Hierdie pasiënt was betrokke in ‘n MVO en OSCE 1 Hierdie pasiënt was betrokke in ‘n MVO en presenteer na 4 ure. Daar is ‘n deformiteit van sy dy en die pasiënt kla van erge pyn in sy kuit en voet sonder frakture van die onderbeen of voet. Hoe sal u die pasiënt hanteer en ondersoek in ongevalle? (3x½)=1½ Hoe sal u ‘n vaskulêre besering uitskakel? (2) Indien daar ‘n vaskulêre besering is  U verdere hantering? (3x½)=1½ This patient was in a MVA and presented after 4 hours. There is a deformity of the thigh and the patient complains of severe pain in the calf and foot without any fractures of the lower leg or foot. How will you treat and examine the patient in casualties? (3x½)=1½ How will you exclude a vascular injury?(2) If there is a vascular injury  Your further treatment. (3x½)=1½ ABC manage airwa,breathing, circulation make sure they are stable. IV ringers lactate. Treat as for hypovolaemic shock. Approach is look (deformity,etc) , feel( pulses), move. Examine for vascular injury, neurological 2. Exclude vascular injury: Look for hard signs ( pulsatile bleed,expanding haematoma,bruit or thril over area,) look for soft signs-( hx of pulsatile bleed, non-expanding haematoma,nerve fallout close to injury for possible arterial injury,) if soft signs do arteriogram. Feel for peripheral pulses. Duplex doppler. ABI studies less than 1/ 0.9 3. Immobilse limb, stabilise patient. Refer to vascular surgeon. If hard signs- do vascular surgical intervention. Must stent or embolise or anastomose the arteries in question.

Chest X-ray of an adult victim of a kick to the abdomen OSCE 2 Chest X-ray of an adult victim of a kick to the abdomen Give the radiographic diagnosis (1) What lesion could result in this picture (1) What would you expect to find clinically (1) If not timeously treated, what major complication could result (1) What should be the definitive treatment in this case (1) Borskas X-straal van ‘n volwasse slagoffer van ‘n skop op die buik Gee die radiologiese diagnose (1) Watter letsel kan hierdie beeld veroorsaak (1) Wat sou jy verwag om klinies te vind (1) Indien nie tydig behandel nie, watter major komplikasie kan ontwikkel (1) Wat sou die definitiewe behandeling in die geval wees (1) Haemoperitoneum 2. Rupture of liver or spleen (organs that bleed) 3. Distended abdomen, signs of peritonitis 4. Shock- hypotensive,pale, tachycardia 5.Surgical exploration to stop bleeding

OSCE 3 A young victim of a motor vehicle accident presents with a swollen thigh and abrasions to the contralateral knee as depicted. Clinically he has a femur fracture and a cold foot. What could be the reason for the cold foot (1) What could this be due to (2) What would be the major complication if not treated adequately (1) What treatment would you recommend (1) ‘n Jong slagoffer van ‘n motorvoertuig ongeluk presenteer met ‘n geswolle dy en abrasies van die kontralaterale knie. Klinies het hy ‘n femur fraktuur en ‘n koue voet Wat kan die rede vir die koue voet wees (1) As gevolg van wat kan dit wees (2) Wat sou die major komplikasie wees indien die besering nie voldoende bahandel sou word nie (1) Watter behandeling sou jy voorstel (1) Insufficient blood supply to the foot 2. Acute arterial insufficiency-due to femur fracture Compartment syndrome Possibly knee dislocation with popliteal a. obstruction 4. Limb threatening complications (due to muscle necrosis, gangrene), if not managed becomes a life threatening complication 5. Vascular repair

Chest X Ray of a 7 year old pedestrian involved in a motor vehicle accident OSCE 4 Identify the lesions / diagnosis present (2) What immediate steps would you take on recognition of the X-ray findings (1) What is the definitive treatment of these lesions (1) What would you expect to be the major signs and symptoms in this child (1) Borskas X-straal van ‘n 7 jarige voet- ganger betrokke in ‘n motor voertuig ongeluk Identifiseer die letsels / diagnose (2) Watter onmidelike stappe sal jy neem wanneer jy die X-straal diagnose gemaak het (1) Wat is die definitiewe behandeling van die letsels (1) Wat sou jy verwag sal die major simptome en tekens in hierdie kind wees (1) Right- multiple rib fractures, R tension pnuemothorax, Haemoperitoneum and haemothorax on left Insert needle into 2nd ICS midclavicular line to drain blood ICD insertion, surgical exploration for haemoperitoneum Respiratory distress, signs and symptoms of shock

A young man sustained a pelvic injury in a tractor accident OSCE 5 A young man sustained a pelvic injury in a tractor accident What is the special investigation depicted (1) What is the radiographic diagnosis (1) What bedside tests would you perform (1) What treatment options are open to this condition (2) ‘n Jong man doen ‘n pelviese besering in ‘n trekker ongeluk op Watter spesiale ondersoek word hier gewys (1) Wat is die radiologiese diagnose (1) Watter sykamer ondersoek sal jy doen (1) Watter behandelingsopsies is daar vir hierdie toestand (2) Cystogram Bladder rupture- probably extraperitoneal with pelvic fracture Auscultate for bowel sounds, percuss for bladder, suprapubic tenderness Conservative: Large bore catheter, Surgival- surgical exploration

OSCE 6 This patient was involved in a high voltage electrical incident. Describe the pathology of limb shown. (2) What specific local complications would you anticipate. (1) What systemic complication would you expect. (1)] What urgent treatment would you prescribe. (1) Hierdie pasiënt was beseer deur ‘n hoë spanning elektriese stroom. Beskryf die afwykings van die ledemaat wat vertoon word. (2) Watter spesifieke lokale komplikasie sal u verwag? (1) Watter sistemiese komplikasie sal u verwag? (1) Watter dringende behandeling sou u voorskryf? (1)

Spot the abnormality on this X-ray. (1) OSCE 7 Spot the abnormality on this X-ray. (1) What anatomic factors contributed to this lesion. (1) What complication(s) may arise from this lesion (2) What treatment would you advise. (1) Identifiseer die afwyking op hierdie X-straal. (1) Watter anatomiese faktore het bygedra tot hierdie letsel? (1) Watter komplikasie(s) mag ontwikkel as gevolg van hierdie letsel? (2) Dui die toepaslike behandeling aan. (1) Foreign body in the trachea Narrowing of the trachea, aortic arch Tracheal trauma and obstruction Sedation, flexible (or rigid) bronchoscopy

What type of fracture is this? (1) OSCE 8 What type of fracture is this? (1) 2.  What brain injuries are frequently associated with this kind of fracture? (3) 3. How are these fractures caused? (1) 1. Watter tipe fraktuur is hierdie? (1) 2. Watter tipe breinbesering is dikwels hiermee geassosieer? (3)  3. Hoe word hierdie frakture veroorsaak? (1) type I hinge fracture 2. What brain injuries are frequently associated with this kind of fracture? (3) • brain stem injuries being accompanied by avulsion and laceration of the large blood vessels in the base of the skull. 3 Motorcyclists that fall of bike and hit head,or mandible, chin,

OSCE 1 Which landmarks do you use when looking to these x-rays in a patient who was involved in a motor vehicle accident? [5] Watter landmerke sou u gebruik op hierdie X-strale van ‘n pasiënt wat in ‘n motorvoertuig ongeluk was. C1-T1,, anterior vertebral line, posterior vertebral line, spinolaminar line, intervertebral discs (Spinous processes, transverse processes)

1. What is the condition shown?(1) Describe 3 clinical signs seen (3) OSCE 2 1. What is the condition shown?(1) Describe 3 clinical signs seen (3) What could have been cause of the condition?(1) Wat is die toestand wat gewys word. (1) Noem 3 kliniese tekens wat gesien word. (3) Wat kan die oorsaak hiervan gewees het. (1) Volkmans contracture pain on passive extension of fingers, swollen limb, untreated compartment syndrome or Colle’s fracture 2. Describe 3 clinical signs seen (3) • Shortened limb, pronated hand, angulation of the distal fragment dorsally, # of distal radius 3. What could have been causes of the condition?(2) • Falling on extended wrist and outstretched arm 4. Rx: • Closed reduction with analgesia • Cast for 6 weeks