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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 23 March 2011 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 vrae moet beantwoord word. Elke vraag moet in ’n aparte boek (of boeke indien meer as een nodig is vir ’n vraag) geskryf word

1 a) A 27-year-old man was assaulted by a mob and presents with multiple injuries in your emergency unit. Discuss the following regarding crush (sjambok) syndrome i) Pathophysiology. (7) ii) Management. (10) b) A 36-year-old female patient sustained a blunt injury to the right eye. Write notes on the definition and management of traumatic hyphema. (8) [25] 1 a) ʼn 27-Jarige man is aangerand deur ʼn skare en presenteer met veelvuldige beserings in u noodgevalle eenheid. Bespreek die volgende rakende samboksindroom i) Patofisiologie. (7) ii) Hantering. (10) b) ʼn 36-Jarige vroulike pasiënt het ʼn stomp besering opgedoen van die regteroog Skryf notas oor die definisie en hantering van troumatiese hifeem. (8) [25] 2 a) Name the 4 major bioethical principles. (4) b) You are telephoned by a family member giving assistance to an adult victim of sudden cardiac arrest. She is alone at the scene and has no CPR training. Describe the telephonic advice you would give to her. (5) c) Discuss the use of polyvalent antivenin for South-African snake bite victims under the following headings i) For which snakes is polyvalent antivenin effective? (8) ii) Dosage. (3) iii) Precautions prior to and during administration. (5) [25] 2 a) Noem die 4 hoof bioetiese beginsels. (4) b) U word gebel deur ʼn familielid wat eerstehulp verskaf aan ʼn volwasse slagoffer van skielike hartstilstand. Sy is alleen op die toneel en het geen eerstehulp opleiding nie. Beskryf die telefoniese advies wat u aan haar sou gee. (5) c) Beskryf die gebruik van polivalente teengif vir Suid-Afrikaanse slangbyt slagoffers onder die volgende hoofde i) Vir watter slange is polievalente teengig affektief? (8) ii) Dosering. (3) ii) Voorsorg maatreëls voor en tydens toediening. (5) [25]

(10) b) Skryf kort notas oor die volgende toestande of toerusting i) Ontslag instruksies vir ʼn hoof beseerde 11-jarige manlike pasiënt na ʼn skool rugby skrum.(4) [25] 3 a) Dit is bewys dat ʼn trouma pasiënt wat koagulopaties by toelating tot die hospitaal is meer dikwels massiewe bloedoortapping ontvang en multi-orgaan versaking ontwikkel. (4) [25] 4 a) A 5-year-old boy is hit by a vehicle while crossing a road and is brought to the emergency department fully immobilised on a spine board. Skryf kort notas oor die evaluasie van ʼn spinaal besering in so pasiënt. (5) ii) Check list for a defibrillator. (5) ii) Nagaan lys vir ʼn defibrillator. Write short notes on the evaluation of cervical spine injury in such a patient. (6) ii) Acidosis. Hy word na u noodgevalle afdeling gebring ten volle geïmobiliseerd op 'n spinaal bord. (8) c) Comment on your ideal “point of care” test to monitor end points of resuscitation. (3) iii) Hemoverdunning. (10) b) Write short notes on the following conditions or equipment i) Discharge instructions for a head injured 11-year-old male patient after a school rugby scrum. (2) iv) Inflammasie. Hy huil weens pyn. (2) iv) Inflammation. develop multi-organ failure and have up to a fourfold chance of dying. Hulle het ook tot ʼn viervoudige verhoogde kans om te sterf. (5) iii) Laktaat asidose in ʼn pasiënt op Hoogs Aktiewe Anti-Retrovirale Terapie HAART. (5) iii) Lactic acidosis in a patient on Highly Active Anti-Retroviral Treatment (HAART) (5) [25] 4 a) ʼn 5-Jarige-seun word deur ʼn motor raak gery terwyl hy oor ʼn straat loop. Skryf kort aantekeninge oor elk van die volgende meganismes wat kan lei tot hierdie trouma geinduseerde koagulopatie i) Hipotermie. Write short notes on each of the following mechanisms that may lead to this trauma induced coagulopathy i) Hypothermia. (8) c) Lewer kommentaar op u ideale "punt van sorg" toets om die eind punte van resussitasie te moniteer. (2) b) Beskryf ʼn "massiewe bloedtransfusie protokol" en lys daarin die intraveneuse vloeistowwe en bloedtransfusie produkte wat u as gepas beskou. (6) ii) Asidose.3 a) It has been shown that a trauma patient who is coagulopathic at admission to hospital is more likely to require massive blood transfusion. He is crying in pain. Gee ook die verhoudings ten opsigte van volumes wat gebruik behoort te word van elke produk / vloeistof. (5) [25] . (3) iii) Haemodilution. (2) b) Draw up a “massive transfusion protocol” listing the fluids and blood transfusion products you would consider appropriate and the ratios in respect of volumes used.

(10) b) ʼn 24-Jarige vroulike pasiënt presenteer met die klagte van vaginale bloeding in die noodgevalle eenheid. write short notes on Sudden Infant Death Syndrome. aetiology. iii) Carbamates. risiko faktore en kliniese beeld. risk factors and prevention. (10) b) A 24-year-old female patient complains of vaginal bleeding on her presentation in the emergency unit. (6) [25] 2 a) ʼn Boer presenteer by u noodgevalle afdeling nadat hy deur ʼn meerkat aan beide onderbene gebyt is op sy plaas.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 24 March 2011 Paper 2 (3 hours) All questions to be answered. She is 26 weeks pregnant. risk factors and clinical presentation. (9) ii) Under which circumstances would broad spectrum antibiotics be indicated to prevent wound infection? (3) b) Describe the cardiovascular (including ECG) changes associated with Tricyclic antidepressant overdose. skryf kort notas oor Skielike-suigelingsterftesindroom. i) Write short notes on all the steps you would take to manage his injuries. (3) [25] 2 a) A farmer presents to your emergency department after being bitten on both legs by a meerkat on his farm. The attack was unprovoked. etiologie. Discuss the most likely causes of antepartum haemorrhage and focus on definition. iii) Karbamate. . (7) c) List 6 World Health Organisation criteria for severe malaria. (12) c) Lys die agensspesifieke behandeling(s) wat betrekking het op die volgende vergiftigings i) Bleikmiddel (natrium-hipochloriet). (12) c) List the agent-specific therapy(s) pertaining to the following poisonings i) Bleach (sodium hypochlorite). (3) [25] 1 a) Onder die volgende opskrifte: definisie. risiko faktore en voorkoming. ii) Etileenglikol. Bespreek die mees waarskynlike oorsake van antepartum bloeding en konsentreer op die definisie. Die aanval was sonder provokasie. Sy is 26 weke swanger. Each question to be answered in a separate book (or books if more than one is required for the one answer) Al die vrae moet beantwoord word. Elke vraag moet in ’n aparte boek (of boeke indien meer as een nodig is vir ’n vraag) geskryf word 1) a) Under the following headings: definition. ii) Ethylene glycol.

old boy following a rugby injury. Sy rapporteer dat hy nie meer gewig kan dra op sy regter been nie. (8) b) U word gevra om ʼn junior dokter te help met die reduksie van ʼn ontwrigte skouer in ʼn 15-jarige seuntjie na ʼn rugby besering. Describe what parameters you would use to decide whether you would commence antibiotics on this patient. (2) ii) Pathophysiology. (10) [25] i) 4 a) Discuss food poisoning under the following headings i) Definition. (5) b) In a concise summary. (3) ii) The process you would follow to perform procedural sedation. (5) iv) Kliniese beeld. (4) c) You are presented with a 18-month-old girl. (5) b) Maak gebruik van ʼn bondige opsomming om u benadering te beskryf vir die hantering van ʼn uitbraak van voedselvergiftiging van 80 skoolkinders wat presenteer by u noodgevalle afdeling. (4) c) ʼn 18-maande-oue dogtertjie presenteringer akuut by u met ʼn temperatuur van 39. (10) [25] 3 a) ʼn Moeder daag op by u noodgevalle afdeling met haar 3-jarige kind. (10) [25] 4 a) Bespreek voedsel vergiftiging onder die volgende opskrifte i) Definisie. (3) iii) Causes. method of examination and potential differential diagnosis. Skryf aantekeninge oor die volgende i) Toestemming vir die proseduur. including the pharmacological agents you would use. Bespreek in detail u benadering. ondersoek metode en moontlike differensiële diagnose. (6) [25] 3 a) A mother arrives in the emergency department with her 3-year-old child reporting that he is no longer weight bearing on the right lower limb and cries when trying to do so. (8) b) You are asked to help a junior doctor with the relocation of a dislocated shoulder in a 15-year. insluitend die farmakologiese agense wat u sou gebruik ter uitvoering daarvan. Discuss in detail your approach. Hy huil wanneer hy probeer om dit te doen. (3) ii) Die proses wat u sou volg vir bewuste sedasie. (2) ii) Patofisiologie . (7) c) Lys 6 Wêreld Gesondheid Organisasie kriteria vir ernstige malaria.5°C. who has an acute presentation with a temperature of 39.Skryf kort notas oor al die stappe wat u sou neem om sy beserings te behandel (9) ii) Onder watter omstandighede sou ʼn breë spektrum antibiotika aangedui wees om wond infeksie te voorkom. Write notes on the following i) Consent for the procedure. (3) iii) Oorsake. (10) [25] . (5) iv) Clinical presentations. Beskryf watter parameters u sal gebruik om te besluit of u antibiotiese behandeling sou oorweeg vir hierdie pasiënt. (3) b) Beskryf die kardiovaskulêre veranderinge (insluitende EKG veranderinge) geassosieerd met trisikliese antidepressant oordosering. describe your approach in managing a food disease outbreak with 80 school children presenting to your emergency department.5ºC.