FCEM(SA) Part II

THE COLLEGES OF MEDICINE OF SOUTH AFRICA
Incorporated Association not for gain Reg No 1955/000003/08

Final Examination for the Fellowship of the College of Emergency Medicine of South Africa 22 March 2011 Paper 1 (3 hours)

All questions are to be answered. Each question to be answered in a separate book (or books if more than one is required for the one answer)

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Clinical decision rules form a core part of emergency medicine practice. Write short notes on the following rules which provide guidelines with respect to referral for radiographic imaging a) The Ottawa ankle rule. (5) b) The Canadian computed tomography rule. (10) c) The Nexus cervical spine rule. (5) d) The Paediatric Emergency Care Applied Research Network (PECARN) rule for paediatric neuro-imaging after head injury. (5) [25] Emergency ultrasound is a useful tool in evaluating patients with an undifferentiated presentation. a) Write short notes on how the FEER (focused echocardiographic evaluation during resuscitation) can be used to guide treatment during the management of a patient in cardiac arrest. (10) b) Write short notes on how emergency ultrasound techniques can be used to guide the initial management of an elderly patient presenting with profound hypotension. (15) [25] a) Discuss the steps which you would institute in your emergency department to deal with a large scale outbreak of influenza in patients in your drainage area. (8) In what circumstances should antiviral therapies be used in the treatment of Influenza? (4) Write short notes on the clinical and radiological findings in an adult with acute epiglottitis. (7) A previously healthy 32-year-old male presents to your emergency department with acute onset sore throat. You make a diagnosis of bacterial pharyngitis. i) Discuss the role of steroid therapy in his management. (3) ii) How would you exclude the presence of a peritonsillar abscess? (3) [25] PTO/-Page-2-Question-4…

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(5) d) A patient is found by paramedics and brought to your unit. (3) d) Name 3 forms of regular wide complex tachycardias. (3) g) Name 3 drugs that can be used to treat polymorphic ventricular tachycardia associated with a prolonged QT interval. (5) [25] A 50-year-old patient presents to your emergency department complaining of severe palpitations and chest discomfort. (3) e) Name 3 forms of irregular wide complex tachycardias. including precautions that should be considered. With regard to the recognition and management of emergency tachyarrhythmias a) Describe the exact technique of performing carotid sinus massage. indicating what modification is required. He is unconscious and hypoventilating. (5) c) Name 3 drugs that can be used to treat pre-excited atrial fibrillation. (3) f) Name 3 drugs that can be used to treat polymorphic ventricular tachycardia associated with a normal QT interval. (5) b) List 5 drugs that necessitate a modification to the dosage of adenosine. indicating the various factors that can affect it and where it takes place. (3) [25] 5 6 . (5) c) Ipratropium bromide. (5) b) The chemoprophylaxis for young children to prevent them contracting tuberculosis. (5) d) The role of leukotriene receptor antagonists in the management of asthma. (5) e) An eradication regimen for Helicobacter pylori. (5) b) Briefly discuss the factors that will increase cardiac output. Tabulate the stimuli affecting the respiratory centre. (5) [25] Write short notes on the following a) The neurotoxic adverse effects of isoniazid (INH).-24 In shock. (10) c) Write short notes how the body acclimatises to the hypoxia of high altitude. vital signs are not adequate to assess tissue oxygen delivery and oxygen consumption. a) Use a graph to explain oxygen dissociation from haemoglobin.

(4) ii) The paraglossal laryngoscopic technique. (5) d) A Monteggia fracture of the forearm. a) An undisplaced torus fracture of the distal radius. (5) b) A greenstick fracture of the distal radius and ulna with 40 degrees of volar angulation but no displacement. (5) d) List the main features of lung protective ventilation strategy. (10) c) A displaced supracondylar fracture. Describe in detail the techniques you might use to overcome the potential difficulties of intubation caused by the craniofacial abnormalities by using i) The Glidescope™. You are in a fully equipped emergency department which has a computer with internet access. (5) c) Describe the initial ventilator settings you would select (assume a weight of 6kg). Each question to be answered in a separate book (or books if more than one is required for the one answer) 1 A five-year-old child falls off a jungle gym and injures his left upper limb. Write short notes on the management of the following injuries.FCEM(SA) Part II THE COLLEGES OF MEDICINE OF SOUTH AFRICA Incorporated Association not for gain Reg No 1955/000003/08 Final Examination for the Fellowship of the College of Emergency Medicine of South Africa 23 March 2011 Paper 2 (3 hours) All questions are to be answered. The parents report that the infant was diagnosed with pneumonia yesterday and now has severe breathing difficulties. (6) b) This patient has respiratory failure and requires tracheal intubation. (5) [25] 2 You are on duty when the triage nurse informs you that an infant with Pierre-Robin Syndrome is en route to the emergency department. a) How could you use the internet to provide useful information on this condition before the patient arrives? Name three sites that you might use for this research. (5) [25] PTO/-Page-2-Question-3… .

i) Which emergency department based interventions are effective in detecting and reducing intimate partner violence? (5) ii) Describe the strategy you would use to implement such interventions in your emergency department. and management of lightning injury. (5) e) Strategies to reduce the risk of brain injury.-23 a) A 62-year-old patient is known with chronic obstructive pulmonary disease. The cough has been present for 2 weeks already. The baby first had a cold but the cough started a week later. (5) b) Special precautions. i) What is the most likely notifiable disease the baby is suffering from? (2) ii) Write short notes on the diagnostic tests one can perform to confirm the diagnosis . (7) [25] Describe the clinical picture and treatment of a patient with acute salicylate poisoning. (5) How do the following diving related emergencies present. He presents to your emergency department acutely breathless. (3) ii) Dental barotraumas. (5) iv) How would you manage the contacts of this baby? (3) [25] b) c) 4 a) b) c) 5 a) b) 6 Discuss in detail how the initial resuscitation of a newly born 28 week premature infant differs to that of a full-term infant with respect to the following a) Specific risk factors. (5) [25] . (5) iii) Write short notes on your management of the baby. It is more at night and is so bad that he coughs continually until he is blue in his face and gasps for air after a coughing episode. (7) Discuss the relevant physics. (5) c) Temperature maintenance. (3) iii) Decompression illness. The baby is well-fed and has no TB contacts. (5) d) Oxygen management. i) What are the three most common causes of acute exacerbation which must be looked for? (3) ii) Discuss the role of non-invasive ventilation in this patient. (10) A mother presents with her 13-month-old baby complaining that the baby has a severe cough. (7) What clinical findings would you expect in a patient with central spinal cord ischaemia at the C-5 level? (5) A young adult female presents to your emergency department following an assault by her partner. (5) [25] Write short notes on the gas laws which are of most relevance to affecting divers. and how should they be managed? i) Inner ear barotraumas.