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MODULE 12 short answer questions.

Below are 7 SAQs. Make sure you put your email in before you start so that you receive a copy of your answers. 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.
    Picture
    Question 1. (3 marks)
     
    Give 3 major abnormalities shown on the ECG.


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

    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?

    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
    Picture
    Question 1. (4 marks)
     
    Give 4 major abnormalities from the ECG?
     
    Question 2. (2 marks)
     
    Where is the anatomical lesion? 
    Question 3. (2 marks)
     
    What further ECG investigations will you perform and why? 
    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 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.

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

     
    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 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.
    Picture
    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

    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 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.

    Picture
    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.

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