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Fellowship course Week 12 - Exam

WRITTEN EXAMINATIONSHORT ANSWER QUESTIONS

Time: 33 min

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Question 1 (18 marks) 9 minutes

A 5 year old girl is referred by a GP with pallor and lethargy. On examination she is extremely pale but appears alert and interactive.Her observations:

BP 100/60 mmHg

HR 110 /min

RR 20 /min

O2 saturations 98% on room air

Temperature 36.8 °C

GCS 15

Selected blood tests are taken- refer to the props booklet- page 6.i) List four (4) different pathological causes for these results. (4 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

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Question 1 (continued)ii) List six (6) further investigations that you would perform in the emergency department for this child. (6 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

5. _______________________________________________________________________

6. _______________________________________________________________________

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Question 1 (continued)

The mother refuses any blood products based on religious beliefs.

ii) List four (4) situations under which you may override these wishes. (4 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

None of these situations are met.

iii) List two (2) alternative treatments that you could institute, other than the provision of blood products for this patient. (2 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

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Question 1

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Question 2 (12 marks) 6 minutes

A 5 year old boy sustains an isolated injury to his lip.

A photo of the boy on arrival is taken:

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Question 2 (continued)

i) List four (4) factors that would influence your choice of location of closure (in theatre vs in the Emergency Department). (4 marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

The wound is to be repaired in the ED.

ii) State your choice of local anaesthesia. (1 mark)

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iii) State two (2) reasons to justify your choice of local anaesthesia. (2 marks)

1. _____________________________________________________________________

2. _____________________________________________________________________

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Question 2 (continued)

iv) State your choice of suture material. (1 mark)

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v) State two (2) reasons to justify your choice of suture material. (2 mark)

1. _______________________________________________________________________

2. _______________________________________________________________________

vi) State your choice of sedation. (1 mark)

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vii) State two (2) reasons to justify your choice of sedation. (2 mark)

1. _______________________________________________________________________

2. _______________________________________________________________________

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Question 3 (15 marks) 6 minutes

A 4 month old boy presents with a suspected non accidental injury.

i) List five (5) historical findings that would support your suspicion in this patient. (5 marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

5. ________________________________________________________________________

ii) List five (5) examination findings that would support your suspicion in this patient. (5 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

5. _______________________________________________________________________

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Question 3 (continued)

iii) List five (5) radiological findings that would support your suspicion in this patient. (5 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

5. _______________________________________________________________________

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Question 4 (13 marks) 6 minutes

A 16 year old female presents to the emergency department with lower abdominal discomfort and per vaginal bleeding of 24 hour duration. She thinks that she may be pregnant on the basis of one missed period (LNMP 6 weeks ago).

a. Complete the table below, demonstrating, in list format, your understanding of the role of a urine pregnancy test in this patient. (4 marks)

Significance of a positive result(2 marks)

1.

2.

Significance of a negative result(2 marks)

1.

2.

Her urinary pregnancy test is positive.

b. List two (2) circumstances in which a vaginal speculum examination would be indicated for this patient. (2 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

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Question 4 (continued)

A transvaginal ultrasound shows a normal 6 week intrauterine pregnancy. The patientstates that she does not wish to continue her pregnancy.

c. List three (3) factors on history that you would seek from the patient with respect to this statement. (3 marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

The patient’s parents arrive and demand to know what is wrong with her.

d. List four (4) steps that you would take in response to this request. (4 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

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Question 5 (8 marks) 6 minutes

A 2 year old boy is brought to your emergency department by his grandparents, having found him unresponsive in their home. He has no significant past medical history.

A venous blood gas taken on arrival:

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Question 5 (continued)

i) Provide two (2) calculations to help you to interpret these results.(2 marks)

Derived value 1: _____________________________________________________________

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Derived value 2: _____________________________________________________________

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ii) Using the scenario and the derived values, define the primary acid/base abnormality/s. (2 marks)

___________________________________________________________________________

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Question 5 (continued)

iii) Using the scenario and the derived values, define the secondary acid/base abnormality/s. (1 mark)

___________________________________________________________________________

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iv) Provide a unifying explanation for these results. (3 marks)

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