OSCE answers (Part two) Raika Jamali M.D. Gastroenterologist and hepatologist Sina hospital Tehran University of Medical Sciences

Case 12 Attention to the monosodium urate crystal on polarized light microscopy and the tophus. The correct diagnosis is gouty arthritis Intraarticular steroid is already considered the best treatment in gouty knee monoarthritis.

Case 13 Attention to the Subungueal splinter hemorrhage and Janeway lesions (non-tender, small erythematous or haemorrhagic macular or nodular lesions on the palms or soles only a few millimeters in diameter). The correct diagnosis is infective endocarditis. Intravenous antibiotic is the best treatment.

Case 14 Attention to the Spherocytes. The correct diagnosis is Spherocytosis. Folate supplement is recommended in this case with mild anemia.

Case 15 Attention to the hairy cell. The correct diagnosis is Hairy cell leukemia. Bone marrow transplant is the best treatment option.

Case 16 Attention to the hypersegmented neutrophil. The correct diagnosis is megaloblastic anemia. B12 supplement is the best treatment option. Shilling test might help in defining the etiology.

Case 17 The diagnosis is fecal impaction.

Case 18 Attention to the food material in stomach and empty duodenum. The correct diagnosis is gastric outlet obstruction.

Case 19 Acute viral hepatitis does not match with the patient diagnosis. In acute viral hepatitis the ichterus appears when the fever is decreased.

Case 20 Diagnostic paracentesis should be considered for the diagnosis of ascitis etiology. Shock liver do not match the patient diagnosis according to history.

Case 21 The patient is a case of severe preeclampsia. Termination of pregnancy is the best treatment strategy.

Case 22 Considering the increased gamma globulin level, autoimmune hepatitis is the best diagnosis. Steroid is the best treatment in this patient.