5TH OSCE OF INTERNL MEDICINE RESIDENCY

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5TH OSCE OF INTERNL MEDICINE RESIDENCY
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• MANAGER
• DR IRAJ HEYDARI

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• PULMONARY DISEASE
• DR IZADI

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????? ????? ?? ???? 24 ???? ?? ??? ?? ?? ?????
???? ??? ???????? ? ???? ??? ??? ?? ?????? ???
?????? ????? ??? .1-????? ?????????? ?? ??? ????
2-????? ?? ????? ??????? ?? ??? ???????
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???? 45 ???? ?? ????? ?? ? ????? ????? ? ???? ???
???????? ? ???? ??? ???? ?? ????? ??? ?? ??????
??? ?????? ????? ??? .1- ????? ?????????? ?? ???
???? 2- ????????? ????? ?????
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??? 48 ???? ??? ?????? ?????? ??? ???? ??????????
??? ?? ????? ????? ??? ?? ??? CXR ????? ??? ???.
????? ??????? ?????? ????? ? ?????? ??? ? ??? ?
???? ??????? ?? ?? ????? ???.?- ????? ??? CXR??
???????2- ????? ????? ????3- ????? ?? ?????
??????? ?? ???????
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• ???????? ???? ???? ?????? ?? ??????? ???? ???
  ???? ?? ??? ??? ???
• Protein45oo mg/dL
• LDH750 U/L
• 50mg/dL GLUcose
• WBC3000/mm3
• Neutrophils15
• Lymphocytes85
• ? ?? ????? ??? ??????
• Protein7 gr/dL
• LDH350 U/L
• 80mg/dL GLUcose
• ??? - ??? ???? ?? ????? ????
• ?- ????? ?? ????? ??????? ?? ???????.

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????? ???? 51 ???? ?? ??? ?? ?? ??? ???? ? ????
??? ?? ??? ?????? ???? ??? ????? ??? ????? ?? ??
???? ??? ???. ????? ?? ?????
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Nephrology DR SAVAJ
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Nephrology ( Case 1)

• A 71 yrs man with history of End stage renal
  failure since 10 years ago due to Diabetes
  Mellitus referred us with leg ulcer .He denied
  any trauma.
• Please write your clinical diagnosis with two
  differential diagnosis?

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Nephrology ( Case 2)

• A 45 Yrs old man referred to clinic for
  evaluation of renal stone. Kidney ultra
  sonography showed a 14 mm stone in right kidney
• ( pelvic) and urine analysis showed microscopic
  hematuria.
• Whats your diagnosis and treatment ?

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Nephrology ( Case 3)

• A 33 Yrs old lady referred to clinic for
  evaluation of edema.BP 130/85
• Urine analysis showed 3 proteinuria and
  microscopic hematuria.
• What does arrow show?
• What is your clinical diagnosis?

Patients Urine Sediment
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Nephrology ( Case 4)
The slide is from a 45 yrs old lady with end
stage renal disease on Peritoneal dialysis What
is your clinical diagnosis? What is your
treatment?
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Nephrology ( Case 5)

• A 51 years old man with history of renal
  transplantation since 6 months ago receives
• Cyclosporin,Mycophenolate mefotil ,Prednisolone ,
  Cotrimoxazole and Calcium D Cap
• What do the arrow show?
• Which one of drugs are responsible for it?

Patients urine sediment
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• RHEUMATHOLGY
• DR ZABIHI

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?? ????? ??? ????? ?????? ????? ??? ???? ???? 4
????? ??????? ???? ????? ???? ???????
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????? ??? ????? ?? MRI T1-weighted ????? ??????
???? 27 ???? ?? ?? ????? ??? ??? ? ?? ?????? ????
??? ?? ????.1- ????? ??? ????????? ?? ???
???????2- ????? ??? ?????
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11- ????? ??? ????? ?? ??? ????? ???? ?2-
????????? ??????? ??? ???????
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• ????? ???? ????? ???? ?? ???? ?? ?? ???? 66
  ???? ?? ?? ????? ???? ??? ???? ??? ? ???? ?????
  ?????? ???? ??? ?? ?????? ?? ??????? ????? ???
  ??? ????? ??? ?? ???? ???????
• (????? 3 ????)

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1- ????? ????? (1) ???????????? ?? ?????? ???
?2- ????? ????? (2) ?? ???? ?????? ???? ?? ??? ?
1
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HEART DR FARAHANI
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A 24 years woman with nauseaWhat is your
diagnosisWhat is the most appropriate diagnostic
test

• What is your diagnosis.?
• What is the most appropriate test?
• 16

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24 years old man with dizzinessBP120/80What is
your diagnosis
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77 years old man with worsening heart
failureWhat is the most appropriate diagnostic
test
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• What is the name of this murmur?
• Mention 3 causes of this murmur

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Write three diagnosis
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GI
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Case 1

• A 35 Y/O male patient with chronic abdominal pain
  and diarrhea
• Questions
• 1-What do you see in this picture?
• 2-What is your diagnosis?

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Case 2

• A 25 Y/O woman with mild RUQ pain and normal LFT
• Questions
• 1-What do you see in this dynamic CT scan?
• 2-What is the two major differential diagnosis?

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Case 3

• A 25 Y/O male with chronic dysphagia to solids
  and liquids, retrosternal burning and mild weight
  loss
• Questions
• 1-What do you see in this picture?
• 2-What do you recommend for next diagnostic
  step?

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Case 4

• A 24 Y/O female with anemia, abdominal bloating
  and these skin changes
• Questions
• 1-Define this skin finding.
• 2-What is the main diagnosis for these GI and
  skin signs?

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Case 5

• A 28 Y/O male with 2 months history of
  rectorrhagia and presenting with tachycardia,
  fever and severe abdominal pain and tenderness
• Questions
• 1-What do you see in this picture?
• 2-What is the best management for this patient?

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• ENDOCRINOLGY
• DR MORADI

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• ???? 32???? ?? ??? ???? ?????? ?????? ????? ???.
• ???-????? ??? ???? ?? ?????????? ?? ???? ????
• ?-????? ?????? ?????????? ?????

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• 2-???? 51???? ?? ??? ???? ?????? ???? ???.
• ???- ????? ??? ???? ??????????
• ?-??????

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• Mention 2 findings in this picture.
• Mention other signs that you will look for.

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• -????? ????? ????? ?? ????? 26???? ???. ????? ?
  ???? ?????

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• 5-???? 16 ???? ?? ?????? ?? ?????? ????? ???.
  ????? ????? ????? ?? ???? ?????? ?? ?? ????.
• ???-????? ?????
• ?-?? ????? ???? ?? ??????? ?? ?????

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• INFETIOUS DISEASE
• DR RANJBAR

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CASE 1- A 30 year-old IDU man presented with
three days of fever, chills, cough, and dyspnea,
and had bilateral infiltrates by chest x-ray, but
was unable to produce any sputum
A. What is your diagnosis? B. What is your
next decision?
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CASE 2 This 38 year-old female was receiving
high-dose steroids for inflammatory bowel
disease, and presented with fever, headache, and
meningismus. What does the Gram's stain of the
cerebrospinal fluid show (show Gram stain
question 2)
A. What is your diagnosis? B. What is your
treatment?
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Case 3.A 33-year old man present to the clinic
with a skin lesion on his face for the past 2
day.There is no fever.
A. What is diagnosis and differential
diagnosis?
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CASE 4 This sputum specimen was obtained from a
58 year-old man with pneumonia following a viral
illness. What does the Gram's stain show (show
Gram stain)
A.What do you see? B.What is your diagnosis?
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Case 5-A 36 years old HIV infected man present
with odynophagia and dysphagia for the past 10
day.There is no fever.Physical examination is
normal.His CD4 cell count is 150.Barium swallow
radiography shows
A.What is your diagnosis and differential
diagnosis?
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• HEMATHOLOGY
• DR VAKILI

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• A 54 y/o woman is referred for evaluation of an
  elevated white blood cell count, identified on a
  routine annual medical evaluation. She is
  asymptomatic. P/E shows no adenopathy or
  splenomegaly. CBC reveals WBC 29,000/µL,
  hemoglobin 13g/dL, and platelets 17400/µL. The
  blood smear is as follow

What is your diagnosis? Whats your treatment
plan?
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• What is your diagnosis?

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• Whats your diagnosis?

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• What is the name of this cell?

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• A 38 y/o African-American black man is admitted 3
  weeks after renal transplan- tation with severe
  hemolytic anemia. His post-transplant medications
  include cyclosporine, prednisolone 20 mg/day,
  trimethoprim-sulfamethoxazole, acyclovir. Coombs
  test is negative. peripheral blood smear are
  shown below.

Whats your next step in the manage- ment of
this patient?
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• Please write three causes of this serum protien
  electrophoresis pattern

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• GENRAL
• DR SOLTANI ARABSHAHI

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• ??? 55 ???? ?? ????? ? ??? ? ???? ??? ??????
  ????? ????? ?? ??? ?????? ???? ??? .
• ????? ??? ?????

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• ??? 60???? ?? ?? ?? ?? ?? ?????? ?????? ????
  ??????? ???? ???? ??? ? ???? ?? ????? ?? ???????
  ?? ???. CT ???? ?? ?????? ?? ???? ?????.

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• ????? ??? ????????????? ??
• .??? ??? ?? ??? ?????
• ?? ?? ?????? ???? ?? ????

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• ??? 73 ???? ?? ?? ??? ??? ??? ????? ?? ??? ?
  ?????? ?? ?? ? ????????? ???? ???. CBC ????? ???
  39 ???? ????.???????? ? ????? ??? ??? ?????
  ???.?????????? ??? ? ??? ? ????????? ?? ??? ?????
  ???. ??? ???? ??? ????? CONFUSE ??? ? ???????
  ????? ???????????? ???? ?? ???.?? ???? ?? ???
  ????? ??? ?????

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• ??? 68 ???? ?? ????? CVA ?CAD?? ??? ????? ???.??
  ??????????????????? ??12 ?? 7 ???? ??? ?? ???
  ???????? ???.
• ????? ??? ???? ?????? ?????.
• ??? ??? ? ?????? ??? ???? ????? ??.??? ??? ?????
  ? ????? ??? ??????? ?????? ???.????? ??? ?????

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• NEUROLOGY
• DR MEHR POR

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???? 53 ???? ?? ????? ? ???????? ?????? ???? ???
?? ???? ?? ????? ?? ????????? ???? ????? ???????
?? ????? CT
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• ???? 57 ???? ?? ??? ???? ?? ??????? ?????? ?? ???
  ????? ?????? ?????? ? ?????? ???? ??? ???? ???.
  ??????? ????? ?? ??? ???? ????? ???? ? ???? ??? ?
  ???????? ???? ??? ????? ???? ???. ?? ????? ??????
  ???? ?? ??? ? ??? ??? ???? ?? ????. ???? ?? ????
  ??? ?? ???? ?????? ????? ???? ??? ????? ?????? ??
  ? ?????? ?? ?? ??? ???? ????? ??? ???? ??? ??
  ???. ?? ?????? ????????? ????? ????? ??? ???? ?
  ??????? ???????? ?????? ????. ????? ?? ??? nipple
  ???? ?? ??? ?? ??? ????. ?? ???? ????? ??????
  ????? ???. ??? ??????? ???? ?? ??? ???? ???. 2a

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????? ????? ????? ?????? ????? ???? ????? ?????
2b
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• ????? ???? 58 ???? ?? ????? ? ???? ???? ??????
  ???? ???. ????? ?? ???? ???? ?? ??? ????? ?????
  ???. ????? ?????? ???. ???? ??? ??? ??? ?? ?????
  ????? ???.

2a
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????? ??? ??????? ????? ?? ??? ?????? ????? ?????
????? ?? ????? ?????
2b
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• ???? 38 ???? ?? ???? ??? ??????? ?? ??????? ?????
  ??? ???. ?? ???? ??????? ????? ????? ???? ????
  ???? ????? ???. ?? ?????? ????? ???? ??? ????
  ????? ? ????? ?? 2-3 ???? ??? ? ?? ??? ???? ??
  ???. ?? ????? ?????? ??????? ?? ???? ?? ???.
  ????? ?? ????? ??? ??????? ?? ???? ????. ??? ???
  ????? ????? ???. ????? ????? ??. EKG ? CT-Scan

3a
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1- ???? ????? ???? ????? ???? ???? 2- ???? ???
?????? ?? ??????? ?? ????? 3- ??????? ??????
????? ?? ??? ?????
3b