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
– Cardiac rupture
– Perforation of thoracic duct
• What is the best treatment?
– Antibiotic therapy
– NPO
– Surgical intervention
– endoscopy
Case 2
• A middle age woman with dysphagia.
• What is your diagnosis?
– Corrosive esophagitis
– Reflux esophagitis
– Esophageal web
– Esophageal ring
– Esophageal tumor
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:
• 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
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)
• 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
Case 5
• A diabetic woman with dyspnea, and
vertigo.
• BP: 70/46
• RR: 22
• 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
Case 6
• Young girl presented with chest pain.
• What is the diagnosis?
– Dissection of aortic aneurysm
– Pulseless syndrome
– Coarctation of aorta
• What is the best treatment?
– Surgical consult
– Steroid
– Stent placement
Case 7
• Patient with flank pain and hematuria.
• You see the CT angiography of the
patient.
• What is your diagnosis?
– Renal artery stenosis
– Renal artery occlusion
– Renal vein trombosis
• What is the best management?
– Anticoagulation
– Stent placement
– Surgical consult
CASE 8
• Patient presented with confusion, fever, and
ichterus.
• 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
Case 9
• Young boy with fever and chills. Diffuse rales
in both lung fields.
• What do you see in PBS?
– Hemolytic anemia
– Basophilic stippling
– Heinz body
– Tear drop cell
– Toxic granulation
CASE 10
• A young girl with anemia and abdominal pain.
• 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?
Case 11
• This patient presented with chronic cough.
• 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