ROAD BLOCK 2

    ROADBLOCK 2

    QUESTION 1.

    A 19 year old man presents to the ED complaining of acute dyspnoea and right sided chest pain. He has no medical history of note.
     
    His vital signs are:
     
    HR                   88        /min
    BP                    120/80 mmHg
    RR                   19        /min
    Sats                 99%     RA
    Temp               37.1     oC

    i. (5 marks)
     
    Other than the vital signs, give five (5) signs of pneumothorax that you will assess this patient for on clinical examination.
    ii. (3 marks)
     
    The patient’s chest xray is shown below.
     
    What is the major finding?
    iii. (12 marks)
     
    Give 4 options for managing this patient’s pneumothorax in the ED, and an advantage and disadvantage for each.

    QUESTION 2.

    You receive notification from the local emergency services that there has been an explosion at the local football stadium while a match is being played. It is 6pm on Saturday evening and you are the only consultant on duty in your metropolitan emergency department.

    i. (7 marks)
     
    Give 7 pieces of information you will seek from the notifier.
    ii. (2 marks)
     
    In the context of disaster medicine, define a major incident.
    iii. (6 marks)
     
    Give three priorities you now have, and state your action(s) to enact them.

    Question 3.

    A 39 year old female presents to your department after an unknown drug overdose. Just prior to arrival the ambulance report she began to seize, and had a large vomit. There is no history of trauma.
     
    Her vital signs are:
     
    HR                   70        /min
    BP                    77/32  /min
    RR                   33        /min
    Sats                 99%     RA
    GCS                 6          E2M2V2

    ​
    i. (3 marks)
     
    The patient’s ECG on arrival is shown below.
     
    Give 3 abnormalities seen.
    ii. (6 marks)
     
     
    The patient has a blood gas in resus and the results are shown below. Give the acid base disturbances present and indicate if they are primary or secondary.

    Blood gas chemistry
     
    FiO2                    0.5
     
    pH                       7.12
    pCO2                   66              mmHg
    PO2                     88              mmHg
    HCO3                   16              mmol/L
    BE                       -8
     
    Na+                     145            mmol/L
    K+                        5.8`            mmol/L
    Cl-                       109            mmol/L
     
    Urea                   19              mmol/L
    Creatinine          190            umol/L
     
    Glucose              6.2             mmol/L
     
    iii. (3 marks)
     
    List 3 classes of drugs which may cause similar derangements to this on an ECG.

    Question 4. (continues from q3)

    The ambulance is able to confirm that the patient from question 3 has taken 40 100mg propranolol tablets.

    i. (1 mark)
     
    What is considered a lethal dose of propranolol?
    ii. (5 marks)
     
    List 5 potential clinical features of this overdose.

    iii. (5 marks)
     
    In the course of your management, the patient develops a ventricular arrhythmia
     
    (a) List 3 potential treatments
    (b) List 2 drugs that must be avoided


    iv. (5 marks)
     
    The patient’s blood pressure remains low. Give 5 treatments you could use to correct this.

    Question 5.

    A 50 year old diabetic presents with a painful swollen left knee. He has no history of trauma.
     
    His vital signs are:
     
    HR                   105      /min
    BP                    110/70 mmHg
    RR                   16        /min
    Sats                 99%     RA
    T                      37.9     oC
     
    A clinical image of his knee is shown below.
    i. (5 marks)
     
    Describe the photo and give 3 differentials.
     
    ii. (5 marks)
     
    Describe your procedure for aspirating this joint.

    iii. (4 marks)
     
    The joint aspirate results are shown below. The patient has significant pain after the aspirate.
     
    a) Give the likely diagnosis.
    b) Give 3 management steps you will enact

    question 6.

    A 4 year old boy presents to the hospital with a seizure of 30 minutes duration. He is noted to be bleeding from his right ear and have bruising to his right temple.
     
    You have received prehospital notification of the child’s arrival and are prepared to perform an RSI.

    ​
    i. (9 marks)
     
    Give 3 induction agents (or combinations of agents you would consider using in this child and specify an advantage and disadvantage of each.

    ii. (3 marks)
     
    Give three anatomic differences compared to an adult that you will need to consider when intubating this child.

    iii. (7 marks)
     
    List and describe the equipment you will require for this intubation.

    question 7. (Continues from question 6)

    The patient is taken to CT scan and the image is shown below.

    i. (4 marks)
     
    Describe the image findings and 2 implications

    ​
    ii. (11 marks)
     
    Social work brings the patient’s mother in from the waiting room where she has just arrived. She has a black eye.
     
    Outline the management that you will institute for the child and mother.
     
    a) List 3 immediate concerns in this case that you will need to address.
    b) List 4 elements of the history you will need to obtain from the mother
    c) Assuming your concerns are verifiable, outline the actions you will take to manage this case.

    question 8.

    Your regional emergency department receives a patient from the ambulance. The patient had just completed a 45 minute 20m scuba dive and collapsed after resurfacing.
     
    i. (6 marks)
     
    List 6  symptoms that would suggest acute decompression illness?

    ii. (5 marks)
     
    A provisional diagnosis of acute decompression illness is made. The nearest decompression chamber is 450km away. Outline your preparations for retrieval.

    iii. (15 marks)
     
    A provisional diagnosis of acute decompression illness is made. The nearest decompression chamber is 450km away.
     
    Give three options for transporting this patient and 2 pros and 2 cons for each.

    question 9.

     
    A 5 year old boy presents to your emergency department with a toothache, complaining of severe pain. The nurse in the paediatric area noticed that the child was tachycardic and so has performed an ECG which is reproduced below.
    i. (5 marks)
     
    Describe  and interpret the ECG.

    ii. (5 marks)
     
    What are the normal features of a paediatric ECG compared to that of an adult?

     
    ii. (2 marks)
     
    How will you manage this child on the basis of this ECG?

    question 10.

    A 20 year old man presents to your department concerned that he has been bitten by a snake. He did not actually see the snake, but felt a sharp bite on his right ankle during a bushwalk.

    i. (9 marks)
     
    Give 3 clinical effects that snakebite causes, and 2 examples of symptoms or signs you will seek in this patient for each.

    ii. (7 marks)
     
    The patient’s coagulation profile returns from the laboratory. He has no other symptoms or signs on exam.
     
    The results are shown below.
     
    a) Describe the results
    b) Outline your further treatment.

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