MBChB V REKENAAR- OSCE 3



MBChB V REKENAAR- OSCE 4 2008.

COMPUTER = 25 MCQ’S + 15 CONS = 40

WRITTEN = 25

DIE VOLGENDE VRAE MOET OP DIE REKENAAR BEANTWOORD WORD:

PLEASE ANSWER THE FOLLOWING QUESTIONS ON THE COMPUTER:

? 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

?Choose the correct treatment regime for a female, non pregnant patient and with no allergies, presenting with a vaginal discharge:

Kies die korrekte behandelingsregime vir ‘n vroulike, nie-swanger pasiënt, wat geen allergieë het nie en wat presenteer met ‘n vaginale afskeiding:

a) Doxycycline 100mg bd po x 7 days.

b) Erythromycin 500 mg qid po x 7 days.

c) Ciprobay 500 mg stat po.

d) Flagyl 400 mg bd po pc x 7 days.

e) Amoxil 500 mg tds po x 7 days.

@a,c,e

@b,d

@b,c,d

@c,d,e

@+a,c,d

?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 dipstick test, read at 60 seconds. What investigation would you do next?

Mnr. X, ‘n gesonde 55-jarige man, is deur sy versekeringsmaatskappy gestuur vir ‘n roetine ondersoek. Bestudeer die volgende resultaat van sy urien doopstokkietoets, wat gelees is na 60 sekondes. Watter ondersoek sal u volgende doen?

‘Insert’ u-dipstix-proteiene

@No actions needed.

Geen optrede nodig nie.

@Do a fasting blood glucose.

Doen ‘n vastende bloedglukose bepaling.

@Do a urine albumin measurement.

Doen ‘n urien albumien bepaling.

@+Do a 24h creatinine clearance test.

Doen ‘n 24-uur kreatinien opruiming bepaling.

@Send the urine for MC+S.

Stuur die urien vir MK+S.

?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

?This child came for his routine immunizations. The mother says he was born at 36 weeks gestation. His birth weight was 2.2kg. What is your assessment after studying the growth chart?

Hierdie kind besoek u vir roetine immunisasies. Die ma sê dat hy op 36 weke swangers-kapsduur gebore is. Geboortegewig was 2.2kg. Wat is u afleiding nadat u die groeikaart bestudeer het?

@This child is normal in all aspects.

Hierdie kind is normaal in alle opsigte.

@+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 growth 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 underweight.

Die kind is ondergewig.

‘Insert’ prem groeikaart

?You did a full bloodcount on a 36-year old woman with palpitations who also appeared anaemic. This is her result:

U het ‘n volbloedtelling op ‘n 36-jarige vrou met palpitasies gedoen wat ook anemies gelyk het. Hier is die resultaat:

•WCC 6.30 (4 - 11)

•Hb 8.9 (12 - 16)

•HCT 0.27 (0.395 - 0.525)

•MCV 73.0 (82 - 100)

•MCH 23.7 (27 - 32)

•MCHC 32.4 (30 - 35)

•Platelets 163 (140 - 400)

The most likely diagnosis is:

Die mees waarskynlike diagnose is:

@Vitamin B deficiency anaemia.

Vitamiene B tekort anemie.

@+Iron deficiency anaemia.

Ystergebrekanemie.

@Sickle cell anaemia.

Sekelselanemie.

@Thalassemia.

Thalassemie.

@Pellagra.

?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.

?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

?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.

@Abdominal examination.

Abdominale ondersoek.

@Endometrial biopsy.

Endometriële biopsie.

@Transvaginal sonar.

Transvaginale sonar.

@Laparoscopy.

Laparoskopie.

?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

?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.

?Mr. X presents with a cough, fever and chest pain for 2 days. On admission he is in respiratory distress with a respiratory rate of 32/min.

This is the patient’s chest x-ray photo. The most likely diagnosis is?

Mnr. X presenteer met hoes, koors en borskaspyn vir die afgelope 2 dae. Tydens opname is hy in respiratoriese nood met ‘n asemhalingstempo van 32/min. Hierdie is die pasiënt se borskas x-straalfoto. Wat is die mees waarskynlike diagnose?

@Spontaneous pneumothorax.

Spontane pneumotoraks.

@Tuberculosis.

Tuberkulose.

@Acute asthma.

Akute asma.

@Pulmonary oedema.

Pulmonale edeem.

@+Bacterial lobar pneumonia.

Bakteriële lobêre pneumonie.

‘Insert’ lobere pneumonie

?What is the BMI (Body Mass Index) of the following 30-year old female patient?

Wat is die LMI (Liggaamsmassa-indeks) van hierdie 30-jarige vroulike pasiënt?

Weight / Gewig 41kg

Length / Lengte 1,6m

Waist circumference/ Middelomtrek 55cm

Shoe size / Skoengrootte No. 4

@14

@22

@+16

@18

@20

?Study the following ECG:

Bestudeer die volgende EKG:

‘Insert’ EKG met gepiekte T-golwe 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.

?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 6-12 weeks.

The pasiënt se glukose kontrole van die afgelope 6-12 weke.

@ 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.

?K is a 12-year old boy with a longstanding history of allergies. He presents with the following rash which has intermittently appeared since his childhood. The most probable diagnosis is:

K is ‘n 12-jarige seun met ‘n langstaande geskiedenis van allergieë. Hy presenteer met die volgende veluitslag wat hy gereeld sedert sy kinderjare kry. Die mees waarskynlike diagnose is:

@Urticaria.

Urtikaria.

@Contact dermatitis.

Kontak dermatitis.

@Intertrigo.

@+Atopic eczema.

Atopiese ekseem.

@Fungal infection.

Swaminfeksie.

‘Insert’ atopiese ekseem hier

?The absolute contra indications for taking an oral temperature are:

Die absolute kontra-indikasies vir die neem van ‘n orale temperatuur is:

a) Use in geriatric patients / gebruik in geriatriese pasiënte.

b) Use in babies / Gebruik in babas.

c) Use in psychiatric patients / gebruik in psigiatriese pasiënte.

d) Use in comatose patients / gebruik in komateuse pasiënte.

e) Use in pregnant patients / gebruik in swanger pasiënte.

@a, b,c

@+b,c,d

@c,d,e

@a,b,e

@b,d,e

?The absolute contra indications for syringing a patient’s ear are:

Die absolute kontra-indikasies vir die uitspuit van ‘n pasiënt se oor is:

a) Earache / Oorpyn.

b) Previous middle ear surgery / vorige middeloor chirurgie.

c) Perforated tympanic membrane / geperforeerde oordrom.

d) Acute tonsillitis / akute tonsillitis.

e) Otitis externa.

@a,b,c

@a,b,e

@+b,c

@d,e

@a,d,e

?Miss T, a 16-year old girl, requests a termination of her pregnancy. She is 13 weeks pregnant. According to the law…..

Me. T, ‘n 16-jarige meisie, versoek ‘n terminasie van haar swangerskap. Sy is 13 weke swanger. Volgens die wet……

@you are obliged to do the termination, for whatever reason, as soon as possible.

is u verplig om die terminasie, vir watter rede ook al, so spoedig moontlik te doen.

@Miss T has to inform her parents and get their permission to have the termination done.

moet Me T haar ouers inlig en hulle toestemming kry om die terminasie te laat doen.

@the termination can be done in any clinic or hospital, as long as a registered person performs the procedure.

kan die terminasie in enige hospitaal of kliniek gedoen word, solank ‘n geregistreerde persoon dit doen.

@Miss T can only have the abortion if the pregnancy would endanger her life, or would result in severe malformation of the foetus, or pose a risk of injury to the foetus.

kan Me T slegs die aborsie laat doen as die swangerskap haar lewe bedreig, of ‘n erge misvorming van die fetus sal veroorsaak, of ‘n gevaar van besering vir die fetus inhou.

@+the state has to promote the provision of non-mandatory and non-directive counseling, before and after the termination.

moet die staat die voorsiening van nie-verpligte en nie-voorskriftelike voorligting bevorder, voor en na die be-eindiging van ‘n swangerskap.

?A 25-year old woman visits her doctor requesting refills of her β2 inhaler. She has had asthma with daily symptoms for the past 10 years. She generally uses 2 puffs of her β2 inhaler 4 times daily. She wakes up with asthma symptoms 1 to 2 nights a week. Taking 2 puffs from her inhaler always bring complete relief of her wheezing and cough. Her peak expiratory flow rate (PEFR) is 400 L/min, which is 100% of predicted. Besides rewriting her prescription for the β2 inhaler, which of the following is the best management option for this patient?

‘n 25-jarige vrou besoek haar dokter en versoek ‘n herhaalvoorskrif vir haar β2 inhaleerder. Sy het die afgelope 10 jaar asma en ervaar daagliks simptome. Sy gebruik gewoonlik 2 inhalasies van haar β2 inhaleerder 4 keer per dag. Sy word omtrent 1 of 2 nagte per week wakker met asma simptome. 2 inhalasies van haar inhaleerder bring dan volkome verligting van haar hoes en “wheezes”. Haar piekvloei is 400L/min wat 100% van die verwagte waarde is. Buiten om haar voorskrif vir die β2 stimulant te herhaal, watter een van die volgende sal die beste behandelingsopsie vir die pasiënt wees?

@Have her return for a visit in 3 months.

Laat sy oor 3 maande opvolg .

@+Start therapy with a combination of a β-agonist and an inhaled corticosteroid.

Begin met kombinasie terapie van ‘n β-agonis en steroid inhaleerder

@Start therapy with an ipratropium bromide inhaler.

Begin terapie met ‘n ipratropium bromied inhaleerder.

@Start therapy with an antibiotic.

Begin terapie met ‘n antibiotikum.

@Start therapy with a long acting β-agonist.

Begin terapie met ‘n langwerkende β-agonis.

? Select the correct statement regarding clinical records:

Kies die korrekte stelling omtrent kliniese rekords:

@ Do not use the patient's own words in your records.

Moet nie die pasiënt se eie woorde in jou rekords gebruik nie.

@ The records has no legal importance at all.

Die rekords het geen wetlike waarde nie.

@ Clear handwriting is not important.

Leesbare handskrif is nie belangrik nie.

@+ Do not change written records; rather add the correct facts to the records.

Moet nie geskrewe rekords verander nie; voeg eerder die korrekte feite by.

@ Compact and time saving records are legally unacceptable.

Bondige en tydbesparende rekords is wetlik onaanvaarbaar.

?Mr. Z presents with complaints of weight loss and a “black mole” that worries him. He also developed a dry cough over the past few weeks. His HIV test came back negative. Study the following X-ray photo and then answer the question.

Mnr. Z presenteer met klagtes van gewigsverlies en ‘n swart moesie wat hom bekommer. Hy het ook ‘n droë hoes die afgelope paar weke ontwikkel. Sy HIV toets se resultaat was negatief. Bestudeer die volgende X-straalfoto en beantwoord dan die vraag:

‘Insert’ X-straal metastasis hier

What is the most likely diagnosis?

Wat is die mees waarskynlike diagnose?

@Tuberculosis.

Tuberkulose.

@Pneumonia.

Pneumonie.

@Pneumocystis Carinii.

@Pulmonary oedema.

Longedeem.

@+Lung metastases.

Long metastases.

?The following pictures (A and B) are from one of your patients. What is the most likely diagnosis?

Die volgende foto’s (A en B) is van een van jou pasiënte. Wat is die mees waarskynlike diagnose?

@Previous hand trauma.

Vorige hand trauma.

@Osteo-arthritis.

Osteo-arthritis.

@+Rheumatoid arthritis.

Rheumatoide arthritis.

@Psoriatic arthritis.

Psoriatiese arthritis.

@Normal old age changes.

Normale ouderdoms-veranderinge.

‘Insert’ rumatoide arthritis foto’s hier

?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

?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 kreatinienbepaling.

@Ultrasonography of the kidneys.

Nier sonar.

@+Urine albumin measurement.

Urien albumienbepaling.

?Look at the following video consultation and answer the questions:

Kyk na die volgende video konsultasie en beantwoord dan die vrae:

‘Insert’ video consultation clips-bad interview

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 the 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 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. | | |

|Display 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:

?Write down the steps in HIV post-test counselling where the result of the test is positive. (5)

Skryf die stappe in HIV na-toets berading neer waar die resultaat van die toets positief is. (5)

?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

?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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