university hospital, geelong emergency medicine trial fellowship … · 2019-07-17 · university...
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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
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Question1(18marks)
A65yearoldmanpresentswithsymptomssuggestiveofrightrenalcolic.
a. Statesix(6)aimsintheuseofradiologicalinvestigationforthispatient.(6marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
4. ________________________________________________________________________
5. ________________________________________________________________________
6. ________________________________________________________________________
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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)
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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. ______________________________________________________________________
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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
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Question4
UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek11
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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
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Question8