JCM OSCE
4th July 2012
AHNH
1) TCA poisoning
• Name 3 ECG findings.
– Tachycardia
– Widened QRS
– R in aVR
• What is the most likely diagnosis?
– TCA poisoning
• Give 3 complications and their treatments.
– NaHCO3 for ventricular arrhythmias
– Fluid, NaCO3 and inotrope for hypotension
– Benzodiazepine for seizure
2) Hyperkalaemia
• Name 3 ECG findings.
– Bradycardia
– Flattened p wave
– Tall T wave
• What is the most likely diagnosis?
– Hyperkalaemia
• What is the treatment?
– 10% Calcium gluconate 10 ml iv over 2-3 minutes
with cardiac monitoring
– Dextrose-insulin infusion
– 250 mL D10 or 50 mL D50 with 8-10 units Actrapid HM
over 30 minutes
– Sodium bicarbonate 8.4% 100-150 ml over 30-60
min
– Resonium C / A: 15-50 g orally Q 4-6 hr
– Hemodialysis
3) Posterior shoulder dislocation
• Name 2 findings.
– Posterior glenohumeral joint dislocation
– Fracture humeral head
• What other view may be needed?
– Scapular Y view
• Name 3 common causes of the condition.
– Convulsion
– Electric shock
– Fall/direct blow
• What is the typical position of the arm on
presentation?
– Shoulder adducted and internally rotated
• What is the treatment?
– Closed reduction
• axial traction, gentle pressure on the posteriorly
displaced head, and slow external rotation
– Operation
4) Masionneuve fracture
• What is the obvious lesion?
– Fracture proximal fibula
• What associated injury should be looked for?
– Deltoid ligament tear or medial malleolar fracture
• How would you confirm the diagnosis?
– Ankle mortise view or stress view
• What is the treatment of choice?
– Operation
5) Aortic dissection
• What is the diagnosis?
– Aortic dissection
• What is the extent of involvement?
– Aortic arch to left external iliac artery
• Name 3 complications of the condition.
– CVA
– Cardiac tamponade
– Aortic regurgitation and CHF
– AMI
– Ischemic paraparesis
– Mesenteric ischemia
– Renal failure
• Give 3 aims of treatment at A&E?
– ABC
– Pain control
– Control BP
– Urgent CTS consultation
The end