AEA 01/2014

CLASS TEST 03

INSTRUCTIONS
1. Read the questions thoroughly
2. Answer all the questions on the answer sheet provided
3. Write neatly and legibly ensuring that your answers are clearly numbered.
4. Any attempt at examination fraud will result in immediate disqualification from the
assessment process.
PAGES: (Including cover)
MARKS 82 Marks
TIME: 82 Minutes
NUMBER OF PAGES:
13 including cover page and answer sheets MARKS: Marks
PASS MARK: 50%

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CLASS TEST 03

QUESTION 1

CARDIAC (29Marks)

1. Your patient has a blood pressure of 110/50mmhg. Work out this patients map and
show all your calculations. (5)

MAP= diastolic+ (systolic- diastolic)

MAP= 50mmHg+ (110mmHg-50mmHg)

= 50mmHg+20mmHg = 70mmHg

2. An elderly patient (84 years) has fallen. He has no severe external bleeding and is alert
to your arrival. Skin colour, condition and temperature – pale, diaphoretic, warm. Vital
signs: Respirations- 25 b/min, Pulse- 100b/min, Blood Pressure- 80/50, HGT- 4 mmol/l,
Saturation of 90%. He is a known cardiac patient on ECOTRIN, ZOCOR, ADALAT
30XL, MODURETIC. You estimate his weight to be 65kg.

3. Explain fluid resuscitation of this patient. Include your fluid of choice, administration
set and the intravenous catheter (jelco) of choice as well as bolus doses.(5)
Administer 10ml/kg / 650ml of Ringers Lactate over 20min in increments of 250ml through a
ten dropper administration set using 14G or 16G.Reassess the blood pressure after each bolus
dose.
4. What are the 5 important points to remember when trying to interpret an ECG? (5)
Is it too fast?
Is it too slow?
Is it stable?
Is it unstable?
Is it shockable?

5. What 2 things would you take into account before you declare a patient dead? (2)
Hypothermia and drug overdose

6. Name each of the reversible causes of Pulseless Electrical Activity (PEA) and what
actions you would perform to correct them. (12) 0.5 mark per cause; 0.5 mark per
action
I. Hypoxia- oxygenate
II. Hypovolemia- fluid resuscitation
III. Hydrogen ion imbalance- ringers lactate
IV. Hypo or hyperkalaemia- ringers lactate
V. Hypoglycemia- administer dextrose
VI. Hypothermia- passive warming and warm fluids
VII. Test other pulses- check other pulses

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VIII. Tension pneumothorax- needle thoracentesis

IX. Thrombo-embolism- treat supportively and transport
X. Tamponade ( cardiac)- treat supportively and transport
XI. Toxins- treat supportively call ALS, transport
XII. Trauma- minimize intra-cranial pressure, stop life- threatening bleeding

QUESTION 2

CENTRAL NERVOUS SYSTEM (29 Marks)

1. Differentiate between a seizure and a convulsion. (4)

Seizure- a brief alteration in behavior or consciousness. Caused by abnormal electrical Activity
of one or more groups of neurons in the brain.
Convulsions- an involuntary contraction of muscles producing contraction of the body and
limbs.

2. List and discuss the phases of a grand mal seizure. (10)

Phase 1- Aura (1): forewarning before convulsion, a strange smell, feeling, etc. the
patient may Recognize the aura as a sign of an impending seizure. (1)
Phase 2- Tonic(1) : loss of consciousness (1`); muscle twitching (contraction/ spasm) (1);
apnea, bladder and bowel incontinence (1).
Phase 3- Clonic (1): dyspnea, salivation, tachycardia, hyperventilation, muscles contract
and relax rapidly (1)
Phase 4- post ictal (1)- the patient starts to wake up. It can take minutes to hours. The
patient may be aggressive, combative, confused(1)

3. Discuss and explain the 2 different types of stroke (4)

• Ischemic- Ischemic Strokes are caused by a cerebral thrombosis or an embolus. Thrombosis is

caused by an atherosclerotic plaque or pressure from a mass in the brain.Cerebral Embolus.
An intracranial vessel is blocked by a foreign substance. The substance originates outside the
CNS.

• Hemorrhagic-Hemorrhage may occur in any structure of the brain. Fatal in 50% to 80%
Causes: aneurysm, AV malformations. (Asymptomatic until they rupture).

4. Explain the difference between TIA and RIND (4)

• TIA- neurological deficit resolves within 1 hour lasts 5-15min

• RIND- Reversible ischemic neurological deficit- neurological deficit that resolves within
24hrs.

5. Discuss and describe the method you would use to assess a patient you suspect may have
suffered a stroke (7)

The Cincinnati stroke scale (1)

Facial droop- ask the patient to smile- asymmetry of the mouth is present (2)

Slurred speech – ask the patient to say a sentence (2)

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Arm drift- asks the patient to close his eyes and raise both arms in front of him
simultaneously. (2)

QUESTION 3

RESPIRATORY SYSTEM (14 MARKS)

Scenario: At 11H00 you are despatched to the local high school for a “difficulty in breathing”. You
arrive on scene to find a 16-year old female patient clearly in respiratory distress sitting in a tripod
position.
She is surrounded by her concerned class mates. An adult identifies herself as the teacher.
The teacher tells you that the patient tried to use her asthma pump several times but it was not helping
her.
As you approach your patient you find she is wide eyed and is cyanosed with audible wheezes. When
you introduce yourself she is unable to speak back to you but acknowledges your presence.
Your assessment reveals the following vital signs:
Blood Pressure: 90/60mmHg
Pulse: 120 beats/min, weak
Respirations: 18 breaths/ min, shallow.
Saturation: 84%
Air entry: decreased bilaterally. Bilateral expiratory and inspiratory wheezing
HGT: 4mmol/l
GCS 13/15
1.1 What pharmacological agents would you use to relieve this patient’s respiratory distress?(2)
β2 adrenergic stimulants and Ipratropium bromide.
1.2 Explain your dosage and administration of these agents for this specific patient. (4)
1,25mg of Fenoterol UDV/ 1mg of Salbutamol + 0,5mg of Ipratropium bromide diluted to
5ml in a nebuliser mask connected to oxygen with a flow rate sufficient to cause a mist (6-
4l/min)
1.3 Explain how these drugs work and why we administer them together( 8)
Ipratropium Bromide causes relaxation of bronchial muscles due to its anti-cholinergic
effects (blocks parasympathetic system) causing bronchodilation.
β2 adrenergic stimulants act on β2 receptors in the lungs (bronchial smooth muscle cells)
causing bronchodilation. Therefore these drugs work together, through different pathways
to achieve the same effect.

Question 4

ENDOCRINE SYSTEM (10 Marks )

5.1 Discuss the pathophysiology of Diabetic Ketoacidosis (10)

Absence of or resistance to insulin =Low insulin= glucose cant enter cells=Glucose accumulates
in the blood.
Cells starved for glucose. Other sources of energy (principally FAT).Fat metabolism= generation
of fatty acids and glycerol. Glycerol provides some energy
Fatty acids further metabolized= ketoacids= acidosis.
Acidosis= increased loss of potassium from cells into the blood= high K loss from the urine. Na
outside the cells decreases= replaced by increased hydrogen ions.
Acidosis.
Increased Blood sugar = osmotic diuresis (the amount of glucose is above the kidney’s ability to
reabsorb it, glucose enters the urine. The osmotic effect prevents the kidneys from reabsorbing
fluids.)

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CLASS TEST 03

Signs and symptoms- diuresis, warm, dry skin, dry mucous membranes, tachycardia, thready
pulse, arrhythmias, postural hypotension, weight loss, polyuria, polydypsia, acidosis, anorexia,
nausea, vomitting, acetone breath odor, kussmaul respirations, decreased level of consciousness.