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General medicine internal examination 1


 















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OSCE PREFINAL EXAM

 OSCE- PREFINALS DEC 2023: Case report :    I have tried to answer some of the questions regarding case discussion of our patient    1. How to clinically differentiate between coarse and fine crepitations ? Ans-  well, crepitations or crackles  are adventitious respiratory sounds which occur when an obstructed airway due to accumulated  secretions opens in inspiratory phase. The sudden opening of an obstructed airway causes an immediate re-equilibration of the pressures on both sides creating vibrations in the airway walls.  Fine crackles --  A).  having a short duration and a higher pitch,           Often, fine crackles are repetitive, originate          in the basal part of the lung, and not altered          by coughing. B) Coarse crackles  appear to be a longer                     durati...
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21

  Case History and Clinical Findings 57 YEAR OLD MALE PATIENT CAME WITH C/O OF SLURRED SPEECH 4PM ON 5/08/2023 C/O RIGHT UPPER LIMB &LOWER LIMB WEAKNESS SINCE 4PM. PATIENT PRESENTED TO CASUALITY WITH ALTERED SENOSIRUM SINCE 4PM HOPI: PATIENT HAS A H/O SLURRED SPEECH AND H/O RIGHT UPPER LIMB AND LOWER LIMB WEAKNESS SINCE THEN ASSOCIATED WITH FALL. NO LOC, NO ENT BLEED NO H/O FEVER, BURNING MICTURITION, LOOSE STOOLS NO H/O SOB, PALPITATIONS, ORTHOPNEA, PND HISTORY OF PAST ILLNESS: NOT A K/C/O HTN,DM,EPILEPSY, THYROID DISORDERS. O/E: GCS-E5 V4 M5 BP- 90/60MMHG PR- 68BPM CVS- S1S2 + RS- NVBS + SPO2- 97% ON RA CNS- TONE: RIGHT LEFT UL INCREASED INCREASED LL INCREASED INCREASED POWER: UL &LL COULDNT ELICIT REFLEXES: B +++ ++ T + + S + + K - + A - - P FLEX FLEX PUPILS- B/L CONSTRICTED, SLUGGISH REACTIVE COURSE OF ADMISSION: PATIENT WAS ADMITTED I/V/O ABOVE MENTIONED COMPLAINTS. NECESSARY INVESTIGATIONS WERE DONE. MRI FINDINGS- ACUTE INFARCT IN LEFT CAUDATE AND LE...
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23

  Case History and Clinical Findings 74 YEAR OLD FEMALE PATIENT WAS BOUGHT TO CASUALITY WITH GENERALISED WEAKNESS SINCE 3 DAYS HOPI: PATIENT WAS APPARENTLY ALRIGHT 3 DAYS BACK TODAY PATIENT ATTENDER SAW HER ON THE FLOOR WITH HER CLOTHES STAINED WITH FAECES AND MICTURTION NO FOOD INTAKE SINCE LAST 3 DAYS NO C/O CHEST PAIN , FEVER , SOB , PALPITATIONS NO VOMITINGS , LOOSE STOOLS SHE IS ABLE TO LIFT HER HANDS AND LEGS PAST HISTORY : N/K/C/O HTN , DM 2 , THYROID DISORDERS , CVA , CAD PERSONAL HISTORY: MIXED DIET APPETITE LOST BOWEL AND BLADDER - REGULAR ADDICTION : REGULAR 180 ML DAILY ALCOHOL CONSUMPTION SINCE 10 YEARS GENERAL EXAMINATION: PATIENT IS CONSCIOUS,COHERENT,COOPERATIVE NO SIGNS OF PALLOR,ICTERUS,CLUBBING,CYANOSIS ,LYMPHADENOPATHY,EDEMA VITALSTEMP- 99.9 F PR- 124 BP RR-22 CPM BP-120/70MMHG SPO2- 99% AT RA CVS- S1,S2 HEARD , NO MURMERS RS- BLAE PRESENT , NO ADDED SOUNDS P/A- SOFT, NON TENDER NO ORGANOMEGALY CNS- RIGHT LEFT TONE : UL N N LL N N POWER : UL 4/5 4/5 LL 4/5 ...
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