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MODULE​ Five short answer questions.

saq 1.

A 32 year old man presents to your emergency department with complaining of pain and parasthesiae in the right hand. There is no history of trauma.

A clinical image of the hand is shown below.

Question 1. (3 marks)

What are the major abnormalities shown and what is the differential diagnosis?

Question 2. (5 marks)

Give 2 features you will inquire about on history and 3 features you will seek on examination.

Question 3. (2 marks)

What investigation will you perform in this patient?

saq 2.

An 85 year old man presents with an episode of syncope preceded by sudden onset acute abdominal pain. His daughter tells you he has a history of an “artery problem” in the abdomen. The patient’s vital signs are:

HR    114    /min
BP    95/52    mmHg
RR    24    /min
Sats    98%    RA
T        37.1    oC

Question 1. (3 marks)

What features on examination will make you suspect a bleeding abdominal aortic aneurysm?

Question 2. (4 marks)

A CT scan of the patient’s abdomen is performed, and an image is shown below.

What is the scan that has been performed, what are the major abnormalities and what is the diagnosis?

Question 3. (3 marks)

What actions will you now take?

saq 3.

A 75 year old man presents with sudden onset central abdominal pain. He has no known medical history of note. His vital signs are:

HR     99    /min
BP     115/60    mmHg
RR     18    /min
Sats    99%    RA
T        37.1    oC

Your registrar sees the patient and returns to you telling you she suspects a leaking abdominal aortic aneurysm.

Question 1. (8 marks)

For each listed imaging type give 2 advantages and 2 disadvantages of the modality for investigation of suspected leaking AAA. (8 marks)

1. Ultrasound
2. Contrast CT of the abdomen.

Question 2. (2 marks)

Because of pre-existing renal impairment, the radiology department insists on performing a non contrast CT scan prior to the injection of contrast. A slice from this CT is shown below.

What is the major finding and diagnosis?


saq 4.

A 55 year old man presents with tearing onset chest pain radiating through to his back. He looks distressed with the pain, and is pale and diaphoretic.

The patient’s vital signs are:
HR     120        /min
BP      190/110    mmHg
RR       25        /min
Sats    99%        RA
T         37.2        oC   

Question 1. (3 marks)

Give three features on clinical examination that would make you suspect dissection of the ascending aorta.

Question 2.  (2 marks)

A contrast CT scan is performed and an image is shown below.

What does the image show?
Question 3. (2 marks)

Is there sufficient diagnostic information on this CT to definitively determine the patient’s management strategy? Why or why not?

Question 4. (3 marks)

Describe your immediate actions to manage this patient.

saq 5.

A 26 year old motor bike rider has presented to your department 3 hours previously after sustaining a closed mid tibial and fibular fracture, which has been reduced and placed in a cast. The nurse looking after the patient has asked you to review him because he is complaining of increasing pain.


Question 1. (2 marks)

What is the most important diagnosis that you now need to evaluate for?

Question 2. (8 marks)

What features will you seek on history and examination? (8 marks)