JCM OSCE 4 th July 2012 AHNH

1) TCA poisoning Name 3 ECG findings. – Tachycardia – Widened QRS – R in aVR What is the most likely diagnosis? – TCA poisoning

Give 3 complications and their treatments. – NaHCO3 for ventricular arrhythmias – Fluid, NaCO3 and inotrope for hypotension – Benzodiazepine for seizure

2) Hyperkalaemia Name 3 ECG findings. – Bradycardia – Flattened p wave – Tall T wave What is the most likely diagnosis? – Hyperkalaemia

What is the treatment? – 10% Calcium gluconate 10 ml iv over 2-3 minutes with cardiac monitoring – Dextrose-insulin infusion – 250 mL D10 or 50 mL D50 with 8-10 units Actrapid HM over 30 minutes – Sodium bicarbonate 8.4% ml over min – Resonium C / A: g orally Q 4-6 hr – Hemodialysis

3) Posterior shoulder dislocation Name 2 findings. – Posterior glenohumeral joint dislocation – Fracture humeral head What other view may be needed? – Scapular Y view

Name 3 common causes of the condition. – Convulsion – Electric shock – Fall/direct blow

What is the typical position of the arm on presentation? – Shoulder adducted and internally rotated

What is the treatment? – Closed reduction axial traction, gentle pressure on the posteriorly displaced head, and slow external rotation – Operation

4) Masionneuve fracture What is the obvious lesion? – Fracture proximal fibula What associated injury should be looked for? – Deltoid ligament tear or medial malleolar fracture How would you confirm the diagnosis? – Ankle mortise view or stress view

What is the treatment of choice? – Operation

5) Aortic dissection What is the diagnosis? – Aortic dissection What is the extent of involvement? – Aortic arch to left external iliac artery

Name 3 complications of the condition. – CVA – Cardiac tamponade – Aortic regurgitation and CHF – AMI – Ischemic paraparesis – Mesenteric ischemia – Renal failure

Give 3 aims of treatment at A&E? – ABC – Pain control – Control BP – Urgent CTS consultation

The end