Transcript OSCE (Question)

OSCE - Questions
PMH
Jan 2012
Case 1
F/38, history of Schizophrenia
Drank a bottle (60ml) of Red Flower Oil
Repeated vomiting, denied any tinnitus
GCS 15, BP 159/90, P 83, Temp 37.2oC
H’stix 6.3, SpO2 98% room air
•What is the main toxic component of Red Flower Oil? (0.5 mark)
•What is the difference between the above component and
acetylsalicylate? (0.5 mark)
Case 1
Blood gas and electrolytes result in A&E
• pH 7.5, HCO3 20 mmol/l
• pCO2 26mmHg, PO2 250 mmHg
• Na 146 mmol/l, K 3.2 mmol/l, Cl 104 mmol/l
• Serum salicylate level = 6.19 mmol/l
•What are the acid-base disturbances? Why? (1.5 marks)
•If the patient required intubation due to decreased consciousness and
airway protection, what precaution about ventilation should be made? (0.5
mark)
•What is the treatment for the current clinical condition? (0.5 marks)
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6
Serum Salicylate level (mmol/l)
5
4
3
2
1
0
12:00
18:00
0:00
6:00
12:00
18:00
0:00
6:00
12:00
18:00
0:00
6:00
12:00
18:00
Time
Repeated serum salicylate level was measured.
• What is the half-life of salicylate in therapeutic dose? (0.5 mark)
• Why was the serum salicylate level of this patient behaved differently?
(1 mark)
Case 2
F/78, history of DM, HT, old right hip fracture with OT
Right side abdominal pain for 1 week
Preceded by on and off right hip pain for recent 1 month
No dysuria, or urinary frequency reported
No shifting pain, nausea, vomiting or diarrhea
BP 90/40 P 130, Temp 39.2oC, H’stix 13.2
•What are the abnormalities in AXR? (2 marks)
•What is the diagnosis? (1 mark)
•What would be the predisposing factor presented in this case? (1 mark)
•Would you recommend Xigris® (Drotrecogin alfa)?
Yes/No - Why? (1 mark)
Case 3
M/50, private car driver with good past health
Severe head injury with right chest wall injury
CXR – Right side pneumothorax, multiple ribs fracture
Intubated and right intercostal drain inserted, swinging
and bubbling were present, post-insertion CXR taken
Noticed desaturation few minutes after insertion
•What are the X-ray findings? (3 marks)
•What is the most likely cause of deterioration? (1 mark)
•What is the treatment option for the above deterioration? (1 mark)
Case 4
F/30, no major medical chronic illness,
Presented with abdominal pain, nausea, vomiting and
diarrhea for 7 days
Abdominal distension and headache were reported
BP 135/86 P 110, Temp 37.5oC
Pregnancy test negative
Bedside ultrasonography was performed
•What are the abnormalities? (1.5 mark)
•What is your diagnosis? (0.5 mark)
Patient becomes drowsy and developed seizure during
observation, CT brain was performed.
•What abnormalities has been shown in CT Brain? (1 mark)
•What other signs you would like to look for in Contrast film? (1 mark)
•What is the diagnosis? (0.5 mark)
•Is there any association with the patient’s presenting problem? (0.5 mark)
Case 5
M/70, History of HT, IHD, presented with dizziness
Not associated with chest pain, No LOC reported
BP 82/46 P 43, Temp 36.8oC, H’stix 5.3, ECG was done
•What are the ECG findings? (2 mark)
Due to persistent symptoms and medical treatment has
been tried, but failed
•What would be the treatment option in A&E? (0.5 mark)
•What medications you would like to use for better tolerance of the above
treatment? (0.5 mark)
•List 4 causes of failure for the above treatment (2 marks)
The END of the Questions