MBChB V REKENAAR- OSCE 1 van 2008



MBChB V REKENAAR- OSCE 6 van 2008

COMPUTER = 20 MCQ’S + 15 CONS = 35

WRITTEN = 25

DIE VOLGENDE VRAE MOET OP DIE REKENAAR BEANTWOORD WORD:

? Study the following chest X-Ray photo. How would you confirm the diagnosis?

Kyk na die volgende borskas X-straalfoto. Hoe sal jy die diagnose bevestig?

@+Sputum for acid fast bacilli.

Sputum vir suurvaste bacilli.

@Blood culture.

Bloedkultuur.

@Urine dipstix.

Uriene doopstokkie.

@ECG.

EKG.

@Sonar examination of the chest.

Sonar ondersoek van die borskas.

‘Insert’ TB X 2

?A 81-year old female presents for a yearly follow-up visit for her hypertension. The following is a copy of her routine ECG. The most probable diagnosis is:

‘n 81-jarige vroulike pasiënt presenteer vir ‘n jaarlikse opvolg besoek vir haar hipertensie. Hierdie is ‘n kopie van haar roetine EKG. Die mees waarskynlike diagnose is:

@Ischaemic heart disease.

Isgemiese hartsiekte.

@Left bundle branch block.

Linker bondeltak blok.

@Bradycardia.

Bradikardie.

@+Left ventricular hypertrophy.

Linker ventrikulêre hipertrofie.

@Hyperkalaemia.

Hiperkalemie.

‘Insert’ LV hipertrofie hier

?The following is a picture of:

Die volgende is ‘n foto van:

@+Diabetic retinopathy.

Diabetiese retinopatie.

@Ocular vein occlusion.

Okkulêre vena okklusie.

@Retinitis pigmentosa.

Retinitis pigmentosa.

@Hypertensive retinopathy.

Hipertensiewe retinopatie.

@A normal fundus.

‘n Normale fundus.

‘Insert’ diabetiese retinopatie hier

?Mr. B, 50 years old, is a known asthmatic patient. He is 180cm tall and presents for a follow-up. He is on Ventolin (ß2-stimulant) 2 puffs 6 hourly and Becotide (steroid) 50 µg bd. He has night symptoms more than twice a week and easily tires on exertion.

Mr. B, 50 jaar oud, is ‘n bekende asmatiese pasiënt. Hy is 180cm lank en presenteer vir ‘n opvolg besoek. Hy gebruik Ventolin (ß2-stimulant) 2 inhalasies 6 uurliks en Becotide (steroid) 50 µg bd.

Hy ervaar meer as twee keer per week nag simptome en word gou moeg met oefening.

‘Insert’ piekvloeikaart hier

This is his best peak flow result for today:

Hierdie is sy beste piekvloeiresultaat vir vandag:

‘Insert’ piekvloei 500 hier

On examination he has diffuse, bilateral expiratory wheezes. His respiration rate is 20/min and he is not in acute respiratory distress. How would you interpret the peak flow result?

Met ondersoek het hy diffuse, bilaterale ekspiratoriese “wheezes”. Sy respirasiespoed is 20/min en hy is nie in akute respiratoriese nood nie. Hoe sal jy hierdie piekvloeiresultaat interpreteer?

@+His peak flow is above 80% of his predicted value. His asthma is not optimally controlled.

Sy piekvloei is bo 80% van verwagte waarde. Sy asma is nie optimaal gekontroleerd nie.

@His peak flow is less than 80% of his predicted value. He is in acute respiratory distress.

Sy piekvloei is onder 80% van verwagte waarde. Hy is in akute respiratoriese nood.

@His peak flow is between 60% and 80% of his predicted value. He is not optimally controlled.

Sy piekvloei is tussen 60% en 80% van verwagte waarde. Hy is nie optimaal gekontroleerd nie.

@His peak flow is less than 60% of his predicted value. He is in acute respiratory distress.

Sy piekvloei is onder 60% van verwagte waarde. Hy is in akute respiratoriese nood.

@His peak flow is above 80% of his predicted value. His asthma is optimally controlled.

Sy piekvloei is bo 80% van verwagte waarde. Sy asma is optimaal gekontroleerd.

?Mr. X, a healthy 55-year-old man, was send by his insurance company for a routine check-up. Study the following result of his urine dipsticks test, read at 60 seconds.

Mnr. X, ‘n gesonde 55 jarige man, is deur sy versekerings- maatskappy gestuur vir ‘n roetine ondersoek. Bestudeer die volgende resultaat van sy urien doopstokkietoets, wat na 60 sekondes gelees is.

‘Insert’ glukosurie hier

What investigation would you do next?

Watter ondersoek sal jy volgende doen?

@No actions needed.

Geen optrede nodig nie.

@Do a glucose tolerance test.

Doen ‘n glukosetoleransie toets.

@+Do a random blood glucose test.

Doen ‘n lukraak bloedglukose bepaling.

@Do a HBA1c.

Doen ‘n HBA1c.

@Send the urine for MC+S.

Stuur die uriene vir MK+S.

?A patient has a random plasma glucose level of 10,8 mmol/L. Which one of the following steps is most appropriate to confirm a diagnosis of Diabetes Mellitus?

’n Pasiënt het ‘n lukraak plasma glukose vlak van 10,8 mmol/L. Watter een van die volgende stappe is die beste om die diagnose van Diabetes Mellitus te bevestig?

@Determine the patient’s hemoglobin A1c percentage.

Bepaal die pasiënt se hemoglobien A1c persentasie.

@Determine the patient’s postprandial plasma glucose level.

Bepaal die pasiënt se postprandiale plasma glukose vlak.

@Perform an oral glucose tolerance test.

Doen ‘n orale glukosetoleransie toets.

@+Perform a fasting plasma glucose test.

Doen ‘n vastende plasma glukose toets.

@Perform no further tests.

Doen geen verdere toetse nie.

?Which one of the following is the most sensitive test for diagnosing diabetic nephropathy?

Watter een van die volgende is die mees sensitiewe toets vir die diagnose van diabetiese nefropatie?

@Creatinine clearance measurement.

Kreatinienopruiming bepaling.

@Glucose tolerance measurement.

Glukosetoleransie toets.

@Serum creatinine measurement.

Serum kreatinien bepaling.

@Ultrasonography of the kidneys.

Nier sonar.

@+Urine albumin measurement.

Uriene albumien bepaling.

?To make the diagnosis of pelvic inflammatory disease, you have to do a:

Om die diagnose van pelviese inflammatoriese siekte te maak moet jy die volgende doen:

@+Vaginal examination.

Vaginale ondersoek.

@Rectal examination.

Rektale ondersoek.

@Endometrial biopsy.

Endometriële biopsie.

@Transvaginal sonar.

Transvaginale sonar.

@Laparoscopy.

Laparoskopie.

?Mr. J is 55 years old and presents with severe left big toe pain for a few hours. This is a picture of his left foot. He likes to take a drink when having a barbeque, as he did last night at his birthday party. What is the most likely diagnosis?

Mnr. J is 55 jaar oud en presenteer met erge linker groottoon pyn vir die afgelope paar uur. Hierdie is ‘n foto van sy linkervoet. Hy drink graag ‘n drankie wanneer hy vleis braai, soos wat gisteraand gebeur het tydens sy verjaarsdagpartytjie. Wat is die mees waarskynlike diagnose?

@+Gout of the left big toe.

Jig van die linker groottoon.

@Left big toe fracture.

Linker groottoon fraktuur.

@Osteo-arthritis of the left foot.

Osteo-arthritis van die linkervoet.

@Metatarsalgia.

Metatarsalgie.

@Neuroma.

Neuroom.

‘Insert’ jig hier

?Which one of the following is NOT a contraindication to postmenopausal Hormonal Replacement Therapy?

Watter een van die volgende is NIE ‘n kontra-indikasie vir die gebruik van hormoonvervangingsterapie nie?

@Chronically impaired liver function.

Kroniese lewerfunksie inkorting.

@Endometrial Adeno carcinoma.

Endometriële Adeno-karsinoom.

@History of breast cancer.

Geskiedenis van borskanker.

@Hypertriglyceridaemia.

Hypertrigliseridemie.

@+Impaired glucose tolerance.

Ingekorte glukosetoleransie.

?Identify the following clinical sign:

Identifiseer die volgende kliniese teken:

@Liver nails.

Lewernaels.

@Koilonychia.

@Digital thickening due to rheumatoid arthritis.

Digitale verdikking as gevolg van rumatoide arthritis.

@Heberden’s nodules.

Heberden se nodules.

@+Digital clubbing.

Trommelstok vingers.

‘Insert’ trommelstok vingers

?What is the BMI (Body Mass Index) of the following patient?

Wat is die LMI (Liggaamsmassa-indeks) van die volgende pasiënt?

@32.

@34.

@27.

@22.

@+47.

‘Insert’ BMI x2 hier

?Study the following ECG:

Bestudeer die volgende EKG:

‘Insert’ EKG ‘Peaked T waves’ hier

This is a middle-aged man with acute renal failure. What is the most obvious abnormality on this ECG?

Hierdie is ‘n middeljarige man met akute nierversaking. Wat is die mees opvallende abnormaliteit op die EKG?

@ST-segment depression.

ST-segment afskuiwing.

@ST-segment elevation.

ST-segment opskuiwing.

@Inverted T waves.

Omgekeerde T-golwe.

@+Peaked T waves.

Gepiekte T-golwe.

@Big QRS complexes.

Groot QRS komplekse.

?The following patient presented with pain and a tingling sensation under his right breast for a few hours before the rash appeared. What is the diagnosis?

Die volgende pasiënt het gepresenteer met pyn en ‘n tintelende gevoel onder sy regter bors vir ‘n paar uur voordat die uitslag verskyn het. Wat is die diagnose?

@Herpes Simplex.

@Chicken pox.

Waterpokkies.

@+Varicella (Herpes) Zoster.

@Molluscum contagiosum.

@Staphylococcal infection.

Stafilokokkale infeksie.

‘Insert’ herpes zoster hier

?The following child presents with an itchy skin rash as shown in the pictures. His siblings are also affected. What is the most likely diagnosis?

Die volgende kind presenteer met ‘n jeukende veluitslag soos gewys op die foto. Sy broers en susters is ook aangetas. Wat is die mees waarskynlike diagnose?

@Heat rash.

Hitte uitslag.

@Eczema.

Ekseem.

@Herpes Simplex.

@Molluscum contagiosum.

@+Scabies.

‘Insert’ scabies hier

?The following growth chart reflects data of a child presenting for his routine immunizations. According to the mother the child has no complaints. Today he weighs 10kg. How would you interpret the growth pattern of this child?

Die volgende groeikaart reflekteer die data van ‘n kind wat presenteer vir sy roetine immunisasies. Die kind se ma rapporteer geen probleme nie. Vandag weeg hy 10kg. Hoe sou u hierdie kind se groeipatroon interpreteer?

@This child is normal in all aspects.

Hierdie kind is in alle opsigte normal.

@This child has marasmus.

Hierdie kind het marasmus.

@This child has kwashiorkor.

Hierdie kind het kwashiorkor.

@+The growth pattern is abnormal possibly due to chronic malnutrition.

Die groeipatroon is abnormal, moontlik as gevolg van kroniese wanvoeding.

@This growth pattern is abnormal possibly due to an acute disease like diarrhoea.

Die groeipatroon is abnormaal, moontlik as gevolg van ‘n akute siekte soos diarree.

‘Insert’ groeikaart – chroniese malnutrition hier

?The following is a growth chart of a child presenting for his routine immunizations. He has no complaints today. How would you interpret the growth pattern of this child?

Die volgende is ‘n groeikaart van ‘n kind wat presenteer vir sy roetine immunisasies. Hy het tans geen klagtes nie. Hoe sal u die groeipatroon interpreteer?

@+This child is normal in all aspects.

Hierdie kind is in alle opsigte normal.

@This is a premature baby with a normal growth pattern.

Hierdie is ‘n premature baba met ‘n normale groeipatroon.

@This is a premature baby with an abnormal pattern.

Hierdie is ‘n premature baba met ‘n abnormale groeipatroon.

@This growth pattern is abnormal, possibly due to an acute disease like diarrhoea.

Die groeipatroon is abnormaal, moontlik as gevolg van ‘n akute siekte soos diarree.

@This child is obese.

Hierdie kind is vetsugtig.

‘Insert’ groeikaart – normale kind hier

?Mr. Z presents in casualty unit after being involved in a motor vehicle accident. He is in severe respiratory distress. This is his chest X-ray photo. Your initial management would be:

Mnr. Z presenteer in noodvalle eenheid nadat hy in ‘n motorvoertuig ongeluk betrokke was. Hy is in akute respiratoriese nood. Hierdie is sy borskas X-straalfoto. Jou aanvangshantering sal wees:

@to give oxygen therapy per facial mask.

om suurstofterapie m.b.v. ‘n gesigmasker te gee.

@to give oxygen therapy after orotracheal intubation.

om suurstofterapie, na orotrageale intubasie, te gee.

@to place an intercostal drain.

om ‘n interkostale drein te plaas.

@+to do a needle decompression.

om ‘n dekompressie met ‘n naald te doen.

@to make sure all the necessary monitors are connected to the patient, so that the patient can be monitored closely.

om seker te maak dat al die nodige monitors aan die pasiënt gekoppel is, sodat die pasiënt goed gemonitor kan word.

‘Insert’ tension pneumothorax hier

?What clinical information do you obtain from a HbA1c result?

Watter kliniese inligting verkry u van ‘n HbA1c resultaat?

@The patient’s glucose control for the past 1 year.

The pasiënt se glukose kontrole van die afgelope 1 jaar.

@ The patient’s glucose control for the past 6 months.

The pasiënt se glukose kontrole van die afgelope 6 maande.

@+The patient’s glucose control for the past 3 months.

The pasiënt se glukose kontrole van die afgelope 3 maande.

@ The patient’s glucose control for the past 1 month.

The pasiënt se glukose kontrole van die afgelope 1 maand.

@ The patient’s glucose control for the past 1 week.

The pasiënt se glukose kontrole van die afgelope 1 week.

?You perform the following test on a 55-year old diabetic patient. The patient can feel everywhere except under his big toe. What does this result mean?

Jy voer die volgende toets op ‘n 55-jarige diabetiese pasiënt uit. Die pasiënt kan oral voel behalwe onder sy groottoon. Wat beteken hierdie resultaat?

@Although this patient has a diabetic foot, he is not at risk for ulceration.

Alhoewel hierdie pasiënt ‘n diabetiese voet het, het hy nie ‘n risiko om ‘n voet ulkus te ontwikkel nie.

@+This patient is at risk of developing an ulcer under his big toe.

Hierdie pasiënt het ‘n risiko om ‘n ulkus onder sy groottoon te ontwikkel.

@This patient has a diabetic foot and needs an amputation.

Hierdie pasiënt het ‘n diabetiese voet en benodig ‘n amputasie.

@This patient has a diabetic foot and will definitely develop an ulcer under his big toe.

Hierdie pasient het ‘n diabetiese voet en gaan definitief ‘n ulkus onder sy groottoon ontwikkel.

@Of no clinical significans.

Van geen kliniese waarde nie.

Insert monofilament 1-3

?Study the following video consultation and then answer the questions:

Bestudeer die volgende video konsultasie en beantwoord dan die vrae:

‘Insert’ video consultation clip – VAN VERLEDE JAAR-slegte konsultasie

Which of the following communication and consultation skills did the doctor apply correctly?

Watter van die volgende kommunikasie en konsultasie vaardighede het die dokter korrek aangewend?

|Skill used / Vaardigheid gebruik |Yes / ja |No / nee |

|Introduced self to patient. | |* |

|Stel self aan die pasiënt voor. | | |

|Puts patient at ease. | |* |

|Stel pasiënt gerus. | | |

|Allow patient to elaborate presenting problem fully. | |* |

|Gee pasiënt die geleentheid om die presenterende probleem | | |

|volledig te noem. | | |

|Listens attentively. | |* |

|Luister met aandag. | | |

|Uses silence appropriately. | |* |

|Gebruik stilte toepaslik. | | |

|Recognizes verbal and non-verbal clues. | |* |

|Herken verbale en nie-verbale leidrade. | | |

|Identifies patient’s reason for consultation. | |* |

|Identifiseer die rede vir die konsultasie. | | |

|Considers physical, social and psychological factors if and when | |* |

|appropriate. | | |

|Neem fisiese, sosiale en psigologiese faktore in ag waar en | | |

|wanneer nodig. | | |

|Checks patient’s level of understanding | |* |

|Maak seker wat die pasiënt se vlak van begrip is. | | |

|Generated an appropriate working diagnosis. |* | |

|Genereer ‘n toepaslike werkende diagnose. | | |

|Maintains a friendly but professional relationship. | |* |

|Handhaaf ‘n vriendelike, dog professionele verhouding. | | |

|Uses time appropriately. |* | |

|Gebruik tyd toepaslik. | | |

|Uses clear and understandable language. |* | |

|Gebruik duidelike en verstaanbare taal. | | |

|Conveys sensitivity to the needs of the patient. | |* |

|Dra ‘n sensitiwiteit teenoor die behoeftes van die pasiënt oor. | | |

|Displays patient centeredness throughout the consultation. | |* |

|Is pasiëntgesentreerd deur die hele konsultasie. | | |

THE FOLLOWING QUESTIONS MUST BE ANSWERED IN AN EXAMINATION BOOK.

DIE VOLGENDE VRAE MOET IN ‘N ANTWOORDBOEK BEANTWOORD WORD:

?This is a basic CPR protocol for an adult victim. There are a few steps missing. Write them down. (5)

?Hierdie is ‘n basiese KPR protokol vir ‘n volwasse beseerde. Daar is ‘n paar stappe uitgelaat. Skryf die stappe neer wat uitgelaat is. (5)

‘Insert’ KPR hier

?Write down the steps in HIV pre-test counselling. (5)

Skryf die stappe in HIV voor-toets berading neer. (5)

?List the steps in using a MDI (asthma pump) correctly as you would describe them to a patient. (6)

Lys die stappe in die korrekte gebruik van ‘n MDI (asmapompie) soos wat u dit aan ‘n pasiënt sou verduidelik. (6)

?Mrs. N, a 65-year old lady, presents with vague chest pains. She is a known diabetic and hypertensive patient, not well controlled. Her husband recently died due to a myocardial infarction and she fears that the same might happen to her. She lives alone and her only income is her small pension. She doesn’t follow a correct diet or exercise program, nor does she regularly follow up at the clinic.

Write an assessment for this patient according to the three stage assessment model. (9)

Mev. N, ‘n 65-jarige dame, presenteer met vae borskaspyn. Sy is ‘n bekende diabeet en hipertensiewe pasiënt wat nie goed gekontroleer is nie. Haar man is onlangs aan ‘n hartaanval dood en sy is bang dat dieselfde met haar mag gebeur. Sy woon alleen en haar enigste inkomste is haar karige pensioen. Sy volg nie ‘n behoorlike dieet of oefenprogram nie en sy volg nie gereeld by die kliniek op nie. Skryf ‘n samevatting vir hierdie pasiënt volgens die 3-stadia assesseringsmodel. (9)

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