Second part OSPE Slideshows

years 2019 2021

2023
25 60 2020
Momin

page

Extra

Best of luck
Haneen H Alsultan
MEDICINE 2 ١٧١ ‫ڡﻌﺘﻨﺎ‬,‫ﺤﻤ&ٮﻌﺎت د‬#‫ ﺗ‬- male

26 Fib 2023
OSPE (5 stations ): ‫ى‬8‫ڡ&ٮﺼﻞ اﻟﺘﺮك‬,
1/ CXR showing rib notch ( COA )
2/ microscopic picture of GOUT
3/ gram stain of syphilis
4/
Give 2 MRI findings
Two manifestation of this condition
5/
‫ﺳﺄل ﻋﻦ ال‪cause‬‬
‫و ‪ describe‬اﻟﺼورة‬
‫ووش اﻟﺪواء ال‪8‬ى ﺗﻌﻄ&ٮﻪ‬
‫‪OR‬‬
‫‪,‬ڡ&ٮﺼﻞ اﻟ‪#‬ٮﺴﺎم ‪OSPE :‬‬
‫‪Cortication of aorta‬‬
‫اﻟﺼورة اﻟوردٮ&ﺔ ‪,‬ڡوق = ‪Gout‬‬
‫ﻣﺐ اﻛ&ٮﺪ اﻟ‪#‬ﺤواب ‪^ MS‬‬
Post traumatic central cord syndrome
2 findings mri
2 manifestation for this disease

OR
Ospe: ‫ﺤﻬول‬#‫ﻃﺎﻟﺐ ﻣ‬
MRI of spine
Ct of liver cysts
X-ray
Microscope ‫ﺛﻨﺘ&ٮﻦ‬
‫اﻟﻜ&ٮﺴﺎت كﻠﻬﺎ اﻛﺲ راي‬

r
 Dec 2022 58.611
65
Questions was
in details

1 4 MS
5 Spondylo etc
2 Syphilis

2 Wave of JVP
 MED 634
Slideshow and Case scenarios
By:
Mujahid Nasser Almuhaydib

2022
Slides Show
ØWhat is the finding?
Xanthelasma
ØDiagnosis?
Primary Biliary CHOLANGITIS (PBC)
ØDiagnostic test?
Antimitochondrial antibody in the blood (A.M.A)
ØTreatment?
Urso-deoxy-cholic acid
Ø What is the finding?
blast cells with Auer rods
Ø Diagnosis?
Ø ACUTE MYELOBLASTIC LEUKEMIA
Ø Write 2 Treatment?
-Chemotherapy: Cytarabine, Daunorubicin
-Stem cell transplant
Ø What is the finding?
Left ventricular hypertrophy
Ø Write 3 causes?
A 34-year-old man was referred for evaluation of a nonpruritic skin rash.
The rash had appeared on his abdomen 3 weeks earlier and, over 1
week, had spread to his entire body. He admitted to having performed
unprotected sex with a new partner about 6 weeks before the onset of
his lesions. Examination revealed generalized non-tender
lymphadenopathy and rash as shown.
Ø What is the Diagnosis?
Secondary syphilis
Ø Causative agent?
Treponema pallidium (TP)
Ø Diagnostic test?
Agglutination test (TPHA – T Pallidium Hemagglutination Assay)
FTA-abs – Fluorescent Treponemal antibody absorb test
(Most specific test ) .
Ø Treatment?
Procaine penicillin
Ø Name 2 clinical findings of diagnostic importance?
Prognathism
Large tongue

Ø Name a laboratory test for definitive diagnosis?

Serum IGF -1/Growth hormone/GTT with growth hormone essay

Ø What is best treatment option recommended?

Surgery
 MED 634
17/11/2021
Batch 16 – Males
OSPE, OSCE, CS
OSPE
 MED-II 634
Female - October 2021
OSPE (Final)

Slide 1:

1. What is the likely diagnosis of metabolic syndrome?

-Hyperosmolar hyperglycemic state.

2. What type of Diabetes this condition will happen?

-Type 2 DM (uncontrolled).
 3. What is the effect of this disease on the blood vessels? (Double
check the answer)
-It will affect the Macrovascular (occlude the coronary artery which
cause hypotension).
-It can lead to stroke, MI, thromboembolic disease.

4. What you will find in urine investigation? (Double check the

answer)
-High glucose (glucosuria).
-No urine ketones.
-Hyperosmolar urine.

Slide 2:

1. What is the sign?

Heliotrope rash.

2. Mention 2 specific auto-anti body?

-Myositis-specific autoantibodies (MSA)/ Myositis-associated
autoantibodies (MAA).

3. Recommend treatment for rash?

Hydroxyqlorquine.
Slide 3:

30 year old lady is a known case of multiple sclerosis on treatment with

disease modifying drug beta interferon. She presented with new episode
of acute painful visual loss of her right eye.
1. What treatment will you recommend for acute painful loss of
vision?
-Methyl prednisolone pulse therapy.

2. Describe the anatomical localization of the lesion in panel “A” and

panel “B”?
-Panel “A”: Periventricular.
-Panel “B”: Corpus callosum.

3. Where the lesion is will be if the patient presented with

hypotonia? (Double check the answer)
- Lower motor neuron lesion (LMNL).
Slide 4:

This figure is a diagrammatic representation of the “Anterior cord

syndrome” of the spinal cord at C3 level.
1. Describe 3 recognized clinical features of this syndrome?
- Bilateral UMN signs.
- Bilateral loss of pain and temperature sense.
- Preserving of JPS, fine touch, vibration.

2. What is the most likely cause of this syndrome?

-Anterior spinal artery infarction.
 Slide 5:

There were 4 ECG picture, the doctor wrote the diagnosis and asked us
to match it with a proper letter.
A: Atrial fibrillation.
B: 3rd degree heart block.
C: Inferior STEMI. > Note: ST elevation were in V5, V6) < (sorry I didn’t
find the same picture)
D: Right ventricular hypertrophy. (Sorry I didn’t find the same picture)
 MED2
BATCH15 – Females
Slide Show – Case Scenario – OSCE
Feb. 2021
Slide Show
5 Slides
10 Marks
What is the Cause of the rash:
Vasculitis

What is the diagnosis:

Churg strauss syndrome

What is significance of eosinophils in this condition:

More than 1000

What antibody will you do:

P ANCA
 *This question was out of the curriculum. However Dr. Sofi asked us to read about it.*
Male Pt with jaundice k/c of ulcerative colitis for 5y.

What is the diagnosis:

Primary sclerosing cholangitis

What are the differences between biliary cholangitis and primary sclerosing cholangitis:

What is relation between sclerosing cholangitis and ulcerative colitis:

What imaging will you do:

ERCP
What is the X Ray finding:
Pericardial effusion
Cardiomegaly

What is the diagnosis:

Pericarditis

What will be heard on auscultation:

Pericardial friction rub

Mention one indication for pericardiocentesis:

Cardiac tamponade
Mention each type of heart block in order with the pictures:

3rd degree heart block

2nd degree heart block Mobitz1

1st degree heart block

3rd degree heart block

What is the X Ray finding:
Multiple lytic lesions

Mention blood and urine investigations:

Urine: Urine protein electrophoresis
Blood: Plasma protein electrophoresis

What is the histological finding in this condition:

Presence of plasma cells
BEST OF LUCK
 Final Medicine 2 Slide show/ Case Scenario / OSCE
11/11/2020 Female section
Slide show 5 stations 15 min
1\

A 50 year old man presents with a H/O slowly increasing abdominal girth for the past 3
month and weight gain. Physical examination reveals slightly yellow sclerae; palmar
erythema; bilateral Dupuytren contractures; a large distended abdomen with shifting
dullness; 2+ edema to the knees bilaterally.
1. What is the cause of abdominal distension?

a. Portal hypertensions/Cirrhosis

2. Name the best test that helps establish cause of ascites?

a. Assessment of SAAG Gradient

 3. The presence of total PMN in peritoneal fluid > 250/ μL is suggestive of what
disease?
a. Spontaneos bacterial perionitis

3. What determines refractory ascites

a. Failure to loose weight by 200/gm on maximum diuretic therapy

2\ Both patients have long-standing lung disease and include

A A B

Patient B: Productive cough, wheezy

Patient A: Dyspnea with hyper-
and right side heart failure.
inflated quiet chest.
Both patients have long-standing lung disease:
Patient A: Dyspnea with hyper-inflated quiet chest.
Patient B: Productive cough, wheezy and right side heart failure.

1. What is the clinical description of patient “A”

 a. Pink puffer

2. What is the description of patient “B”?

a. Blue blotter

3. What will be PCO2 in patient “A”

a. Normal or decreased

4. What will be PCO2 in patient “B”

a. Increased

3\
30 year old lady is a known case of multiple sclerosis on treatment with disease
modifying drug beta interferon. She presented with new episode of acute painful
visual loss of her right eye.

A B
30 year old lady is a known case of multiple sclerosis on treatment with disease
modifying drug beta interferon. She presented with new episode of acute painful
visual loss of her right eye.
1. What treatment will you recommend for acute painful loss of vision?

a. Methyl prednisolone pulse therapy

2. Describe the anatomical localization of the lesion in panel “A” and panel “B”?

a. Panel “A” Periventricular

b. Panel “B” Corpus callosum

3. What is the clinical type of MS of this patient?

a. Remitting relapsing type

4\
48 year male presented with paroxysms of hypertension, headaches and sweating.
His urine tested positive for VMA and contrast enhanced CT shows right adrenal
mass as shown by arrow.
48 year male presented with paroxysms of hypertension, headaches and sweating.
His urine tested positive for VMA and contrast enhanced CT shows right adrenal
mass as shown by arrow.
1. What is the most likely cause of his symptoms?

a. Hyper adrenergic spells

2. What is the likely diagnosis of contrast enhanced mass lesion seen in CT

abdomen?

a. Pheochromocytoma

3. What tumors of extra-adrenal site may produce similar symptoms?

a. Paraganglioma

4. Name 2 diseases which may be associated with this type of tumor?

a. von Recklinghausen disease

b. Von Hippel-Lindau (VHL) syndrome / MEN 2

5. What type of cardiomyopathy may be rarely associated with this tumor?

a. Dilated cardiomyopathy

6. Which anti-hypertensive drug should first be used pre-operatively first for surgical
resection of this tumor?

a. Alph-adrenergic blocker
7. What is most definitive treatment for this patient?

a. Surgical resection of tumor

5\ Heart block 1st, 2nd, 3rd degrees

 2023
CXR for Internal Medicine II Course

For SS & CS MED 634

My by Talal M. AK.

18th of February 2023, Saturday

“Çdo njeri ndërton fatin e vet – Everyone builds their own destiny.”
An Albanian Saying
 COPD

Igfndin
Wide intacista
space
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flat diaphragm
poor vascularity
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pneumonia
effusion
hyperinflated
became 8 ribs
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atelectasis Normal is 6 ribs
 DI
Miliary TB
Hx of cough

appearance

slight
honeycombing

Miliary
shadsus
 Rt UL

perihilar Lns
fibrosis
Trachea is
slightly deviated
 DDI
Sarcoidosis
Bilateral
pulmonary
oedema
in bilateral
palms oedema
Cardiomegaly t
UL deviation
are found

finding
hilor shadows
orincast
of oedema
Bat appearan
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DI
LungAhsees

level
Multiple
Abscesses

CommonCausah
Organism

pseudomonas
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pulmonaryEmbl

Dr Waqar
wally bring CXI finding
Westmark Sign
Hampton's Hump
DI
RUL Pneumon

Cxrfinding
Air bronchogra
Tubular
markings
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moderate
pleural
effusion

sign

Kighilitin
paraparamo
edema
Empyema
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pleural
effusion caused
Ht failure
by
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pneumothorax
with lungcollapse

CXRfinding
mediastinal
shift
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Hydatid cyst Itt lesions not
in lung M homogenous in
opacity
Wegner Granulomatosis
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Massive
pericardial
effusion

multiple
Lesions
Valvular

Dilated
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 DI
post me with CABG

CXRfindige or possibilities

previously done CABG

pacemaker
Ischaemic At discos
Electrode of pacemaker

if CXR with bilateral hila Lns

and Dx Sarcoidosis
pacem ter
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com

pulmonaryoeden
VL Diversion
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Cxrfinding
Mitralisation
value replaced
Lu starting to breakgal
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Dextro cardia
Karategame's Syndrome

Dextrocardio
infertility L At
young
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BInchiedesis

Element
fibro cavitary
si n

multiple cystic lesions

TB Plomhage very old technique

of filling TB cavities with

Dx Ankylosing Spondylitis
x Bamboo Spine Halo shadows
ray finding
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Complete It sided
Lung Collapse pneumonia
pneumonectomy
kyphosis
 I paid
Rt massive
effusion

CXRfinding
Trachea
pushed
 Bilateral
shadowing

pulmonary
oedema with Itt failure
 Dx
Df It sided pneumonia

EE.tiig.am
Trachea is centra

i
opacity
Dr Nada

Is
stress Sob

u BP

DI
Massive Pericardial
effusion

Ck Finding
Ex
Pericardiocente I Cardiomegaly Bottle Sign
sista
om ul
gen
pacified
lesions

k Cannon
ball appearance

I
Lung metastasis
Cyrfinding
Cyst filled
with fluid

abscess
typical X
ray of Rt sided Lang
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consolidation

Small
Cavitations

DI
pneumonia
 NG Tube
mis displaced

f
NG Tube to the Rt
bronchus
main

Dr
Nada
she won't
bring it
 Sx of
pleuritic
chestpain
D

I
t UL Pneumothorax

exrfinding
y

Dx Coartication of Aorta
CxR findings Rib notching
Coarctation

Anting
 DI
Hiatus
Hernia
 DDI
sarcoidosis
Mass

pulmonary aneurysm

Enlarged pulmonary Trunk

CXIlining
upper crowding
Trachea is deviated

Dx UL Fibrosis
 gill
Aspen ma
O
Ball like
tra tune in
t Upper lobe
 Cir shows multiple nodules
Limb x shows this
as well ray

Caplan Syndrome
DI
STATION - I
A 24-year-old African woman
presented in 2015 with sudden
bilateral painful loss of vision and
progressive weakness in both her
lower limbs for one day. She had
been previously well with no known
chronic medical conditions. Eight
months later, she presented with
inability to walk and urinary
incontinence for three days. She
denied travel abroad, infections, or
vaccinations.
1. Describe the radiological abnormality of the MRI?

a. Long segment hyper-intense lesion of spinal cord

2. What other MRI will you request other than spinal cord?

a. MRI optic nerves (fat suppressed)/MRI brain

3. What is the likely clinical diagnosis?

a. Transverse myelitis/Bilateral Retrobulbar neuritis

4. Name 2 tests of CSF for diagnostic work up?

a. Oligo-clonal bands/IgG index

b. Aquaporin 4 antibodies

5. Name 2 causes for spastic paraplegia?

a. Multiple sclerosis

b. Neuromyelitis optica/Vasculitis/Anterior spinal artery thrombosis

6. What treatment is recommended on this admission?

a. Plasma exchange/Rituximab/pulse therapy

A 25 year old female
presented to emergency
room with 1week history
of right eye pain with
diminished vision and
blurring of her vision.
This is the first time she
got this symptom.
On examination, she has
diminished visual
activity of the right eye
eye and no other
neurological deficit.
A. Describe the abnormality of the fundoscopic examination?

a. Optic neuritis/Swollen disc/Papilledema

A. What is the likely diagnosis?

a. Multiple sclerosis

A. Name most useful imaging investigation of choice for diagnostic work up?

a. MRI brain& spinal cord

A. What is the next step immediate step in her management?

a. I/V methylprednisolone 1 Gm daily for 5 days (Pulse therapy)

A. Name 4 clinically recognized types of types of multiple sclerosis?

a. Relapsing-Remitting MS (RRMS). This is the most common form of multiple

sclerosis.

a. Secondary-Progressive MS (SPMS). In SPMS, symptoms worsen more steadily

over time, with or without the occurrence of relapses and remissions.

a. Primary-Progressive MS (PPMS).

a. Progressive-Relapsing MS (PRMS).
SLIDE - II
30 year old lady is a known case of multiple sclerosis on treatment
with disease modifying drug beta interferon. She presented with
new episode of acute painful visual loss of her right eye.
A B
30 year old lady is a known case of multiple sclerosis on treatment with disease
modifying drug beta interferon. She presented with new episode of acute painful
visual loss of her right eye.

1. What treatment will you recommend for acute painful loss of vision?

a. Methyl prednisolone pulse therapy

1. Describe the anatomical localization of the lesion in panel “A” and panel “B”?

a. Panel “A” Periventricular

a. Panel “B” Corpus callosum

1. What is the clinical type of MS of this patient?

a. Remitting relapsing type

STATION - III

30 year old lady is

a known case of
multiple sclerosis
on treatment with
disease modifying
agents of beta
interferon. She
presented with
new episode of
acute painful
visual loss of her
right eye.
1. Mention 4 clinical types of multiple sclerosis (MS)?

a. Remitting relapsing (RRMS)

a. Primary progressive (PPMS)

a. Secondary progressive (SPMS)

a. Progressive relapsing (PRMS)

1. Name 2 abnormal CSF findings in a patient of MS?

a. Oligoclonal bands

a. High IgG index

1. Name 2 disease modifying treatment options used for MS?

a. Alpha Interferon/Beta Interferon

a. Fingolimod
SLIDE - I
53 year old female
rapidly developed
weakness and numbness
of her lower limbs,
deficits in sensation and
motor skills, urethral
and anal sphincter
dysfunction.

F/U MRI 3/12 later

demonstrated
significant reduction in
the size of the lesion.
53 year old female rapidly developed weakness and numbness of the
lower limbs, deficits in sensation and motor skills, urethral and anal sphincter
dysfunction. F/U MRI 3/12 later demonstrated significant reduction in the size of
the lesion.

1. Describe the imaging abnormality present?

a. An MRI scan shows a T2 weighted hyperintensity lesion at D10 and D12 levels.

1. What is the likely cause of this lesion?

a. Demyelinating plaques

1. How will you clinically demonstrate the site of the lesion?

a. Clearly defined sensory/motor level

1. What treatment is recommended?

a. IV methyl prednisolone
64 year old man presented with sudden retrosternal chest pain, SOB and sweating
A. Name 3 abnormal findings present in the ECG?

a. ST segment elevation leads I, AVL

a. ST segment elevation leads V1 –V5

a. Reciprocal ST segment depression Lead III

A. What is the likely diagnosis?

a. STE Anterior wall MI

A. Name 2 blood tests for immediate diagnostic work up?

a. Troponin I

a. Creatinine Kinase (CPK - MB fraction)

A. What is the most fatal arrhythmia likely to occur in this condition?

a. Ventricular fibrillation

A. What is the recommended treatment of choice for this patient?

a. Thrombolysis
50 year old man presented with severe retrosternal chest pain with SOB and sweating. He
was brought to A/E and had ECG shown above?
1.Name 3 abnormalities seen in this ECG?
1.ST elevation in II, III and aVF.
2.Q-wave formation in III and aVF
3.Reciprocal ST depression and T wave inversion in aVL
2.What is the clinical diagnosis based on ECG findings?
1.STMI with elevation of ST in lead II & lead III and absent reciprocal change in lead I
(iso-electric ST segment) suggest a circumflex artery occlusion
1.Describe rhythm abnormality?
1.Atrial fibrillation
2.What neurological risk of this rhythm?
•Cardio-embolic stroke
1.Name 2 cardiac causes for this rhythm abnormality?
1.Mitral stenosis
2.Atrial septal defect
SLIDE – I
59 year old man presented to A/E with acute retrosternal chest
pain which worsened with exertion. Pain radiated to jaw and was
breathless at rest. Pain subsided by sub-lingual nitroglycerine.
1. What is the likely ECG diagnosis?

a. Acute STEMI acute anterior MI

1. What is the likely artery involved?

a. LAD artery

1. Name 2 typical ECG changes?

a. ST elevation is maximal in the anteroseptal leads (V1-4).

a. Q waves are present in the septal leads (V1-2).

SLIDE - V

D
Describe the type/grade of heart block for ECG
rhythm strip A. B. C. D?
1. Rhythm strip “A”?
First degree heart block
1. Rhythm strip “B”?
Second degree heart block
1. Rhythm strip “C”?
Third degree heart block
1. Rhythm strip “D”?
Left bundle branch block
STATION - IX

58 year old man presented with acute crushing

retrosternal chest pain with SOB and sweating.
This is his ECG on arrival to hospital.
58 year old man presented with acute crushing retrosternal chest pain with SOB and sweating. This is his ECG on arrival to hospital.

1. Describe major abnormal ECG findings?

a. S-T elevation in lead II and III & AVF

1. What is clinical diagnosis?

a. Inferior wall STE myocardial infarction

1. Which coronary artery is likely etiologically involved?

a. Right coronary artery

1. Name 4 initial steps of medical management?

a. -Morphine

a. Oxygen

a. Nitroglycerin (GTN)

a. Aspirin

1. What therapy should this patient receive for coronary reperfusion?

a. Percutaneous coronary intervention (PCI)/Thrombolysis

 STATION - III

58 year old man presented with acute crushing retrosternal chest pain
with SOB and sweating. This is his ECG on arrival to hospital.
58 year old man presented with acute crushing retrosternal
chest pain with SOB and sweating. This is his ECG on arrival to
hospital.
1. Name 2 ECG abnormalities present on this ECG?

a. ST elevation of Lead II , III and AVF

a. Reciprocal changes in Lead AVL

1. What is the ECG diagnosis?

a. Inferior wall infarction

1. Which coronary artery is likely involved for this ECG finding?

a. Right coronary artery

SLIDE – I
This is an ECG of a 60 year old man presented with fatigue,
dizziness and fainting.
This is an ECG of a 60 year old man presented with fatigue, dizziness and fainting.

1. What is the heart rate?

a. Slow heart rate of 40 BPM

1. Describe the P-R interval change?

a. Complete A/V dissociation

1. What is the ECG diagnosis?

a. Complete heart block/3rd degree heart block

1. What treatment is recommended?

a. Cardiac pacemaker
STATION – 1
52 Year old man K/C of DM on insulin presented to A/E with
acute crushing retrosternal chest pain associated with vomiting
and sweating. He had ECG on arrival as shown.
STATION - I

1. Name 3 ECG abnormalities present on this ECG?

a. ST elevation LII

a. ST elevation LIII

a. ST elevation LVF

1. What is the ECG diagnosis?

a. STEMI Inferior wall

1. Which coronary artery is likely involved for ECG finding?

a. Right coronary artery

1. What is the most common type of arrhythmia seen in this type of MI?

a. Complete heart block

1. Why should the use of nitroglycerin avoided in this type of MI?

a. Cause of severe hypotension/Shock

1. What is the most useful therapeutic option for this patient?

a. PTC/thrombolysis
SLIDE – II
61 year (F) had body pains, abdominal groans and renal
stones with spells of confusion off and on for 9 months.
Her serum calcium was 3. 4 mmol/l and had elevated
levels of serum parathyroid hormone.

A B
1. What is the most likely clinical diagnosis?
a. Primary hyperparathyroidism

1. What is the most common cause of primary hyperparathyroidism?

a. Non-cancerous adenoma/Hyperplasia

1. Describe radiological features of panel “A” and “B”?

a. Osteolytic lesion and salt and pepper appearance of skull
vault(A)
b. Osteitis fibrosa cystica (B)
2. Name 3 clinically recognized types of hyperparathyroidism?
a. Primary
b. Secondary
c. Tertiary

1. Name 2 treatment options for severe hypercalcaemia?

a. I/V Bisphosphonates/Loop diuretic furosemide
b. Calcitonin

1. What is the recognized renal complication associated with primary

hyperparathyroidism?
a. Nephrocalcinosis
61 year (F) had body pains, abdominal groans and renal stones with spells
of confusion off and on for 9 months. Her serum calcium was 3. 4 mmol/l
and had elevated levels of serum parathyroid hormone.
1. What is the most likely clinical diagnosis?

a. Hyperparathyroidism
1. What is the most common cause of primary hyperparathyroidism?

a. Parathyroid adenoma(s)
1. Describe radiological features of panel “A” and “B”?

a. Pepper pot appearance of skull vault (A)

a. Osteitis fibrosa cystica (Brown tumor) (B)

STATION - III

A 50 year old female

presented to OPD
with renal colic due
to stones. On further
inquiry she
complained of bone
pains and psychic
moans. Her blood
analysis showed
serum calcium 3.4
mmol/L. Her X-ray
skull is shown:

Plain X-ray skull vault

A 50 year old female presented to OPD with renal colic due to stones. On further inquiry
she complained of bone pains and psychic moans. Her blood analysis showed serum
calcium 3.4 mmol/L. Her X-ray skull is shown:

1. What is the likely diagnosis?

a. Hyperparathyroidism

2. What 2laboratory investigations will you do?

a. Parathyroid hormone

b. Serum calcium

3. What is the best treatment modality?

a. Parathyroidectomy
SLIDE - II
76 year man had 6/12 H/O of double vision towards the
end of day with fatigue and generalized weakness
76 year man had 6/12 H/O of double vision towards the end of day with fatigue and
generalized weakness

1. Describe the ocular physical sign?

a. Bilateral ptosis

2. What is the likely diagnosis?

a. Myasthenia gravis

3. Name an imaging test of diagnostic value?

a. CT chest/MRI chest

4. Name a useful electrophysiological test for diagnosis?

a. Single Fiber Electromyography (SFMG)

SLIDE – V
Colored area shows sensory loss and motor weakness.
1. What is clinical diagnosis?
a. Paraplegia
2. What is the MRI abnormality present?
a. TW2 weighted hyperintensity lesion of the spinal cord
3. Name 2 expected UMN signs of clinical importance in this
patient?
a. Hyper-areflexia below the site of lesion
b. Up-going planter response
SLIDE – II A
A16 year old boy presented
with long history of chronic
diarrhea, flatulence and
increased abdominal
borborygmi (rumbling
noise). NORMAL
VILLUS

He had iron deficiency B

anemia and significant
weight loss.

He had Jejunal biopsies as

shown in Panel “B”.
PATIENT ‘S
SPECIMEN
A16 year old boy presented with long history of chronic diarrhea, flatulence and
increased abdominal borborygmi (rumbling noise). He had iron deficiency anemia
and significant weight loss. He had Jejunal biopsies (specimen) shown in Panel
“B”.
1. Describe Jejunal biopsy finding of panel “B”?

a. Sub-total villus atrophy

1. What is the likely diagnosis?

a. Celiac disease

1. Name the most useful laboratory test used for diagnosis for this disorder?

a. Anti-Transglutaminase antibodies (ATA)

1. What treatment is recommended for this patient?

a. Gluten free diet
A16 year old boy presented with long history of chronic diarrhea, flatulence
and borborygmi. He had iron deficiency anemia and significant weight
loss. He had six Jejunal biopsies one sample shown in Panel “B”.
1. Describe the abnormality of the biopsy specimen of panel “B” specimen?

a. Villous atrophy

1. What is the likely cause of this histological finding?

a. Gluten sensitive atrophy

1. What is the most useful serological test used for the diagnosis?

a. A tissue transglutaminase antibody IgA (tTg-IgA)

1. What treatment is to be recommended?

a. Gluten free diet

48 year male presented with paroxysms of hypertension,
headaches and sweating. His urine tested positive for VMA and
contrast enhanced CT shows right adrenal mass as shown by What is the name of the triad that causes his symptoms:
arrow Hyper adrenergic spells
2. What is the likely diagnosis of contrast enhanced mass lesion
seen in CT
abdomen:
Pheochromocytoma
3. What tumors of extra-adrenal site may produce similar
symptoms:
Paraganglioma
4. Name 2 diseases which may be associated with this type of
tumor:
Von Recklinghausen disease
Von Hippel-Lindau (VHL) syndrome / MEN 2
5. What type of cardiomyopathy may be rarely associated with
this tumor:
Dilated cardiomyopathy
6. Which anti-hypertensive drug should first be used pre-
operatively first for surgical
resection of this tumor:
Alpha-adrenergic blocker
7. What is most definitive treatment for this patient:
Surgical resection of tumor
What is the X Ray finding:
Pericardial effusion
Cardiomegaly
What is the diagnosis:
Pericarditis
What will be heard on auscultation:
Pericardial friction rub
Mention one indication for pericardiocentesis:
Cardiac tamponade
What is the likely clinical diagnosis?
Acute gouty arthritis
Name 2 conditions that may present as inflammatory
monoarthritis?
Septic arthritis
Crystal arthritis/Pseudogout/Rheumatoid arthritis

Name a laboratory tests for diagnostic work up?

Serum uric acid level/24 hour urinary uric acid
What is will be thetypical finding of joint aspirate?
Urate crystals seen on polarizing microscopy
What is th expected bone change on plain x-ray of gouty
arthritis?
Punched-out erosions or lytic areas with overhanging edges
What is the first line treatment for acute gouty arthritis?
NSAID/Corticosteroids
What treatment is recommended for chronic goit
Uricosuric therapy allopurinol/Probencid
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