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Monash Health Practice Exam 2017 Monash Health Practice Exam 2017

Monash Health Practice Exam 2017 - PowerPoint Presentation

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Uploaded On 2018-01-16

Monash Health Practice Exam 2017 - PPT Presentation

Question 27 Jon Dowling Deputy Director Emergency Services Peninsula Health Deputy Censor Victoria Question 27 A 48 year old woman with shortness of breath for 2 days She has a history of diabetes and depression Her LMO has been treating her for an URTI without improvement ID: 623868

question part questions marks part question marks questions exam timing indication showing pass approaching errors information list complete scored

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Slide1

Monash Health Practice Exam 2017Question 27

Jon Dowling

Deputy Director Emergency Services

Peninsula Health

Deputy Censor VictoriaSlide2

Question 27A 48 year old woman with shortness of breath for 2 days. She has a history of diabetes and depression. Her LMO has been treating her for an URTI without improvement.

On assessment she is awake and oriented. Her vital signs are:

BP 150/90

mmHgHR 120 /min Sats 99% RA Temp 36.8°C Slide3

ABGSlide4

About the examClose to the real thingIndividual markers

No standard setting

Individual marks for questions Slide5

When approaching your resultsBenchmark against your peersDon

t worry about individual questions unless

You are discovering new information. If you are still studying new information then you are not readyDo not underestimate the negative effects of failing the real examSlide6

Question 27Aka – the last question

Deliberately placed

17 marks with a ‘Pass’ mark of 12

17 gettable marks Pretty much done poorly (with a few exceptions)Had this question been Q1 pass rate would have been much higher9/45 ‘pass rate’ = 20%5 scored zero22/45 (50%) scored 8 or underSlide7

Question 27The biggest issue……….

TIMINGSlide8

When approaching these questions…….Place yourself in the moment

What would you do if you had this patient present to your department?

What treatment would be mandatory?Slide9

ABGSlide10

Question 27 part aWhat is the Acid base abnormality

High (expanded, increased) Anion gap metabolic acidosis

Incomplete

resp compensationErrors“Metabolic acidosis”Slide11

Part bComplete the table showing calculations

A-a gradient

(FiO2 – PaCO2/R) – paO2

Delta gapDelta Anion gap/Delta Bicarb0.6Expected KWording of question0.5 increase in K for every 0.1 decrease in pH

1.5

mmol

changeSlide12

Part bComplete the table showing calculations

Corrected Na

Measured Na + (measured Glucose minus normal)/3

ErrorsNot showing calculationsSimple maths errorsPutting wrong qualifying statementSlide13

Part CList three essential treatments including dosages

What is the diagnosis? DKA

Fluid resuscitation

InsulinPotassiumSlide14

Part C Errors

Fluids

Insufficient detail – “Saline 1L stat”

No indication of degree of dehydrationNo titration, no indication of requirement for dextroseInsulinInsufficient detail – “Actrapid”, “Actrapid infusion” with no indication of titration

Lack of appreciation K will fall

AntibioticsSlide15

Part DDecreased LOC. List 3 Ix with justification that should be urgently done

BSL (mandatory)

CT Brain

Plus one other Slide16

Part DErrors

Not checking BSL

Inadequate justification

“EUC – check electrolytes”Slide17

Final Thoughts…..Read the questionPractice your timing

Whole exam practice

Timing, timing, timing

If you spend an extra minute on every question you will miss the last 3 questions (at least)The last 3 questions might be worth 50 marks!Place yourself in the momentDon’t write medical student level answers