WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal...

of 41 /41
1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions 30 Questions 180 minutes (No reading time) Answer all questions Write your answers on this question paper. Write your name on the top of the first page of each answer Write your DEMT/ FACEM who will mark your paper here:

Transcript of WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal...

Page 1: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

1

NSWFaculty

TRIALFELLOWSHIPEXAMINATION

RoyalPrinceAlfredHospital2015.1

WRITTENEXAMINATION

ShortAnswerQuestions

• 30Questions• 180minutes(Noreadingtime)• Answerallquestions• Writeyouranswersonthisquestionpaper.• Writeyournameonthetopofthefirstpageofeachanswer

• WriteyourDEMT/FACEMwhowillmarkyourpaperhere:

Page 2: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

2

Question1A3½yearoldboyaccompaniedbymumpresentstoEDwithpainfulleftlegandongoinglimpleftlegforlastfourdays.Accordingtomumthereisnohistoryoffallortrauma.Onexamination,heisholdingleftleginslightflexionandisunabletoweightbear.YoudecidetodoapelvicX-ray.Hisobservationsare:Pulse95bpmBP90/60mmHgRR22/minSats97%airTemp37.1C

Right Left1.DescribetheabnormalityontheXR(1mark)

2.Whatisthemostlikelydiagnosis?(1mark)

Page 3: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

3

3.List8importantcausesofatraumaticlimpinachildthisage(4marks)123456784.List4assessmentparameters(Kochercriteria1999)arethemostusefulforsuspectedsepticarthritisinachildwithapainfulhip(4marks)1234

Page 4: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

4

Question2An84year-oldfemaleattendedyourEDafterallegedlytaking38tabletsofParacetamol16hoursago(total19grams).ObservationsarestableandherGCSis15.1.List8investigationsyouwouldperformandwhy(2marks)12345678

2.State3elementsrequiredtodemonstratecompetence(3marks)123

Page 5: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

5

3.Sherefusestreatmentandwantstodischargeherself.Uponassessment,youfindthatshelackscapacity.Listyourimportantactionsandexplaineach(5marks)12345

Page 6: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

6

Question3AdiabeticpatientarrivestotheEDandrequiresfluidresuscitation.Hehasbilateralbelowkneeamputations.SeveralattemptstoestablishIVaccessfailed.YoudecidetogowiththeIOroute.1.List3alternativeanatomicalsitesthatareavailableforintraosseousaccess?(3marks)1232.Whatistheclinicalindicationforintraosseousaccess?(1mark)3.List4contraindicationsforIOinsertion(2marks)12344.Listthe4maincomplicationsassociatedwithintraosseoususe?(2marks)1234

Page 7: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

7

5.List4diagnosticstudiesthatcanbeobtainedviaintraosseousaccessthataccuratelyequatestoivcollection(2marks)1

2

3

4

Page 8: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

8

Question4A25yearoldmalewasassaultedwithabaseballbat.HehadawitnessedLOCfor5minutesandGCSwas10whenparamedicsattended.OnarrivaltotheED,hehadageneralisedseizurefollowingwhichhebecameagitatedandcombativewithaGCSof8.HisleftpupilisdilatedandhehasalreadyvomitedatsceneandtheED. R L

1.Describethe4abnormalitiesonthisCT.Giveasmuchdetailsaspossible(2marks)12342.List9importantinitialstepsinthispatient’sinitialprimarysurvey,includingendpointswhereappropriate(6marks)1234

Page 9: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

9

567893.Describe4methodsofreducingintracranialpressureinthispatientandtherationaleofeachmethod(2marks)1234

Page 10: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

10

Question5A45yearoldfemalehaslongstandinglowbackpainwasdischargedtheprecedingdaybyaJMOinyourEDwithadiagnosisofmalingering.ShenowpresentstotheEDwithasuddenandseverelowerbackpainradiatingdownthelegs.Inthedepartmentshewasunabletocontrolherselfandwasincontinentofurine.1.What6featureswouldsuggestcaudaequinasyndrome?(3marks)123456

2.Listtheessentialtesttoaidtheassessmentofapatientwithsuspectedcaudaequinasyndrome(1mark)3.YouinvestigateandfindthattheJMOdidnotexaminethepatient,wrotenonotesandwasheardbytheEDRNtotellthepatientthatthereisnothingwrongwiththemandtheyshouldnothavecometotheED,again.YouaretheJMO’ssupervisor.Outlinethestepstohowyouwouldapproachtothissituationwithdetails.(4marks)123456

Page 11: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

11

4.Outlinethe4mostimportantimmediatestepsinthetreatmentanddispositionofthispatient(2marks)1234

Page 12: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

12

Question6An18month-oldboyisbroughtbyhisworriedmothertotheEDwitharashandspotsinhisbuccalcavity.Heisalsopyrexial(T38.9°C).

1.Whatchangesareshownandwhatisthediagnosis?(2marks)122.List2acutecomplicationsofthiscondition(2marks)123.Whatlaboratoryfindingswouldbeexpectedwiththisdiagnosis(3marks)1234.IntheED,thechildstartsfitting.Theyareplacedontheirsidewithoxygengivenbymask.Anivisplaced.Outlineyourimmediatemanagementincludingdrugdoses(3marks)1

2

3

Page 13: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

13

Question7A29yearoldfemalepresentstotheEDwithlowerabdominalpain.Observationsarestable,bloodtestsarewithinnormalrangeandherpregnancytestisnegative.1.Which4riskfactorssuggestpelvicinflammatorydisease?(2marks)12342.Whenshouldtreatmentbeinitiated?(2marks)123.Whatarethe4mainindicationsforhospitaladmission?(2marks)12344.Whatdischargetopicsshouldbediscussedwiththepatient?(4marks)1234

Page 14: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

14

Question8A35year-oldfemaleisbroughttotheEDbyherhusband.Shehasnotbeenfeelingwellandisbecomingirritable,agitatedandisconstantlysweaty.Sheisknowntohavehyperthyroidismandlastweekunderwentsurgery.ExaminationrevealsaHR144bpmandT38.4°C.1.Whatthreeclinicalfeaturesaremostrelevanttoassessforthyroidstorm?(3marks)1232.List4specificdrugsthatwouldbeusedtotreatthispatientandoutlinetheirmechanismofaction.Providedoseswhereappropriate.(4marks)12343.Apartfromsupportivemeasuressuchasivifluids,correctingfluidorelectrolyteimbalance,externalcooling,outlineoptionsforrefractorythyroidstorm(3marks)123

Page 15: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

15

Question9Apatientpresentstotheemergencydepartmentaftersustainingmultiplelacerationstothesoleofthefootfromoystershellsafterwalkingonthebeach.Youwishtoperformaregionalblocktotheplantaraspectofthefoot.

1.Namethe3nervesinvolvedandtheircutaneousdistribution(3marks)

1

2

3

2.WherewouldyouinsertLAtoanaesthetisetheseregions(3marks)

1

2

3

4.What4otherissuesmustbeaddressedinthetreatmentofthisinjuryprioratdischargeincludingdrugdoseswhereappropriate(4marks)

1

2

3

4

Page 16: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

16

Question10A25year-oldmaleinvolvedinamotorbikeaccidentwasbroughttotheEDatatertiarylevelcentre.AtraumaserieswasperformedwithanormalCXRandC-spineXray.Thefollowingradiologicalimagingwasundertaken.Vitalsignsare:RR20sat99%onroomairHR115BP80/50GCS15

1.ListtheabnormalitiesonthisXray(2marks)

1

2

2.Whatclinicalsignsareassociatedwiththisinjuryonexamination(1mark)

1

2

3

3.Givethe4mostlikelycausesofhypotensioninthispatient(2marks)

1

2

3

4

Page 17: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

17

4.Listthefivemostimportanttreatmentanddispositionpriorities,astheteamleader,intreatingthispatient’shypotension.Givedetails(5marks)

1

2

3

4

5

Page 18: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

18

Question11A38year-oldfemalewasbroughttotheEDbyherhusband.ShewasagitatedbutisnowdrowsyandherGCSis13.AnECGwasperformed.

1.Younoteawidecomplextachycardia.DescribethetwootherimportantfindingsontheECG(2marks)122.Whatisthelikelydiagnosis(1mark)?

3.HerGSCdecreasesto10andyoudecidetoproceedwithintubation.

HR120BP95/70Sats98%onNRMRR30Temp36.8degrees

NS500mlsbolusisstarted.

Page 19: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

19

Whatmedicationswouldyougiveduringthenext5-20minutespriorandduringtheintubation?Includedoseswhereappropriate(5marks)123454.Afterintubationshehasageneralisedseizure.Whatmedicationswouldyougiveatthispoint(2marks)?1

2

Page 20: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

20

Question12YouareworkingataruralEDlocatednearanAustralianskifield.Youreceivea27yearoldmanwhohasfallenintoafrozenlakewhilehiking.Hehasarrivedtoyourresuscitationroom30minutesaftersubmersion.Hiscoretemperatureis27.40C1.Definehypothermiaandhypothermiaseverity?(2marks)12342.WhatfourfeaturesofhypothermiaaredemonstratedonanECGotherthanVF?(2marks)12343.HisrhythmonthemonitorchangestoVF.ACLSalgorithmisstartedwithbreathsandcompression,butnocessationofVFafter3roundsofdefibrillationand1mgofadrenalineiv.HowwillyounowdifferyourresuscitationcomparedtotheusualACLSalgorithm?(4marks)12344.Whatarethe2maintypesofwarmingand2giveexamplesofhoweachcanbeachieved?(2marks)12

Page 21: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

21

Question13Itis1600onSaturdayafternoon.A75yearoldwomanwithabackgroundofCRFonperitonealdialysisanddietcontrolleddiabetespresentswithretrosternalchestpainradiatingtoneckandbotharmswhichstarted60minutespreviously.Sheiswellfunctioninginthecommunityandheronlymedicationsareirbesartan,calciumandvitaminD.Shehasnoallergies.SheisvitallystableandthefollowingECGisperfomed:

1.WhatarethediagnosticfeaturesontheECG?(1mark)1232.Ifyouwereworkingatanurbanmajorreferralhospitalwith24houron-callPCIcapabilities,wouldyouactivatethePCIteam–theyhavenoaccesstotheECGandwillactonyourrecommendationandoutlineyourreasoning?(2marks)

Page 22: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

22

3.IfyouwereworkingataruralemergencydepartmentwouldyougivethombolysisconsideringthatatthistimetheavailabilityoftransfertoPCIis3hours(2marks)4.List10features(4history,3ECGand3otherinvestigations)thatwouldincreasethediagnosticpossibilityofSTEMIoverpericarditis(5marks)12345678910

Page 23: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

23

Question14Yourregistrarasksyouforadvice.A50yearoldfemalehaspresentedfollowingacollapseandisnowincreasinglyconfused.Heronlyinjuryisaminorabrasiontoherforehead.Youhavethefollowingblood/urineresultsthusfar:Glucose16.4 Hb13.1Na111 WCC12.2K4.2 Plts175Urea7.2Creatinine102 Patientweight65kgUrineOsmolality125 UrineNa421.WhatishercalculatedNa?(1mark)

2.Whatishercalculatedosmolality(1mark)3.Whatare12criteriaforSIADHonhistory,examinationandinvestigations?(6marks)1234567891011124.Sheremainsconfusedandthenhasaseizure.Whatisyourspecifictreatmentandwhatisyourendpoint.(2marks)12

Page 24: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

24

Question15

1.Whatisthisdevice?(1mark)2.Describe2clinicalsituationswhenyoumightconsiderusingthisdeviceinED?(1mark)123.Howcanyouconfirmtheplacementofthisdevice?(3marks)1234.Describeclinicalsituationswhenthisdevicewouldbeinappropriate/contraindicated.(5marks)12345

Page 25: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

25

Question16A22yearoldfemalemedicalstudentisbroughtinbyambulancefollowingashortseizureathome.ShehasrecentlyreturnedfromherelectiveinMalawi.Herstudentfriendsareunsureifshetookanyofhermedicationsbecausetheygavehernightmares.Sheisnowdrowsyandnotorientated.YoucallpublichealthandtheydonotsuspectEbola.1.Namethemostlikelycausativeorganism(1mark)2.ABSLisnormal.Whatotherfourinitialbloodtestswillyouarrangeimmediatelyandwhatwouldyouexpectforeach?(4marks)12343.Publichealthcallsbackastherehasbeenanewreportof5casesofEbolaconfirmedinMalawiintheclinicthemedicalstudentwasat.Outlinetheimportantissues.(5marks)12345

Page 26: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

26

Question17A70kg26yearoldmanisinvolvedinahousefireinanenclosedroom.Hehasburnstothewholeofhishead,theventralaspectsofbotharmsand3%onhischest.1.Whatarethesignsthatwouldalertyoutoanairwayprobleminthispatient?(4marks)12342.Calculatethe%burn(1mark)

3.Whatfluidwouldyouchart(typeandamount)eachhourforthefirst8hours–showyourcalculation?(3marks)4.Whatanalgesiawouldyougiveandbywhatroute?(1mark)5.Whatwouldyouaimhisurineoutputtobe?(1mark)

Page 27: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

27

Question18A2yearoldboyisbroughtintotheEDbyhismotherafterswallowinghisoldersister’searring.

1.Whatinthehistorywouldalertyoutothepresenceofaforeignbody?(3marks)123

Page 28: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

28

2.YoureviewtheXray.DoyouthinktheFBisinthetracheaoroesophagusandwhy?(1mark)3.Whereintheoesophagusmightaforeignbodybecomelodged?(3marks)1234.Describe3instanceswherethisFBwouldneedtoremovedurgently(3marks)123

Page 29: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

29

Question19

A19yearoldgirlisbroughtinbyherfriendafteranepisodeofcollapse.Theyhadbeentakingecstasyanddancingallnight.Shehasatemperatureof39degrees,HR140bpm,BP190/110.Sheappearsdehydrated,agitatedandhasarestingtremor.Sheiscatheterisedwiththeaboveurine.

1.Whatisthelikelydiagnosis?(1mark)2.Whatisthemostimportantelectrolyteresultyouwouldwanttoknowbeforestartingtreatmentandwhy?(2marks)3.ThelaboratoryringyouwithanurgentNaresultof112mmol/l.NamefourfurtherstepsintheEDmanagementincludingdrugdosesandroutewhereappropriate.(4marks)12344.Name3clinicalsignsinthispatientthatwouldbestcorrelatewithserotonintoxicity(3marks)123

Page 30: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

30

Question20A42yearoldmanfelloffhisbicyclewhentravellingat20km/h.Hecomplainedofleftforearmpain.HehadthefollowingX-raystaken.

1.WhataretheabnormalitiesontheX-ray?(2marks)

Page 31: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

31

2.Listthe2mostlikelynerveinjuries(2marks)123.Yourregistrardecidestoperformproceduralsedation.Outlineyourchecklistwithdetailsofeachofthemajorarea.(6marks)123456

Page 32: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

32

Question21A57yearsoldmalepresentedtoEDwithasuddenonsetredpainfulrighteye.Yoususpectadiagnosisofacuteglaucoma1.WhatarethefeaturesofacuteGlaucomaonexamination?(4marks)12342.Howdoesglaucomacauseblindness?(1mark)

3.Listthe5mostrelevanttopicalmedicationsusedinprimaryopenangleglaucomaandexplainwhytheyareused:(5marks)12345

Page 33: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

33

Question22A32year-oldalcoholicdiabeticmalepresentswithapainfulfacialswellingfromatoothabscesswhichhasbeengettingworseover2days.Heisofnofixedaddressandhasbeenunabletogettoadentist.HisvitalsignsshowaHR:110bpm,BP120/75;RR24withsaturationof94%andauraltempof38.5degreesC.Hisneckandthroataretendertopalpationandareswollen.Hehasdifficultyopeninghismouthandisunabletoprotrudehistongue.Histongueappearsdisplacedsuperiorlyandanteriorly.1.Whatisthelikelydiagnosis?(1mark)2.Whatarethe2seriouscomplicationsofthisdiagnosis?(2marks)123.Listyourtop3treatmentpriorities(3marks)1234.Listtheantibioticchoicesthatmaybeusefulandstatetherationalforyourchoice.(4marks)1234

Page 34: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

34

Question23A32yearoldladywhois36weekspregnantpresentedwithheadache,drowsinessandherobservationsandresultsareasfollows:Pulse110bpm Hb9gm/dlBP180/110mmhg WCC8x109/LRR24/min PLT34x109/LSats96%air LFT:AST120u/L,ALT135u/L LDH750u/L1.Whatisthediagnosis?(2marks)2.What2anti-hypertensivedrugswouldyouconsidertotreatherbloodpressure,statedoses?(2marks)123.YouhavepagedthePICUdoctorandobstetriciantoyourresuscitationroom.Yourpatientstartstohaveaseizure.Whatarethefirstfourthingsyouwoulddo?(4marks)12344.Whatarethe4signsofmaternaltoxicitywithmagnesiumsulphatewhichwouldpredicteitherrespiratoryorcardiacarrest?(2marks)1234

Page 35: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

35

Question24A4yearoldmaleisbroughttoyouremergencydepartmentbyhisparentsbecauseheishavingdifficultybreathing.Younoticethereisanaudiblewheeze,RR36andheisabletospeakinsentences.1.List6featuresofacutesevereasthma(2marks)1234562.Listthemedicationsyouwoulduseinitiallyincludingdosesinthischildifyouidentifiedthefeaturesofmoderateseverityasthmapriortobeingabletoplaceaniv(4marks)12343.Whatarethesignsofsalbutamoltoxicity?(4marks)1

2

3

4

Page 36: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

36

Question25A22yearoldmalewithknowncerebralpalsypresentedtoEDwithaseizure.HecomplainsofworseningheadacheandisknowntohaveVPshunt.HisobservationsarestableandGCS15.1.Listthe2mostlikelycausesofworseningheadacheinthisman?(2marks)122.Howdoyouinterpretshuntfunctionafterlocatingandpressingthechamber?(2marks)123.What2radiologicalinvestigationswillyouarrangeforasuspectedblockedVPshunt.Explainyourrationalforeach(2marks)124.Theneurosurgicalregistrarasksyoutoperformashunttap.Outlinethesteps(2marks)4.Whatarethepossibleoutcomesoftheshunttapandwhatistheirsignificance?(2marks)12

Page 37: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

37

Question26Theconcernedparentsofa2dayoldinfantpresentforreviewatyouremergencydepartment.Theyhavenotedthatthereismarkedyellowingoftheskin.Younotethattheyellowdiscolourationextendsfromtheheadtothetrunkbutnottothearmsorlegs.1.List6differentialsyouwouldconsiderforthisneonate.(3marks)1234562.ListthemostrelevantinvestigationswhichyouwouldconsiderintheED.(5marks)123453.Theconjugatedbilirubinlevelisgreaterthan15%ofthetotal(measuredlevelat15microM/L).Whatwouldbethenextappropriateinvestigationandwhy?(2marks)

Page 38: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

38

Question27A25yearoldmalepresentedtoyourEDaftertakinganoverdoseof100tabletsofaspirin300mg.1.Listthreespecificclinicalfeaturesofaspirintoxicitythatyoumightexpecthimtodevelop?(3marks)1233.AVBGisperformed.Whatwouldyouexpect?(3marks)1234.Whatreasonswouldyouconsiderhaemodialysis?(4marks)1234

Page 39: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

39

Question28A52year-oldfemaleispresentingtotheEDwitha3dayhistoryoffeelinggenerallyunwellwithnauseaandabdominalpain.Sheisapyrexial(T36.7°C),HR78andBP85/50mmHgBloodresultsareasfollows:Na126mmol/LK5.7mmol/LGlucose2.3mmol/LCalcium2.6mmol/L1.Whatisyourprovisionaldiagnosisforthiswoman?(2marks)2.Listthe2mainpathophysiologicalcausesforthispresentation?(2marks)123.Whatotherbloodinvestigationswillbehelpfulinconfirmingyourdiagnosis?(2marks)124.Listfourmanagementstepsandrationalebehindeach(4marks)1234

Page 40: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

40

Question29A5yearoldboyhasbeenbroughttoyouremergencydepartmentafteraroadtrafficaccident.Hehashadabloodtransfusioncommencedbytheretrievalserviceforhaemorrhagicshock.Thesecondunithasalreadybeencommenced.1.Whatisthedefinitionofmassivetransfusioninthischild?(2marks)2.Listeightpotentialcomplicationsofmassivetransfusionforthischild(4marks)123456783.Ifhewastohaveacardiacarrest.Whatarethe4likelycauses(4marks)1234

Page 41: WRITTEN EXAMINATION Short Answer Questions · 1 NSW Faculty TRIAL FELLOWSHIP EXAMINATION Royal Prince Alfred Hospital 2015.1 WRITTEN EXAMINATION Short Answer Questions • 30 Questions

41

Question30

A2yearoldboyweighingabout20kgwasbroughttoyourregionalEDbyhismotherhavingaccidentallyswallowedhydrochloricacidkeptnearaBBQ.Theingestiontookplace20minutespriortoarrival1.Whatare5featuresthatwouldalertyoutoimpendingairwaycompromise?(5marks)123452.Howwouldyoudecontaminatethisingestion?(1mark)3.Whataretheindicationsforendoscopywithinthefirst24hours?(4marks)1234