Fw: Medical Videos Lectures and Clinical Examination Videos
- Doru Steopan----- Forwarded Message -----
From: Medical Osce <joolyusa2@...>
Sent: Saturday, January 12, 2013 3:09 PM
Subject: Medical Videos Lectures and Clinical Examination Videos
Posted: 12 Jan 2013 05:06 AM PSTQuestionA woman presented with painless, subcutaneous nodules that had developed during the previous 5 months on her buttocks, shoulders, and left wristWhat is the most likely diagnosis in this 36-year-old woman with chronic renal failure?Lipoma
- What is the most likely diagnosis in this 36-year-old woman with chronic renal failure?
- A 46-year-old woman had an enlarging, tender, draining nodule on the upper arm
- A 14 months old baby presented with a lesion on her abdomen ,which started from 2 months of age,
- A old man presented with frontal headache
- A 34-year-old woman presented to her primary care physician with vulvar pruritus
- An 83-year-old man was being treated for diabetes mellitus, hypertension, and ischemic heart disease.
- A woman presented with a 4-day history of mouth pain and a 3-month history of fatigue
- A 56-year-old woman with hypertension presented with a sudden onset of painless impaired vision in the right ey
- What is this genetic disorder ?
CalcinosisShow Correct.AnswerCorrect Answer : CalcinosisExplanation :Tumoral calcinosis is characterized by soft-tissue calcium and phosphate deposits which are most commonly due to chronic renal failure. These nodules resolved after parathyroidectomy.Her medical history was notable for glomerulonephritis leading to dialysis at 14 years of age. She later underwent transplantation of a kidney from a deceased donor; the transplant failed, and for the 3 years since, the patient has been undergoing peritoneal dialysis. A plain film of her left wrist showed numerous lobulated, septated calcific masses (Panel B). Laboratory tests revealed severe secondary hyperparathyroidism, with a calcium level of 10.5 mg per deciliter (2.6 mmol per liter) (normal range, 8.4 to 10.2 [2.1 to 2.6]), a phosphate level of 6.4 mg per deciliter (2.1 mmol per liter) (normal range, 2.7 to 4.5 [0.9 to 1.5]), an alkaline phosphatase level of 458 U per liter (normal range, 40 to 120), and a parathyroid hormone level of more than 2000 pg per milliliter (normal range, 15 to 65). Attempts to suppress the parathyroid hormone level with the use of medication were unsuccessful. Three months after a partial parathyroidectomy to remove a 4-g left hyperplastic inferior gland, there was complete resolution of the subcutaneous nodules, including those in the wrist (Panels C and D). Laboratory values improved considerably: calcium level, 9.8 mg per deciliter (2.5 mmol per liter); phosphate level, 5.4 mg per deciliter (1.7 mmol per liter); and parathyroid hormone level, 177 pg per milliliter. Tumoral calcinosis is characterized by soft-tissue calcium and phosphate deposits, which are most commonly due to chronic renal failure.The post What is the most likely diagnosis in this 36-year-old woman with chronic renal failure? appeared first on Medical Osce.Posted: 12 Jan 2013 04:02 AM PSTQuestionThis patient reported bleeding gums. What is the diagnosis?Acromegaly
Scurvy"Show" "Correct.Answer"Correct answer : DermatomyositisExplanationExamination of the mouth reveals markedly dilated capillaries in the attached gingiva, with bushy loop formations that spread over the lower teeth. These areas reflect the vasculopathy associated with dermatomyositis, particularly in its juvenile form.this 16-year-old girl with long-standing juvenile dermatomyositis had an illness marked by intermittent clinical flares, including increased muscle weakness, joint contractures, photosensitive rashes, and dysphagia, despite treatment with multiple immunosuppressive drugs. At presentation, Gottron’s papules, a heliotrope rash, and periungual capillary changes were visible, including dilated and tortuous blood vessels with areas of atrophy, telangiectases, and bushy loop formation along the fingernail bed (Panel A, arrows). The patient reported having had bleeding gums that had not responded to traditional dental treatment. Close examination of the mouth revealed markedly dilated capillaries in the attached gingiva, with bushy loop formations that spread over the lower teeth .These areas reflect the vasculopathy associated with dermatomyositis, particularly in its juvenile form. Periungual capillary changes have been reported frequently in patients with juvenile dermatomyositis, whereas the accompanying gingival changes are often present but not frequently recognized. Periungual capillary changes correlate with underlying disease activity, particularly in the skin, and persistent abnormalities are associated with a long course of illness.Posted: 12 Jan 2013 02:56 AM PSTQuestionA 46-year-old woman had an enlarging, tender, draining nodule on the upper arm. Prior treatment consisting of hot compresses and a course of oral antibiotics had had no effect. The patient had no other symptoms or findings, and the results of routine blood studies were normalWhat is the diagnosis?Cutaneous leishmaniasis
Cutaneous larva migrans
TungiasisShow Correct.AnswerCorrect Answer : Furuncular myiasisExplanation :The image shows a human botfly larva (Dermatobia hominis) emerging from an inflamed nodule on the patient’s upper arm. Cutaneous leishmaniasis, cutaneous larva migrans, epidermoid cyst, and tungiasis have distinct appearances.She had traveled to southern Mexico six weeks earlier for an archaeological dig. During her clinic visit, a human botfly larva (Dermatobia hominis) began to emerge from the nodule. The traditional treatment in areas where myiasis is endemic (Mexico and South and Central America) is occlusion of the furuncular punctum with pork fat to stimulate extrusion of the larva. Neither the pork-fat treatment nor surgical treatment with a cruciate excision and gentle extraction of the larva was required in this patient, because the larva (approximately 2 cm long) (Panel B) emerged from the lesion spontaneously. The female botfly deposits her eggs on the legs or body of an insect or tick. The patient presumably was infected when bitten by such an insect or tick. At the time of the bite, the botfly eggs hatch, and the larvae quickly burrow into the host’s skin. Within days, the host’s immune response causes the development of an inflamed furuncle. The larva has characteristic black, backward-pointing spines that anchor it in the host’s skin and make removal difficult.The post A 46-year-old woman had an enlarging, tender, draining nodule on the upper arm appeared first on Medical Osce.Posted: 12 Jan 2013 01:53 AM PST1.What is the lesion?2.What is your management?The post A 14 months old baby presented with a lesion on her abdomen ,which started from 2 months of age, appeared first on Medical Osce.Posted: 12 Jan 2013 12:52 AM PST63-year-old man presented with a long-standing history of sinusitis and 3 weeks of frontal headache. The physical examination was unremarkable. The alkaline phosphatase level was elevated at 434 IU per liter (upper limit of the normal range, 129). The serum calcium level was within normal limitsComment about his Radiographic findings?What are the DDx ?What is the Rx for headache ?Posted: 11 Jan 2013 11:51 PM PSTQuestionA 34-year-old woman presented to her primary care physician with vulvar pruritus, which she reported having had for several months.What is the diagnosis?Behçet’s syndrome
Lichen simplex chronicus
Vestibular papillomatosisShow Correct.AnswerCorrect Answer : Vestibular papillomatosisExplanation :These shiny, soft, linearly arrayed papules are the typical presentation of vestibular papillomatosis, a variant of vestibular mucosa commonly mistaken for genital wartsA diagnosis of condyloma on the vulvae was made, and the patient was referred for treatment. Many flesh-colored, soft pearly papules, which were 1 to 2 mm in diameter, with some grouped and some discrete, were observed on the inner aspects of her labia minora. These papules were linearly distributed and symmetrically located along both inner sides of the vulvae (arrows). Grouped projections on the right inner labium minus were easily separated from each other on examination. The shiny, soft, linearly arrayed papules are the typical presentation of vestibular papillomatosis, a variant of vestibular mucosa commonly mistaken for genital warts. Clinically, genital warts, or condyloma, are not confined to the vestibule. Filiform or cauliflower projections of condyloma tend to fuse at the base. When 5% acetic acid is applied to condyloma acuminatum, a whitening typically occurs; with vestibular papillomatosis, there is usually no whitening. Vestibular papillomatosis is a normal vulvar anatomical condition that can be seen as the female counterpart of male pearly penile papules. A correct diagnosis of vestibular papillomatosis prevents unnecessary concern and laboratory tests.The post A 34-year-old woman presented to her primary care physician with vulvar pruritus appeared first on Medical Osce.An 83-year-old man was being treated for diabetes mellitus, hypertension, and ischemic heart disease.Posted: 11 Jan 2013 08:29 PM PSTQuestionAn 83-year-old man was being treated for diabetes mellitus, hypertension, and ischemic heart disease. What is the diagnosis?Pancreatic pseudocyst
Emphysematous cholecystitisShow Correct.AnswerCorrect Answer : Emphysematous cholecystitisExplanation :The computed tomogram shows an air-fluid level in the lumen of a dilated gallbladder and gas within the gallbladder wall. These findings suggest emphysematous cholecystitis.Cholelithiasis had previously been detected by abdominal ultrasonography. After drinking alcohol at home, the patient had acute abdominal pain. Plain-film radiography of the abdomen (Panel A) showed air (arrow) in the upper right quadrant. After antibiotic therapy, cholecystectomy and drainage were performed. Clostridium perfringens was isolated from the culture of drained biliary fluid. The patient recovered uneventfully.The post An 83-year-old man was being treated for diabetes mellitus, hypertension, and ischemic heart disease. appeared first on Medical Osce.Posted: 11 Jan 2013 07:17 PM PSTQuestionA 26-year-old malnourished woman presented with a 4-day history of mouth pain and a 3-month history of fatigue, general malaise, and palpitations.What is the most likely diagnosis?End-stage renal disease
SarcoidosisShow Correct.AnswerCorrect answer : Iron deficiencyExplanation :There is pallor of the nail beds, as well as koilonychia (spoon-shaped nails). Though koilonychia can be present in other diseases, together these findings are most suggestive of iron-deficiency anemia.The post A woman presented with a 4-day history of mouth pain and a 3-month history of fatigue appeared first on Medical Osce.A 56-year-old woman with hypertension presented with a sudden onset of painless impaired vision in the right eyPosted: 11 Jan 2013 06:13 PM PSTQuestionA 56-year-old woman with hypertension presented with a sudden onset of painless impaired vision in the right eye. On the previous day, she had undergone cardiac catheterization for evaluation of hypertensive emergency (chest pain and blood pressure of 235/110 mm Hg) with mild troponin elevation.What is the diagnosis?Central retinal vein occlusion
ToxoplasmosisShow Correct.AnswerCorrect Answer : Cholesterol embolismExplanation :The image demonstrates cholesterol emboli with surrounding white lucency representing retinal edema. Fluorescein angiography confirmed occlusion of the cilioretinal artery with nonperfusion of the tissue bed in the hypofluorescent areas. Cholesterol emboli are crystals that are released in the arterial bloodstream from ulcerated or disrupted atherosclerotic plaques and can be an initial sign of vascular disease.The post A 56-year-old woman with hypertension presented with a sudden onset of painless impaired vision in the right ey appeared first on Medical Osce.Posted: 11 Jan 2013 05:08 PM PST
- Doru Steopan----- Forwarded Message -----
Subject: Medical Videos Lectures and Clinical Examination Videos
Posted: 13 May 2013 10:14 PM PDTA 67-year-old woman presented with a 6-month history of dyspnea and dysphagia, What is the diagnosis?Coarctation of the aorta
- Woman with dyspnea and dysphagia
- This patient presented with cough
- What is the diagnosis?
- A 70-year-old woman was referred by her general practitioner for evaluation of an ulcerative lesion on her lower right leg
- Movement, bathing, and exercise triggered pain in this patient’s right hand
- This 68-year-old woman presented with hair growth and a sore furrowed tongue.
- A 16-year-old, blonde-haired patient was evaluated for a new band of lighter-colored hair
- A 61-year-old man presented for evaluation of increasing abdominal pain
- Which one of the following medications is most characteristically associated with the illustrated finding?
- A 4-year-old girl with progressive abdominal pain
Substernal goiterShow Correct.AnswerCorrect Answer : Substernal goiterExplanation :The chest radiograph demonstrates tracheal deviation. Ultrasonography of the neck revealed a large goiter with the right lobe extending into the anterior superior mediastinumPosted: 13 May 2013 09:06 PM PDTQuestionA 56-year-old female presented with cough, a weight loss of 27 kg over a period of 6 months, and diffuse bone pain.What diagnosis accounts for the combination of findings on the bone scan?Adverse effect of chronic glucocorticoids
Metastatic lung cancer
Osteomalacia with fracture
Paget’s diseaseShow Correct.AnswerExplanation :The bone scan shows areas of uptake consistent with metastases as well as diffuse linear uptake in the femoral and tibial bones, consistent with hypertrophic pulmonary osteoarthropathy. Examination of specimens obtained by CT-guided biopsy of an 11-cm right lung mass was consistent with large-cell adenocarcinoma. Hypertrophic pulmonary osteoarthropathy is most frequently associated with lung and gastric carcinomas.Posted: 13 May 2013 07:50 PM PDTQuestionA 36-year-old woman with mild mental retardation presented for evaluation of recurrent seizures, which she reported having had since childhood. What is the diagnosis?Condylomata lata
Neurofibromatosis type 1
von Hippel-Lindau disease
Tuberous sclerosisShow Correct.AnswerCorrect Answers : Tuberous sclerosisExplanation :Periungual fibromas such as those in the image are typical in adults with tuberous sclerosis. This patient had tuberous sclerosisTuberous sclerosis is a congenital disease characterised by hamartomatous lesions in the skin, nervous system and internal organs, principally heart and kidney.It is dominantly inherited but many cases result from new mutations.The most frequent presentation is a triad of:
A 70-year-old woman was referred by her general practitioner for evaluation of an ulcerative lesion on her lower right legPosted: 13 May 2013 06:43 PM PDTQuestionWhat is the most likely diagnosis?Chronic venous insufficiency
- adenoma sebaceum:
- actually an angiofibroma with passive involvement of sebaceous glands
- mental retardation
Chronic renal failure
PseudohypoparathyroidismShow Correct.AnswerCorrect Answer : Chronic venous insufficiencyExplanation :Chronic venous insufficiency may be accompanied by subcutaneous calcifications. These calcifications are often discovered by chance on plain radiographs.She had worn compression stockings for several years because of bilateral recurrent ulcers caused by venous stasis. Chronic venous insufficiency was seen on duplex ultrasonography. The patient had no other associated illnesses and had normal levels of C-reactive protein, parathyroid hormone, calcium, phosphorus, serum creatinine, and 25-hydroxycholecalciferol. Chronic venous insufficiency may be accompanied by subcutaneous calcifications. These calcifications are often discovered by chance on plain radiographs (Panel B, arrows) or on ultrasonographic examination of the soft tissues and must be distinguished from calcification of the arterial or venous walls and phleboliths. The patient underwent venous stripping, curettage of the ulcer, and compression therapy; she was subsequently lost to follow-up.The post A 70-year-old woman was referred by her general practitioner for evaluation of an ulcerative lesion on her lower right leg appeared first on Medical Osce.Posted: 13 May 2013 05:35 PM PDT
Movement, bathing, and exercise triggered pain in this patient’s right hand. What is the most likely diagnosis?
The post Movement, bathing, and exercise triggered pain in this patient’s right hand appeared first on Medical Osce.Posted: 13 May 2013 04:30 PM PDTQuestionA 68-year-old woman requested medical attention for a sudden increase in hair growth that she had noticed 11 months earlier. She had lost more than 30 kg during this same period. Physical examination revealed fine lanugo hair all over her face and body and a deeply furrowed tongue, which caused a burning sensation What is the most likely diagnosis?Cushing’s syndrome
- Brachial plexus injury
- Raynaud phenomenon
- Subclavian artery stenosis
Prophyria cutanea tarda
Polycystic ovarian syndromeShow Correct.AnswerCorrect Answer : Paraneoplastic disorderExplanation :Acquired hypertrichosis lanuginosa is a rare disorder of abnormal and excessive growth of fine lanugo hair, most often associated with an internal malignancyThe post This 68-year-old woman presented with hair growth and a sore furrowed tongue. appeared first on Medical Osce.Posted: 13 May 2013 03:29 PM PDTQuestionA 16-year-old, blonde-haired patient was evaluated for a new band of lighter-colored hair located approximately 3 cm from the scalp. The patient first noted the change in hair color 1 week after returning from a 2-week vacation in Costa Rica,What medication is most likely to be responsible for the finding in this woman’s hair?Carbamazepine
VerapamilShow Correct.AnswerCorrect Answer : ChloroquineExplanation :Hair hypopigmentation is a rare but reversible side effect of chloroquine. Although most cases occur after 3 consecutive months of treatment, rapid onset is also possible.which she took chloroquine phosphate for malaria prophylaxis. Instead of taking 500 mg weekly, the recommended dose for prophylaxis, the patient took 500 mg of chloroquine phosphate daily, starting 1 week before the trip, during the 2 weeks in Costa Rica, and for 1 week after returning home. She had taken the first dose 3.5 months before presentation. Hair hypopigmentation is a rare but reversible side effect of chloroquine. Although most cases occur after 3 consecutive months of treatment with daily doses of more than 500 mg of the drug, rapid onset is also possible.The post A 16-year-old, blonde-haired patient was evaluated for a new band of lighter-colored hair appeared first on Medical Osce.Posted: 13 May 2013 02:20 PM PDTQuestionA 61-year-old man presented for evaluation of increasing abdominal pain of eight months’ duration. Basophilic stippling was evident on a blood smear. What is the most likely diagnosis?Acute myelogenous leukemia
Chronic lead poisoning
Sickle cell anemiaShow Correct.AnswerExplanation :Chronic lead poisoning was the diagnosis in this case. Lead poisoning is associated with abdominal pain, blue discoloration of the gums, and basophilic stippling.The patient reported having worked in a lead-smelting company for the past 30 years. The physical examination showed a bluish discoloration of the gums (Panel A). The blood level of lead was 130 μg per deciliter (6.3 μmol per liter [reference range, <20 [1.0 μmol per liter]). His hemoglobin level was 11.5 mg per deciliter, and basophilic stippling was evident in some erythrocytes on a blood smear stained with May–Grunwald–Giesma stain (Panel B). The patient was given a diagnosis of chronic lead poisoning and treated with edetate calcium disodium for 10 days and with 2,3-dimercapto-1-propanesulfonic acid sodium (Dimaval) for 4 weeks. His abdominal pain resolved, and at three months, the blood level of lead was 50 μg per deciliter (2.4 μmol per liter). At follow-up two years later, he remained asymptomatic and his blood lead level was 38 μg per deciliter (1.8 μmol per liter). The reaction of circulating lead with sulfur ions released by oral microbial activity may cause the deposition of lead sulfide at the interface of the teeth and gums, referred to as Burton’s line.The post A 61-year-old man presented for evaluation of increasing abdominal pain appeared first on Medical Osce.Which one of the following medications is most characteristically associated with the illustrated finding?Posted: 13 May 2013 01:11 PM PDTQuestionAn 80-year-old woman presented with longitudinal dark pigmentation of the nails .Which one of the following medications is most characteristically associated with the illustrated finding?Alendronate
ZidovudineShow Correct.AnswerCorrect Answers : ZidovudineExplanation :Longitudinal melanonychia, or longitudinal dark pigmentation of the nails is characteristically associated with use of the medications zidovudine, hydroxyurea, minocycline, doxorubicin, and cyclophosphamideThe post Which one of the following medications is most characteristically associated with the illustrated finding? appeared first on Medical Osce.Posted: 13 May 2013 12:03 PM PDTQuestionA 4-year-old girl presented to the hospital with progressive abdominal pain and distention after a 1-week history of watery diarrhea. The physical examination showed a body temperature of 36.2°C, a distended abdomen, hypoactive bowel sounds, and diffuse tenderness without rebound pain. The laboratory evaluation revealed a white-cell count of 5000 per cubic millimeter, with 63% segmented neutrophils,What is the diagnosis?Ankylosing spondylitis
Perforation of a viscusShow Correct.AnswerExplanations :The plain-film radiograph of the abdomen shows several signs of free intraperitoneal gas. These include air accumulation in the right upper quadrant; the falciform-ligament sign, visible as a longitudinal linear density on the ventral surface of the liver; the ligamentum teres sign, visible as a linear density running along the inferior edge of the falciform ligament; and the visualization of air on both sides of the bowel wall. The patient had a perforated cecum.