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UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek25
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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
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Question1(18marks)a. Definepsychosis.(1mark)________________________________________________________________________
b. Listthefive(5)DSMIVcriteriaforthediagnosisofSchizophrenia.(5marks)
1. _______________________________________________________________________
2. _______________________________________________________________________
3. _______________________________________________________________________
4. _______________________________________________________________________
5. _______________________________________________________________________
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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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Question1(continued)
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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Question5(continued)
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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Question7(continued)
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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Question9(continued)
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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UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek25
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IDNUMBER:
UniversityHospital,Geelong
EmergencyMedicine
TrialFellowshipExam
ShortAnswerQuestions(SAQ)
Week25
PROPBOOKLET
UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek25
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Question4
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Question7
MICROSCOPYLeucocytes >1000x10^6/L (<2x10^6/L)RedBloodCells 220x10^6/L(<13x10^6/L)SquamousEpithelialCells +STANDARDBACTERIALCULTURE 1.Escherichiacoli>10^9cfu/L
SENSITIVITIES:1AmpicillinSAugmentinSCefotaximeSCephalothinSCotrimoxazoleSGentamicinSNitrofurantoinSTrimethoprimR
UniversityHospital,Geelong-FellowshipExamShortAnswerQuestionsWeek25
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Question8
Xray1 Xray2
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Question8continued Xray3