صفحه 1:
بسم الله النور
صفحه 2:
Rheumatology : OSCE &
PMP
صفحه 3:
A 35 y/o woman presented with progressive polyuria, fatigue &
dry cough since 2 m ago. Past medical history was
unremarkable except for hypertension & nephrolithiasis.
Physical examinations showed a normal appearing young
woman with mild tachypnea. She is not using any drug except
Enalapril & OCP. Which tests are suitable at this time?
1.86, 8.CBC, FBS,HbA
2.Psychiatric exams 9.UA, Urine volume, Urine ١
electrolytes
3.Na,K,Ca,P,Ma\>
10.ANA,RF,ANCA
4.Uric acid,B12,folate
11.CPK
5.Retic, LDH
12.Serum protein electrophoresis
6.TG,Cholestrol,LDL,HDL,V
LDL 13.Stool Exam
I a aa a :جل 91 3A RETIET
صفحه 4:
تا زمان آماده شدن آزمایشات بیمار به الکتروکاردیوگرام وی دقت کنید. کدام یک از یافته های زیر در اين
نوار جلب cian :
صفحه 5:
Na: 145 UA: few hyaline casts + 11 RBC
r 1
1 I
ا K: 4.4 Urine SG: 1.007 ا
| BUN: 30 Urine Na: 18 mm/I 1
1١ 6 Urine K: NI I
[1 35 FBS: NI ا
1 CBC: NL Alc: 4.4 I
| AST:29 Lipid profile : الا i
| 35 8:6 I
‘ Alk:450 Ca: 13.3 ۰
What is the best next test:
1.Brain CT scan 3.Serum
صفحه 6:
What do you see in this X-Ray?
> 1.Pleural effusion
2.Osteolytic rib lesions
3.Pericardial effusion
4.Reticulonodular opacities
6.Cavitary lung lesion
صفحه 7:
کدام گزینه ها بهترین تصیف را ارایه میکند ؟
۱.کدورت های منتشر شيشه مات
۲.خطوط کرلی منتشر
۲ .ضایعات میکروندولر
۴.توزیع ساب پلورال
۵.توزیع پری برونکیال-پری فیشرال)
Crazy-paving ۶.نمای
۷نمای 6۵۳۵۵19 ۳۱۵8۵۷
صفحه 8:
تست های تکمیلی موید پایین بودن سطح ۳۲۳۱ و سطح ۲۵ هیدروکسی ویتامین د طبیعی بود.با توجه
به جمیع یافته های فوق کدام یک از تشخیص های زیر کمتر در مورد بیمار مطرح میباشد؟
2.Tuberclousis
Hyperparatnyroidism
5.Lymphoma
صفحه 9:
+ Which of the below assessments are most appropriate at
this step???
oe 2.High dose 1 3.TBLB/LNB 4.Kidney biopsy
EEN 5 ی
joracic Echo
Figure 5-52 Sarcoidosis, microscopic
Interstitial granulomas can produce a restrictive
lung disease. The granulomas tend to have a
bronchovascular distribution. The small sarcoid
granulomas shown here are noncaseating, but
larger granulomas may have central caseation.
The granulomatous inflammation is characterized
by collections of epithelioid macrophages, Lang-
1 hans giant cells, lymphocytes (particularly 4
Rig| colls), and fibroblasts. The CD4 cells participate in
% a T,11 immune response. However, immune dys-
۲ regulation can occur along with anergy. Not seen
here are inclusions within the giant cells, such as
asteroid bodies and Schaumann bodies.
صفحه 10:
In the face of negative biopsy which tests would
be expected in this case????
1.High 25-OH vit D
level
3.BAL Neutrophilia
'4.High CD4/CD8 Ratio in BAL
'5.BAL lymphocytosis
صفحه 11:
صفحه 12:
۱.نام ۲ یافته اختصاصی در تصویر روبه رو؟
۲ نام روش تصویربرداری ؟
FIGURE 1. Panda sign in Gallium-67 sean
صفحه 13:
Panda Sign © A
roti lands
@
\ PretrachealLN
> e
‘ight Paratracheal
Lambda Sign
Poratracheal
صفحه 14:
PaTient MANAGEMENT FOR SARCOIDOSIS.
Patient refered or possibie sarcoidosis [| لم
Biopsy showing ] | Features suggesting sarcoidosis
granuloma: ‘Consistent chest roentgenogram (adenopathy)
Ro alternative | | Consistent skin lesione: lupus perio, erythema nodosum,
diagnos maculopapular lesions
Uveitis, optic neuritis, hypercalcemia, hypercalciuria
seventh nerve paralysis,
Biopsy affeotod organ if posciblo
Bronchoscopy: biopsy with granuloma
Needle aspirate: granulomas
Negative but no evidence
‘of allornativo diagnosis
Features highly consistent with sarcoidosis:
Serum ACE level >2 times upper limit normal
BAL lymphocytosis >2 times upper mt normal
Panda/lambda sign on gallium sean
Possible sarcoidosis: seek other diagnosis | Sarcoidosis
FIGURE390-8 Proposed approach to management of patient with possible sarcoid-
fis. Prasence of cne or more of thase features supports the diagnosis of sarcoides's: uve
its, optic neuritis, hypercalcemia, hypercalciuria, seventh cranial nerve paralysis, diabetes
insipidus. ACE, angiotencin-convarting enzyme; BAL, brnchoalvects
صفحه 15:
HGIRE39E7_Postvon emislon tomography and computed
مي nice ey corn
FIGURE390-5_ Maculopapular lesions on the trunk
صفحه 16:
CLINICAL MANIFESTATIONS
Mild hypercalcemia (up to 11-11.5 mg/dL) is usually asymptomatic
and recognized only on routine calcium measurements. Some patients
may complain of vague neuropsychiatric symptoms, including trouble
concentrating, personality changes, or depression. Other presenting
symptoms may include peptic ulcer disease or nephrolithiasis, and
fracture risk may be increased. More severe hypercalcemia (>12-13
mg/dL), particularly if it develops acutely, may result in lethargy, stu-
por, or coma, as well as gastrointestinal symptoms (nausea, anorexia,
constipation, or pancreatitis). Hypercalcemia decreases renal concen-
trating ability, which may cause polyuria and polydipsia. With long-
standing hyperparathyroidism, patients may present with bone pain
or pathologic fractures. Finally, hypercalcemia can result in significant
electrocardiographic changes, including bradycardia, AV block, and
short QT interval; changes in serum calcium can be monitored by fol-
lowing the QT interval.
صفحه 17:
]7۳113/۳3[ )1۸65۱۲۱۵۸۲۱۵۱۱ 0۲ CAUSES ۸
|, Parathyroid-Related
A. Primary hyperparathyroicism
1, Adenomals)
2. Multiple endocrine neoplasia
3, Carcinoma
8, Lithium therepy
. Familial hypocalciuric hypercalcemia
Il, Malignancy-Related
A. Solid tumor with metastases (breast)
8. Solid tumor with humoral mediation of hypercalcemia (lung, kidney)
. Hematologic malignancies (muktiple myeloma, lymphoma, leukemia)
Ill, Vitamin D-Related
A. Vitamin D intoxication
8. 1 1,25(OH),D; sarcoidosis and other granulomatous diseases
C1 1,25(0H),D; impaired 1,25(0H),D metabolism due to 24-hydroxylase
deficiency
IV. Associated with High Bone Turnover
A. Hyperthyroidism
B. Immobilization
C Thiazides
D. Vitamin A intoxication
E, Fat necrosis
V. Associated with Renal Failure
A. Severe secondary hyperparathyroidism
8. Aluminum intoxication
C Milk-alkali syndrome
EVALUATION OF POLYURIA
POLYURIA (282 h)
T
‘Urine osmatliy|
Ceo nena 300 mesmo!
Solute duresi
‘Sowa ao,
radocontast urea
(fom igh ratin
وم
۳
۳
‘robetuston hureics
Histon,
ADH tevet
Diabetes insipidus (00)
Central Dl (vasopressin-senstve)
Primary polydipsia posthypophysectomy, tauma,
موم رو |
Hypothalamic disease histooystesis or granuloma,
Drugs (hiendazne, encreachimen! by snourysm,
chlorpromazine, Sheehan's syndrome, infection,
تست ۳
ام رو
۳
‘Acquird tubular diseasoe:pyolonepii,analgosio nephropathy,
‘lie myeloma, amyloldoas,obsiruction,sarcoidess,
hypercalcemia, nypokalomia, Sjogren's syndrome, seks
۳
Drugs or toxins hum, damecloeycine, methoxyflurane, eno
ighenyliydantsin,propoxyphene, amphotericin
Congenital: hereditary, polycystic or metulry eystic disease
FIGURE61-4 Approach to the patient with polyuria. ADH, antic:
ی بر ATM acure vuibelat hearse,
صفحه 18:
خانم ۷۳ ساله با درد مفاصل
صفحه 19:
۳
A
صفحه 20:
صفحه 21:
آقای ۵۷ ساله با سابقه مصرف
مواد مخدر با شکایت فشار خون
بالاء درد شکم و اختلال عملکرد
کلیه مراجعه نموده است
Polyarteritis nodosa. Renal angiogram showing
multiple microaneurysms.’
صفحه 22:
صفحه 23:
صفحه 24:
صفحه 25:
آقای ۵۷ ساله سیگاری با درد سینه و تعریق مراجعه نموده و پس از ۳1 در بخش 2010© بستری میشود. ۳ روز پس از
بستری دچار درد مفاصل تاری دید و ضایعات پوستی ميشود. :
صفحه 26:
44 y,o man withHematuria + Proteinuria
صفحه 27:
آقای ۴۴ ساله با درد شکم و پهلو و تغییر رنگ مدفوع و ضایعات پوستی زیر
صفحه 28:
صفحه 29:
صفحه 30:
خانم ۳۹ ساله با فشار خون مقاوم به درمان از ۵ سال قبل
و افزایش کراتینین پس از افزودن داروی جدید
Figure 39-6 Fibromuscular dysplasia. A, Selective renal arteriogram
illustrating the beaded appearance of fibromuscular dysplasia with multiple
webs characteristic of medial fibroplasia in a 39-year-old woman. B, Selec-
tive injection of the same renal artery after technically successful percutane-
ous transluminal renal angioplasty. (Courtesy Michael McKusick, MD, Mayo
Clinic, Rochester, Minn.)
صفحه 31:
Extraskeletal calcification in chronic renal failure. A, Arterial calcification (arrows). B, Pulmonary calcification. €, Periarticular calcification
صفحه 32:
آقای ۳۴ ساله با درد و تورم اندام تحتانی
چپ پس از مسافرت هوایی
صفحه 33:
Figure 85-8 Subperiosteal erosions in hyperparathyroidism. Severe
subperiosteal erosions as a manifestation of hyperparathyroidism (arrows).
The extensive scalloped appearance of the middle phalanx on the left Figure 88-2 Prurigo nodularis. (Courtesy I. Macdougall, London, United
(arrowheads) represents a small brown tumor. Kingdom.)
صفحه 34:
pila ۵۴ ساله مورد 610 با شکایت سردرد های شدید ۱ ماه قبل
در سرویس نورولوژی بستری شده است که پس از کنترل
فشارخون سردرد وی بهبود یافته است. در حال حاضر با يافته
های زیر به شما مراجعه نموده است.
Figure 68:9 Nephrogeni systemic fibrosis , feu crane apps
Sree B,Swcling ofthe hans, accompanied by هه ری دما
tnd contracture of he fingers
صفحه 35:
Clinical Significance of Urinary Casts Urine Dipstick Testing
9
Cast ‘Main Clinical Associations Constituent False-negative Results Results
: individual; i Specific Urine pits Urine pros
Hyaline Normal individual; renal disease -- ae
Hyaline-granular Normal individual; renal disease 3 مقعم values In presence —
‘of formaldehyde
Granular Renal disease; acute tubular necrosis = ees میرم
2 2 موی که کج ی Microbial
Waxy Renal disease with function impairment ی 901007 سف اميد
Fatty Proteinuria; nephrotic syndrome to reese ale
‘Ascorbic acid oxidizing
Erythrocyte Glomerular hematuria; proliferative/ تن detergents
necrotizing GN Immunoglobulin ight Urine pit 29.0
سس تس
Leukocyte Acute interstitial nephritis; acute Seder ete ی
itis; proliferati سس نها
pyelonephritis; proliferative GN ee
Renal tubular Acute tubular necrosis; acute interstitial ee
epithelial cell nephritis; proliferative GN; nephrotic Glucose 2200 of Formaldehyde
Gocaled Synarome on 0
epithelial casts) سب سا
Cephalexin (+)
Hemoglobin Same as for erythrocyte cast; hemoglobinuria Tebramycin ب١
caused by intravascular hemolysis igh 36 of urine
5 2 3 Bacteria that do not reduce Abnormally colored
Myoglobin Rhabdomyolysis nitrates to nitrites rine
Nia vegetables in het
Bilirubin Jaundice caused by increased direct bilirubin ‘Short bladder incubation
time
Bacterial, fungal Bacterial or fungal infection in the kidney ER
Containing Normal individual; renal stone disease;
crystals crystalluric AKI
Mixed According to components present in the cast
صفحه 36:
Hematology : OSCE & PMP
صفحه 37:
خانم 21 ساله بی علامت که طی آزمایشات درخواستی توسط یکی از همکاران پزشک عمومی برای وی
هموگلوبین 13 گلبول های سفید 7800 با افتراق سلولی نرمال و پلاکت 33000 گزارش شده است.
در شرح حال وی 4 مورد که از اهمیت بالایی جهت هدایت بررسی های تکمیلی برخوردار است را
انتخاب نماييد :
1.مصرف قرص هاى ضد باردارى
5.سابقه قبلى كم خونى فقر آهن
6.شرح حال اليكومنوره يا امنوره
7|اكيموز هاى كذراى يوستى ]
8. حملات همارتروز در كودكى
صفحه 38:
کدام یک از اقدامات زیر جایگاه بالاتری در بررسی تکمیلی
بیمار دارد (3 مورد):
3.بررسی مغز استخوان
4 بررسی تست های ANA-AntiDs DNA-ESR-
CRP-CANCA-PANCA
5.بررسی سطح سرمی ترومبوپویتین
6.بررسی ژنتیک از نظر JAK-2
7.فلوسیتومتری خون محیطی از نظر CD55,CD59
[ 8. تكميل شرح حال از نظر مصرف آخير آنتى بيوتيكا
صفحه 39:
جهت تایید نشخیص کدام مورد یا موارد زیر را پیشنهاد میکنید (هر انتخاب غلط نمره منفی دارد):
1,تکرار نمونه 080 با لوله حاوی EDTA
صفحه 40:
خانم ۳۲ ساله با شکایت سیری زود رس و ضعفو بی حالی به شما مراجعه میکند. در
معاینات اولیه متوجه آنمی و اسپلنومگالی متوسط در بیمار میشوید. آزمایشات اولیه
درخواستی نشان دهنده لکوسیتوز ۲۹۰۰۰ میباشد. به درخواست شما لام خون محیطی بیمار
الصاق ميشود. ۱
ليع - عدن - -
00 ا 5 .650 oe 9
| توصیف؟ 82 060 وه 5 2
BS°o 6.088۳ 6
۲,تشخیص؟؟ ۰ 0و۵ بم ۵ 8 ,8 8
و 0
9 قح 0 C
۳. تششخيص افتراقى؟؟؟ ost ف 9 01 29
١ 66م ©
٩ ۲9 ۷۹ REL AS of وه
صفحه 41:
ادامه کیس : . طبق در خواست شما آزمایشات تکمیلی انجام شد که نتیجه بررسی سیتوژنتیک
مشهود است,
توصيف و تشخيص؟؟؟ | 2 9
2
صفحه 42:
Skin nodules in CML
7
ب
Nac
صفحه 43:
© ©
© 0 S00
Fig. 105: Peripheral ood pcre aceeated phase of chronic myeloid Fig. 106% Dagrmmatic pevphen ood pce in acceleted
Teukeriashoweg rinerous bbs0-198) an sting basephia pee of cone’ myo leukemia showing numerous
سس
|
] shoving numerous lass 20% ormore)and ting basophils dane myelod ltemia showing tuametous st 0086 mo)
اس و مج
صفحه 44:
۲ ماه پس از شروع درمان بیمار دچار تغیبرات زیر در گرافی
سینه شده است. alas درمان برای وی تجویز شده است؟؟
FFE
صفحه 45:
TKI side effects:
Imatinib: fluid retention/weight gain, nausea, diarrhea, rashes, periorbital
edema, bone or muscle aches & fatigue. Second-generation TKls are
associated with less adverse events.
Dasatinib: myelosuppression (particularly thrombocytopenia)
pleural/pericardial effusions . PHTN reported (<2%) & presents with
shortness of breath + normal CXR. reversible with dasatinib discontinuation
and use of sildenafil.
Nilotinib: hyperglycemia/DM, pruritus/rashes, headaches, pancreatitis &
vasospastic -vasoocclusive events (angina, CAD, AMI, PAD, TIA, CVA &
Raynaud’s)
Bosutinib: high rates of GI complications- diarrhea (70%).
Ponatinib: rashes, pancreatitis, increased amylase/lipase, HTN &
vasospastic/occlusive events.
Nilotinib and dasatinib may cause prolonged QTc & should be evaluated
cautiously in patients with QTc >470-480 ms.
These side effects can often be dose-dependent and are generally
ravarcihla with dAnca radiirctinnce | nwact actimatad affartivia Ancac nf TKic
صفحه 46:
آقای 65 ساله با شکایت ضعف و
بی حالی و پارستزی نواحی دیستال
اندامها مراجعه نموده است
صفحه 47:
۸
۲۱6۵8۶ 1282 A. The peripheral blood in severe megaloblastic anemia, B. The bone marrow in severe megaloblastic anemia. (Reprinted from AV
صفحه 48:
‘Subacute combined degeneration of the cord (SCD) is caused by 3
Epidemiology
Clinical presentation
صفحه 49:
(a) Lateral column hyperintensity
(arrows), (b) posterior column
(arrows) and lateral column
Posterior column hyperintensity on
sagittal (a) and axial (b) sections
صفحه 50:
صفحه 51:
خانم ۳۴ ساله که دچار زردی پیش رونده و ضعف و بی حالی شدید شده است.
9 جع
صفحه 52:
يسر ١5 ساله با تنكى نفش بسيار شديد و ضعف و حمر a
بی حالی و ایکتر پس از مصرف غذای رستوران ٠١ © © Lo
LOSS \ _@
6 7 ©
0
صفحه 53:
G6PDD is X-linked, thus males have only one gene (hemizygous)
- either normal or G6PD deficient.
By contrast, females, have two genes- normal, deficient
(homozygous) or intermediate (heterozygous).
Because of X chromosome inactivation, heterozygous females
are mosaics with variable degree of expression; some
heterozygotes present as hemizygous male
Among 180 mutations, those underlying chronic nonspherocytic
hemolytic anemia (CNSHA) are discrete. In this severe
phenotype enzyme deficit is more extreme, because of a more
severe instability of the enzyme.
صفحه 54:
آقای۳۴ ساله با درد شدید کف دستها و پاها و گزگز شدید هر ۴ اندام از ۱ ماه قبل
Multikinase inhibitors
Sorafenib Renal cell, hepatocellular, differentiated thyroid Diarrhea Targets c-raf, VEGFR
carci Han footsynarome : سوال بوردی
Regorafenib Second-line colorectal cancer; Gl stromal tumor Hypertension VEGFR/TIE2 داروی ۲
Hand-foot syndrome
Astin Renal cell carcinoma, second line Darhea/oter Gl Target EGFR POGRCKt يا oh yi ga
Fatigue / ثراپی
عارضه مشابه بت
Capecitabine
Diarthea Prodrug of SFU due tointratumoral metabolism) ggg را نام
20-00 06 پبری
صفحه 55:
آقای ۴۳ ساله راننده كاميون با سابقه DVT که از دو هفته قبل تحت درمان
میباشد.
۱.تشخیص؟
۲ علت؟؟
صفحه 56:
Mechanism of Warfarin necrosis
Warfarin induced skin necrosis
+ Typical patient appears to be an obese, middle aged
woman
Usually occurs between the 3 and 10" days of
therapy
Associated with the use of large loading doses at the
start of treatment
— Increased initial dose(max 0.75 mg/kg) hasten onset of
anticoagulant effect
~ Beyond this dosage, speed of onset is independent of dose
se
صفحه 57:
Gastroenterology : OSCE & PMP
صفحه 58:
Question 35
* A 54 Y/O gentleman presents with
melena
۰ After making sure of hemodynamic
stabilization, endoscopy shows this
lesion i in the bulb of duodenum
۰ 65] 0
rt feeding and rae the
patient the s:
* B- Apply dual pherapy (a اه
anda th ermal)
* C- Inject the lesion with diluted
epinephrine only
* D- Repeat endoscopy in two days and
then decide
صفحه 59:
FIGURES7-1 Suggested algorithm for patients with acute upper gastrointestinal (Gi) bleeding. Recommendations on level of care and
time of discharge assume patient is stabilized without further bleeding or other concomitant medical problems. \CU, Intensive care unit; PP,
Proton pump inhibitor.
صفحه 60:
Question 36
This is the radiography of
abdomen of a patient
during a GI procedure.
A- What is this
procedure?
B- Name two indications
for this procedure?
Enteroscopy; double balloon or single balloon, B- Obscure GI
bleeding, Malabsorption
صفحه 61:
Question 34
* A 22 Y/O lady walks in for
evaluation of progressive
intermittent severe colicky
abdominal pain in the past 3
months
+ A representative picture of
small bowel series is shown
+ A- Name two findings on the
X-ray
* B- What is the most likely 1
diagnosis? “aA
Stenosis, fistula, sinus tract, Crohn’s
صفحه 62:
Quaestion-33
* A 36 Y/O gentleman presents for
evaluation of persistent
asymptomatic abnormal LFT
* P/E is remarkable for a just
palpable spleen.
* The serum immunoelectrophoresis
is shown
* In which option it has therapeutic
implications? | /
+ A- Chronic hepatitis C A 5
B- Autoimmune hepatitis ~~
* C- Primary biliary cholangitis (PBC)
* D- This a nonspecific finding and
does not point to any specific
diagnosis
0
صفحه 63:
combination regimens, 6-mercaptopurine may be substituted for its
prodrug azathioprine, but this is rarely required. Azathioprine alone,
however, is not effective in achieving remission, nor is alternate-
day glucocorticoid therapy. Limited experience with budesonide in
noncirrhotic patients suggests that this steroid side effect-sparing
drug may be effective.|
improvement of fatigue, anorexia, malaise, and jaundice tends
to occur within days to several weeks; biochemical improvement
occurs over the course of several weeks to months, with a fall in
serum bilirubin and globulin levels and an increase in serum albu-
min. Serum aminotransferase levels usually drop promptly, but
improvements in AST and ALT alone do not appear to be reliable
markers of recovery in individual patients; histologic improve-
ment, characterized by a decrease in mononuclear infiltration
and in hepatocellular necrosis, may be delayed for 6-24 months.
EEEMI AUTOIMMUNE HEPATITIS
The mainstay of management in autoimmune hepatitis is GIUEOEOR
ficoid therapy. Several controlled clinical trials have documented
that such therapy leads to symptomatic, clinical, biochemical, and
histologic improvement as well as increased survival. A therapeutic
response can be expected in up to 809% of patients. Unfortunately,
therapy has not been shown in clinical trials to prevent ultimate pro-
gression to cirrhosis; however, instances of reversal of fibrosis and ci
thosis have been reported in patients responding to treatment, and
rapid treatment responses within 1 year do translate into a reduction
iniprogression to’eirrhosis, Although some advocate the use 8
‘isolone (thethepsatic metaboliteot prednisone)/prednisone s just as
effective and is favored by most authorities. Therapy may be initiated
at 20 mg/d, but a popular regimen in the United States relies on an
initiation dose of 60 mg/d. This high dose is tapered successively over
the course of a month down to a maintenance level of 20 mg/d. An
alternative, but equally effective, approach is to begin with half the
prednisone dose (30 mg/d) along with azathioprine (50 mg/d). With
azathioprine maintained at 50 mg/d, the prednisone dose is tapered
over the course of a month down to a maintenance level of 10 mg/d.
The advantage of the combination approach is a reduction, over the
span of an 18-month course of therapy, in serious, life-threatening
complications of steroid therapy (e.g., cushingoid features, hyperten-
sion, diabetes, osteoporosis) from 66% dawn to under 20%. Genetic
analysis for thiopurine S-methyltransferase allelic variants does not
correlate with azathioprine-associated cytopenias or efficacy and
is not assessed routinely in patients with autoimmune hepatitis. In
صفحه 64:
Question-32
+ A 64 Y/O man presents with
LLQ pain that has
progressively worsened over
the past three days.
* Past medical Hx:
Unremarkable
+ P/E: lower abdominal
tenderness with mild rebound
tenderness, otherwise
unremarkable
ColdA te EAT GRE THE CT
stratieghg "ns فا کات
صفحه 65:
Question 31
A patient with history
of recent antibiotic
therapy for pneumonia,
was referred with
diarrhea and
abdominal pain. This is
the colonoscopy
picture.
A- What is this? ۳
B- What is the cause?
seudomembraneous colitis, B- Clostridium difficile
صفحه 66:
Question 5
In the endoscopy
of a patient with
chronic reflux
disease you see
this finding in the
astric retro
exion maneuver.
A- what is it
B- What do you
00۶ 2 ‘
9 ۲ Sliding hiatal hernia, B- PPI therapy
صفحه 67:
۳20 تن Hernia وعد Hernia
صفحه 68:
سا
a
olin (araosophapel hiatus hema The Cortrast sy deronsiraing a combined-ype__lanentoy poy arrows ya at
عدو Fri es lrgsoe te lwer haas Reman Note he rling campenars wh 2 eho osteo
سبط )0( موه pat ol seth bree agra tal
i abn the acto عدا تيز اتوت ارمع a0
rae ca
Sing hau erm هس sili shove sa ere, Th ewer end fhe serophagie 8) The Brg may nema
tore tan Sem wie with est Senco seen enening be wit Zn above (x shawn ete) a sw he as.
Tost Sarna favnig te urna BD Ths te ootopmagen vers may rarely be sto ar le
gave oesopnagel ncion » V-=vesinie The Aring وج te agtvagati haus) Sl Saya era wt ask
ate) CT san sho oe cara te prog Bian Geneon sav)”
[ere sepa ny 2mm (nrmal is <tr. The is
2 Nine bac ate apes ate
صفحه 69:
Question 6
In the endoscopy
of a patient with
upper GI bleeding
you see this
finding in the
esophagus.
A- what is it
B- What do you iw ۲ pe A
5 ۳
3 نا Weiss tear, B- PPI therapy, supportive care
صفحه 70:
Question 7
In the endoscopy
of a patient with
massive upper
astrointestinal
leeding, you see
this finding in the
stomach.
A- what is it
B- What do you
do?
A- Dieulafoy Lesion, B- Endoscopic therapy
with Endoclin
صفحه 71:
Question 8 ۳ ی 5 ۹
In the endoscopy
of a patient with
mild upper a
gastromntestina| a
leeding you see
this finding in the
stomach.
A- what is it
do you » A و
93
- Erosive Gastritis, B- PPI Therapy, HP eradication
صفحه 72:
Question 11
A 35 years old man
referred with chief
complaint of food
regurgitation, and
halitosis. You see the
radiography of this
patient.
A - what is this
radiography?
t diagnosis? ae
A- B pat Is your عام ع ا diverticulum
صفحه 73:
Question 13
A 45 years old man
with liver cirrhosis
and iron deficiency
anemia, referred for
upper GI endoscopy,
you see the
endoscopy of
stomach.
A- what is your
diagnosis?
- Gastric antral vascular ectasia (gave)
صفحه 74:
*A 24 year old lady referred with
abdominal pain and distension
since few days ago. In her liver
function test there were
abnormalities of the liver
enzymes. There was previous
history of leg venous
thrombosis. You see the
abdominal CT scan of the
patient.
* A- Name the labeled letters; A,
B,C, Dsce,
°B- 1 اج ent
8- ماد ee erie al
٠ D- Collateral vessels
B- Diagnosis: Budd Chiari Syndrome
صفحه 75:
* A 30 years old man presented with bloody diarrhea,
mucus passing per rectum, and skin ulcers since 1
month ago.
* Lab: ESR=45mm/hr, CRP = +++
* For the patient colonoscopy was done.
+ A- What is the skin lesions?
+ B- Describe the endoscopic view?
* C- What is your diagnosis
A- Pyoderma
gangrenosum, B-
decreased vascular
pattern, bleeding
ulcers, inflammation,
friability, C- IBD;
lIlerarativea colitic
صفحه 76:
*A25 y/o man has presented with intermittent colicky peri-umbilical abdominal
pain since two months ago.
+ Next slides shows the physical findings and findings of small bowel enteroscopy
with biopsy
+ A- What is your diagnosis ?
» B- Name one associated cancer?
Peutz-Jeghers Syndrome, B- Pancreas
صفحه 77:
Question 25
A 83 years old man
referred with dysphagia
to you. The patient has
been treated by
antibiotics for his
pneumonia recently.
A-What is your
diagnosis?
B- What is your
treatment?
25- -A- esophageal candidiasis, B- fluconazole
صفحه 78:
* This patient presented with recurrent attacks of heartburn and
epigastric burning since few years ago. Recently has developed
difficulty with swallowing, and weight loss. You see the physical
findings and barium swallow of the
* A- What is (are) the differential diag
٠. 2 0 د 9 فیح an?
صفحه 79:
A- Scleroderma severe esophagitis,
esophageal stricture, esophageal
carcinoma
* B- Endoscopy and biopsy
صفحه 80:
Cardiology : OSCE & PMP
صفحه 81:
ig. 15. Normal cardiac anatomy. Posteroanterior (a) and lateral (b) chest X-ray, the correct placement of the atrial lead is in the atrial appendage (green dotted circle) and
the right ventricle lead isin the apex of right ventricle (RV) (blue dotted circle).
صفحه 82:
موه
Fig. 4. Normal components of a pacemaker. (a) Chest X-ray shows the basic components (generator and leads), (b) Lead is connected to generator through a header which
holds one or more connection ports. Manufacturer logo is also appreciated (see Fig. 7)
صفحه 83:
iad
صفحه 84:
4 Connector
oc ۸
3
0
individual device’
identifier
صفحه 85:
2 b.
Figure 1. Cardiac pacemaker. Photograph (a) and radiograph (b) show a single-chamber pace-
maker before implantation.
صفحه 86:
صفحه 87:
صفحه 88:
توصیف کامل یافته های بیمار
اول (تصویر۸) و بیمار دوم
(تصاویر wil § 59 (B,C,D
مشاهده شده را بنویسید:
A: Normal SCPM
B,C,D: tip of the electrode
beyond the cardiac
silhouette and below the
diaphragm. CT axial (c)
and coronal (d) images
showing cardiac
perforation by right
@ ventricle electrode. The
tip of the electrode is
ی سم سس سس
صفحه 89:
آقای 45 ساله به دنبال
تعبیه پیس میکر دچار
تنگی نفس و هیپوکسی شده
است.
. | Chest X-ray before (a)
and after (b)
pacemaker placement
shows increased
cardiac silhouette and
right pleural effusion.
due to cardiac
perforation
صفحه 90:
خانم 63 ساله به دنبال تعبیه پپس میکر دچار تنگی نفس
و هیپوکسی شده است.
توقای تشهیجن 3
Fig. 3. Chest X-ray showing left pneumothorax (arrow) after placement of a left-
sided permanent dual chamber pacemaker.
صفحه 91:
1 1 | 5
آقای ۴۲ ساله با درد سینه» ae وت شير سار thn
a. Ean “ ! +
تب و تنگی نفس؟؟؟
AMI
الا Ce سيم ا
1 ریا ما | ص ا | Pericarditis
ایا حلسم با لسالس ل نإ ای سس
صفحه 92:
FIGURE288-1 Acute pericarditis. There are diffuse ST-seament elevations (in this case in leads |, I, aVF, and V, to V,) due to a ventricular cur-
rent of injury. There is PR-segment deviation (opposite in polarity to the ST segment) due to a concomitant atrial injury current.
صفحه 93:
آقای ۵۴ ساله با سابقه بیماری هوچکین با شکایت تنگی نفس
پیشرونده. توصیف ۲ یافته مهم و تشخیص؟
جر سس سم اس م مص سس ص مس ماه یی سملم اميرك یبای
0 ۵ 200mm Hg
ee ee ا
Inspiration Inspiration Inspiration مود mam Hg ines
ortic pressur Left ventricular
‘ a a omens presgure ۵
1 eh
۷ ۳4 9 ۷۳ VA 1
50 mm Hg
Pulmonary-
artery wedge
Inspiration pressure OmmHg
a
Expiration
صفحه 94:
11 1 بقه ب » .0
آقای ۳۴ ساله با سابقه بیماری هوچکین و
نفس پیشرونده و ادم اندام و افزایش سايز شکم:
۱.توصیف؟
۲.تشخیص؟
CONSTRICTIVE PERICARDITIS
صفحه 95:
آقای ۴۳ ساله با سابقه تنگی نفس از ۶ ماه قبل که در معاینه بالینی ۷/2[ بسیار برجسته داشته و
65 وی در زیر مشاهده میشود. فشار خون وی کاملا طبیعیست. تشخیص؟؟
سوب تس
1 | ۱ ۱ ليسا ی
ie acc rT
ers جب
ea a ای اا ]اسلا
is
صفحه 96:
گاید
در زیر
بررسی های
گرانولوم رو
اكو
تكميلى
۰ سى سى مايع سروزا
cual. و
خنیه
انژینوس
شامل Jus PCR منفی گزارش
شما چیست؟
شده است,
از پریکارد بیمار خارج
در نمونه پاتولوژ
میشود که تمامی
ی شواهد وجود
صفحه 97:
Tuberculous Pericardial Disease This chronic infection is a common
cause of (chronic pericardial effusion; although less so in North
America than in the developing world where active tuberculosis is
endemic. The clinical picture is that of a chronic, systemic illness in a
patient with pericardial effusion. It is important to consider this diag-
nosis in a patient with known tuberculosis, with HIV, and with fever,
chest pain, weight loss, and enlargement of the cardiac silhouette of
undetermined origin. If the etiology of chronic pericardial effusion
remains obscure despite detailed analysis of the pericardial fluid (see
above), a pericardial biopsy, preferably by a limited thoracotomy,
should be performed. If definitive evidence is still lacking but the
specimen shows granulomas with caseation, antituberculous chemo-
therapy (Chap. 202) is indicated.
If the biopsy specimen shows a thickened pericardium (after 2-4
weeks of antituberculin therapy, pericardiectomy should be carried
out to prevent the development of constriction. Tubercular cardiac
constriction should be treated surgically while the patient is receiving
antituberculous chemotherapy.
صفحه 98:
دختر ۱۲ ساله با سسابقه فشار خون مزمن و هیپوکالمی که با شکایت همی پارزی
سمت راست ان ۳ ساعت قبل و تب و کاهش وزن و تنگی نفس از ۲ ماه قبل مراجعه
نموده است,
توصیف ضایعات؟
Sf jai
صفحه 99:
صفحه 100:
آقای ۳۲ ساله راننده سواری به دنبال تصادف شدید با خودروی روبرو دچار درد سینه شدید شده است.
نوار قلب زیر از وی به دست آمده است. در آزمایشات انجام شده تروپونین وی افزايش ۳ برابر را نشان
میدهد. کدام یک از اقدامات زیر در این مرحله توصیه نمیشود؟
۱.کوکاردیوگرافی اورژانس
۲آسپرین ۳۲۰ میلیگرم جویدنی
۳.آنورواستاتین ۸۰ میلیگرم
۴.انوکساپارین ۶۰ میلیگرم وریدیب 4 زر hae ناآ soe
صفحه 101:
و ات ار قاع تلام Occasional
undetected at the time of the initial injury or developed subsequently.
Therefore, trauma patients should be examined carefully several weeks
after the injury. If a mechanical complication is suspected, it can be
confirmed by echocardiography or cardiac catheterization.
TRAUMATIC CARDIAC INJURY سين
hap. 295). Acute myocardial failure
resulting from traumatic valve rupture usually requires urgent
Gaaanetenrecton Immediate thoracotomy should be carried
out for most cases of penetrating injury, or if there is evidence of
cardiac tamponade and/or shock regardless of the type of trauma.
Pericardiocentesis may be lifesaving in patients with tamponade
but is usually only a temporizing measure while awaiting definitive
surgical thera
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