Osce lab med. update 12ธค49

MED IV by yong 69 MED 30KKU : 

MED IV by yong 69 MED 30KKU 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

TRICK : 

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

BLOOD SMEAR : 

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

Slide 15: 

Ring Shizont Gamete Plasmodium falciparum

Slide 16: 

Ring Shizont Gamete Plasmodium vivax

Slide 17: 

Compact Ring Rosette Shizont Band Shizont Plasmodium malariae

Slide 18: 

Ring Shizont Gamete

??????! : 

??????!

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 33: 

Thalassemia aniso-poikilocytosis

Target cell : 

Target cell Inclusion body

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 Heinz body

Slide 40: 

????? 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

?????????????? chest x ray : 

?????????????? chest x ray 1.????????????(????????? identified patient and date) -???? film …Chest x ray -position(????????????????????)..PA upright ???? AP supine scapula / air in stomach -inspiration………fully inspired anterior 6-8 /posterior 8-10 -exposure……… air in lung compared air outside lung spine ????liver,????heart Normal exposure / ???under exposure ?????(????????????)/ over exposure ??????(???????????????????) Position??????????????????????????=?spinous process of vertebra and 2 heads of clavicle 2.????skin?soft tissue?bone?lung &trachea?heartXX

Finding : 

Finding Skin &soft tissue calcified ,mass,muscle Bone ? spine,ribs ,clavicle,scapula fracture,lytic lesion[malignant],degerative change,osteophyte,spondylosis,scoliosis Trachea shift ? to lesion = atelectasis ? contralateral = mass,pleural effusion,pneumothorax Mediastinum windening?anterior,retrosternal?L3T lymphoma,teratoma,thymoma,thyroid goitre middle[along heart shadow]? vascular mass posterior [spine] ?neurogenic tumor

Slide 55: 

Hila [pulmonary vessels] pulmonary trunk ,pulmonary vessels normal = lung marking = 2/3 lung field Heart Cardiomegaly?? cardiothoracic ratio> 0.5 LVH ?PMI shift LA ?enlargement, [prominent LA appendage,wide carina > 70º - 90 º ,double contour] RVH ?apex ?? RA enlagement ? bulging right cardiac border Pericadial effusion ?flask shape cardiomegaly TB Constrictive pericarditis ? calcified pericardium Mitral configuration left atrial enlagement, cephalization,straightening left heart border

Slide 56: 

Lungs Infiltration -Alveolar pattern acinar shadow ? mottling infiltration ?patchy infiltration ?consolidation with/without air bronchogram [Homogenous density, haziness] -Interstitial infiltration ground glass/granular pattern nodular pattern reticular pattern reticulonodular pattern

Pneumonia : 

Pneumonia Bronchopneumonia multifocal patchy consolidation Staph. aureus Lobar pneumonia homogeneous nonsegment consolidation with air bronchgram Strep. pneumo. Interstitial pneumonia extensive perihilar infiltration and ill defied reticulonodular shadowing Virus,Mycoplasma

X ray sign : 

X ray sign Silhuette sign Cavitary lesion ± air fluid level TB,lung abscess,tumor with central necrosis,Staphylococcus aureus,Gram negative[Klepsiella,Melioid],Nocardia Solitary nodular lesion,sharp margin Primary CA lung,metasCA [satellite],infection [TB,fugus],Rheumatoid nodule Bronchiectatic change?infected?

X ray sign : 

X ray sign Diffuse nodular infiltration Hematogenous pneumonia{Melioid,Staph.aureus,Gram negtive},TB,Metastatic CA Perihilar infiltration,pulmonary congestion left side heart failure/ volume over load ?????????????????Cardiomegaly

Slide 60: 

Pleura -pleural effusion?blunt Costophrenic angle -pneumothorax?visible visceral pleura -pneumohemothorax?visible visceral pleura with air fluid level -pleural mass ex. Mesothelioma Others ex. Tube,monitor,line ET tube? optimal position = 4 cm. above carina ???????? : ?????film????????????????? ???????????????????????????

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 66: 

Honeycomb appearance

Cotton ball : 

Cotton ball

Lung atelectasis : 

Lung atelectasis

Miliary TB : 

Miliary TB

Interstitial infilltration : 

Interstitial infilltration Interstitial infilltration

Slide 71: 

Fungal ball {Cresent shape}

Pleural effusion : 

Pleural effusion Blunt costophrenic angle

Slide 73: 

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

Pneumothorax : 

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

Slide 75: 

???????? ????? 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 87: 

scoliosis

Constrictive Pericarditis : 

Constrictive Pericarditis

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 101: 

Erythematous macule ,maulopapule well defined margin

Seborrheic dermatitis : 

Seborrheic dermatitis Narsolabial distribution Ill defined scaly

Slide 103: 

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

Paederus dermatitis : 

Paederus dermatitis

Atopic dermatitis : 

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

Dermographism : 

Dermographism Dermographism

LE skin lesion : 

LE skin lesion

Lichen planus : 

Lichen planus Polish plannar polygonal purple papules

Slide 116: 

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 132: 

Bullous impetigo

Ecthyma gangrenosum : 

Ecthyma gangrenosum Pseudomonas aeruginosa

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

Plantar wart : 

Plantar wart

Larva migran : 

Larva migran

Mycetoma : 

Mycetoma

Alopecia : 

Alopecia

1.????????????????2.????????????????3.????????????? : 

1.????????????????2.????????????????3.?????????????

Microbiology : 

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

Slide 155: 

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

Slide 156: 

Streptococcus pneumoniae

Staphylococcus aureus : 

Staphylococcus aureus

Slide 158: 

Klebsiella pneumoniae

School of fish[Hemophilus ducreyi] : 

School of fish[Hemophilus ducreyi]

Pseudomonas aeruginosa : 

Pseudomonas aeruginosa

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

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

Neisseria gonorrheae : 

Neisseria gonorrheae Urethral swab Gram’ s stain

Urethral swab Gram’ s stain : 

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

Enterococci : 

Enterococci Urine Gram’s stain

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

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

Slide 166: 

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 172: 

Cryptosporidium oocyst modified AFB 40X

Slide 173: 

Isospora belli oocyst modified AFB 20X

Slide 174: 

Nocardia = ???????? mAFB

Nocardia asteroides : 

Nocardia asteroides

Actinomyces : 

Actinomyces

Corynebacterium diphtheriae : 

Corynebacterium diphtheriae

Bacillus cereus : 

Bacillus cereus

Clostridium tetani : 

Clostridium tetani

??????????????????? : 

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

Candida albicans : 

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

Cryptococcus neoformans : 

Cryptococcus neoformans

Slide 183: 

Wright’s stain Acid-fast stain

Histoplasma capsulatum : 

Histoplasma capsulatum

Penicillium maneffei : 

Penicillium maneffei

Slide 189: 

Mucormycosis

Slide 190: 

Aspergillus spp.

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

??????? : 

??????? Sengstaken-Blackmore tube WINTROBE TUBE Spinal needle Refractometer Sphygmomanometer

??????? : 

??????? Spirometer

SPOT DIAGNOSIS??????????????????????????????????part ??? ?? 4????????????? ?????5????????? : 

SPOT DIAGNOSIS??????????????????????????????????part ??? ?? 4????????????? ?????5?????????

Pretibial myxedema : 

Pretibial myxedema

Hypothyroid : 

Hypothyroid

Acromegaly : 

Acromegaly

Xanthelasma : 

Xanthelasma

Glossitis : 

Glossitis

Candidiasis : 

Candidiasis OT

Ptosis : 

Ptosis

Marked jaundice : 

Marked jaundice

KF ring : 

KF ring arcus cornealis

Spider nevi : 

Spider nevi

Gynecomastea : 

Gynecomastea

Pelagra : 

Pelagra

Cullen’s sign : 

Cullen’s sign

Splenomegaly : 

Splenomegaly

Mump : 

Mump

Angioedema : 

Angioedema

Slide 224: 

Koilonychia - spoon shaped nail

Clubbing finger : 

Clubbing finger

Acropachy in hyperthyroidism : 

Acropachy in hyperthyroidism

Chonic trophaceus gout : 

Chonic trophaceus gout

Rheumatoid arthritis : 

Rheumatoid arthritis

Marfan Syndrome : 

Marfan Syndrome

Meningococcemia : 

Meningococcemia

Secondary syphilis : 

Secondary syphilis

Infective endocarditis : 

Infective endocarditis

Roth spot : 

Roth spot

Thalassemia : 

Thalassemia

Avascular necrosis : 

Avascular necrosis

Rheumatoid arthritis : 

Rheumatoid arthritis

Gouty arthritis : 

Gouty arthritis

CPPD=Pseudogout : 

CPPD=Pseudogout

Bamboo spine : 

Bamboo spine

Abnormal calcification : 

Abnormal calcification

: 

Cysticercosis ??????????????????? ????????????????

Trauma : 

Trauma

BrainTumor : 

BrainTumor

Plummer - vinson syndrome : 

Plummer - vinson syndrome

Dysmorphic red blood cell& RBC cast : 

Dysmorphic red blood cell& RBC cast

Multinucleated giant cell : 

Multinucleated giant cell

LE cell : 

LE cell

????????????? : 

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

Slide 254: 

Snake bite

Slide 255: 

??????? (King cobra) Neurotoxin; ??-????-???-???

Slide 256: 

?????? (Thai cobra or spitting cobra) Neurotoxin

Slide 257: 

???????????? (Banded krait) Neurotoxin ???????????? (Malayan krait)

Slide 258: 

Hematotoxin;???-??-???????/???????????? ???????? (Russell’s viper) Viper ?????? (Malayan pit viper) Pit- viper

Slide 259: 

Hematotoxin Pit- viper ?????????????? (Green pit viper)

Slide 260: 

Myotoxin ?????? (Laticudinae spp)

Slide 261: 

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