UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek19

1

IDNUMBER:

UniversityHospital,Geelong

EmergencyMedicine

TrialFellowshipExam

ShortAnswerQuestions(SAQ)

Week19

DIRECTIONSTOCANDIDATE

1. Answereachquestioninthespaceprovidedinthisquestionpaper.

2. Donotwriteyournameonthisquestionpaper.

3. Enteryourexaminationnumberinthespacebelow.

4. Crossoutanyerrorscompletely.

5. Donotbegintheexamuntilinstructedtodoso.

6. Donottakeexaminationpaperormaterialsfromthisroom.

7. Thebookletbindermayberemovedduringtheexam.

QUESTION&ANSWER

BOOKLET

UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek19

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Question1(18marks)

A10yearoldgirlpresentstotheemergencydepartmentafterafallfromthemonkeybarsafterschoolandcomplainsofapainfulelbow. AnelbowX-rayistaken-refertothepropbookletpage2.

a. Statefour(4)abnormalitiesshowninthisxray.(4marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

Afterfullassessment,thegirlisconfirmedtohavethisisolatedinjuryandisverydistressedwithpain.Sheisfasted.Shehasreceivednoprehospitaltreatment.ShedoesnotcurrentlyhaveIVaccess.

b. Listyourapproachtoanalgesiainthefirst20minutesofthispresentation.Statefive(5)points,providingdoseandroutewhereapplicable.(5marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

5. ________________________________________________________________________

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Question1continued

c. List four (4) indications for corrective treatment of this injury in the emergencydepartment.(4marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

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Question1continued

Anindicationforurgentcorrectivetreatmentexists.

Inpreparation for this corrective treatment, youattempt cannulation and fail 3 attempts.The patient’s mother becomes very distressed and requests no further attempts atcannulation. She is verbally aggressive towards you. Corrective treatment is still requiredsemiurgently.

d. Statefive(5)pointstodemonstratehowyouwouldhandlethissituation.(5marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

5. ________________________________________________________________________

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Question2(14marks)A24yearoldwomanwhoispregnantpresentswithpervaginalbleeding.

a. Completethetable,listingtheexpectedfindingsateachstatedstageofanormalpregnancy.(12marks)

Stageofpregnancy

Approximate

QuantativeΒHCG(3marks)

Transvaginalultrasound(3marks)

Transabdominalultrasound(3marks)

5weeks 6weeks 7weeks

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Question2continued

b. Statethree(3)specificfindingsonultrasoundthatdefineafailureofpregnancy.(3marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

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Question3(12marks)A65yearoldmalepresentswith4daysofscrotalpain.Aphotoofthepatientistaken-refertothepropbookletpage3.

a. Whatisthediagnosis?(1marks)

_________________________________________________________________________

b. Whatisthesignificanceofthiscondition?Statethree(3)pointsofsignificance.(3marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

c. Listtwo(2)riskfactorsforthedevelopmentofthiscondition?Statetwo(2)pointsofsignificance.(2marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

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Question3(Continued)

Analgesiaisprovided.Dispositionisarranged.

d. Listtwo(2)keytreatmentstepsthatyouwouldinstituteinthefirst20minutesofyourcare.Provideone(1)justificationforeachchoice.(4marks)

Treatmentstep(2marks)

Justification(2marks)

1

2

e. Listtwo(2)treatmentmethodsthatareutilisedfordefinitivetreatment.(2marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

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Question4(12marks)A25yearoldmanisintubatedfordecreasedconsciousstatefollowingapolydrugoverdose.Thepatientremainsinyouremergencydepartmentovernight.Followingyourwardroundinthemorningyouassessthepatientasbeingsuitableforextubation.

a. Listfour(4)patientfactorsthatarerequiredtoallowsafeextubationofthispatient.Foreachfactor,statehowyouwouldensureadequacy.(8marks)

Patientfactor(4marks)

Howwouldyouensureadequacyofthefactor(4marks)

1.

2.

3.

4.

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Question4(continued)Yousuccessfullyperformextubation.

b. Listfour(4)stepsinyourpost-extubationcareforthispatient.(4marks)1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

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Question5(11marks)A75yearoldmanpresentsfollowingacollapse.

AnECGistaken-refertothepropbookletpage4.

a. Statefive(5)abnormalitiesshowninthisECG.(5marks)1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

5. ________________________________________________________________________

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Question5(continued)

b. Listsix(6)possiblecausesforthisECGproblem.(6marks)1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

5. ________________________________________________________________________

6. ________________________________________________________________________

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Question6(12marks)A35yearoldmanpresentswithrightsidedfacialswelling24hoursafterbilateralwisdomtoothremoval.

ACTistaken-refertothepropbookletpage5and6.

a. Statetwo(2)abnormalfindingsintheCTscanslicelabelled1.(2marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

b. Statetwo(2)abnormalfindingsintheCTscanslicelabelled2.(2marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

c. Statetwo(2)abnormalfindingsintheCTscanlabelled3.(2marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

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Question6(continued)

d. Listsix(6)likelycomplicationsofthiscondition.(6marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

5. ________________________________________________________________________

6. ________________________________________________________________________

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Question7(11marks)A74yearoldmanisbroughttoyouremergencydepartmentwith1weekofshortnessofbreathandchestpain.Hisobservationsare:

BP 135/870 mmHgsupine

HR 110 /min

Temperature 38°C

Arterialbloodgasesandserumbiochemicalresultsaretaken-refertothepropsbookletpage7.

a. Providetwo(2)calculationstohelpyoutointerprettheseresults.Statethesignificanceofeachfinding.(4marks)

Derivedvalue1:_____________________________________________________________

___________________________________________________________________________

Significance:_____________________________________________________________

Derivedvalue2:_____________________________________________________________

___________________________________________________________________________

Significance:_____________________________________________________________

b. Usingthescenarioandthederivedvalues,statetheprimaryacid/baseabnormality/s.Statetwo(2)points.(2marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

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Question7(continued)

c. Listfive(5)likelyunifyingcausesforthesepathologicalfindingsforthispatient.(5marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

5. ________________________________________________________________________

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Question8(12marks)

A65yearoldmanpresentswithaheadache.Hehasnotexperiencedtraumapriortotheheadacheonset.Hisobservationsare:

BP 255/150 mmHgsupine

HR 90 /min

Temperature 37°C

a. Other than phaeochromocytoma and idiopathic hypertension, list six (6) likely

underlyingcausesforhishypertension.(6marks)1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

5. ________________________________________________________________________

6. ________________________________________________________________________

Youhaveastrongsuspicionofthediagnosisofphaeochromocytoma.

b. Listthree(3)drugsinyourpreferredregimetotreatthebloodpressureinthissetting(dosesarenotrequired).(3marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

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Question8continued

c. Listthree(3)investigationsthatmaybeperformedtoassistinconfirmationofthediagnosisofphaeochromocytoma. (3marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

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Question9(16marks)

A35yearoldmanpresentstoyouremergencydepartmentafterahighvoltageelectricalinjury.

Aphotographofthemanistaken-refertothepropsbookletpage8

a. Statefour(4)featuresofthisphotographthatsuggestasignificantinjury.(4marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

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Question9(continued)

b. Listsix(6)systemic/distantcomplicationsfromthepassageofhighcurrentthroughthebody.(6marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

5. ________________________________________________________________________

6. ________________________________________________________________________

c. WhatistheroleofthepresentingECGinhousehold(240V)electricalexposure?State

two(2)pointsinyouranswer.(2marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

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Question9(continued)

d. Listsix(6)indicationsforongoingECGmonitoringfollowinganelectricalexposure.(6marks)

1. _____________________________________________________________________

2. _____________________________________________________________________

3. _____________________________________________________________________

4. _____________________________________________________________________

5. _____________________________________________________________________

6. _____________________________________________________________________

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UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek19

1

IDNUMBER:

UniversityHospital,Geelong

EmergencyMedicine

TrialFellowshipExam

ShortAnswerQuestions(SAQ)

Week19

PROPBOOKLET

UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek19

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Question1

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Question3

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Question5

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Question6

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Question6continued

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Question7

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Question9