MODULE 19 short answer questions

saq 1.

 A 45 year old female presents at 1900hrs after ingesting an unknown quantity of slow release paracetamol tablets. She is uncertain about the time of the ingestion because she is also grossly intoxicated, but a friend is able to substantiate that the overdose must have been between 1700hrs and 1830hrs.
 
Question 1. (4 marks)
 
Describe your assessment strategy for this patient. 
 
Question 2. (2 marks)
 
The patient’s paracetamol level at 2100hrs is 165mg/L (1100mmol/L). Interpret this result.

Question 3. (4 marks)
 
Describe the treatment you will institute over the next 24 hours.
 

saq 2.

A 26 year old female presents with the ambulance after taking 4g of propranolol 45 minutes previously. The ambulance has placed an IVC and on arrival to the ED she has a generalized tonic clonic seizure for which she is intubated under ketamine and rocuronium. No other medications have been administered.
 
At this stage her vital signs are:
HR                              45
BP                              80/40
RR                              16 (ventilated)
Sats                           100% RA
GCS                           intubated
BSL                            2.1
 
Question 1. (10 marks)
 
Give 10 interventions you will institute for this patient’s current clinical state. 

saq 3.

A 29 year old patient presents after taking a large number of unknown tablets. On arrival he is drowsy and combative.

​His initial ECG is shown below.
Question 1. (5 marks)
 
Give 5 abnormalities present on this ECG.
 
Question 2.  (3 marks)
 
Give three classes of drugs and an example of each that this patient could have taken.

Question 3. (2 marks)
 
Give two possible indications for the administration of sodium bicarbonate 8.4% in this patient.
 

saq 4.

An 78 year old woman with a history of atrial fibrillation presents to the emergency room complaining of dizziness and crampy abdominal pain. She gives a history of a 3 day episode of vomiting and diarrhoea, which ceased the day prior. She does not know her own medication, but mentions that she is on the “blue pills”.
 
Her vital signs are:
HR            38            /min
BP            98/69    mmHg
RR            24            /min
Sats         98%        RA
Temp      37.3        oC
 
Question 1. (3 marks)
 
List 6 investigations you will perform.
 
Question 2. (5 marks)
 
Selected results are shown below. Comment on the major abnormalities.
 
Na+                             140         mmol/L
K+                                 6.7           mmol/L
Cl-                                114         mmol/L
HCO3-                          18            mmol/L
Urea                            18.6        mmol/L
Creatinine                   200         umol/L
 
Digoxin level               4.6           ng/mL
  
Question 3. (2 marks)
 
Give 2 indications for the administration of digoxin-FAB fragments in this patient.
 

SAQ 5.

 
A 38 year old male with a history of bipolar disorder presents to the department feeling generally unwell. He has previously been on lithium as a mood stabilizer.
 
Question 1. (8 marks)
 
Give 8 symptoms will you ask about with respect to assessing for possible lithium toxicity?
 ​
Question 2. (2 marks)
 
Select pathology results are shown below. What are the major abnormalities? 
 
Na+                            141         mmol/L
K+                               4.7           mmol/L
Cl-                              100         mmol/L
HCO3-                         23            mmol/L
Urea                          16.8        mmol/L
Creatinine                 170         umol/L
 
Lithium level              4.9           mEq/L
 
Question 3. (2 marks)
 
What immediate therapy will you institute?

Question 4. (2 marks)
 
What are the indications for haemodialysis in acute and chronic lithium toxicity?

SAQ 6.

An 8 year old boy presents to your department with his parents who are concerned that he has been bitten by a snake while playing in the garden. A pressure immobilization bandage is currently in situ.
 
Question 1. (6 marks)
 
Give three classes of symptoms, and an example of each that you will assess this patient for.
  
Question 2. (5 marks)
 
Give 5 investigations will you perform on this patient initially? 

Question 3.
 
The patient complains of some drowsiness and slurred speech. Select pathology results are shown below.
 
INR                            6.5
APTT                         >200
Plt                              50 x 109/L
D-Dimer                   14.2        mg/dL
 
CK                              14320   IU/L.
 
Give two genus of snake (common name is acceptable) that may have bitten this child?