OSCE
Raika Jamali M.D.
Gastroenterologist and hepatologist
Sina hospital
Tehran University of Medical Sciences
Case 35
• A kidney transplant patient with chronic
diarrhea. You see the duodenal biopsy.
• What is the diagnosis?
– Giardiasis
– Sterongiloidosis
– Tuberculoma
– Sarcoidosis
• What is the treatment?
– Metronidazole
– Ivermectin
– Steroid
– Praziquantel
Case 36
• An old man with RUQ pain and elevated
liver enzyme.
• You see the splenoportography.
• What is the diagnosis?
– Hepatic vein trombosis
– Portal vein trombosis
– splenic vein trombosis
– IVC trombosis
• What is the treatment?
– Anticoagulation
– IVC basket
– Angioplasty
– Surgical repair
Case 37
• Young woman with OCP use presented
with acute severe abdominal pain and
tense ascitis.
• You see the hepatic angiography.
• What is the diagnosis?
– Hepatic vein trombosis
– Portal vein trombosis
– splenic vein trombosis
– IVC trombosis
• What is the treatment?
– Anticoagulation
– IVC basket
– Angioplasty
– Surgical repair
Case 38
• An old man with history of CCU admission
presented with severe abdominal pain.
• What is the diagnosis?
– Acute mesenteric ischemia
– Portal vein trombosis
– Non obstructive mesenteric ischemia
– IVC trombosis
• What is the best initial treatment?
– Anticoagulation
– IVC basket
– Angioplasty
– Surgical repair
Case 39
• A young woman with abdominal pain and
skin rash.
• What is the diagnosis?
– Vasculitis of mesenteric arteries
– Non obstructive mesenteric ischemia
– Thromboemboli in mesenteric arteries
• What is the best initial treatment?
– Anticoagulation
– Steroid plus anticoagulation
– Angioplasty
– Surgical repair
Case 40
• A young girl with severe abdominal pain.
• What is the diagnosis?
– Vasculitis of mesenteric arteries
– Non obstructive mesenteric ischemia
– Thrombosis in mesenteric arteries
• What is the best initial treatment?
– Anticoagulation
– Steroid plus anticoagulation
– Angioplasty
– Surgical repair
Case 41
• A YOUG BOY WITH SEVERE
ABDOMINAL PAIN, VOMITING AND
HYPERTENSION.
• What is the diagnosis?
– Vasculitis of mesenteric arteries
– Non obstructive mesenteric ischemia
– Thrombosis in mesenteric arteries
• What is the best initial treatment?
– Anticoagulation
– Steroid plus anticoagulation
– Angioplasty
– Surgical repair
Case 42
• An old woman with fatigue and fever from
4 weeks ago. A systolic murmur in LSB is
heard.
• What is the diagnosis?
– Left atrial myxoma
– Infective endocarditis
– Vasculitis of coronary arteries
• What is the best initial treatment?
– Anticoagulation
– Steroid plus anticoagulation
– Antibiotic therapy
– Surgical repair
Case 43
• A young kidney transplant with
odynophagia.
• What is not the diagnosis?
– CMV esophagitis
– Candidiasis
– Pill induced esophagitis
– Herpes esophagitis
Case 44
• A man with chronic abdominal pain,
diarrhea, rectal bleeding and severe anal
pain for last one year.
 What is your diagnosis?
 Anal fissure
 Perianal abcess
 Anal fistula
 What is the best initial therapeutic
strategy?
 Metronidazole and ciprofloxacin
 Infliximab
 Steroid and azathioprine
Case 45
A middle age man with intermitant episodes of dysphagia.
No weight loss.
 What is your diagnosis?
 GERD esophagitis
 Pill induced esophagitis
 Eosinophilic esophagitis
Case 46







An old man presented with dyspnea and RUQ
pain.
Physical examination revealed:
Distension of the jugular vein,
Spider nevi,
Bilateral leg edema
Tenderness in RUQ
Span of liver 16 cm.
What is your diagnosis?




Constrictive pericarditis
Pericardial tamponade
Hydatid cyst
What is the best initial therapeutic strategy?




Pericardiectomy
Antibiotic therapy
Steroid and azathioprine