HO CME 1

A patient in c5 informed you she was breathless. She could tell you that her chest felt tight and you heard no wheeze/stridor. Which of the following is the most correct statement?

• Her airway is most likely obstructed

• You should scoop the mouth to make sure no foreign body

• Airway is intact, move on to breathing assessment

• She needs a full clerking and full set of bloods with CXR

You moved on to assess her breathing. Which of the following is NOT part of breathing assessment?

• Saturation

• Bedside Swallowing Test

• Respiratory Rate

• Chest Examination

Her Spo2 is 92% under RA. RR is 30. What should you do next?

• Move on to circulation assessment

• Order a CXR

• >90% is acceptable range

• Put the patient on face mask oxygen

After you put her on FM 5L/min, her Spo2 improved to 98% and appeared less tachypnoiec. You quickly auscultated the lungs and noted bilateral fine inspiratory crackles up to mid zones. Which of the following is the least likely diagnosis?

• Acute Pulmonary Oedema

• Inferior MI with RV involvement

• Pulmonary Fibrosis

• Fluid overload with worsening AKI

You proceeded to circulation assessment. Her BP was noted to be 220/140mmHg. Which of the following is wrong?

• Start IVI Norad

• Give IV lasix 40mg stat

• T amlodipine 10mg stat

• Start IVI GTN

Your MO attended the case and stabilised the patient. However, after 1hour, the staff nurse informed that the patient is not responsive. What is your next step?

• Ask SN to inform back MO

• Order a CT brain

• Start CPR

• Re-assess the airway, breathing, circulation

After your assessment, you noticed her GCS is now E2V2M5. Which of the following management is incorrect?

• Check her reflo

• Request urgent CT brain

• Empirically give aspirin 300mg stat to treat for stroke

• Check the pupils

Her reflo was 5.8. Pupils were unequal. BP is now 180/100 after T amlodipine. What is your top differential diagnosis?

• Acute Upper GI Bleed

• Hypertensive Urgency

• Meningitis

• Intracerebral haemorrhage

The patient now is able to open her eyes, though looking lethargy. She is unable to talk or make any noise nor response to command. Her hands try to push you away when you exert pain on her. What is her GCS?

• E4V1M4

• E3V2M5

• E4V1M5

• E3V2M6

What is the new 'DEFG' in the ABC assessment?

• Don't ever forget glucose!

• Don't ever forget gait!

• Don't ever forget GERD!

• Don't ever forget gonorrhoea!