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MODULE 16 short answer questions.

saq 1.

A 36 year old woman with a history of chronic thyroid disease presents to the emergency room with confusion and a productive cough. Her vital signs are:
 
HR            65            /min
BP            87/70    mmHg
T                33.8        oC
RR            15            /min
Sats         99%        RA
GCS         7
 
Initial pathology is shown below.
 
Free T4                    0.12        pmol/L
TSH                            0.01        mU/L
 
Question 1. (3 marks)
 
What is the diagnosis? Give 2 complicating diagnoses which should be considered? 
 
Question 2. (4 marks)

Give 4 interventions you will undertake for this patient.

Question 3. (3 marks)
 
Give 3 indications for ICU admission for this patient.

saq 2.

A 10 year old patient presents with his mother with a reduced level of consciousness. He has developed respiratory distress over the course of the day, and she is convinced that his asthma has “flared up”.
 
His vital signs on arrival to the emergency department are:
  • HR            145         /min
  • BP            91/60    mmHg
  • RR            42            /min
  • Sats         99%        RA
  • T                37.2        oC
  •  GCS         10
 
Urgent arterial blood gas analysis is performed and the results are shown below.
 
pH                              7.02
PCO2                        17            mmHg
PO2                           112         mmHg
HCO3-                      6               mmol/L
 
Na+                            131         mmol/L
K+                               6.5           mmol/L
Cl-                              91            mmol/L
 
Glucose                   21            mmol/L
Lactate                    1.1           mmol/L
Urea                          5.7           mmol/L
Creatinine               60            umol/L
 
Question 1. (3 marks)
 
What are the two major acid base abnormalities on the ABG? Which is the primary disturbance?

Question 2. (2 marks)
 
Calculate a derived value that allows you to interpret the primary disturbance. 
  
Question 3. (1 mark)
 
What is the most likely diagnosis?

Question 4. (2 marks)
 
Correct the Na and K for the derangements in the ABG.

Question 5. What critical intervention will you institute to manage this patient? (2 marks)

saq 3.

 A 54 year old type two diabetic presents to your department after being found unconscious by his wife. She states that aside from the diabetes he has no major medical problems, but he has been complaining of dysuria for 2 days. On arrival his vital signs are:
 
HR            120         /min
BP            99/60    mmHg
RR            22            /min
Sats         94%        RA
T                39.3        oC
Cap refill  5            s
 
His bedside BSL reads “High”.
 
Question 1. (4 marks)
 
His initial electrolyte profile returns below:
 
Na+                            153         mmol/L
K+                               5.4           mmol/L
Cl-                              124         mmol/L
HCO3-                      19            mmol/L
Urea                          18            mmol/L
Creatinine                200         umol/L
Glucose                     58            mmol/L
 
Give 4 major abnormalities present.
 
Question 2. (3 marks)
 
Give 2 derived values from the electrolyte profile and the likely diagnosis. 
 
Question 3. (6 marks)
 
Give 6 interventions you will undertake as part of your management.

saq 4.

A 28 year old girl presents to our department with acute confusion. She had been complaining of acute anterior neck pain for the prior 4 days, and has no other medical history of note. She had attended the department the previous evening and had blood drawn. She was subsequently discharged with a diagnosis of “neck strain”. On arrival she has the following vital signs:
 
HR            150         /min
RR            26            /min
BP            85/58    mmHg
Sats         99%        RA
T               39.7        oC
 
Question 1. (3 marks)

Select results from the previous evening’s presentation are presented below.
 
Free T4                    26            pmol/L
TSH                          0.01        mU/L
 
What do they show, and what is the diagnosis on this presentation? 
 
Question 2. (5 marks)
 
Give 5 interventions you will immediately apply
 
Question 3. (3 marks)
 
Give a brief outline of your approach to the quality control issues in this case. 

SAQ 5.

​Compare and contrast DKA and HHS using the table below.
ATTRIBUTE

​Diabetes type




Blood glucose



​
Ketones




​Fluid deficit





Precipitant
DKA
HHS