#OSCE
◽CVS
🔹️AS

Q1_ What're the BP changes could you see in pt with AS ?
➡️Low BP with narrow pulse pressure

Q2_What're the puse changes could you see in pt with AS ?
1_Slow volume ( pulsus parvus)
2_Slow Rising pulse (pulsus tardus)
3_Pulses bisferiens (AS+AR)

Q3_ What's the type of murmur and it's radiation in pt with AS?
➡️ Ejection systolic murmur radiates to the root of neck

Q4_ How to differentiate between AS radiation and Carotid a atherosclerosis?
➡️Phonoangiography

#OSCE
◽CVS
🔹️Apex beat

Q1_ Prescribe the normal apex beat site and character ?
1_lt 5th intercostal space midclvicular line
2_gentle non sustained

Q2_ Mention 2 manoeuvres in case of impalpable?
1_Turn pt to lt lateral position
2_palpate at Rt side

Q3_Mension 3 abnormal character?
1_ Forceful sustained / AS
2_ Forceful unsustained / AR , MR
3_ Tapping / MS
4_ Diffuse / DCM
5_ Double / HOCM

Q3_What valve is responsible for S1 , S2 ?
1_S1 / Closure of M
2_ S2 / Closure of A

Q4_ What signs you should look for in case with Dextrocardia ?
1_ Cyanosis
2_ Clubbing
3_During measuring the liver span ➡️The liver is at Lt side ( if Dextrocardia with situs inversus )

Q5_ Pt with ⬆️ JVP , LL edema , ascitis what could be the cause ?
Rt side heat failure

#OSCE
◽GIT
🔹️Ascitis

Q1_ What is the mechanism of ascitis in liver cirrhosis?
1_ ⬆️ Hydrostatic pressure
2_ ⬇️ Osmotic pressure ( Hypoalbumenia)
3_ ⬆️ Aldesterone ( renal Na+ retention)
4_ lymphatic obstruction

Q2_ What is the most common organism which cause SBP ?
E.choli

Q3_What are the causes of absent bowl sounds?
1_ Postsurgical paralytic ileus
2_ Peritonitis

Q4_ What is the cause of Hepatomegally + LLO + ⬆️ JVP?
RHF

#OSCE
⬜Respiratory
🔹️ Percussion note

Q1_ What are the types of percussion notes + DD ?
👇
1_ Resonace ➡️ Normal
2_ Hyper_resonance ➡️ Emphysema, Pneumothorax
3_ Dullness➡️ Collapse, Consolidation
4_ Stony dullness ➡️Massive Pl.Eff

Q2_ Where are the sites of normal dullness over the chest on percussion ?
👇
Percussion over soild structures
1_ Liver/ Upper level of liver dullness at Rt fifth inercostal space midclavicular line
2_ Heart / Dullness over the anterior chest

Q3_ What are the examination findings of pt with lt side lung collapse ?
👇
1_ ⬇️ Chest expansion at lt side of chest
2_ ⬇️ TVF at lt side of chest
3_ Pulled Trachea to lt side
4_ Dullness percussion note
5_ ⬇️ air enty at lt side

Q4_ لما نبي نفحص ال middle lobe
وين ندير ال percussion ؟
👇
Over the Rt Axilla

Q5_ Who to do chest expansion by percussion?
👇
Tidal percussion

Q6_ What is the type of percussion in pt with pl.eff ?
👇
Stony dullness.

#OSCE
⬜CNC
🔹️Cerebellum

Q1_ What is the definition of Apraxia ?
👇
Apraxia is a neurological disorder characterized by the inability to perform learned (familiar) movements on command, even though the command is understood and there is a willingness to perform the movement.

Q2_ What are the types of apraxia ?
👇
1_ melokinetic (or limb‐kinetic)
2_ ideomotor apraxia
3_ ideational apraxia
4_ Conceptual apraxia
5_ Buccofacial apraxia
6_ Constructional apraxia
7_ Oculomotor apraxia
8_ Verbal apraxia


Q3_ How to examine constructional apraxia ?
⬇️
By writing words and numbers.

شرح مفصل للأنواع 💡

1_Limb-kinetic apraxia
👇
Pt is unable to use a finger, arm, or leg to make precise and coordinated movements. Although people with limb-kinetic apraxia may understand how to use a tool, such as a screwdriver, and may have used it in the past, they are now unable to carry out the same movement.
متلاً مش قادر يحرك يديه يفتح و يصكر .

2_Ideomotor apraxia
👇
Pt is unable to follow a verbal command to copy the movements of others or follow suggestions for movements.
مش قادر يقلد حركة.

3_Conceptual apraxia
👇
similar to ideomotor apraxia. Pt is also unable to perform tasks that involve more than one step.
مش قادر يقلد مجموعة من الحركات .

4_Ideational apraxia
👇
Pt is unable to plan a particular movement. They may find it hard to follow a sequence of movements, such as getting dressed or bathing.
مش قادر يلبس ملابسه

5_Buccofacial apraxia
👇
Pt is unable to make movements with the face and lips on command.
مش قادر يحرك عضلات وجهه

6_Constructional apraxia
👇
Pt is unable to copy, draw, or construct basic diagrams or figures.
مش قادر يقلد رسمة او يكتب حرف

7_Oculomotor apraxia
👇
Pt have difficulty making eye movements on command.
مش قادر يحرك عضلات عيونه

8_Verbal apraxia
👇
Pt find it challenging to make the movements necessary for speech. They may have problems producing sounds and understanding rhythms of speech.
مش قادر يحرك العضلات المسؤولة على الصوت بشكل سليم ، فيبدا صوته مش واضح و كلامه مش مفهوم.

شيت مجمعة فيه اهم الحالات اللي تجي في امتحان الكلينك بال DD و ال Inv
شوفوه حيفيدكم هلبا باذن الله 🌸🌸

#General
لو كانت الفايندينق jaundice

~يسألك بعدها عال DD of jaundice ؟

A_per_hepatic / Hemolysis
B_Hepatic / hepatitis , liver cirrhosis and its cases , malignancies
C_pos_thepatic / Stone , PBC , PSC , Cancer head of pancreas

~بعدها يسالك على ال investigations ؟
🔸️per_hepatic
CBC
Blood film
LDH
Heptoglobulin
Bilirubin
ESR , ANA , Anti ds
( على خاطر ال acquired causes of hemolytic anemia )

و باقي التحاليل اللي خاصة بكل نوع من ال congenital causes
HB electrophoresis
Osmotic fragility test
G6P level

🔸️Hepatic , post_hepatic
LFT
Abdominal US
MRCP
ERCP

#General
لو كانت الفاينديق Signs of anemia
~يسألك بعدها على أنواع الانيميا و ال DD لكل نوع؟
➡️Microcytic
1_ Iron deficiency anmia
2_ Thalassemia
3_ Sidroplastic anemia
4_ lead poisoning
5_ Anemia of chronic illness

➡️Macrocytic..
1_ Megaloplastic anemia
2_ Liver disease
3_ Alcholism
4_ Renal failure

➡️Normocytic..
1_ Anemia of chronic illness
2_ hemolytic anemia


~و يسألك بعدها عال investigations ؟
اول شي نبعت
CBC
🔸️لو طلعت microcytic
نبعت
Iron study
Upper and lower git endoscopy ( if old age)
Stool analysis
🔸️لو طلعت macrocytic
نبعت
Folic acid level
Methylmalonic acid
B12 level
🔸️لو طلعت Normocytic
نفكر في hemolytic
نبعت
Blood film
LDH
Heptoglobulin
Bilirubin
و لما التحاليل هادي تاكدلي انها فعلاً hemolytic
نبعت تحاليل باش نعرف السبب👇

ESR CRP ANA Antids...(على خاطر ال acquired causes / eg :- SlE )

و بالنسبة لل congenital causes هوني كل نوع عنده تحليل خاص بيه تقوله .
Osmotic fragility test
G6P level
Hemoglobin electrophoresis

#General
**Rheumatology

بما انه Hand examination على طول ال DD بيكون
DD of small joint arthritis 💡

بعد ما تكمل خطوات الاقزامنيشن تسمي ال DD و اللي هما
1_RA
2_SLE
3_Psoriatic arthritis
4_Osteoarthritis
5_ Gouty arthritis

~و يسألك كيف تعرف الحالةactive و لا لا ؟

Hx / joint pain ,morning stifness, joint swelling
Ex/ Tenderness , Hotness ,joint Swelling , Rhematoid nodules
Inx / CBC ,ESR ,CRP

و طبعاً هني على حسب شن شوفت في الاقزامنيشن ، لو فيه تندرنس و هوتنس بتقوله اكتف .

~ و يسألك بعدها عال investigations؟
CBC
ESR
CRP
RF
AntiCCP
ANA ,Antids
Joint aspiration
X,ray

#General
**Endocrine
الفايندينق حتكون يا اما signs of hypo or hyperthyroidism

~بعدها يسألك على ال Causes ؟

🔸️لو كانت hypo
1_Autoimmune/ Hashimoto,s
2_Post_thyrodectomy or radiotherapy
3_Iodine deficiency
4_Drugs SE / lithium, Amiodarone

🔸️لو كانت hyper
1_ Graves
2_ Multinodular goiter
3_ Single toxic nodule
4_ Thyroiditis

~و بعدها يسألك على investigations ؟

TFT / Free T3 , T4 , TSH
Neck US
Antibodies اللي خاصة بكل واحد منهم
Anti TSH stimulating hormone antibodies
Anti thyroid peroxidase antibodies

#CNS
➡️Motor examination
اكثر فايندينق ممكن تجي UMNL

~و بعدها يسألك على ال DD
1_Vascular ( ischemic, hemorrhagic )MCC
2_Tumer
3_Trauma
4_Infection
5_Inflammation_MS

~و بعدها يسألك على ال investigations ؟
Non contrast CT
MRI
ECG
ECHO
Carotid duplex
CBC
ESR___if high / نبعت حتى ANA , Antids
RBS , HBA1c
Lipid profile
Coagulation profile
LFT
RFT
CSF examination
Oligoclonal IgG
...........................
➡️Cerebellar examination

الفايندينق ح تكون signs of ataxia

~يسألك بعدها على ال DD ؟

A_Congenital
1_spinocerebellar ataxia
2_freidreich ataxia
3_a beta lipoproteinemia
4_ataxic telagectasia
B_Acquired
1_Trauma
2_tumer
3_infection
4_Inflammation/ MS
5_Vascular ( ischemic, hemorrhagic)
6_Alcohol, phenyton toxicity
7_Autoimmune ( SCC , Celiac)
8_Hypothyroidism
9_Vit B deficiency _ especially B12

~بعدها يسألك على ال investigations ؟
نفس اللي فوق تزيد عليهم 👇

Vit B 12 level
Blood film
TSH
Free T4


➡️ Crainal nerve examination

يا اما يبيك اديرهم كلهم و مرات بس يبي 7 بروحه او 3 و 4 مع بعض
و الدسكشن عالاغلب حتكون على facial nerve palsy و شن أسبابه؟
🔸️Causes of upper facial nerve palsy
1_ Trauma
2_ Tumer
3_ Infection
4_ Inflammation/ MS
5_ Vascular/ Stroke

بالنسبة لل investigations نفسهم متع ال UMNL


🔸️Causes of lower facial nerve palsy (Unilateral )
1_ Bells palsy
2_ DM
3_ Post acoustic neuroma surgery
4_ Ramsy hunt syndrome
5_ OM
6_Parotid tumer

🔸️Causes of lower facial nerve palsy( Bilateral )
2L , 2 syndrome
1_ leprosy
2_ lyme disease
3_ fisherman syndrome (part of GBS)
4_ Heerfords syndrome (part of sarcidosis)

#Respiratory
اكثر فايندينق تجي
🔸️Rhonchi
~و يسالك بعدها على ال DD ؟
1_Asthma
2_COPD
3_Pneumonia
...ect
~بعدها يسألك على ال investigations ؟
طبعاً زي ما محفظنا سيف
ABG ,pusle oxymetry
CXR
PFT
و تزيد عليهم👇
Spirometry , peak flow meter
(على خاطر الازما )
HRCT
(على خاطر لو عنده امفيزيما )
CBC
Sputum culture, blood culture, urine culture
(على خاطر النيومونيا )
المهم الخلاصة بتسمي الانفزتيقيشن على حسب ال DD
..........................................................................
🔸️Fine crepitation
~يسألك بعدها عال DD
1_ILD
2_early pneumonia
3_pulmonary edema as complications of HF
~ و يسألك بعدها عال investigations ؟
نفس الشي
ABG
PFT
CXR
و تزيد عليهم 👇
CBC
ESR , CRP
CTD screening / ANA , Antids
HRCT
BAl
Biopsy
( على خاطر ال ILD )
Echo
(على خاطر pulmonary edema )
Sputum culture , blood culture
(على خاطر النيومونيا )
...........................................................................
🔸️Course crepitation
~يسألك بعدها عال DD ؟
1_Bronchiactasis
2_chronic bronchitis
3_late pneumonia
~ و يسألك بعدها عال investigations ؟
نفس الشي
ABG , pusle oxymetry
PFT
CXR
و تزيد عليهم 👇
HRCT
Sputum microbiology
Serology
Sacharin test
Ig level
(على خاطر ال Bronchiactasis )
CBC
Sputum culture, blood culture
(على خاطر ال نيومونيا )

حاجة تانية في الريسبيراتوري ، مرات الفياندينق تكون👇
Decreased air entry
Dullness at lower zones
Chest tube under water seal
~يسألك بعدها على ال DD of dulness ؟
1_Pleural effusion
2_Collapse
3_Consolidation
~و يسألك بعدها على ال most likely Diagnosis و اللي هو plural effusion.
~و يسألك على ال causes ؟
➡️A_General
CHF
Nephrotic syndrome
Liver cell failure
➡️B_local
Pneumonia
TB
CTD / SLE , RA
Malignancies
Pulmonary infarction
~بعدها يسألك على ال investigations ؟
CXR
CT scan
US مرات تفيدني بس
ABG , pulse oxymetry
Plurocentesis /باش نحدد النوع exudative او transudative

و على أساس التحليل هذا بنبعت تحاليل تانية باش نزبط ال cause ؟
لو كان transudative
بنبعت
ECG
Echo
Urine for RE
U/Cr/E
LFT
Abdominal US
لو كان السبب exudative
نفس الشي بتبعت تحاليل باش تستبعد كل الاسباب
CBC
Sputum culture, blood culture
Quantiferon test
ESR , CRP
ANA , Anti ds