MODULE 21 short answer questions

saq 1.

A 26 year old woman presents to your costal hospital feeling generally unwell. She reports that she has been out with a local scuba diving boat, and has performed 3 dives for the day.
 
Question 1. (2 marks)
 
How is decompression illness diagnosed?
 
Question 2. (6 marks)
 
List 6 symptoms you will ask about.
 
Question 3. (2 marks)

What is the difference between AGE and DCS?
 
Question 4. (3 marks)

How will you manage this patient? 

Question 5. (1 mark)

The nearest recompression chamber is 240km away, and the only available platform is a helicopter. What is the major disadvantage of a helicopter in this situation?

saq 2.

A 19 year old man is brought in by the ambulance after being found immersed in the sea. He had been snorkelling with friends, and was noted missing for 5 minutes, after which he was found face down unresponsive in the water.
 
On arrival his vital signs are:
 
HR         113      /min
BP         135/55 mmHg
RR          26        /min
T            35.2     oC
Sats       91%     15L NRB (FiO2 .60)
GCS       E2M5V1 (8)
 
The ambulance report that he has had an altered LOC during their treatment, but has never lost cardiac output.
 
Question 1. (4 marks)
 
List 4 indicators of adverse prognosis in near drowning.
 
Question 2. (4 marks)
 
Give 4 potential indications for RSI in this patient.
 
Question 3. (6 marks)
 
An arterial blood gas taken shortly after the patient’s arrival is shown below. Describe and interpret the results.
 
pH                   7.22
PCO2              55        mmHg
PO2                 70        mmHg
HCO3-             16        mmol/L
Lactate             4.6       mmol/L

saq 3.

A 42 year old man is brought to your hospital by the ambulance. He has collapsed while running a local marathon. On arrival to the ED his vital signs are:
 
HR      138      /min
BP       88/55   mmHg
T          42.6     oC
RR       33        /min
Sats     99%     RA
 
Initial pathology is shown below.
 
Hb                   192      mg/dL
WCC               26.3     x109/L
Plt                    190      x109/L
 
Na                   157      mmol/L
K                     6.1       mmol/L
Urea                29.1     mmol/L
Creatinine     300      umol/L

CK                   36210  IU/L
 
Question 1. (10 marks)
 
What are the major abnormalities, and what diagnoses do they each suggest?
 
Question 2. (4 marks)
 
What initial treatment will you institute?
 
Question 3. (1 mark)
 
If this patient requires rapid sequence intubation, what agent will you use for paralysis if any?

saq 4.

A 19 year old woman is brought in by the ambulance from a local nightclub. She has had a seizure on the dance floor.
 
Her vital signs on arrival are:
 
BP       165/99 mmHg
HR      132      /min
RR       30        /min
Sats     99%     RA
T          41.0     oC
GCS    E2V2M4 (8)
 
Question 1. (5 marks)

List 5 differential diagnoses.
 
Question 2. (4 marks)
 
Give 4 features on examination that would make you suspect sympathomimmetic toxicity?

Question 3. (3 marks)

A friend of the patient arrives in the hospital and admits that the patient had taken illicit drugs thinking they were ecstasy. What treatment will you administer?

SAQ 5.

A 25 year old man presents to your hospital in the South Island of New Zealand. He has just returned from a day of skiing in the local ski field (altitude 2585m to 3100m).
 
The patient is complaining of significant headache, and abdominal cramps.
 
Question 1. (4 marks)

List 4 differential diagnoses.
 
Question 2. (4 marks)
 
What are the criteria for diagnosis of acute mountain sickness?

Question 3. (4 marks)
 
What treatment options are available for acute mountain sickness in this patient?