OSCE

3 Sep 2014PYNEH

Q1: This is a 46 female with ankle injuryHer X-ray ankle is shown below:

Q1: Questions

1. What are the pathology noted on ankle x-ray 2. What is the likely mechanism of injury 3. Is this a stable injury? 4. What associated injury one should look out

for?

Q1 Answer-1/2

1. What are the pathology noted on ankle x-ray# medial malleolus; with soft tissue swelling2. What is the likely mechanism of injuryEversion + ext rotation3. Is this a stable injury?Unstable (widening of joint space of ankle

mortise severe ligamentous disruption)

Q1 Answer-2/2

• 4. What associated injury one should look out for?

# fibular neck: Maissoneuve#

Q2: M/50 back seat passenger involved in RTA, X-ray L-spine taken for backache:

Q2: Besides X-ray, CT spine has also been down

Q2: Questions

1. What is the abnormality shown in plain LS spine X-ray?

2. What is the name of this condition?

3. What is the mechanism of this injury?

4. Name TWO possible associated injuries:

Q2: answer1. What is the abnormality shown in plain LS spine X-ray

and CT?Transverse # of L3 body and posterior colume2. What is the name of this condition?Chance #3. What is the mechanism of this injury?

-- flexion distraction4. Name TWO possible associated injuries:

-- mesenteric tear--duodenum rupture--pancreas injury

Q3: A 81 yo male is presenting to A&E with bradycardia. His ECG is shown below

Q3 Questions

1. What is the ECG findings?2. The patient is edematous all over his body.

What is the most suspected underlying cause of this condition?

3. If the BP is 76/45mmHg, give your emergency treatment before you confirm your suspicion?

4. What are the specific treatment to initiate in A&E after quickly confirm your suspicion?

Q3 Answer -1/3

1. What is the ECG findings?Junctional bradycardia (about 22/min)Tall T wave and widen QRS2. The patient is edematous all over his body.

What is the most suspected underlying cause of this condition?

• Hyper K (9.3 in this patient)

Q3 Answer -2/3

3. If the BP is 76/45mmHg, give your emergency treatment before you confirm your suspicion?

- CaCl2 or Ca gluconate- Atropine- Transcutaneous pacing with sedation(Do not give fluid bolus)

Q3 Answer -3/3

4. What are the specific treatment to initiate in A&E after quickly confirm your suspicion?

- Insulin glucose infusion- Resonium C ( PO or rectal)

Q4: A 67yo female present with SOB in the middle of the night.

• The patient experienced rapidly onset of SOB while in bed with no chest pain

• She had cough and sputum for 3 days with chills• Her BP: 166/62mmHg; p=88/min• SaO2=88% with 100% O2; no fever• Physical exam: labored breathing with bilateral

lung crepitations and dilated neck veins• ECG: sinus, LVH, no ST changes• CXR is shown

Q4 CXR

Q4 Questions

1. Describe the CXR finding:2. What is your clinical diagnosis?3. What drug(s) would you offer for her condition?4. After drug treatment, the patient deteriorated

with BP 89/57mmHg and she need intubation. What induction agent would you choose in considering her hemodynamic status?

5. What imaging study would you suggest at this moment?

Q4 Answers -1/2

1. Describe the CXR finding:Cardiomegaly, congested lung2. What is your clinical diagnosis?CHF, APO 3. What drug(s) would you offer for her

condition?nitrate infusion, lasix IV

Q4 Answers -2/2

4. After drug treatment, the patient deteriorate with BP 89/57mmHg and she need intubation. What induction agent would you choose in considering her hemodynamic status?

Ketamine5. Imaging Study: echo/USG for possible

pericardial effusion (that account for rapid development of tamponade with venodilator drugs)

Q5: A 3 yo child swallowed a $2 coin 1 days ago.

His parents expected 1 day and did not find the coin from his stool.

Q5 question

1. Could this location be managed expectantly?2. What location will be more concern for this

coin?3. What other clinical and X-ray parameters will

lead to operative management?

Q5 Answer

1. Could this location be managed expectantly?Yes2. What location will be more concern for this coin?If it is still above diaphragm3. What other clinical and X-ray parameter will lead

to operative management? - Increasing abdominal pain- Sign of Perforated visera (free gas on XR)- Dilated bowel (IO)

END