IRB Roadblock form

INITIATION ROAD BLOCK EXAM

INITIATION ROAD BLOCK

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QUESTION 1.

A 58 year old man presents to your department by ambulance from a construction site after being hit in the chest and face by a large concrete block swinging from a pulley. He has sustained no other injuries.

His vital signs on arrival are:

HR                    115      /min
BP                    99/66   mmHg
RR                    28        /min
O2 sats             95%      6L via mask
GCS                  7

i. (4 marks)

Give 4 signs on chest examination that may indicate the possibility of a pneumothorax.

Answer: Give 4 signs on chest examination that may indicate the possibility of a pneumothorax. *

ii. (4 marks)

The patient’s chest xray is taken just after arrival and is shown below. Give 2 major abnormalities from the film and the underlying diagnosis.

Answer: Give 2 major abnormalities from the film and the underlying diagnosis. *

iii. (2 marks)

After the patient’s xray returns he suffers increasing respiratory distress, de-saturates and has a cardiac arrest. What two actions would you immediately undertake?

Answer: After the patient’s xray returns he suffers increasing respiratory distress, de-saturates and has a cardiac arrest. What two actions would you immediately undertake? *

iv. (1 mark)

After your actions above the patient regains immediate output but remains hypotensive with a systolic BP of 78mmHg. What volume resuscitation will you administer to this patient?

Answer: After your actions above the patient regains immediate output but remains hypotensive with a systolic BP of 78mmHg. What volume resuscitation will you administer to this patient? *

v. (5 marks)

Give 5 endpoints you would use to judge the efficacy of your volume resuscitation

Answer: Give 5 endpoints you would use to judge the efficacy of your volume resuscitation *

QUESTION 2.

A 35 year old motor bike rider is brought in by ambulance after a collision with a car. The ambulance report multiple injuries on scene. The accident occurred 500m from the entry to the hospital, so the ambulance have applied a c-collar, inserted an IVC and brought the patient to your department with no other interventions undertaken.

The patient’s vital signs on arrival are:

HR                          145         /min
BP                           90/72     mmHg
RR                           29           /min
O2 sats                 98%        6L via mask
GCS                        6

i. (2 marks)

Which induction agent will you use to intubate this patient? Justify your choice.

Answer: Which induction agent will you use to intubate this patient? Justify your choice. *

ii (12 marks)

Give 2 paralytic agents you would consider using, the dose of each agent, and two advantages and disadvantages of each.

Answer: Give 2 paralytic agents you would consider using, the dose of each agent, and two advantages and disadvantages of each. *

Question 3.

A 19 year old man presents with the ambulance after being assaulted with a broken glass at a nightclub.

On arrival his vital signs are:

HR          105         /min
BP           99/62     /min
RR           16           /min
Sats        98%       RA
T              36.3        oC

A clinical image of the patient’s wound is shown below.

i. (10 marks)

List five anatomic structures which may be injured, and give a clinical feature or complication for each that would indicate damage.

Answer: List five anatomic structures which may be injured, and give a clinical feature or complication for each that would indicate damage. *

ii. (4 marks)

Is imaging appropriate in THIS patient and why?

Answer: Is imaging appropriate in THIS patient and why? *

iii. (4 marks)

List 2 important imaging studies that you could perform and the indication for each.

Answer: List 2 important imaging studies that you could perform and the indication for each. *

Question 4.

A 55 year old man presents 5 days after a colonoscopy with left iliac fossa pain. During his colonoscopy several polyps were removed, and significant diverticular disease was noted to the descending and sigmoid colon. He has a history of COPD, and uses nebulized bronchodilators at home.

His vital signs are:

HR          90                           /min
BP           120/80 mmHg
RR           22                           /min
Sats        98%                        RA
T              38.2                        oC

i.(3 marks)

A venous blood gas is taken by the resident, and results are shown below. What are the major acid-base disturbances present?

Answer: A venous blood gas is taken by the resident, and results are shown. What are the major acid-base disturbances present? *

ii. (2 marks)

Provide 2 derived values to support your answer.

Answer: Provide 2 derived values to support your answer. *

iii. (4 marks)

List 4 differentials for this patient’s presentation.

Answer: List 4 differentials for this patient’s presentation. *

iv. (4 marks)

A CT scan of the patient’s abdomen is shown below. What is the major abnormality and what diagnosis does it imply?

Answer: A CT scan of the patient’s abdomen is shown. What is the major abnormality and what diagnosis does it imply? *

Question 5.

A 58 year old man presents with a history of dizziness and feeling lightheaded. He has a history of hypertension and osteoarthritis.

His vital signs are:
HR                          77           /min
BP                           115/70 mmHg
RR                           17           /min
Sats                        98%        RA
T                              37.1        oC
GCS                        15

i. (4 marks)

His ECG is shown on page 6 of the supplementary clinical information booklet. List 3 abnormalities on the ECG and give your diagnosis

Answer: His ECG is shown. List 3 abnormalities on the ECG and give your diagnosis *

ii. (6 marks)

List 3 potential causes of these changes and give an example of each.

Answer: List 3 potential causes of these changes and give an example of each. *

iii. (3 marks)

Give 3 pharmacologic therapies you could institute if this patient became bradycardic and hypotensive.

Answer: Give 3 pharmacologic therapies you could institute if this patient became bradycardic and hypotensive. *

iv. (5 marks)

In the event of non responsiveness to drugs, describe your procedure for transthoracic pacing.

Answer: In the event of non responsiveness to drugs, describe your procedure for transthoracic pacing. *

question 6.

A 66 year old woman presents to the department with severe right upper quadrant pain of 36 hours duration. She has a prior history of biliary colic and is awaiting elective cholecystectomy.

Her vital signs are:

HR          102                         /min
BP          99/59                    mmHg
RR          27                           /min
Sats       99%                       RA
T             39.6                       oC

Her UEC and LFT profile returns from the laboratory and is shown below.

i. (3 marks)

What are the major abnormalities, and what do they suggest?

Answer: What are the major abnormalities, and what do they suggest? *

ii. (2 marks)

Your registrar has ordered a chest xray and the film is reproduced below. What is the major abnormality and what is the likely diagnosis in view of the information you have so far gathered?

Answer: Your registrar has ordered a chest xray and the film is reproduced. What is the major abnormality and what is the likely diagnosis in view of the information you have so far gathered? *

iii. (6 marks)

List 5 important management interventions you will institute

Answer: List 5 important management interventions you will institute *

question 7.

A 36 year old male presents to the emergency department with a suspected overdose of an unknown tablet 2 hours previously.

Her vital signs are:

HR                          112         /min
BP                           118/60 mmHg
RR                           27           /min
Sats                        100%     RA
T                              39           oC
His ECG shows sinus rhythm.

i. (6 marks)

The patient’s venous gas is reproduced below.

Describe and interpret the major abnormalities. Provide calculations where relevant to support your answers.

Answer: The patient’s venous gas is reproduced above. Describe and interpret the major abnormalities. Provide calculations where relevant to support your answers. *

ii. (3 marks)

What active treatment apart from haemodialysis, would you commence on this patient?

Answer: What active treatment apart from haemodialysis, would you commence on this patient? *

iii. (4 marks)

Give 4 indications for haemodialysis in this patient.

Answer: Give 4 indications for haemodialysis in this patient. *

iv. (4 marks)

Outline your criteria for medically clearing this patient for discharge.

Answer: Outline your criteria for medically clearing this patient for discharge. *

question 8.

A 15 month old girl is brought to your emergency department by her nanny with burns, only to the areas shown in the photograph below. The history given is that the toddler pulled a cup of hot coffee from a bench onto herself.

i. (6 marks)

Describe the burn.

Answer: Describe the burn. *

ii. (5 marks)

Give 6 steps in your initial management of this patient.

Answer: Give 6 steps in your initial management of this patient. *

iii. (5 marks)

List 5 characteristics of burns that mandate transport to a burns centre.

Answer: List 5 characteristics of burns that mandate transport to a burns centre. *

question 9.

A 26 year old woman is brought in by ambulance following drinking an unknown quantity of domestic bleach as a suicide attempt. She denies taking any tablets. Her complaints are nausea and pain on swallowing.

HR          115                        /min
BP           110/63                  /min
RR          22                           /min
Sats        99%                       RA
T             38                           oC

i. (5 marks)

List 5 features you would seek in history or examination to evaluate the severity of potential oesophageal burns.

Answer: List 5 features you would seek in history or examination to evaluate the severity of potential oesophageal burns. *

ii. (6 marks)

List 6 investigations you would perform and the indication for each.

Answer: List 6 investigations you would perform and the indication for each. *

iii. (7 marks)

Comment on the role and use of the following in this patient:
1. MOUTH RINSE
2. ACTIVATED CHARCOAL
3. STOMACH ASPIRATION
4. NEUTRALISING SOLUTION
5. INTUBATION
6. BROAD SPECTRUM ABX
7. CORTICOSTEROIDS

Answer: Comment on the role and use of the following in this patient: MOUTH RINSE ACTIVATED CHARCOAL STOMACH ASPIRATION NEUTRALISING SOLUTION INTUBATION BROAD SPECTRUM ABX CORTICOSTEROIDS *

iv. (2 marks)

Briefly outline your discharge criteria for any patient presenting to the ED following corrosive ingestion.

Answer: Briefly outline your discharge criteria for any patient presenting to the ED following corrosive ingestion. *

question 10.

A 78 year old woman presents after (?injury) with acute neck pain and difficulty moving her arms and legs. She has severe respiratory distress and is being bagged by the ambulance.

A decision is made to perform a rapid sequence intubation. Following induction and paralysis, the patient’s airway obstructs and she becomes unable to be bagged. A view of the cords is unobtainable on laryngoscopy due to upper airway haematoma obstructing the view.

The patient has desaturated to 82% and you are not able to ventilate via bag valve mask.

i. (8 marks)

List 4 approaches you might take to ventilate the patient with either an advantage or disadvantage of each.

Answer: List 4 approaches you might take to ventilate the patient with either an advantage or disadvantage of each. *

ii. (3 marks)

A CT scan of the patient’s c-spine is taken and an image is shown below. Describe the major abnormalities.

Answer: A CT scan of the patient’s c-spine is taken and an image is shown below. Describe the major abnormalities. *

ii. (3 marks)

A CT scan of the patient’s c-spine is taken and an image is shown on page 11 of the supplementary information booklet. Describe the major abnormalities.

Answer: A CT scan of the patient’s c-spine is taken and an image is shown on page 11 of the supplementary information booklet. Describe the major abnormalities. *

iii. (1 mark)

The patient’s CT scans (pelvis, abdomen, chest & head) show no other injuries. There are no long bone fractures evident on secondary survey.

The patient’s vital signs on returning from CT are:

HR                          41           /min
BP                           72/42     mmHg
RR                           16           /min (ventilated)
O2 sats                 100%     FiO2 tube 40%

What is the diagnosis?

Answer: What is the diagnosis? *

iv. (2 marks)

Give 2 interventions you will apply to treat this issue.

Answer: Give 2 interventions you will apply to treat this issue. *

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