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OSCE

OSCE. JCM Mar 2017. Case 1. F/81, attended A&E for suicidal attempt with Dettol poisoning. She drank about 100 ml of dettol 30 minutes before arrival at A&E. GCS15/15, BP 124/69 mmHg, pulse 88/min, SaO2 98% RA. Dettol. Name 3 ingredients in Dettol.

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  1. OSCE JCM Mar 2017

  2. Case 1 • F/81, attended A&E for suicidal attempt with Dettol poisoning. • She drank about 100 ml of dettol 30 minutes before arrival at A&E. • GCS15/15, BP 124/69 mmHg, pulse 88/min, SaO2 98% RA.

  3. Dettol

  4. Name 3 ingredients in Dettol. • Isopropyl alcohol, pine oil, chloroxylenol • What are the clinical features of Dettol poisoning? ( Please name 2) • CNS depression, GI irritative symptoms, laryngeal edema, aspiration • Is gastric lavage indicated? Why? • Supportive and symptomatic treatment are the mainstay of treatment. Risk of aspiration in gastric lavage.

  5. Case 2 • F/64 fell with left leg pain, X ray of left femur showed fracture shaft of left femur. • X ray of right femur was also taken for her.

  6. Left femur

  7. Right femur

  8. Please name 2 atypical features that you can spot on the X ray. • Medial spike, beaking, localized periosteal thickening. • What medication is associated with this type of fracture ? • Biphosphonate.

  9. Left femur Medial spike Beaking or localized periosteal thickening

  10. Right femur Localized periosteal thickening

  11. Case 3 • F/20 with good past health presented with seizure to A&E department. • Seizure controlled with IV valium. • Plain CT brain was done.

  12. Name TWO abnormalities you could spot on the CT brain. • Homogeneous hypodense lesion at right basal ganglia with a hyperdense rim. • Perilesional cerebral edema. • Mid line shift.

  13. Name ONE likely diagnosis. • Brain abscess. • Tumour ( cystic, necrotic). • Subacute brain contusion, haemorrhage.

  14. Further history from parents revealed that she had pneumonia 2 weeks ago, treated in outpatient setting with oral augmentin. • She had fever and difficulty to control her left hands for 2 days before onset of seizure.

  15. Name 3 principles of management for this patient. • Seizure control ( PRN valium, ativan, IV dilantin infusion). • Further Ix ( Contrast CT brain, Biopsy of brain tissue). • IV antibiotics. • Drainage of abscess.

  16. Case 4 • M/48 presented to A&E with collapse, decrease in general condition. GCS 3/15 on arrival. BP 95/50 mmHg. Noticed left sided weakness. Left side power 0/5. Right sided power 3/5. CT brain was done and revealed infarct over right side of brain.

  17. Inequality of BP was noticed for this patient. A CT angiogram was done for investigation and was shown.

  18. Intimal flap Intimal flap

  19. What is the radiological feature you could spot on the CT angiogram? • Intimal flap ( descending and ascending aorta) . • What is the diagnosis based on the CT angiogram? • Aortic dissection.

  20. Name ONE classification system of the condition based on CT angiogram. • Stanford • Debakey • What is the type of condition based on the classification system named? • Stanford type A • Bebakey type I

  21. From cedmcurriculum.com

  22. Which branch of aorta is involved to give rise to the picture of stroke? • Right common carotid artery or branchiocephalic artery.

  23. From studyblue.com

  24. Case 5 • M/21 presented with syncope. His vital sign is stable at A&E. ECG was done for him and was as shown.

  25. What is the diagnosis? • Brugada syndrome

  26. From emedhome.com

  27. What should be the definitive treatment? • Implantation of an automatic implantable cardiac defibrillator ( ICD)

  28. Thank you

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