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FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
FELLOWSHIPEXAM.COMROADBLOCKTEST1.
Questionpaper.
Instructionstocandidates
1. Thisbookcontains10shortanswerquestions.2. Youhave1hourand6minutestocompletetheexam.3. Question1istwicethelengthoftheotherquestionsandyoushould
allotyourtimeaccordingly4. Each2pagequestionisdesignedtobecompletedinthesameamount
oftime,irrespectiveofthenumberofmarksassigned5. Each2pagequestionwillbescaledtocontributeequallytothe
examinationoutcome,6. Answerinthespaceprovidedwithinthisbooklet.7. Writeinblueorblackpen.8. Wherereferencedrefertothesupplementaryclinicalinformation
bookletforclinicalinformation.9. Whereanumberofanswersarerequestedonlythatnumberwillbe
marked.
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question1.A32yearoldmotorbikeriderisbroughtintoyourdepartmentafterbeingstruckbyamotorbike.Thefronttirerandirectlyoverherabdomenjustinferiortothecostalmargins.Hervitalsignsare: HR 128 /min BP 90/44 mmHg RR 29 /min Sats 94% 6LO2
T 35.8 oCi.(5marks)Whatistheevidencefortheempiricuseoftranexamicacidinthispatient?
ii.(5marks)Thepatienthasavenousgastakenintheresusroom.Theresultsareshownonpage2ofthesupplementarybooklet.Givethe2primarydisturbancespresentandjustifyyouranswer.
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question1.iii.(8marks)BasedontheVBGresultsusethefollowingtabletolisttwomajorpathologicprocessesyouareconcernedabout,andthreeinjurieswhichmaycontributetoeach.PATHOLOGICPROCESS INJURIES
iv.(4marks)ThepatientistakentoCTscan,andacopyoftheimageisreproducedonpage3ofthesupplementarybooklet.Listfour(4)majorabnormalitiespresent?
1.2.3.4.
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question1.v.(1mark)Whatgradeofkidneyinjuryisthis?
vi(4marks)Give4indicationsforoperativemanagementofthispatient.(4marks)
1.2.3.4.vii.(5marks)Givefive(5)elementsimportantinamassivetransfusionprotocol.
1.2.3.4.5.
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question1.Question6.(6marks)Give6endpointsyouwouldusetojudgetheefficacyofyourtransfusion.
1.2.3.4.5.6.vii.(2marks)IsthereanyevidencefortheuseoflowBPtargets(permissivehypotension)intrauma?
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question2.YouaretheEDconsultantondutyinaregionalhospitalwithnoobstetricorneonatalspecialistservices.Aprimigravid25yearoldpatientpresentstoyouremergencydepartmentat8am.Sheis31weekspregnantwithappropriateantenatalcarewhichhaselicitednocomplicationsofpregnancy.Shedescribessevererhythmiclowerabdominalpainswhichhavebeeninprogressforthepast4hours.i.(2marks)Give2differentialdiagnosesforthispresentation.
1.2.ii.(8marks)Usingthetablebelowoutline4features(notinclusiveofvitalsigns)youwillassessonclinicalexaminationandtherationaleforeach.
FEATURE RATIONALE
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question2.iii.(5marks)Yourexaminationindicatesthatpretermlabourisinprogresswithoutanymajorcomplicationstofurthermedicationadministration.Give5stepsinmanagementyouwillnowinstitute.
1.2.3.4.5.iv.(4marks)List4contraindicationstotocolytictherapyinpatientswithpretermlabour.
1.2.3.4.
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question3.An18yearoldmanpresentstoyouremergencydepartmentwithanacutelypainfulrighttesticle.Heisvisiblydistressedbythepainandisvomitingattriage.Hehasnopastmedicalhistoryofnote.Hestatesthepainbeganmorethan4hoursago.Hisvitalsignsare:
HR 110 /minBP 135/92mmHgRR 24 /minSats 98% RAT 37.4 oC
i.(4marks)List4differentialdiagnosesforthispresentation.
1.2.3.4.ii.(3marks)Whatfurtherfeaturesonexaminationwouldsupportadiagnosisoftesticulartorsion?
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question3.iii.(6marks)Yourresidentwhohasprimarycareofthepatientreturnstoyouandasksyoutoapproveanultrasoundofthetesticle.Usingthetablebelowoutlineoftwoissuesinthiscasewhichmaylimittheutilityofultrasoundinthispatient.
ISSUE OUTLINE
iv.(2marks)Yourresidentreturnstoyoutosaythesurgicalregistrarisrefusingtoseethepatientuntilanultrasoundisperformed.Atthisstagethepatienthasbeeninyourdepartment45minutes.Outlineyournextactions.
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question4.An82yearoldfemaleisbroughtinbytheambulanceafterbeingfoundfaecallyincontinentonherbathroomfloor.Itisunclearhowlongshehasbeenthere.Herneighboursintheapartmentblockhavenotseenherfor3days.OnarrivaltotheEDsheisconfusedanddisoriented.Hermedicationlistincludeswarfarin,telmisartan,atorvastatinanddigoxin.Hervitalsignsare:
HR 45 /minBP 99/66 mmHgRR 28 /minSats 92% RAT 33.1 oC
i.(3marks)Thepatient’sECGisreproducedonpage4ofthesupplementaryinformationbooklet.Give3abnormalitieswhichrelatetothislady’spresentation.
1.2.3.ii.(4marks)Theresidentbringsyouavenousbloodgaswhichisreproducedonpage5ofthesupplementaryinformationbooklet.Give2acid-basedisturbancespresentandprovide2derivedvaluestosupportyouranswer.
1.2.Derivedvalue1:Derivedvalue2:
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question4.iii.(12marks)Usingthetablebelowlist6investigationsyouwillperformnowinthispatient.Giveajustificationforeach.
TEST INDICATION
iv.(4marks)Give4methodswhichyouwillusetoactivelyrewarmthispatient.(4marks)
1.2.3.4.
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question5.
A35yearoldmalepresentstoyourdepartmentaftercatchinghisrightfootunderneathadoor.
Aclinicalimageofthefootisreproducedonpage6ofthesupplementaryinformationbooklet.
i.(2marks)Describetheimportantfindingsintheimage.
ii.(5marks)
Describeyourtechniquetoanaesthetisethispatienttoexamandtreathim.
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question5.iii.(6marks)
Thepatienthastheinjuredtoenailwithhiminhispocket.
Describethetreatmentyouwillprovideincludingyourdisposition&management.
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question6.A46yearoldmalewithahistoryofgastro-oesophagealrefluxandintravenousdrugusepresentstotheemergencydepartmentwithsuddenonsetcentralabdominalpain.Onexaminationhehasarigidabdomentopalpation,andhisvitalsignsare:
HR 125 /minBP 98/42 /minRR 29 /minSats 99% RAT 38.4 oC
ACTscanofhisabdomenisorganised,andanimageisshownonpage7ofthesupplementaryinformationbooklet.i.(5marks)WhataretheimportantfindingsontheCTimage?
ii.(4marks)Give4differentialdiagnosesfortheCTfindings.
1.2.3.4.
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question 6.iii.(8marks)Describeyourimmediatemanagement(8marks)
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question 7.A38yearoldfemalepresentstoyouremergencydepartmentwithsevereconstantrightupperquadrantpain.Shecomplainsofurinethatisdarkercolourthannormalandsignificantsweatingovernight.Shealsofeelsnauseousandhasnoappetite.Onexaminationshehassevererightupperquadranttendernessandnotableocularjaundice.Hervitalsignsare: HR 125 /min BP 89/52 mmHg RR 29 /min Sats 98% RA T 39.6 oCi.(6marks)Give3pathologytestswillyouperformonthispatientandajustificationforeach?
ii.(8marks)Selectedpathologyisshownonpage8ofthesupplementaryinformationbooklet..Describetheresultsandtheirimplications.
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question 7.iii(3marks).WhataretheadvantagesofultrasoundoverCTinimagingthispatient?(3marks)
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question8.A48yearoldmalepresentstoyourdepartmentafterbeingstruckintherighteyewithasquashball.Heiscomplainingofblurredvisionandaheadache.Hisrightorbitisswollenandbruisedbuttherearenoothermajorinjuries.i.(5marks)Foreachcategorylistedbelowgivetherequestednumberoffeaturesyouwillexamineforandtheinjuriestheymayrepresent
PUPIL:1.2.EYEMOVEMENTS1.2.LIP1.ii.(2marks)ACTscanofthepatient’sfaceisshownonpage9ofthesupplementaryinformationbooklet.Whatarethetwomajorabnormalities?
1.2.
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question8.iii(4marks).Whataretheindicationsforsurgeryinthisfracture?
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question9.A46yearoldpatientpresentstoyourhospitalwith20minutesofcrushingcentralchestpain.YoudonothavePCIfacilitiesinyourinstitution.Thenearestcardiaccatheterlaboratoryis40minutesaway.i.(4marks)HisECGisshownonpage10ofthesupplementaryinformationbooklet.Give3majorabnormalitiesandalikelydiagnosis.
ii.(6marks)ExplainthreeissuesyouwouldconsiderindeterminingwhethertosendthispatientforprimaryPCIorusethrombolysisintheED.
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
iii.(6marks)LogisticfactorspreventthetimelytransferofthepatienttothePCIfacilityandadecisionistakeninconsultationwithcardiologytodeliverprimarythrombolysis.Listthemedicationsinsequencethatyouwillgivetoachievethis.
iv.(1mark)OnehourafterlysisthepatientispainfreeandtheSTsegmentshaveresolved.WhatisyourtimeframefortransferringthemtoaPCIcentre?
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question10.A16yearoldapprenticepresentstoyouremergencydepartmentafteranindustrialaccident.Alargeglasspanedroppedfromaheightontohisrightarmonabuildingsite.i.(5marks)Hisinitialxrayisshownonpage11ofthesupplementaryexaminationbooklet.Givefive(5)importantfeaturesofthexray.
ii.(8marks)Usingthetableonthefollowingpagelist4structureswhichmaybedamagedinassociationwiththisorthopaedicinjury,andgiveaclinicalsignyouwillassessfortoevaluatethestructure.