university hospital, geelong emergency medicine trial fellowship … · 2019-07-17 · university...

IDNUMBER:

UniversityHospital,Geelong

EmergencyMedicine

TrialFellowshipExam

ShortAnswerQuestions(SAQ)

Week11DIRECTIONSTOCANDIDATE

1. Answereachquestioninthespaceprovidedinthisquestionpaper.

2. Donotwriteyournameonthisquestionpaper.

3. Enteryourexaminationnumberinthespacebelow.

4. Crossoutanyerrorscompletely.

5. Donotbegintheexamuntilinstructedtodoso.

6. Donottakeexaminationpaperormaterialsfromthisroom.

7. Thebookletbindermayberemovedduringtheexam.

QUESTION&ANSWER

BOOKLET

UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek11

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Question1(18marks)

A65yearoldmanpresentswithsymptomssuggestiveofrightrenalcolic.

a. Statesix(6)aimsintheuseofradiologicalinvestigationforthispatient.(6marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

5. ________________________________________________________________________

6. ________________________________________________________________________

UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek11

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Question1(continued)

b. Listthree(3)typesofuretericcalculithathavedifferentchemicalcomposition.Listtwo(2)clinicalorepidemiologicalfeaturesforeachtypeofcalculi.(9marks)

Calculitype(3marks)

Feature(6marks)

1.

1.

2.

2.

1.

2.

3.

1.

2.

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Question1(continued)ThepatientisconfirmedtohaveasinglerenalcalculionCTKUB.Thisishisfirstepisodeofrenalcalculi.

c. What is the role ofmedical expulsive therapy in hismanagement? State three (3)

pointsinyouranswer.(3marks)

1. _____________________________________________________________________

2. _____________________________________________________________________

3. _____________________________________________________________________

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Question2(12marks)A25yearoldemergencydepartmentnursesustainsaneedlestickfromausedvenepunctureneedlefromaknownpatientintheEmergencyDepartment.Thedetailsoftheexposureareobtainedanddocumented.

a. Otherthandetailsoftheexposure,listsix(6)keyfeaturesinhistorythatyouwouldseekfromthisnurse.(6marks)

1. ______________________________________________________________________

2. _____________________________________________________________________

3. _____________________________________________________________________

4. ______________________________________________________________________

5. ______________________________________________________________________

6. ______________________________________________________________________

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Question2(continued)

ThesourceisidentifiedashavingHepatitisB,HepatitisCandHIV.

a. Listtheapproximateriskoftransmissionofeachvirusforthispatient(3marks)

Virus Riskoftransmission(%)(3marks)

HepatitisB

HepatitisC

HIV

b. Completethetablebelow,listingthetimecourseofrequiredserologicialtestingforthispatient.(6marks)

SerologicalTest

Timeframeoftest/s(3marks)

HepatitisB

HepatitisC

HIV

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Question3(12marks)

a. Completethechartbelow,statingthepercentageofburnestimationforaninfantfortheareasindicatedwithabox.(7marks)

UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek11

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Question3(continued)A35yearoldmanisbroughtintoyouremergencydepartmentwithextensiveburnstohisupperbodyfollowingahousefire.

b. Statethree(3)indicationsforemergencyescharotomy.(3marks)

1. _____________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

c. Assuming adequate analgesia and sedation, consent and explanation, list two (2)

stepsintheprocedureofupperlimbescharotomy.(2marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

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Question4(12marks)A76yearoldwomanpresentstoyouremergencydepartmentwithonehourofseverechestpain.

AnECGistaken-refertothepropsbooklet-page1.

a. Statefour(4)abnormalfindingsinthisECG.(4marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. _______________________________________________________________________

b. WhatisthesignificanceoftheseECGchangesforthispatient?Satefour(4)pointsin

youranswer.(4marks)

1. _____________________________________________________________________

2. _____________________________________________________________________

3. _____________________________________________________________________

4. ______________________________________________________________________

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Question4(continued)The cardiology registrar does not agree with your assessment of this ECG and its’significance.

c. State four (4)piecesof information fromabedsideECHOthatwouldsupportyour

case.(4marks)

1. _____________________________________________________________________

2. _____________________________________________________________________

3. _____________________________________________________________________

4. ______________________________________________________________________

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Question5(12marks)

A52yearoldItalianwomanpresentstoyouremergencydepartmentwithgraduallyincreasingbreathlessnessoverthelast3days.Itis1weeksinceherlastchemotherapytreatmentforcancer.Shehasaportocathinsitu.Herobservationsonarrivalare:

BP 130/60 mmHg

PR 110 /min

RR 28 /min

Temp 37.8 °C

Oxygensaturation 90% Roomair

AChestX-rayistaken-refertothepropsbooklet-page2

a. Otherthantheportocath,listfour(4)abnormalitiesshowninthisxray.(4marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

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Question5(continued)

HerFBEshowsnormalHbandplateletcounts.HerWCCis1.5(ref4-11)andherneutrophilcountis0.4(ref2.0-7.5).

b. Stateyourantibioticchoice/s.(2marks)

___________________________________________________________________________

___________________________________________________________________________

c. Statetwo(2)pointstojustifyyourchoice/s.(2marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

d. OtherthanU+EandLFT,listfour(4)keyinvestigationsthatyouwouldorderforthispatientintheemergencydepartment.(4marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

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Question6(12marks)

A65yearoldmanpresentswithabdominaldistensionandpain.ThepatientisnotedtohavefreefluidonanEmergencyDepartmentscreeningultrasound.

Anaspirateofperitonealfluidistaken-refertothepropsbooklet-page3.

a. Statethemostlikelydiagnosis.(1mark)

________________________________________________________________________

b. Listfive(5)likelycausesforthiscondition.(5marks)

1. ______________________________________________________________________

2. ______________________________________________________________________

3. ______________________________________________________________________

4. ______________________________________________________________________

5. ______________________________________________________________________

UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek11

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Question6(continued)c. List three (3) key pathological investigations that you would perform in the

emergencydepartment.Stateone(1)justificationforyourchoice.(6marks)

Investigation(3marks)

Justification(3marks)

1. 2. 3.

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Question7(12marks)

a. Listfour(4)drugsforwhichmultipledosecharcoalmaybeofbenefit.(4marks)

1. ___________________________________________________________________

2. ___________________________________________________________________

3. ___________________________________________________________________

4. ___________________________________________________________________

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Question7(continued)

b. List four (4) drugs forwhich charcoal is not indicated, independent of the time ofingestion.(4marks)

1. ______________________________________________________________________

2. _____________________________________________________________________

3. _____________________________________________________________________

4. _____________________________________________________________________

c. Listfour(4)drugsforwhichhaemodialysisistheeliminationmethodofchoiceinthe

managementofseveretoxicityfromoverdose.(4marks)

1. ___________________________________________________________________

2. ___________________________________________________________________

3. ___________________________________________________________________

4. ___________________________________________________________________

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Question8(8marks)

A34yearoldwomanpresentstoyouremergencydepartmentwithahistoryofabdominalpain,vomitinganddiarrhoeafortwoweeks.Anarterialbloodgashasbeentaken-refertothepropsbooklet-page4.

a. Providetwo(2)calculationstohelpyoutointerprettheseresults.(2marks)

Derivedvalue1:_____________________________________________________________

___________________________________________________________________________

Derivedvalue2:_____________________________________________________________

___________________________________________________________________________

b. Usingthescenarioandthederivedvalues,definetheprimaryacid/baseabnormality/s.(2marks)

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

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Question8(continued)

c. Usingthescenarioandthederivedvalues,definethesecondaryacid/base

abnormality/s.(2marks)

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

d. Stateone(1)likelyunifyingexplanationfortheseresults.(2marks)

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

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Question9(18marks)

A20yearoldfemalepresentsafteramarineenvenomation.

a. Listtwo(2)historicalfindingsthatareconsistentwithBoxJellyfishenvenomation.(2marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

b. Listtwo(2)examinationfindingsthatareconsistentwithBoxJellyfishenvenomation.(2marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

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Question9(continued)

c. List two (2) historical findings that are consistent with Irukandji envenomation. (2marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

d. Listtwo(2)examinationfindingsthatareconsistentwithIrukandjienvenomation.(2marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

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Question9(continued)

e. Completethetablebelow,listingtheroleofeachmanagementmodality.(10marks)

Boxjellyfish(5marks)

Irukandji(5marks)

Mainstayoftreatment(2marks)

Roleofapplicationofice

(2marks)

Roleofvinegarapplication(2marks)

Roleofpressureimmobilisation

(2marks)

Roleofantivenom(2marks)

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IDNUMBER:

UniversityHospital,Geelong

EmergencyMedicine

TrialFellowshipExam

ShortAnswerQuestions(SAQ)

Week11

PROPBOOKLET

UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek11

1

Question4

UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek11

2

Question5

UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek11

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Question6

Peritonealfluid

Appearance darkbrown

Whitebloodcellcount 1500

Polymorphcount 1000

Glucose 0.1 mg/Dl

LDH 450

Albumin 36 g/dL

SerumAlbumin 34 g/dL

UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek11

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Question8