Last 2 Weeks

Question 1

Response to a complaint

Answer 1

Support 
Acknowledge 
Investigate 
Notify / document 
Respond 
Implement 
Communicate 
Evaluate

Question 2

Open Disclosure

Answer 2

Acknowledgement of event 
Expression of regret 
Factual explanation 
Further treatment 
Potential consequences 
Steps taken to manage / prevent recurrence

Question 3

TV ultrasound - visible cardiac activity, CRL and expected BHCG

Answer 3

5.5 weeks, CRL 5 mm, BHCG 1500

Expect gestational sac at 1500

Question 4

Criteria for pregnancy failure

Answer 4

Mean sac diameter > 25 mm and no foetal pole

CRL > 7 mm with no FHR

Question 5

Steps to support impaired colleague

Answer 5

Assure confidentiality 
Relieve of duty 
Support time off 
Seek cause 
Assist with NOK 
APHRA notification 
Notify director 
Documentation

Question 6

Depression screening questions

Answer 6

Mood? 
Sleep?
Activity enjoyment? 
Appetite? 
Concentration? 
Irritable / interpersonal conflict? 
Suicide / self harm?

Question 7

Design of protocol

Answer 7

Plan: research, benchmark, stake holders

Do: draft.

• Indications / Contraindications
• Preparation & supervision
• Description
• Outcome
• Complications

Study: input / feedback from stakeholders
Act: implement
Cycle: follow up and review

Question 8

Disaster Management

Answer 8

Space - clear, allocate
Personelle - retain / call in / roster. Form teams. Brief teams. Other teams - surg / ortho
Equipment
Drugs
Organisation - media, exec, ED leadership, security

Post disaster - stand down, restocking, debriefing

Question 9

Describe when to give epipen

Answer 9

If mild-moderate reaction (swelling of lips/face/eyes, hives, tingling of mouth) - locate epipen. Given antihistamine. Phone emerg contact.

If anaphylaxis:
- swelling of tongue / tightness of throat
- difficulty breathing, wheezing of persistent coughing. Hoarse voice.
- persistent dizziness or collapse (pale and floppy child)
Lie down, give adrenaline. Phone ambulance. Phone emerg contact. Repeat at 5 min.
CPR if not responsive and not breathing normally.

Question 10

Calculate A-a gradient

Answer 10

PAO2 - PaO2
FiO2 (Patm - Pwv) - PaCO2 / 0.8
FiO2 (713) - PaCO2 x 1.25
150 - PaCO2 x 1.25

Normal < age/4 + 4

Question 11

FiO2 2L & 4L min NP

Answer 11

0.28 & 0.36

Question 12

FiO2 6L & 8L HM

Answer 12

0.4 & 0.6

Question 13

FiO2 NRBM 15L min

Answer 13

0.9

Question 14

Warfarin reversal

Answer 14

INR > 1.5 critical bleeding 
Stop warfarin 
IV vitamin K 10 mg 
Prothrombin complex concentrate 50 IU/kg 
FFP 300 mls

Question 15

Rivaroxaban / apixaban reversal

Answer 15

TXA 1g
PCC 50 IU / kg
Andexanet if available

Question 16

Dabigatran reversal

Answer 16

Idarucizumab 5g

TXA 1g

Question 17

VT vs SVT

Answer 17

NW axis
Very broad (>160 msec)
AV dissociation
Capture / fusion beats
Positive or negative concordance precordial leads
RSR’, taller left r wave ear
Brugada sign (onset R to nadir S) > 100 msec
Josephsons sign: notching / slurring near nadir of S
Initial R wave in aVR (Vereckei)

Age > 35, structural or ischaemic heart disease, IHD, FHx SCD.

Question 18

Nexus criteria

Answer 18

Normal alertness 
No intoxication 
No painful distracting injury 
No focal neurological deficit 
No midline tenderness 

Alt: canadian C-spine rule.

Question 19

Metabolic Alkalosis

Answer 19

H+ loss: vomiting, NGT drainage, renal diuretic - frusemide, or bartters synd.
HCO3 inc: citrate, admin HCO3, laxatives, milk alkali
Cushings: adrenal tumour, ectopic ACTH, steroids

Question 20

PDA murmur

Answer 20

continuous, left infraclavicular

Question 21

HCM murmur

Answer 21

midsystolic, inferior left sternal border, increase with valsalva / standing

Question 22

VSD murmur

Answer 22

pan systolic murmur, inferior left sternal border

Question 23

Diastolic murmur

Answer 23

Aortic regurgitation or mitral stenosis

Question 24

Anion gap

Answer 24

Na - Cl + HCO3 = 12 +/-4

Question 25

Corrected Na

Answer 25

Na + (glucose - 5) / 3

Question 26

Delta ratio

Answer 26

``` Increase in AG / Dec in HCO3 AG - 12 / 24 - HCO3 0.4-0.8 = normal + HAGMA 1-2 = pure HAGMA > 2 = HAGMA + resp acidosis / met alkalosis ```

Question 27

Expected HCO3 in respiratory acidosis

Answer 27

Acute = 1, chronic = 4 | For every 10 increase in PaCO2, HCO3 goes up 1 / 4 depending if acute / chronic

Question 28

Expected HCO3 in respiratory alkalosis

Answer 28

Acute = 2, chronic = 5 | For every 10 decrease in PaCO2, HCO3 goes down 2 / 5

Question 29

Urea: creatinine ratio

Answer 29

Urea : Creatinine (divided by 1000) > 100 = prerenal < 40 = renal

Question 30

Metabolic alkalosis, expected CO2

Answer 30

20 + 0.7 x HCO3 (+/- 5)

Question 31

Consent

Answer 31

Informed Specific to procedure / treatment No coersion Have capacity

Question 32

Capacity

Answer 32

Understand facts Weight up consequences Communicate choice

Question 33

Triage in disaster

Answer 33

``` RR, SBP and GCS each aspect given a score of 0-4 Score < 10 - priority 1, resus Score 11 - priority 2, monitored bed Score 12 - priority 3 - observed area ```

Question 34

Phone call for external emergency

Answer 34

``` Major disaster declared? Exact location? Type of incident? Hazards Access No of casualties Emerg services present / needed ```

Question 35

Requirements for transfer

Answer 35

Patient with monitoring Equipment and drugs, anticipation of complications Staff with appropriate skills set Department safe

Question 36

Thrombolysis in CVA

Answer 36

IV tPA/alteplase 0.9mg/kg to 90 mg, 10% initial bolus and then remaining over 60 min

Question 37

Thrombolysis in PE

Answer 37

Massive PE (arrest, SBP < 90 15 min) tPA / Alteplase IV 90 mg over 2 hrs Arrest - 50 mg bolus

Question 38

Thrombolysis in STEMI

Answer 38

Suggestive Hx, ECG diagnosis, Chest pain > 30 min < 12 hrs, no PCI within 90 min Tenecteplase IV 1000 units / kg to 10,000 units.

Question 39

Contraindications to thrombolysis

Answer 39

HTN > 180/110 Active bleeding / coagulopathy / anticoagulation CNS: ICH, CVA, CNS tumour, AVM Major surgery < 1 month GI / GU bleeding < 1 month Life limiting illness: advanced liver disease, dementia

Question 40

DDx right heart strain

Answer 40

``` Pulmonary hypertension Pulmonary embolism Chronic lung disease Mitral stenosis Congenital heart disease (PS or TOF) ARVD ```

Question 41

Signs of PE on ECG

Answer 41

``` Sinus tachycardia Anterior (V1-v3) TWI Right axis deviation Right bundle branch block S wave I Q wave and TWI in III ```

Question 42

Causes of LBBB

Answer 42

``` Ischaemic heart disease Anterior MI HTN Aortic stenosis Cardiomyopathy Myocarditis Hyperkalaemia ```

Question 43

Causes of LAD

Answer 43

``` LAFB LBBB LVH Inferior MI WPW Pacing / VEs ```

Question 44

Causes of RBBB

Answer 44

``` RVH Pulmonary embolism Ischaemic heart disease Congenital heart disease (ASD) Myocarditis Cardiomyopathy ```

Question 45

Causes of RAD

Answer 45

``` LPFB RVH Lateral MI Lung disease / PE VT Hyperkalaemia Sodium channel blockade ```

Question 46

How to give urinary alkalinisation

Answer 46

1-2 mEq/kg Sodium bicarbonate 150 mmol NaHCO3 in 950 mls 5% glucose at 250 mls/hr, add 20 mmol/KCL Target urine pH > 7.5

Question 47

ECG findings in TCA poisoning

Answer 47

``` IVCD - QRS > 100 msec RAD RS Ratio > 0.7 in aVR Sinus tachy (muscarinic) Prolonged QT ```

Question 48

Causes of high osmolar gap

Answer 48

``` Tox -ethanol, ethylene glycol, methanol - polypropylene glycol - mannitol Non-tox - ketoacidosis - alcoholic, DKA - renal failure - hyperlipidaemia and hyperproteinaemia - Severe lactic acidosis, trauma, burns ```

Question 49

Examination elements in cerebellar disease

Answer 49

Vital signs - fever, hypotension Speech - staccato, slurred Gait - wide based, ataxia. normal rhombergs. CnNv - associated abn, nygstagmus, ophthalmoplegia, RAPD, facial weakness Limb neuro - hypotonia, cooridnation - disdiadochokinesis, intention tremor, pendular reflexes Ear - HZV lesions Eye - papilloedema CVS - PR & rhythm, postural hypotension, murmurs, carotid bruits, pulses Disdiadochokinesis, Ataxia, Nystagmus, Intention tremor, Slurred/staccato speech, Hypotonia

Question 50

Examination elements in vertigo

Answer 50

Vital signs Speech - slurred / staccato Gait - ataxia, normal rhombergs Nystagmus Head impulse Test of skew CnNv - specifically opthalmoplegia, RAPD, facial weakness, hearing loss PNS - hypotonia, coordination - disdiadochokinesis / intention tremor, pendular reflexes Ear - obstruction canal, cholesteatoma, HZV CVS - postural BP, HR and rhythm, pulses, murmurs, carotid bruits BPPV - dix hallpike / epley

Question 51

Causes of complete heart block

Answer 51

AMI - inferior / anterior Hyperkalaemia Drug toxicity - ca / b-blocker Inflammatory - myocarditis, rheumatic fever Infiltrative - sarcoid, haemochromatosis Autoimmune - SLE Idiopathic fibrosis