Candidate name

Fellowship course

Week 6–Exam

WRITTEN EXAMINATION

SHORT ANSWER QUESTIONS

Time: 33 min

Question 1 (12 marks) 6 minutes

A 28-year-old man is brought into your emergency department after being stabbed whilst at a night club. He is brought in by ambulance after having been intubated for respiratory distress.

A photo is taken.

Soon after this photograph, is taken he rapidly deteriorates and is found to have pulseless electrical activity.

Question 1 (continued)

  1. List six (6) likely causes for his haemodynamic deterioration. (6 marks)
  1. ______
  2. ______
  3. ______
  4. ______
  5. ______
  6. ______

Despite appropriate treatment, the patient dies shortly after in the department.

  1. List six (6) steps in your management of the situation in the next 2 hours. (6 marks)
  1. ______
  2. ______
  3. ______
  4. ______
  5. ______
  6. ______

Question 2 (13 marks) 6 minutes

A 35-year-old woman driver was involved in a motor vehicle collision. She was wearing a seatbelt, self-extricated herself and was ambulant at the scene. While giving details to the police, she reported neck pain which was not present for the first 10 minutes post collision. She arrives by ambulance in sitting position without spinal immobilisation. A rigid cervical collar is placed at triage. Her main complaint is of moderate severity neck pain.

  1. List four (4) features on history or examination that would mandate the need for cervical spine imaging. (4 marks)
  1. ______
  2. ______
  3. ______
  4. ______
  1. Assuming the absence of all of these features, list three (3) low risk factors of this presentation as stated that allow safe assessment of range of movement of her cervical spine. (3 marks)
  1. ______
  2. ______
  3. ______

Question 2 (continued)

  1. A decision is made to progress to imaging. State one (1) important pro and one (1) important con for the imaging options below, for this patient. (6 marks)

Imaging option / Pro
(3 marks) / Con
(3 marks)
Plain xray series
CT C Spine
MRI C spine

Question 3 (13 marks) 6 minutes

A 65-year-old male presents following a house fire.

i)Other than decreased conscious state, list two (2) indications for immediate intubation in this patient. (2 marks)

  1. ______
  2. ______

A photograph of the man is taken.

ii)List three (3) features shown in this image that predict the probability of significant airway burns. (3 marks)

  1. ______
  2. ______
  3. ______

Question 3 (continued)

The patient deteriorates and requires intubation. Your 1st attempt at direct laryngoscopy fails.

ii)List four (4) steps that you would institute to improve your likelihood of success for your next attempt. (4 marks)

  1. ______
  2. ______
  3. ______
  4. ______

iii)What is the Brooke-Parkland formula? (1 mark)

______

iv)How is Brooke-Parkland formula applied? State three (3) points of explanation. (3 marks)

  1. ______
  2. ______
  3. ______

Question 3

Question 4 (12 marks) 6 minutes

A 25-year-old male presents via ambulance to your rural emergency department. He fell from a motorbike and complains of neck pain. After complete examination and investigation, he is found to have an isolated neck injury.

Observations:

GCS 15

A cervical spine x-rays is take.

  1. State three (3) abnormal findings shown in this X-ray. (3 marks)
  1. ______
  2. ______
  3. ______

It is determined that the patient requires transfer by road ambulance to a trauma centre 150

km away.

  1. State six (6) key preparations for transfer that are specific for this injury. (6 marks)
  1. ______
  2. ______
  3. ______
  4. ______
  5. ______
  6. ______

Question 4 (continued)

  1. You suspect a spinal injury. List one (1) pro and two (2) cons for using steroids for this patient. (3 marks)

Pro:

  1. ______

Cons:

  1. ______
  2. ______

Question 5 (18 marks) 9 minutes

A 10-year-old girls presents to the emergency department after a fall from the monkey bars after school and complains of a painful elbow.

An elbow XRis taken.

i)State four (4) abnormalities shown in this x-ray. (4 marks)

  1. ______
  2. ______
  3. ______
  4. ______

After full assessment, the child is confirmed to have this isolated injury and is very distressed with pain. She is fasted. She has received no prehospital treatment. She does not currently have IV access.

ii)List your approach to analgesia in the first 20 minutes of this presentation. State five (5) points, providing dose and route where applicable. (5 marks)

  1. ______
  2. ______
  3. ______
  4. ______
  5. ______