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Question 1

60 years old man was brought in to ED unconscious. Cardiac monitor was attached to the patientand the rhythm is as above. Picture of asystole on monitor

1. hat is your immediate action to confirm the rhythm !"#ar$s% Flat line protocol

a. : Check monitor display for sensitivity or "gain"

b. : Check LEAD SELEC

c. : Check po!er to both defibrillator and monitor

d. : Check all connections: device cables cables patient device paddles paddle patient

&. 'fter completing the immediate action as above the EC( rhythm remained the same.hat is your EC( diagnosis !1#ar$%

Asystole

). Enumerate your immediate actions after confirming the diagnosis. !*#ar$s%

a# Assess for responsiveness

b# Assess air!ay breathing circ$lation %&' !ith man$al res$scitator

c# Chest compression: ventilation ():*

d# Complete + cycles of C: & and re,assess -& dr$gs of adrenaline and atropine inbet!een cycle

e# Look for ca$se of asystole /0s and + 0s

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Question &

+n one of your night shift in Emergency Department you received a "* year old man, brought in by the paramedics following a motor vehicle crash in which he was at the frontseat, restrained passenger. -he driver of the car died at the scene.

-he following are the findings during uic$ primary surveyPicture of car crash Air!ay: Clear

%reathing: 1espiratory 1ate 211#: *34min L$ng: e ual air entry bilaterally

Circ$lation: C1 : 5* sec. Pulse /0 min, P 120 110

Dysf$nction: (lasgow Coma 3core * !E141#)%. 5eft pupils dilated

E6pos$re: o other obvious in7uries

1. hat is the triage you should give to this patient base on the above information8!& #ar$s%

riage 7 21ed#&. hat is the resuscitation principle in your management of this patient8 !6#ar$s%

a# 8pen air!ay and C spine control b# 9rovide 86ygenation and ventilationc# 'aintain good circ$lation,-& accessd# look o$t for severe hemorrhage2open or conceal#e# e6pose and environment control

f# immediate C 18 brain in $ry

). ame the clinical state that give rise to above vital signs findings !ar$s% C$shing 1efle6

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Question )

9/ y.o. lady who is hypertensive and diabetic, was brought in by a relative to the ED. the relativeinformed that the patient has been acting :strangely:, not ta$ing her brea$fast this morning andalso having generali;ed wea$ness.

7. 5ist ) component of Cincinnati Prehospital stro$e scale !6 #ar$s%a. arm drift b. facial asymmetryc. sl$rred speech

*. 5ist ) most li$ely differential diagnosis !) #ar$s%

a# /ypoglycemiab# //S c# Stroke C&A

d# Dementiae# Sepsis

). ame one important immediate bed side test that should be done in EmergencyDepartment for this patient !1 #ar$%a# ;l$cometer b# EC;c# A%;

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Question "

#r. 5im =?> 1&/ min, ??> &" min, 3 P> 9/mm=g, (C3> 1* 1*, o obvious

e@ternal hemorrhage was noted. =is peripheries are cold and peripheries veins are collapsed.'d7unct to primary survey revealed free fluid in the abdominal cavity via A'3-.Picture of Pelvic 'P @ ray

1. Describe the @ ray findings. !& #ar$s%a# Left and lateral p$bic ram$s < b# 9rotr$sion acetab$l$m4 acetabel$m fract$re

&. ame patient clinical state. ! & #ar$s%a# /ypovolemic shock

). ame three sites for insertion of B4 access8 !) #ar$s%

a# Antec$bital fossab# Femoral veinc# -=&

". hat is the reason for choosing the above sites8 !& #ar$s%a# Collapsed peripheriesb# Aim for large bore vein

*. ame & other alternative available if you failed to get B4 access !ar$s%a# -ntraosseo$s 2-8#b# &eno$s 0c$t do!n0 c# E

6. ame ) types of fluids that can be used for fluid resuscitation in trauma !) #ar$s%a# Crystalloid b# Colloid c# %lood

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Question *

Picture shown is the commonly used e uipment in Emergency department

1. ame the item ', ,C and D. !ar$s%a. '> E-- b. > +P'c. C> P'd. D> 5#'

&. Describe correct way to insert item !"mar$s%a. Place the oropharyngeal airway along the outside of the casualty:s 7aw with one

end of the airway at the bottom tip of the casualty:s ear. b. -he airway should reach from the bottom tip of his ear to the corner of his mouth.

Patient in supine positionc. Place your thumb and inde@ finger of one hand on the casualty:s upper and lower

teeth near a corner of his mouth so the thumb and finger will cross when thecasualty:s mouth is opened.d. Place the tip end of the airway into the casualty:s mouth. #a$e sure the tip is on

top of the tongue.e. Point t he tip of the airway toward t he roof of the patient:s mo ut h to

preven t t he tongue from being pushed in to t he bac$ of t he th roat.f. 3lide the airway along the roof of th e mouth, following the natural

curvature of th e tongue, past th e soft palate.g. rotate the airway 1/0 degrees as th e tip reaches th e bac$ of th e tongue

). Bndication when to use item D !"#ar$s%a. 3ituations involving a difficult mas$ ! 4#% fit.

b. #ay be used as a bac$ up device where endotracheal intubation is not successful.c. #ay be used as a second last ditch airway where a surgical airway is the only

remaining option.

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Question 6

E uipment showed commonly used in Emergency department.

1. hat is the name of the e uipment shown8 !& #ar$s%

Ad $stable traction splint4/are traction splint

&. 5ist two of its functions8! " #ar$s%

a. raction

b. immobili>ation

hese !ill red$ce pain and bleeding

). riefly describe the principle by which it reduces bleeding in closed fracture. !" #ar$s%

Convert a spherical vol$me into a cylindrical vol$me thereby red$cing the hemorrhage

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Question 9

6/ years old lady found unconscious with no breathing and no pulse.

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Question /

EC( 3-E#B

6) year old man presented with central chest pain of two hours duration. +n e@amination his blood pressure was 20 60 mm =g, he had a wea$ pulse, distended nec$ veins with elevated 7ugular venous pressure, normal first and second heart sounds and lung fields were clear onauscultation

1. Describe the EC( findings !) #ar$s%a. S elevation on lead -- --- a&F

&. hat is your diagnosis8 !ar$s%a. -nferior '-

). Describe the principle of management in Emergency Department. !* #ar$s%a. A%CD of res$scitation

b. '8@Ac. hrombolysisd. 9roper 1eferral4disposition

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+3CE 2

"* years old man arrived to Emergency department with chest discomfort and palpitation and

about to faint. arre 9&C,like comple6es5).7* sec large !ave of opposite

polarity from 1S &.

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Question 10

&& years old female came to emergency department with shortness of breathing. +ne of the itemsused to assess her condition shown in the picture.

Picture of pea$ flow meter 1. ame the e uipment above. !1 #ar$%

9eak E6piratory Flo! 'eter &. Describe the techni ue would you tell the patient before using the above e uipment.

!6mar$s%a. Bero the indicator b. Attach the disposable paper mo$th piece to e $ipment

c. -nstr$ct her to take the deep breath and e6haled. @o! instr$ct her to take deep breath again hold and p$t e $ipment to mo$the. E6hale as strong and as fast as possible

f. 1epeat three times and gate the average reading. ). 5ist three signs which indicate that she is having a severe attac$. !)#ar$s%

a. nable to complete sentencesb. 9F' (+c. Silent chest d. Cyanosise. drop in Sp8 *

f. breathing $sing accessory m$scles

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Question 11

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Question 1&

1* years boy was brought by his mother to emergency department. =e was stung by an insect

half an hour agoG they managed to $ill the insect and brought it along !shown above%.-he child appeared flush and uncomfortable.=is vital> Pulse rate 1)) min, ?espiratory rate )& min, 3ystolic blood pressure /0mm=g, 3p+ &2/H on air. Picture of bee

1. hat is the name of the insect shown !1#ar$%ee

&. hat is your wor$ing diagnosis at this point.!ar$s%'llergic reaction with anaphylactic shoc$

3. 5ist other four clinical features of this conditions that you would li$e to loo$ for!ar$s%a. 3wollen face periorbital

b. 3tridor c. Difficulty in breathingd. ' red rash, with welts, that usually is itchy.e. 3wollen throat or swollen areas of the body.f. hee;ing !breathing that sounds li$e whistling from your chest%.g. 5+Ch. Chest tightness.i. ' hoarse voice.

7. -rouble swallowing.$. 4omiting.l. Diarrhea.

m. 'bdominal cramping.". Describe the management of this conditions.!*#ar$s%

a. ' CD of resuscitation b. 'drenalinc. Piritoin antihistamined. =ydrocortisone

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Question 1)

' warehouses and nearby tire factory are on fire. Estimated more than )0 wor$ers were wor$ingwhen the li uid petroleum cylinder tan$ e@ploded.

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Question 1"

66 years old patient was brought to emergency department by his son with complain of mild

headache for the past & days. =e was reviewed by an emergency medicine medical officer andlater discharged home with paracetamol for his headache.-en days later the same patient was brought in unconscious, reviewed and investigation revealedhe had sustained subarachnoid hemorrhage.-he son was not happy with new findings and wanted to ta$e legal action to previous doctor andto the hospital, giving reason why the initial doctor didnIt performed early C- scan to his father.1. Defined negligence.!& mar$s%

-he breach of legal duty to ta$e care which results in damage, undesired by the defendant, tothe plaintiff infield

J Bt properly connotes the comple@ concept of duty, breach and damage thereby suffered by the person to whom the duty was owing 5ord right

#edical negligence is concerned with the tort of negligence applied in specific conte@t of the provision of healthcare

&. ame the four elements that must be establish before a claim of medical negligence canraised

a. D$ty to act b. %reach of the d$tyc. 9resence of harmd. he harm arose from the breach of d$ty

). hat should be done by the initial doctor to avoid claim of negligence in the casea. ;ood doc$mentationb. 9roper4appropriate cons$ltation to emergency specialist or to respective team

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Question 1*

+bserve the PictureG

1. hat is the ha;ard in shown in this picture8 !& mar$s%

Aloods heavy rains typhoon monsoon rains

&. hat are the health ris$s8 3tate ) conditions !) mar$s%

ater borne illnesses, drowning, hypothermia !immersion syndrome%, trauma, fractures, headin7uries, death

). 3tate ) steps to be done after this ha;ard impact to decrease vulnerability of this communityto this ha;ard. !) mar$s%

?ehabilitation, return to normal living, preparedness activities, re engineering waterways

". 3tate & things a hospital can do to prepare for this ha;ard. !& mar$s%Develop early warning systems, emergency planning, response drills and e@ercises, rescuecapabilities li$e water rescue, and develop evacuation areas in high place which are not flood

prone

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