tamworth fellowship saq 2015 - LITFL
Transcript of tamworth fellowship saq 2015 - LITFL
Question1:
A20yomaleattendswithagrosslyswollenpainfulhandfromapunchinginjuryat36hours.Thereisbrokenskinoverthe3rdMCPjoint.
(a) Whatcomplicationsmayarisefromthisinjury?(20%)(b) Outlineyourexamination(20%)(c) Giventheappearanceofthehandshown,whatinvestigationswouldyourequest,assuming
nocomorbiditiesandthatthisisanisolatedinjury?(20%)(d) Whataretheindicationsforadmission?(20%)
Question2:
A45yomaleisbroughttoLauncestonEDbyambulancefromapropertynearLauncestonTasmania.Hereportsthathehasbeenbittenonthehandinthefield“byatigersnake”20minutesearlier.Apressurebandageandsplintwereappliedinthefield.Heexperiencedabriefsyncopewithinafewminutesofthebiteandnowcomplainsofmilddiscomfortinthehand,visualblurringandfeelinglightheaded.
(a) Sequenceyourmanagementsteps(35%)(b) WhatistheroleforVDKinthisman?(10%)(c) Whatlaboratorytestsareappropriatetothemanagementofthiscase?(30%)(d) CompletethetablefortheclinicalpresentationofTigersnakeenvenomationinhumans?
(30%)Symptom/sign/labresult present/absent(crossout
incorrectanswer)Severepainatthebitesite present/absent
Defibrinatingcoagulopathy present/absentAnti-coagulantcoagulopathy present/absentMyolysis(clinicallysignificant) present/absentPresynapticparalysis present/absentPostsynapticparalysis present/absent
Question3:
ImmediatelyuponcommencingTigersnakeantivenomtherapya45yomaledevelopsseveredyspnoea,throat“tightness”andlightheadedness.
(a) Describeyourimmediateactions.(70%)(b) Describethehypersensitivityreactioninvolved.(30%)
Question4:
A45yomalehasbecomeunresponsiveafewsecondsafterreceiving500mcgofIMadrenalineforfloridanaphylaxis(hypoxia,hypotension,welting,wheezeandtongueswelling)tosnakebiteantivenom.
(a) Youelecttointubateusingketamineandsuxamethonium(assumingthattherearenocontraindications).Completethetablebyenteringdifficultiesthatyoumayanticipateandenteringtheimmediateremediesthatyou’dinstituteforthese.
Potentialdifficulty Remedy1. 1.2. 2.3. 3.4. 4.5. 5.
Question5:
A45yomalehasbecomeunresponsiveafewsecondsafterreceiving500mcgofIMadrenalineforfloridanaphylaxis(hypoxia,hypotension,welting,wheezeandtongueswelling)tosnakebiteantivenom.
(a) Outlinetheventilationstrategythatyouwillemployinthiscase.
Question6:
A47yoCaucasianmalewhohasapriorhypoxicbraininjury(secondarytoanaphylaxis)complicatedbyseizures.Heisbroughttoyourdepartmentwithanongoinggeneralizedseizuredespitehavinghad15mg(0.2mg/kg)ofmidazolamen-route.HisBGLis12.0mmol/L.Notrauma.Noothercomorbidities.
(a) Assumingthattherearenodrugallergies,inthetablebelowsequencethenextfourmedicationsthatyouwouldusetocontrolthisseizure
Medication Immediatepotentialcomplications
(b) Recordtheimmediatecomplicationsthatyouwouldanticipatewithusingthesemedications
Question7:
Whistrestraininga47yomalewithaconvulsiveseizureanursewaskneedinthecheek,includingtheorbitandnose.Sheexperiencedimmediateepistaxis,facialpainandvisualblurring.(photo)
(a) Assumingthatthisisanisolatedfacialinjurywithoutlossofconsciousness,listsixpotentialimmediateocularcomplicationsthatyouwouldexclude.(25%)
(b) Whatnon-occularcomplicationswouldyouseektoexclude?(25%)(c) Describeyourmanagementofaprobableacutelyfracturednose.(25%)(d) Whataretheclinicalsignsoforbitalcompartmentsyndrome?Whatistheimmediate
management?(25%)
Answers
Question8:
YouworkinametropolitanED.Inworkingthroughyouralgorithmforstatusepilepticusyouelecttousepropofolasafourthlineagent.Younotethatthepatienthasashort,thickneck,protuberantteethandahypertrophictracheostomyscar.
(a) Whatisyourapproachtothissituation?(30%)(b) Describe4-10stepsinperforminganemergencysurgicalairway.(50%)(c) Whatare5potentialcomplicationsofthisprocedure?(20%)
Question9:
A70yofemaleattendswithacute,non-traumaticpainlessrightunioccularblindness.
(a) List5potentialaetiologiesforthispresentation(50%)(b) WhataretheclinicalfeaturesthatwouldsuggestGiantCellArteritis?(30%)(c) WhatisthetreatmentforGiantCellArteritis?(10%)(d) WhatarethecomplicationsofdelayedtreatmentofGiantCellArteritis?(10%)
Question10:
A55yomalefarmhandattendswithpalpitationsfor8hoursandisfoundtobeinAF.Hehasnohistoryofrheumaticfever,IHD,hypertension,valvularheartdisease,previouscerebralischaemia,peripheralvasculardiseaseordiabetes.HeisnormotensiveandhasnoECGevidenceofischaemia.Thisishisfirstepisode.ApartfromtheAFhisechoisnormal.
(a) CalculatehisCHADS2score(b) Whatisthepurposeofthisscore(c) WhatisthepurposeoftheHASBLEDscore(d) InthetablebelowList4pharmacologicmanagementoptionsforthispatientandlisttwo
clinicallyimportantpros(excludinghypersensitivityreactions)foreach
Medication Pros Cons1. 1(i). 1(i)
1(ii) 1(ii)2. 2(i) 2(i)
2(i) 2(ii)3. 3(i) 3(i)
3(ii) 3(ii)4. 4(i) 4(i)
4(ii) 4(ii)
Question11:
A30yoIVdruguserisBIBAwithacutestridor.En-routehehasbeengivenadrenaline500mcgIM,ventolinandoxygen.HehasanIVinplace.
Heisalert,diaphoretic,andpale,febrileT-38.5C,PR100SR,BP120/80,RR20,Sats96%R/A.Hehasimpairedmouthopeningandabdominalrigidity.Hereportsfeelingunwellandcomplainsofdifficultyswallowingandbackpainandoverthepastthreedays.
(a) WhatisyourDDxforthispresentation?(40%)(b) Whatisthepathophysiologyoftetanus(20%)(c) Whataretheprioritiesinthemanagementofthismanwithgeneralizedtetanus?(40%)
Question12:
A24yofemaleisBIBAwithfever,mutismandincreasedmuscletone.
(a) List5druginducedsyndromesthathavehyperthermiaasapresentingsign.(10%)(b) Whatarethecardinalfeaturesofthehistoryandclinicalexaminationthatdefinethisas
NeurolepticMalignantSyndromeasdistinctfromHyperserotonism?(40%)(c) WhataretheindicationsforintubationinthiswomanwithNMS?(25%)(d) Howwouldyoumanageherhyperthermia?(25%)
Question13:
A55yomaleisBIBAwithsevereCPof45minutesduration.Hehashadoxygen,600mcgofGTN,300mgoforalaspirinfollowedby250mlsofNSforhypotension.ECGattached(assumestandardcalibrationandpaperspeed)
(a) WhatisthediagnosisfromthisECG?(15%)(b) Whatarethemostlikelycausesforacutehypotensioninthissetting?(30%)(c) WhataretheprincipalinterventionsforcardiogenicshockinAMI?(20%)(d) List8absolutecontraindicationstogivingfibrinolytictherapy.(35%)
Question14:
A74yo,normallyactiveandindependentfemalepresentswithlightheadedness.PR30bpm,BP70/40.Sheisonnomedications.Shedenieschestpainatanystage.
(a) WhatisthediagnosisfromthisECG?(20%)(b) Whatareyouroptionsformanagingthisconditionacutely?(40%)(c) Describethestepsinexternalpacing(40%)
Question15:
A22yofemaleattendswithasuddenonsetsevereunilateralheadache.
(a) WhatfeaturesonhistoryandexaminationsupportthediagnosisofAcuteSub-arachnoidHaemorrhage?(20%)
(b) Whatfeaturessupportthediagnosisofhemicrania?(20%)(c) WhatistheoptimaltimingforanLPtoexcludethediagnosisofSAH?(10%)(d) Describeyourprocedure/techniqueforlumbarpuncture.(30%)
TheLPresult(afteranegativeCTforSAH)follow:
(e) Whatisthenextstepinthediagnosticworkupgiventhisresult?(20%)
Question16:
A28yomalehasbeenBIBA.
Assaultedbya“business”partnerinacarparklateatnight.
Foundunconscious,pronewhenpeoplewerealertedbyyelling.
Hehasastabwoundtotherightlateralchestandabluntskullinjurywithbogginess.
GCS–3,PR140,BP70/40,RR36,Satsnotaccurate(poorperipheralperfusion),pupilsequal4mm,sluggish.
Pre-hospitalMx:intercostalneedlerightchest,3sideddressingrightchest,IVC,NS250mls,oxygen,collar.
(a) Howdoyoumanagehisshock(25%)
(b) DescribeyourtechniqueforICCinsertionforastabbedchest(25%)(c) Describeyourapproachtointubationinthissituation(25%)(d) WillyouintubatebeforeorafterICCinsertion?Justifyyourdecision.(25%)
Answers16
Question17:
Youhaveintubatedapatientwithasevereheadinjuryfromanassault.
HisCTisattached.
(a) ListtheabnormalitiesonthisCT(50%)(b) Wouldyouprovideseizureprophylaxis?(20%)(c) Outlineyourmanagementanddefineyourphysiologicaltargetsintheinitialresuscitation
forthispresentation.(30%)
Question18:
Athreeyearoldchildisbroughtinbyhermotherinwiththepresentingcomplaintofvomiting.
Herinitialobservationsare:Temp37C,PR120,normalcolour,RR18,Oxygensaturation99%R/A,GCS15,pupils3mm,brisklyreactive.
After10minutesinthewaitingroomthetriagenotesthatshehasastaggeringgait.YouarecalledtoreviewherintheCINroom.
Sheispaleanddrowsywithgenerallyreducedtone,PR88,RR10,pupils2mmandslightlysluggish.
(a) Outline5essentialstepsinherresuscitation(20%)(b) Apartfromingestionslist4potentialaetiologiesforherpresentation(20%)(c) List5potentialtoxicologicalaetiologiesforthispresentation(20%)(d) Youlearnthathermotherhadgivenmethadonetosettleherbehaviour.Whatisyour
response?(20%)