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Fellowship course Week 8 – Exam

WRITTEN EXAMINATIONSHORT ANSWER QUESTIONS

Time: 36 min

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Question 1 (12 marks) 6 minute

A 70-year-old woman presents with two days of increasing abdominal pain and vomiting.

An abdominal x-ray is taken - refer to the props booklet page 5.

i) List three (3) abnormal findings shown in her x-ray. (3 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

ii) List six (6) possible causes for this xray appearance. (6 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

5. _______________________________________________________________________

6. _______________________________________________________________________

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Question 1 (continued)

iii) List three (3) key treatment tasks in the first 1 hour of your care. (3 marks)

1. ________________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

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Question 1

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Question 2 (20 marks) 9 minutes

With respect to the cervical spine:

i) List the two (2) components of the anterior column. (2 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

ii) List the two (2) components of the middle column. (2 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

iii) List the six (6) components of the posterior column. (6 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

5. _______________________________________________________________________

6. _______________________________________________________________________

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Question 2 (continued)

iv) What is the role of flexion/ extension x-rays in the initial Emergency Department investigation of traumatic cervical spine injury? State four (4) points to your answer. (4 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

A 47 year old man is brought into your emergency department with fever, throat pain and difficulty swallowing.

A lateral C spine x-rays is taken - refer to the props booklet page 2.

v) State two (2) abnormalities shown in this x-ray. (2 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

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Question 2 (continued)

vi) List four (4) key management steps that you would institute for this patient in the next 30 minutes. (4 marks)

1. ________________________________________________________________________

2. _______________________________________________________________________

3. _______________________________________________________________________

4. _______________________________________________________________________

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Question 2

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Question 3 (20 marks) 9 minutes

i) Complete the table to distinguish between the historical features of Guillain-Barré Syndrome and Multiple Sclerosis. (5 marks)

Historical feature Guillain-Barré Syndrome Multiple sclerosis

2.(1 mark)

4.(1 mark)

5.(1 mark)

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Question 3 (continued)

ii) List the two (2) investigations of choice to assist with the diagnosis of Multiple Sclerosis. State two (2) diagnostic findings that are supportive of Multiple Sclerosis for each investigation. (6 marks)

Investigation of choice 1:_______________________________________________________Supportive findings:

1. _____________________________________________________________________

2. _____________________________________________________________________

Investigation of choice 2:_______________________________________________________Supportive findings:

1. _____________________________________________________________________

2. ____________________________________________________________________

iii) Assuming the diagnosis of Guillain-Barré Syndrome, which drug must not be given if intubation is required? State the reason why. (2 marks)

Drug:____________________________________________________________________

Reason: __________________________________________________________________

_________________________________________________________________________

iv) List the two (2) options for specific treatment of Guillain-Barré Syndrome. (2 marks)

1. _____________________________________________________________________

2. _____________________________________________________________________

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Question 4 (10 marks) 6 minutesAn 87 year old man from a nursing home presents following a generalised seizure.

His observations are:

BP 120/70 mmHg

HR 100 bpm

Temperature 36.8 °C

Oxygen saturation 97% room air

GCS 12 E4, V3, M5

Initial blood results are taken.

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Question 4 (continued)

i) Provide two (2) calculations to help you to interpret these results. (2 marks)

Derived value 1: _____________________________________________________________

___________________________________________________________________________

Derived value 2: _____________________________________________________________

___________________________________________________________________________

ii) What is the likely cause for this clinical picture? (2 marks)

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

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Question 4 (continued)

iii) Complete the following table demonstrating three (3) key treatment tasks and state how you would achieve each of these. (6 marks)

Key treatment task(3 marks)

How will you achieve the task?(3 marks)

1

2

3

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Question 5 (12 marks) 6 minutesA 6 year old presents with a left supracondylar humeral fracture.

i) State two (2) types of pain scoring systems that you could apply to this child. (2 marks)

1. _________________________________________________________________________

2. _________________________________________________________________________

ii) List two (2) reasons why a pain score is used. (2 marks)

1. _______________________________________________________________________

2. _______________________________________________________________________

iii) List four (4) indications for general anaesthetic, manipulation and plaster for this patient. (4 marks)

1. _____________________________________________________________________

2. _____________________________________________________________________

3. _____________________________________________________________________

4. _____________________________________________________________________

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Question 5 (continued)

iv) List four (4) pieces of advice that you would give to a parent if the patient is able to be discharged from the emergency department. (4 marks)

1. _____________________________________________________________________

2. _____________________________________________________________________

3. _____________________________________________________________________

4. _____________________________________________________________________