JCM OSCE TMH AED Nov 2013. Case 1 M/66 Known HT FU private c/o Chest pain since 1 hour ago BP 133/84 P 65 T 36 Physical exam unremarkable Chest X-ray.

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Presentation transcript:

JCM OSCE TMH AED Nov 2013

Case 1 M/66 Known HT FU private c/o Chest pain since 1 hour ago BP 133/84 P 65 T 36 Physical exam unremarkable Chest X-ray unremarkable

Name the ECG abnormalities

What are the possible territories involved?

Name the most likely culprit artery

The patient is in a local hospital where PCI is unavailable. What is the preferred treatment according to the latest AHA guidelines?

Suppose tenecteplase was given for thrombolysis, however the patient developed VF arrest & cardiogenic shock after ROSC.

What treatment should be considered?

Case 2 M/44 Known HT c/o Severe low back pain BP 192/112 P 67 T 36 SpO2 99% (RA) CT was performed

What is the diagnosis?

Outline initial management with target end-points

When to consider alternative treatments?

This condition belongs to a spectrum of diseases. What is the spectrum called?

Case 3 F/55 PH: Ca rectum with total mesorectal excision & ileostomy 1 year ago Closure of ileostomy 2 weeks ago c/o Persistent wound pain, swelling, low grade fever

Describe the X-ray findings

Describe the abnormalities in CT

What is your diagnosis?

List 4 common etiologies

List 4 important aspects in conservative treatment

When should corrective surgery be considered?

Case 4 F/47 PH: Schizophrenia DO 40 tab amisulpride (800mg/tab) 10 tab ativan (1mg/tab) 1.5 hours ago BP 81/31 P82 SpO2 100% GCS 14 Pupil 3mm

(a) What is the most important cardiac toxicity of amisulpride overdose?

(b) Name 4 other drug classes causing similar effect as in (a)

(c) What arrhythmia can the above drugs cause?

(d) Name the antidotes for amisulpride

(e) How long should an asymptomatic patient with normal ECG be observed?

Case 5 F/54 Fall when walking downstairs in bus c/o R knee pain

Describe the XR finding

What is the usual injury mechanism?

Which site is more commonly involved?

Name the classification system

What does lipohemarthrosis indicate?

List 4 indications of operative repair

Thank You