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#13 · SVH2021

Info (stem): SAQ 10 A 60-year-old male is brought to ED after falling from a 2-meter ladder. His only complaint is a sore lower back and R groin. There was no head strike. He is taken to the Resus bay and a Trauma call is put out. His past medical history is sigificat for atrial fibrillation, for which he is on Digoxin and Warfarin. A chest x-ray and eFAST is performed and is negative for acute injury. His pelvic x-ray is shown below.
ortho pelvis trauma
Q1: List four bony abnormalities visible on the X-ray? (4 marks)
Q2: There are 2 classification systems for traumatic pelvic fractures: “Tile” and “Young and Burgess”. Complete the table below to identify what these classification systems are based on (2 marks)
Q3: Based on the Young and Burgess classification system, what type of injury is shown on this X-ray? (1 mark)
Q4: A pelvic binder was applied when the patient arrived in ED. Outline the two guiding principles behind pelvic binder application (2 marks)
Q5: The lab calls to inform you that the INR is 4. The patient’s blood pressure is now 80/40. Airway and breathing both remain stable. List three actions that you would take with regards to haemorrhage control (3 marks)

#12 · SVH2021

Info (stem): SAQ 9 A 54 years old male present with sudden onset SOB from the day before. He is previously well , on no regular medication. He does not drink alcohol but has been smoking a pack of cigarette a day for the past 20 years. On examination He appears well, alert and orientated and speaks in full sentences. RR 16 , Sats 95% RA with reduced AE on the left side and occasional bibasal creps R>L. The rest of his examination was unremarkable. His CXR is attached
Pneumothorax
Q1: 1.What is the treatment of choice for this patient and why? 2
Q2: 2.What are the 4 indications of immediate chest drain when CXR is delayed or not available immediately in an awake patient with suspected pneumothorax? 4
Q3: 3.List six factors to determining your treatment of choice? 6
Q4: 4.List 3 signs of pneumothorax on bedside ultrasound? 3

#11 · SVH2021

Info (stem): SAQ 8 An otherwise well 45 year old female presents to your ED with acute onset of left sided facial droop that began three hours ago. She has no medical history and only takes the oral contraceptive pill as daily medication. Her observations are as follows:- BP 150/70 - Pulse rate 90 bpm, regular - RR 18 - Sats 99% on room air - GCS 15/15 The patient has asymmetrical facial weakness on examination. You suspect a diagnosis of Bell’s Palsy.
bells palsy neuro
Q1: i) List five features other than facial weakness on clinical assessment (history and examination) that you might find in this patient
Q2: ii) Other than Bell’s palsy, list four stroke mimics relevant to this patient’s presentation (4 marks)

#10 · SVH2021

Info (stem): SAQ 7 SAQ -12 marks A 19 year old male presents to your Emergency Department for the first time concerned about being followed by street gangs. He is agitated and pacing. His vital signs are as follows: Temp 36.9 HR 90 bpm BP 115/70 mmHg
Q1: a. List five (5) features on history that make you more likely to consider an organic cause for his presentation rather than a psychiatric cause.
Q2: b. The mental health team have asked you to ‘medically clear’ this patient. State three (3) objectives of a medical assessment.
Q3: The mental health team believe his presentation is most likely a drug induced psychosis. c. State four (4) factors that might lead you to consider drug induced psychosis above schizophrenia.

#9 · SVH2021

Info (stem): SAQ 6 A 43-year-old homeless male is brought to the emergency department by ambulance following concern for welfare after being found lying on a footpath. He appears highly intoxicated with an unsteady gait and attempts to leave the department following triage.
alcohol duty of care short stay
Q1: i. Define duty of care (2 marks)
Q2: Following verbal de-escalation, he is placed into a non-monitored corridor bed and is reviewed by a junior registrar with a plan for observation and discharge once sober. 6 hours later he becomes agitated and appears anxious. ii. List the domains of the Alcohol withdrawal assessment scale (CIWA-Ar) (4 marks)
Q3: He has a CIWA-Ar score of 24 and is requesting alcohol detox. You are asked to review the patient. iii. List four (4) risk factors for severe alcohol withdrawal (4 marks)
Q4: iv. List two (2) key issues for your initial management and details for how you would accomplish them (4 marks).
Q5: He is admitted to the Psychiatric, Alcohol and Non-Prescription Drug Assessment (PANDA) Unit. v. List two (2) benefits of an inpatient short stay ward tailored to alcohol and other substance withdrawal and two (2) hazards that may arise. (4 mark)

#8 · SVH2021

Info (stem): SAQ 5 A 3-year-old boy is brought to the emergency department by his parents with a two day history of feeling generally unwell, fevers, lethargy and vomiting. A venous blood gas is obtained and the results are as follows: pH 7.08 pCO2 30 mmHg HCO3 10 mmol/L Na+ 145 mmol/L K+ 3.9 mmol/L Cl- 100 mmol/L Creatinine 160 micromol/L Urea 20 mmol/L Lactate 4.7 mmol/L
Q1: List two important abnormalities in the venous blood gas. For each abnormality, provide your calculations alongside an explanation of the likely underlying cause (6 marks)
Q2: ii. The patient develops seizures and the decision is made to intubate. Complete the following table regarding the equipment and medications you would prepare for this patient (0.5 marks per box, 5 marks total).
Q3: iii. List one advantage and one disadvantage of commencing sodium bicarbonate therapy in this child (0.5 marks per box, 1 mark total).

#7 · SVH2021

Info (stem): SAQ 4 You are the consultant in a regional emergency department. A 35 year old G3P2 female presents at 35+5 weeks gestation
Obstetrics Resuscitation
Q1: List 3 features of this cardiotocographic (CTG) tracing and your interpretation (4 marks)
Q2: The woman delivers a neonate with APGAR scores of 7 and 9 (at 1 and 5 minutes respectively) in the resuscitation cubicle following a precipitous labour. There was an estimated 650mls of maternal vaginal blood loss Complete the following table with regards to the risk factors for post partum haemorrhage (9 marks).
Q3: You suspect the underlying cause is uterine hypotonia. You activate a massive transfusion protocol and administer 10units of IM syntocinon (oxytocin) followed by an infusion. List 2 other medical therapies you could commence to treat the underlying cause of her haemorrhage (2 marks).
Q4: List 3 advantages of the use of a massive transfusion protocol compared to red blood cell only transfusion in any patient with haemorrhagic shock (3 marks).

#6 · SVH2021

Info (stem): SAQ 3 A 30 year old female presented to the emergency department via ambulance from a party. Her friend reports she took 2 ecstasy pills and alcohol during it and subsequently felt unwell feeling, hot, sweating and tremors. In the ambulance ride she had a tonic clonic seizure lasting 1 minutes. She has a background of depression and is on fluoxetine. On examination BP 80/40, HR 140, T39.3, Sa02 97% RA. GCS 10 E3V3M4 and agitated. She has muscle rigidity and sustained clonus. You suspect serotonin syndrome
serotonin syndrome
Q1: What 3 characteristic findings do you expect from serotonin syndrome (3 marks)
Q2: Other than toxicological causes list 3 differential diagnosis (3 marks)
Q3: List 3 important differences between serotonin syndrome and neuroleptic syndrome (3 marks)
Q4: List the Hunter serotonin toxicity criteria (4 marks)
Q5: List the is the priorities of your management of the patient including drug doses and reasons why (5 marks)

#5 · SVH2021

Info (stem): SAQ 2: Retrieval/Trauma You are a FACEM in a small rural emergency department with no trauma capacity and no anaesthetics support. The nearest trauma centre is 3 hours away by road. A patient presents who was struck in the neck with a cricket ball one hour earlier and since then has had hoarseness, persistent stridor and progressive neck swelling.
airway trauma
Q1: List 3 immediate interventions required during your initial assessment. (3 points)
Q2: During your assessment you find the respiratory rate is 40 and SpO2 is 88% on 15L O2. You decide this patient needs an immediate definitive airway. State 3 changes to a standard intubation procedure that may be required in this patient. (3 points)
Q3: You have organised for the patient to be transferred by the state retrieval service to a trauma centre. State 3 limitations of transfer by road and 3 limitations of transfer by helicopter. (6 points)

#4 · SVH2021

Info (stem): SAQ 1 An otherwise healthy 25-year-old man was riding a scooter at 20 km/hr and was struck by another vehicle at low speed. He has sustained an isolated injury to his right foot. There are no open wounds over the foot or ankle. An Xray is provided below:
lower limb ortho trauma
Q1: a. Detail three (3) abnormalities in the imaging provided (3 marks)
Q2: Complete the following table with regards to the mechanisms of injury for this injury type (6 marks)
Q3: Outline three (3) important steps in the management of this injury in this patient in the Emergency Department (3 Marks)