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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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22

41 YEAR OLD FEMALE  Patient was brought with complaints of 2 episodes of involuntary movements of upper and lower limbs and hemoptysis .History of present illness :- Patient was apparently asymptomatic till 5 am then she developed sudden onset of movements of both upper and lower limbs at 5am in the morning which lasted for about 4-5mins , not associated with any trigger, no aura and the patient was confused after the episode she had an other similar episode while bringing to the hospital.She had two similar episodes at the hospital.Sequence of events :- 13 years ago she developed low back ache and generalised weakness started for which she went to local hospital.Then during the investigations was found to be having soft tissue overgrowth,(as said by attenders ,no documentation)and need to get operated, during routine investigations creatinine was elevated, then she was started on conservative management .(Sod bicarb,Shelcal,Omeprazole,Iron folate)Since then ,she is on routine fol...
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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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