IDNUMBER:
UniversityHospital,Geelong
EmergencyMedicine
TrialFellowshipExam
ShortAnswerQuestions(SAQ)
Week29
DIRECTIONSTOCANDIDATE
1. Answereachquestioninthespaceprovidedinthisquestionpaper.
2. Donotwriteyournameonthisquestionpaper.
3. Enteryourexaminationnumberinthespacebelow.
4. Crossoutanyerrorscompletely.
5. Donotbegintheexamuntilinstructedtodoso.
6. Donottakeexaminationpaperormaterialsfromthisroom.
7. Thebookletbindermayberemovedduringtheexam.
QUESTION&ANSWER
BOOKLET
UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29
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Question1(18marks)An84yearoldwomanisbroughttoyouremergencydepartmentbyherdaughter,whoishercarer.Herdaughterreportsthatthepatientishavingdifficultwithmobilisationtoday.Thetriagenurseapproachesyouwithaconcernofpossibleelderabuse.
a. Listfour(4)behavioursthatthecarermaydisplaythatwouldsupporttheconcernofelderabuse.(4marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
4. ________________________________________________________________________
b. Listfour(4)examinationfeaturesofthepatientthatwouldsupporttheconcernofelderabuse.(4marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
4. ________________________________________________________________________
UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29
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Question1(continued)Thepatientappearsunwellandfrail.Youmakeaclinicalandradiologicaldiagnosisofleftlowerlobepneumonia.Hervitalsigns: BP 75/60 mmHg
HR 160 bpm(sinustachycardia)
RR 50 bpm
Temp 39.6 °C
O2sat 86% onroomair
GCS 10 (E3,V3,M4)
Thepatientfailstorespondtoyourescalationoftreatmentoverthenext1hour.Thedaughtersaysshewants“everythingdone”.
c. Listfive(5)factorsthatyouwouldconsiderwhendiscussingthisrequestwiththedaughter.(5marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
4. ________________________________________________________________________
5. ________________________________________________________________________
UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29
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Question1(continued)Thedaughterreportsthatthepatientisaregisteredorgandonorandwishestopursuethepossibilityoforgandonation.
d. Listfive(5)criteriathatmustbemet,ingeneral,fortheconsiderationoforgandonation.(5marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
4. ________________________________________________________________________
5. ________________________________________________________________________
UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29
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Question2(13marks)A35year-oldwomandriverwasinvolvedinamotorvehiclecollision.Shewaswearingaseatbelt,self-extricatedherselfandwasambulantatthescene.Whilegivingdetailstothepolice,shereportedneckpainwhichwasnotpresentforthefirst10minutespostcollision.Shearrivesbyambulanceinsittingpositionwithoutspinalimmobilisation.Arigidcervicalcollarisplacedattriage.Hermaincomplaintisofmoderateseverityneckpain.
a. Listfour(4)featuresonhistoryorexaminationthatwouldmandatetheneedforcervicalspineimaging.(4marks)
1. _______________________________________________________________________
2. _______________________________________________________________________
3. ________________________________________________________________________
4. ________________________________________________________________________
b. Assumingtheabsenceofallofthesefeatures,listthree(3)lowriskfactorsofthispresentationasstatedthatallowsafeassessmentofrangeofmovementofhercervicalspine.(3marks)
1. _________________________________________________________________________
2. _________________________________________________________________________
3. _________________________________________________________________________
UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29
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Question2(continued)c. Adecisionismadetoprogresstoimaging.Stateone(1)importantproandone(1)
importantconfortheimagingoptionsbelow,forthispatient.(6marks)
Imagingoption Pro(3marks)
Con(3marks)
Plainxrayseries
CTCSpine
MRICspine
UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29
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Question3(13marks)A16yearoldgirlpresentstotheemergencydepartmentwithlowerabdominaldiscomfortandpervaginalbleedingof24hourduration.Shethinksthatshemaybepregnantonthebasisofonemissedperiod(LNMP6weeksago).
a. Completethetablebelow,demonstrating,inlistformat,yourunderstandingoftheroleofaurinepregnancytestinthispatient.(4marks)
Significanceofapositiveresult(2marks)
1.
2.
Significanceofanegativeresult(2marks)
1.
2.
Herurinarypregnancytestispositive.
b. Listtwo(2)circumstancesinwhichavaginalspeculumexaminationwouldbeindicatedforthispatient.(2marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29
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Question3(continued)
Atransvaginalultrasoundshowsanormal6weekintrauterinepregnancy.Thepatientstatesthatshedoesnotwishtocontinueherpregnancy.
c. Listthree(3)factorsonhistorythatyouwouldseekfromthepatientwithrespecttothisstatement.(3marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
Thepatient’sparentsarriveanddemandtoknowwhatiswrongwithher.
d. Listfour(4)stepsthatyouwouldtakeinresponsetothisrequest.(4marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
4. ________________________________________________________________________
UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29
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Question4(12marks)
An18monthboypresentswith24hoursofvomitingandbloodydiarrhoea.
a. OtherthanHaemolyticuraemicsyndrome,listfour(4)likelycausesforthispresentation.(4marks)
1. _________________________________________________________________________
2. _________________________________________________________________________
3. _________________________________________________________________________
4. _________________________________________________________________________
b. Listfour(4)featuresonexaminationthatwouldsupportthediagnosisofhaemolyticuraemicsyndrome.(4marks)
1. _________________________________________________________________________
2. _________________________________________________________________________
3. _________________________________________________________________________
4. _________________________________________________________________________
UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29
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Question4(continued)
c. Listfour(4)laboratoryfindingsthatareconsistentwithhaemolyticuraemicsyndrome.(4marks)
1. _________________________________________________________________________
2. _________________________________________________________________________
3. _________________________________________________________________________
4. _________________________________________________________________________
UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29
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Question5(12marks)A64year-oldmanpresentstoyourEmergencyDepartmentwithchestpain.AnECGistaken-BothhispreviousrestingECG(“ECG1”)andECGhiscurrentECGwithpain(“ECG2”)areshown-refertothepropsbookletpage1.
a. Statefive(5)abnormalfindingsinECG1.(5marks)1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
4. ________________________________________________________________________
5. ________________________________________________________________________
b. Statetwo(2)differentabnormalfindingsshowninECG2.(2marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29
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Question5(continued)
c. StatethesignificanceofthechangesinECG2,whencomparedtoECG1.Includereferencetoevidencebasedcriteriainyouranswer.Includefive(5)statementsinyouranswer.(5marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
4. ________________________________________________________________________
5. ________________________________________________________________________
UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29
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Question6(12marks)A3yearoldmalepresentswithshortnessofbreath.
ACXRistaken-refertothepropbookletpage2.
a. Whatisthediagnosis?(1mark)
___________________________________________________________________________
b. Statefive(5)radiologicalfeaturesinthisCXRthatsupportthisdiagnosis.(5marks)
1. _________________________________________________________________________
2. _________________________________________________________________________
3. _________________________________________________________________________
4. _________________________________________________________________________
5. _________________________________________________________________________
UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29
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Question6(continued)c. Listsix(6)factorsthatyouwouldconsiderwhendeterminingdispositionforthis
patient.(6marks)
1. _________________________________________________________________________
2. _________________________________________________________________________
3. _________________________________________________________________________
4. _________________________________________________________________________
5. _________________________________________________________________________
6. _________________________________________________________________________
UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29
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Question7(12marks)A23yearoldmanwithadecreasedlevelofconsciousnessisbeingassessedinyourEmergencydepartment.Anarterialbloodgasistaken-refertothepropsbookletpage3.Hisarterialbloodgasresultswithreferencerangesareshownbelow:
a. Providefour(4)calculationstohelpyoutointerprettheseresults.(4marks)Derivedvalue1:
___________________________________________________________________________
___________________________________________________________________________
Derivedvalue2:___________________________________________________________________________
___________________________________________________________________________
Derivedvalue3:___________________________________________________________________________
___________________________________________________________________________
Derivedvalue4:___________________________________________________________________________
___________________________________________________________________________
UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29
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Question7(continued)
b. Usingthisscenarioandthederivedvalues,listthree(3)likelypotentialcausesfortheabnormalresults.(3marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
c. Statetwo(2)prosandthree(3)consfortheuseofbicarbonateinthispatient.(5
marks)
Pros:
1. ________________________________________________________________________
2. ________________________________________________________________________
Cons:
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29
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Question8(13marks)Completethetablebelow,bystatingone(1)expecteddose-dependentclinicaleffectforeachdoserangeofVenlafaxineoverdose.Statealsoone(1)pointofmanagementofvenlafaxineoverdoseforeachdoserangeupuntil>7grams-forthisdoserangestatethree(3)managementsteps.(10marks)
Doserange Clinicaleffect(4marks)
Managementindicated(6marks)
<1.5g
1.
1.
>3-4.5g
1.
1.
>4.5-7g
1.
1.
>7g
1.
1.
2.
3.
UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29
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Question8(continued)
a. Listthree(3)criteriathatmustbemetinapatientwithavenlafaxineoverdosefortheuseofactivatedcharcoal.(3marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29
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Question9(18marks)
Youhavejustcommencedyourmorningshiftintheemergencydepartment.Anurseasksyoutocomeandseea50yearoldmalepatientattherequestofoneofthenightregistrarswhoishavingdifficultyplacingacentralvenousline.ThepatientrequiresintravenousaccessforseverecellulitisthathasbeenresistanttooralantibioticsandtheregistrarwasunabletoobtainperipheralIVaccess.Onyourarrival,theregistrarnotesthathewasonlypartiallyabletoinsertarightinternaljugularcatheterandhas“lost”thewireinthepatient.Achestxraythathehasperformedconfirmsthattheguide-wireisintheSVCandrightatrium.
a. Listthefive(5)elementsofopendisclosure.(5marks)
1. _______________________________________________________________________
2. _______________________________________________________________________
3. _______________________________________________________________________
4. _______________________________________________________________________
5. _______________________________________________________________________
UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29
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Question9(continued)
b. Otherthanopendisclosure,listsix(6)KEYmanagementstepsforthissituation.(6marks)
1. _______________________________________________________________________
2. _______________________________________________________________________
3. _______________________________________________________________________
4. _______________________________________________________________________
5. _______________________________________________________________________
6. _______________________________________________________________________
c. Listthree(3)stepsthatcouldbeusedtodeterminethataregistrarissafetoperformacentralvenouslineunsupervised.(3marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29
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Question9(continued)
d. Listfour(4)limitationsthatcouldbeplacedontheinitialperformanceofunsupervisedinsertionofacentralvenousline.(4marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
4. ________________________________________________________________________
IDNUMBER:
UniversityHospital,Geelong
EmergencyMedicine
TrialFellowshipExam
ShortAnswerQuestions(SAQ)
Week29
PROPBOOKLET
UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29
1
Question5
ECG1 PreviousrestingECG
ECG2 CurrentECGwithpain