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MODULE 15 short answer questions

saq 1.

A 32 year old female presents to the emergency department complaining of fever and pain in the hands and feet. She describes increasing fatigue and 3kg of weight loss over a two month period. She has also noted a rash to her face, a picture of which is shown below.
 
Her vital signs are:
  • HR      75        /min
  • BP       110/82 mmHg
  • RR       16
  • Sats     96%     RA
  • T          37.8     oC
 
A clinical photo of the patient’s face is shown below.
Question 1. (4 marks)
 
Describe the rash. 
 
Question 2. (6 marks)
 
Give 5 differential diagnoses, nominating your most likely diagnosis first.
 
Question 3. (10 marks)
 
Using the table below, give 5 investigations you will order and indication for each.

 INVESTIGATION

1. ​

2. 

3. 

4. 

5. 
 COMPLICATION

1. 

2. 

3. 

4. 

5. 

saq 2.

A 4 year old girl presents with an acutely painful right hip. The child’s vital signs are:
 
HR      115      /min
BP       98/61   mmHg
T          37.1     oC
RR       24
Sats     99%     RA

Question 1. (4 marks)
 
List 4 differential diagnoses.
 
Question 2. (4 marks)
 
Give 4 elements of the history that you will enquire about. 
 
Question 3. (4 marks)
 
List 4 investigations you may perform on this child. 

saq 3.

An 81 year old female with a history of rheumatoid arthritis presents after tripping and falling from standing height while gardening. She did not hit her head and there is no loss of consciousness, amnesia or vomiting. She is complaining of midline neck pain without any neurology.
 
Question 1. (3 marks)
 
Give 3 reasons this patient may be at increased risk of a c-spine injury. 
 
Question 2. (2 marks)
 
What investigation will you perform on this patient and why? 
 
Question 3. (5 marks)
 
An image from the investigation you perform is shown below. Give 5 abnormalities seen. 

saq 4.

A 24 year old man presents with a painful swollen left knee of 48 hours duration. There is no history of trauma. His vital signs are:

  • HR      99        /min
  • BP       125/81 mmHg
  • RR       16        /min
  • Sats     98%     RA
  • Temp   37.6   oC
 
Question 1. (4 marks)
 
Give 4 differential diagnoses.
 
Question 2. (4 marks)
 
Give 2 features on history and 2 on examination that would suggest a diagnosis of reactive arthritis?
 
Question 3.  (2 marks)
 
Given your differential diagnoses, give 2 investigations will you perform on this patient to evaluate these possibilities? 

Question 4. (3 marks)
 
Briefly describe your procedure for arthrocentesis of the knee. 

SAQ 5.

A 66 year old female with a history of rheumatoid arthritis presents feeling generally unwell. She complains of some moderate abdominal pain, but has no surgical signs on examination. Her usual medications include prednisone 10mg daily and methotrexate weekly. She has no other medical history of note. Her vital signs are:

  • HR      115      /min
  • BP       85/68   mmHg
  • RR       28        /min
  • Sats     98%     RA
  • T          38.1     oC
 
A venous blood gas is performed and the results are shown below.
 
pH                   7.18
 
PO2                 46        mmHg
PCO2              32        mmHg
HCO3-            16        mmol/L
 
Na+                126      mmol/L
K+                   6.5       mmol/L
Cl-                  105      mmol/L
 
Lactate          1.2       mmol/L
 
Question 1. (4 marks)
 
What are the major abnormalities on the blood gas, and what is the likely cause?
 
Question 2. (4 marks)
 
Give 4 investigations you will perform. 
 
Question 3. (4 marks)
 
List 4 interventions you will perform.