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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 1 September 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

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A 25-year-old male patient has been admitted to your emergency centre, with a gunshot wound to his head, following an attempted suicide. He appears to be brain dead. His medic alert bracelet indicates that he is an organ donor a) Fully describe the tests you would perform to confirm brain death in this patient. (15) b) Describe the precautions you would take to preserve organ function in this patient. (10) [25] ’n 25-Jarige manlike pasiënt, word toegelaat tot u noodeenheid, met ’n ernstige kopskietwond, na ’n mislukte selfmoord poging. Klinies blyk hy moontlik breindood te wees. Sy medic alert armband toon aan hy is ′n geregistreerde orgaan skenker. a) Beskryf volledig die toetse wat u sal doen om te bevestig of hierdie pasiënt breindood verklaar kan word. (15) b) Beskryf die voorsorgmaatrëels, wat u sal in plek sal stel, om optimale orgaan funksie te verseker, in bogenoemde pasiënt. (10) [25] In the context of advising the emergency medical services (EMS) personnel on personal safety regarding contagious pathogen exposure, discuss the following scenarios a) An EMS staff member is exposed to the blood of a known HIV positive patient. Discuss both high and low risk exposure scenarios, and their respective management. (8) b) An EMS staff member is exposed to a patient with proven meningococcal meningitis during a primary transfer. (4) c) A paramedic sustains a needle stick injury from a patient known with Hepatitis B. infection. (4) d) A paramedic is exposed to a patient with severe chicken pox during a transfer. (3) e) A patient, with known active XDR-TB, who requires 150 km transportation by ambulance. What advice would you give to EMS staff, who would accompany the patient, when planning the transfer? (6) [25] Watter advies sal u vir nooddienste personeel gee, insake hulle persoonlike veiligheid, wanneer hulle blootgestel word aan die volgende patogene a) ’n Nooddienste personeel lid is blootgetel deur direkte kontak met die bloed van ’n bevestigde MIV gediagnoseerde pasiënt. Bespreek beide lae en hoe risiko blootstellings situasies en hoe u elkeen sal hanteer. (8) b) ’n Nooddienste personeel lid is blootgestel aan ’n pasiënt met bevestigde meningokokkale meningitis tydens ’n primêre oorplasing. (4) c) Paramedici lid word per ongeluk geprik met ′n naald wat gekontamineerd is met die bloed van ’n Hepatitis B pasiënt. (4)

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i) Indien sy Glascow Koma Skaal 15 is. when signing a DO NOT RESUSCITATE (DNR) order. wat betrokke was in ’n hoe spoed motor ongeluk. sepsis and respiratory distress. aan ’n pediatriese pasiënt met ’n geslote femur fraktuur.d) e) Paramedici word blootgestel aan ’n pasiënt met erge waterpokkies tydens ’n oorplasing. for a 82-year-old terminal patient with end stage metastatic lung cancer. vir ’n 82-jarige oue terminale pasiënt met gevorderde metastatiese long karsinoom. a) Write short notes on how you would go about evaluating this patient for potential cervical spine injuries i) If he has a Glasgow Coma Scale of 15. (7) b) Skryf kort notas oor. waarmee u pynverligting sal verskaf. ten volle geimmobiliseerd a) Skryf kort notas oor hoe u hierdie pasiënt sal verder ondersoek vir moontlike nek werwel beserings. (3) List both the specific and general complications of a blood transfusion.b) (above).2. (hierbo) te verminder. as listed in 3. and what further treatment should you offer the patient? (4) [25] Lys 3 tipes frakture wat gekompliseer word deur nie-hegting. in 3. (3) ’n Pasiënt met aktiewe XDR-TB benodig oorplasing per ambulaans oor ’n afstand van 150 km. (3) How should you go about installing the DNR order for this patient. (5) Discuss the ethical principles. sepsis en erge respiratories nood. (10) Beskryf algemene maatrëels om die risiko van die bloedoortappings komplikasies. beide die farmakologies en nie-farmakolgiese metodes. (3) Lys beide die spesifieke en algemene komplikasies van ’n bloedoortapping tydens die ressussitasie van ’n hypovolemiese pasiënt wat stomp trauma aan die romp opgedoen het. (10) ii) Indien sy Glascow Koma Skaal 10 is. Watter advies sal u aan die nooddienste personeel verskaf wat die oorplasing gaan behartig? (6) List 3 fractures commonly associated with non-union. who sustained blunt trauma to the torso. (3) Hoe sal u te werk gaan om hierdie MOET NIE RESSUSSITEER NIE bevel te implimenteer in bogenoemde pasiënt? Watter verdure behandeling sal u vir hierdie pasiënt voorskryf? (4) [25] 3 a) b) c) d) e) 3 a) b) c) d) e) 4 A 26-year-old male patient is involved in a high speed motor vehicle accident and is brought into the emergency centre fully immobilised. you should consider. (7) b) Write short notes on pharmacological and non-pharmacological methods of providing analgesia for a paediatric patient with a closed mid-shaft femur fracture. word na u noodeenheid gebring. (8) [25] 4 ’n 26-Jarige man. (5) Beskryf die etiesse beginsels wat u sal gebruik wanneer u ’n MOET NIE RESUSSITEER NIE bevel. (10) ii) If he has a Glasgow Coma Scale of 10. moet implementeer. whilst resuscitating a hypovolaemic patient. (10) Describe general measures to reduce the risk of the blood transfusion complications. (8) [25] .

(2) ii) List the possible causes of syncope in this patient. Her partner tells you that – on her last antenatal visit – the obstetrician informed them that her foetus was in a breech position a) Describe how you would confirm the current composition of the foetus. Sy het ’n vriendin besoek in dieselfde hospitaal. She was in the hospital’s coffee shop. volterm.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 2 September 2011 Paper 2 (3 hours) All questions to be answered. describing a typical syncope episode. utilising the measures described in 1 a) (above). (15) c) Onmiddelik na die bevalling. term. (15) c) Immediately following the delivery. What is the most probable diagnosis? Describe your management thereof. Describe how you would deliver this baby. met haar 2-jarige kind. the mother appears to have a tonic-clonic seizure. haas u noodeenheid binne. (5) b) The obstetrician is busy in theatre. (5) [25] ’n 39-Jarige. whilst you are on duty. pasiënt presenteer by u noodeenheid in volle kraam. Elke vraag moet in ’n aparte boek (of boeke indien meer as een nodig is vir ’n vraag) geskryf word 1 A 39-year-old. Haar metgesel deel u mee. (5) A 65-year-old woman presents to your emergency centre. (6) iii) Explain your diagnostic work up of this patient. after you have confirmed a breech presentation. a) Beskryf hoe u die huidige posisie van die fetus gaan bevestig. Terwyl sy in die hospitaal kafetria was. On pelvic examination you determine that she is fully dilated and that the foetus’s presenting part is fully engaged. nadat u ’n stuit posisie bevestig het. with her 2-year-old child. (5) b) Die enigste verloskundige is besig in teater met ’n ander gekompliseerde keisersnit en kan u daarom nie help nie. met die metodes genoem in 1 a) (hier bo). presenteer die moeder met ’n toniese-kloniese konvulsie. dat met haar laaste voorgeboorte ondersoek. (5) [25] a) A young mother rushes into the emergency centre. and is therefore unable to assist you. het haar kind skielik begin gekonvulseer 1 2 b) 2 a) . primigravida. (5) ii) Define the term febrile seizure. Wat is die mees algemeenste oorsaak in hierdie geval? Beskryf hoe u die moeder gaan hanteer met hierdie kondisie. i) Define the term syncope. when her child began to fit i) Describe your immediate treatment approach to this child. die verloskundige bevestig het dat haar baba in die stuit posisie was. Beskryf volledig hoe u hierdie fetus gaan verlos. Met pelviese ondersoek is haar serviks ten volle gedilateerd met volledige applikasie van die voorliggende deel. tending to another emergency caesarean section. waar u werk. 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. (3) iii) List the circumstances under which you would consider not admitting this child into the hospital. (4) [25] ’n Jong moeder. primigravid patient presents to your emergency centre in the advanced stages of labour.

by the attending nursing staff. (4) An adult patient presents with self-poisoning to your emergency centre i) List the indications for using activated charcoal in this patient.s.eclampsia i) Which observations would you ask nursing staff to perform. (5) U gee magnesium sulfaat (MgSO 4 ) vir n pasiënt met erge pre-eklampsie i) Watter observasies instruksies sal u vir verpleegpersoneel gee. a) Lys 6 lewensdreigende oorsake van borskaspyn. (9) [25] ’n 75-Jarige pasiënt. (5) ’n 65-Jarige dame presenteer in u noodeenheid met die geskiedenis van ’n tipiese sinkopie aanval. (5) ii) Definëer die term koorskonvulsies. wat na bogenoemde pasiënt omsien. and how often? State the limits of each observation. tot hierdie 2-jarige kind. die behandeling. Watter waardes moet die observasies oorskry voordat die verpleegpersoneel u daarvan moet verwittig. (3) iii) Lys die situasies wanner u nie bogenoemde pasiënt sal toelaat as ’n binnepasiënt nie. met erge sentrale borskas en boonste rugpyn. The pain started with a severe tearing sensation in the upper back and progressively worsened. with severe central chest and upper back pain.b) Beskryf u onmiddelike benadering. vir meer as 2 uur durasie. i) Definëer die term sinkopie. (5) ii) List the substances / poisons which will not be affected by activated charcoal treatment (ie those in which there is no treatment benefit). (8) 4 . (6) iii) Beskryf u diagnostiese beplanning van hierdie pasient. dose and contraindications) that should be administered in the emergency centre to a patient with an acute myocardial infarction. (6) ii) Which immediate laboratory tests would you do? Motivate each test. Die pyn het begin met ′n erge skeur sensasie in die boonste rug area wat daarna nog progressief vererger het. of more than two hours’ duration. (5) ii) Lys die substanse/gifstowwe wat nie beinvloed word deur geaktiveerde koolstof behandeling nie (d. in u noodeenheid. (4) [25] A 65-year-old male presents to your emergency centre with septic shock i) List the immediate treatment priorities in managing this case. at which you would want to be notified.t. (5) You administer magnesium sulphate (MgSO 4 ) to a patient with severe pre. The patient is known to have poorly-controlled hypertension a) List six life-threatening causes of chest pain. (6) ii) Watter laboratorium spesiale ondersoeke sal u onmiddelik aanvra? Motiveer redes vir elke toets. en hoe gereeld. presents to the emergency centre. (5) [25] c) 4 A 75-year-old male patient. m. (4) i) 3 a) b) c) 3 a) b) ′n Volwasse pasiënt presenteer met selfvergiftiging. terwyl u op diens is. daar is geen voordeel nie). i) Lys die indikasies vir die gebruik van geaktiveerde koolstof in bogenoemde geval. (2) ii) Lys die moontlike oorsake van sinkopie in hierdie pasient. What is the most likely diagnosis in this patient? (8) b) List the electrocardiographic (ECG) changes that are suggestive of acute myocardial infarction.b. Die pasiënt is bekend met swak gekontroleerde hipertensie. Watter een is die hoogs waarskylikste diagnose in hierdie pasient? (8) b) Lys die elektrokardiografiese (EKG) veranderinge wat kan dui op ’n acute miokardiale infark. presenteer in u noodeenhied. (8) c) Write short notes on six medications (including medication name. (5) [25] ’n 65-Jarige man presenteer in u noodeenheid met septiese skok i) Lys die onmiddelike behandelings prioriteite in die hantering van hierdie geval.w.

dosering en kontra indikasies).c) Skryf kort notas oor 6 medikasies (insluitend medikasie naam. wat gebruik word in die noodeenheid. tydens die behandeling van ’n miokardiale infarksie. (9) [25] .