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University Hospital, Geelong Emergency Medicine Trial ... · you to come and see a 50 year old male...

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ID NUMBER: University Hospital, Geelong Emergency Medicine Trial Fellowship Exam Short Answer Questions (SAQ) Week 29 DIRECTIONS TO CANDIDATE 1. Answer each question in the space provided in this question paper. 2. Do not write your name on this question paper. 3. Enter your examination number in the space below. 4. Cross out any errors completely. 5. Do not begin the exam until instructed to do so. 6. Do not take examination paper or materials from this room. 7. The booklet binder may be removed during the exam. QUESTION & ANSWER BOOKLET
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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

1

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

2

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

3

Question1(continued)Thedaughterreportsthatthepatientisaregisteredorgandonorandwishestopursuethepossibilityoforgandonation.

d. Listfive(5)criteriathatmustbemet,ingeneral,fortheconsiderationoforgandonation.(5marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

5. ________________________________________________________________________

UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29

4

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

5

Question2(continued)c. Adecisionismadetoprogresstoimaging.Stateone(1)importantproandone(1)

importantconfortheimagingoptionsbelow,forthispatient.(6marks)

Imagingoption Pro(3marks)

Con(3marks)

Plainxrayseries

CTCSpine

MRICspine

UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29

6

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

7

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

8

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

9

Question4(continued)

c. Listfour(4)laboratoryfindingsthatareconsistentwithhaemolyticuraemicsyndrome.(4marks)

1. _________________________________________________________________________

2. _________________________________________________________________________

3. _________________________________________________________________________

4. _________________________________________________________________________

UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29

10

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

11

Question5(continued)

c. StatethesignificanceofthechangesinECG2,whencomparedtoECG1.Includereferencetoevidencebasedcriteriainyouranswer.Includefive(5)statementsinyouranswer.(5marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

5. ________________________________________________________________________

UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29

12

Question6(12marks)A3yearoldmalepresentswithshortnessofbreath.

ACXRistaken-refertothepropbookletpage2.

a. Whatisthediagnosis?(1mark)

___________________________________________________________________________

b. Statefive(5)radiologicalfeaturesinthisCXRthatsupportthisdiagnosis.(5marks)

1. _________________________________________________________________________

2. _________________________________________________________________________

3. _________________________________________________________________________

4. _________________________________________________________________________

5. _________________________________________________________________________

UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29

13

Question6(continued)c. Listsix(6)factorsthatyouwouldconsiderwhendeterminingdispositionforthis

patient.(6marks)

1. _________________________________________________________________________

2. _________________________________________________________________________

3. _________________________________________________________________________

4. _________________________________________________________________________

5. _________________________________________________________________________

6. _________________________________________________________________________

UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29

14

Question7(12marks)A23yearoldmanwithadecreasedlevelofconsciousnessisbeingassessedinyourEmergencydepartment.Anarterialbloodgasistaken-refertothepropsbookletpage3.Hisarterialbloodgasresultswithreferencerangesareshownbelow:

a. Providefour(4)calculationstohelpyoutointerprettheseresults.(4marks)Derivedvalue1:

___________________________________________________________________________

___________________________________________________________________________

Derivedvalue2:___________________________________________________________________________

___________________________________________________________________________

Derivedvalue3:___________________________________________________________________________

___________________________________________________________________________

Derivedvalue4:___________________________________________________________________________

___________________________________________________________________________

UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29

15

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

16

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

17

Question8(continued)

a. Listthree(3)criteriathatmustbemetinapatientwithavenlafaxineoverdosefortheuseofactivatedcharcoal.(3marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29

18

Question9(18marks)

Youhavejustcommencedyourmorningshiftintheemergencydepartment.Anurseasksyoutocomeandseea50yearoldmalepatientattherequestofoneofthenightregistrarswhoishavingdifficultyplacingacentralvenousline.ThepatientrequiresintravenousaccessforseverecellulitisthathasbeenresistanttooralantibioticsandtheregistrarwasunabletoobtainperipheralIVaccess.Onyourarrival,theregistrarnotesthathewasonlypartiallyabletoinsertarightinternaljugularcatheterandhas“lost”thewireinthepatient.Achestxraythathehasperformedconfirmsthattheguide-wireisintheSVCandrightatrium.

a. Listthefive(5)elementsofopendisclosure.(5marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

5. _______________________________________________________________________

UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29

19

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

20

Question9(continued)

d. Listfour(4)limitationsthatcouldbeplacedontheinitialperformanceofunsupervisedinsertionofacentralvenousline.(4marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29

21

IDNUMBER:

UniversityHospital,Geelong

EmergencyMedicine

TrialFellowshipExam

ShortAnswerQuestions(SAQ)

Week29

PROPBOOKLET

UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29

1

Question5

ECG1 PreviousrestingECG

ECG2 CurrentECGwithpain

UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29

2

Question6

UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek29

3

Question7


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