MOCK PEG STEM

Zhengjie Lim 2018

 Part 1

Instructions to candidate

You will be given 2 minutes to prepare a short case presentation on an interesting patient
you met during your clinical rotation in 2017 and 2018.

Questions relating to your case presentation will be asked along the way – the examiner will
interject at regular intervals to test your medical knowledge and understanding of the topic
you have chosen.

Mock PEG stem

Zhengjie 2018
 Part 2

Interpretation of test results

TAN Tony
DOB: 1-1-1949
S1234567H

ABG report

pH 7.30
PaCO2 7.25
HCO3 20

(1) Interpret your findings to the examiner

(2) What are the likely causes for this? Name 3 potential causes

Solutions:
https://lifeinthefastlane.com/investigations/acid-base/ and
https://lifeinthefastlane.com/wp-content/uploads/2012/08/acid-base-disorders-
worksheet3.pdf

CXR 1 – 85yo Male with acute on chronic SOB, known IHD, previous CABG

Mock PEG stem

Zhengjie 2018
Answer: https://tinyurl.com/y9t7mhpa

CXR 2: 20yo Female presents with 1 month of cough, fever, and weight loss

Answer: https://tinyurl.com/ybcf3aaq

CXR 3: 30yo Male presents with chronic cough

Answer: https://tinyurl.com/y956o66v

Mock PEG stem

Zhengjie 2018
AXR: 70yo male with abdominal pain and discoloured stools

Answer: https://tinyurl.com/ycjwe9t4

ECG 1: 40yo male with chest pain

Mock PEG stem

Zhengjie 2018
ECG 2: 42yo male, asymptomatic

What is the management plan for this patient?

ECG 3: 70yo male, asymptomatic

The “Random” question

This 70yo patient (from ECG 3) now presents to you with palpitations, shortness of breath
and paraesthesia of the hands and feet. Potassium is 8.5mmol/L. Please manage the
patient.

Mock PEG stem

Zhengjie 2018
Hyperkalaemia
- Investigations
o ECG
 Tall tented  p-wave flattening  widened QRS  deep S  sine
wave
o Bloods – FBE, UECr, CK, ABG ?Acidosis
- Management
o Fluid resus to enhance renal perfusion and elimination
o Monitoring ECG continuously + serial ABG/VBG
o Acute Mx
 Calcium gluconate (In this case you wouldn’t give, because gluconate
is contraindicated in digoxin toxicity)
 Insulin with glucose (bonus points if you mention novorapid 20 units +
serial monitoring of BGLs)
 Sodium bicarbonate for acidosis
 Salbutamol (only nebuliser, the puffer won’t do shit)
o Long term
 Calcium resonium
 Frusemide
 Normal saline
 Dialysis

ECG answers
1. Pericarditis
a. Widespread concave ST elevation and PR depression in V2-V6 and I, II, aVL
and aVF
b. Reciprocal ST depression and PR elevation in aVR
c. Management: NSAIDS  colchicine
d. If purulent: percutaneous pericardiocentesis + systemic antibiotics
e. Consider complications (e.g. tamponade, pericardial effusion, constrictive
pericarditis)
2. AV block; 2nd degree mobitz I (Wenckebach)
a. Asymptomatic do not require treatment
b. If symptomatic, consider atropine
c. Permanent pacing rarely required
3. Digoxin effect
a. Downsloping ST depression – Salvador dali sagging
b. Flattened T waves
c. Shortened QR interval

Mock PEG stem

Zhengjie 2018