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JCM OSCE

JCM OSCE. YCH 3/7/2013. Question 1. F/57, slip and fell land sustained left wrist injury What are the x-ray findings & diagnosis? What is the treatment? What complication is expected if she was put on short arm dynacast?. Question 1. F/57, slip and fell land sustained left wrist injury

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JCM OSCE

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  1. JCM OSCE YCH 3/7/2013

  2. Question 1 • F/57, slip and fell land sustained left wrist injury • What are the x-ray findings & diagnosis? • What is the treatment? • What complication is expected if she was put on short arm dynacast?

  3. Question 1 • F/57, slip and fell land sustained left wrist injury • What are the x-ray findings & diagnosis? • Intra-articular fracture of radius (volar side), volar displacement of carpus, Barton’s fracture • What is the treatment? • Open reduction and internal fixation • What complication is expected if she was put on short arm dynacast? • Malunion / displacement of the fracture

  4. Question 2 M/80 History of recurrent AROU Presented with right hip pain 1. What is the x-ray finding? 2. What is the diagnosis? 3. What other malignant tumor would present with similar x-ray finding?

  5. Question 2 • M/80 • History of recurrent AROU • Presented with right hip pain. • 1. What is the x-ray finding? • Osteosclerotic lesion over pelvis and Right hip • 2. What is the most likely diagnosis? • CA prostate with bone secondaries • 3. What other malignant tumor would present with similar x-ray finding? • CA breast with bone secondaries

  6. Question 3 • A boy presented with slip and fell landed on outstretched hand 1. What are the x-ray findings? 2. What is the diagnosis? 3. What is the most common associated injury? 4. What is the treatment?

  7. Question 3 • A boy presented with slip and fell landed on outstretched hand • 1. What are the x-ray findings? • Anterior Fat pad sign, crack over radial neck • 2. What is the diagnosis? • Type II epiphyseal injury over radial neck • 3. What is the most common associated injury? • Posterior interosseous nerve • 4. What is the treatment? • Immobilization for 2-3 weeks

  8. Question 4 • 20-year-old man presented with recurrent episodes of palpitation. 1. Describe the ECG. 2. What is the diagnosis? 3. What are the 2 common arrhythmias associated with this condition?

  9. Question 4 • 20-year-old man presented with recurrent episodes of palpitation. • 1. Describe the ECG. • Sinus rhythm, Short PR interval, widen QRS, delta wave • 2. What is the diagnosis? • Wolff-Parkinson-White syndrome • 3. What are the 2 common arrhythmias associated with this condition? • AVRT, pre-excited AF

  10. Question 5 • 70 year-old-man presented with left upper abdominal discomfort for months. • Recent weight loss x 5kg/several months • P/E: • Splenomegaly, tip 8cm below left costal margin

  11. COMPLETE BLOOD COUNT WBC 57.5 H 3.7 - 9.2 x10^9/L RBC 3.70 L 4.30 - 5.90x10^12/L HGB 10.8 L 13.4 - 17.1 g/dL HCT 0.322 L 0.400-0.510 L/L MCV 87.0 82.0 - 97.0 fL MCH 29.2 27.0 - 33.0 pg MCHC 33.5 32.0 - 35.0 g/dL RDW 15.3 H 11.0 - 14.0 % PLT 78 L 145 - 370 x10^9/L WBC DIFFERENTIAL Neutrophil 47.8 H 1.7 - 5.8 x10^9/L NEU % 83.0 H 43.0 - 71.0 % Lymphocyte 2.3 1.0 - 3.1 x10^9/L LYM % 4.0 L 19.0 - 46.0 % Monocyte 1.2 H 0.1 - 0.8 x10^9/L MON % 2.0 L 3.0 - 12.0 % Eosinophil 0.6 H 0.0 - 0.5 x10^9/L EOS % 1.0 0 - 7.0 %

  12. Question 5 • Name 4 differential diagnosis? • Chronic myeloid leukemia, Myelofibrosis, Chronic malaria, Kala-azar (Visceral leishmaniasis) 2. What is the most likely diagnosis? • CML 3. Name 2 further investigations? • Peripheral blood smear, Bone marrow biopsy

  13. End Thank you

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