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MEDICINE OSCE
AL 2003 Batch2008
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Common areas
Haematology Anaemia Clotting disoders
Blood grouping CVS
ECG Mx of MI
RS CXR L! ABG
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Common areas
CNS CSF report
CT
GUT UFR
Imaging
RFT
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Common areas
Clinical signs Photo graphs-patients ,fundus,hand,eye,nail, Characteristic facies ermatological conditions Clinical features in te!t True " False
#thers Specimen collection $ %ottles e&uipments Clinical stations " clinical inter'ie(
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Haematology Slides
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Anaemia
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Microcytic anaemia
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Sickle cell anaemia
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Hereditary Sherocytosis
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Hereditary sp"ero#ytosis
Autosomal dominant
Anaemia$%aundi#e$"epatomegaly
In#reased osmoti# fragility
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!sm. "ragility test
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Macrocytic anaemia
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Microangioathic Haemolytic Anaemia
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Leu&aemias
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ALL. Bone marrow.Complete replacement by small/medium sized blasts with scanty cytoplasm
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AML Myeloblast cells
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AML
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#LLNumerous Mature lymphocytes, few smear cells
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#LL
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#MLNiroshan_loku@ yahoo.com
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'umerous
granulo#yti# #ells
At different stages ofdifferentiation(
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MM $ %lasma cells
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MM $ Skull & 'ones
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Serum %rotein (lectrohoresis ) monoclonal gammoathy
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Salah BMA needle
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*amshidi BM +rehine Biosy needle
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,eed)Stern'erg cell ) HL
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,S cells ) HL
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Other Slides
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A thi "il " 22 ld l h lid i i
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A thin "ilm "rom a 22)year)old male holidaying inAnuradhaura one month re-iously. ntermittent "e-ers
since returning.
/e-eloing and thick signet1 ring "orms(nlar ed red cells %- malaria
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Numerous "ine ring "orms
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%" malaria ring "orms sausage shaed gametocytes
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Malaria
)n#ompli#ated *ral C"loro+uine
Compli#ated IV +uinine
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Instruments
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A'rahams %leural Biosy needle
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%/ catheter
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/es"errio4amine n"usion %um)50mg & kg&d o-er 6hrs er day ara
um'ilically
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ECG
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http://upload.wikimedia.org/wikipedia/commons/9/96/ECG_Paper_v2.svg
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http://upload.wikimedia.org/wikipedia/commons/9/96/ECG_Paper_v2.svg
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ECG
RA!E
RH,!HM - REG)LAR . IRREG)LAR
CAR/IAC AXIS
C*'/)C!I*' I'!ERVALS - 0R$1RS
AB'*RMALI!, I' - 0$1RS$S!$!
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RA!E
Heart rate 2 344.R5R inter6al
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Heart rate
R5R I'!ERVAL 2 7 large s+uare
So HR 2344.7 2 37.min
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Normal (#7
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R"yt"m a8normalities
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55
V! 9 SV!
1RS #omplx : 4(;< s V!
1RS #omplx = 4(;< s SV!
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57
8+
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8+
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60
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Atrial fi8rillation - #auses>5 MV disease $ IH/ 9 #ardiomyopat"y$ !"yrotoxi#osis$ LA fi8rillationRx>5 /igoxin to #ontrol Ventri rate$ ?arfarin to pre6ent t"rom8oem8olism
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Atrial flutter
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@
HEAR! BL*C
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st degree HB
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Mo'it9 :enke'ach1
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67
Mo'it9
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68 2;< 'lock
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3rd
degree heart 'lock & comlete heart 'lock
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3rd degree heart 'lock & comlete heart 'lock
Atrio entricular dissociation. Atrium ! entricle hae
separate rhythms
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<
Bundle 8ran#" 8lo#&
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7"
RBBB
V; M Da6e . RSR
V@ deep S Da6e
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7#
LBBB
V@ M Da6e . RSR
V; deep S Da6e
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,BBB
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LBBB
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AM in the setting o" LBBB
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7
AXIS /EVIA!I*'
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7$
AXIS /EVIA!I*'
RA/ LIII : L II : LI
RVH$RBBB
LA/
LI : LII : LIII LVH$LBBB
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80
%A&
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8'
(A&
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LA/
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,A/
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8#
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86
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LA/
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7F
H,0ER!R*0H, * HEAR!
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$0
HEAR! CHAMBERS 5 H,0ER!R*0H,
LVH !all R Da6e in V@ 9 deep S Da6e in V;
V@ R Da6e :
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$'
HEAR! CHAMBERS 5 H,0ER!R*0H,
RVH !all R Da6e in V; 9 deep S Da6e in V@ RA/
RAH 0 Da6e : 3mm 0 pulmonale
LAH 0 mitrale
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$) (*+
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LVH
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RA H,0ER!R*0H, - 0 0)LM*'ALE
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RAH
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F
ISCHAEMIC CHA'GES I' ECG
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$8
Leads 9 is#"aemi# area
Anterior MI V; to V
Lateral MI V to V@ 9 aVL$ LI
Inferior MI LII$LIII(aV
Anterolateral V
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Anterior M
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Anterior M
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n"erior M
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;4
*!HER CHA'GES I' ECG
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Hyerkalaemia
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Hyerkalaemia
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Chest X-Rays
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'')
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L&leural e""usion&haemothora4
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,&%neumothora4
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,&+ension neumothra4
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L& yoneumothora4
http://www.brooksidepress.org/Products/OBGYN_101/MyDocuments4/Xray/Chest/CONSOLIDRULPA.JPG
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,&uer lo'e consolidation
http://www.brooksidepress.org/Products/OBGYN_101/MyDocuments4/Xray/Chest/CONSOLIDRULLAT.JPGhttp://www.brooksidepress.org/Products/OBGYN_101/MyDocuments4/Xray/Chest/CONSOLIDRULPA.JPG
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=i'rosis.
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Bronchiectasis
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,ome consolidation in the ri-ht upper lobe
with a caity arrowed typical o1
secondary tuberculosis
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#a-ity Lunga'scess1
A well2
de1ined
rounded in (
upper lobe
white
arrow.3'/)
o1 the caityis 1illed with
1luid and air
blac4
arrow.
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#a-ity Lung a'scess1
(ateral iew he
caity in the le1t
upper lobe isdepicted with the
air21luid inter1ace
arrow.
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ell2de1ined so1t
tissue mass in the
ri-ht upper zone anda smaller mass
medial to it. here is no bone destruction and no
mediastinal
lymphadenopathy.
coin & cannon 'allshado>s
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Multile lung mets
,eeral
di11erently2
sized mostly
round shadows
with the
intensity o1 so1t
tissue in both
lun-s. Most o1them are in the
lower lobes
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Milliary shado>s
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Milliary shado>s
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Hilar lyhadenoathy
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Lymhoma
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%ericardial calci"ication
,ead; causes "or cardiomegaly
http://www.aic.cuhk.edu.hk/web8/Hi%20res/0025%20Gas%20under%20diaphragm.jpg
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http://www.aic.cuhk.edu.hk/web8/Hi%20res/0025%20Gas%20under%20diaphragm.jpg
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C T SCNS
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(/H
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Acute S/H
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B&L chronic S/H
http://www.aic.cuhk.edu.hk/web8/Hi%20res/0256%20Chronic%20subdural.jpghttp://images.google.lk/imgres?imgurl=http://www.ne.jp/asahi/ueda/stroke/ct-hemo-put.jpg&imgrefurl=http://www.ne.jp/asahi/ueda/stroke/ich.html&h=593&w=465&sz=36&tbnid=FuRxC907f33GqM:&tbnh=133&tbnw=104&hl=en&start=1&prev=/images%3Fq%3DICH%2Bct%26svnum%3D10
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#H
http://images.google.lk/imgres?imgurl=http://www.ne.jp/asahi/ueda/stroke/ct-hemo-put.jpg&imgrefurl=http://www.ne.jp/asahi/ueda/stroke/ich.html&h=593&w=465&sz=36&tbnid=FuRxC907f33GqM:&tbnh=133&tbnw=104&hl=en&start=1&prev=/images%3Fq%3DICH%2Bct%26svnum%3D10
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SAH
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M#A in"arct
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,&Anterior middle cere'ralin"arct
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'#0
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#ere'ral a'scess%in- enhancement in capsule
o1 a bacterial abscess
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ntracranial other S!Ls eg; ,& Acoustic Neuroma
A round mass o1 mied si-nal in
%/C9 an-le. :t causes sli-ht
displacement o1 the brain stem
medially and etends into the
auditory canal on the ri-ht. he ed-e
o1 the mass ma4es an acute an-le
with the petrous bone.
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M(NN7!MA in #ontrast)enhanced #+
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Other In!esti"ations
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,ugger *ersy Sine
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8? ) Hydronehrosis
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Bone S#ans
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Bone S#ans
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M, scan $ 'rain
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#arotid angiogram
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8& scan ) %(
/!0A s#an&iethelene riamine 9enta Acetic acid
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&iethelene2riamine29enta2Acetic acid
Althou-h the 4idneys are the same sizethe center o1 the %/ 4idney has areas o1
decreased radioactiity; the hilum o1 the
%/4idney is li-hter -rey. his indicates that
the 4idney has hydronephrosis; the pelis
is so lar-e that the renal parenchyma is
stretched oer it.
(e1t 4idneys show pea4 concentration
computer -enerated cure at about 52
7min. (/4idney promptly drains cure
drops rapidly. he computer cure o1 theri-ht 4idney shows a much more -radual
rise and it continues to rise almost to the
end o1 the study. his shows that the ri-ht
4idney doesn?.
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Normal /MSA renal study.
Normal right kidney >ith ossi'le scar inuer ole and scarred le"t kidney at uer
ole middle and lo>er ole.
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/MSA ) HSC
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'56
rterial #loodGas analysis
ABG Reference Values
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'57
@ p+ 7."5 2 7.#5
@ +C?" ))2)6 mmol/( )#
@ pC?) "52#5 mm+- #0 #.72649a
@ p?) 802''0 mm+- ''2'549a
@ ,a?) $72'00@ B ) to D)
@ AE F')2'8
ABG Reference Values
'. G now the p+; p+ determines whether theprimary disorder is an acidosis or an al4alosis
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'58
primary disorder is an acidosis or an al4alosis
). hat is the primary problem metabolic orrespiratory
". Any compensationH
Compensation tries to normalize the p+
Both C?) ! +C?" -oes to same direction
=nusual to oercompensate
%espiratory compensation is immediate while renalcompensation ta4es time
8. '"yr boy omitin- and diarrhea 1or "
d + l th i d l t
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'5$
days. +e appears lethar-ic and cool to
touch with a prolon-ed capillary re1illtime. ABE p+I7."# pC?)I)6
+C?"I')
9artially compensated metabolic acidosis
he prolon- history o1 1luid loss throu-h diarrhea has
caused a metabolic acidosis. lactic acid production
1rom the hypoolemia and tissue hypoper1usion D
bicarbonate losses in the stool. he body has
compensated by hyperentilation.
$ )"yr student Hdru- oerdose +e su11ers
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'60
$. )"yr student Hdru- oerdose. +e su11ers
a si-ni1icant depression o1 mental status andrespiration. %% 6. p+ I 7.'6 pC?) I 70
+C?" I ))
=ncompensated respiratory acidosis
here has not been time 1or metabolic compensation to
occur.
)6yr male abd. pain ! ,?B
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'6'
p+I7.) 9aC?)I)) +C?"I')
9a?) I $$. CB,I 5$0m-/dl
Met acidosis with partial resp. compensation
#5yr 1emale deeloped hypoentilation ! sli-ht
disorientation a1ter &) o1 peptic ulcer ,
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'6)
disorientation a1ter &) o1 peptic ulcer ,
?/ JE in situ
B9 pulse ! CE JA&
%esp. shallow ! %%I'0
p+I7.5# 9aC?)I#6 +C?"I") 9a?) I $$. B D$
9artially compensated met al4alosis
eD #auses(
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'6"
Resp )cidosis
!ype II Resp failure
Resp )l*alosis
Hyper6entilation
JC'S - stro&e$
meningitis$ anxiety$fe6er$ drugs5
sali#ilates(K
eD #auses(
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'6#
+et )cidosis
Renal failure
eto5a#idosis
La#ti# a#idosis
/iarr"ea
Illeostomy
Renal !A
+et )l*alosis
Vomiting
re+( 'G su#tion
Hyperaldosteronism
/iureti#s
Respiratory ailure
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'65
p y
HypoxiaJ0a*< = 7 &0a or =@4 mmHgK
Dit" normo#apnia J0aC*
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'66
,es. =unction +ests
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$undos%o&y
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/M retinoathy
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/M retinoathy %roli"erati-e1
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L(=+; Moderate hyertensi-e retinoathy >ith hemorrhages and e4udates.
,7H+; +his atient de-eloed central retinal -ein occlusion as a result o"
uncontrolled hyertension an-ry loo4in- eye
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Ht retinoathy grade 81 & %ailloedema $ ll de"ined disk margin enlarge disk cucant see -essel markings are reduce. %ulsations in-isi'le
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Macular star in Ht
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!tic atrohy
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'8#
AL! : @ !imes 9 AL0 =
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;7
!R)E . ALSE
1)ES!I*' ;
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'86
)rine Ix of a man during test for insuran#e
is gi6en 8eloD
B) 9 S(Cr 'A/
)R pus #ells 4."pf
protein
appearan#e - #lear urine #ulture 5 negati6e
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'87
List 3 #auses )rinary #al#uli
!B
)rinary tra#t malignan#y
#ystitis
1uestion
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'88
In a patient Dit" %aundi#e Biliru8in 5;< mg.dl J = ;(mg.dl K
AS! 5;44 I) J = 3 I) K
AL! - F4 I) AL0 - 744 I
?HA! IS !HE /IAG'*SIS
'AME ; Ix !* C*'IRM !HE /IAG'*SIS LIS! < AE!I*L*GICAL AC!*RS
1uestion 3
http://www.aic.cuhk.edu.hk/web8/Hi%20res/0256%20Chronic%20subdural.jpg
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'8$
!R)E . ALSE
http://www.aic.cuhk.edu.hk/web8/Hi%20res/0256%20Chronic%20subdural.jpghttp://www.aic.cuhk.edu.hk/web8/Hi%20res/0256%20Chronic%20subdural.jpg
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'$0
It is an E/H
/ue to 8leeding from middle meningeal
artery
CS Dill 8e xant"o#"romi#
Al#o"olism is a ris& fa#tor
0atient may "a6e #onfusion
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%hysical Signs
Niroshan_loku@ yahoo.com
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Acromegaly "ace
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Hyothyroid "acies
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+hyroto4ic "acies
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L & 3rd #N alsy
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=acial N alsy
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Addison disease $ oral igmentation
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!ral candidasis
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,A ) HandNiroshan_loku@ yahoo.com
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?lnar ner-e alsy
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/uutrens contracture
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+endon Danthoma
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Sca'ies hands legs
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N=
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%laEue %soriasis
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E( nodosum
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E( multiforme
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!yp"us
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Snakes
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Miscellaneous
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Katty lier
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Macronodular cirrhosis
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+CC/ (ier ::ry
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Niyangala
7ood LuckF$eed'a%(s to niroshan)lo(u*yahoo+%om
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