JCM OSCE

YCH 3/7/2013

Question 1

• F/57, slip and fell land sustained left wrist injury

1. What are the x-ray findings & diagnosis?

2. What is the treatment?

3. What complication is expected if she was put on short arm dynacast?

Question 1

• F/57, slip and fell land sustained left wrist injury

1. What are the x-ray findings & diagnosis?• Intra-articular fracture of radius (volar side), volar displacement of

carpus, Barton’s fracture

2. What is the treatment? • Open reduction and internal fixation

3. What complication is expected if she was put on short arm dynacast?• Malunion / displacement of the fracture

Question 2

• M/80

• History of recurrent AROU

• Presented with right hip pain

1. What is the x-ray finding?

2. What is the diagnosis?

3. What other malignant tumor would present with similar x-ray finding?

Question 2

• M/80• History of recurrent AROU• Presented with right hip pain.• 1. What is the x-ray finding?

• Osteosclerotic lesion over pelvis and Right hip

• 2. What is the most likely diagnosis?• CA prostate with bone secondaries

• 3. What other malignant tumor would present with similar x-ray finding?

• CA breast with bone secondaries

Question 3

• A boy presented with slip and fell landed on outstretched hand

1. What are the x-ray findings?

2. What is the diagnosis?

3. What is the most common associated injury?

4. What is the treatment?

Question 3

• A boy presented with slip and fell landed on outstretched hand

• 1. What are the x-ray findings?• Anterior Fat pad sign, crack over radial neck

• 2. What is the diagnosis? • Type II epiphyseal injury over radial neck

• 3. What is the most common associated injury?• Posterior interosseous nerve

• 4. What is the treatment?• Immobilization for 2-3 weeks

Question 4

• 20-year-old man presented with recurrent episodes of palpitation.

1. Describe the ECG.

2. What is the diagnosis?

3. What are the 2 common arrhythmias associated with this condition?

Question 4

• 20-year-old man presented with recurrent episodes of palpitation.

• 1. Describe the ECG. • Sinus rhythm, Short PR interval, widen QRS, delta

wave

• 2. What is the diagnosis?• Wolff-Parkinson-White syndrome

• 3. What are the 2 common arrhythmias associated with this condition?

• AVRT, pre-excited AF

Question 5

• 70 year-old-man presented with left upper abdominal discomfort for months.

• Recent weight loss x 5kg/several months

• P/E:

• Splenomegaly, tip 8cm below left costal margin

COMPLETE BLOOD COUNT WBC 57.5 H 3.7 - 9.2 x10^9/L RBC 3.70 L 4.30 - 5.90x10^12/L HGB 10.8 L 13.4 - 17.1 g/dL HCT 0.322 L 0.400-0.510 L/L MCV 87.0 82.0 - 97.0 fL MCH 29.2 27.0 - 33.0 pg MCHC 33.5 32.0 - 35.0 g/dL RDW 15.3 H 11.0 - 14.0 % PLT 78 L 145 - 370 x10^9/L WBC DIFFERENTIAL Neutrophil 47.8 H 1.7 - 5.8 x10^9/L NEU % 83.0 H 43.0 - 71.0 % Lymphocyte 2.3 1.0 - 3.1 x10^9/L LYM % 4.0 L 19.0 - 46.0 % Monocyte 1.2 H 0.1 - 0.8 x10^9/L MON % 2.0 L 3.0 - 12.0 % Eosinophil 0.6 H 0.0 - 0.5 x10^9/L EOS % 1.0 0 - 7.0 %

Question 5

1. Name 4 differential diagnosis?• Chronic myeloid leukemia, Myelofibrosis, Chronic malaria, Kala-azar

(Visceral leishmaniasis)

2. What is the most likely diagnosis?• CML

3. Name 2 further investigations?• Peripheral blood smear, Bone marrow biopsy

End

Thank you