Joint Clinical Meeting & Didactic Lectures
OSCE
RHTSK
June 2012
Case 1
 M/29
 He presented to AED after syncope and minor head
injury
 Physical examination was unremarkable
CT Brain
 Q1. Identify the abnormality on the CT film and suggest
2 differential diagnoses?
DDx:
-Pituitary
Macroadenoma
-Meningioma
-Lymphoma
-Metastasis
Hyperdense
mass at
pituitary fossa
 Q2. Suggest another investigation to delineate the nature
of the lesion.
MRI Brain
Large lobulated sellar/ suprasellar mass
 Q3. Which cranial nerves may be affected by this lesion?
 Q4. Suggest 2 systemic complications associated with
the lesion.
 Endocrine manifestation – Excess vs Inhibition
 Hyperprolactinaemia
 Acromegaly
 Cushing’s Disease
 Hyperthyroidism
 Pan-hypopituitarism
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
Bedside USG LL and
Echo
 Bedside USG popliteal fossa revealed thrombosis of
popliteal vein
 Bedside Echo
 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
 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)
Q3. What is your diagnosis?
 Left popliteal vein thrombosis complicated with
submassive pulmonary embolism
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.
 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.
Extensive tumor mass at
nasopharynx
Hypodens area at left
temporal lobe
 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
 Q5. Suggest 1 vascular pathology which can also cause
the same clinical presentation.
 Aneurysm at posterior communicating artery
 Cavernous sinus pathologies (e.g. thrombosis)
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
 Q1. Give 3 abnormal findings of this ECG.
 Tall T wave
 RBBB
 absence of p wave
 Widened ORS complex (Any 3 of them)
 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
 Q4. What other drugs can be given?
 DI drip
 NaHCO3
 Resonium
 Beta-agonist
 Loop diurteics
(Any 2 of them)