FCEM(SA) Part I

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Incorporated Association not for gain Reg No 1955/000003/08

Part l Examination for the Fellowship of the College of Emergency Medicine of South Africa 27 March 2012 Paper 1 (3 hours)

All questions are to be answered. Each question to be answered in a separate book (or books if more than one is required for the one answer)

a)

b) c)

A 2-year-old child is brought in to the emergency department with the history that he swallowed a R2 coin a few hours ago. Describe the functional constrictions of the oesophagus which may be of importance in this patient.(6) Write short notes on how drug pharmacokinetics differ in the elderly compared with a younger adult population. (6) In a patient with diabetic ketoacidosis write notes on the pathophysiology of i) Alteration in level of hydration. (3) ii) Acid-base disturbance. (5) iii) Changes in potassium homeostasis. (5) [25]

A 44-year-old lady comes into your emergency department with a sudden onset of palpitations which has been going on for 2 hours. She has a heart rate of 170 per minute. She is haemodynamically stable a) Discuss the physiology of the Valsalva manoeuvre as it might be used for this patient. (6) b) What is the carotid sinus? Describe the position and the landmarks of the carotid sinus. (5) c) Write short notes on the carotid body including what stimulates it and what is the result of its stimulation. (4) d) Discuss the use of amiodarone under the following headings i) Indications. ii) Mechanism of action. iii) Precautions and contraindications. iv) Dosages and preparation. (10) [25] A man is brought into your emergency department on a winters day and is found to be hypothermic a) Write short notes on the mechanisms of heat loss. (8) b) Write short notes on the pathophysiology of malignant hyperthermia. (7) c) List 2 medications which may trigger malignant hyperthermia in the emergency department. (2) d) Describe the ocular muscles responsible for eye movement in terms of their actions and innervation. (8) [25] PTO/ Page 2 Question 4...

-24 A 60-year-old male patient presents to the emergency department complaining of shoulder pain of some months duration. You suspect a degenerative rotator cuff injury a) Write short notes on the muscles that make up the rotator cuff under the following headings: name, innervation, action, and how their function can be tested on clinical examination. (9) b) Write short notes on the pathophysiology of referred pain and include four examples to assist your answer. (8) c) You decide to prescribe a non-steroidal anti-inflammatory drug as part of your analgesic strategy. Write short notes on ibuprofen and celecoxib using the following headings i) Mechanism of action. ii) Dosages. iii) Side-effects. iv) Precautions. (8) [25]

FCEM(SA) Part I

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Incorporated Association not for gain Reg No 1955/000003/08

Part I Examination for the Fellowship of the College of Emergency Medicine of South Africa 28 March 2012 Paper 2 (3 hours)

All questions are to be answered. Each question to be answered in a separate book (or books if more than one is required for the one answer)

a) b) c) d)

Write short notes on the control of respiration and the response to hypoxia and hypercapnoea in an adult patient. (10) Write short notes on the pathophysiology of the Brown-Sequard syndrome. (5) List the named branches of the external carotid artery. (5) Write short notes on tramadol with respect to i) The mechanism of action. ii) Indications. iii) Dosages. (5) [25]

A 54-year-old male is brought into your emergency department by his family with sudden onset of right sided weakness of the arm and leg which started an hour before. He also has difficulty talking with right facial droop. His BP is 190/110. a) Describe the major arterial blood supply of the brain. (8) b) What fibrinolytic drug may be indicated? (1) c) Describe the dose, indications, mechanism of action and pharmacokinetics of labetalol as it may be used in this patient. (8) d) Describe the main factors influencing the regulation of cerebral blood flow. (8) [25] An elderly man is brought into the emergency department complaining of chest pain. a) Draw and label the action potential of a cardiac cell. (4) b) Tabulate the categories of the Singh Vaughn-Williams classification of antiarrhythmic drugs and give an example in each category. (9) c) With the aid of a diagram, write short notes on the arterial supply of the heart. (8) d) Write short notes on the pathology of coronary plaque progression in acute coronary syndromes. (4) [25]

PTO/ Page 2 Question 4 a)...

-24 While on duty in the emergency department you see a patient with a severe crushing wound of his right hand and wrist. a) You decide to provide analgesia using a forearm ultrasound nerve block (FUN block). Draw a cross-sectional diagram of the right mid-forearm illustrating the important relations (adjacent structures) of the radial, ulnar and median nerves. (8) b) Write short notes on the pathophysiology of the reperfusion syndrome and myoglobinaemia / myoglobinuria. (8) c) Tabulate the difference between Normal saline 0.9%, Ringers Lactate and 5% dextrose water using the following headings i) pH. ii) Osmolarity. iii) Electrolyte content. (9) [25]