MODULE 22 short answer questions

saq 1.

You are called to the resuscitation room to assist your colleague in managing a labouring mother. She is at term, and fully dilated. Your colleague assigns you to manage the newly born infant, while she will continue to manage the third stage of labour.
 
Question 1. (3 marks)
What three things will you assess initially in this newborn?
 
Question 2. (1 mark)
The child remains floppy and listless after the cord is cut. What actions will you take next? 

Question 3. (3 marks)
After this action the child remains cyanosed and apnoeic with insufficient respiratory effort. What are your actions now? 

Question 4. (4 marks)
After this action the child’s heart rate continues to drop, and reaches 50 beats per minute. What are your actions now?

saq 2.

A 4 year old boy presents to your department with a fever and progressive petechial rash. He has become increasingly obtunded and unresponsive over the course of the morning.
 
On arrival his vital signs are:
HR                      166  /min
BP                       72/41        mmHg
Cap refill            6       seconds
RR                      38     /min
Sats                    99% RA
T                          39.6 oC
BSL                    6.7    mmol/L
 
Question 1. (3 marks)
A clinical image of the rash is shown. What are the important features and likely diagnosis?
Question 2. (3 marks)
What immediate treatment will you administer? 
 
Question 3. (5 marks)
The child continues to deteriorate. His GCS has dropped to 6, and despite 60ml/kg of intravenous normal saline as a child his systolic blood pressure remains 75mmHg. Give 4 actions you will now undertake? 

saq 3.

A 2 year old child is brought in to your emergency department after taking an overdose of his grandmother’s doxepin tablets. Shortly after arriving at triage he becomes floppy and unwell. He is transferred to the resus room, where he is found to be pulseless.
 
Question 1. (3 marks)
Describe your immediate actions.

Question 2. (3 marks)
The defibrillator shows the following rhythm. What is the rhythm, and what will your actions be? 
Question 3. (2 marks)
What are the doses of adrenaline and amiodarone for this patient? 

Question 4.  (2 marks)
The patient recovers output, and their ECG taken immediately after this is shown below. What is the major abnormality, and what medication will you administer?

saq 4.

An 11 year old boy presents with his mother to the emergency department. She complains that he has been progressively more dyspnoeic over the prior four days, and attributes this to asthma, which his brother also suffers from. She has been trying him on his brother’s ventolin puffer, 6 puffs every two hours for the last 8 hours, without any improvement.
 
On arrival his vital signs are:
 
HR             162            /min
BP             82/40        mmHg
RR             42              /min
Sats           99%          RA
T                37.9           oC
Capillary refill 4 seconds centrally
 
Question 1. (5 marks)
An urgent arterial blood gas is taken in resus. What do the results show and what is the likely diagnosis?
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pH             6.99
pO2            119  mmHg
pCO2         17     mmHg
HCO3-        6       mmol/L
 
Na+            128  mmol/L
K+               2.2    mmol/L
Cl-              92     mmol/L
 
BSL           26.3 mmol/L

Question 2. (1 mark)
Correct the sodium for the glucose.
 
Question 3. (4 marks)
What treatment will you administer in resus.

SAQ 5.

A 7 year old boy presents to the emergency department complaining of abdominal pain, pain in both shoulders, both hips and his left knee, and a rash to both lower limbs.
 
A clinical image of the rash is shown below.
Question 1. (4 marks)
Give a list of four differentials for the rash. 

Question 2. (5 marks)
Give 5 features will you look for on examination? 
 
Question 3. (10 marks)
List 5 investigations will you order and the indications for each?