MODULE 20 short answer questions
saq 1.
A 4 year old child presents to the emergency department after ingesting 4 of his grandmother’s 60mg modified release gliclazide tablets 30 minutes previously. This was a witnessed ingestion, and no other tablets were taken. The child is currently well. It is 4pm
His vital signs are:
HR 110 /min
BP 93/66 mmHg
RR 26 /min
T 36.7 oC
GSC 15
Question 1. (3 marks)
The child has been in your department for 2 hours. At this stage the resident looking after the child informs you that the BSL is 5.6mmol/L.
Outline your disposition considerations.
Question 2. (6 marks)
An hour later your resident informs you that the paediatrics registrar told her that as the child was well at 3 hours with a normal BSL he could be discharged. Subsequently the resident discharged the child.
What actions will you take?
Question 3. (1 mark)
The child returns 2 hours later (7 hours after the original overdose). He is drowsy and partially responsive.
What investigation will you order?
Question 4. (4 marks)
The BSL returns at 1.6. Give two alternatives to managing this toxic ingestion.
His vital signs are:
HR 110 /min
BP 93/66 mmHg
RR 26 /min
T 36.7 oC
GSC 15
Question 1. (3 marks)
The child has been in your department for 2 hours. At this stage the resident looking after the child informs you that the BSL is 5.6mmol/L.
Outline your disposition considerations.
Question 2. (6 marks)
An hour later your resident informs you that the paediatrics registrar told her that as the child was well at 3 hours with a normal BSL he could be discharged. Subsequently the resident discharged the child.
What actions will you take?
Question 3. (1 mark)
The child returns 2 hours later (7 hours after the original overdose). He is drowsy and partially responsive.
What investigation will you order?
Question 4. (4 marks)
The BSL returns at 1.6. Give two alternatives to managing this toxic ingestion.
saq 2.
A 19 year old man presents to your ED after a fire at the factory he works at. He has no major injuries, but is complaining of severe dyspnoea.
His vital signs are:
HR 136 /min
BP 167/99 mmHg
RR 46 /min
Sats 100% 60% O2
T 37.1 oC
A primary survey in resus indicates that there is no mechanical injury. An urgent arterial blood gas is taken and the results are shown below.
FiO2 0.6
pH 6.95
pO2 445 mmHg
PCO2 17 mmHg
HCO3- 6
Na+ 149 mmol/L
Cl- 113 mmol/L
Lactate 10.2 mmol/L
Question 1. (6 marks)
Describe the major acid base disturbances present and provide calculations to substantiate your answer.
Question 2. (2 marks)
Your registrar suggests the patient may have a chemical pneumonitis from smoke inhalation. Comment on this in light of the ABG findings.
Question 3. (2 marks)
What is the likely diagnosis and why?
Question 4. (2 marks)
Give 2 treatment options for this patient.
His vital signs are:
HR 136 /min
BP 167/99 mmHg
RR 46 /min
Sats 100% 60% O2
T 37.1 oC
A primary survey in resus indicates that there is no mechanical injury. An urgent arterial blood gas is taken and the results are shown below.
FiO2 0.6
pH 6.95
pO2 445 mmHg
PCO2 17 mmHg
HCO3- 6
Na+ 149 mmol/L
Cl- 113 mmol/L
Lactate 10.2 mmol/L
Question 1. (6 marks)
Describe the major acid base disturbances present and provide calculations to substantiate your answer.
Question 2. (2 marks)
Your registrar suggests the patient may have a chemical pneumonitis from smoke inhalation. Comment on this in light of the ABG findings.
Question 3. (2 marks)
What is the likely diagnosis and why?
Question 4. (2 marks)
Give 2 treatment options for this patient.
saq 3.
Two patients present to your department after an industrial accident at their factory. Their factory specialises in glass etching, and a vat of hydrofluoric acid tipped over and splashed them.
Question 1. (3 marks)
List risk factors for systemic toxicity in hydrofluoric acid burns.
Question 2. (3 marks)
The first patient has sustained burns to the fingers of his left hand. He states the HF solution they were using was 21%. He is complaining of severe pain.
Give 3 options for managing this patient’s burn.
Question 3. (5 marks)
The second patient received a large splash of HF to the face. On arrival to the ED with the ambulance he suffers a cardiac arrest. He is wheeled into your resus room covered in vomit.
Outline the important steps you will take as part of your ALS efforts.
Question 1. (3 marks)
List risk factors for systemic toxicity in hydrofluoric acid burns.
Question 2. (3 marks)
The first patient has sustained burns to the fingers of his left hand. He states the HF solution they were using was 21%. He is complaining of severe pain.
Give 3 options for managing this patient’s burn.
Question 3. (5 marks)
The second patient received a large splash of HF to the face. On arrival to the ED with the ambulance he suffers a cardiac arrest. He is wheeled into your resus room covered in vomit.
Outline the important steps you will take as part of your ALS efforts.
saq 4.
A patient is brought into your hospital after collapsing at a local beach.
Question 1. (16 marks)
List six organisms that may have been responsible for envenomation of this patient. For each, list the
major mechanisms of toxicity.ralysis
Question 1. (16 marks)
List six organisms that may have been responsible for envenomation of this patient. For each, list the
major mechanisms of toxicity.ralysis
SAQ 5.
A 45 year old butcher is brought to your department unconscious after an apparent suicide attempt. He was found in his butcher store kitchen with an open packet of curing salt, and had left a suicide note.
His vital signs are:
HR 110 /min
BP 96/45 mmhg
RR 29 /min
O2 sats 86% RA
T 36.7 oC
On arrival an arterial blood gas is taken in the resuscitation room. The results are shown below.
pH 7.10
PO2 105 mmHg
CO2 32 mmHg
HCO3- 16 mmol/L
O2 sat 95%
Na+ 145 mmol/L
Cl- 109 mmol/L
Lactate 5.2 mmol/L
Your registrar notes a brown appearance to the patient’s blood.
Question 1. (5 marks)
What are the major disturbances in the arterial blood gas? Provide calculations to substantiate your answer.
Question 2. (2 marks)
What is the likely diagnosis and how will you confirm it?
Question 3. (3 marks)
Give 2 therapies will you institute for this patient
His vital signs are:
HR 110 /min
BP 96/45 mmhg
RR 29 /min
O2 sats 86% RA
T 36.7 oC
On arrival an arterial blood gas is taken in the resuscitation room. The results are shown below.
pH 7.10
PO2 105 mmHg
CO2 32 mmHg
HCO3- 16 mmol/L
O2 sat 95%
Na+ 145 mmol/L
Cl- 109 mmol/L
Lactate 5.2 mmol/L
Your registrar notes a brown appearance to the patient’s blood.
Question 1. (5 marks)
What are the major disturbances in the arterial blood gas? Provide calculations to substantiate your answer.
Question 2. (2 marks)
What is the likely diagnosis and how will you confirm it?
Question 3. (3 marks)
Give 2 therapies will you institute for this patient