THE WRITTEN EMERGENCY MEDICINE FELLOWSHIP COURSE
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MODULE 13 short answer questions.

Below are 5 SAQs.  Good luck!

    Module 13 saQS

    SAQ 1.

    A 66 year old woman presents to the emergency department with fever and malaise. She has a past medical history of locally invasive breast cancer currently treated with Avastin (bevacizumab). Her last therapy was 6 days prior. She has no known drug allergies.
     
    On arrival to the emergency department her vital signs are:
     
    HR      134      /min
    BP       89/60   mmhg
    RR       28        /min
    Sats     90%     RA
    T          39.6     oC
    ​Question 1. (6 marks)
     
    Describe 3 immediate therapeutic actions you will immediately undertake.

    Question 2. (10 marks)
     
    Give 5 investigations will you order and justification for each? 
    Question 3. (4 marks)
     
    The lab rings you to tell you the patient’s blood count sent on arrival has clotted. A repeat has been sent and will be ready in 45 minutes. How and why will this effect your immediate management of this patient?
     

    SAQ 2.

    A 78 year old female presents to your department with increasing dyspnoea and lethargy. She describes a decrease in her exercise tolerance from being able to walk 200m to 50m over 6 months.
     
    Her vital signs are:
    HR      96        /min
    BP       134/65 mmHg
    RR       18        /min
    Sats     96%     RA
    T          37.2     oC
     
    She has been seen by your intern who has performed a full blood count, the results of which are shown below.
     
    HB                                              92        mg/dL
    White cell count                       8.7       x109/L
    Platelet count                           474      x109/L
     
    Haematocrit                            .31
    MCV                                          76        fL
    MCHC                                       22        g/dL
     
    Neutrophils                             6.32     x109/L
    Lymphocytes                           2.1       x109/L
    Monocytes                              0.3       x109/L
    Basophils                                0.02     x109/L
    Eosinophils                             0.02     x109/L
    Question 1. (7 marks)
     
    Give 6 important findings from the full blood count and the likely underlying diagnosis.

    Question 2. (4 marks)
     
    Give 4 other investigations will you ask for from the emergency department?

    Question 3. (3 marks)
     
    Give 3 criteria for initiating blood transfusion in this patient?

    SAQ 3

    A 6 year old boy presents to the emergency department with his mother. He is complaining of a sore throat and decreased oral intake.
     
    On examination he has large erythematous tonsils without any pus.
     
    A full blood count has been taken by your registrar and is shown below.
     
    HB                                              68        mg/dL
    White cell count                       1.7       x109/L
    Platelet count                           44        x109/L
     
    Haematocrit                             .29
    MCV                                           84        fL
    MCHC                                        36        g/dL
     
    Neutrophils                             1.12     x109/L
    Lymphocytes                           0.1       x109/L
    Monocytes                               0.3       x109/L
    Basophils                                 0.02     x109/L
    Eosinophils                              0.02     x109/L
    Question 1. (5 marks)
     
    Describe the blood film.

    Question 2. (4 marks)
     
    List 4 differential diagnoses.

    Question 3. (4 marks)
     
    Give four (4) features that will you examine the child for?

    SAQ 4

    A 67 year old female presents with left sided thigh pain. There is no history of trauma. Her vital signs are:
     
    HR      86                    /min
    BP       153/92             mmHg
    RR       20                    /min
    Sats     99%                 RA
    T          36.8                 oC
     
    An xray of the affected area is shown below.
    Picture
    Question 1. (3 marks)

    Give 3 important features of the x-ray.

    Question 2.  (5 marks)
     
    Select pathology results are shown below.

    Describe the major abnormalities.
     

    Na+                              135      mmol/L
    K+                                4.6       mmol/L
    Cl-                                103      mmol/L
    HCO3-                         18        mmol/L
     
    Urea                            18        mmol/L
    Creatinine                   180      umol/L
     
    Ca2+                             3.79     mmol/L
    Mg2+                            0.85     mmol/L
    PO43-                           0.78     mmol/L
    Question 3. (1 mark)
     
    What is the most likely diagnosis?

    Question 4 (3 marks)
     
    What management will you institute for this patient?

    SAQ 5

    A 63 year old man presents with fever and abdominal pain. He has no medical history of note. His vital signs on arrival are:
     
    HR      105      /min
    BP       120/80 mmHg
    RR       29        /min
    Sats     99%     RA
    T          39.6     oC
     
    His full blood count is shown below.
     
    HB                                              88        mg/dL
    White cell count                       136      x109/L
    Platelet count                           44        x109/L
     
    Haematocrit                             .31
    MCV                                           82        fL
    MCHC                                        34        g/dL
     
    Neutrophils                             1.12     x109/L
    Lymphocytes                           0.70     x109/L
    Monocytes                               0.3       x109/L
    Basophils                                 0.02     x109/L
    Eosinophils                              0.02     x109/L
     
    Smear – heterogeneous blasts noted.
    Question 1. (7 marks)
     
    What are the major abnormalites, and what is the likely diagnosis?

    Question 2. (3 marks)
     
    Give 3 likely complications of this presentation?

    Question 3. (3 marks)
     
    Give 3 management points that you will institute?

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