JCM OSCE

CMC

Q1• A 3 year-old boy complained of vomiting and looked

‘blue’ after taken vegetable soup prepared by his parents. RR 28/min. SaO2 90% RA. Clinical photos were taken.

• A) What is the clinical finding? • B) What is the most likely diagnosis?• C) What investigations will you perform?• D) What is the antidote and its dosage?• E) Is G6PD deficiency an absolute contra-indication to

the antidote? • F) What is the color change of urine after treatment?• G) What precautions will you give to his parents?

Q1. Pre-treatment 1

Q1. Pre-treatment 2

Q2• A 16-year-old boy complained of nausea, vomiting, throat

and chest pain for few days. X-ray neck and chest were performed.

• A) What are the X-rays findings?• B) What specific physical signs will you look for?• C) Give 4 causes of this condition.

• The patient was transferred to ICU for further management and other investigations were performed.

• D) What is the arterial blood gas result?• E) What is contrast CT neck, thorax and abdomen finding?• F) What is the most likely diagnosis?

Q2 CXR

Q2 X-ray Neck

Q2. Arterial blood gas

• pH 7.118• pCO2 14 mmHg• pO2 138 mmHg• HCO3 4.4 mmol/L• Base Excess -22.5 mmol/L• O2 Saturation 99%

Q2 CT neck, thorax, abdomen

Q2 CT neck, thorax, abdomen

Q 3

• A 60 year-old lady presented with abdominal pain and shock.

• A) What is the CT abdomen finding? • B) What are the significant laboratory

results? • C) What is the ECG finding? • D) Name 4 causes of the pathology in (A). • E) What is the management plan?

Q 3 CT abdomen 1

Q 3 CT abdomen 2

Q 3 Complete Blood Picture

Q 13 Liver and renal function test

Q3 ECG

Q4

• A 66 year-old-lady, with history of DM and HT, complained of fever, headache and diarrhea for 3 days. BP 90/41, P 126/min, Temp 38C.

• A) What are the significant laboratory findings?• B) She had recently travelled to Indonesia. Give

one specific investigation you will ask for. • C) What is the most likely pathogen?• D) Give 3 differential diagnosis. • E) What is the treatment for this pathogen?

Q4 Arterial Blood gas

Q4 Complete Blood Picture

Q4 liver and renal function test

Q 5

A 79-year-old lady complained of headache and diplopia for 1 week. Physical examination showed right third nerve palsy. A CT brain was performed.

A) What is the CT brain finding? B) What are the causes of third nerve palsy? C) MRI was done to delinerate the pathology.

What is the MRI brain finding?

Q5. CT brainwith contrast

Q5

MRI Plain

T2

Q5

MRI with contrast

Q6• A 67 year-old lady with history of DM, HT,

hyperlipidemia, complained of drowsiness for 1 day. Her medications included valsartan, betaloc, meformin, diamicron, gemfibrozil. Her vital signs were BP 118/51, P 23/min, SaO2 99%, Temp 35.8C, GCS 13/15. ECG was performed.

• A) What is the ECG finding? • B) What is the most likely diagnosis?• C) How does the ECG finding associated with the

severity of her condition?• D) Which of her medication can be the culprit?• E) What is the AED management?

Q5 ECG

Thank you!