Download - University Hospital, Geelong Emergency Medicine Trial ... · to Perichondritis of the ear. (3 marks) 1. ___ 2. _ 3. ___ University Hospital, Geelong- Fellowship Exam Short

UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek25

1

IDNUMBER:

UniversityHospital,Geelong

EmergencyMedicine

TrialFellowshipExam

ShortAnswerQuestions(SAQ)

Week25

DIRECTIONSTOCANDIDATE

1. Answereachquestioninthespaceprovidedinthisquestionpaper.

2. Donotwriteyournameonthisquestionpaper.

3. Enteryourexaminationnumberinthespacebelow.

4. Crossoutanyerrorscompletely.

5. Donotbegintheexamuntilinstructedtodoso.

6. Donottakeexaminationpaperormaterialsfromthisroom.

7. Thebookletbindermayberemovedduringtheexam.

QUESTION&ANSWER

BOOKLET


2

Question1(18marks)a. Definepsychosis.(1mark)________________________________________________________________________

b. Listthefive(5)DSMIVcriteriaforthediagnosisofSchizophrenia.(5marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

5. _______________________________________________________________________


3

Question1(continued)

YouareprovidingmedicalassistanceattriageonabusySundaynight.A34yearoldmanpresentstotriage.Heappearsintoxicated,agitatedandhaspressureofspeech.Herequestsexcisionofalesiononhisforeheadthathasbeenpresentforover20yrs.Duringthediscussion,hesuddenlypullsoutaknifeanddeclaresthatifwedon’tcutoutthisthing,he’lldoithimself.Thetriagenursehasrequestedhehandovertheknifeandhestates“Youwillhavetofightmeforit”.

c. Definethissituation.(1mark)

_________________________________________________________________________

d. Listfive(5)featuresofhispresentationthatraiseconcernsaboutimmediateviolence.(5marks)1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

5. _______________________________________________________________________


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Thepatientisdisarmedandrequiresphysicalandchemicalrestrainttoallowassessment.Nodrug/medicationhistoryisavailable.

e. Listyourpreferredinitialpharmacologicaltreatmentwithdoserangeandrouteofadministrationinthecaseof:

i. Patientbeingcompliantwithmedicationadministration:(3marks)

Drug/s

(1mark)

Route

(1mark)

Initialdose

(1mark)

ii. Patientbeingnon-compliantwithmedicationadministration:(3marks)

Drug/s

(1mark)

Route

(1mark)

Initialdose

(1mark)


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Question2(12marks)WithrespecttoheadinjuryintheAdulttraumapatient:

a. Listfour(4)riskfactorsthatwouldleadyoutoobtainanurgentCTbrain(iewithinthefirst1hour).(4marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

b. Listfour(4)riskfactorsthatwouldleadyoutoobtainasemi-urgentCTBrain(iewithinthefirst8hours).(4marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________


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Question2(continued)WithrespecttoheadinjuryinthePaediatrictraumapatient:

c. Listfour(4)variationswhencomparedtoAdultguidelines,intermsofriskfactorsforwhichCTBrainisrecommendedforthePaediatricpatientwithinthefirst1hour.(4marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________


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Question3(12marks)

a. WhatisPerichondritisoftheear?(1mark)_________________________________________________________________________

b. Listthree(3)causesofperichondritisoftheear.(3marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

c. Otherthananalgesia,listthree(3)keycomponentstothemanagementofperichondritisoftheear.(3marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________


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Question3(continued)d. WhatisChondritisoftheear?(1mark)

___________________________________________________________________________

e. Whatclinicalfeaturedifferentiatesperichondritisoftheearfromchondritisoftheear?(1mark)

___________________________________________________________________________

f. Statethree(3)differencesinthemanagementofChondritisoftheear,ascomparedtoPerichondritisoftheear.(3marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________


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Question4(12marks)

A46yearoldwomanpresentswithchestpain.Hervitalsignsare:

BP 130/60 mmHg

RR 22 /min

Temperature 36.5 °C

GCS 15

AnECGistaken-refertothepropbookletpage2.

a. Whatisaunifyingdiagnosisforthispatient,basedonthisECG?(1mark)

___________________________________________________________________________

b. Listthree(3)abnormalitiesshowninthisECGthatsupportthisdiagnosis.(3marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________


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Question4(continued)c. Listfour(4)keyinvestigationsthatyouwouldperform.Stateone(1)justificationfor

eachchoice.(8marks)

Investigation

(4marks)

Justification

(4marks)

1.

2.

3.

4.


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Question5(12marks)A25yearoldwomanpresentsfollowingastingfromanunknownanimalwhilstcamping.

a. Listthree(3)clinicallyrelevantdifferencesbetweenwaspstingsandbeestings.

(6marks)

Featureofsting

(3marks)

Wasp

(1.5marks)

Bee

(1.5marks)

1.

2.

3.


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b. Listthree(3)clinicalfeaturesofabullantbite.(3marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

c. Listthree(3)clinicalfeaturesofanAustralianscorpionsting.(3marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________


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Question6(12marks)(samepatientasquestion5)

a. Whatistheclinicaldefinitionofanaphylaxis?(1mark)

_________________________________________________________________________

b. Ingeneral,listtwo(2)indicationsforapatienttousetheirownEpipen.(2marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

c. Otherthantheindicationsforuse,listfour(4)instructionsthatyouwouldgivea

patientwithrespecttothetechniqueofEpipenuse.(4marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________


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Question6(continued)Thepatientexperiencesanaphylaxis.ShehasIVaccess.Adrenalineisgiveninappropriatedoses.Shefailstorespondtomaximumadrenalinetherapy.

d. Listfive(5)additionalmedicationsthatyoucouldinitiateinthissituation.(5marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

5. ________________________________________________________________________


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Question7(12marks)

DuringyourroutinepathologyresultcheckingyounoticeaMSUresultofapatientseenbyanotherdoctorinyouremergencydepartmenttwodaysago.MSUresult-refertothepropbookletpage3.Thepatientrecordsshow:

35yearoldwoman,15weekspregnantwithleftflankpainanddysuria.Noallergies.Rxtrimethoprim.F/Uprn.

a. OtherthanaconfirmedUTI,statefour(4)clinicalproblemswiththispatient.(4marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________


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b. List4(4)keystepsthatyouwouldundertakeinthiscase.Stateone(1)justificationforeachstep.(8marks)

Step

(4marks)

Justification

(4marks)

1.

2.

3.

4.


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Question8(14marks)

A34yearoldmanpresentsleftanklepainfollowingafallataBBQ.ThreeXraysaretaken-refertothepropbookletpage4and5.

a. Statefour(4)abnormalfindingsinthesexray.(4marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________

Hehadbeendrinkingbeerforseveralhoursprior.HehasaPastHistoryofchroniclowerbackpain.Hetakesbuprenorphinepatchesforchronicpain.Hetakesnootherregularmedications.YouhaveIVaccess.Hehasanisolatedankleinjury.HisPBTis0.25.

b. Statefour(4)issuesinyourapproachtohisanalgesicregimeforthefirst1hour.(4marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________


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Question8(Continued)

Itbecomesapparentthatthepatientisafamousfootballer.

c. Statefour(4)techniquesthatyoucouldemploytomaintainthepatients'privacy.(4marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________


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Question9(18marks)A3year-oldboyisbroughttoyourdepartmentbyhismotherwithabdominalpainandvomiting.ThemotherisconcernedthatthechildmayhaveingestedsomeofherIron(Ferrogradumet)tablets.Sheissurethattherearemorethan10tabletsmissingfromthebottle.EachFerrogradumettabletcontains105mgofelementalIron.

a. Listthree(3)historicalorexaminationfeaturesthatyouwouldseektoassesstheriskoftoxicity.(3marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________


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Question9(continued)b. WhatistheroleofSerumIronlevelsinthetreatmentofthispatient?State(3points

inyouranswer.(3marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

c. Listfour(4)keyinvestigationsforthischildthatwillassistwithanestimationof

severityoftoxicity.(4marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

4. ________________________________________________________________________


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d. Whatdecontaminationmaybeofbenefitinthisingestion?(1mark)

___________________________________________________________________________

e. Listthree(3)indication/sforthisdecontamination.(3marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________

f. Whatspecificantidotethatmaybeofbenefitinthisingestion?(1mark)

___________________________________________________________________________

g. Listthree(3)indicationsfortheuseofantidoteinthispatient.(3marks)

1. ________________________________________________________________________

2. ________________________________________________________________________

3. ________________________________________________________________________


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1

IDNUMBER:

UniversityHospital,Geelong

EmergencyMedicine

TrialFellowshipExam

ShortAnswerQuestions(SAQ)

Week25

PROPBOOKLET


2

Question4


3

Question7

MICROSCOPYLeucocytes >1000x10^6/L (<2x10^6/L)RedBloodCells 220x10^6/L(<13x10^6/L)SquamousEpithelialCells +STANDARDBACTERIALCULTURE 1.Escherichiacoli>10^9cfu/L

SENSITIVITIES:1AmpicillinSAugmentinSCefotaximeSCephalothinSCotrimoxazoleSGentamicinSNitrofurantoinSTrimethoprimR


4

Question8

Xray1 Xray2


5

Question8continued Xray3

Download - University Hospital, Geelong Emergency Medicine Trial ... · to Perichondritis of the ear. (3 marks) 1. _____ 2. _____ 3. _____ University Hospital, Geelong- Fellowship Exam Short

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Download - University Hospital, Geelong Emergency Medicine Trial ... · to Perichondritis of the ear. (3 marks) 1. ___ 2. _ 3. ___ University Hospital, Geelong- Fellowship Exam Short