1. OSCE
3 Sep 2014
PYNEH

2. Q1: This is a 46 female with ankle injury Her X-ray ankle is shown below:

3. Q1: Questions What are the pathology noted on ankle x-ray
2. What is the likely mechanism of injury
3. Is this a stable injury?
4. What associated injury one should look out for?

4. Q2: M/50 back seat passenger involved in RTA, X-ray L-spine taken for backache:

5. Q2: Besides X-ray, CT spine has also been down

6. Q2: Questions
1. What is the abnormality shown in plain LS spine X-ray? 2. What is the name of this condition? 3. What is the mechanism of this injury? 4. Name TWO possible associated injuries:

7. Q3: A 81 yo male is presenting to A&E with bradycardia
Q3: A 81 yo male is presenting to A&E with bradycardia. His ECG is shown below

8. Q3 Questions What is the ECG findings?
The patient is edematous all over his body. What is the most suspected underlying cause of this condition?
If the BP is 76/45mmHg, give your emergency treatment before you confirm your suspicion?
What are the specific treatment to initiate in A&E after quickly confirm your suspicion?

9. Q4: A 67yo female present with SOB in the middle of the night.
The patient experienced rapidly onset of SOB while in bed with no chest pain
She had cough and sputum for 3 days with chills
Her BP: 166/62mmHg; p=88/min
SaO2=88% with 100% O2; no fever
Physical exam: labored breathing with bilateral lung crepitations and dilated neck veins
ECG: sinus, LVH, no ST changes
CXR is shown

10. Q4 CXR

11. Q4 Questions Describe the CXR finding:
What is your clinical diagnosis?
What drug(s) would you offer for her condition?
After drug treatment, the patient deteriorated with BP 89/57mmHg and she need intubation. What induction agent would you choose in considering her hemodynamic status?
What imaging study would you suggest at this moment?

12. Q5: A 3 yo child swallowed a $2 coin 1 days ago.
His parents expected 1 day and did not find the coin from his stool.

13. Q5 question Could this location be managed expectantly?
What location will be more concern for this coin?
What other clinical and X-ray parameters will lead to operative management?

14. END