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JCM OSCE

JCM OSCE. 4 th July 2012 AHNH. 1) TCA poisoning. Name 3 ECG findings. Tachycardia Widened QRS R in aVR What is the most likely diagnosis? TCA poisoning. Give 3 complications and their treatments. NaHCO3 for ventricular arrhythmias Fluid, NaCO3 and inotrope for hypotension

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JCM OSCE

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  1. JCM OSCE 4th July 2012 AHNH

  2. 1) TCA poisoning • Name 3 ECG findings. • Tachycardia • Widened QRS • R in aVR • What is the most likely diagnosis? • TCA poisoning

  3. Give 3 complications and their treatments. • NaHCO3 for ventricular arrhythmias • Fluid, NaCO3 and inotrope for hypotension • Benzodiazepine for seizure

  4. 2) Hyperkalaemia • Name 3 ECG findings. • Bradycardia • Flattened p wave • Tall T wave • What is the most likely diagnosis? • Hyperkalaemia

  5. What is the treatment? • 10% Calcium gluconate 10 ml iv over 2-3 minutes with cardiac monitoring • Dextrose-insulin infusion • 250 mL D10 or 50 mL D50 with 8-10 units Actrapid HM over 30 minutes • Sodium bicarbonate 8.4% 100-150 ml over 30-60 min • Resonium C / A: 15-50 g orally Q 4-6 hr • Hemodialysis

  6. 3) Posterior shoulder dislocation • Name 2 findings. • Posterior glenohumeral joint dislocation • Fracture humeral head • What other view may be needed? • Scapular Y view

  7. Name 3 common causes of the condition. • Convulsion • Electric shock • Fall/direct blow

  8. What is the typical position of the arm on presentation? • Shoulder adducted and internally rotated

  9. What is the treatment? • Closed reduction • axial traction, gentle pressure on the posteriorly displaced head, and slow external rotation • Operation

  10. 4) Masionneuve fracture • What is the obvious lesion? • Fracture proximal fibula • What associated injury should be looked for? • Deltoid ligament tear or medial malleolar fracture • How would you confirm the diagnosis? • Ankle mortise view or stress view

  11. What is the treatment of choice? • Operation

  12. 5) Aortic dissection • What is the diagnosis? • Aortic dissection • What is the extent of involvement? • Aortic arch to left external iliac artery

  13. Name 3 complications of the condition. • CVA • Cardiac tamponade • Aortic regurgitation and CHF • AMI • Ischemic paraparesis • Mesenteric ischemia • Renal failure

  14. Give 3 aims of treatment at A&E? • ABC • Pain control • Control BP • Urgent CTS consultation

  15. The end

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