Week 12 SAQ electronic

MODULE 12 short answer questions.

Below are 7 SAQs. You have 42 minutes. Good luck!

Module 12 saQS

SAQ 1.

A 55 year old man presents to your emergency department with sudden onset central crushing chest pain.

His vital signs are:
HR       60                    /min
BP       108/55             mmHg
RR       28                    /min
Sats     92%                 6L

His ECG on presentation is shown below.

Question 1. (3 marks)

Give 3 major abnormalities shown on the ECG.

Question 1. (3 marks) Give 3 major abnormalities shown on the ECG. *

Question 2. (2 marks)

What is the diagnosis?

Question 2. (2 marks) What is the diagnosis? *

Question 3. (4 marks)

Which is the most likely artery affected, and why?

Question 3. (4 marks) Which is the most likely artery affected, and why? *

Question 4. (1 mark)

What other ECG will you perform on this patient?

Question 4. (1 mark) What other ECG will you perform on this patient? *

SAQ 2.

A 66 year old female presents to your department with acute central crushing chest pain of 2 hours duration.

Her vital signs are:

HR       48        /min
BP       69/45   mmHg
RR       32        /min
Sats     92%     6L

Question 1. (4 marks)

Give 4 major abnormalities from the ECG?

Question 1. (4 marks) Give 4 major abnormalities from the ECG? *

Question 2. (2 marks)

Where is the anatomical lesion?

Question 2. (2 marks) Where is the anatomical lesion? *

Question 3. (2 marks)

What further ECG investigations will you perform and why?

Question 3. (2 marks) What further ECG investigations will you perform and why? *

Question 4. (2 marks)

Why is this test important for management?

Question 4. (2 marks) Why is this test important for management? *

SAQ 3

A 48 year old male presents with acute chest pain of 90 minutes duration. An ECG is performed on arrival and shows an anterior STEMI.

Question 1. (3 marks)

What is your preferred repercussion strategy and why?

Question 1. (3 marks) What is your preferred repercussion strategy and why? *

Question 2. (3 marks)

The cardiology lab phones you to tell you there will be a 60 minute delay to the patient being transferred. Does this change your repercussion strategy?

Question 2. (3 marks) The cardiology lab phones you to tell you there will be a 60 minute delay to the patient being transferred. Does this change your repercussion strategy? *

Question 3. (5 marks)

A further delay of 60 minutes is anticipated. Describe your subsequent management of the patient.

Question 3. (5 marks) A further delay of 60 minutes is anticipated. Describe your subsequent management of the patient. *

SAQ 4

A 55 year old male presents to your ED with new onset central chest pain that occurred by walking up a hill. The pain was relieved by GTN and aspirin with the ambulance service.

He has no medical history of note, and takes no medications.

Question 1. (2 marks)

Give 2 further ACS high risk features you will look for as part of your workup.

Question 1. (2 marks) Give 2 further ACS high risk features you will look for as part of your workup. *

Question 2. (3 marks)

The patient’s ECG is shown below. What is the major abnormality and what is the diagnosis?

Question 2. (3 marks) The patient’s ECG is shown below. What is the major abnormality and what is the diagnosis? *

Question 3. (5 marks)

Your resident advises you the cardiology registrar has reviewed this patient, and plans to perform a stress test if serial troponin are negative at 6 hours. Describe your response.

Question 3. (5 marks) Your resident advises you the cardiology registrar has reviewed this patient, and plans to perform a stress test if serial troponin are negative at 6 hours. Describe your response. *

SAQ 5.

A 31 year old man on dialysis for end stage glomerulonephritis presents with central chest pain. He missed his dialysis 2 days ago.

An ECG on arrival is shown below.

Question 1. (3 marks)

What are the major abnormalities and what is the likely diagnosis?

Question 1. (3 marks) What are the major abnormalities and what is the likely diagnosis? *

Question 2. (5 marks)

Give 5 features on history and examination will you seek to would support this diagnosis?

Question 2. (5 marks) Give 5 features on history and examination will you seek to would support this diagnosis? *

The patient's urea and electrolyte profile returns.

Na+ 142 mmol/L
K+ 5.8 mmol/L
Cl- 102 mmol/L
HCO3- 15 mmol/L

Urea 38 mmol/L
Creatinine 780 umol/L

Question 3. (2 marks)

Give 4 major abnormalities present.

Question 3. (2 marks) Give 4 major abnormalities present. *

Question 4. (2 marks)

Give two management steps you will institute for this patient.

Question 4. (2 marks) Give two management steps you will institute for this patient. *

SAQ 6.

A 72 year old lady with a history of diabetes presents complaining of frequency of urine and dysuria. She takes metformin 500mg BD for her diabetes but has no other medical history or medication use.

Her vital signs are:

HR 145/min
BP 86/40 mmHg
RR 28 /min
Sats 99% RA
T 39.6 oC

Her ECG taken as part of her initial work up is shown below.

Question 1. (5 marks)

Describe the ECG and give a diagnosis.

Question 1. (5 marks) Describe the ECG and give a diagnosis. *

Question 2. (8 marks)

The patient's electrolyte profile is shown below.

Give 4 interventions you will apply to this patient, including any endpoints you would use.

Na+ 141 mmol/L
K+ 2.8 mmol/L
Cl- 102 mmol/L
HCO3- 19 mmol/L
Ca++ 2.25 mmol/L
Mg++ 0.5 mmol/L

Urea 5.8 mmol/L
Creatinine 70 umol/L

Give 4 interventions you will apply to this patient, including any endpoints you would use. *

Question 3. (4 marks)

After your initial treatment the patient remains hypotensive with the same heart rhythm. A decision is taken to cardiovert the patient.

Describe your procedure for this.

Question 3. (4 marks) After your initial treatment the patient remains hypotensive with the same heart rhythm. A decision is taken to cardiovert the patient. Describe your procedure for this. *

SAQ 7.

Your registrar calls you to resus to see a patient he is concerned about. A 50 year old man has presented with 3 days of profuse vomiting, and is moderately dehydrated. Your registrar mentions that intravenous access was extremely difficult, but he has successfully sent bloods. The patient's vital signs are:

HR 110/min
BP 99/60 mmHg
RR 12 /min
Sats 99% RA
T 37.3 oC

Your registrar is concerned about the venous blood gas he has run in resus, which is reproduced below.

pH 7.58
PCO2 45 mmHg
HCO3- 28 mmol/L

Na+ 138 mmol/L
K+ 5.8 mmol/L
Cl- 72 mmol/L

Question 1. (4 marks)

Give 4 abnormalities seen on the blood gas.

Question 1. (4 marks) Give 4 abnormalities seen on the blood gas. *

Question 2. (1 mark)

What is the likely aetiology of the primary acid-base disturbance?

Question 2. (1 mark) What is the likely aetiology of the primary acid-base disturbance? *

Question 3. (2 marks)

The patient has an ECG taken.

Give 2 abnormalities seen on the ECG.

Question 3. (2 marks) The patient has an ECG taken. Give 2 abnormalities seen on the ECG. *

Question 4. (2 marks)

What electrolyte abnormality is the ECG most consistent with, and how does this fit with the patient's presentation?

Question 4. (2 marks) What electrolyte abnormality is the ECG most consistent with, and how does this fit with the patient's presentation? *

Question 5. (3 marks)

Give 3 actions you will undertake for this patient in resus.

Question 5. (3 marks) Give 3 actions you will undertake for this patient in resus. *

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