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 60 Marks
TIME: 60 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

ETHICS (14Marks)

1. List 6 patients’ rights. (7)

Any 6 of the following are acceptable- A healthy and safe environment; Access to
health care; Confidentiality and privacy; Informed consent; To be referred for a
second opinion; To exercise choice in health care; Continuity of care;
participation in decision making that affects his/her health; To be treated by a
named health care provider; To refuse treatment; knowledge of their health
insurance/ medical aid scheme policies; To complain about the health service
they receive.

2. Name and describe 4 core ethical values as defined by the HPCSA . (8)
Autonomy: the right to make informed decisions.
Beneficence: action that is done for the benefit of others; practitioners must put
the patient’s interest first.
Confidentiality: you must maintain the confidentiality of medical information.
Confidentiality respects patient autonomy.
Do no harm: non-maleficence- do no harm to patients.
Equality: the principle of justice deals with issues of treating patients equally.
Fairness: the principle of procedural justice requires that the process for making
decisions for patients be fair and just.

QUESTION 2

HEAD INJURY (18 Marks)

1. You and your partner are dispatched to a Pedestrian Vehicle Accident. On arrival, you
encounter 1 patient with an isolated head injury. Explain how you would minimize
intracranial pressure in this case. (10)
Limiting intracranial pressure
A. Thermoregulation
B. Normoglycemia
C. Limit fluids
D. No occlusive dressings
E. No ill fitting collars
F. 30 degree elevation- of the spine board
G. Minimize movement of the patient
H. No hyper or hypoventilation.
I. Pain relief
J. Do not stimulate the gag reflex

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CLASS TEST 03

2. Explain the Monroe-Kellie- Hypothesis. (6)

The skull is a closed container(1) it consists of 3 components- blood, brain and
csf(1). If one components increases (1), the other 2 must decrease (1) to maintain
equilibrium / homeostasis (1)
3. Differentiate between coma and unconsciousness (2)
Unconsciousness- the patient has a decreased level of consciousness which can be
reversed by external stimuli.
Coma- a state of unconsciousness in which the patient cannot be aroused by
external stimuli

QUESTION 3

SHOCK (19 Marks)

1. Identify the different types of shock and differentiate between them using their
specific signs and symptoms

Haemorrhage Shock

1. Probably bleeding internally or externally

2. Tachycardic
3. Tachpnea
4. Maintain a BP during the Compensatory phase

Cardiogenic shock

1. Underlying history of medical or trauma to cardiac muscle

2. Inability to maintain BP
3. Shorter compensatory phase

Septic shock

1. History of infection
2. Widened Pulse pressures
3. May present as either hot or cold

Anaphylaxic shock

1. Severe oedema
2. Respiratory distress
3. Stable blood pressure initially with rapid decrease

Neurogenic shock

1. Usually a history of trauma to spine

2. Severe hypotension despite interventions
3. Poiko thermia

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CLASS TEST 03

QUESTION 4

CARDIAC (8 Marks)

1. Discuss the pathophysiology of left ventricular failure.

 Damage to the left ventricle results in decreased pumping ability.

 Heart attempts to compensate to maintain the blood pressure by increasing the
heart rate, and enlarging the left ventricle to increase the stroke volume.
 When these two compensatory mechanisms are no longer effective, there is a
back up of blood in the pulmonary circulation.
 The increased pressure leads to a fluid shift from the capillaries into the alveoli –
pulmonary oedema.