Saq questions from demt discussion Group: November 2014 Note

Note - Summary Recommendations ARC 2009

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Note - Summary Recommendations ARC 2009

Class A
 Wide-QRS tachycardia should be presumed to be VT if the diagnosis is unclear.

(Level of Evidence: C)

 Direct current cardioversion with appropriate sedation is recommended at any point in the treatment cascade in patients with suspected sustained monomorphic VT with hemodynamic compromise. (Level of Evidence: IV)

Class B
 Intravenous amiodarone is reasonable in patients with sustained monomorphic VT

that is haemodynamically unstable, refractory to conversion with countershock, or recurrent despite other agents. (Level of Evidence: IV)

88. A 35 year old woman presents to your ED with an acute asthmatic attack. She is on continuous salbutamol nebs, is highly distressed and only speaking single words.
a. Name 4 features on history that increase the risk of severe life threatening asthma. (2 marks)

  1. previous life-threatening attack,

  2. previous intensive care admission with ventilation,

  3. requiring three or more classes of asthma medication,

  4. heavy use of β-agonists,

  5. repeated emergency department attendances in the last year and having required a course of oral corticosteroids within the previous 6 months.

  6. Behavioural and psychosocial factors have also been implicated in life-threatening asthma including non-compliance with treatment or follow up, obesity and psychiatric illness.

Cameron 4th ed Ch 6.2

a. List at least 6 therapeutic drug classes that may be used in the treatment of a severe attack. (2 marks)

  • Oxygen

  • B2 agonist inh/neb/IV

  • Corticosteroids

  • Ipratropium

  • Adrenaline

  • Magnesium

  • Aminophylline

  • Heliox

  • Ketamine (preferred induction agent.)

b. Outline what your initial ventilator settings would be. (4 marks)

  • Needs a safe approach.

  • Need to mention permissive hypercapnia to be tolerated if necessary.

  • Lung protective Strategy

  • Pressure or Volume control with attention to ensuring adequate minute ventilation.

  • Tidal volume - maximum of 8ml/kg (6-8)

  • RR – may need to be very low – start at 10 bpm, but be prepared to titrate down.

  • I:E ratio – at least 1:3, may need to be 1:5. May need to adjust inspiratory time to achieve.

  • Fi02 100%

  • PEEP – controversial 0 or 5 mmHg (may have autopeep)

  • Limits – Peak insp 35-40, plateau -35

c. What physiological targets are you aiming for? (2 marks)

  • Pt heavily sedated

  • Sats > 92%

  • PaCO2 – tolerate PaCo2 up to 80 or higher if required.

  • pH > 7.15

  • normothermia

Alternative question parts.

  • Describe the advantages and disadvantages of a class of medication. (ie. Magnesisum, or Salbutamol)
  • What are the advantages and disadvantages of Non Invasive Ventilation.

  • Describe how you would intubate this patient.

  • The patient become hypotensive 5 minutes after intubation. What immediate actions do you take?

89. A 7 year old boy presents with acute respiratory distress. He is intubated in your department by a senior registrar as he has oxygen saturations of 84% on 15L oxygen via NRB mask and is tiring. You are called to the resuscitation room after intubation as his HR falls from 142 /min to 70 /min and oxygen saturations drop from 90% to 75% on 100% oxygen. He is attached to the Oxylog 3000 ventilator. The registrar reports a first pass intubation taking 40 seconds to complete.
a. List your top 6 differential diagnosis for this deterioration (6 marks)
Intubation issues: Anaphylaxis to induction agent, Tube misplacement (oesophageal/bronchial), Tube blocked

Ventilation issues: Ventilator settings inadequate/failure technical with e.g. gas trapping, pneumothorax

Worsening of underlying pathology
b. Outline your approach to the airway in the order that you would perform. (4 marks)
Disconnect from ventilator and bag mask for feel with 100% oxygen

Check ETT placement (ETCO2, auscultation)

Suction ETT

Reintubate if suspected failed intubation

90. A 70 year old man with type 2 diabetes presents to your ED with 24 hours of malaise. His initial observations are: HR 120 /min and BP 70/40 mmHg. His bedside BSL is 11.2 mmol/L and his central capillary refill is 5 seconds. He is confused and review of past notes indicates that this is new and he has a history of alcoholism.

a. What are the 3 most likely causes of this presentation? (3 marks)

Sepsis, Haemorrhage, Cardiogenic

b. What key initial investigations will you perform? (4 marks)
Any of: VBG with stat profile, RUSH USS exam, ECG, urine

analysis, CXR, Clotting screen

c. You perform a PR that shows heavy melena, the patient then has a large fresh haematemesis. List 4 initial management. (2 marks half a point for each)
Blood and products avoiding with permissive hypotension

Terlipressin 2g IV(or vasopressin/octreotide)

Cefotaxime 1g IV

Vitamin K 10mg IV,

1. This 24 year old female presented to the emergency department complaining of painful lumps and redness confined to her lower legs which had developed over the last two weeks.
a. List your main differential diagnosis with the most likely listed first. (5 marks)
Erythema nodosum


Contact dermatitis

Insect bites


Erythema multiforme



Erythema induratum

Well’s syndrome

b. List the most likely aetiologies for the most likely diagnosis. (5 marks)
minimum of 3 from bold list

Streptococcal pharyngitis

Sulphonamides other drugs and vaccines e.g. OCP







Rickettsial infections

Eponymous – Bechet’s

Hansen’s disease

Neoplasia (lymphoma)



Hep B


92. A 17 year old male is brought to ED by ambulance, complaining of abdominal pain and vomiting. He appears confused and is unable to prvide a good history. On examination his vitals are: Temp 37.9 oC, BP 100/50 mmHg, HR 110 /min.
Blood tests taken on arrival show:
Na 140 mmol/l (135-145)

K 5.0 mmol/l (3.5-5.5)

Chloride 100 mmol/l (95-110)

Creatinine 0.1 mmol/l (0.03-0.08)

Urea 16 mmol/l (3.0-8.3)

Glucose 40 mmol/l (3.3-8.3)

Hb 167 g/l (135-175)

PCV 50 % (41-53)

Plt 224 (140-400)

WCC 21.8 (4-11)

Neutrophils 19.2 (4-11)
pH 7.133 (7.35-7.45)

pC02 24.8 (35-45)

p02 112 (90-100)

HCO3 8.3 (24-32)

BE -19.6

Sa02 96.8 %

a. List the major abnormalities. (4 marks ½ for each)

Marked hyperglycaemia

Severe metabolic acidosis

Elevated anion gap of 27 (includes K)

Mild respiratory acidosis as expected C02 20.45 +/- 2

High osmolality 336

Elevated WCC: sirs/sepsis

Corrected Na 149 elevated

Potassium normal but secondary to shift with dehydration and acidosis so whole body stores likely low

b. What is the diagnosis? (1 mark)
c. What is your initial management? (5 marks)
Initial fluid resus correct shock then 500ml/hr for 4 hrs (titrate to response) Crystalloid of choice

Insulin 0.1 units/kg/hr initial rate

K+ replacement 10mmol/hr and monitor

Prophylactic LMW heparin

Teat precipitant

Disposition ICU/HDU

93. A 30 year old man presents after 24 hours of vomiting. He looks sweaty and unwell.
Initial observations: Temp 37.2°C, HR 120 /min, BP 80/50 mmHg, RR 22 /min, Sa02 99% on room air.

Initial lab results:

Hb 154 g/L (110-165)

WCC 13.3 x109/L (3.5-11)

Plt 239 x109/L (140-400)

Na 130 mmol/L (135-145)

K 5.2 mmol/L (3.5-4.5)

Cl 101 mmol/L (100-110)

HC03 21 mmol/L (22-33)

Urea 10.7 mmol/L (3-8)

Creat 94 umol/L (50-100)

Ca (total) .39 mmol/L (2.15-2.6)

Alb 48 g/L (33-47)

Gluc 4.1 mmol/L (3-7.8)

a. What are the abnormalities? (2 marks)
(must grade levels of abnormality for full marks)

Mild hyponatraemia

Mild hyperkalaemia

Mild metabolic acidosis with normal anion gap of 13

b. List your differential diagnosis with most likely listed first. (7 marks)

Hyperemesis from cannabis


Hypoadrenalism (although normal glucose against)

Drugs (ACE inhib, K sparing diurectics, CAH inhibitors)

Renal Tubular acidosis




Any other reasonable cause

c. What test is used to confirm the most likely endocrine diagnosis? (1 mark)
Short Synacthen test

94. A 55 year old man is referred to your ED by his GP with a complaint of being “generally unwell”. He has a history of hypertension.
The patients chemistry and venous blood gas are shown below:
Na 144 mmol/L (135-145)

K 1.7 mmol/L (3.3-4.9)

Cl 85 mmol/L (98-106)

HC03 40 mmo/L (3.0-8.0)

Creat 0.08 umol/L (0.05-1.12)
pH 7.56 (7.35-7.45)

pC02 44 mmHg (35-45)

p02 68 mmHg (90-100)
a. Describe and summarise the results. (4 marks)

Life threatening hypokalaemia (mandatory to pass)


Metabolic alkalosis with elevated bicarbonate

Anion Gap 20

Normal renal function

Expected C02 43 – appropriate resp compensation

Borderline hypoxia (likely secondary to hypoventilation)

Hypochloraemic hypokalaemic metabolic acidosis

b. What is your differential diagnosis? (6 marks)
Loss of Hydrogen

Renal: Hyperaldosteronism, primary (Conn’s) or secondary, Cushing’s, Bartter’s syndrome)

Upper GI: Vomiting

Drugs: corticosteroids, diuretics

Gain of bicarbonate

Sodium bicarb tablets

Secondary hyperparathyroidism

95. A 65 year old man with insulin dependent diabetes mellitus presents to the ED with a marked sudden decrease in vision.
a. What are your top 6 differential diagnoses? (3 marks)
Central retinal artery occlusion - mandatory

Central retinal vein occlusion - mandatory

Retinal detachment - mandatory

Vitreous haemorrhage - mandatory

Optic neuritis

Loss of contact lens

Cranial nerve palsy causing diplopia

Giant Cell arteritis

Toxic metabolic neuropathy/any post chiasmal cause e.g. CVA, acute glaucoma/local trauma etc
b. What are the key historical features you would ask for to help differentiate between these? (7 marks)

Monocular vs binocular

- Moncular – ophthalmologic cause

- Binocular- central cause – need stroke workup

Painful vs painless visual loss

- Painful favors acute glaucoma, optic neuritis and iritis

Sudden onset profound loss in CRAO

- often preceded by episodes of amaurosis fugax

- occurs over seconds

Spectrum of loss in CRVO

- variable extent: blurring to complete monocular vision loss

- more gradual onset than CRAO


- with retinal detachment and vitreous haemorrhage

- associated with underlying diabetic retinopathy

- decreased central/peripheral deficit e.g. dark curtain in visual field


- with diabetic cranial nerve palsy

- vascular compromise of cranial nerves to EOM

- direction of gaze producing symptom gives clue to nerve affected

96. A 60 year old female presents to ED with a painful red eye. There is no history of trauma.
a. What features on history and examination would you expect in acute closed angle glaucoma? (3 marks)

  • Severe unilateral pain

  • Nausea +/- Vomiting

  • Reduced vision and halo’s

  • Known Glaucoma

  • Absence of trauma

  • Presence of risk factors; e.g anticholinergic drugs, mydriatics, age, family history, known shallow anterior chamber

b. You diagnose acute closed angle glaucoma. Outline your management. (7 marks)

Antiemetic e.g ondansetron 4mg IV - mandatory

Analgesia likely opiate - mandatory

Acetazolamide 500mg IV then 250mg PO tds – mandatory

Pilocarpine 2% every 5 min for 1hr

Timoptol 0.5% every 30-60mins

Consider mannitol

Urgent Opthalmology consultation – mandatory

97. A 58 year old woman presents to the ED complaining of a five day history of sore throat and progressive difficulty swallowing. Examination reveals she is febrile with stridor at rest. Oropharyngeal examination does not reveal an overt diagnosis.
a. What is your differential diagnosis? (2 marks)

Retropharyngeal abscess – most likely

Prevertebral abscess – rare

Epiglottitis – rare

Peritonsillar abscess – expect local signs

Submandibular cellulitis – expect local signs

b. What are the key features in your immediate management? (8 marks)
ABC approach in Resus and keep sitting in comfortable position

Have difficult airway kit ready if needed

Keep NBM

Analgesia e.g. morphine/fentanyl

IV fluids if clinically dehydrated

Nebulised Adrenaline 5mg - mandatory

Dexamethasone 5mg IV - mandatory

IV Ceftriaxone 2g and Flucloxacillin 1g and metronidazole 500mg (or other appropriate as per local guidelines) - mandatory

Urgent ENT review – mandatory

Anaesthesia and ICU

Disposition HDU/ICU

97. A 74 year old female presents to ED with 2 hrs of left sided epistaxis. HR is 80 /min, all other vitals are within normal limits. She has been pinching the anterior nares tight for 20 minutes.
a. List 4 risk factors for epistaxis in this patient population. (2 marks)




General: trauma, infection, nose picking, allergies, travel, low humidity
b. You examine the nose and the nostril is full of clotted blood, there is still active bleeding around this and the patient reports blood trickling down the back of their throat. Outline your approach. (6 marks)

Sit up in room with ENT equipment and good lighting

Ensure BP monitoring

IV access and check Hb and G+H

Personal PPE - mandatory

Nasal speculum to allow visualisation

Suction clots

Local anaesthesia spray with constrictor e.g. lignocaine and phenylephrine spray, or co-phenelcaine

Can try adrenaline soaked pledget with pressure if bleeding spot seen

Cautery (ring if active bleeding spot)

Disposition is discharge if treated ENT if packing or unable to obtain haemostasis

c. You are now able to examine the nose and there is still active bleeding but you are unable to see a bleeding point.
The patient’s vitals are HR 115 /min, BP 105/60 mmHg, Sa02 96% RA.
What methods are available to specifically treat this scenario? (2 marks)
Posterior packing: e.g rapid rhino or other device

Foley catheter if above unavailable/not working

Arterial ligation/embolisation if still bleeding and unstable

98. You have just intubated a 75 year old 60kg woman with deteriorating respiratory function after a fall causing isolated closed chest injuries. She has a history of COPD. She has become increasingly hypoxic and hypotensive since intubation. Your hospital does not have an intensive care unit.
a. List 8 causes for her deterioration (4 Marks)

Ventilator failure / O2 disconnect

ETT misplacement / blockage

Pneumothorax (iatrogenic or traumatic

Breath stacking / hyperinflation

Lack of synchronisation / need for paralysis


Worsening pulmonary contusions

b. Her hypotension resolves although she has an ongoing high oxygen requirement and high ventilator peak pressures. You have a simple VOLUME cycled ventilator.

List basic ventilator settings for this woman and outline your ventilation strategy. (4 Marks)

Lung protective ventilation. (1)

Avoid volutrauma (1)

Avoid barotrauma (0.5)

Accept permissive hypercapnoea. (0.5)

Use lowest FiO2 possible to avoid hypoxia.(0.25)

Rate 6-10 min (0.25)

TV 240-350mL (4-6mL/kg) (0.25)

PEEP 10cm H20 (or higher) (0.25)

c. This woman needs to be transferred to a tertiary hospital for ongoing management. A retrieval team will arrive in 2 hours to transfer her by fixed wing. You do not need to supply staff for the retrieval. Outline how you would prepare for this transfer. (2 marks)
Communicate with receiving team – where is she going who will be responsible?(0.5)

Prepare the patient – lines, medications, avoid pressure areas, ETT, catheter_(0.5

Prepare notes / xrays_(0.5)

Ongoing monitoring and care of patient while awaiting retrieval team (0.5)

99. A 68 year old woman presents with central chest heaviness and nausea. An ECG is performed and is shown below.

Her vitals are:

BP 120/70 mmHg

PR 60 /min

RR 18 /min

SaO2 99 % RA

GCS 15
a. List the 4 most important features on this ECG. (2 marks)

No model answer provided
b. List 3 arrhythmias associated with these ECG findings. (3 marks)
No model answer provided
c. You are 3 hours away from the nearest cardiac catheter facility. Describe how this might change your management approach. (3 marks)
No model answer provided

d. List 2 important management differences between an inferior ST-elevation myocardial infarction and an anterior ST-elevation myocardial infarction. (2 marks)

No model answer provided

100. The mother of a child makes a complaint.
She states that three days previously, her 5 year old son had presented to the ED with elbow pain after a fall onto his outstretched hand.
Following x-rays, the treating doctor had “pulled on the elbow several times causing him to cry”. The doctor stated that he had suffered a “sprained elbow” and to return if the pain did not settle. The mother is distressed that her son had received no analgesia for the sprain and that he continued to not move the elbow because of pain. She also complained that the doctor spoke in a rude and insulting manner, and was very rough in his examination.
During your investigation, you find that the official report of the x-ray revealed a supracondylar fracture.
a. Describe 3 steps in dealing with this child’s second presentation.
No model answer provided
b. List the 4 most important steps in dealing with the mother’s complaint.
No model answer provided
c. Describe 3 strategies to mitigate the risk of this happening again.
No model answer provided
d. List 3 key features which define a pulled elbow.
No model answer provided

101. Your director wants you to write a set of guidelines for the use of physical restraints on a patient in the ED.
a. List 3 indications and three contraindications for patients under these guidelines.
No model answer provided
b. Outline 4 mandatory observations that should occur during restraint.
No model answer provided

c. Describe 3 circumstances under which you would remove the physical restraints.

No model answer provided
d. List 3 legal frameworks under which physical restraint could occur.
No model answer provided

102. A number of staff have been assaulted over the last 6 months in your ED.
a. List 5 key stakeholders to involve in discussions around this issue.
No model answer provided
b. Outline 3 measures at triage to potentially decrease these assaults.
No model answer provided
c. Outline 4 hospital-wide measures (i.e. non-emergency department specific) to potentially decrease these assaults.
No model answer provided
d. List 4 factors which may have led to the increase in assaults.
No model answer provided

103. You have been called to assist a junior doctor dealing with an upset family. The family is unhappy with the proposal of a “Do Not Resuscitate” (DNR) order for their elderly mother.
a. List 4 factors which would support the proposal of a DNR order.
No model answer provided
b. Describe 3 specific methods for dealing with the upset family.
No model answer provided
c. List 3 key pieces of advice you would give your junior doctor in dealing with this in future.
No model answer provided
d. Assuming a DNR order was written up and a decision was made to palliate this patient, list 4 medications you would chart on the patient’s drug chart to assist this goal.
No model answer provided

104. A 48 year old man presents with dizziness and palpitations. An ECG is performed and is shown below.

The patient’s vitals are:

BP 100/60 mmHg

RR 18 /min

GCS 15
a. What is the diagnosis? (1 mark)

No model answer provided
b. List 3 features on this ECG which supports your diagnosis. (3 marks)
No model answer provided
c. The patient’s BP drops to 70/40 mmHg and he becomes confused. Describe your 2 most important management priorities at this time. (4 marks)
No model answer provided
d. Is implantable defibrillator an option in this patient? Justify your answer. (2 marks)
No model answer provided

105. This 77 year old man presents with chest pain and dizziness on the background of Type II diabetes mellitus and a permanent pacemaker (PPM) for a sick sinus syndrome 3 years earlier. A recent PPM check was normal.
An ECG is performed and is shown below.

a. List 2 important abnormalities on this ECG. (2 marks)
No model answer provided
b. What is the likely pacing mode shown in this ECG? (1 mark)
No model answer provided
c. List 3 common pacing modes in use in Australia and the common clinical circumstances they are used in. (3 marks)
No model answer provided

d. Describe your immediate management priorities in this patient. (4 marks)

No model answer provided

06. A 48 year old haemodialysis patient presents to ED complaining of muscle weakness and nausea.
Vital signs are:

Temp 37.2 °C

BP 100/50 mmHg

RR 20 /min

Sa02 94 % on air

GCS 15

Weight 76 kg
he following ECG is performed:

a. What is the key diagnostic feature of this ECG?

No model answer provided
b. List 5 potential causes of this condition in this patient.
No model answer provided
c. List 6 treatments for this condition in this patient.
No model answer provided

107. An 18 year old male presents the ED having a severe asthma attack. He is on high flow oxygen and receiving nebulised salbutamol.
His vitals are as follows:

HR 140 /min

BP 110/60 mmHg

RR 32 /min

GCS 13/15
An ABG is taken.

pH 7.10 (7.35-7.45)

pO2 54 mmHg (90-10)

PCO2 120 mHg (35-45)

HCO3 18 (24-32)

BXS -5

Lactate 4

a. List 4 abnormalities on this ABG. (2 marks)
No model answer provided
b. Give the names, routes and doses of 6 medications you would treat this man with. (3 marks)
No model answer provided
c. List 4 complications of RSI/ intubating this man. (2 marks)
No model answer provided
d. Describe your ventilator settings in a patient with acute asthma. (3 marks)
No model answer provided

108. A 55 year old man is brought to the ED after being found collapsed at home. He has a medication alert bracelet indicating he has type 1 diabetes.
His observations are:

GCS 12

BP 90/60 mmHg

HR 130 /min

RR 30 /min

Temp 38 °C

A photograph of the patient’s left thigh is taken and is shown below.

a. Give 3 differential diagnoses. (3 marks)
No model answer provided
b. Name the antibiotics, routes and doses you would use. (2 marks)
No model answer provided
c. Give a detailed description of management priorities for this patient. (5 marks)
No model answer provided

109. A 46 year old man is brought to your ED by ambulance following an overdose of unknown medications. He has had a brief generalized seizure en route.

On arrival his observations are:

GCS 12

BP 85/60 mmHg

Temp 37.0 °C

O2 Sat 100 % on 8 L/min O2
His ECG is shown below:

a. Describe the ECG. (5 marks)

No model answer provided
b. What are the first 5 things you would do to manage the patient? (5 marks)
No model answer provided

110. An elderly man collapses and is unresponsive at a shopping centre.
a. What are the 4 elements in the chain of survival that improve the probability of survival? (2 marks)
No model answer provided
He receives prompt BLS from bystanders, then defibrillation from an AED prior to the arrival of the ambulance 10 minutes post-arrest. He is found to be in VF and does not revert with defibrillation by the ambulance crew. He is transported to ED, where he is still pulseless and the monitor shows this rhythm.

b. What are your immediate actions? (8 marks)
No model answer provided

111. Old Format SAQs

a. Discuss the investigations for a suspected pulmonary embolus in a 24 year old woman who is 10 weeks pregnant.

(100%) (2010.1)
No model answer provided

b. A 24 year old woman presents with a left sided spontaneous pneumothorax.

Discuss the treatment options for her pneumothorax (100%) (2011.2)

No model answer provided

112. A 48 year old man is brought by ambulance to your tertiary ED following a collapse at home. GCS on arrival is 3. He is immediately intubated and ventilated before CT scanning of his head and neck. CT reveals a massive intraparenchymal haemorrhage with obstructive hydrocephalus. The neck CT scan is normal. He was previously well on no medication. His partner is present and requests information about his treatment and prognosis.
His observations are:

HR 60 /min

BP 180/110 mmHg

O2 sats 100 %

Temp 36.3 °C
Old Format Question

Describe your management (100%)

No model answer provided
New Format questions

a. What are your management priorities?

No model answer provided
b. List and justify 4 other investigations you would perform.
No model answer provided
c. Describe 5 urgent interventions you would perform.
No model answer provided
d. What are the principles for gaining consent for organ donation?
No model answer provided

113. You work in a rural

edwith only basic specialties represented. An 80 year old man is delivered to your ED with an acute anterior ST elevation MI. He developed central chest pain 2 hours ago, which is ongoing. He is anxious, pale and diaphoretic. Widespread crepitation can be heard throughout his lung fields. Your local helicopter is out on another job and you have no alternative retrieval options for at least 4 hours.

His observations are:

GCS 15

HR 100 /min

BP 190/105 mmHg

RR 24 /min

O2 sats 91 %

Temp 36.8 °C
Old Format Questions

A. Outline your treatment. (70%)

No model answer provided
b. List absolute and relative contraindications to fibrinolytic treatment in patients with acute MI.
No model answer provided
New Format Questions

a. What are your treatment priorities?

No model answer provided
b. List absolute and relative contraindications to lysis. (as above)
No model answer provided
c. Despite your treatment, the patient drops their GCS to 7. List 5 reasons that may explain this deterioration.
No model answer provided
d. You elect to intubate this patient. Outline your drug options for induction.
No model answer provided

114. A baby is born in your resuscitation room after a precipitous birth from a 32 week pregnant woman. The baby is not breathing and there is thick meconium stained liquor on the bed. The delivery is otherwise uneventful and the mother requires no acute medical treatment. There is no on-site neonatal or obstetric service.
Old Format question

a. Describe your management. (100%)

No model answer provided
New Format Question

a. List seven essential equipment items that should be available for resuscitation of a neonate.

No model answer provided
b. List the immediate complications of this preterm labour.
No model answer provided

c. Describe the main differences between the adult and neonatal airway.

No model answer provided
d. List the management priorities for this child for the first 5 minutes.
No model answer provided
e. What preparations do you need to make prior to transfer to definitive care?
No model answer provided


a) Adrenaline

e) Milronone

b) Dobutamine

f) Noradrenaline

c) Dopamine

g) Vasopressin

d) Levosimendan

For each pharmacological effect below chose the corresponding drug from the list above.

  1. It is a phosphodiesterase III inhibitor

e. Milronone

  1. It is a non adrenergic peripheral vasoconstrictor

g. Vasopressin

  1. It has a potent alpha agonist with significant action at beta 1 receptors and a relative absence of beta 2 effects

f. Noradrenaline

  1. It is indicated in the treatment of anaphylaxis

a. Adrenaline


a) 0.1-0.2 mmol/kg

f) 5 mg/kg

b) 1 mmol/kg

g)5 mcg/kg

c) 1 mg/kg

h)10 mcg/kg

d) 2 J/kg

i) 20 mcg/kg

e) 4 J/Kg

Regarding paediatric cardiac arrest match the correct dosing schedule.

  1. Adrenaline

h. 10 mcg/kg

  1. Magnesium

a. 0.1-0.2 mmol/kg

  1. Amiodarone

f. 5 mg/kg

  1. Defibrillation

e. 4 J/Kg

  1. Atropine

i. 20 mcg/kg

  1. Bicarbonate

b. 1 mmol/kg


a) Adrenaline

g) Crystalloids

b) Atropine

h) Lignocaine

c) Amiodarone

i) Magnesium

d) Bicarbonate

j) Potassium

e) Bretylium

k) Lignocaine

f) Calcium

In each of the situations below choose the drug which is most appropriate in that setting.

  1. A 23 year old man with a history of depression presents via ambulance with a GCS of 10, has a generalised tonic clonic seizure followed by brief VF arrest. They have return of circulation after one DC shock. This was the initial ECG.

d. Bicarbonate

  1. A 72 year old woman presents to resus via ambulance having arrested during offload. She has known ischaemic heart disease but is otherwise well. The ambulance was called for a complaint of chest pain. CPR has been commenced and a single shock has been given.

a. Adrenaline

  1. A 1 week old baby presents to resus in extremis with poor perfusion, tachypnoea with recessions. The baby has a prolonged apnoea and you decide to intubate. Post successful intubation the heart rate drops to 50, there is still a palpable pulse

b. Atropine

  1. A 64 year old is in VF arrest, they have had 2 shocks and one dose of adrenaline. You are preparing to give the 3rd shock.

c. Amiodarone


a) 0.05-0.15 mg/kg

f) 5 mg/kg

b) 0.3 mg/kg

g) 0.5 mcg/kg

c) 1 mg/kg

h) 1.5 mcg/kg

d) 2 mg/kg

i) 5 mcg/kg

e) 3-4 mg/kg

j) 10 mg/kg

Match the best dose (or range) with each scenario

  1. Propofol initial dose for procedural sedation for young adult requiring relocation of an elbow

  2. Intranasal fentanyl initial dose for analgesia in a child

  3. Ketamine IM dose for procedural sedation in a child

  4. Midazolam IV dose for anxiolysis and amnesia during a minimally painful procedure


a) Bladder lavage

e) Peritoneal lavage

b) Cardiac bypass

f) Thoracic lavage

c) Forced hot air blanket

g) Warm blanket and removal of wet clothing

d) Gastric lavage

h) Warmed IV fluids

Which single rewarming technique from the list is the most appropriate for the given scenario? All patients have been retrieved to your tertiary ED.

1. A 20 year old university student has consumed 6 beers and has decided to paddle to a nearby island on a lilo. He missed the island and was picked up by a rescue helicopter. Immersion time 60 minutes. Temperature on arrival 35C shivering vigorously.
2. A 34 year old woman was ice skating on a frozen lake in the South Island. She fell through the ice. She was recovered after 30 minutes of submersion. CPR commenced immediately. Temperature 19C. She is asystollic
3. A 58 year old man has overdosed on quetiapine in the bush. He has been in the open for 12 hours. Haemodynamics normal. Drowsy but following commands. Temperature 33C. Not shivering.


a) PO Chloral hydrate

f) Inhaled Nitrous oxide

b) Intranasal Fentanyl

g) IV Propofol with IV Fentanyl

c) IV Ketamine

h) IV Propofol

d) IV Midazolam

i) IV Thiopentone

e) Intranasal Midazolam

j) IV Propofol with nitrous oxide

You are a staff specialist working in a well-staffed tertiary Australasian ED. Choose the best option from the list for each of the following scenarios.

a. Sedation of a 3 year old child with a displaced distal radius greenstick fracture requiring reduction.
2. Sedation of an otherwise well haemodynamically stable 45 year old man requiring DC cardioversion for atrial fibrillation.
3. Sedation for a cooperative 15 year old boy during a lumbar puncture.


a) Bendrofluazide

f) Labetalol

b) Cilazapril

g) Metoprolol

c) Doxazosin

h) Midazolam

d) Frusemide

i) MgSO4

e) GTN

j) Nifedipine

  1. A 48 year old man presents with confusion and is found to be hypertensive 260/130 mmHg. What is the most appropriate agent?

  1. A 76 year old woman presents with severe breathlessness and bilateral crepitations at 0500h. Her blood pressure is 210/110 mmHg. What is the most appropriate agent?

  1. An agitated 21 year old man with needle tracts on his forearms presents with a blood pressure of 200/100 mmHg. What is the most appropriate agent?

  1. A 29 year old woman who is 39/40 pregnant presents with headache, abdominal pain, swollen ankles and altered vision. Her blood pressure is 210/120mmHg. What is the best agent?

  1. A 20 year old woman is 29/40 pregnant and presents in labour. Her blood pressure is 130/90. What is the best agent?


a) Anterior AMI

f) Posterior AMI

b) Inferior AMI

g) Lateral ischaemia

c) High lateral AMI

h) Pericarditis

d) Left main coronary stenosis


Consider 4 previously well middle aged men presenting with severe central chest pain. Each has an ECG taken. Select the most likely diagnosis for each of the following ECGs.

  1. T
    his ECG is most consistent with

d. Left main coronary stenosis

  1. T

    his ECG is most consistent with

h. Pericarditis

  1. T
    his ECG is most consistent with

f. Posterior AMI

  1. T
    his ECG is most consistent with

c. High lateral AMI

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