر‬ ‫جامعة‬
‫لكم‬ ‫مدين‬ ‫اكن‬ ‫ولسوف‬ ‫وخارجه‬‫لكم‬ ‫مدين‬ ‫اكن‬ ‫ولسوف‬ ‫وخارجه‬
)‫سنايري‬ ‫الي‬ ‫خاصة‬ ‫وبصفة‬
--‫عرفتهم‬ ‫الذين‬ ‫والي‬ ‫وبرالمتي‬
‫عني‬ ‫بعيدا‬ ‫الذهاب‬ ‫أثروا‬ ‫ثم‬5/1/2011
111
drShawgi Adugory

‫ك‬‫ع‬‫د‬‫و‬‫ت‬‫س‬‫ن‬ ‫ب‬‫ر‬‫ا‬‫ي‬
‫ل‬ ‫ه‬‫ن‬‫إ‬‫ف‬ ‫ا‬‫ن‬‫ت‬‫م‬‫ل‬‫ع‬ ‫ا‬‫م‬
‫ك‬‫ع‬‫ئ‬‫ا‬‫د‬‫و‬ ‫ع‬‫ي‬‫ض‬‫ت‬.....
( ‫م‬‫ل‬‫ع‬ ‫ل‬ ‫ك‬‫ن‬‫ا‬‫ح‬‫ب‬‫س‬
‫ا‬‫ن‬‫ت‬‫م‬‫ل‬‫ع‬ ‫ا‬‫م‬ ‫ل‬‫ا‬ ‫ا‬‫ن‬‫ل‬
‫م‬‫ي‬‫ل‬‫ع‬‫ل‬‫ا‬ ‫ت‬‫ن‬‫ا‬ ‫ك‬‫ن‬‫ا‬
‫م‬‫ي‬‫ك‬‫ح‬‫ل‬‫ا‬)

Osce dr shawgi adugory

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