ED 15

A 25yo man presents with haematemesis after binge drinking. How would you
assess and manage him?

1. Provisional & >5 differentials
2. What is the potential emergency in this case? Appropriate referrals?
3. Describe how you would manage this patients bleeding.
a. What would you do while waiting for the patients blood to be cross-
matched?
4. Describe what would you ask for in the history, including but not limited to,
relevant past medical history (4) & medications (4)
5. Relevant aspects of the GI examination to look for (3). Any other systems you
would examine?
6. List appropriate initial investigations (5)
7. Acute supportive management after stabilization (6)
8. List 4 possibilities for definitive treatment.
a. What are the two drugs which can temporarily stop bleeding, but with
high incidence of re-bleeding after cessation?
i. Describe the mechanism of action of octeotride. Dosage?
ii. Vasopressin dosage, efficacy & 3 SEs
b. Describe how endoscopic haemostasis can be achieved in variceal
bleeding what adjunct may also be considered?
c. Describe how a Sangstaken-Blakemore/Minnesota tube works

ED 16

A 82yo woman in brought to ED by ambulance with a history of falling down in the
bathroom. She is unable to stand and is lying in bed with external rotation of the left
lower limb. How would you assess and manage her?

1 Provisional diagnosis
2 Her management will be mainly determined by?
3 Overview of management
4 Overview of the primary survey
Extra aspect to check for in Airway?
Why is hypovolaemic shock an important consideration?
5 Describe the relevant parts of the history you would ask
M relevant medications to ask about (4)
P relevant PMHx as reversible causes of risk factors for falls (5)
L time criteria for last meals or fluids before surgery?
6 Relevant aspects of the examination (4)
What would you examine the hip (3) and leg (3) for?
How do you assess for neurovascular compromise?
7 Relevant investigations: bloods & imaging
Investigations to satisfy anaesthetic requirements for surgery
8 Acute supportive management (3)
9 Describe the main surgical techniques used to treat intracapsular vs
extracapsular hip fractures
What is the treatment if the woman if found to be unfit for surgery?
10 Relevant post-op management (4)
Methods of non-pharm & pharm DVT prophylaxis
Relevant involvement by allied health & MDT (4)

ED 18

A 70yo woman who has bony metastases from breast cancer presents to the ED with
a one week history of constipation, lethargy, thirst and increasing confusion. She is
dehydrated. Her serum creatinine is 220uM (50-110), urea 25 mM (3.8-8.0), calcium
3.3mM (2.1-2.6) and albumin 33g/L (32-45). How would you manage her?

1 Provisional & at least 4 differentials (including the most common cause of
hypercalcaemia)?
2 Overview of management
3 Primary Survey
When [Ca] > ___, what becomes likely?
Important initial bloods to take
4 Important parts of the history to ask
Importance of asking about onset?
Name at least 4 additional signs of hypercalcaemia
4 other systems which can be affected by metastasis or
paraneoplastic syndromes
Name at least 3 medications that can exacerbate hypercalcaemia
and should be ceased
5 3 main aspects to the examination
6 Name appropriate investigations in addition to initial bloods, split into those
to diagnose hypercalcaemia, and to rule out DDxs
Expected serum PTH levels in malignancy? Why?
7 Management disposition / referrals / liaision?
Decision whether to treat the hypercalcaemia depends on what 3
patient factors?
Examples of palliative therapy
8 2 main methods of definitive treatment of hypercalcaemia
Bisphosphonates MoA, serum level indicators
Drugs used for acute Rx dose, diluent, route?
IV bisphosphonates when effective reduce serum Ca levels
for around how long? How can repeats be given?
What must you do before giving bisphosphonates to prevent
renal failure? Or to reduce risk of osteonecrosis of the jaw?
Other more common side-effects?
Denosumab MoA, dose, route?
When may denosumab be preferred to bisphos.?
Supplementation for hypercalcaemia Rx

ED 19

A 70yo man with a history of prostatism presents in acute urinary retention. How
would you manage him?

1 Acute urinary retention is an emergency, requiring ______.
2 Name the most common cause, and at least 5 other differentials,
categorized if possible.
3 Overview of management (4)
4 Describe how you would clinically stabilize this man
D more in-depth neuro assessment involving?
Appropriate analgesia (with dose)?
5 Describe how you would confirm and perform the bladder decompression
Investigations to perform on the collected urine
If catheterization fails?
If there is haematuria?
6 Relevant aspects of the history (2)
Common symptoms experienced in urinary retention
7 Relevant systems to examine (2)
Findings to look for in particular on abdo (3) & PR (4) examination
8 Relevant investigations
Expected results of routine bloods in urinary retention?
If prostate Ca or spinal compression is highly suspected?
9 Management disposition, referrals, liaison?
10 Discharge advice after underlying cause has been found and managed? (2)
11 Follow-up

ED 20

A 23yo man is brought to ED after being knocked unconsciousness by a tackle in a
football game. He regained consciousness within a few minutes and insists he is well
now and wishes to leave. How would you manage the situation?

1 Two main issues in this situation
2 dangerous differentials you need to exclude before discharge?
2 Describe how you would deal with the patient who wishes to leave against
medical advice.
What if the patient becomes aggressive? (4)
3 Overview of management if he agrees to stay for work-up
4 Describe how you would clinically stabilize this patient
How would you risk-stratify this patients head injury?
5 Relevant aspects of the history
Relevant PMHx (3)
6 Relevant aspects of the examination (5)
Symptoms of raised ICP (5) and base of skull fracture?
7 Relevant Investigations
8 Management disposition, referral, liaison
Having risk-stratified the head injury, what are the broad
management principles for each of these categories?
Name at least 5 strong indications for CT in the high-risk mild
category
9 Mx and discharge advice if CT is clear? (3)
Monitoring involves
Red flags that require re-presentation (4)
Common post-concussion symptoms? (3)

ED 21

A 70yo man presents to ED with an acutely painful and pulseless right leg. How
would you assess and manage him?

1