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

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 pasint, 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 pasint breindood verklaar kan word. (15) b) Beskryf die voorsorgmaatrels, wat u sal in plek sal stel, om optimale orgaan funksie te verseker, in bogenoemde pasint. (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 pasint. Bespreek beide lae en hoe risiko blootstellings situasies en hoe u elkeen sal hanteer. (8) b) n Nooddienste personeel lid is blootgestel aan n pasint met bevestigde meningokokkale meningitis tydens n primre oorplasing. (4) c) Paramedici lid word per ongeluk geprik met n naald wat gekontamineerd is met die bloed van n Hepatitis B pasint. (4)

d) e)

Paramedici word blootgestel aan n pasint met erge waterpokkies tydens n oorplasing. (3) n Pasint met aktiewe XDR-TB benodig oorplasing per ambulaans oor n afstand van 150 km. Watter advies sal u aan die nooddienste personeel verskaf wat die oorplasing gaan behartig? (6) List 3 fractures commonly associated with non-union. (3) List both the specific and general complications of a blood transfusion, whilst resuscitating a hypovolaemic patient, who sustained blunt trauma to the torso. (10) Describe general measures to reduce the risk of the blood transfusion complications, as listed in 3.b) (above). (5) Discuss the ethical principles, you should consider, when signing a DO NOT RESUSCITATE (DNR) order, for a 82-year-old terminal patient with end stage metastatic lung cancer, sepsis and respiratory distress. (3) How should you go about installing the DNR order for this patient, and what further treatment should you offer the patient? (4) [25] Lys 3 tipes frakture wat gekompliseer word deur nie-hegting. (3) Lys beide die spesifieke en algemene komplikasies van n bloedoortapping tydens die ressussitasie van n hypovolemiese pasint wat stomp trauma aan die romp opgedoen het. (10) Beskryf algemene maatrels om die risiko van die bloedoortappings komplikasies, in 3.2. (hierbo) te verminder. (5) Beskryf die etiesse beginsels wat u sal gebruik wanneer u n MOET NIE RESUSSITEER NIE bevel, vir n 82-jarige oue terminale pasint met gevorderde metastatiese long karsinoom, sepsis en erge respiratories nood, moet implementeer. (3) Hoe sal u te werk gaan om hierdie MOET NIE RESSUSSITEER NIE bevel te implimenteer in bogenoemde pasint? Watter verdure behandeling sal u vir hierdie pasint voorskryf? (4) [25]

a) b) c) d)

e)

a) b)

c) d)

e)

A 26-year-old male patient is involved in a high speed motor vehicle accident and is brought into the emergency centre fully immobilised. 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. (10) ii) If he has a Glasgow Coma Scale of 10. (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. (8) [25]

n 26-Jarige man, wat betrokke was in n hoe spoed motor ongeluk, word na u noodeenheid gebring, ten volle geimmobiliseerd a) Skryf kort notas oor hoe u hierdie pasint sal verder ondersoek vir moontlike nek werwel beserings. i) Indien sy Glascow Koma Skaal 15 is. (10) ii) Indien sy Glascow Koma Skaal 10 is. (7) b) Skryf kort notas oor, beide die farmakologies en nie-farmakolgiese metodes, waarmee u pynverligting sal verskaf, aan n pediatriese pasint met n geslote femur fraktuur. (8) [25]

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. 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

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

b)

a)

b)

Beskryf u onmiddelike benadering, tot hierdie 2-jarige kind, m.b.t. die behandeling. (5) ii) Definer die term koorskonvulsies. (3) iii) Lys die situasies wanner u nie bogenoemde pasint sal toelaat as n binnepasint nie. (5) n 65-Jarige dame presenteer in u noodeenheid met die geskiedenis van n tipiese sinkopie aanval. i) Definer die term sinkopie. (2) ii) Lys die moontlike oorsake van sinkopie in hierdie pasient. (6) iii) Beskryf u diagnostiese beplanning van hierdie pasient. (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. (6) ii) Which immediate laboratory tests would you do? Motivate each test. (4) An adult patient presents with self-poisoning to your emergency centre i) List the indications for using activated charcoal in this patient. (5) ii) List the substances / poisons which will not be affected by activated charcoal treatment (ie those in which there is no treatment benefit). (5) You administer magnesium sulphate (MgSO 4 ) to a patient with severe pre- eclampsia i) Which observations would you ask nursing staff to perform, and how often? State the limits of each observation, at which you would want to be notified, by the attending nursing staff. (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. (6) ii) Watter laboratorium spesiale ondersoeke sal u onmiddelik aanvra? Motiveer redes vir elke toets. (4)

i)

a)

b)

c)

a)

b)

n Volwasse pasint presenteer met selfvergiftiging, in u noodeenheid, terwyl u op

diens is. i) Lys die indikasies vir die gebruik van geaktiveerde koolstof in bogenoemde geval. (5) ii) Lys die substanse/gifstowwe wat nie beinvloed word deur geaktiveerde koolstof behandeling nie (d.w.s. daar is geen voordeel nie). (5) U gee magnesium sulfaat (MgSO 4 ) vir n pasint met erge pre-eklampsie i) Watter observasies instruksies sal u vir verpleegpersoneel gee, wat na bogenoemde pasint omsien, en hoe gereeld. Watter waardes moet die observasies oorskry voordat die verpleegpersoneel u daarvan moet verwittig. (5) [25]

c)

A 75-year-old male patient, presents to the emergency centre, with severe central chest and upper back pain, of more than two hours duration. The pain started with a severe tearing sensation in the upper back and progressively worsened. The patient is known to have poorly-controlled hypertension a) List six life-threatening causes of chest pain. What is the most likely diagnosis in this patient? (8) b) List the electrocardiographic (ECG) changes that are suggestive of acute myocardial infarction. (8) c) Write short notes on six medications (including medication name, dose and contraindications) that should be administered in the emergency centre to a patient with an acute myocardial infarction. (9) [25] n 75-Jarige pasint, presenteer in u noodeenhied, met erge sentrale borskas en boonste rugpyn, vir meer as 2 uur durasie. Die pyn het begin met n erge skeur sensasie in die boonste rug area wat daarna nog progressief vererger het. Die pasint is bekend met swak gekontroleerde hipertensie. a) Lys 6 lewensdreigende oorsake van borskaspyn. 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. (8)

c)

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