1. OSCE
JCM
Mar 2017

2. 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.
GCS15/15, BP 124/69 mmHg, pulse 88/min, SaO2 98% RA.

3. Dettol

4. Name 3 ingredients in Dettol.
Isopropyl alcohol, pine oil, chloroxylenol
What are the clinical features of Dettol poisoning? ( Please name 2)
CNS depression, GI irritative symptoms, laryngeal edema, aspiration
Is gastric lavage indicated? Why?
Supportive and symptomatic treatment are the mainstay of treatment. Risk of aspiration in gastric lavage.

5. 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.

6. Left femur

7. Right femur

8. Please name 2 atypical features that you can spot on the X ray.
Medial cortical spike, beaking, localized periosteal thickening.
What medication is associated with this type of fracture ?
Bisphosphonate or glucocorticoids.

9. Left femur
Medial spike
Beaking or localized periosteal thickening

10. Right femur
Localized periosteal thickening

11. ASBMR (American Society for Bone and Mineral Research) criteria for AFF (atypical femoral fracture)
All major features must be present while minor features may or may not be present

12. 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.

14. Name TWO abnormalities you could spot on the CT brain.
Homogeneous hypodense lesion at right basal ganglia with a hyperdense rim.
Perilesional cerebral edema.
Mid line shift.

15. Name ONE likely diagnosis.
Brain abscess.
Tumour ( cystic, necrotic).
Subacute brain contusion, haemorrhage.

16. 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.

17. Name 3 principles of management for this patient.
Seizure control ( PRN valium, ativan, IV dilantin infusion).
Further Ix ( Contrast CT brain, Biopsy of brain tissue).
IV antibiotics.
Drainage of abscess.

18. Case 4
M/48 presented to A&E with collapse, decrease in general condition. GCS 3/15 on arrival. BP 95/50 mmHg. 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.

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

22. Intimal flap
Intimal flap

23. What is the radiological feature you could spot on the CT angiogram?
Intimal flap ( descending and ascending aorta) .
What is the diagnosis based on the CT angiogram?
Aortic dissection.

24. Name ONE classification system of the condition based on CT angiogram.
Stanford
Debakey
What is the type of condition based on the classification system named?
Stanford type A
Bebakey type I

25. From cedmcurriculum.com

26. Which branch of aorta is involved to give rise to the picture of stroke?
Right common carotid artery or branchiocephalic artery.

27. From studyblue.com

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

30. What is the diagnosis?
Brugada syndrome

31. From emedhome.com

32. What should be the definitive treatment?
Implantation of an automatic implantable cardiac defibrillator ( ICD)

33. Thank you