WESTMEAD SAQ General 5 TRIAL FACEM QUESTIONS

Transcription

1 WESTMEAD SAQ General 5 TRIAL FACEM QUESTIONS TIME = 30 mins Return Questions to Andrew Coggins andrewrcoggins@gmail.com or in Pigeon Hole for marking and feedback 1 P age

2 QUESTION 1 A 24 year old Eritrean male presents with an injury to his left eye after being struck by a golf ball Examination of the right eye is normal. His vital signs are: BP 115/60 mmhg HR 80 beats/min RR 15 /min Temperature 36.2 o C This is a picture of his right eye: i. Briefly describe the appearance of the patient s eye. (2 marks) 2 P age

3 ii. List five (5) complications associated with this presentation and the clinical findings that you would look for on examination (5 marks) Complication of the Eye Injury Examination finding iii. List 3 underlying conditions that would put this patient at a higher risk of permanent visual loss (3 marks) 3 P age

4 QUESTION 2 A 68 year old woman is brought to your emergency department from a shopping centre where she had sudden onset chest pain and a syncopal episode. On examination there is no evidence of trauma. Observations: Blood Pressure 97/40, Respiratory Rate 20/min Heart Rate 125, Temperature 37.1 degrees, Oxygen Saturations 97% (on 8 litres by Hudson Mask) i. List four (4) critical diagnoses you would consider and (one (1) risk factor that is associated with each of these diagnoses. (4 marks) Critical diagnosis Risk Factor P age

5 ii) Describe the Echocardiogram (still image shown below) in terms of the diagnosis and potential complications. (6 marks) Echo Findings Potential Complications 1) 1) 2) 2) 3) 3) 5 P age

6 QUESTION 3 A 47-year-old lady presents to the Emergency Department (ED) with a history of knee pain and ankle pain after a fall from a bicycle. She is brought in by ambulance and was given intranasal fentanyl on route. She has no past medical history. After assessment the painful leg is found to be an isolated injury. Observations: Blood Pressure 120/81 Respiratory Rate 20/min Heart Rate 75 Temperature 37.1 degrees Oxygen Saturations 98% (on room air) (Mobile Knee X-ray is shown on the next page) i) Describe the patient s Knee X-ray. (3 marks) 6 P age

7 7 P age

8 II) List three (3) complications that could be associated with this traumatic injury. (3 marks) II) List 2 further investigations you would like to perform on this patient and why. (4 marks) Investigations Rationale 1) 1) 2) 2) 8 P age

9 QUESTION 4 You are the only consultant working a busy evening shift in emergency department when the triage nurse tells you that 3 patients have self-presented to triage in the last five minutes with having ingested a large quantity of special tea made from a yellow flowering plant at a nearby music festival. An ambulance officer states that a further 10 people were involved in the game and that ambulances have been called to the scene. i) What further information do you ask the ambulance officer? (3 marks) ii) What key steps do you take to prepare your emergency department for this situation? (3 marks) 9 P age

10 You review the first patient in the ED. His ECG is shown below iii) Briefly describe the ECG and given 3 possible causes (4 marks) 10 P age

11 QUESTION 5 A 55-year-old man presents to the Emergency Department (ED) by ambulance with a history of nausea, headache and blurred vision. There is no known past medical history. Observations: Blood Pressure 231/129, Respiratory Rate 20/min Heart Rate 80, Temperature 37.0 degrees, Oxygen Saturations 94% (on room air) i) List 3 clinical features that would support a diagnosis of Malignant Hypertension in this man (3 marks) ii) List four secondary causes of malignant hypertension (4 marks) 11 P age

12 iii) Discuss your approach to managing this patient s blood pressure in the ED. (3 marks) END OF PAPER 12 P age