osce

KWH

Aug 2013

Case 1

• M/38

• Right shoulder contusion after S/F

• PE: tenderness and swelling over his right upper chest . No skin impingement and no external wound found. No distal neurological deficit elicited

Questions

• 1) what is the diagnosis?

• 2) what is the classification of the fracture?

• 2) what is the management?

Case 2

• F/6

• Left elbow contusion after S/F in 2 months ago

• c/o: persistent pain after the injury

• PE: tenderness and swelling over her left elbow. ROM: 0-90 degree. No distal neurological deficit elicited.

• X rays left elbow was taken

Questions

• 1) what is the diagnosis?

• 2) what is the associated injury to look for?

• 3) what is the management?

Case 3

• M/70

• Left shoulder contusion after S/F

• PE: left shoulder in abducted position

• X rays of left shoulder was taken

Questions

• 1) what is the diagnosis?

• 2) what is the method of reduction?

Case 4

• M/24

• He complained of epigastric and LUQ abdominal pain after having been assaulted by someone on two days ago.

• PE: tenderness over his LUQ abdomen. No external wound was found.

• BP 148/74 mmHg P93/min SaO2 99%

• His BP drop to 60/30 mmHg after admission and return to 130/70 mmHg after 1000 ml gelofusin infusion.

• Urgent CT was performed

Plain films

Plain films

Plain films

Contrast film

Contrast films

Contrast films

Contrast films

Contrast films

Delay contrast films

Delay contrast

Delay contrast

Delay contrast

Questions

• 1) describe the CT findings

• 2) what is the diagnosis?

• 3) what is the management?

• 4) What is the abnormal CT findings that indicate surgical intervention ?

Case 5

• F/25

• She attempted suicide by burning charcoal at home

• PE: GCS 14/15, BP 98/73 mmHg, Pulse 83/min, SaO2 99% on 100%O2

• Systems review were unremarkable. No focal neurological sign elicited.

Question

• 1) describe the CT findings

• 2) what is the diagnosis?

• 3) what is the management?

Case 6

• F/25, Phx depression

• Attempted suicide by drug overdose

• PE: unconscious, GCS 4/15, BP 100/60 mmHg Pulse 70/min

• She was intubated in AED.

Questions

• 1) describe the ECG finding

• 2) what is the diagnosis?

• 3) what is the mangement?

Case 7

• M/37

• Family history of premature death of unknown cause

• Complained of palpitation and atypical chest discomfort for few episodes.

• PE: BP 140/80 mmHg P 95/min

• Systems review were unremarkable.

Questions

• 1) describe the ECG findings

• 2) what is the diagnosis?

• 3) what is the management?