OSCE learning points

 Date:7/12/23

K.Lahari 

Roll no. 61

Prefinal examination 

OSCE learning points:

●Differential diagnosis of PERIORBITAL edema: 

 Infectious:

      Orbital cellulitis

      Rhinocerebral mucormycosis

      Aspergillosis sinusitis

      Trichinosis

Traumatic:

      Orbital hematoma from self-multilating          behavior

      Orbital fracture

      Boerhaave's syndrome

      Traumatic asphyxia

Endocrine:

      Graves' ophthalmopathy with thyrotoxicosis

      Hypothyroidism

Allergic/toxic:

      Anaphylactic reaction

      Hymenoptera sting

      Angioedema

      Vascular/obstructive

      Superior vena cava syndrome

      Cavernous sinus thrombosis

Renal:

      Drug-induced interstitial nephritis

      Postinfectious glomerulonephritis

     Goodpasture's syndrome

     Nephrotic syndrome

     Wegener's granulomatosis 

●Takotsubo cardiomyopathy :

It is a temporary heart condition that develops in response to an intense emotional or physical experience.

It's also known as stress cardiomyopathy or broken heart syndrome. 

In this condition, the heart's main pumping chamber changes shape, affecting the heart's ability to pump blood effectively.

The heart’s chamber looks similar to a Tako -Tsubo pot, which is a Japanese fishing pot used to catch octopus.

The video below shows the normal shape of the ventricle after is contracts:

The video below shows the shape of the ventricle in Takotsubo cardiomyopathy:

•What are the causes of Takotsubo cardiomyopathy?

Takotsubo cardiomyopathy is brought on by an extremely stressful physical or emotional event.

Common triggers can include the death of a loved one, a serious accident, a fierce argument, an unexpected loss or a sudden illness. These triggers are the reason for the condition’s nickname, broken heart syndrome.

Takotsubo cardiomyopathy can occur at any age in both men and women, but it mostly affects older women.

•What are the signs and symptoms of Takotsubo cardiomyopathy?

The main symptoms are sudden chest pain, shortness of breath or fainting - usually after feeling severe stress.

These symptoms are similar to those of a heart attack, so if you experience these symptoms, call an ambulance straight away (dial 000 if in Australia).

•What are the possible tests to diagnose Takotsubo cardiomyopathy?

Your doctor will perform several tests to rule out a heart attack and confirm your diagnosis. You may need one or more of the following tests to determine the cause of your symptoms:

1.ECG – an electrical recording of your heart’s action 

2.Blood test – to check for enzymes that indicate damage to the heart muscle

3.Echocardiogram – an ultrasound of your heart which studies the heart’s shape and detects any abnormal movements of the main pumping chamber

4.Coronary angiogram - to check the blood flow through your heart’s blood vessels (coronary arteries). People with Takotsubo cardiomyopathy don’t have a blockage in their coronary arteries, whereas in heart attacks there is a blockage.

•learning points:

-How to make out Differential diagnosis by chief complaints

-Importance of  taking detailed history from the patient before and after the onset of I'll health and how it affected her daily life routine 

-How stress affects once health

-How hypothyroidism cause puffy face?

Hypothyroidism causes an increased amount of water in the skin and a loosening of collagen. This is due to a buildup of mucopolysaccharides, a type of amino sugar that attracts water and causes the collagen in your skin to separate

-How to approach a patient to get our diagnosis