Environmental Emergencies

Question 1 of 10

A 35 year old male is brought into the Emergency Department after being found in a local park on a winter night. He was surrounded by empty beer cans. His core temperature is recorded as 29°C. His initial ECG is shown below:
Courtesy of WikiSysop [CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons

Courtesy of WikiSysop [CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons


  1. Give three abnormalities seen on this ECG which relate to this patient’s clinical condition. (1 mark)
  2. Give two possible methods of active external warming. that can be performed in ED (1 mark)
  3. Whilst preparing to warm the patient you note that the cardiac monitor now shows asystole. You cannot feel a central pulse. You commence CPR. Give two ways in which emergency drugs are administered differently in a severely hypothermic patient compared to normal ALS protocol. (1 mark)

Paediatrics

Question 2 of 10

A 4 year old child is brought into AED with a sore throat and a generalised red sandpaper-like rash. He has had a fever and a sore throat for the last couple of days, and the rash erupted in the last few hours, initially starting on his chest and spreading to his limbs. You examine his mouth and throat and an image is shown below:
Courtesy of Afag Azizova (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

Courtesy of Afag Azizova (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons


  1. Describe the finding seen in the image. (1 mark)
  2. What is the diagnosis? (1 mark)
  3. What is the causative infective agent? (1 mark)

Orthopaedics

Question 3 of 10

A 40 year old man presents to ED with a painful swollen left knee. He was playing football for his local team when he was tackled to the floor. His knee was painful and immediately became grossly swollen, now to the point where he is having difficulty bending it. An x-ray of his knee is shown below:
Courtesy of James Heilman, MD (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons. Modified by FRCEMSuccess

Courtesy of James Heilman, MD (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons, modified by FRCEMSuccess


  1. What abnormal finding is seen on the x-ray and what injury is most likely the cause of this finding? (2 marks)
  2. Give three indications for x-ray for knee injuries using the Ottawa knee rule. (1 mark)

Anaesthetics & Pain Management

Question 4 of 10

A 67 year old woman presents to the ED following a fall. She describes slipping on an icy pavement. An x-ray has confirmed a dorsally angulated distal radius fracture, your consultant advises you to perform a reduction using a Bier’s block.
  1. What pressure should the double cuff be inflated to? (1 mark)
  2. What is the minimum time the cuff must remain inflated? (1 mark)
  3. What drug must be immediately available when performing a Bier’s block, giving your rationale? (1 mark)

General Surgery

Question 5 of 10

A 75 year old male patient is brought into AED by ambulance with a 2 day history of abdominal pain. His abdomen is clearly distended and tender on palpation. An abdominal X-ray is performed which is shown below:
Courtesy of James Heilman, MD (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons, modified by FRCEMSucces

Courtesy of James Heilman, MD (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons, modified by FRCEMSuccess


  1. What is the diagnosis? (1 mark)
  2. Give two further symptoms that the patient will likely complain of. (1 mark)
  3. Give two possible causes for this diagnosis. (1 mark)

Respiratory

Question 6 of 10

A 20 year old female patient, with known asthma, presents to AED with an asthma attack. She has tried her blue inhaler at home but it has not helped. She is complaining of shortness of breath, chest tightness and wheeze. She is alert and orientated, and clearly short of breath and is not able to speak in full sentences. Her observations are: temperature 36.7°C, BP 115/85, HR 112 bpm, RR 26, sats 91% OA.
  1. Give four drugs (including dose, frequency and route) that you would initially prescribe for this patient. (2 marks)
  2. Give three markers of severity of acute asthma that could be identified on arterial blood gas. (1 mark)

Resuscitation

Question 7 of 10

A 76 year old man is brought into ED by ambulance. The paramedic handover tells you the patient was witnessed to collapse at home and found to be in cardiac arrest. The paramedics have initiated cardiopulmonary resuscitation. The patient has IV access, but has not yet received any drugs. On the rhythm check, the cardiac monitoring shows the following:
Courtesy of Jer5150 (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

Courtesy of Jer5150 (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons


  1. What is the ECG diagnosis? (1 mark)
  2. What two drugs (including dose, timing and frequency) should be given to this patient? (2 marks)

ENT

Question 8 of 10

A 40 year old lady presents to AED with a history of persistent discomfort and foul-smelling discharge in her left ear. She has been treated for otitis externa by her GP and has tried numerous topical antibiotic and steroid ear drops. The hearing in that ear is muffled. On performing Rinne’s test, the patient can hear the tuning fork louder on the mastoid than in front of her left ear. You perform otoscopy and the image is shown below:
Courtesy of Michael Hawke MD (Own work) [CC BY 4.0 (http://creativecommons.org/licenses/by/4.0)], via Wikimedia Commons

Courtesy of Michael Hawke MD (Own work) [CC BY 4.0 (http://creativecommons.org/licenses/by/4.0)], via Wikimedia Commons


  1. What is the primary diagnosis? (1 mark)
  2. What additional finding can you identify on the image? (1 mark)
  3. What finding would you expect if you performed Weber’s test. (1 mark)

Ophthalmology

Question 9 of 10

A 68 year old woman presents to the Emergency Department with a history of sudden painless loss of vision in her left eye. She has recently been diagnosed with atrial fibrillation. Your fundoscopy findings are shown below:
Courtesy of LJames via retinagallery.com

Courtesy of LJames via retinagallery.com


  1. Describe the two most obvious abnormalities seen on fundoscopy. (1 mark)
  2. What is the diagnosis? (1 mark)
  3. Give one pharmacological treatment that can be administered in AED to manage this condition. (1 mark)

Obstetrics & Gynaecology

Question 10 of 10

A 28 year old lady who is 11 weeks pregnant, presents to AED with PV bleeding with large clots which started earlier today associated with cramping lower abdominal pain. On arrival to the department, her observations are stable. Whilst waiting to be seen by the AED doctor, she suddenly develops worsening abdominal pain, increased bleeding and becomes bradycardic (HR 54 bpm) and hypotensive (BP 86/54).
  1. What is the likely complication that has occurred? (1 mark)
  2. How would you diagnose this condition in the AED? (1 mark)
  3. What is the definitive management of this condition? (1 mark)

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