OSCE answers (Part two)

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OSCEanswers(Part two)

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

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Case 12

• Attention to the monosodium urate crystal on
  polarized light microscopy and the tophus. The
  correct diagnosis is gouty arthritis
• Intraarticular steroid is already considered the
  best treatment in gouty knee monoarthritis.

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Case 13

• Attention to the Subungueal splinter hemorrhage
  and Janeway lesions (non-tender, small
  erythematous or haemorrhagic macular or nodular
  lesions on the palms or soles only a few
  millimeters in diameter) . The correct diagnosis
  is infective endocarditis.
• Intravenous antibiotic is the best treatment .

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Case 14

• Attention to the Spherocytes. The correct
  diagnosis is Spherocytosis .
• Folate supplement is recommended in this case
  with mild anemia.

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Case 15

• Attention to the hairy cell. The correct
  diagnosis is Hairy cell leukemia.
• Bone marrow transplant is the best treatment
  option.

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Case 16

• Attention to the hypersegmented neutrophil . The
  correct diagnosis is megaloblastic anemia.
• B12 supplement is the best treatment option.
• Shilling test might help in defining the
  etiology.

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Case 17

• The diagnosis is fecal impaction.

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Case 18

• Attention to the food material in stomach and
  empty duodenum. The correct diagnosis is gastric
  outlet obstruction.

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Case 19

• Acute viral hepatitis does not match with the
  patient diagnosis.
• In acute viral hepatitis the ichterus appears
  when the fever is decreased.

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Case 20

• Diagnostic paracentesis should be considered for
  the diagnosis of ascitis etiology.
• Shock liver do not match the patient diagnosis
  according to history.

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Case 21

• The patient is a case of severe preeclampsia.
  Termination of pregnancy is the best treatment
  strategy.

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Case 22

• Considering the increased gamma globulin level,
  autoimmune hepatitis is the best diagnosis.
• Steroid is the best treatment in this patient.