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OSCE and key learning points (prefinal examination)

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  Following the case discussion of a 60 year old female who presented with active uncontrolled abnormal movements of the limbs, some questions which were discussed as part of the Objective Structured Clinical Examination are: 1. What triggers Status epilepticus in a patient with pre-existing epilepsy?   There are many etiologies for status epilepticus including both obvious causes like non-compliance with the prescribed anti-epileptic medication (To be noted: the medication prescribed in the past for this patient was chronically underdosed) and other causes like: Cerebrovascular accidents Central nervous system infections Drug withdrawal syndromes (alcohol, benzodiazepines) Metabolic derangements (hypoglycemia) Hypoxia Head trauma Hypertensive emergencies Autoimmune disorders In this patient it was noted that at the time of admission, patient had hyperglycemia (GRBS: 222mg/dL) which later normalized without the need for medical intervention.   The next question then becomes: Can hyper
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A 60 year old female came with uncontrolled abnormal movements lasting more than 30 minutes

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This is an elog prepared with the de-identified health data collected after taking the informed consent of the patient and her attender reflecting an attempt at patient-centered approach to learning clinical medicine.  The patient was brought is a 60 year old woman hailing from Nalgonda. She lives with her elder daughter's family and spends most of her time at home, managing the housework. She was brought to the OPD by her daughter 3 days ago in an unconscious state , with uncontrolled abnormal movement of limbs lasting for more than 30 minutes . HOPI The patient was apparently asymptomatic 23 years ago when, due to a head injury she sustained during a fall a few years before, she began experiencing these episodes of "fits" or (uncontrolled abnormal movements of the limbs and loss of consciousness) with a frequency of 0-2 times/year . Patient has been on anticonvulsive medication since the past 23 years. A typical episode begins with headache and dizziness, up-rolli
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SECOND INTERNAL EXAMINATION SEPT 2023

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A 45 year old male came to the OPD with generalized weakness and mild SOB since 5 months

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This is an elog that contains the de-identified health data of this patient which was collected after taking the patient's informed consent for the purpose of clinical discussion. HOPI Patient was apparently asymptomatic 5 months ago when he developed fatigue which was insidious in onset, gradually progressive and associated with mild shortness of breath, especially on prolonged exertion. Patient came to the OPD 4 days ago because of worsening of symptoms and limitation of daily activities. Patient also complains of severe pain in the heels of both legs on walking since one year. PAST HISTORY No history of diabetes mellitus, hypertension, tuberculosis, asthma, epilepsy or cardiovascular disease. No history of previous surgeries. FAMILY HISTORY No significant family history. PERSONAL HISTORY Diet: Mixed Appetite: Normal Sleep: Adequate Bladder: No urinary symptoms. Bowel movements: Normal Addictions: No addictions GENERAL EXAMINATION Patient was explained regarding the procedure of
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A 70 year old male came to the OPD with weakness of all four limbs and oliguria since one week

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 The patient's and his attender's consent was obtained, following which detailed history was taken and examination was performed. HOPI The patient was apparently asymptomatic one week ago when, the day after his wife's demise, he suddenly developed weakness in all four limbs. His right hand(dominant hand) showed some level of movement. However, he was unable to get out of bed or even brush his own teeth or feed himself. He was taken to a hospital in Nalgonda and from there, he was referred to this hospital. He also had reduced urine production around the same time. He had been caring for his sick wife for the past three months. Yesterday, he fell while using the washroom and sustained a minor injury to the head. There was some bleeding and he was immediately taken to the OPD and treated. PAST ILLNESS 15 years ago, he was found to have an abdominal mass which was benign but he refused surgery. Around the same time (15 years ago)  he underwent hernia surgery. He underwent cat
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