NLTH OSCE May 2017.

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Presentation transcript:

NLTH OSCE May 2017

Q1 What are the X-ray findings and diagnosis? a Q1 b How will you manage this patient? Q1 c What are the associate injuries? A 25-year-old lady presented with left shoulder pain after sustained left shoulder contusion

Posterior shoulder dislocation Q1 X-ray: light bulb sign and rim sign (widened joint space) Management: sedation and closed reduction Associated injuries: tuberosity and surgical neck fractures of the humerus, reverse Hill-Sachs lesions, and injuries to the labrum and rotator cuff

( Post reduction)

Q2 Q2 Q2 A 20-year-old man complained of palpitation BP 110/70 mmHg a What are the ECG findings and diagnosis? a Q2 b How will you manage this patient? Q2 c What is the definite treatment? A 20-year-old man complained of palpitation BP 110/70 mmHg

RVOT Tachycardia Q2 ECG: WCT with AV dissociation, LBBB, right axis deviation Management: IV ATP or verapamil Definite treatment: catheter ablation

Q3 What are the X-ray findings and diagnosis? a Q3 What other investigations can help to confirm the diagnosis? b Q3 What will you do if the patient refuses further investigations? c A 38-year old Venezuelan lady was brought in by custom for physical examination

Body Packer (Liquid cocaine) X-ray: repeated geometric pattern, double condom sign Diagnosis: Body packing Other investigations: US abdomen, CT abdomen Management: Stayed in AED for inspection of stool

Q4 What are the CT findings and diagnosis? a Q4 What other investigations can help to confirm the diagnosis? b Q4 What is the commonest underlying cause? c Referred by GP for management of a 64-year old lady with one month history of headache

Subarachnoid Bleeding Q4 Subarachnoid Bleeding CT signs of SAH: - blood in the basilar cisterns - isodense basilar cisterns - hydrocephalus (temporal horns of lateral ventricles) - reflux of blood into 4th ventricle Other investigation: LP (bloody CSF Vs xanthochromia) Commonest cause: rupture or leaking of cerebral aneurysm

Q5 What are x-ray findings and possible common causes? a Q5 What other investigation can help to confirm the diagnosis? b Q5 c How will you manage this patient? Nurse reported to you that a 80-year-old gentleman got repeat vomiting during EMW stay

Q5 Gastric Outlet Obstruction X-ray: right staghorn stone & gastric dilatation Causes: malignant (CA pancreas) & non-malignant (PU) Other investigations: CT abdomen (with contrast) Management: RT insertion, NS infusion