JCM 2021 Feb OSCE Tin Shui Wai Hospital A&E

Question 1 Middle-aged man, sudden onset crushing chest pain since 1 hour before A&E presentation.

What is the ECG diagnosis? (1)

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Where is the likely culprit lesion? (1)

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Name one ECG feature that can help differentiate the location of different culprit lesion. (1)

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One additional POC investigation in A&E with this ECG diagnosis. (1)

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What is the definitive treatment? (1)

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What is the ECG diagnosis? (1)

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Name a specific site of lesion that can lead to this ECG diagnosis. (1)

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Name 2 mechanical complications of such ECG diagnosis. (2)

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If a patient presents with chest pain and such ECG after bee sting, name the condition. (1)

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Question 2

50-year-old, good past health, sudden severe dizziness, vomiting then collapsed. GCS 3 on arrival.

CT brain was performed.

Name the diagnostic radiological sign of in the CT image. (1)

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What is the diagnosis based on the clinical and radiological findings? (2)

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Suggest 2 relevant POC investigations in ED. (2)

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What would you suspect if the patient has neck pain preceding to collapse? (1)

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Name 3 risk factors that cause stroke in young patients. (3)

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What is the definitive treatment? (1)

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Question 3 A manual worker accidentally fell from a 2-metre high platform and sustained right knee injury. X-ray of the right knee was performed.

What is the radiological diagnosis? (1) __________________________________________________________________________

Which is the most common type of this condition? (1)

Suggest one most important clinical assessment that should be done in ED. (1)

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What should be performed in ED? (1)

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What is the clinical sign that suggests possible failure of intervention in ED? (1)

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Some patients may have spontaneous recovery after injury. Suggest one radiological sign that may hint a

prior injury. (1)

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Name 4 conditions in which emergency operative intervention is indicated. (4)

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Question 4 A 80-year-old male presented to the ED with severe abdominal pain and repeated vomiting. Blood was taken including POC arterial blood gas and electrolytes. The results are as follows.

pH pCO2 PO2 HCO3 Base excess O2 saturation Na K Cl

7.05 10.1 kPa 13.9 kPa 21.0 mmol/L -11.0 mmol/L 95% 146 4.8 98

Describe the abnormalities in the POC blood gas and electrolytes result. (2)

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Suggest 3 relevant ED investigations that could be performed. (3)

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In view of the abnormalities in the blood results, an urgent CT abdomen and pelvis with contrast was performed. The following are some of the CT images.

Name 2 important findings from the CT images. (2)

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Suggest 2 differential causes that could result in such imaging findings. (2)

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It was noted that the patient has a medical record of history of atrial fibrillation. Suggest one relevant clinical diagnosis of his presentation. (1)

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Question 5

A 25-year-old male motorcyclist was sent to the ED after he was thrown away from a motor vehicle crash. He appeared dyspnoeic on arrival.

Chest X-ray was taken.

Describe the most important finding in this CXR. (1)

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What classical clinical sign would you look for in this patient? (1)

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If the patient presents with further respiratory distress, what complication would you consider in the patient? Name one relevant radiological sign you would look on a supine CXR. (2)

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CT was performed and it showed left haemopneumothorax.

What is considered massive haemothorax? (1)

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Name 4 conditions that can cause shock in a polytrauma patient. (4)

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Name a method of pain control in this patient. (1)

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