OSCE Pok Oi Hospital Jan 2020

Case 1

A 15 years old girl, with a history of bipolar affective disorder FU in private psychiatrist,

was found over-dosed with 10 tablets of 600mg Lithium carbonate by her mother 1

hour ago before AED attendance. She was asymptomatic.

On physical examination: GCS 15/15 with stable vital signs

X-rays were taken.

1. What is the X-ray findings?

2. Name 5 other drugs that is radio-opaque in plain x-ray.

3. What are the possible GI decontamination which can be done in the ED?

4. What are the 3 types of lithium overdose?

Case 2

A 12 years old girl sustained left ankle sprain while roller skating at park. She

complained left ankle pain with inability to walk. There was left ankle swelling.

X-rays were performed.

1. What is the diagnosis?

2. What is the Salter-Harris type?

3. What is the mechanism of this injury?

4. What are the complications of this injury?

5. What is the indication of operative management?

Case 3

A 22-year-old university student with good past health presented with coarsening of

facial features, headache and visual blurring for 2 years.

CT brain was done.

1. What is the CT findings?

2. What aspects of eye examination do you need to perform?

3. What would be the common findings in eye examination?

4. State 3 relevant blood tests.

Case 4

A 61-year-old gentleman was sent to A&E due to sudden onset of loss of consciousness

in train for 30 seconds. He complained of chest discomfort. He enjoyed good past

health.

Initial vitals on arrival:

BP 100/68; P 92; SpO2 97% RA

GCS 15

ECG was then done in triage.

1. Describe the ECG findings.

2. What is the ECG diagnosis?

3. What is the ED treatment?

4. What is the treatment if the patient become hemodynamically unstable?

5. Suggest one definite treatment so as to prevent recurrence.