OSCE JCM Mar 2017 1 Case 1 F81

OSCE JCM Mar 2017 1

Case 1 • F/81, attended A&E for suicidal attempt with Dettol poisoning. • She drank about 100 ml of dettol 30 minutes before arrival at A&E. • GCS 15/15, BP 124/69 mm. Hg, pulse 88/min, Sa. O 2 98% RA. 2

Dettol 3

• Name 3 ingredients in Dettol. • What are the clinical features of Dettol poisoning? ( Please name 2) • Is gastric lavage indicated? Why? 4

Case 2 • F/64 fell with left leg pain, X ray of left femur showed fracture shaft of left femur. • X ray of right femur was also taken for her. 5

Left femur 6

Right femur 7

• Please name 2 atypical features that you can spot on the X ray. • What medication is associated with this type of fracture ? 8

Case 3 • F/20 with good past health presented with seizure to A&E department • Seizure controlled with IV valium • Plain CT brain was done. 9

10

• Name TWO abnormalities you could spot on the CT brain. • Name ONE likely diagnosis. 11

• Further history from parents revealed that she had pneumonia 2 weeks ago, treated in outpatient setting with oral augmentin. • She had fever and difficulty to control her left hands for 2 days before onset of seizure. 12

• Name 3 principles of management for this patient. 13

Case 4 • M/48 presented to A&E with collapse, decrease in general condition. GCS 3/15 on arrival. BP 95/50 mm. Hg. Noticed left sided weakness. Left side power 0/5. Right sided power 3/5. CT brain was done and revealed infarct over right side of brain. 14

15

• Inequality of BP was noticed for this patient. A CT angiogram was done for investigation and was shown. 16

17

• What is the radiological feature you could spot on the CT angiogram? • What is the diagnosis based on the CT angiogram? 18

• Name ONE classification system of the condition based on CT angiogram. • What is the type of condition based on the classification system named? 19

• Which branch of aorta is involved to give rise to this clinical picture of stroke? 20

Case 5 • M/21 presented with syncope. His vital sign is stable at A&E. ECG was done for him and was as shown. 21

22

• What is the diagnosis? • What should be the definitive treatment? 23