OSCE
Raika Jamali M.D.
Gastroenterologist and hepatologist
Sina hospital
Tehran University of Medical Sciences
Case 47

An old man presented with mild RUQ pain
without jaundice.

What is your diagnosis?





Porcelin gall bladder
Gall bladder abcess
Acute cholecystitis
Hydatid cyst
What is the best initial therapeutic
strategy?



Metronidazole and ciprofloxacin
Cholecystectomy
Albendazole
Case 48

A young man presented with jaundice, fever and
RUQ pain.

What is your diagnosis?





Porcelin gall bladder
Gall bladder abcess
Biliary leak
Primary sclerosing colangitis
What is the best initial therapeutic
strategy?



Metronidazole and ciprofloxacin
Steroid and azathioprine
Ursodeoxycholic acid
Case 49

A young man presented with generalized edema.

What is your diagnosis?




Celiac disease
MALTOMA
Intestinal lymphangiectasis
What is the best initial therapeutic
strategy?



Metronidazole and ciprofloxacin
Steroid and azathioprine
MCT oil
Case 50



A middle age woman with RUQ pain
from 6 months ago and normal
findings in physical examination.
Hx of OCP use for 7 years.
You see the hepatic angiography of
the patient in next slide.

What is your diagnosis?





Focal nodular hyperplasia
Hemangioma
Adenoma
Hepatocellular carcinoma
What is the best initial therapeutic
strategy?




Metronidazole and ciprofloxacin
Steroid and azathioprine
Discontinuation of OCP
Surgical removal
Case 51



A middle age man presented with
abdominal pain, weight loss and
depression.
Tenderness in epigastrium was
detected.
You see the CT scan of abdomen in
next slide.

What is your diagnosis?





Focal nodular hyperplasia
Hemangioma
Adenoma
Metastatic carcinoma
What is the best initial therapeutic
strategy?




CT guided biopsy of the lesion
Steroid and azathioprine
Chemoembolization
Surgical removal
Case 52


A young man with fever, RUQ pain
and ichterus.
History of diarrhea in 3 weeks ago.
Physical examination:
Conscious, cooperative
BP  120
80
PR  95
min
Icteric sclera,
She was pale ,
No peripheral LNP,
Heart and lung are normal.
Abdomen:
RUQ & epigastric tenderness,
No Morphy sign,
Liver span=16 cm,
No shifting dullness,
T (oral) = 39.5°c
Lab findings
Hb = 9.4 gr/dl, RBC = 5.1x10 6 , MCV=102,
MCH & MCHC = normal
PLT = 217000
WBC = 11100 , poly = 80% lymph = 20%
ESR = 22 , PT = 32.5 sec. INR = 5.1,
Albumin = 3.4 g/dl / total protein = 6.7g/dl
BUN, Creatinine= normal
24 hour urinary protein= normal
AST = 194 U/L
ALT = 328 U/L
T= 12
Bilirubin
mg/dl
D=5.8
Alkaline phosphatase = 769 U/L
Viral markers = negative
Alpha feto protein = normal
What is your diagnosis?
A)
B)
C)
D)
E)
F)
G)
Liver metastasis
Liver abcess
Liver hemangioma
Liver cyst
Focal nodular hyperplasia
Liver adenoma
Hepatocellular carcinoma
What is the best treatment?





A) Prompt surgical consult for
resection
B) Intraveous antibiotic plus
appropriate hydration
C) Emergent percutaneous drainage
D) Angiographic chemoembolization
E) Follow up visits with oral antibiotics
Case 54


A middle young woman with RUQ
pain.
You see the Dynamic CT scan of the
patient in next slides.
Physical examination:
Conscious, cooperative
Vital signs are stable.
No Icteric sclera,
She was not pale ,
No peripheral LNP,
Heart and lung are normal.
Abdomen:
RUQ tenderness,
No Morphy sign,
Liver span=15 cm,
No shifting dullness,
Lab findings
Hb = 12.4 gr/dl, RBC = 5.1x10 6 , MCV=102,
MCH & MCHC = normal
PLT = 217000
WBC = 7100 , poly = 68% lymph = 27%
ESR = 22 , PT = 12.5 sec. INR = 1.1,
Albumin = 4.4 g/dl / total protein = 5.7g/dl
BUN, Creatinine= normal
24 hour urinary protein= normal
AST = 19 U/L
ALT = 32 U/L
T= 1.2
Bilirubin
mg/dl
D=0.8
Alkaline phosphatase = 769 U/L
Viral markers = negative
Alpha feto protein = normal
What is your diagnosis?
A)
B)
C)
D)
E)
F)
G)
Liver metastasis
Liver abcess
Liver hemangioma
Liver cyst
Focal nodular hyperplasia
Liver adenoma
Hepatocellular carcinoma
What is the best treatment?





A) Prompt surgical consult for
resection
B) Intraveous antibiotic plus
appropriate hydration
C) Emergent percutaneous drainage
D) Angiographic chemoembolization
E) Follow up visits
Case 55


A middle young woman with RUQ pain
and the history of OCP use.
You see the CT scan of patient in next
slide.
Physical examination:
Conscious, cooperative
Vital signs are stable.
No Icteric sclera,
She was not pale ,
No peripheral LNP,
Heart and lung are normal.
Abdomen:
RUQ tenderness,
No Morphy sign,
Liver span=17 cm,
No shifting dullness,
Lab findings
Hb = 13.4 gr/dl, RBC = 5.1x10 6 , MCV=102,
MCH & MCHC = normal
PLT = 217000
WBC = 7100 , poly = 68% lymph = 27%
ESR = 22 , PT = 12.5 sec. INR = 1.1,
Albumin = 4.4 g/dl / total protein = 5.7g/dl
BUN, Creatinine= normal
24 hour urinary protein= normal
AST = 19 U/L
ALT = 32 U/L
T= 1.2
Bilirubin
mg/dl
D=0.8
Alkaline phosphatase = 769 U/L
Viral markers = negative
Alpha feto protein = normal
What is your diagnosis?
A)
B)
C)
D)
E)
F)
G)
H)
Polycystic kidney disease
Liver abcess
Liver hemangioma
Liver simple cyst (congenital)
Focal nodular hyperplasia
Liver adenoma
Hydatid cyst versus cystadenocarcinoma
Hepatocellular carcinoma
What is the best treatment?





A) Prompt surgical consult for
resection
B) Intraveous antibiotic plus
appropriate hydration
C) CT guided percutaneous aspiration
D) Angiographic chemoembolization
E) Follow up visits