1. OSCE 13 Radial nerve anatomical snuffbox
after the radial nerve branches into posterior interosseus as wrist extention still intact.
extensors of Mpjoints fingers

2. This is a view into the right nasal space from anterior.
OSCE 1
This is a view into the right nasal space from anterior.
What is your diagnosis?
What structure can be seen through the perforation?
Explain the pathophysiology of this condition following nasal trauma (5)
Hierdie is die beeld wat u sien indien u in die regter neusgang kyk van anterior.
Wat is u diagnose?
Watter struktuur kan u deur die perforasie sien?
Wat is die patofisiologie in die ontstaan van die patologie na trauma aan die neus. (5)
a) Perforated nasal septum
b) Middle turbinate
c) Trauma causes bleeding, which causes hematoma, abscess, causes cartilage necrosis

3. OSCE 2
Patient involved in MVA. Pelvic rami fracture identified with a pelvic x-ray. Blood was seen at the urethral meatus.
1.What radiological investigations is seen on the picture? (1)
2.What is the radiological diagnosis? (1)
3.What other clinical symptoms will you look for to confirm the diagnosis? (3)
How will you treat the urological injury of this patient? (1)
Pasiënt was in ‘n motorongeluk betrokke. Pelviese rami frakture is gesien met die x-strale van die pelvis. Bloed is gesien by die uretrale meatus.
1.Wat is die radiologiese ondersoek op die foto? (1)
2.Wat is die radiologiese diagnose? (1)
3.Watter ander kliniese simptome sal jy voor soek om die diagnose te bevestig? (3)
4.Hoe sal jy die pasiënt se urologiese besering verder hanteer? (1)
1. Urethragram
2. Urethral trauma
3. • Urinary retention /
• Haematoma / bruising of the perineum
• Heamaturia
• Swollen penis
• Floating prostate / dysuria, haematuria, suprapubic pain
4. Pain management
Surgical exploration rail roading after 2-3 days, early intervention can cause more complications

4. OSCE 3
Patient with a history of scrotal trauma He complains of severe testicular pain. Examination reveals scrotal swelling and a palpable mass in the right hemiscrotum.
1.What special investigation was done? (1)
2.What will your management be? (3)
Pasiënt met ‘n geskiedenis van skrotale trauma. Hy kla van erge testikulêre pyn. Met ondersoek word daar skrotale swelling en ‘n pynlike, tasbare massa gevoel in die regter hemiskrotum.
1.Watter spesiale ondersoek is gedoen) (1)
2.Wat is u verdere hantering van die pasiënt? (3)
Ultrasound
Analgesia for pain and for the swelling
Confirm if the mass is a haematoma or haematocele – surgically explore - manage accordingly – drain and repair surgically tunica albuginea or do orchidectomy if not successful.

5. OSCE 4 Define a 3rd degree burn. (1)
What is defined as a major burn in a child? (1)
What special problem would this specific patient present? (2)
What would be your specific treatment of it? (1)
Definieer ‘n 3de graadse brandwond. (1)
Wat word beskou as ‘n major brandwond in ‘n kind? (1)
Met watter spesifieke probleem presenteer hierdie kind? (2)
Noem ‘n spesifieke terapie tot hierdie probleem? (1)
1. Deep burn wound
All skin rests and appendages are destroyed (hair etc)
Burns are less painful (cause the nerves are destroyed)
Dry surface, appears patched, brown or charred depending on the agent that caused the burn wound
Boiling water: parchment-like
Open flame: brown or carbonized 2.
3. Hypovolaemic Shock
These wounds will not epithelialise spontaneously ---
4. Adequate fluid resuscitation
Skin graft will be needed

6. OSCE 5 Identify the lesions. (1)
What are the typical features of the lesions. (3)
What type of instrument was probably used to inflict these wounds? (1)
Identifiseer die letsels. (1)
Wat is die eienskappe van die letsels. (3)
Watter tipe wapen is waarskynlik gebruik om die wonde te veroorsaak? (1)
Stab wounds
2.Multiple stab wounds showing marked variations in wound size
Deeper than it is long
Edges are smooth
CT bridges absent
3.Double edged knife

7. Supracondylar fracture
compartment syndrome , mal-union
reduce fracture, pop cast, xray

8. OSCE 8 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)
Watch swolled 2.

9. OSCE 16 This young man was a victim of a shark attack.
What do you think might have been the outcome and why. (3)
If you were at the scene during the incident what steps could you take to influence the outcome. (2)
Hierdie jong man was die slagoffer van ‘n haai aanval.
Wat dink u kon die uitkoms gewees het en waarom. (3)
Indien u op die toneel was tydens die aanval, watter stappe sou u kon doen om die uitkoms te beïnvloed. (2)
Death due to massive trauma to lower limb and vascular strucures nearby, massive haemorrhage.exsanguination
apply pressure to wound, tourniquet the leg to reduce blood loss, get help asap

10. OSCE 1
This patient was involved in a car accident and sustained right hip injury.
1.What is the Radiological diagnosis? (1)
2.Mention the landmarks ( two) you will use to confirm your diagnosis. (2)
3.What will be the clinical attitude of the limb in this patient ? (3)
Hierdie pasiënt was in ‘n motorvoertuigongeluk betrokke en het ‘n regter heup besering opgedoen.
1.Wat is die radiologiese diagnose. (1)
2.Noem die twee landmerke wat die diagnose sal bevestig (2)
3.In watter posisie lê die ledemaat. (3)
1.Posterior dislocation of the right hip
2. acetabulum, head of the femur
3. adduction,internal rotation, shortened, flexion of the hip

11. 0SCE 2
The casualty officer executes the procedure shown on a traumatized patient.
What is this procedure called? (1)
What is the surface anatomy of the puncture site? (2)
Describe the direction of the needle. (1)
Name two structures that can be accidentally injured when doing this procedure. (1)
Die noodgevalle beampte voer die aangetoonde prosedure uit op ‘n getroumatiseerde pasiënt.
Wat word die prosedure genoem? (1)
Wat is die oppervlaksanatomie van die plek van inplasing? (2)
Beskryf die rigting van die naald. (1)
Noem twee strukture wat per abuis beseer kan word tydens die uitvoer van die prosedure. (1) 2 1
CVP
• The apex of the ∆ formed by the 2 heads of the sternocleiodomastoid m. and the clavicle
• The apex is more or less 5cm superior to the clavicle
• The apex of the v. is located between the sternocleidomastoid m. and the apical pleura of the lung
• The v. is at the depth of 1,0 to 1,5cm from the skin
• Advancement of the needle must never exceed 1.5cm to avoid a pneumothorax
The needle is placed 30 to 45°posterior to the frontal plane in an inferior direction, parallel with the sagital plane
• Accessory n.
• Lung (apex)

12. OSCE 13 This child fell off a tree and injured his right elbow.
Name two orthopaedic pathologies obvious on these X-rays. (2)
What is the eponym for this injury? (1)
How would you treat this patient? (2)
Hierdie kind het uit ‘n boom geval en sy regter elmboog beseer.
Noem 2 ortopediese toestande wat duidelik is op hierdie X-strale. (2)
Wat is die eponiem vir hierdie besering. (1)
Hoe sal u die pasiënt behandel. (2)
1 . Fracture of the proximal part of ulna, dislocation of radio-capital joint
2. Monteggia fracture
3. Closed reduction (open reduction in older children)
• if radio-capitular j. doesn’t reduce, an open reduction of the j. should be performed, with soft tissue reconstruction
• Isolated radial head dislocations because of boney plasticity of children

13. b) Where would the corresponding dermatome be for this nerve root (2)
OSCE 15
a) In the examination of the neck – what myotome is being tested with the above tests (1)
b) Where would the corresponding dermatome be for this nerve root (2)
If there is a radiculopathy in this distribution due to a disk protrusion, at what level would the protrusion most probably be. (1)
a) By die ondersoek van die nek, watter miotoom word ondersoek ? (1)
b) Waar is die ooreenstemmende dermatoom vir die senuweewortel? (2)
c) Indien daar ‘n radiculopatie in die bogenoemde distribusie is as gevolg van ‘n diskusprotrusie, op watter vlak is die protrusie waarskynlik? (1) A B C

14. ‘n 60 jarige vrou het ‘n servikale rugbesering in ‘n voertuigongeluk
OSCE 7 -A 60 year old woman sustained a cervical spine injury in a road accident
Is this lateral cervical spine x-ray adequate or not. Give reasons (1)
Identify the injury (2)
What is the treatment on admission to the hospital and why (2)
‘n 60 jarige vrou het ‘n servikale
rugbesering in ‘n voertuigongeluk
opgedoen
Is hierdie laterale servikale x-straal voldoende of nie. Gee redes (1)
Identifiseer die besering (2)
Wat is die behandeling ten tye van opname en hoekom (2)
no. must visualise c1 to t1
C5/6 dislocation- bifacet (greater than 50%)
Rigid neck collar/brace- you don’t want further damage.

15. OSCE 9
The chest X-ray was obtained after insertion of a central venous catheter.
By which two pathogenetic mechanisms can the mediastinum be displaced? (1)
Is the mediastinum displaced on this X-ray? (1)
What is the pathology or diagnosis? (1)
What is the emergency management of this condition? (1)
What is the definitive treatment of this condition? (1)
Die borskas X-straal foto is verkry na plasing van ‘n sentraal veneuse kateter.
Deur watter twee patogenetiese meganismes kan die mediastinum verplaas word? (1)
Is die medistinum verplaas op hierdie X-straal foto? (1)
Wat is die patologie of diagnose? (1)
Wat is die noodhantering van hierdie toestand? (1)
Wat is die definitiewe behandeling van hierdie toestand? (1)
Collapsed lung from punctured lung apex
Yes
Collapsed lung
Thoracocentesis
ICD

16. Noem ‘n moontlike oorsaak van hierdie besering. (1)
OSCE - 12
Noem ‘n moontlike oorsaak van hierdie besering. (1)
Met watter metode sal jy die fraktuur spalk om die pasiënt te vervoer? (1)
Watter komplikasies kan jy kry direk na die besering? (1)
Watter lewensbelangrike komplikasies kan jy kry teen die derde dag? (1)
Wat is jou spoedbehandeling vir hierdie pasiënt? (1)
Give a possible cause for this injury. (1)
You have to transfer this patient. How will you splint his leg? (1)
Which complications can you get directly after the injury? (1)
Which life threatening complication can you get by the third day post injury? (1)
What treatment shall you give immediately after the injury? (1)
Hi energy impact, MVA
thomas splint
Popliteal artery obstruction/dissection
fat embolism syndrome
Pain killers,analgesics, (solumediol 2-3mg iv 4hourly- fat embolism)