DKA Secondary spontaneous pneumothorax in COPD Methanol intoxication Closed abdominal trauma emergency topics make osce station cases
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All four OSCE stations are complete. Here's what each case covers:
What's included in each station:
Station 1 - DKA
Clinical vignette of a T1DM patient who missed insulin. Tests ability to recognize Kussmaul breathing, calculate anion gap, identify the hyperkalemia/hypokalemia paradox, and sequence fluids → K+ replacement → insulin correctly. Critical pitfall: insulin must be held if K+ <3.3.
Station 2 - Secondary Spontaneous Pneumothorax in COPD
Elderly COPD patient with sudden respiratory collapse and tracheal deviation - a tension pneumothorax presentation. Tests whether the candidate knows: (1) SSP requires tube thoracostomy (not simple aspiration), (2) needle decompression first if tension, (3) controlled O2 targeting SpO2 88-92% in COPD.
Station 3 - Methanol Intoxication
Alcohol-use patient with the classic triad: visual "snowstorm" disturbance + high anion gap metabolic acidosis + elevated osmolar gap. Tests the candidate's knowledge of fomepizole as first-line (loading 15 mg/kg), indications for urgent hemodialysis (pH <7.3, methanol >50 mg/dL, visual symptoms), and folinic acid for formate metabolism.
Station 4 - Closed Abdominal Trauma
High-speed MVA with hypotension and positive eFAST. Tests the key decision: hemodynamically unstable + free fluid = OR directly (not CT). Also covers massive transfusion protocol (1:1:1), tranexamic acid within 3 hours, permissive hypotension, and the lethal triad of trauma.
Generate a comparison poster (DKA vs Hyperosmolar Hyperglycemic State)
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Here's the full comparison at a glance:
| Feature | DKA | HHS |
|---|---|---|
| Patient | Type 1 DM, younger | Type 2 DM, elderly |
| Onset | Hours | Days to weeks |
| Blood Glucose | >11 mmol/L (variable) | >33 mmol/L (markedly high) |
| Ketones | Present +++ | Absent or trace |
| pH | <7.3 (acidosis) | >7.3 (normal) |
| Bicarbonate | <15 mEq/L | >15 mEq/L |
| Osmolality | Variable (<320) | >320 mOsm/kg |
| Anion Gap | Elevated (>12) | Normal |
| Mental Status | Alert to drowsy | Profound obtundation / coma |
| Key Symptoms | Kussmaul breathing, fruity breath, vomiting, abdominal pain | Extreme dehydration, focal neuro deficits, seizures |
| Mortality | 1-5% | 10-20% (higher - older patients, delayed presentation) |
| Treatment Focus | Insulin + fluids + K+ replacement | Aggressive fluid replacement first |
Key clinical pearls:
- DKA: The problem is lack of insulin - correct the ketoacidosis with insulin. Potassium management is critical (K+ <3.3 = hold insulin; replace first).
- HHS: The problem is profound dehydration (fluid deficit 8-12 L) - correct with fluids first. Insulin plays a secondary role. Transition slowly to avoid cerebral edema.
- Overlap: A mixed DKA/HHS picture can occur, especially in Type 2 DM patients under severe physiologic stress.
Generate a step-by-step insulin dosing and potassium replacement protocol
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