JCM OSCE YCH 3/7/2013

Question 1 F/57, slip and fell land sustained left wrist injury What are the x-ray findings & diagnosis? What is the treatment? What complication is expected if she was put on short arm dynacast?

Question 1 F/57, slip and fell land sustained left wrist injury What are the x-ray findings & diagnosis? Intra-articular fracture of radius (volar side), volar displacement of carpus, Barton’s fracture What is the treatment? Open reduction and internal fixation What complication is expected if she was put on short arm dynacast? Malunion / displacement of the fracture

Question 2 M/80 History of recurrent AROU Presented with right hip pain 1. What is the x-ray finding? 2. What is the diagnosis? 3. What other malignant tumor would present with similar x-ray finding?

Question 2 M/80 History of recurrent AROU Presented with right hip pain. 1. What is the x-ray finding? Osteosclerotic lesion over pelvis and Right hip 2. What is the most likely diagnosis? CA prostate with bone secondaries 3. What other malignant tumor would present with similar x-ray finding? CA breast with bone secondaries

Question 3 A boy presented with slip and fell landed on outstretched hand 1. What are the x-ray findings? 2. What is the diagnosis? 3. What is the most common associated injury? 4. What is the treatment?

Question 3 A boy presented with slip and fell landed on outstretched hand 1. What are the x-ray findings? Anterior Fat pad sign, crack over radial neck 2. What is the diagnosis? Type II epiphyseal injury over radial neck 3. What is the most common associated injury? Posterior interosseous nerve 4. What is the treatment? Immobilization for 2-3 weeks

Question 4 20-year-old man presented with recurrent episodes of palpitation. 1. Describe the ECG. 2. What is the diagnosis? 3. What are the 2 common arrhythmias associated with this condition?

Question 4 20-year-old man presented with recurrent episodes of palpitation. 1. Describe the ECG. Sinus rhythm, Short PR interval, widen QRS, delta wave 2. What is the diagnosis? Wolff-Parkinson-White syndrome 3. What are the 2 common arrhythmias associated with this condition? AVRT, pre-excited AF

Question 5 70 year-old-man presented with left upper abdominal discomfort for months. Recent weight loss x 5kg/several months P/E: Splenomegaly, tip 8cm below left costal margin

COMPLETE BLOOD COUNT WBC 57.5 H 3.7 - 9.2 x10^9/L RBC 3.70 L 4.30 - 5.90x10^12/L HGB 10.8 L 13.4 - 17.1 g/dL HCT 0.322 L 0.400-0.510 L/L MCV 87.0 82.0 - 97.0 fL MCH 29.2 27.0 - 33.0 pg MCHC 33.5 32.0 - 35.0 g/dL RDW 15.3 H 11.0 - 14.0 % PLT 78 L 145 - 370 x10^9/L WBC DIFFERENTIAL Neutrophil 47.8 H 1.7 - 5.8 x10^9/L NEU % 83.0 H 43.0 - 71.0 % Lymphocyte 2.3 1.0 - 3.1 x10^9/L LYM % 4.0 L 19.0 - 46.0 % Monocyte 1.2 H 0.1 - 0.8 x10^9/L MON % 2.0 L 3.0 - 12.0 % Eosinophil 0.6 H 0.0 - 0.5 x10^9/L EOS % 1.0 0 - 7.0 %

Question 5 Name 4 differential diagnosis? Chronic myeloid leukemia, Myelofibrosis, Chronic malaria, Kala-azar (Visceral leishmaniasis) 2. What is the most likely diagnosis? CML 3. Name 2 further investigations? Peripheral blood smear, Bone marrow biopsy

End Thank you