A 45 year old presents with left loin pain. You perform a departmental FAST and note the following image. he feels otherwise well and has no significant past medical history.
Acknowledged that should put “in this patient” for Q2.
Q3 particularly important type of question as requires you to apply knowledge
A 78 year old woman complains of back pain. Her GP has arranged an Xray of her spine which is shown.
Acknowledged the picture is not great reproduction
This man becomes aggressive in the department
- Are proportionate to the risk and potential seriousness of harm
- Are the least restrictive option to meet the need
- Are used for no longer than necessary
- Take account of the service user's preferences, if known and it is possible to do so
- Take account of the service user's physical health, degree of frailty and developmental age
Stressed the importance of knowing guidelines – especially NICE etc – which are a good resource in preparation
Discussed whether VBG would be accepted – agreed if many candidates put that – would accept but it is the specific test that is needed because that is what is requested. Should add “and why” which would allow any answer if justified.
This 14 month old has a barking cough.
There is marked stridor
The answers would be varied- as long as the answer captures the principles of the ideal answer – they would get a mark
Specific descriptors like turbulence would be needed
A 20 year old, previously well, presents with a syncopal event associated with bradycardia. Her ECG in the ambulance is shown below (a), with the repeat in the department (b)
In this type of question – again we should add “and why” to Q2 – as an answer yes or no otherwise has to be accepted
A 87 year old presents in cardiac arrest. He feels cold and a core temperature is measured as 28C. His tracing is shown below.
The key here is the active warming question which should be underlined – and an understanding that active rewarming in this way is not recommended as the volumes are too high – indicates discriminatory thought on the processes.
A 36 year old presents with chest pain. It is sharp and worse on inspiration. She feels breathless on exertion and more recently at rest. A CT has shown multiple PEs
A 85 year old is brought in by their neighbours because they have noticed a change in behaviour. The patient has been found wandering in the street in their nightclothes and they are concerned as they found the gas turned on but not lit.
- Recent onset of fluctuating awareness
- Impairment of memory and attention
- Disorganised thinking
Important to specify pharmacological to avoid the desensitisation etc therapies.
Benzodiazepine would be acceptable although not recommended in the NICE guidance
A 48 year old woman presents with a fracture dislocation of her ankle and you decide to perform procedural sedation. The view on her opening her mouth is shown below.
Accepted that the Mallampatti alone does not predict a difficult airway but that anyone who said it didn’t suggest a problem would not be given marks. If they said a Laryngeal mask/igel would be better that would be acceptable only if they said so.
A 24 year old is brought in very unwell, they have recently started clozapine. They are confused with profound widespread muscle rigidity. Their vital signs are as follows:
Temp 38.5C- sweating
Pulse 120 beats per minute
Blood pressure 190/95 mmHg
Respiratory rate 29 breaths per minute
Needed to specify ABC and monitoring was in place- only one ABC type answer per paper will be expected.
A 2 year old is brought in having stopped using her right arm
Note the detail of the procedure is required Marks should be reversed so 1 mark first bit – 2 marks for procedure
A 45 year old alcoholic presents with melaena. He is shocked and has obvious encephalopathy minute
A 45 year old man presents with a three week history of headaches which occur daily lasting 2-3 hours. He is distressed and agitated in the department. The current headache started about 30 minutes ago.
Analgesia question was too open – wanted to get people to recognise it was severe pain so might need opiates but might be better to have “analgesia regime”
A 35 year old African woman presents with yellow sclerae and pruritus. She has no pain and has no significant past medical history. She recently travelled to Kenya on holiday. On examination she has a palpable spleen but no liver edge. She is febrile at 38C.
Her Hb is 90 g/Dl