FELLOWSHIPEXAM.COM ROADBLOCK EXAM 1. EXAMINATION PAPER FELLOWSHIPEXAM.COM ROADBLOCK TEST 1. Question paper. Instructions to candidates 1. This book contains 10 short answer questions. 2. You have 1 hour and 6 minutes to complete the exam. 3. Question 1 is twice the length of the other questions and you should allot your time accordingly 4. Each 2 page question is designed to be completed in the same amount of time, irrespective of the number of marks assigned 5. Each 2 page question will be scaled to contribute equally to the examination outcome, 6. Answer in the space provided within this booklet. 7. Write in blue or black pen. 8. Where referenced refer to the supplementary clinical information booklet for clinical information. 9. Where a number of answers are requested only that number will be marked.
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FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
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.
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
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.
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question1.Question6.(6marks)Give6endpointsyouwouldusetojudgetheefficacyofyourtransfusion.
1.2.3.4.5.6.vii.(2marks)IsthereanyevidencefortheuseoflowBPtargets(permissivehypotension)intrauma?
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question2.YouaretheEDconsultantondutyinaregionalhospitalwithnoobstetricorneonatalspecialistservices.Aprimigravid25yearoldpatientpresentstoyouremergencydepartmentat8am.Sheis31weekspregnantwithappropriateantenatalcarewhichhaselicitednocomplicationsofpregnancy.Shedescribessevererhythmiclowerabdominalpainswhichhavebeeninprogressforthepast4hours.i.(2marks)Give2differentialdiagnosesforthispresentation.
1.2.ii.(8marks)Usingthetablebelowoutline4features(notinclusiveofvitalsigns)youwillassessonclinicalexaminationandtherationaleforeach.
FEATURE RATIONALE
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question2.iii.(5marks)Yourexaminationindicatesthatpretermlabourisinprogresswithoutanymajorcomplicationstofurthermedicationadministration.Give5stepsinmanagementyouwillnowinstitute.
1.2.3.4.5.iv.(4marks)List4contraindicationstotocolytictherapyinpatientswithpretermlabour.
1.2.3.4.
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
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?
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
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:
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question4.iii.(12marks)Usingthetablebelowlist6investigationsyouwillperformnowinthispatient.Giveajustificationforeach.
TEST INDICATION
iv.(4marks)Give4methodswhichyouwillusetoactivelyrewarmthispatient.(4marks)
1.2.3.4.
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question5.
A35yearoldmalepresentstoyourdepartmentaftercatchinghisrightfootunderneathadoor.
Aclinicalimageofthefootisreproducedonpage6ofthesupplementaryinformationbooklet.
i.(2marks)Describetheimportantfindingsintheimage.
ii.(5marks)
Describeyourtechniquetoanaesthetisethispatienttoexamandtreathim.
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question5.iii.(6marks)
Thepatienthastheinjuredtoenailwithhiminhispocket.
Describethetreatmentyouwillprovideincludingyourdisposition&management.
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
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.
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question 6.iii.(8marks)Describeyourimmediatemanagement(8marks)
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
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.
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question 7.iii(3marks).WhataretheadvantagesofultrasoundoverCTinimagingthispatient?(3marks)
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question8.A48yearoldmalepresentstoyourdepartmentafterbeingstruckintherighteyewithasquashball.Heiscomplainingofblurredvisionandaheadache.Hisrightorbitisswollenandbruisedbuttherearenoothermajorinjuries.i.(5marks)Foreachcategorylistedbelowgivetherequestednumberoffeaturesyouwillexamineforandtheinjuriestheymayrepresent
PUPIL:1.2.EYEMOVEMENTS1.2.LIP1.ii.(2marks)ACTscanofthepatient’sfaceisshownonpage9ofthesupplementaryinformationbooklet.Whatarethetwomajorabnormalities?
1.2.
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question8.iii(4marks).Whataretheindicationsforsurgeryinthisfracture?
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question9.A46yearoldpatientpresentstoyourhospitalwith20minutesofcrushingcentralchestpain.YoudonothavePCIfacilitiesinyourinstitution.Thenearestcardiaccatheterlaboratoryis40minutesaway.i.(4marks)HisECGisshownonpage10ofthesupplementaryinformationbooklet.Give3majorabnormalitiesandalikelydiagnosis.
ii.(6marks)ExplainthreeissuesyouwouldconsiderindeterminingwhethertosendthispatientforprimaryPCIorusethrombolysisintheED.
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
iii.(6marks)LogisticfactorspreventthetimelytransferofthepatienttothePCIfacilityandadecisionistakeninconsultationwithcardiologytodeliverprimarythrombolysis.Listthemedicationsinsequencethatyouwillgivetoachievethis.
iv.(1mark)OnehourafterlysisthepatientispainfreeandtheSTsegmentshaveresolved.WhatisyourtimeframefortransferringthemtoaPCIcentre?
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
Question10.A16yearoldapprenticepresentstoyouremergencydepartmentafteranindustrialaccident.Alargeglasspanedroppedfromaheightontohisrightarmonabuildingsite.i.(5marks)Hisinitialxrayisshownonpage11ofthesupplementaryexaminationbooklet.Givefive(5)importantfeaturesofthexray.
ii.(8marks)Usingthetableonthefollowingpagelist4structureswhichmaybedamagedinassociationwiththisorthopaedicinjury,andgiveaclinicalsignyouwillassessfortoevaluatethestructure.
FELLOWSHIPEXAM.COMROADBLOCKEXAM1.EXAMINATIONPAPER
STRUCTURE CLINICALSIGN
iii.Givefour(4)interventionsorconsultationsyouwillundertakeaspartofyourmanagement.
1.2.3.4.
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