University Hospital, Geelong Emergency Medicine …...University Hospital, Geelong- Fellowship Exam...
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University Hospital, Geelong- Fellowship Exam Short Answer Questions Week 19 1 ID NUMBER: University Hospital, Geelong Emergency Medicine Trial Fellowship Exam Short Answer Questions (SAQ) Week 19 DIRECTIONS TO CANDIDATE 1. Answer each question in the space provided in this question paper. 2. Do not write your name on this question paper. 3. Enter your examination number in the space below. 4. Cross out any errors completely. 5. Do not begin the exam until instructed to do so. 6. Do not take examination paper or materials from this room. 7. The booklet binder may be removed during the exam. QUESTION & ANSWER BOOKLET
Transcript of University Hospital, Geelong Emergency Medicine …...University Hospital, Geelong- Fellowship Exam...
UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek19
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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
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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
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IDNUMBER:
UniversityHospital,Geelong
EmergencyMedicine
TrialFellowshipExam
ShortAnswerQuestions(SAQ)
Week19
PROPBOOKLET
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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
