INTERLUDE EXAM 1.

    interlude exam 1.

    QUESTION 1.

    A 48 year old man presents to your department by ambulance a fire at a factory. He has sustained mid to deep thickness burns circumferentially over his right arm, his entire head, and his anterior torso and abdomen. You estimate his weight at 80kg.
     
    His vital signs on arrival are:

    HR                    119      /min
    BP                    103/66 mmHg
    RR                    28        /min
    O2 sats             95%      6L via mask
    GCS                  15

    i. (4 marks)
     
    Calculate the percentage of body surface area involved in this man’s burn.
    ii. (7 marks)
     
    Describe your fluid management strategy for this patient, including your underlying formula.

    iii. (4 marks)
     
    You are concerned about the patient’s airway status. Besides the facial burns themselves, give 4 examination findings that would indicate an airway burn.

    iv. (8 marks)
     
    Based on your findings above you elect to intubate the patient in the resus room. Your fellow consultant asks you to prepare for a surgical airway. Describe the procedure you will use in the event of failed oral or nasal intubation.

    QUESTION 2.

    A 60 year old man is brought by ambulance to your emergency department after a fire at a factory. He has no airway compromise or evidence of cutaneous burns, but he is GCS 12 and acutely confused.
     
    An arterial blood gas is shown below.
     
    The patient’s vital signs on arrival are:
     
    HR                    105      /min
    BP                    106/72 mmHg
    RR                    31        /min
    O2 sats             100%    Room air
    GCS                  12

     i. (10 marks)
     
    Describe and interpret the patient’s blood gas.

    ii (6 marks)
     
    Outline your specific management of this patient.
    iii. (3 marks)
     
    Give 3 indications to consider hyperbaric oxygen for this patient

    Question 3.

    You are asked to review your department’s radiology from the weekend. You find the xray of a 25 year old male who fell on his outstretched arm playing rugby league.
     
    A clinical image of the patient’s xray is below.
     
    The clinical notes record that the patient was diagnosed with a wrist sprain and discharged with a crepe bandage for GP follow up.

    ​
    i. (3 marks)
     
    Give two abnormalities present and a diagnosis.

    ii. (3 marks)
     
    Outline 3 actions you will now take.

    iii. (5 marks)
     
    The Emergency Director asks you to investigate the incident. Outline 5 steps you will take to do this.  

    iv. (3 marks)
     
    List 3 interventions that you can undertake to prevent a recurrence of a similar incident.

    Question 4.

    A 45 year old man presents having developed palpitations 4 hours previously. He is definite that this is the time of onset. He has no medical history of note.
     
    His vital signs are:
     
    HR        140                  /min
    BP        120/80             mmHg
    RR        17                    /min
    Sats      98%                  RA
    T          37.1                 oC

    i.(6 marks)
     
    His presentation ECG is shown below. Describe the ECG and give the diagnosis.
    ii. (9 marks)
     
    Give 3 options for managing this rhythm and a pro and con of each.

    ​
    iii. (4 marks)
     
    A decision is taken to electrically cardiovert the patient. Describe your procedure to achieve this.
     

    Question 5.

    A 22 year old woman presents via ambulance to the ED with no prearrival phone call. She is G4P3 at 39+2 weeks and labouring. As she is wheeled into your resus room the vertex is on view.
     
    The ambulance hands over that she has been labouring for 35 minutes, and has had appropriate antenatal care with no complications identified.
     
    Her vital signs with the ambulance en route have been normal.

    i. (8 marks)
     
    Describe your process for the management of the second stage of labour

    ​
    ii. (7 marks)
     
    The delivery of the child is uncomplicated. Describe your management of the third stage of labor.

    question 6.

    A 78 year old woman presents to the after an unwitnessed collapse from standing height. Her medical history includes the atrial fibrillation, managed with metoprolol and warfarin. She has a headache.
     
    Her vital signs are:
     
    HR       95                    /min
    BP        139/79             mmHg
    RR        17                    /min
    Sats     99%                 RA
    T          36.6                 oC
    GCS      15
    i. (3 marks)
     
    Give 4 clinical signs of skull fracture that you will assess as part of your examination of this patient.
     
    ii. (8 marks)
     
    Give 4 investigations you will order in this patient and a rationale for each.

    iii. (5 marks)
     
    The patient’s CT brain scan is shown below. Describe and interpret the major abnormalities.

    iv. (2 marks)
     
    The patient’s INR comes back at 1.8. Outline your management of this result.

    question 7.

    A 67 year old man presents with sudden complete painless visual loss in his left eye. He has a history of diabetes.

    i. (6 marks)
     
    Give 3 features on history you will enquire about and the potential disease they indicate.
    ii. (4 marks)
     
    A photo of the patient’s fundus is shown. Describe the major findings and the likely diagnosis.

    iii. (9 marks)
     
    There is no ophthalmology service at your hospital. Briefly outline 3 possible treatments that may benefit this patient, and a pro and con of each.

    question 8.

    A 65 year old man presents with right sided rhythmic loin pain. He has a prior history of presenting to the ED 6 months prior with a right sided renal stone of 3mm, diagnosed on CT KUB. His vital signs are:
     
    HR       85                    /min
    BP        149/85             mmHg
    RR        17                    /min
    Sats     99%                 RA
    T          37.1                 oC
    GCS      15

    i. (3 marks)
     
    List three differential diagnoses.

    ii. (10 marks)
     
    Give 2 medications classes you could use for analgesia and 2 advantages and disadvantages of each.
    iii. (9 marks)

    Give three imaging options in this patient and an advantage and disadvantage of each.

    question 9.

    A 21 year old man presents to the ED with a severe left temporal headache of 24 hours duration. He describes 3 days of preceding left ear ache. He has no medical history of note. His vital signs are:
     
    HR        105                   /min
    BP        110/63             /min
    RR        22                    /min
    Sats      99%                  RA
    T          38.6                 oC

    i.  (5 marks)
     
    List 5 differential diagnoses for this presentation.
    ​
    ii. (6 marks)
     
    List 4 features you will seek on clinical examination, and the rationale for each.
    iii. (4 marks)
     
    The patient has a CT scan of the head performed. An image is shown below. Describe the 2 major abnormalities and give a likely diagnosis.

    iv. (2 marks)
     
    Briefly outline your 2 next major steps in management.
    ​

    question 10.

    An 18 year old man presents after receiving an elbow to the face playing football.
     
    He is given a triage category 4 and put in the waiting room.

    i. (15 marks)

    List the 5 Australasian Triage Scale Categories, and for each give the timeframe to be seen and expected compliance rate.
    ii. (5 marks)
     
    The patient has avulsed his right incisor and has the tooth with him in his hand. Describe your management.