Mock SAQ – July 2016 London ST3 and above trainees

24 questions – 1 hour

0
1690

Question 1.

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.

No because you have to lose 90% of renal tissue to start to get renal failure.

Acknowledged that should put “in this patient” for Q2.
Q3 particularly important type of question as requires you to apply knowledge

Question 2.

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

Anterior longitudinal ligament and anterior half of the vertebral bodies.

Question 3.

This man becomes aggressive in the department

Ensure that the techniques and methods used:
  • 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.

Question 4.

This 14 month old has a barking cough.
There is marked stridor

This allows the airway to be as straight as possible therefore reducing the restriction in ventilation

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

Question 5.

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)

(a)

(b)

Vagal discharge on the SA and AV nodes causing profound bradycardia (1 mark) and so cardiac output to fall (1 mark)
No =- pre-test probability negative if all returned to normal, too young and no reason for autonomic dysfunction

In this type of question – again we should add “and why” to Q2 – as an answer yes or no otherwise has to be accepted

Question 6.

A 87 year old presents in cardiac arrest. He feels cold and a core temperature is measured as 28C. His tracing is shown below.

3 shocks only then withhold until 30C Drugs withheld until 30C then twice as long between

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.

Question 7.

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

The difference between the alveolar and arterial oxygen concentration and so tells you about the degree of shunting- or whether hypoxia is intra or extra pulmonary in origin Needed to specify abnormal as normal is the most common finding.

Question 8.

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

Question 9.

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.

Mallampati 3 - This suggests that endotracheal intubation may be difficult
The action would be to have a difficult airway trolley nearby and/or call for senior help

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.

Question 10.

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 38.5C- sweating
Pulse 120 beats per minute
Blood pressure 190/95 mmHg
Respiratory rate 29 breaths per minute

Neuroleptic malignant syndrome
  • Reduction of temperature – tepid bathing, paracetamol IV cold fluids
  • Manage ABC and monitor carefully for seizures
  • Consider dantrolene

Needed to specify ABC and monitoring was in place- only one ABC type answer per paper will be expected.

Question 11.

A 2 year old is brought in having stopped using her right arm

Fix the elbow with one hand, apply axial compression at the wrist while supinating the forearm and flexing the elbow.

Note the detail of the procedure is required Marks should be reversed so 1 mark first bit – 2 marks for procedure

Question 12.

A 45 year old alcoholic presents with melaena. He is shocked and has obvious encephalopathy minute

Screens for likelihood of blood transfusion or endoscopy and possibly those who can go home
It is a somatostatin and causes a relaxation of vascular smooth muscle and reduce portal venous pressure.

Question 13.

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”

Question 14.

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 38C.

Her Hb is 90 g/Dl

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