OSCE Question 02/2015

TMH AED

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Question 1

• M/69• Known history of HT, IHD, PVD• Sudden onset of constant low back pain• BP 162/85mmHg• P 78/min

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Question 1

• Suggest 5 differential diagnosis of acute low back pain

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Question 1

• Bedside abdominal USG was performed

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Question 1

• What’s the sonographic diagnosis?

• How to measure the size of the lesion?

• How to classify the type of the lesion using ultrasound?

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Question 1

• State the microbe that is most commonly associated with this condition?

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Question 2

• F/40• Good past health• Sudden onset of right sided weakness 1 hour

before• BP 180/93 mmHg• P 104/min• GCS 15/15

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Question 2

• Urgent CT brain was performed

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Question 2

• Described the CT finding

• Suggest 3 more hyperacute stroke CT signs

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Question 2

• Outline subsequent management plan for this patient

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Question 2

• State 3 etiologies for young onset stroke

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Question 2

• Cerebral angiogram was performed after stabilization

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Question 2

• Describe the finding

• What is the diagnosis?

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Question 3

• F/56• Good past health• Vehicle-pedestrian collision with left knee

injury• BP 153/79mmHg• P 95/min

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Question 3

• Left knee X-ray was taken

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Question 3

• Describe the X-ray finding

• What is the classification of the aboved condition?

• Which type this patient belonged to?

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Question 3

• What is the mechanism of the injury?

• Name 4 potential complications

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Question 4

• M/72• History of DM, HT, SSS on pacemaker• Sudden onset of severe chest pain for 3 hours,

only partially relieved by TNG• BP 164/88 mmHg• P 62/min

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Question 4

• ECG was performed

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Question 4

• Describe the ECG findings

• State an ECG criteria for assistance of diagnosis

• What is the diagnosis?

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Question 4

• Outline the management in AED

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Question 5

• M/62• Repeated vomiting for 1 day, with mild epigastric pain

after an alcohol binge• First vomited out undigested food and then mild blood

streak• BP 123/59 mmHg• P 84/min• Abdominal examination was unremarkable. Per rectal

examination noted brownish stool.• CXR was normal

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Question 5

• Name 3 clinical prediction rules/scores in upper gastrointestinal bleeding to risk stratification

• He asked if his condition could be managed without hospital admission

• State which score is the most relevant in this scenario? What cut-off and associated clinical implication for the score?

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Question 5

• More history was taken and he had known alcoholic with alcoholic liver cirrhosis

• Blood tests result:– Hb 13.4 g/dL– Urea 7.8 mmol/L

• How would you management this patient?

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Question 5

• He developed gross haematemesis during his stay in AED

• BP 96/49 mmHg• P 106/min

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Question 5

• How would you manage this patient in addition to the management you ordered before?

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Question 6

• M/69• History of HT, DM, old CVA• Decrease general condition for 1 month

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Question 6

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Question 6

• Describe the CT finding

• What further investigations would you proceed?

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Question 6

• If the opening pressure of the lumbar puncture is 12 cm H2O

• What is the condition called?

• What is the classic triad of this condition?

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Question 6

• What is the definitive treatment?

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