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MODULE 13 short answer questions

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.
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?