SAQ 1
A 60-year-old male presents with one hour of anterior epistaxis. He has a history of HTN and AF, for which he is on warfarin. His observations are: BP 110/60, HR 60, Afebrile, Sats 98% RA.
- List five immediate steps in your management of this patient.
- Simple pressure fails to control his bleeding and you have already suctioned all visible clots. List three more invasive options to control his bleeding directly.
- His bleeding persists despite these efforts and ENT input is requested. They are travelling from another hospital, and request reversal of his warfarin in the interim. What drugs and doses will you administer to achieve reversal?
- How does complete reversal of his warfarin affect his annual risk of stroke, assuming he has no other medical issues and his AF is chronic?
SAQ 2
A 4-year-old boy presents with a peanut up his left nostril.
- Give four methods for removing the peanut in ED.
- After removing the peanut, you notice the child is hypotensive, floppy, and has a widespread urticarial rash. You diagnose anaphylaxis and decide to intubate the child. Complete the following table with appropriate values.
| Factor | Value |
| Estimated weight of child | |
| Size(s) of ETT | |
| Induction – sedation | |
| Induction – paralysis | |
| Fluid bolus | |
| Adrenaline dose (IM) |
SAQ 3
A 45-year-old male is brought into ED by ambulance after attempting to hand himself with a belt in his bedroom. On arrival, he is GCS 7.
- Briefly describe the different mechanism of death in judicial vs non-judicial hanging.
Judicial:
Non-judicial: - Give five anticipated complications of hanging in this patient.
- List five symptoms/signs that predict a poor outcome in hanging victims.
SAQ 4
A 58 year old female presents to your rural ED with 5 days of sore throat and progressive dysphagia. Examination shows she is febrile, with stridor at rest. Oropharyngeal examination is unremarkable.
- Give 4 differential diagnoses for her symptoms
- A lateral neck X ray is obtained. List 3 findings (positive or negative) on this x-ray and suggest the most likely diagnosis.
- Give four management options for this patient with doses where appropriate.
SAQ 5
A 25-year-old male presents with facial pain following an alleged assault on Saturday night (see image).
- List four features on this image that suggest a fracture involving the zygomatic bone or zygomatico-maxillary complex.
- List four other clinical findings that would suggest this injury.
- What features on examination mandate urgent operative management of this fracture?
- After surgical review, the patient is discharged with operative management in 5 days time. What advice will you give the patient on discharge?
- The following day, the patient returns with increased pain and decreased acuity (image).
- What is the diagnosis?
- Briefly describe the steps involved in lateral canthotomy.
