Transcript OSCE - HKCEM

OSCE
3 Sep 2014
PYNEH
Q1: This is a 46 female with ankle injury
Her X-ray ankle is shown below:
Q1: Questions
1. 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?
Q1 Answer-1/2
1. 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)
Q1 Answer-2/2
• 4. What associated injury one should look out
for?
# fibular neck: Maissoneuve#
Q2: M/50 back seat passenger involved in
RTA, X-ray L-spine taken for backache:
Q2: Besides X-ray, CT spine has also been
down
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:
Q2: answer
1. 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
Q3: A 81 yo male is presenting to A&E with
bradycardia. His ECG is shown below
Q3 Questions
1. What is the ECG findings?
2. The patient is edematous all over his body.
What is the most suspected underlying cause
of this condition?
3. If the BP is 76/45mmHg, give your
emergency treatment before you confirm
your suspicion?
4. What are the specific treatment to initiate in
A&E after quickly confirm your suspicion?
Q3 Answer -1/3
1. 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)
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)
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)
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
Q4 CXR
Q4 Questions
1.
2.
3.
4.
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?
5. What imaging study would you suggest at this
moment?
Q4 Answers -1/2
1. 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
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)
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.
Q5 question
1. Could this location be managed expectantly?
2. What location will be more concern for this
coin?
3. What other clinical and X-ray parameters will
lead to operative management?
Q5 Answer
1. 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)
END