OSCE (Part one) Answers

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OSCE (Part one)Answers

• Raika Jamali M.D.
• Gastroenterologist and hepatologist
• Sina hospital
• Tehran University of Medical Sciences

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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.

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Case 2

• The typical esophageal web in the upper third of
  esophagus.
• It is frequently seen in middle age woman with
  iron deficiency anemia.

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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.

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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.

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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.

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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.

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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.

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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

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Case 9

• The patient has pneumonia. Mention to the
  increase of acute phase reactants in serum
  protein electrophoresis.
• Toxic granulation is seen in neutrophils.

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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

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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.