Week 15: Medicine 5 – Renal/ Metabolic/ Endo2
1. 2011.1 Q6
A 57 year old man with chronic renal failure has been brought to your
emergency department following a syncopal episode posthaemodialysis
Describe your assessment of this patient
(100%)
2. NSW 2010.1 Q7
A fifty-year (50) old with alcoholic cirrhosis has been brought in by
ambulance. He is confused and complaining of abdominal tenderness
when you palpate the abdomen of tense ascites. There are no external
signs of bleeding and he has observations as follows:
Blood pressure 100/40 mmHg
Pulse 110 beats per minute
Sats 98% on Hudson mask
Temperature 35.6oC
GCS E = 4; V = 3; M = 6
Describe your further assessment and risk stratification of this patient.
(100%)
3. NSW 2009.1 Q8
A father brings his fourteen-month (14) old boy to your metropolitan
emergency department. The child has a 2-day history of vomiting and
diarrhea and has been fed on sweetened condensed milk with a vitamin
supplement. On arrival the child’s weight is 9.5kg, systolic blood
pressure 90 mmHg, temperature 35oC (tympanic), respiratory rate 50
breaths per minute and heart rate 140 beats per minute.
Serum electrolytes:
Na+ 160 mmol/l (134 – 146)
K+ 3.6 mmol/l (3.4 – 5.5)
Cl- 60 mmol/l (90 – 110)
HCO3
- 2 mmol/l (22 – 28)
a) List the differential diagnosis. (25%)
b) Describe your management of this infant, including a detailed plan for
fluid resuscitation. (75%)
4. NSW Mock 2008.2 Q5
You are the consultant on duty at a major tertiary hospital that is
receiving patients from a local ‘Fun-run marathon’. A twenty-four (24)
year old male participant has finished the race in four (4) hours and
collapsed at the finish line. He had been taken to the onsite medical area
prior to transfer to your facility.
His pre-hospital observations were –
Pulse 148 bpm
Blood pressure 160/40 mmHg
Respiratory rate 35 per minute
O2 Sats 95% on face-mask oxygen at 6 L/min
GCS 5 / 15 (E=1; V=1; M=3)
Temperature 41.5oC
Glucose 2.7 mmol/L
The medical team at the course have intubated the patient and inserted
two (2) large bore intravenous cannulae and given 1.5 litres of
crystalloid. There are no external signs of trauma.
Describe your assessment of this patient (100%)
5. (Own Q)
A 22 YO woman is brought to your ED by ambulance with an altered conscious state.
She is known to have type 1 Diabetes Mellitus and was recently discharged from your hospital
HDU after an episode of DKA.
Her vital signs are:
GCS 15
HR 124 /min
BP 100/58 mmHg
RR 26 /min
Temperature 37.1 oC
a) Outline the investigations you would perform, and explain their utility, in this patient (50%)
b) Outline the factors you will consider in determining her disposition (50%)
6. (Own Q)
A 45 year old woman presents to your emergency department after seeing her LMO for
palpitations and weight loss (approx. 11kg) over the preceding 7 weeks.
Her LMO performed TFTs and had called her to say she needed to go to the emergency
department her tests had shown her “ thyroid is severely overactive”.
Outline your further assessment (100%)
7. Own A 45 year old man presents after an episode of syncope. History reveals a 6 day
prodrome of weakness, nausea and crampy abdominal pains.
His vital signs are:
BP 105/55 mmHg
HR 105 regular
Afeb
RR 22
O2 Saturation 96 % on air
His Electrolytes are as follows:
Na: 133 (134-140) mmol
K+ 3.0 (3.5-5.0)
Cl- (90-98)
HC03- 18 (20-25)
Mg+ 1.4 (1.2-1.8)
Ca+ 5.5 (1.8-2.2)
PO4 0.8 (0.9-1.1)
Outline your management of this man (100%)
8. 2013. 2 Q8
A 14 year old female presents to your tertiary level Emergency Department two hours following
self-reported overdose of one box (100x500mg) of sodium valproate. She is currently
asymptomatic and is cooperative with your management.
Observations:
P 85 beats/min (regular)
BP 110/65 mmHg
RR 16 /min
SaO2 99 % on air
Afebrile
GCS 15
Describe your management. (100%)