opse-suggested answer prepared by: dr. hk ngan pmh aed
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OPSE-suggested answer
Prepared by: Dr. HK NganPMH AED
Case 1
• M/65• PH:DM, HT• Attended AED because of abdominal
distension and constipation for two days
Case 1
Case 1
• 1) Describe the x-ray findings?• 2) What is the diagnosis?• 3) What are the main complications of this
condition?• 4) Name three predisposing factors for this
condition?• 5) What is the treatment?
Case 1-suggested answer• 1) a loop of dilated(1) large(1) bowel pointing toward the
diaphragm with demonstration of “coffee bean” (2)sign or “bent inner tube”(2) sign (4 mark)
• 2) Sigmoid volvulus (2) (2 mark)• 3) bowel obstruction(1),perforation(1),bowel ischaemia(1)• (3 mark)• 4) Redundant sigmoid colon with narrow mesentery,
chronic constipation, Chacas disease(trypanosomiasis), Parkisonism, spinal cord disease, mental illness, high fiber diet, high altitude (3 mark)
• 5) Sigmoidoscopy(1) and insertion of rectal tube(1) for decompression; operative (1)management and resection
• (3 mark)
Case 2
• Nigerian tourist• F/42• Brought in by police from airport for
abdominal pain
Case 2
Case 2
• 1) Describe the x-ray findings?• 2) What is the diagnosis?• 3) What will be the complication of this
condition?• 4) What is your management?
Case 2-suggested answer• 1) Bowel is not dilated; no air-fluid level; multiple oval soft
tissue(packet)homogenous shadows (2)inside the bowel with rim of halo(1) “double condom sign”(2) (4 mark)
• 2) Body packing, body stuffing, internal carrier, balloon swallower (any one) (2 mark))
• 3) bowel obstruction(1); toxicity (1)due to rupture of contained drug (2 mark)
• 4) Asymptomatic: Whole bowel irrigation(1) and laxative(1) (2 mark) Symptomatic: i)Operative intervention(1) in case of obstruction(1), retention(1)
of packet and sign of leakage/rupture(1) of packet ii) Antidote administration(1) (5 mark)
Case 3
• PH: Good• M/50• Presented to AED for chest pain on and off for
3 weeks. Now symptoms free. • Serial Troponin I<0.03 (not rasied)
Case 3
Case 3
• 1) What is the ECG findings ?• 2) What is the diagnosis?• 3) What is the significance of this condition
and what will be the complication?• 4) What is the best treatment for this
condition and why?
Case 3-suggested answer• 1) NSR; HR 60/min;PR interval normal; QRS not widen ; Axis
normal ; TWI at V3,V4 (either one 1 mark); biphasic T wave inversion at V3 V4(2) (3 mark)
• 2) Wellens syndrome (2 mark)• 3)Critical proximal LAD stenosis and preinfarction stage of coronary
artery disease; left untreated may proceed to anterior wall infarction of resulting in serious ventricular dysfunction, CHF and death (7 mark)
• 4) Urgent coronary angiography and revascularization(2) as 75 % of this patient will proceed to AMI(1) even with medical treatment (aspirin, beta-blocker therapy, nitroglycerin, morphine, heparin, clopidogrel, and glycoprotein (GP) IIb/IIa inhibitors) (1)
(3 mark)
Case 4
• F/40• Brought in by mother with abnormal behavior
and delusional idea for one month. No history of head injury.
Case 4
Case 4
Case 4
• 1) What is the CT findings?• 2)Give 3 differential diagnosis from the CT
finding?• 3)Give the cistern/fissure name of A,B, C, D • 4)What physical examination you would
emphasis with this CT findings?• 5)What other investigation you would like to
do to confirm your suspicion?
Case4- suggested answer• 1) A mass leision over the suprasellar region (2);
( 2mark)
• 2) Pituitary adenoma(macroadenoma); aneurysm; craniopharyngioma; meningioma; Rathke’s cyst ;chiasmatic glioma ; dermoid; epidermoid,schewannoma;geminoma; metastasis (any three) (3 mark)
• 3)A-Suprasellar cistern ; • B-Circummesencephalic (ambient) cistern• C-Sylvian cistern/fissure• D- Quadrigeminal cistern (4 mark)• 4)Visual field & acuity exam; fundi; neurological exam (3 mark)• 5) CT brain with contrast; MRI; Angiogram (3 mark)
Case 4
Case 4-suggested answer
Case 5
• 63/M• Construction site worker• Right eye being splashed by liquid concrete
(cement)• Used tap water to rinse it briefly• C/O pain, tearing, blurring of vision
Case 5
Case 5
1. Describe the clinical findings from the photo.2. What is the likely culprit chemical causing
such injury?3. Name one essential bedside test.4. Which will have more serious injury, acid or
alkali? Give your explanation5. How would you grade the severity of this
injury?
Case 5 –suggested answers1. Injected conjunctiva/ hazy cornea/ FS +ve with epithelial defect at cornea
(3 mark)2. Lime or calcium hydroxide ( CaOH2) causing alkali burn
(3 mark)3. pH in the conjunctival sac (1 mark)4. Alkali.(1) Alkali will have more damage because alkaline penetrates faster
and deeper than acid through the cornea. The fatty acids in cell membranes are broken down into soap and glycerol by the process of saponification. While acids result in coagulative necrosis at surface and form a protective barrier to prevent further penetration ( 4 mark)
5. Determined by severity of cornea injury, extensiveness of limbal involvement and percentage of conjunctival involvement
The Roper-Hall(1) classification on the degree of corneal involvement(1`) and limbal ischemia(1). The Dua(1) classification on an estimate of limbal involvement (in clock hours)(1) and the percentage of conjunctival involvement(1). (4 mark)
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