1. OSCE - Questions PMH Jan 2012

2. Case 1 F/38, history of Schizophrenia Drank a bottle (60ml) of Red Flower Oil Repeated vomiting, denied any tinnitus GCS 15, BP 159/90, P 83, Temp 37.2 o C H’stix 6.3, SpO 2 98% room air What is the main toxic component of Red Flower Oil? (0.5 mark) What is the difference between the above component and acetylsalicylate? (0.5 mark)

3. Case 1 Blood gas and electrolytes result in A&E pH 7.5, HCO 3 20 mmol/l pCO 2 26mmHg, PO 2 250 mmHg Na 146 mmol/l, K 3.2 mmol/l, Cl 104 mmol/l Serum salicylate level = 6.19 mmol/l What are the acid-base disturbances? Why? (1.5 marks) If the patient required intubation due to decreased consciousness and airway protection, what precaution about ventilation should be made? (0.5 mark) What is the treatment for the current clinical condition? (0.5 marks)

4. Repeated serum salicylate level was measured. What is the half-life of salicylate in therapeutic dose? (0.5 mark) Why was the serum salicylate level of this patient behaved differently? (1 mark)

5. Case 2 F/78, history of DM, HT, old right hip fracture with OT Right side abdominal pain for 1 week Preceded by on and off right hip pain for recent 1 month No dysuria, or urinary frequency reported No shifting pain, nausea, vomiting or diarrhea BP 90/40 P 130, Temp 39.2 o C, H’stix 13.2 What are the abnormalities in AXR? (2 marks) What is the diagnosis? (1 mark) What would be the predisposing factor presented in this case? (1 mark) Would you recommend Xigris® (Drotrecogin alfa)? Yes/No - Why? (1 mark)

7. Case 3 M/50, private car driver with good past health Severe head injury with right chest wall injury CXR – Right side pneumothorax, multiple ribs fracture Intubated and right intercostal drain inserted, swinging and bubbling were present, post-insertion CXR taken Noticed desaturation few minutes after insertion What are the X-ray findings? (3 marks) What is the most likely cause of deterioration? (1 mark) What is the treatment option for the above deterioration? (1 mark)

9. Case 4 F/30, no major medical chronic illness, Presented with abdominal pain, nausea, vomiting and diarrhea for 7 days Abdominal distension and headache were reported BP 135/86 P 110, Temp 37.5 o C Pregnancy test negative Bedside ultrasonography was performed What are the abnormalities? (1.5 mark) What is your diagnosis? (0.5 mark)

13. Patient becomes drowsy and developed seizure during observation, CT brain was performed. What abnormalities has been shown in CT Brain? (1 mark) What other signs you would like to look for in Contrast film? (1 mark) What is the diagnosis? (0.5 mark) Is there any association with the patient’s presenting problem? (0.5 mark)

15. Case 5 M/70, History of HT, IHD, presented with dizziness Not associated with chest pain, No LOC reported BP 82/46 P 43, Temp 36.8 o C, H’stix 5.3, ECG was done What are the ECG findings? (2 mark) Due to persistent symptoms and medical treatment has been tried, but failed What would be the treatment option in A&E? (0.5 mark) What medications you would like to use for better tolerance of the above treatment? (0.5 mark) List 4 causes of failure for the above treatment (2 marks)

17. The END of the Questions