Week 14 SAQ Electronic

MODULE 14 short answer questions.

Below are 5 SAQs. You have 30 minutes. Good luck!

Module 14 saQS

SAQ 1.

A 65 year old man presents to your emergency department with acute weakness in his right arm, right face and right leg. He states that the weakness occurred 65 minutes previously and has been consistent since its inception.

An urgent CT of his brain is ordered and a slice is shown below.

Question 1. (3 marks)

What are 2 major abnormalities on the CT and what is the likely diagnosis?

Question 1. (3 marks) What are 2 major abnormalities on the CT and what is the likely diagnosis? *

Question 2. (6 marks)

Give six absolute contraindications to possible lysis of this man’s CVA that need to be evaluated for in this presentation.

Question 2. (6 marks) Give six absolute contraindications to possible lysis of this man’s CVA that need to be evaluated for in this presentation. *

Question 3. (4 marks)

The patient’s family ask you about the risk benefit of thrombolysis, and ask you if this depends on how quickly the medicine is given. What response will you give?

Question 3. (4 marks) The patient’s family ask you about the risk benefit of thrombolysis, and ask you if this depends on how quickly the medicine is given. What response will you give? *

SAQ 2.

A 38 year old male presents to your department with a sudden onset severe frontal headache that occurred while he was lifting weights at the gym. He is nauseous and complains of pain when he is looking at bright lights.

An urgent CT scan of the brain is arranged, and an image is shown below.

Question 1. (3 marks)

What are the two major abnormalities on the image, and what is the likely diagnosis?

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

Question 2. (6 marks)

The patient is continuing to complain of severe headache and begins to vomit. His patient’s vital signs are:

HR      115                 /min
BP      188/123         mmHg
RR      22                   /min
Sats    99%               RA

Give 6 management steps you will institute for this man.

Question 2. (6 marks) The patient is continuing to complain of severe headache and begins to vomit. His patient’s vital signs are: HR 115 /min BP 188/123 mmHg RR 22 /min Sats 99% RA Give 6 management steps you will institute for this man. *

SAQ 3

A 22 year old woman presents to your rural emergency department with a sudden onset frontal headache that occurred while having sexual intercourse the previous evening (10 hours previously). She has an ongoing headache and complains of severe nausea. The CT scanner in your rural hospital has been non-operational for 2 days due to complex maintenance requirements.

Question 1. ( marks)

List 4 differentials.

Question 1. ( marks) List 4 differentials. *

Question 2. (4 marks)

Give 4 contraindications to lumbar puncture in this patient.

Question 2. (4 marks) Give 4 contraindications to lumbar puncture in this patient. *

Question 3. (6 marks)

A lumbar puncture is performed and the results are shown below. The patient has a blood glucose of 5.1mmol/L.

Comment on the results and give a likely diagnosis.

Tube 1:

RBC 9000 /uL
WBC 5         /uL

Glucose 3.2      mmol/L
Protein           .20      g/L

Tube 3:

RBC 8720 /uL
WBC 3         /uL

Glucose         3.2      mmol/L
Protein .20      g/L

No formal spectrophotometry is available in your hospital, but the lab rings to tell you the sample has a distinct yellowish tinge when held against white paper.

Comment on the results and give a likely diagnosis. *

SAQ 4

An 18 year old girl presents to your department with her parents who are concerned that she has been behaving erratically for the day. She has complained of severe headache and fevers, and has vomited three times during the afternoon. She is distressed, and is complaining that light hurts her eyes.

Her vital signs on arrival are:
HR      99                   /min
BP      121/79           mmHg
RR      24                   /min
Sats    99%               RA
T         39.6                oC
GCS   E3V4M6

As part of her work up a lumbar puncture is performed.

Question 1. (2 marks)

Give 2 interventions you will undertake while the results of the LP are awaited.

Question 1. (2 marks) Give 2 interventions you will undertake while the results of the LP are awaited. *

Question 2. (5 marks)

The LP results return and are shown below.

Tube 3:

RBC               1         /uL
WBC              451     /uL
(differential 90% PMNS)

Glucose         1.2      mmol/L (BSL 7.9)
Protein           1.28    g/L

Appearance: turbid

What are the major abnormalities?

What are the major abnormalities? *

Question 3. (2 marks)

What is the likely diagnosis?

Question 3. (2 marks) What is the likely diagnosis? *

SAQ 5

A 27 year old girl presents with significant frontal headaches. She describes intermittent fevers and significant diurnal variation in her headache, which is worse in the mornings and evenings.

Her vital signs are:
HR      90                   /min
BP      111/90 mmHg
RR      21                   /min
Sats    99%               RA
T         37.6                oC
GCS   E4V5M6

As part of her workup a decision is taken to perform a lumbar puncture. The results are shown below.

Tube 3:

RBC               1         /uL
WBC              877     /uL
differential:
            50% PMNS
            40% lymphocytes

Glucose         3.2      mmol/L (BSL 4.9)
Protein           .78      g/L

Appearance: clear and colourless

Question 1. (5 marks)

Comment on the 3 major abnormalities and 2 major normal findings in the lumbar puncture.

Question 1. (5 marks) Comment on the 3 major abnormalities and 2 major normal findings in the lumbar puncture. *

Question 2. (1 mark)

What is the likely diagnosis?

Question 2. (1 mark) What is the likely diagnosis? *

Question 3. (4 marks)

Give 4 further tests you will order on this CSF?

Question 3. (4 marks) Give 4 further tests you will order on this CSF? *

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