Title OBA PRO II COMPILATION ✅

BATCH 9 1. 56 years old women recently discharged from the ward with oral antibiotics due to community acquired pneumonia. Now admitted with transient pyrexia and shortness of breath. She is found to have right sided pleural effusion. Pleural tapping reveals pus-like material. Best management for this patient. MXZ Ref : Oxford Handbook of Clinical Surgery 4th Ed page 635 & Bailey and Love’s short practice of surgery 27th Ed page 922 A Chest tube insertion Patient currently at stage II (fibrinopurulent phase) of empyema → drainage at this stage is prudent as antibiotics on their own are unlikely to be curative B Arrange for CT thorax C Intermittent pleural tapping D Start broad spectrum antibiotic 2. 35 years old intravenous drug user (IVDU) presented with fever for 2 weeks. Presence of tricuspid regurgitation murmur, splenomegaly and hematuria. MXZ Ref : Oxford Handbook of Clinical Medicine 10th Ed page 150 National antimicrobial guideline 2019 page 36 A Initiate antibiotic with IV penicillin and gentamicin Infective Endocarditis empirical antibiotic treatment (native valve) B Do echocardiography to know cause of murmur C Initiate antibiotic IV cloxacillin with gentamicin
D Do ultrasound to know cause of splenomegaly and hematuria Notes 3. A 58 years old patient presented to the emergency department (ED) with shortness of breath, pleuritic chest pain, she has a previous history of motor vehicle accident (MVA) 2 weeks ago and was diagnosed to have right neck femur fracture. On examination, normal examination, ECG showed sinus tachycardia, arterial blood gas showed type 1 respiratory failure. What is the best initial management : MXZ Ref : CPG Prevention and Treatment of Venous Thromboembolism A Do the d-dimer General measures : 1. oxygen supplementation/ mechanical ventilation if required 2. cautious fluid resuscitation 3. inotrope if patient in shock B Start thrombolytic therapy
Definitive treatment: 1. Anticoagulant 2. Thrombolytic therapy ➢ for patient with PE & haemodynamic instability (SBP<90 mmHg) : t-PA infused at 100 mg over 2 hours 3. Inferior vena cava infiltration ➢ offer temporary only to patient who cannot have anticoagulant, remove once patient becomes eligible for anticoagulant 4. Pulmonary embolectomy C Oxygen with low molecular weight heparin D Give oxygen therapy and observe, plan for next management if not improved. Notes