ROADBLOCK TEST 1. Question paper. Instructions to candidates...ROADBLOCK TEST 1. Question paper. Instructions to candidates ... Give the 2 primary disturbances present and justify

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FELLOWSHIPEXAM.COMROADBLOCKTEST1.

Questionpaper.

Instructionstocandidates

1. Thisbookcontains10shortanswerquestions.2. Youhave1hourand6minutestocompletetheexam.3. Question1istwicethelengthoftheotherquestionsandyoushould

allotyourtimeaccordingly4. Each2pagequestionisdesignedtobecompletedinthesameamount

oftime,irrespectiveofthenumberofmarksassigned5. Each2pagequestionwillbescaledtocontributeequallytothe

examinationoutcome,6. Answerinthespaceprovidedwithinthisbooklet.7. Writeinblueorblackpen.8. Wherereferencedrefertothesupplementaryclinicalinformation

bookletforclinicalinformation.9. Whereanumberofanswersarerequestedonlythatnumberwillbe

marked.

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Question1.A32yearoldmotorbikeriderisbroughtintoyourdepartmentafterbeingstruckbyamotorbike.Thefronttirerandirectlyoverherabdomenjustinferiortothecostalmargins.Hervitalsignsare: HR 128 /min BP 90/44 mmHg RR 29 /min Sats 94% 6LO2

T 35.8 oCi.(5marks)Whatistheevidencefortheempiricuseoftranexamicacidinthispatient?

ii.(5marks)Thepatienthasavenousgastakenintheresusroom.Theresultsareshownonpage2ofthesupplementarybooklet.Givethe2primarydisturbancespresentandjustifyyouranswer.

FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER

Question1.iii.(8marks)BasedontheVBGresultsusethefollowingtabletolisttwomajorpathologicprocessesyouareconcernedabout,andthreeinjurieswhichmaycontributetoeach.PATHOLOGICPROCESS INJURIES

iv.(4marks)ThepatientistakentoCTscan,andacopyoftheimageisreproducedonpage3ofthesupplementarybooklet.Listfour(4)majorabnormalitiespresent?

1.2.3.4.

FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER

Question1.v.(1mark)Whatgradeofkidneyinjuryisthis?

vi(4marks)Give4indicationsforoperativemanagementofthispatient.(4marks)

1.2.3.4.vii.(5marks)Givefive(5)elementsimportantinamassivetransfusionprotocol.

1.2.3.4.5.

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Question1.Question6.(6marks)Give6endpointsyouwouldusetojudgetheefficacyofyourtransfusion.

1.2.3.4.5.6.vii.(2marks)IsthereanyevidencefortheuseoflowBPtargets(permissivehypotension)intrauma?

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Question2.YouaretheEDconsultantondutyinaregionalhospitalwithnoobstetricorneonatalspecialistservices.Aprimigravid25yearoldpatientpresentstoyouremergencydepartmentat8am.Sheis31weekspregnantwithappropriateantenatalcarewhichhaselicitednocomplicationsofpregnancy.Shedescribessevererhythmiclowerabdominalpainswhichhavebeeninprogressforthepast4hours.i.(2marks)Give2differentialdiagnosesforthispresentation.

1.2.ii.(8marks)Usingthetablebelowoutline4features(notinclusiveofvitalsigns)youwillassessonclinicalexaminationandtherationaleforeach.

FEATURE RATIONALE

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Question2.iii.(5marks)Yourexaminationindicatesthatpretermlabourisinprogresswithoutanymajorcomplicationstofurthermedicationadministration.Give5stepsinmanagementyouwillnowinstitute.

1.2.3.4.5.iv.(4marks)List4contraindicationstotocolytictherapyinpatientswithpretermlabour.

1.2.3.4.

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Question3.An18yearoldmanpresentstoyouremergencydepartmentwithanacutelypainfulrighttesticle.Heisvisiblydistressedbythepainandisvomitingattriage.Hehasnopastmedicalhistoryofnote.Hestatesthepainbeganmorethan4hoursago.Hisvitalsignsare:

HR 110 /minBP 135/92mmHgRR 24 /minSats 98% RAT 37.4 oC

i.(4marks)List4differentialdiagnosesforthispresentation.

1.2.3.4.ii.(3marks)Whatfurtherfeaturesonexaminationwouldsupportadiagnosisoftesticulartorsion?

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Question3.iii.(6marks)Yourresidentwhohasprimarycareofthepatientreturnstoyouandasksyoutoapproveanultrasoundofthetesticle.Usingthetablebelowoutlineoftwoissuesinthiscasewhichmaylimittheutilityofultrasoundinthispatient.

ISSUE OUTLINE

iv.(2marks)Yourresidentreturnstoyoutosaythesurgicalregistrarisrefusingtoseethepatientuntilanultrasoundisperformed.Atthisstagethepatienthasbeeninyourdepartment45minutes.Outlineyournextactions.

FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER

Question4.An82yearoldfemaleisbroughtinbytheambulanceafterbeingfoundfaecallyincontinentonherbathroomfloor.Itisunclearhowlongshehasbeenthere.Herneighboursintheapartmentblockhavenotseenherfor3days.OnarrivaltotheEDsheisconfusedanddisoriented.Hermedicationlistincludeswarfarin,telmisartan,atorvastatinanddigoxin.Hervitalsignsare:

HR 45 /minBP 99/66 mmHgRR 28 /minSats 92% RAT 33.1 oC

i.(3marks)Thepatient’sECGisreproducedonpage4ofthesupplementaryinformationbooklet.Give3abnormalitieswhichrelatetothislady’spresentation.

1.2.3.ii.(4marks)Theresidentbringsyouavenousbloodgaswhichisreproducedonpage5ofthesupplementaryinformationbooklet.Give2acid-basedisturbancespresentandprovide2derivedvaluestosupportyouranswer.

1.2.Derivedvalue1:Derivedvalue2:

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Question4.iii.(12marks)Usingthetablebelowlist6investigationsyouwillperformnowinthispatient.Giveajustificationforeach.

TEST INDICATION

iv.(4marks)Give4methodswhichyouwillusetoactivelyrewarmthispatient.(4marks)

1.2.3.4.

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Question5.

A35yearoldmalepresentstoyourdepartmentaftercatchinghisrightfootunderneathadoor.

Aclinicalimageofthefootisreproducedonpage6ofthesupplementaryinformationbooklet.

i.(2marks)Describetheimportantfindingsintheimage.

ii.(5marks)

Describeyourtechniquetoanaesthetisethispatienttoexamandtreathim.

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Question5.iii.(6marks)

Thepatienthastheinjuredtoenailwithhiminhispocket.

Describethetreatmentyouwillprovideincludingyourdisposition&management.

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Question6.A46yearoldmalewithahistoryofgastro-oesophagealrefluxandintravenousdrugusepresentstotheemergencydepartmentwithsuddenonsetcentralabdominalpain.Onexaminationhehasarigidabdomentopalpation,andhisvitalsignsare:

HR 125 /minBP 98/42 /minRR 29 /minSats 99% RAT 38.4 oC

ACTscanofhisabdomenisorganised,andanimageisshownonpage7ofthesupplementaryinformationbooklet.i.(5marks)WhataretheimportantfindingsontheCTimage?

ii.(4marks)Give4differentialdiagnosesfortheCTfindings.

1.2.3.4.

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Question 6.iii.(8marks)Describeyourimmediatemanagement(8marks)

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Question 7.A38yearoldfemalepresentstoyouremergencydepartmentwithsevereconstantrightupperquadrantpain.Shecomplainsofurinethatisdarkercolourthannormalandsignificantsweatingovernight.Shealsofeelsnauseousandhasnoappetite.Onexaminationshehassevererightupperquadranttendernessandnotableocularjaundice.Hervitalsignsare: HR 125 /min BP 89/52 mmHg RR 29 /min Sats 98% RA T 39.6 oCi.(6marks)Give3pathologytestswillyouperformonthispatientandajustificationforeach?

ii.(8marks)Selectedpathologyisshownonpage8ofthesupplementaryinformationbooklet..Describetheresultsandtheirimplications.

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Question 7.iii(3marks).WhataretheadvantagesofultrasoundoverCTinimagingthispatient?(3marks)

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Question8.A48yearoldmalepresentstoyourdepartmentafterbeingstruckintherighteyewithasquashball.Heiscomplainingofblurredvisionandaheadache.Hisrightorbitisswollenandbruisedbuttherearenoothermajorinjuries.i.(5marks)Foreachcategorylistedbelowgivetherequestednumberoffeaturesyouwillexamineforandtheinjuriestheymayrepresent

PUPIL:1.2.EYEMOVEMENTS1.2.LIP1.ii.(2marks)ACTscanofthepatient’sfaceisshownonpage9ofthesupplementaryinformationbooklet.Whatarethetwomajorabnormalities?

1.2.

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Question8.iii(4marks).Whataretheindicationsforsurgeryinthisfracture?

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Question9.A46yearoldpatientpresentstoyourhospitalwith20minutesofcrushingcentralchestpain.YoudonothavePCIfacilitiesinyourinstitution.Thenearestcardiaccatheterlaboratoryis40minutesaway.i.(4marks)HisECGisshownonpage10ofthesupplementaryinformationbooklet.Give3majorabnormalitiesandalikelydiagnosis.

ii.(6marks)ExplainthreeissuesyouwouldconsiderindeterminingwhethertosendthispatientforprimaryPCIorusethrombolysisintheED.

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iii.(6marks)LogisticfactorspreventthetimelytransferofthepatienttothePCIfacilityandadecisionistakeninconsultationwithcardiologytodeliverprimarythrombolysis.Listthemedicationsinsequencethatyouwillgivetoachievethis.

iv.(1mark)OnehourafterlysisthepatientispainfreeandtheSTsegmentshaveresolved.WhatisyourtimeframefortransferringthemtoaPCIcentre?

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Question10.A16yearoldapprenticepresentstoyouremergencydepartmentafteranindustrialaccident.Alargeglasspanedroppedfromaheightontohisrightarmonabuildingsite.i.(5marks)Hisinitialxrayisshownonpage11ofthesupplementaryexaminationbooklet.Givefive(5)importantfeaturesofthexray.

ii.(8marks)Usingthetableonthefollowingpagelist4structureswhichmaybedamagedinassociationwiththisorthopaedicinjury,andgiveaclinicalsignyouwillassessfortoevaluatethestructure.

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STRUCTURE CLINICALSIGN

iii.Givefour(4)interventionsorconsultationsyouwillundertakeaspartofyourmanagement.

1.2.3.4.