Board 1388

OSCE Examination
ECG 1
Sinus Bradycardia 1 Point
Normal Axis 1 Point
Long QT interval (>500 ms) 2 Point
ST Elongation (ST>T) 2 Point
Diagnosis:
1) Congenital Long QT Syndrome 4 Points
2) Hypocalcemia (Hypoparathyroidism)
3) CVA
Sum 10 Points

ECG 2
Wide QRS Tachycardia 1 Point
North West Axis ( Undifferentiated Axis) 1 Point
RBBB Pattern 1 Point
A-V Dissociation 3 Points
Diagnosis:
Ventricular Tachycardia 3Points
Origin From LV 1 Point
Sum 10 Points

Pacemaker ECG
Wide QRS 0.5 Point
Standard = 10 mV 0.5 Point
Rate = 65 bpm 0.5 Point
Axis: LAD 0.5 Point
P Sensing 2 Points
V Pacing 2 Points
Mode: VDD or DDD 2 Points
Normal PR Interval 1 Point
Negative P in V1 1 Point
Sum 10 Points
EP Tracing 1
4 Surface Lead Recording 1 Point
Intracardiac Recording 1 Point
CL 300 ms 1 Point
AVRT 2 Points
Shortest VA Conduction in CS1&2 2 Points
Left Lateral AP 3 Points
Sum 10 Points

EP Tracing 2
V pacing 1 Point
First 3 beats; Conduction via His + AV Node 1.5 Point
Last 4 beats; Conduction via AP 1.5 Point
Left lateral AP 2 Points
Earliest A in CS1&2 2 Points
HRA activation Changed 2 Points
Sum 10 Points

Echocardiography
LV Enlargement 1 Point
LVEF 55% or Normal Systolic Function 1 Point
Mild LVH 1 Point
Tricuspid Aortic Valve 2 Points
Severe AI 4 Points
Mild MR 2 Points
Mild TR 2 Points
Dilation of Aortic Root and Ascending Aorta 3 Points
Holo diastolic Flow Reversal in Descending Aorta 1 Points
Diastolic Flow Reversal in Abdominal Aorta 1 Points
Color M Mode 2 Points
Sum 18 Points
Angiography 1
Left Main: Dissection(2 point) of Mid (distal) (0.5 point) portion 2.5 Points
LAD: 100% cut off(1 point) in Mid portion(1 point) befor occluded 7 Points
stent(2 point) retrograde filling(1 point) via RV branch(1 point) of RCA(1
point)

Diagonals: 70% stenosis(1 point) at proximal part(0.5 point) with good 2 Points
run off(0.5 point)

LCX: Normal(1 point), Terminally Diminutive(0.5 point) 1.5 Point

OM: Well developed branch(1 point), 50-60% stenosis(1 point) in mid 3 Points
portion(0.5 point) with good run off(0.5 point)
RCA: 100% cut(1 point) just after RV branch(1 point), Faint 3 Points
retrograde(1 point) distal filling via ? (LCA)
Dominancy
Right(1 point) 1 Point
Sum 20 Points

Angiography 2
Left Main: Normal(1 point) 1 Point
LAD: 70-80%(1 point) Stenosis at proximal(1 point) , 100% cut off(1 4 Points
point)
in Mid Portion(1 point)
LCX: Multiple (Diffuse) (1 point) stenosis up to 80%(1 point) in Mid 3.5 Points
portion(1 point) with good run off(0.5 point)
RCA: 100% cut(1 point) at proximal (1 point),distal segment (PLB?) 2 Points
filled via collateral (Kougle)
LV Angiography
Normal Sized LV(1 point) (to Mildly ), LVEF 55%(1 point) 3 Points
Aortography:
1) Aortic root injection: No AI(1 point) 3 Points
2) 4 SVG(2 point)
Grafts: 17 Points
SVG on Diagonal(1 point) : Patent(1 point) , Mild to Moderate
Stenosis(1 point) at junction(1 point) (or Native) with good run off(0.5
point)

SVG on OM1(1 point) : Patent(1 point) with good run off(0.5 point)
SVG on OM2(1 point) : Patent(1 point) with good run off(0.5 point)
SVG on RCA(1 point) : Patent(1 point) with good run off(0.5 point) Mild
to Moderate Narrowing(0.5 point) in Mid portion of RCA
LIMA on LAD(1 point): Patent(1 point), Sequential Anastomosis(2 point)
with good run off(0.5 point)
Diagnosis
3VD(0.5 point) 0.5 Point
Normal LV function(0.5 point) 0.5 Point
Patent SVGs on Diagonal(0.5 point), OM1(0.5 point), OM2(0.5 point), RCA(0.5 2 Points
point)

Patent LIMA on LAD(0.5 point) 0.5 Point

Sum 37 Points