Dip PEC(SA)
THE COLLEGES OF MEDICINE OF SOUTH AFRICA Incorporated Association not for gain Reg No 1955/000003/08
Examination for the Diploma in Primary Emergency Care of the College of Emergency Medicine of South Africa 21 August 2014 Paper 1
(3 hours)
All questions to be answered. Each question to be answered in a separate book (or books if more than one is required for the one answer) Al die vraemoetbeantwoord word. Elkevraagmoet in ’n aparteboek (of boekeindienmeer as eennodig is vir ’n vraag) geskryf word
1
A 56-year-old man presents to the emergency centre. He is complaining of severe epigastric pain, nausea and vomiting since the early hours of the morning. His temperature is 38.3 °C, pulse rate 110 bpm, blood pressure 90/65 mmHg and his respiratory rate is 22 breaths per minute a) Name six causes of acute pancreatitis. (3) b) Compare and contrast lipase and amylase as biochemical markers of acute pancreatitis. (3) c) Define systemic inflammatory response syndrome (SIRS). (5) d) Describe your management of this patient with acute pancreatitis. (10) An 18-year-old male presents to you with testicular torsion e) Describe your management of this patient in the emergency centre.
1
(4) [25]
’n Ses-en-vyftig-jarige man word na die noodeenheidgebring. Hykla van ergeepigastriesepyn, naarheid en braking sedert die vroeëoggendure. Sytemperatuur is 38.3 °C, sypolsspoed is 110 slae per minuut, sybloeddruk is 90/65 mmHg en syrespirasie tempo is 22 respirasies per minuut a) Noemsesoorsake van akutepankreatitis. (3) b) Vergelyk en dui die verskilleaantussen lipase en amilase as biochemiesemerkers van akutepankreatitis. (3) c) Definieersistemieseinflammatorieseresponssindroom (SIRS). (5) d) Beskryfu hantering van hierdiepasiënt met akutepankreatitis. (10) ’n 18-Jarige man presenteer met testikulêretorsie e) Beskryfu hanteringvan hierdie patient in die noodeenheid.
(4) [25]
PTO/Page 2 Question 2…
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A 24-year-old man is brought to the emergency centre by the emergency medical services (EMS). He was an unrestrained passenger in a high-velocity motor vehicle collision. The EMS practitioner informs you that the patient has sustained severe trauma to the head and face, and that he was intubated on scene without using any sedation.Currently, his temperature is 36.6 °C, his pulse rate is 80 bpm and his blood pressure is 120/80 mmHg. He is connected to a ventilator, but has no spontaneous breaths a) Write short notes on the classification of maxillary fractures. In your answer include a description of the fracture lines. (8) b) What life threatening complications arise from these fractures? (2) The nurse informs you that she found an organ donor card in the patient’s identity document while she was undressing him c) Name the internationally accepted preconditions that must exist before one may perform tests to diagnose brainstem death. (5) d) Write short notes on the apnoea test used to diagnose brainstem death. (6) The patient’s mother arrives in the emergency centre. She is very distraught and flatly refuses to donate her son’s organs e) Describe how you would manage this situation. (4) [25]
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’nVier-en-twintigjarige man word deur die nooddienstena die noodeenheidgebring. Hy was ’n passasiertydens ’nhoë-spoedmotorvoertuigbotsing. Hy het nie’nveiligheidsgordelgedranie. Volgens die paramedikus het hyerge kop en gesigbeseringsopgedoen, en hy is op die toneelgeïntubeersonderenigesedasie.Tans is sytemperatuur 36.6 °C, sy pols tempo 80 slae per minuut en sybloeddruk 120/80 mmHg. Hy is aan’n ventilator gekoppel, maar toongeenspontaneasemhalingspogingsnie a) Skryfkortnotasoor die klassifikasie van maxilêrefrakture. In u antwoord, sluit die beskrywing van die fraktuurlyne in. (8) b) Watterlewensbedrygendekomplikasieskomvoor met hierdiefrakture? (2) Die verpleegsterligu in datsy’n orgaanskenkerkaartjie in die pasiënt se identifikasiedokumentgekry het terwylsybesig was omhomteontklee c) Noem dieinternasionaalaanvaardevoorvereisteswatteenwoordigmoetwees alvorenstoetsevir die diagnosering van breinstamdoodgedoen mag word. (5) d) Skryfkortnotasoordieapnee- toetswatgedoen word ombreinstamdoodte diagnoseer. (6) Die pasiënt se moederkom in die noodeenheidaan. weieromhaarseun se organeteskenk e) Beskryf hoe uhierdiesituasiesalhanteer.
Sy is hewigontsteld en (4) [25]
PTO/Page 3 Question 3…
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You are providing the medical support to a local football tournament when one of the 14year-old boys has a sudden cardiac arrest on the field a) List 4 potential causes for sudden cardiac arrest in the young athlete. (4) b) Describe howyou would debrief the remaining people after the patient has been taken to hospital, including family, team-mates and coaching staff. (6) The 12 lead ECG is traditionally reserved for use “in-hospital” c) Provide a clinical motivation for the 12 lead ECG to be routinely available in the prehospital environment. (4) A 50-year-old male patient was working on a power line and got electrocuted d) Explain four differences between high voltage electrical injury and lightning strikes.(4) e) Describe and explain five different mechanisms of lightning injuries. (5) f) If multiple victims are struck by lightning and there are limited health care workers available, what type of triage is used and why? (2) [25]
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Uis die verskaffer vanmediesesteun aan’nplaaslike sokker-toernooi toe een vandie 14-jarigeseuns’nskielike hartstilstandop die veld ontwikkel a) Lys vier van die moontlikeoorsakevir die skielikehartstilstandindiejong atleet. b) Beskryf hoe u die oorblywendemense sou toespreeknadat diepasiëntna die hospitaal geneem is, insluitend familie,spanmaatsen afrigters.
(4) (6)
Die12 kabel EKGis tradisioneelgereserveer virgebruik"in die hospitaal" c) Verskaf ’nkliniesemotivering vir die12 kabel EKGom geredelik beskikbaar te wees indievoor hospitaal omgewing. (4) ’n 50-Jarige manlike pasiënt het gewerkaanoorhoofsekragdrade en is geskok d) Verduidelik 4 verskilletussenhoë voltage elektriesebeserings en weerligbeserings. (4) e) Beskryf en verduidelikvyfverskillendemeganismes van weerligbeserings. (5) f) Indienveelvuldigeslagoffersdeurweerliggeslaan word en daar is beperktegesondheidswerkersbeskikbaaar, wattertipe triage word gebruik en hoekom? (2) [25] 4
A body builder dislocated his shoulder for the first time after he tripped and fell off a cliff while hiking a) Shoulder dislocations are classified into three different types/areas of displacement– name them as well as any subdivisions. (3) b) Name and describethree different methods of shoulder reduction. (9) You are going to use procedural sedation to reduce the shoulder and will be using capnography to monitor your patient c) List the drug(s) you plan on using including the dose of each drug(s). (3) d) Explain how capnography works. (4) e) How does the Pa CO2 (partial pressure of CO2 in arterial blood) compare to the EtCO2
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(1) (5) [25] PTO/Page 4 Question 4… ’n Liggaamsbouer val van ’n krans af tydens ’nstaptog en ontwrig sy skouer vir die eerste keer in sy lewe a) Skouer dislokasies word in drie hoofgroepe geklassifiseer – noem die hoofgroepe asook subklassifikasies indien enige. (3) b) Noem en bespreek drie verskillend reduksie prosedures om ’n skouer te reduseer.(9) f)
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(end tidal carbon dioxide) in the airway? Write short notes on the use of capnography in cardiac arrest.
U gaan van die prosedure-sedasie-tegniek gebruik maak om die skouer te reduseer en u gaan kapnografie as monitering gebruik c) Lys die middel(s) wat u beplan om te gebruik, insluitend die dosis van elke middel(s). (3) d) Verduidelik hoe kapnografie werk. (4) e) Hoe vergelyk die Pa CO2 (CO2 druk in arteriele bloed) met die EtCO2 (end getyvolume koolsuurgas) in die lugweg? (1) f) Skryf kort notas oor die gebruik van kapnografie in hartstilstand. (5) [25]
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Dip PEC(SA)
THE COLLEGES OF MEDICINE OF SOUTH AFRICA Incorporated Association not for gain Reg No 1955/000003/08
Examination for the Diploma in Primary Emergency Care of the College of Emergency Medicine of South Africa 22 August 2014 Paper 2
(3 hours)
All questions to be answered. Each question to be answered in a separate book (or books if more than one is required for the one answer) Al die vraemoetbeantwoord word. Elkevraagmoet in ’n aparteboek (of boekeindienmeer as eennodig is vir ’n vraag) geskryf word
1
a)
A 16-year-old girlis brought to the emergency centre. She is 29 weeks pregnant according to her last normal menstrual period, but has not enrolled for any antenatal care yet. She is complaining of headache and swollen hands and feet.Her blood pressure is 185/120 mmHg, and her urine shows +++ protein i) Describe your management of this patient. (10)
While you are examining this patient, she suddenly starts to convulse ii) Describe your treatment of this complication. (5) b) Write short notes on the management of shoulder dystocia in the active phase of labour. (5) c) A 21-year-old woman is brought to the emergency centre by police officers. She was sexually assaulted four hours ago. Write short notes on post exposure prophylaxis for this patient. (5) [25] 1
a)
’n Sestien-jarigemeisie wordna die noodeenheidgebring. Volgenshaarlaaste normalemenstruasieperiode is sy 29 wekeswanger, maar sy het nooitenigevoorgeboorteondersoekegehadnie. Sykla van hoofpyn, asookgesweldehande en voete. Haarbloeddruk is 185/120 mmHg, en daar is +++ proteïene in haar urine i) Beskryfu hantering van hierdiepasiënt. (10)
Die pasiënt begin ewe skieliktekonvulseerterwyl uhaarondersoek ii) Beskryfu hantering van hierdiekomplikasie. (5) b) Skryfkortaantekeningeoor die hantering van skouerdistosietydens die aktiewefase vankraam. (5) c) ’nEen-en-twintigjarigevrou word na die noodeenheidgebringdeurpolisiebeamptes. Sy is vieruregeledeseksueelaangerand.Skryfkortaantekeningeoor postblootstellingprofilaksevirhierdiepasiënt. (5) [25] PTO/Page 2 Question 2…
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A 50-year-old male patient presents to the emergency centre with a complaint of severe headache, nausea and intermittent chest pain, after being rescued by emergency medical services from a contained industrial fire a) Describe the mechanism of toxicity of carbon monoxide poisoning. (5) b) List four acute neurological signs that may exist with an acute carbon monoxide exposure. (4) c) Describe theexpected arterial blood gas (ABG) result in a severe carbon monoxide poisoning. (3) d) Write short notes on the management of acute cyanide poisoning. (5) Muscarinic antagonists are used commonly in thetreatment of acute organophosphate poisoning e) List 4 indications for giving atropine to a patient with organophosphate overdose. (4) f) Provide a treatment protocol for using atropine in a suspected organophosphate poisoning and include the clinical parameters that would govern this treatment. (4) [25]
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’n50-Jarige manlike pasiëntpresenteer in die noodgevalle eenheidmet ’n klagtevanerge hoofpyn,naarheid en intermitterende borskaspyn,nadat hygered is deurmediese nooddienstevan ’ngesloteindustriëlevuur a) Beskryf die meganisme vantoksisiteitvan koolstofmonoksiedvergiftiging. (5) b) Lysvier akuteneurologiesetekens wat met ’nakuteblootstelling aan koolstofmonoksiedkan presenteer. (4) c) Beskryf die arteriële bloedgas (ABG) resultaat wat u sal verwag in ’n erge koolstofmonoksied vergiftiging. (3) d) Skryf kort aantekeningeoor die hantering vansianiedvergiftiging. (5)
Muskarinieseantagoniste wordalgemeen akuteorganofosfaatvergiftiging e) Lys vier indikasies om atropien organofosfaatvergiftiging. f)
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gebruik toe
Voorsien’n behandelingprotokolvir vermeendeorganofosfaatvergiftiging geval hierdiebehandeling sal lei.
te
dien
die ensluit
indiebehandeling
van
’n
met
vir
pasiënt
(4) gebruik vanatropienin’n in dieklinieseparameterswat (4) [25]
A 60-year-old man presents to your emergency centre with acute back pain a) List 5 serious differential diagnoses that must be considered. (5) b) Discuss clues on history which may be elicited for the above 5 diagnosis. A table with the headings below may be used. (10) Diagnosis c)
Clues on history
List 5 indications for plain radiographs in patients with back pain.
(5)
A 50-year-old patient presents in acute cardiogenic pulmonary oedema. His vitals are: blood pressure 175/105mmHg, pulse rate 112 bpm, saturation 89% on room air. He is awake, but in obvious respiratory distress d) Write short notes on your management of this patient. (5) [25] PTO/Page 3 Question 3…
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’nSestig-jarige man presenteer by u noodeenheid met akute rug pyn. a) Lys vyfernstigedifferensiële diagnoses watoorweegmoet word. (5) b) Bespreekleidrade in die geskiedeniswatuitgelokkan word virbogenoemde diagnoses. ’nTabel met die volgendeopskrifte mag gebruik word. (10) Diagnose
c)
5
Leidrade op geskiedenis
Lys 5 indikasiesvirgewone x-trale in pasiënte met rug pyn.
(5)
’n Vyftig-jarige manlike pasiëntpresenteermetakutekardiogenepulmonaleedeem. Sy vitale is: bloeddruk is 175/105mmHgpolsspoed is 112 slae per minuut, saturasie 89% opkamer lug. Hy is wakker maar in respiratoriesenood d) Skryf kort aantekeningeoor die handtering van die pasiënt. (5) [25] 4
A mum brings in her 1-year-old child to your emergency centre. You clinically suspect him to be suffering from Severe Acute Malnutrition a) List 5 at risk conditions which must be addressed as part of his clinical management. (5) His mum then reports that he had a seizure at home b) Write short notes on Febrile Seizures under the following headings i) Definition. (2) ii) Appropriate investigations. (4) iii) Management. (4) A 50-year-old female is transported to your hospital with a new onset cerebrovascular accident c) Complete thefollowing table by providing the clinical signs for an ischaemic stroke in each of the following vascular distributions 10) [25] Main clinical features Artery Anterior cerebral artery. Middle cerebral artery. Posterior cerebral artery. Lacunar. Vertebro-basilar arteries (brain stem).
PTO/Page 4 Question 4…
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’nMoeder bring haar 1-jarige kind na u noodeenheid. Uvermoedkliniesdathyaanergeakutewanvoeding lei a) Lys 5 risikotoestandewatgeadresseermoet word as deel van sykliniese hantering. (5) Symoederrapporteerdathy’nkonvulsietuisgehad het b) Skryfkortnotasoorkoorskonvulsiesonder die volgendeopskrifte i) Definisie. (2) ii) Toepaslikeondersoeke. (4) iii) Hantering. (4) ’n 50-Jarige vrou word vervoernajouhospitaal met ’nnuweaankomsberoerte c) Voltooi die volgendetabeldeur die kliniesetekensvir’nisgemieseberoerte, in elk van dievolgendevaskulêreverspreidings areas, teverskaf (10) [25] Hoof kliniesekenmerk
Arterie Anterior serebralearterie. Middelserebralearterie. Posterior serebralearterie. Lacunêr. Vertebro-basilêre (breinstam).
arteries
