1. Joint Clinical Meeting & Didactic Lectures OSCE
RHTSK
June 2012

2. Case 1 M/29 He presented to AED after syncope and minor head injury
Physical examination was unremarkable

3. CT Brain
Q1. Identify the abnormality on the CT film and suggest 2 differential diagnoses?
Hyperdense mass at pituitary fossa
DDx:
-Pituitary Macroadenoma
-Meningioma
-Lymphoma
-Metastasis

4. Q2. Suggest another investigation to delineate the nature of the lesion.
MRI Brain
Large lobulated sellar/ suprasellar mass

5. Q3. Which cranial nerves may be affected by this lesion?

6. Q4. Suggest 2 systemic complications associated with the lesion.
Endocrine manifestation – Excess vs Inhibition
Hyperprolactinaemia
Acromegaly
Cushing’s Disease
Hyperthyroidism
Pan-hypopituitarism

7. Case 2
M/49
Presented with left popliteal fossa pain, left calf swelling and shortness of breath for one week
He has history of travelling to Mainland China a week ago. In that trip, he travelled by bus for three hours
Physical Examination: BP 128/83 mmHg, pulse 98/min, SpO2 98%. Chest was clear. Heart sounds were normal
Mild tenderness over popliteal fossa without any swelling
CXR was normal. ECG revealed sinus rhythm at 95/min

8. Bedside USG LL and Echo
Bedside USG popliteal fossa revealed thrombosis of popliteal vein
Bedside Echo

9. Q1a. What is the name of this view? What is the name of chamber a ?
Apical 4 chamber view
Right ventricle
Q1b. What is the abnormality in this view?
Right ventricle dilatation

10. Q 2b. What is the abnormality in this view?
Q2a. What is the name of this view? What is the name of chamber a?
Parasternal short axis view
Left ventricle
Q 2b. What is the abnormality in this view?
Flattening of interventricular
septum (or D shaped LV)

11. Q3. What is your diagnosis?
Left popliteal vein thrombosis complicated with submassive pulmonary embolism

12. Case 3
M/60
Complained about double vision for few days. No limb weakness or numbness was noted.
This is the clinical photo of the patient.

13. Q1. Look at the clinical photo and suggest 1 neurological finding.
Left CN III palsy
Q2. Non-contrast CT brain was performed. Suggest 2 important findings on the CT films.

14. Extensive tumor mass at nasopharynx
Hypodens area at left temporal lobe

15. Q3. What would be the most likely cause for the CT findings?
NPC with brain metastasis
Q4. What further investigation can be done to confirm your diagnosis?
Nasopharyngoscope with tissue biopsy

16. Q5. Suggest 1 vascular pathology which can also cause the same clinical presentation.
Aneurysm at posterior communicating artery
Cavernous sinus pathologies (e.g. thrombosis)

17. Case 4
79/M
Hx of HT, DM with triopathy, IHD, old CVA with good recovery
On OHA and ACEI
Presented with dizziness, generalized malaise
BP 180/90, Pulse 120/min

19. Q1. Give 3 abnormal findings of this ECG.
Tall T wave
RBBB
absence of p wave
Widened ORS complex (Any 3 of them)

20. Q2. What 2 blood tests will you order to confirm your Dx?
RFT
ABG
Q3. Which drug in the emergency trolley will you give to the patient?
Ca gluconate / CaCl

21. Q4. What other drugs can be given?
DI drip
NaHCO3
Resonium
Beta-agonist
Loop diurteics (Any 2 of them)