OSCE - Questions

PMHJan 2012

Case 1

F/38, history of SchizophreniaDrank a bottle (60ml) of Red Flower OilRepeated vomiting, denied any tinnitusGCS 15, BP 159/90, P 83, Temp 37.2oCH’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 1Blood 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)

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 2F/78, history of DM, HT, old right hip fracture with OT Right side abdominal pain for 1 weekPreceded by on and off right hip pain for recent 1 monthNo dysuria, or urinary frequency reportedNo 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 3M/50, private car driver with good past healthSevere head injury with right chest wall injuryCXR – Right side pneumothorax, multiple ribs fractureIntubated and right intercostal drain inserted, swinging and bubbling were present, post-insertion CXR takenNoticed 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 daysAbdominal distension and headache were reportedBP 135/86 P 110, Temp 37.5oCPregnancy test negativeBedside 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 5M/70, History of HT, IHD, presented with dizzinessNot 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