OSCE Question 02/2015 TMH AED 1

Question 1 • • • • • M/69 Known history of HT, IHD, PVD Sudden onset of constant low back pain BP 162/85mmHg P 78/min 2

Question 1 • Suggest 5 differential diagnosis of acute low back pain 3

Question 1 • Bedside abdominal USG was performed 4

Question 1 • What’s the sonographic diagnosis?

• How to measure the size of the lesion?

• How to classify the type of the lesion using ultrasound?

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Question 1 • State the microbe that is most commonly associated with this condition?

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Question 2 • • • • • • F/40 Good past health Sudden onset of right sided weakness 1 hour before BP 180/93 mmHg P 104/min GCS 15/15 7

Question 2 • Urgent CT brain was performed 8

Question 2 • Described the CT finding • Suggest 3 more hyperacute stroke CT signs 9

Question 2 • Outline subsequent management plan for this patient 10

Question 2 • State 3 etiologies for young onset stroke 11

Question 2 • Cerebral angiogram was performed after stabilization 12

Question 2 • Describe the finding • What is the diagnosis?

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Question 3 • • • • • F/56 Good past health Vehicle-pedestrian collision with left knee injury BP 153/79mmHg P 95/min 14

Question 3 • Left knee X-ray was taken 15

Question 3 • Describe the X-ray finding • • What is the classification of the aboved condition?

Which type this patient belonged to?

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Question 3 • What is the mechanism of the injury?

• Name 4 potential complications 17

Question 4 • • • • • M/72 History of DM, HT, SSS on pacemaker Sudden onset of severe chest pain for 3 hours, only partially relieved by TNG BP 164/88 mmHg P 62/min 18

Question 4 • ECG was performed 19

Question 4 • Describe the ECG findings • State an ECG criteria for assistance of diagnosis • What is the diagnosis?

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Question 4 • Outline the management in AED 21

Question 5 • • • • • • • M/62 Repeated vomiting for 1 day, with mild epigastric pain after an alcohol binge First vomited out undigested food and then mild blood streak BP 123/59 mmHg P 84/min Abdominal examination was unremarkable. Per rectal examination noted brownish stool.

CXR was normal 22

Question 5 • • • Name 3 clinical prediction rules/scores in upper gastrointestinal bleeding to risk stratification He asked if his condition could be managed without hospital admission State which score is the most relevant in this scenario? What cut-off and associated clinical implication for the score? 23

Question 5 • • • More history was taken and he had known alcoholic with alcoholic liver cirrhosis Blood tests result: – Hb 13.4 g/dL – Urea 7.8 mmol/L How would you management this patient?

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Question 5 • • • He developed gross haematemesis during his stay in AED BP 96/49 mmHg P 106/min 25

Question 5 • How would you manage this patient in addition to the management you ordered before?

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Question 6 • • • M/69 History of HT, DM, old CVA Decrease general condition for 1 month 27

Question 6 28

Question 6 • Describe the CT finding • What further investigations would you proceed?

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Question 6 • • If the opening pressure of the lumbar puncture is 12 cm H 2 O What is the condition called?

• What is the classic triad of this condition?

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Question 6 • What is the definitive treatment?

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