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osce. KWH Aug 2013. Case 1. M/38 Right shoulder contusion after S/F PE: tenderness and swelling over his right upper chest . No skin impingement and no external wound found. No distal neurological deficit elicited. Questions. 1) what is the diagnosis?

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  1. osce KWH Aug 2013

  2. Case 1 • M/38 • Right shoulder contusion after S/F • PE: tenderness and swelling over his right upper chest . No skin impingement and no external wound found. No distal neurological deficit elicited

  3. Questions • 1) what is the diagnosis? • 2) what is the classification of the fracture? • 2) what is the management?

  4. Case 2 • F/6 • Left elbow contusion after S/F in 2 months ago • c/o: persistent pain after the injury • PE: tenderness and swelling over her left elbow. ROM: 0-90 degree. No distal neurological deficit elicited. • X rays left elbow was taken

  5. Questions • 1) what is the diagnosis? • 2) what is the associated injury to look for? • 3) what is the management?

  6. Case 3 • M/70 • Left shoulder contusion after S/F • PE: left shoulder in abducted position • X rays of left shoulder was taken

  7. Questions • 1) what is the diagnosis? • 2) what is the method of reduction?

  8. Case 4 • M/24 • He complained of epigastric and LUQ abdominal pain after having been assaulted by someone on two days ago. • PE: tenderness over his LUQ abdomen. No external wound was found. • BP 148/74 mmHg P93/min SaO2 99%

  9. His BP drop to 60/30 mmHg after admission and return to 130/70 mmHg after 1000 ml gelofusin infusion. • Urgent CT was performed

  10. Plain films

  11. Plain films

  12. Plain films

  13. Contrast film

  14. Contrast films

  15. Contrast films

  16. Contrast films

  17. Contrast films

  18. Delay contrast films

  19. Delay contrast

  20. Delay contrast

  21. Delay contrast

  22. Questions • 1) describe the CT findings • 2) what is the diagnosis? • 3) what is the management? • 4) What is the abnormal CT findings that indicate surgical intervention ?

  23. Case 5 • F/25 • She attempted suicide by burning charcoal at home • PE: GCS 14/15, BP 98/73 mmHg, Pulse 83/min, SaO2 99% on 100%O2 • Systems review were unremarkable. No focal neurological sign elicited.

  24. Question • 1) describe the CT findings • 2) what is the diagnosis? • 3) what is the management?

  25. Case 6 • F/25, Phx depression • Attempted suicide by drug overdose • PE: unconscious, GCS 4/15, BP 100/60 mmHg Pulse 70/min • She was intubated in AED.

  26. Questions • 1) describe the ECG finding • 2) what is the diagnosis? • 3) what is the mangement?

  27. Case 7 • M/37 • Family history of premature death of unknown cause • Complained of palpitation and atypical chest discomfort for few episodes. • PE: BP 140/80 mmHg P 95/min • Systems review were unremarkable.

  28. Questions • 1) describe the ECG findings • 2) what is the diagnosis? • 3) what is the management?

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