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OSCE. Raika Jamali M.D. Gastroenterologist and hepatologist Sina hospital Tehran University of Medical Sciences. Case 1. An old man with sudden chest pain and dyspnea. You see his CT scans and barium swallow. What is the diagnosis? Dissection of aortic aneurysm Perforation of esophagus

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

  2. Case 1 • An old man with sudden chest pain and dyspnea. You see his CT scans and barium swallow.

  3. What is the diagnosis? • Dissection of aortic aneurysm • Perforation of esophagus • Cardiac rupture • Perforation of thoracic duct • What is the best treatment? • Antibiotic therapy • NPO • Surgical intervention • endoscopy

  4. Case 2 • A middle age woman with dysphagia.

  5. What is your diagnosis? • Corrosive esophagitis • Reflux esophagitis • Esophageal web • Esophageal ring • Esophageal tumor

  6. Case 3 • An old man with severe sudden chest pain and history of hypertension. Gradually he experienced dyspnea. • BP: 190/110 RR:20 T: 37.3 • You see the ECG of patient:

  7. What is your diagnosis? • Acute inferior wall MI • Aortic aneurysm dissection • Pnumothorax • Acute Pericarditis • What is the best initial treatment strategy? • Fibrinilytic therapy • PCI • ASA 325 mg • Antiplatlet therapy

  8. Case 4 • An old man presented with acute sudden chest pain. He became dyspenic soon after admission. The CXR at admission (right) and after 1 hour is shown.(left)

  9. What is your diagnosis? • Acute pnumothorax • Acute pnumonia • Dissection of aneurysm of aorta • Acute pericarditis • What is the best management? • Chest tube insertion • Antibiotic therapy • Surgical consult • NSAID

  10. Case 5 • A diabetic woman with dyspnea, and vertigo. • BP: 70/46 • RR: 22

  11. What is your diagnosis? • True posterior wall MI • Intracerebral hemorrhage • Acute pnumothorax • Aortic aneurysm dissection • What is the best initial management? • Hydration • PCI • Antifibrinolytic therapy • Nitroglycerin infusion

  12. Case 6 • Young girl presented with chest pain.

  13. What is the diagnosis? • Dissection of aortic aneurysm • Pulseless syndrome • Coarctation of aorta • What is the best treatment? • Surgical consult • Steroid • Stent placement

  14. Case 7 • Patient with flank pain and hematuria. • You see the CT angiography of the patient.

  15. What is your diagnosis? • Renal artery stenosis • Renal artery occlusion • Renal vein trombosis • What is the best management? • Anticoagulation • Stent placement • Surgical consult

  16. CASE 8 • Patient presented with confusion, fever, and ichterus.

  17. What do you see in PBS ? • Sickle cell anemia • Spherocytosis • Schistocyte • Basophilic stippling • What is the differential diagnosis? • Hemolytic uremic syndrome • Disseminated intravascular coagulation • Thrombotic thrombocytopenic purpura • All of the above

  18. Case 9 • Young boy with fever and chills. Diffuse rales in both lung fields.

  19. What do you see in PBS? • Hemolytic anemia • Basophilic stippling • Heinz body • Tear drop cell • Toxic granulation

  20. CASE 10 • A young girl with anemia and abdominal pain.

  21. What do you see in PBS? • Target cell • Spherocyte • Heinz body • Sickle cell • What is the next treatment? • Hydration • Blood exchange • Control of infection and hypoxia • All of the above • What is the best treatment?

  22. Case 11 • This patient presented with chronic cough.

  23. What do you see? • Aneurysm of aorta • Pericardial cyst • Duplication cyst • Superior mediastinal mass • What is the differential diagnosis? • Ectopic thyroid • Thymus • Teratoma • All of the above

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