Year 2 Sem 2 - Prof Prac OSCE 2010

 Woman with thyrotoxicosis

o List causes of thyrotoxicosis
o Shown an isotope scan, discuss how this confirms your DDx
o Pt is put on carbimazole, what would you discuss with her? (risk of
agranulocytosis & iatrogenic hypothyroidism)
 Cushings
o What would you expect to see in bloods? (↓ACTH ↑cortisol)
o Discuss why the ACTH is low (negative feedback loops)
o Explain the difference between Cushing’s disease and Cushing’s
syndrome (talk about endogenous vs. exogenous cortisol)
o Explain how steroid hormones exert their action on cells (pass
through lipid bilayer, nuclear intracellular receptors)
 Small child that has lost weight
o Asked for a mind map of hypothesis generation! (was worth 4 points)
o If the child was diabetic, what would you find on history, examination
and investigations
o What is a pheochromocytoma & what are it’s effects (adrenal medulla
tumour that secretes catecholamines, can lead to hypertensive crisis)
o What is an insuloma & it’s effects (pancreatic ß-cell tumour that
secretes insulin, can lead to coma)
 Neuro exam
o What is CN I (olfactory) and how do you test it?
o Shown pictures of pt pulling faces for examination of CN VII (facial),
need to describe what the pt is being asking to do (eg. “puff out your
cheeks”), what nerve is being tested and what muscles are involved (I
think all they wanted was ‘muscles of facial expression’)
o Shown a picture of someone testing proprioception on a big toe, need
to say what is being tested
o Shown a picture of heel-shin test, need to say what it is testing for and
what the pt is told (testing coordination, ask the pt “can you run your
heel up and down your shin”)
o Asks what is CN XI (accessory), how you test it (shrug shoulders, turn
head)
 11yr old boy who is drowsy with eye pain
o What questions would you ask the child & the mother in your history
(TRAUMA, vaccinations, family history, etc…)
o What would you specificially look for in examination (test CNs, esp
check vision, do a GCS, general set of obs)
o What other investigations would you do? (head CT/MRI, LP, bloods to
look for infection/BSL)
o Shown a head CT (?) with 2 coronal and 1 transverse view – name the
pathological signs (had cerebral oedema, very small ventricles,
midline shift, old blood over temple and some more blood on
contralateral side)
 o What would be your next move? (call for paediatric neuro consult! 1st
line is a burr hole, 2nd line is craniomoty)
 Alcoholic man
o Comes in c/o pins & needles in feet, smoker, drinker, on ACEI – what
are some DDx for his issues? (note that ACEI can cause this!!)
o He has loss of temperature and vibration in one leg, and light touch
and proprioception in the other – what are the tracts involved? (this
seemed crazy to me because they don’t match up with what the dorsal
columns and spinothalamic tracts carry)
o What is wrong with him? (?Brown-Sequard)
o He then is withdrawing from alcohol, what are the consequences?
(delerium tremens, serizures, Wernicke-Korsakoff, death)
o What is your treatment for his alcohol withdrawal? (AWS, closely
monitor, give diazepam as per protocol, GIVE THIAMINE)
 Picture of face with facial droop
o Discuss some DDx for what is going on (also had ptosis and a red eye,
so think anhydrosis)
o Pick one and discuss how it would present all over (eg. in a stroke, you
have UMN lesion and forehead is spared, and hemiparesis on
contralateral side)
o What tests would you order (head CT/MRI, LP, chest xray for lung Ca)
 35yr woman with MS
o What would you ask to confirm your suspicions? (relapsing/remitting,
born in a cold climate)
o What is the course of the disease (periods of remission that get
shorter, progressive disease, prednisone to help with symptoms but
doesn’t improve prognosis, use of interferon helpful)
o What other investigations will happen to her? (MRIs to confirm
dissemination in time/space, LP for oligoclonal bands)
 Antidepressants
o Some PH questions where you needed to interpret some graphs and a
table. There was a calculator there but you didn’t actually need it.
o What are 3 things needed to confirm a death is a suicide (intension?)
o What are 4 reasons for a death to be referred to the coroner?
(suspicious, 24hr post anesthetic, hasn’t seen a dr in a while)
o What are some classes of antidepressants and how do they work?
(SSRIs, SNRIs, MAOIs, tricyclics)
o How do you manage a pt who is suicidal?
o Name 4 groups who are at higher risk of suicide (men, Indigenous
Australians, those with mental illness, those from rural areas)
 Old man with delerium
o Give 6 differentials (drugs, dementia, psychosis…)
o He’s on L-dopa and clozapine, why? (clozapine is dopamine antagonist
in mesolimbic to help with psychotic without causing extrapyramidal
side effects)
 Young man with psychosis
o Thinks someone is in love with him, what is that called? (erotomania)
o He says God controls his thoughts, what is this? (thought insertion)
o He had a psychotic episode 2 years prior, and has been delusional for
10 months, what is the diagnosis and subtype (schizophrenia,
undifferentiated type)
o Discuss the laws surrounding detaining mentally disordered people in
NSW