Osce lab medIV.ppt update 26.11.2549

MED IV by yong 69 MED 30 : 

MED IV by yong 69 MED 30 OSCE LAB

PARASITE : 

PARASITE Entamoeba coli Giardia lamblia

Ascaris lumbricoides Enterobius vermicularis : 

Ascaris lumbricoides Enterobius vermicularis

Trichuris trichiura Capillaria philippinensis : 

Trichuris trichiura Capillaria philippinensis

Minute egg. Opisthorchis viverrini : 

Minute egg. Opisthorchis viverrini

Hookworm egg.Ancylostoma duodenaleNecator americanus : 

Hookworm egg.Ancylostoma duodenaleNecator americanus

Echinostom egg. Macracanthorhynchus hirudinaceus : 

Echinostom egg. Macracanthorhynchus hirudinaceus

Moniliformis moniliformis : 

Moniliformis moniliformis ???????? ?????? Macracanthorhynchus hirudinaceus (?????????????????????????????)

Strongyloides stercoralis : 

Strongyloides stercoralis

Taenia egg. Taenia solium&Taenia saginata : 

Taenia egg. Taenia solium&Taenia saginata

Angiostrongylus cantonensis & OV : 

Angiostrongylus cantonensis & OV

Trichinella spiralis Gnathostoma spinigerum : 

Trichinella spiralis Gnathostoma spinigerum

TRICT : 

TRICT Slide stool exam 1 ??? ????!???????????????????????????? ?????????????? ???????????????????????????????????????????? ???? ???????? ??? ???????????? adult ????????????????????????????? ????????? ???????????(??????????????????????)??????( ??????? ????????????) ????????????????????????

BLOOD SMEAR : 

BLOOD SMEAR Plasmodium falciparum Plasmodium vivax ???? bloods mear ????????????????? hematology ???????????? ?????? Malaria ???????

??????! : 

??????!

Normal blood smear : 

Normal blood smear Hematology <???????>

????? : 

????? 1. ??????????????????? (???????????? ????????? Osce) WBC……………………[ / ] RBC……………………….. Plt………………………….. 2 ???????????????? ………………………………… 3. ??? investigation for……………(?????????????? for ???? ? diagnosis or treatment?????????????????????????????????) ??????????????????? blood smear ????????(????????????????? ????? ,??,normal?????????????????????????) ????????????????Diagnosis??

????????????????? blood smear : 

????????????????? blood smear Red blood cell ???????? ??????? ???? ??????????? White blood cell ????? ???? Platelet ????? ???????? ??????????? ?????????!?????????????? series ????????????????????????????? ???? normal???????

Red blood cell : 

Red blood cell 2.??????????????????? Polychromacia,NRC,Howell jollybody ?????????????????????????? ?????????????? ???????blood smear ????????????

Normal red blood cell : 

Normal red blood cell AIHA ????? investigation -?????????????????????? -???????asscociative dz - ???????????????????????? MAHA -????????????????? ?????? ?????? -?????????????????????thrombocytopenia???????????????????platelet ???? G6PD deficiency with hemolysis ?????complication ???investigation?????????????????

Keep in mind : 

Keep in mind -Macrocytic anemia{?????????Lymhocyte },hypersegmented nucleus ??neutrophile ??????Megloblastic anemia -??????? low power ???? RBC ????????????? ?????? ??????G6PD def?????hemolysis ???????D?????????????G6PD???dehydrogenase????????deficiency ???????????? deficiency ??????? ??????????? ?????????????ghost cell ,Hb leakaged ,Hb contracted ????????????????????with Hemolysis???? -Hemolytic blood picture ????? -SLE ????????? AIHA ,MAHA(vasculitis)

White blood cell : 

White blood cell ????? 2 ??????1.Number 2.differential count ??????????????????reaction???leucocytosis ????????PMN???????????????????? platelet????????????????? leukemoid reaction -estimated Wbc count by 40x ?????? 1 field x 1,500 [nomal=5,000-10,000 cell/mm3] ??????? 3 ????? 1.Wbc count ??? 2. ??? 3.????

Wbc ??? : 

Wbc ??? ????? wbc ???????????????????????? Agranulocytosis=PMN??? {<500 cell/mm3,granulocytopenia /neutropenia PMN<1,500cell/mm3},???relate ????? ????lyphopenia ??????? CNT dz ex SLE - viral infetion ex dengue ??????? white count ?????? ????????? series ?????????????????? -Bone marrow failue -Chemical cause -Aplastic anemia ????????????(blast)???series -Acute leukemia???????blast???wbc ?????????????? -myelopthiasis?????blast ????3series????????peripheral blood smear??????????????????????????

Wbc ??? : 

Wbc ??? ????????? ??????reaction differrential count %???????? ???????? Blast cell ??????? ?????? -Acute Leukemia ???????blast cell ?????[???????????????4??? ??????????? blast???lyphoid series] AML* ,ALL ?????????????????? -Chronic Leukemia -CLL ?? mature lymphocyte -CML* ??cell??????? ??????????myeloid ????? Huge(?????) splenomegaly

Platelet : 

Platelet ???????????? ????????? 2 ?????? ??? 1.????? 2.?????? 1.-????? estimated by ?????? oil(100x) 1 field x 15000 [normal 140,000-400,000 cell/mm3] -????????? ???? reaction ????CML,acute hemolysis,blood loss ?????? essential thrombocytopenia -????? ?????????????? (platelet?????????????) MAHA,DIC,ALL ??????????? isolated thrombocytopenia ????????ITP 2.-morphology ????????? ???? ???????? ???????????? - ???? Giant platelet ????~Rbc(non specific???????reaction??? ??????????????????) -pale stain platelet ???????????????????????????? ?????????? platlet dysfunction

Iron Deficiency Anemia : 

Iron Deficiency Anemia

“HYPOCHROMIC MICROCYTICANEMIA” : 

“HYPOCHROMIC MICROCYTICANEMIA” blood Normal Iron def Bone marrow smear Iron def

Slide 29: 

Thalassemia aniso-poikilocytosis

Target cell : 

Target cell

NRC+Howell jolly body+polychromacia=Thalassemia post splenectomy????? complication ?????????????? : 

NRC+Howell jolly body+polychromacia=Thalassemia post splenectomy????? complication ??????????????

Autoagglutination-????? investigation ???????????????????????? ? : 

Autoagglutination-????? investigation ???????????????????????? ?

Rouleux formation??????????? : 

Rouleux formation???????????

G6PD def : 

G6PD def G6PD Deficiency with hemolysis Inclusion body

Slide 36: 

????? investigation ???????????????????????? ?

Hemolytic blood picture : 

Hemolytic blood picture Intravascular hemolysis,MAHA blood picture

MEGALOBLASTIC ANEMIA : 

MEGALOBLASTIC ANEMIA NORMAL MacrocyticRBCHypersegmented nucleus of Nutrophil???????????? ?

Plasma cell myeloma : 

Plasma cell myeloma

Isolated thrombocytopenia : 

Isolated thrombocytopenia

??????????????????? : 

???????????????????

ALL : 

ALL

????? Blast ????? AML : 

????? Blast ????? AML

???????series??????????? blast CML : 

???????series??????????? blast CML

AML : 

AML

Atypical lymphocyte : 

Atypical lymphocyte ?????????????

Infectious mononucleosis : 

Infectious mononucleosis

PANCYTOPENIA : 

PANCYTOPENIA

Chest X Ray : 

Chest X Ray

Right lobe upper middle lower : 

Right lobe upper middle lower

Left lobe : 

Left lobe Upper lingular & lower

Cavitary lesion : 

Cavitary lesion

Air fluid level : 

Air fluid level

Slide 54: 

Honeycomb appearance

Cotton ball : 

Cotton ball

Lung atelectasis : 

Lung atelectasis

Miliary TB : 

Miliary TB

Interstitial infilltration : 

Interstitial infilltration Interstitial infilltration

Slide 60: 

Fungal ball {Cresent shape}

Pleural effusion : 

Pleural effusion Blunt costophrenic angle

Slide 62: 

???????? ????? lesion{?????finding}

Pneumothorax : 

Pneumothorax -Visible visceral pleura and distal area loss of lung marking

Slide 64: 

???????? ????? lesion{?????finding}

Free air ??? dome diaphragm : 

Free air ??? dome diaphragm Hollow viscus organ perforation ex. PU perforation

COPD : 

COPD

Shortening trachea , tubular or hanging heart,increase intercostal space /hyperairation/air trapping,flat diaphragm : 

Shortening trachea , tubular or hanging heart,increase intercostal space /hyperairation/air trapping,flat diaphragm

Lung mass : 

Lung mass

Mediastinal mass : 

Mediastinal mass

Pancoast Tumor : 

Pancoast Tumor

Lesion ????????????CARDIOMEGALY : 

Lesion ????????????CARDIOMEGALY ?? Cardiothoracic ratio

???????????????????????? : 

???????????????????????? LV???????????? ??????RV?? apex ????

Flask shape : 

Flask shape Pericardial effusion

Double contour : 

Double contour

Slide 76: 

scoliosis

Left side heart failure : 

Left side heart failure Congestive heart failure =Lt+Rt failure ???? Rt??????clinical ????? CXR ??? ??????

TRICT : 

TRICT ????? CXR ?? 2 ????? 1???????? CXR ??????????????????????.......chest X ray PA upright/AP supine….?????????????????????????????Tube?????????in tubation????, scoliosis?????????????? 2 ???????? ????? lesion{?????finding} [:??????????????????? ????????????????/ ?????????????? ,??????????????????] ?????! Lesion ??????????????????????????film??????(????????????????)

Skin lesion[ part??????????] : 

Skin lesion[ part??????????] 1.Describe lesion ………………………………………… 2.Diagnosis ………………………………………… ??????????? ?????? /????????????

Prurigo nodularis : 

Prurigo nodularis

?????????Pt. AIDS ????????????????????? ?????? Pt?????????????????? : 

?????????Pt. AIDS ????????????????????? ?????? Pt??????????????????

Pityriasis rosea : 

Pityriasis rosea Herald patch

‘Collarette scale’;christmas tree pattern : 

‘Collarette scale’;christmas tree pattern

Psoriasis : 

Psoriasis

Erythematous macule ,maulopapule with silver scale : 

Erythematous macule ,maulopapule with silver scale

Slide 89: 

Erythematous macule ,maulopapule well defined margin ???????????????????DDx Seborrheic ?????????????????????????(?????)??? psoriasis ???????????? ???????

Seborrheic dermatitis : 

Seborrheic dermatitis Narsolabial distribution Ill defined scaly

Slide 91: 

Distribution

Nummular dermatitis : 

Nummular dermatitis

Discoid dermatitis : 

Discoid dermatitis

Dyshydrosis : 

Dyshydrosis Tense small vesicles and small papules

Flaccid bullous ,denuded skin with crust and oozing : 

Pemphigus valgalis Flaccid bullous ,denuded skin with crust and oozing

Tense bullous with denuded skin : 

Bullous pemphigoid Tense bullous with denuded skin

Kissing lesion : 

Kissing lesion Irregular lesion contact dermatitis

Atopic dermatitis : 

Atopic dermatitis Licheified scaly plaques ??? acute eczema ??????papulovesicle eruption

Dermographism : 

Dermographism Dermographism

Lichen planus : 

Lichen planus Polish plannar polygonal purple papules

Slide 102: 

Polish plannar polygonal purple papules

Polish plannar polygonal purple papules with Wickham’s striae<white reticular scale> : 

Polish plannar polygonal purple papules with Wickham’s striae<white reticular scale>

Lichen simplex chronicus : 

Lichen simplex chronicus

Stasis dermatitis : 

Stasis dermatitis

Target lesion : 

Target lesion ??????????? ???????? ,infection{ HSV ,mycoplasma}

Target lesion Erythema multiforme : 

Target lesion Erythema multiforme

???????????????????? ????????????????? : 

???????????????????? ?????????????????

????????? : 

?????????

steven johnson syndrome : 

steven johnson syndrome

Fixed drug eruption : 

Fixed drug eruption

Infection : Cellulitis : 

Infection : Cellulitis

Erysipelas : 

Erysipelas

??????????? : 

???????????

Carbuncle : 

Carbuncle

Impetigo : 

Impetigo Honey colored crust ,struck on crust

Slide 118: 

Bullous impetigo

Candidiasis : 

Candidiasis Sattelite lesion

Dermatophytoses : 

Dermatophytoses Anular lesion with active border + pruritis

Tuberculoid leprosy : 

Tuberculoid leprosy

Tinea versicolor : 

Tinea versicolor ?????????????? ?

????????????? ??????????????? : 

????????????? ???????????????

Bubo : 

Bubo

Molluscum contagiosum : 

Molluscum contagiosum Umbilicated papule

HSV[herpes simplex virus] : 

HSV[herpes simplex virus]

HSV[herpes simplex virus] : 

HSV[herpes simplex virus]

Herpes zoster (???dermatome) : 

Herpes zoster (???dermatome)

??????? ???dermatome : 

??????? ???dermatome

Ecthyma gangrenosum : 

Ecthyma gangrenosum Pseudomonas aeruginosa

Larva migran : 

Larva migran

1.????????????????2.???????????????? : 

1.????????????????2.????????????????

Microbiology : 

Microbiology Multinucleated giant cell Acantholytic???????????????????????

??????????????????? : 

???????????????????

Candida albicans : 

Candida albicans ?????????Bacteria???????? ???????Gram’s ??? ???????Candida ???????????????? ?????????????? ?????????????????

Slide 140: 

??????????????????????????? Gram’s stain ??????????????

Slide 141: 

Streptococcus pneumoniae

Staphylococcus aureus : 

Staphylococcus aureus

Slide 143: 

Klebsiella pneumoniae

Slide 144: 

Sputum Gram’s stain ????????????????????????

1.?????????????????2.????????????????????+side effect : 

1.?????????????????2.????????????????????+side effect

AFB stain : 

AFB stain

?????????sputum ???? mAFB ????????????? : 

?????????sputum ???? mAFB ?????????????

AFB : 

AFB ????????????????

Stool ???? mAFB : 

Stool ???? mAFB

Slide 150: 

Nocardia = ???????? mAFB

Nocardia asteroides : 

Nocardia asteroides

Actinomyces : 

Actinomyces

Clostridium tetani : 

Clostridium tetani

Sputum Gram ‘s stain 1.???????????????????????? 2.??????????????????????? : 

Sputum Gram ‘s stain 1.???????????????????????? 2.???????????????????????

Cryptococcus neoformans : 

Cryptococcus neoformans

Penicillium maneffei : 

Penicillium maneffei

Histoplasma capsulatum : 

Histoplasma capsulatum

Neisseria gonorrheae : 

Neisseria gonorrheae Urethral swab Gram’ s stain

Sputum VS CSFspecimen ??????? ???????????????????????? : 

Sputum VS CSFspecimen ??????? ???????????????????????? Gram’ s stain

Urethral swab Gram’ s stain : 

Urethral swab Gram’ s stain ??????????????????????????? ?????????????

Sputum Gram’ stain : 

Sputum Gram’ stain ????????????????

Cell diff and cell count : 

Cell diff and cell count

Cell diff and cell count : 

Cell diff and cell count ?????? 40x ???????????????????????????? 2.5 [??? 10 ??????? 4 ???????] ???????? ??????????????? 10 ??? (?????????) ????????? cell/mm3

SPOT DIAGNOSIS?????????????????????????????????? : 

SPOT DIAGNOSIS??????????????????????????????????

Pretibial myxedema : 

Pretibial myxedema

Xanthelasma : 

Xanthelasma

Glossitis : 

Glossitis

Candidiasis : 

Candidiasis OT

Acromegaly : 

Acromegaly

Ptosis : 

Ptosis

Mark jaundise : 

Mark jaundise

KF ring : 

KF ring arcus cornealis

Spider nevi : 

Spider nevi

Gynecomastea : 

Gynecomastea

Cullen’s sign : 

Cullen’s sign

Splenomegaly : 

Splenomegaly

Clubbing finger : 

Clubbing finger

Chonic trophaceus gout : 

Chonic trophaceus gout

Rheumatoid arthritis : 

Rheumatoid arthritis

Mump : 

Mump

Angioedema : 

Angioedema

Slide 192: 

Koilonychia - spoon shaped nail

Meningococcemia : 

Meningococcemia

Infective endocarditis : 

Infective endocarditis

Roth spot : 

Roth spot

Thalassemia : 

Thalassemia

Avascular necrosis : 

Avascular necrosis

Rheumatoid arthritis : 

Rheumatoid arthritis

Gouty arthritis : 

Gouty arthritis

Pseudogout : 

Pseudogout

Bamboo spine : 

Bamboo spine

Abnormal calsification : 

Abnormal calsification

Cysticercosis : 

Cysticercosis

Plummer - vinson syndrome : 

Plummer - vinson syndrome

????????????? : 

?????????????

Slide 209: 

???????????????????????????????? ?????????????????????????????????????? “????????????????????????” 5 ?.?. 2548 Pa-ra-mat yong666666666@hotmail.com