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OSCE

OSCE. 3 Sep 2014 PYNEH. Q1: This is a 46 female with ankle injury Her X-ray ankle is shown below:. Q1: Questions. 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?.

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OSCE

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  1. OSCE 3 Sep 2014 PYNEH

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

  3. Q1: Questions • 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?

  4. Q1 Answer-1/2 • What are the pathology noted on ankle x-ray # medial malleolus; with soft tissue swelling 2. What is the likely mechanism of injury Eversion + ext rotation 3.  Is this a stable injury? Unstable (widening of joint space of ankle mortise  severe ligamentous disruption)

  5. Q1 Answer-2/2 • 4. What associated injury one should look out for? # fibular neck: Maissoneuve#

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

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

  8. 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:

  9. Q2: answer • What is the abnormality shown in plain LS spine X-ray and CT? Transverse # of L3 body and posterior colume 2. What is the name of this condition? Chance # 3. What is the mechanism of this injury?-- flexion distraction 4. Name TWO possible associated injuries:-- mesenteric tear--duodenum rupture--pancreas  injury

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

  11. Q3 Questions • What is the ECG findings? • The patient is edematous all over his body. What is the most suspected underlying cause of this condition? • If the BP is 76/45mmHg, give your emergency treatment before you confirm your suspicion? • What are the specific treatment to initiate in A&E after quickly confirm your suspicion?

  12. Q3 Answer -1/3 • What is the ECG findings? Junctional bradycardia (about 22/min) Tall T wave and widen QRS 2. 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)

  13. 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)

  14. 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)

  15. 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

  16. Q4 CXR

  17. Q4 Questions • Describe the CXR finding: • What is your clinical diagnosis? • What drug(s) would you offer for her condition? • 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? • What imaging study would you suggest at this moment?

  18. Q4 Answers -1/2 • Describe the CXR finding: Cardiomegaly, congested lung 2. What is your clinical diagnosis? CHF, APO 3. What drug(s) would you offer for her condition? nitrate infusion, lasix IV

  19. 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? Ketamine 5. Imaging Study: echo/USG for possible pericardial effusion (that account for rapid development of tamponade with venodilator drugs)

  20. 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.

  21. Q5 question • Could this location be managed expectantly? • What location will be more concern for this coin? • What other clinical and X-ray parameters will lead to operative management?

  22. Q5 Answer • Could this location be managed expectantly? Yes 2. What location will be more concern for this coin? If it is still above diaphragm 3. 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)

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