2003.2 VAQ 3
A 45 year old female gardener presented with a 5 day history of painful left middle
finger. It is her dominant hand.
Question
a. Describe the photograph.
b. What are the possible complications in this case?
(30%)
(70%)
FACEM VAQ Exam 2003.2 – Question 3
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The overall pass rate for this question was 76 / 82 (92.7%).
A photograph of a blistered finger with a cellulitic hand is shown.
Although examiners liked the picture they found the questions did not allow
them to differentiate candidates’ performance.
They expected that the description would include an assessment of severity and
synthesis of a possible cause.
The management needed to be structured.
Failing candidates wrote very little in part a.
2004.1 VAQ 5
A 25 year old man presents after a two day illness of fever and vomiting. The following
investigations have been performed.
Question
a. Describe and interpret these laboratory findings.
FiO2
pH
PCO2
PO2
HCO3
BE
0.4
7.8
15 mmHg
192 mmHg
23
10.1
(75-100)
(100%)
O2 sat
Na
K
Cl
Urea
Creat
Glu
99.7%
119
2.5
65
10.3
0.187
4.5
(100-110)
(3-8)
(0.07-0.12)
(3.0-7.8)
FACEM VAQ Exam 2004.1 – Question 5
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The overall pass rate for this question was 38 / 69 (55%).
This set of results was seen by the examiners as complex to interpret showing a
triple acid base disturbance with profound metabolic alkalosis, respiratory
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alkalosis and metabolic acidosis associated with an elevated anion gap and
increased Aa gradient.
Examiners expected that at least 2 of the acid base disturbances would have
been detected and that a possible explanation in the context of the clinical setting
(such as salicylate poisoning) would be given.
Those who failed did not appreciate the complexity of the disturbance, stated the
obvious (eg hyponatremia) without interpreting or just regurgitated a list of
causes without linking these to the clinical scenario.
2004.1 VAQ 8
This 65 year old woman with diabetes presented one week after some minor trauma to
her right foot.
Question
a. Describe and interpret the photograph.
b. What further investigations are indicated?
(50%)
(50%)
FACEM VAQ Exam 2004.1 – Question 8
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Overall pass rate for this question was 53 / 69 (76.8%).
An infected, necrotic foot ulcer is shown in the appended photograph.
This question demanded that the candidate not only describe the ulcer shown
but also describe all of the features of the leg and speculate on the likely
diagnosis and important differentials.
Investigations needed to address not just the ulcer itself but also search for
underlying cause and possible complications.
Candidates who failed usually neglected to address some or all of these issues.
2004.2 VAQ 1
A 60 year old man is brought to the emergency department with confusion, fever and
a painful left leg.
Question
a. Describe and interpret the photograph.
b. What further investigations would you perform in this man?
(50%)
(50%)
FACEM VAQ Exam 2004.2 – Question 1
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The overall pass rate for this question was 47 / 64 (73.4%).
A photograph shows an oedematous, discoloured and blistered leg
Examiners expected a description of the leg and then an interpretation which
took in to account the information provided in the stem.
More than one differential needed to be offered. Investigations needed to
consider not just the cause but also associated systemic problems like sepsis and
rhabdomyolitic renal failure.
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Failing answers gave a poor description without any interpretation and simply
listed investigations without any evidence of thought of their application to this
patient.
2006.2 VAQ 5
An 6 year old girl has been brought to the emergency department with a fever of 38
degrees Celsius and a painful right eye.
Question
a. Describe the photograph of this girl.
b. What features would you seek in your
examination?
(30%)
(70%)
FACEM VAQ Exam 2006.2 – Question 5
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The overall pass rate for this question was 51/57 (89.5%).
Clinical photograph of unilateral facial swelling and peri-orbital cellulitis.
The examiners felt that this was an adequate question but with low
discriminating capacity.
Pass/fail criteria were a detailed description of the involved region and a focused
examination related to the possible differential diagnosis.
2006.2 VAQ 3
A 69 year old woman is sent to your emergency department by her LMO after a one
day febrile illness. Her chest X-ray reveals lobar pneumonia. Blood tests are
performed.
His observations are:
HR
BP
Temp
SaO2
120
110/60
38.5
90
/min
mmHg supine
Celcius
%RA
Question
a. Describe and interpret her blood test
(70%)
results.
b. Describe and justify your antibiotic choice. (30%)
Reference
Haemoglobin
WCC
Platelets
Red cell count
Haematocrit
Mean Cell
Volume
Neutrophils
63
0.60
8
1.99
0.18
92
gm/L
x 109/L
x 109/L
x 1012/L
fL
Range
115 – 160
4 – 11
150 – 400
3.80 – 5.80
0.37-0.47
80 – 100
0.38 x 109/L 2.0 – 7.5
FACEM VAQ Exam 2006.2 – Question 3
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The overall pass rate for this question was 44/57 (77.2%).
The examiners felt that this was a very appropriate question however few
candidates did very well.
A number of candidates passed part (a) but failed part (b). Pass/fail criteria were
based on a descriptive of the severity of the abnormalities, putting forward an
adequate interpretation (differential diagnosis) and a reasonable choice of
antibiotics.
2008.2 VAQ 8
A 47 year old man presents to your emergency department with a two day history of a
painful rash on the back of his neck.
Question
a. Describe and interpret his photograph
(70%)
b. List the investigations you would perform (30%)
FACEM VAQ Exam 2008.2 – Question 8
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The overall pass rate for this question was 56/81 (69.1%).
Clinical photograph showing a large area of clustered vesicles with associated
erythema. Rash crosses the midline.
The examiners felt that this was a good question based on a high quality image.
Good answers identified a vesicular rash with a reasonable differential of
causes plus a focussed investigation of these causes.
Failed answers misdiagnosed non vesicular rashes (eg carbuncle).
It appeared that some candidates did not allocate their time as per the question
recommendation leading to inadequate detail in one or other section.
5. A 25 year old man presents after a two day illness of
fever and vomiting. The following investigations have
been performed.
FIO2 0.4
pH 7.80 (7.35-7.45)
PCO2 15mmHg (35-45)
PO2 192mmHg (75-100)
HCO3 23mmHg (22-33)
Base excess 10.1 (-3.0 - +3.0)
O2 sat 99.7% (95-98%)
Na+ 119mmol/L (135-145)
K+ 2.5mmol/L (3.2-4.5)
Cl- 65mmol/L (100-110)
Urea 10.3mmol/L (3.0-8.0)
Creatinine 0.187mmol/L (0.07-0.12)
Glucose 4.5mmol/L (3.0-7.8)
Describe and interpret these laboratory findings. (100%)
1. A 25 year old female presents with fever, 4 weeks after return
from a holiday in Africa.
a) Describe the results shown.
b) List the complications of this illness.
c) What is your initial specific treatment?