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TRANSCRIPT
Candidate number ________
�
Fellowship Practice Exam November 2017 - Book 1
WRITTEN EXAMINATION SHORT ANSWER QUESTIONS
EXAMINATION TIME: 3 HOURS - 1 hour per booklet
Directions to Candidates
This booklet is one of three. It contains 9 questions. Allow 9 minutes for 3 page questions (1 and 9), and 6 minutes for 2 page questions (2 - 8). The entire booklet should take you 1 hour to complete.
1. Answer each question in the space provided in this question paper. 2. Do not write your name on this question paper. 3. Write your candidate number on each page in the space provided. 4. Cross out any errors completely. 5. Do not begin the exam until instructed to do so. 6. No examination papers or materials to leave the room. 7. Props are provided in a separate booklet.
Page �1
Candidate number ________
Question 1 (18 marks)
A 52 year old male presents to your Emergency Department with ischaemic sounding chest pain. He has not been seen in any hospital in the last 12 months and has never had Echocardiography.
a) State seven (7) factors that, in combination, would allow safe discharge within 3 hours from presentation. (7 marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
4. ________________________________________________________________________
5. ________________________________________________________________________
6. ________________________________________________________________________
7. ________________________________________________________________________
Page �2
Candidate number ________
Question 1 (continued)
b) If the patient underwent an ECG that demonstrated a left bundle branch block, state three (3)
ECG findings that may be useful for identifying myocardial infarction. (3 marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
An ECG is taken on arrival and shown on PROPS BOOKLET ; PAGE 3.
a) State three (3) significant abnormal findings in this ECG. (3 marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
b) State the significance of these abnormal findings. State two (2) points in your answer. (2 marks)
1. _____________________________________________________________________
2. _____________________________________________________________________
Page �3
Candidate number ________
Question 1 (continued)
Aspirin, GTN and morphine are provided for this patient.The patient has ongoing ischaemic sounding chest pain. His observations are:
BP 130/60 mmHgHR 90 bpmRR 14 bpmSats 94% RA
c) List three (3) further medications that are indicated for this patient. (3 marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
Page �4
Candidate number ________
Question 2 (12 marks)
A two year old well looking boy, is brought to your Emergency Department with rash.
A photo of his rash is shown in PROPS BOOKLET; PAGE 4
a) List Two (2) characteristics when describing his rash.( 2 marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
b) List Three (3) differential diagnosis for his presentation (and one history/examination finding for each to support your diagnosis (6 marks)
DDx Hx/Ex
1
2
3
Page �5
Candidate number ________
Question 2 (continued)
c) State two (2) investigations that are indicated for this patient. List one (1) rationale for each? (4 marks)
Investigation Rationale
1
2
Page �6
Candidate number ________
Question 3 (11 marks)
A 33 yo man presents with 5 days of worsening cough & dyspnoea. His GP has confirmed a diagnosis of influenza B, 7 days ago. His vital signs on arrival:
BP 110/70 mmHgHR 115 bpmRR 30 bpmO2 sat 88% RA temp 39 deg Celcius
His CXRs are shown in PROPS BOOKLET, PAGE 5 .
a) List three (3) abnormalities on the images provided. (3 marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
Page �7
Candidate number ________
Question 3 (continued)
b) List there (3) strategies to improve his respiratory status. For each strategy state one (1) explanation/rationale for its use. (6 marks)
d) List two (2) organisms most likely involved in this complication. (2 marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
Strategy Explanation/rationale
1
2
3
Page �8
Candidate number ________
Question 4 (12 marks)
A 55 year old Female with PMH of CCF and DM, is brought to your emergency department by ambulance with vomiting and drowsiness.here is no clinical signs to suggest trauma. Her Vital signs are :
BP 95/60 mmHgHR 110 bpm RR 28 bpm O2Sat 94% RAT 37 deg celsius GCS 14 (E3V5M6)
Her venous blood gas is shown in PROPS BOOKLET; PAGE 6.
a) What is the likely explanation for these gas results in this patient (2 marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
4. ________________________________________________________________________
5. ________________________________________________________________________
b) Is anion gap normal or abnormal? show your calculation. (2 mark)
________________________________________________________________________
________________________________________________________________________
Page �9
Candidate number ________
Question 4 (continued)
c) Calculate the Approximate Delta Gap and show your calculation. (2 marks)
________________________________________________________________________
________________________________________________________________________
d) What acid base disturbances does the Delta gap suggest? (1 mark)
________________________________________________________________________
________________________________________________________________________
e) List Four (4) expected changes with the ECG for Hypokalaemia.(4 marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
4. ________________________________________________________________________
Page �10
Candidate number ________
Question 5 (12 marks)
A 29 year old female with past history of pelvic inflammatory disease presents to your Emergency Department with severe abdominal pain.
a) List Four (4) investigations you would order for this patient in the ED with one rationale for each choice.(8 marks)
Investigation Justification
1
2
3
4
Page �11
Candidate number ________
Question 5 (continued)
b) List four (4) admission criteria regarding pelvic inflammatory disease. (4 marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
4. ________________________________________________________________________
Page �12
Candidate number ________
Question 6 (12 mark)
An 72 year old lady is brought in by ambulance mid-winter having been found by a neighbour collapsed on the floor of her unheated unit. She was acutely confused in a pool of her urine and unable to get up.
Her vital signs on ambulance arrival:
BP 90/60 mmHgHR 55 bpmRR 10 bpmO2 sat 95% RA Temp 29 deg Celcius
a) List four (4) ECG findings that you may expect for this patient.(4 marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
4. ________________________________________________________________________
Page �13
Candidate number ________
Question 6 (continued)
b) List four (4) rewarming methods that you would use for this patient. (4 marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
4. ________________________________________________________________________
c) List four (4) complications to be aware of during rewarming of this patient. (4 marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
4. ________________________________________________________________________
Page �14
Candidate number ________
Question 7 (12 marks)
A 42-year-old man presents to the ED by ambulance following ingestion of 200mL of anti-freeze. He is drowsy with slurred speech.His observations are: HR 110 bpm, BP 130/75 mmHg, RR 24 bpm, SaO2 95% room air.
His initial blood results include:
pH 7.21 (7.35-7.45)pCO2 24 (35-45)HCO3 6 (24-32)Na+ 140 (135-145)K+ 3.9 (3.5-5.0) Cl- 100 (95-110) glucose 5ethanol - undetectableUrea 5 (3-8)Osmolality 330 (275–295)
a) Provide two (2) calculations to help you interpret these results. (2 marks)
Derived value 1:
________________________________________________________________
________________________________________________________________
Derived value 2:
________________________________________________________________
________________________________________________________________
b) List three (3) possible life-threatening features that could occur from this ingestion (3 marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
Page �15
Candidate number ________
Question 7 (continued)
c) What is the role of decontamination in this poisoning? (1 mark)
________________________________________________________________
________________________________________________________________
d) List three (3) key steps in your management of this patient. State one (1) justification for your choice of each step. (6 marks)
Management step Justification
1
2
3
Page �16
Candidate number ________
Question 8 (12 mark)
A 60 year old female with a past history of SLE presents to the ED with dyspnoea. After initial assessment your are suspicious of alveolar haemorrhage.
a) List two (2) features (excluding dyspnea) in her history supportive of the diagnosis (2 marks).
1. ________________________________________________________________________
2. ________________________________________________________________________
b) List Two (2) diagnostic investigations with one justification for each (4 marks).
Investigation Justification
1
2
Page �17
Candidate number ________
Question 8 (continued)
c) Complete the following table listing organ systems and common conditions associated with SLE. (6 marks)
Organ / system Condition
CVS
1
2
Renal
1
2
GIT or Ocular
1
2
Page �18
Candidate number ________
Question 9 (18 marks)
An 18 year old man is transferred by ambulance to your rural emergency department after a self inflicted burn injury. Two hours ago the patient set himself alight with petrol after a fight with his girlfriend. He was intubated at the scene by the intensive care paramedic.
A clinical photograph is shown in the PROPS BOOKLET; PAGE 7 .
a) State four (4) important features of these burns. (4 marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
4. ________________________________________________________________________
b) List four (4) predictable important complications of this injury. (4 marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
4. ________________________________________________________________________
Page �19
Candidate number ________
Question 9 (continued)
After a thorough examination, you calculate his percentage of body surface area involved to be 80%. During the two hours since the injury the patient has received 2 litres of normal saline. His current blood pressure is 100/60 mmHg and pulse rate is 80 bpm.
c) Assuming the patient weights 70kg, calculate the patient’s fluid requirements for the first 24 hours. Show your calculation. (2 marks)
________________________________________________________________________
________________________________________________________________________
d) Prescribe your fluid treatment for your patient for the first 8 hours ? (4 marks)
Date Fluid Additives Rate ml/hr
Page �20
Candidate number ________
Question 9 (continued)
e) List four (4) measures for monitoring adequate of fluid resuscitation. for this patient (4 marks)
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
4. ________________________________________________________________________
Page �21