mock osce debriefing. station no 1 glucose estimation principle requirements semi-automatic...
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![Page 1: Mock OSCE Debriefing. Station No 1 Glucose estimation Principle Requirements Semi-automatic analyser Adjustable pipette GOD-PAP reagents Working literature](https://reader030.vdocuments.us/reader030/viewer/2022032708/56649e8e5503460f94b914ff/html5/thumbnails/1.jpg)
Mock OSCEDebriefing
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Station No 1Glucose estimation Principle Requirements
Semi-automatic analyserAdjustable pipetteGOD-PAP reagentsWorking literatureGlucose StandardTwo levels of QC materialValue sheets of QC
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Station No 2Levy Jennings’s PlotCalculation of basic statisticsPlotting of Levy Jennings’s (LJ ) chartsApplication of Westgard`s Rules
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Station No 3External Quality Assurance Method means`Z` value for bias (accuracy)Allowable bias Plots for precision (Bio-rad)
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Station No 5Method Evaluation Any step involved in method evaluation can be asked Requirements include:
Semi-automatic analyserAdjustable pipetteGOD-PAP reagentsWorking literatureGlucose Standard Glucose solution (25%)
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Station No 6First scenarios A female patient has very angrily complained you about a
beta-HCG report from your lab. Your result is 1500 IU/L while she got reports of < 1.0 IU/L from other two labs within 24 h of the first test. You repeated the test with another sample and found that it is < 01.0 IU/L from your lab, too. This gross variation is a matter of concern for you, so after apologising the patient you obtain the raw data of the test from the autoanalyser which shows following results of the batch.
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Raw data of autoanalyserSr No Beta HCG result
112 <1.0
113 2.0
115 3.2
116 110,000
117 1500
118 <1.0
119 4.1
Most Probable Cause: Sample carry over.
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Station No 6Second scenarios You have just started an Arterial Blood Gasses (ABG) system
which also incorporates electrolyte analysis. During the first day of analyses of patients` sample the result of Sodium worries you, some of them are like following:
Most Probable Cause: Use of Sodium Heparin as an anticoagulant.
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Station No 6Third scenarios You have received a call from the Intensive Care Unit about
Calcium and Electrolyte reports of two patients with gross Hypocalcaemia and Hyperkalaemia which are otherwise apparently normal.
Most Probable Cause: EDTA Contamination
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EDTA Contamination EDTA binds Calcium False Hypocalcaemia False Hyperkalaemia
“Spurious hyperkalaemia due to kEDTA contamination is common “
Michael P Cornes1, Clare Ford and Rousseau Gama; Spurious hyperkalaemia due to EDTA contamination: common and not always easy to identify Ann Clin Biochem 2008;45:601-603 doi:10.1258/acb.2008.007241© 2008
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Correct Filling Order
Always fill Plain tube and Lithium Heparin tube firstFollowed by EDTA tubes (Glucose and CP tubes)
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Right Order
Serum and Lithium Heparin First
CP and Glucose last
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Station No 7Derived TestsCreatinine Clearance
Urinary Creatinine: 8.5 mmol/L Serum Creatinine : 98 µmol/L Urinary Volume: 1440 ml
Creatinine Clearance : 86.73 ml /min
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Station No 7Derived TestsHOMA –IR
Plasma Glucose Fasting: 6.8 mmol/L Serum Insulin: 18.3 IU/L
HOMA –IR : 5.53
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Station No 7Derived TestsDelta Ratio
pH : 7.57 (7.35 – 7.45)Base Excess: 7.0 (+3 to -3)PCO2 : 2.8 (4.7 – 6.0 kPa)PO2: 19.2 (10.7 – 13.3 kPa)HCO3: 21 (22 – 28 mmol/L)Chloride: 80 (94-111 mmol/L)Anion Gap: 33 (7-17 mmol/L)
Delta Ratio: 7
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DELTA RATIO
The delta ratio is used for the determination of a mixed acid base disorder in an elevated anion gap metabolic acidosis
Measured anion gap – Normal anion gap
Normal [HCO3-] – Measured [HCO3-]
or
(anion gap – 12)
(24 - [HCO3-])
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Station No 9Data Interpretation
a. A patient having following arterial blood gas analyses results: pH : 7.40 (7.35 – 7.45) Base Excess: 21.8 (<+3 - >-3) PCO2 : 10.7 (4.7 – 6.0 kPa) PO2 10.9 (10.7 – 13.3 kPa) HCO3 51.1 (23 – 33 mmol/L) Oxygen Sat 95.1 (95-98%)
What is the most probable biochemical diagnosis:
Correct Answer: Mixed Respiratory Acidosis and Metabolic Alkalosis
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Station No 9Data Interpretation
b. A 60 year old female presented with polyuria and nocturia:
Serum Ca : 3.21 mmol/L (2.15–2.55) PO4 : 2.5 mmol/L (0.60 – 1.25) Albumin : 43 g/L (37-52) ALP : 114 U/L (30 –120) Urea : 6.2 mmol/L (3.3 – 6.6)
What is the most probable diagnosis?
Correct Answer: Vitamin D Intoxication
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Station No 9Data Interpretation
c. A boy of 15 years presented with oedema all over the body:
Serum Total Proteins: 55 g/L (65-80) Albumin: 25 g/L (35-50) Serum Cholesterol : 8.5 mmol/L (<5.1) Serum Triglycerides: 1.8 mmol/L (<2.83)
What is the most likely diagnosis ?
Correct Answer: Nephrotic Syndrome
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Station No 9Data Interpretation
d. A 22 year old female complained of hair growth on face and limbs with regular menstrual cycles:
Serum FSH : 6 mIU/L (2-10) LH : 20 mIU/L (3-14) Testosterone: 5.8 nmol/L (2.2-4.1)
What is the most probable diagnosis?
Correct Answer: PCOS
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Station No 9Data Interpretation
e. An infant with ambiguous genitalia and failure to thrive:
Karyotype: XX
What is the most probable diagnosis?
What investigations you will like to carry out?
Correct Answer: CAH
17 OH Progesterone