Академический Документы
Профессиональный Документы
Культура Документы
(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)
Al die vrae moet beantwoord word. Elke vraag moet in n aparte boek (of boeke indien meer as een nodig is vir
n vraag) geskryf word
Explain in detail why the patient in the recovery room is at risk of hypoxia after he or she
has been subjected to general anaesthesia.
[100]
Bespreek die redes in detail waarom die pasint in die herstelkamer n risiko loop om
hipoksies te word nadat algemene narkose toegedien is.
[100]
(20)
FCA(SA) Part II
(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)
Al die vrae moet beantwoord word. Elke vraag moet in n aparte boek (of boeke indien meer as een nodig is vir
n vraag) geskryf word
A patient sustains severe blunt abdominal trauma and requires surgery for packing of a
ruptured liver and resection of a ruptured spleen. Discuss your management of blood
transfusion and the patients coagulation system to ensure the best possible outcome.
[100]
n Pasint ondergaan erge abdominale stomptrouma en benodig sjirurgie vir die pak
van n geruptuurde lewer en die reseksie van die geruptuurde milt. Bespreek u
bloedtransfusiehantering en die hantering van die pasint se stollingsisteem om die
beste moontlike uitkoms te verseker.
[100]
(50)
(50)
[100]
(50)
(50)
[100]
You are called to theatre because the registrar suspects that he has inadvertently
injected antibiotic intra-arterially
a) What are the likely clinical features of intra-arterial antibiotic injection?
(25)
b) How do you confirm that intra-arterial injection has occurred?
(25)
c) How should the patient be managed after confirmation of intra-arterial injection? (50)
[100]
U word na die teater geroep omdat die kliniese assistent vermoed dat hy onwetend
antibiotika intra-arteriel ingespuit het
a) Wat is die waarskynlike kliniese tekens van die intra-arterile antibiotika inspuiting?
(25)
b) Hoe bevestig u dat die intra-arterile inspuiting wel plaasgevind het?
(25)
c) Hoe moet die pasint hanteer word na bevestiging van die
intra-arterile
inspuiting?
(50)
[100]
4
FCA(SA) Part II
DATA INTERPRETATION
Question 1 - 20
19 AUGUST 2010
Time: 3 hours
CANDIDATE NUMBER
Question 1/Vraag 1
Using the following data, calculate the dead space.
FiO2 of 0.4
PaCO2 = 7.9
[10]
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Question 2 /Vraag 2
A patient with severe sepsis is bleeding. The INR is 1.9, PTT is 85s, fibrinogen is 25% of
normal, d-dimers and fibrin degradation products significantly raised. The patient is not on
any drugs that can cause abnormal clotting.
n Pasint met ernstige sepsis bloei. Die INR = 1.9, GTT 85s, fibrogeen 25% van normaal, ddimers en fibrogeen-afbraakprodukte betekenisvol verhoog. Hy ontvang geen middels wat die
bloeding kan veroorsaak nie.
a) What is the functional diagnosis?
Wat is die funksionele diagnose?
(2)
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b) Briefly note the options for correction of the clinical bleeding and give reasons for your
choices.
Noem kortliks die opsies vir die korreksie van die kliniese bloeding en gee redes vir u
keuses.
(8)
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[10]
Question 3 /Vraag 3
A patient is mechanically ventilated and the following values were obtained:
Tidal volume
Peak Inspiratory Pressure
Inspiratory flow
457 m
42 cmH2O
95 / minute
PEEP
Plateau Pressure
10 cmH2O
28 cmH2O
[10]
Question 4 /Vraag 4
During revision hip surgery, under general anaesthesia, it is noted that the patients core
temperature is 35C.
Tydens n revisie heupvervangingsoperasie onder algemene narkose merk jy dat die pasint
se kerntemperatuur 35C is.
a) What are the adverse outcomes associated with this body temperature?
Wat is die ongewenste effekte geassosieer met hierdie liggaamstemperatuur?
(5)
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b) How can this patients body temperature be corrected?
Hoe kan hierdie pasint se liggaamstemperatuur gekorrigeer word?
(5)
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[10]
Question 5 /Vraag 5
A 21-year-old woman has been given anaesthesia for an emergency appendicectomy.
Intubation was difficult as the patient was not completely relaxed despite an appropriate dose
of suxamethonium being administered. Ten minutes after induction of anaesthesia it is noted
that her end-tidal CO2 is 60mmHg and her heart rate has increased from 100 to 130 beats per
minute. She was pyrexial pre-operatively and her temperature has not changed.
n 21-jarige dame ontvang narkose vir n noodappendisektomie. Intubasie was moeilik
aangesien die pasint nie volledig verslap was nie, ten spyte van n voldoende dosis
suksametonium. Tien minute na induksie van narkose merk jy op dat haar endgety-CO2
60mmHg is en haar harttempo toegeneem het van 100 tot 130 slae per minuut. Sy was
koorsig preoperatief en haar temperatuur het konstant gebly.
a) What potentially serious anaesthetic complication could be arising in this patient?
Watter potensieel gevaarlike narkosekomplikasie kan besig wees om te ontwikkel in
hierdie pasint?
(1)
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b) What are the other clinical signs of this condition?
Wat is die ander kliniese tekens van die toestand?
(5)
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c) What is the differential diagnosis?
Wat is die differensile diagnose?
(4)
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[10]
Question 6 /Vraag 6
A 40-year-old man is to have surgery for removal of an adrenocortical tumour. Pre-operatively
his blood pressure is 190/120, despite treatment with a -blocker, and his serum potassium
remains at 2,8mmol/l, despite treatment with oral potassium
n 40-jarige man moet geopereer word vir die verwydering van n adrenokortikale tumor.
Preoperatief is sy bloeddruk 190/120, ten spyte van behandeling met n -blokker, en sy
serumkalium bly 2,8 mmol/l ten spyte van behandeling met orale kaliumsupplemente
a) What syndrome should be suspected in this patient?
Watter sindroom moet vermoed word in hierdie pasint?
(1)
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b) How can this diagnosis be confirmed?
Hoe kan die diagnose bevestig word?
(2)
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c) How can his blood pressure be controlled pre-operatively?
Hoe kan sy bloeddruk preoperatief beheer word?
(2)
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d) What are the potential cardiovascular problems that can arise during handling of the
adrenal gland during surgery and how can these be managed?
Wat is die potensile kardiovaskulre probleme wat kan opduik tydens chirurgiese
hantering van die bynier, en hoe kan dit hanteer word?
(5)
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[10]
Question 7 /Vraag 7
Study the following blood gas
Bestudeer the volgende bloedgas
pH
PaCO2
HCO3 BE
K+
ClAnion gap
7,46
8,1kPa (60,75mmHg)
43mmol/l
19,1 mmol/l
1,9 mmol/l
87mmol/l
8,1mmol/l
[10]
Question 8 /Vraag 8
a) Describe the solution into which blood is donated.
Beskryf die oplossing waarin bloed geskenk word.
(4)
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b) How long can blood be stored at 4 degrees Celsius and still be safely transfused?
Hoe lank kan bloed gestoor word teen 4 grade Celsius en nog veilig oorgetap word? (2)
c) List the electrolyte contents of the supernatant fluid in a unit of blood within 2 days of
expiry.
Lys die elektrolietinhoud van die supernatante vog in n eenheid bloed 2 dae vanaf die
vervaldatum.
(4)
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[10]
Question 9 /Vraag 9
Tabulate the differences between starches and gelatins.
Tabuleer die verskille tussen stysel- en gelatienoplossings.
Starch / Stysel
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Gelatin / Gelatien
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[10]
Question 10 /Vraag 10
a) Draw the left ventricular pressure volume loop for a patient with clinically significant mitral
regurgitation.
Teken die linker ventrikulre druk-volumekurwe vir n pasint met klinies betekenisvolle
mitraalreguritasie.
(6)
b) List the reasons for improvement of symptoms of mitral regurgitation during pregnancy.
Lys die redes vir die verbetering van die simptome van mitraalregurgitasie gedurende
swangerskap.
(4)
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10]
Question 11 /Vraag 11
a) Draw the left ventricular pressure volume loop for a patient with clinically significant mitral
stenosis.
Teken die linker ventrikulre druk-volumekurwe vir n pasint met klinies betekenisvolle
mitraalstenose.
(6)
b) List the reasons for worsening of symptoms of mitral stenosis during pregnancy.
Lys die redes vir die verslegting van die simptome van mitraalstenose gedurende
swangerskap.
(4)
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[10]
Question 12 /Vraag 12
a) Draw and label the normal waveform as a pulmonary artery catheter is advanced from the
right atrium to wedged position in a pulmonary artery. Indicate the normal pressures for
each as the catheter is moved.
Teken en benoem die normale golfpatroon soos verkry deur n pulmonale arteriekateter te
ryg vanaf die regter atrium tot in die wigposisie in n pulmonale arterie. Dui die normale
drukke aan soos die kateter beweeg.
(5)
b) Draw the waveforms for the following conditions clearly indicating the differences from the
normal trace in a)
i) Complete Heart Block.
ii) Primary Pulmonary Hypertension.
Teken die golfpatrone vir die onderstaande toestande met duidelike aanduiding van die
afwykings van die normale golfpatroon in a)
i) Totale Hartblok.
ii) Primre Pulmonale Hipertensie.
(5)
[10]
Question 16 /Vraag 16
Answer the following questions regarding ulnar nerve stimulation with a peripheral nerve
stimulator and monitoring the response of the adductor pollicis. Draw annotated diagrams of
the response to the application of a train-of-four (TOF) stimulus during the recovery phase of
a non-depolarising block (a d) and a depolarising block (e) to clearly illustrate the following
Beantwoord die volgende vrae oor ulnare senuweestimulasie met n perifere senustimulator
en monitering van die respons van die adduktor pollicis-spier. Teken geannoteerde
diagramme van die respons met die toediening van n rits-van-vier (TOF) stimulus
gedurende die herstelfase van n nie-depolariserende blok (a d) en n depolariserende blok
(e) om die volgende duidelik te illustreer
a) A top-up dose of muscle relaxant becomes indicated during a laparotomy.
n Aanvullende dosis (top-up) spierverslapper word benodig gedurende n laparotomie.(2)
b) The patient is ready to be reversed with neostigmine.
Die pasint is gereed vir omkering met neostigmien.
(2)
(2)
(2)
e) The patient has developed a phase II block after repeated doses of only suxamethonium.
Die pasint het n fase 2-blok ontwikkel na herhaaldoserings suxamethonium.
(2)
Question 17 /Vraag 17
An obese 68-year-old man is brought by ambulance to the emergency unit following a
collapse at home. He has apparently been unwell and generally tired for several months, but
his condition deteriorated over the last few days. On examination his level of consciousness is
depressed, he has cold peripheries with a blood pressure recorded as 80/40 and is
tachypnoeic. His CXR is shown below
n 68-Jarige man is deur n ambulans na die noodeenheid gebring nadat hy by die huis
gekollabeer het. Hy was waarskynlik vir n paar maande sieklik en algemeen moeg, maar sy
toestand het oor die laaste paar dae versleg. Met ondersoek is sy bewussynsvlak onderdruk,
hy is perifeer koud met n bloeddruk van 80/40 en haal vinnig asem. Sy borskas X-straalfoto
word hieronder vertoon
calculation)? Watter persentasie van sy bloedvolume sou jy skat het hy verloor (wys jou
berekening)?
(2)
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d) What fluid resuscitation will you give and how much?
Watter vogresusitasie sou jy toedien en hoeveel?
(4)
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Question 19 /Vraag 19
Interpret the following findings in the investigation of a patient for possible hyperthyroidism
n Pasint het moontlik hipertireose. Interpreteer die volgende bevindings
a) Normal TSH and T3.
Normale TSH en T3.
(2.5)
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b) Low TSH, high T4.
Lae TSH, ho T4.
(2.5)
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c) High TSH, high T4.
Ho TSH, ho T4.
(2.5)
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d) Low TSH, normal T4.
Lae TSH, normale T4.
(2.5)
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[10]
Question 20 /Vraag 20
Give examples of clinical conditions which may be associated with hyponatraemia in the
following circumstances
Gee voorbeelde van kliniese toestande wat geassosieer mag word met hiponatremie in die
volgende omstandighede
a) Total body water deficit with a large sodium deficit.
Totale liggaamswatertekort met n groot natriumtekort.
(5)
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b) Excess total body water.
Oormatige totale liggaamswater.
(3)
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c) Excess total body sodium with a large total body water excess.
Oormatige totale liggaamsnatrium met n groot totale liggaamswater oormaat.
(2)
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[10]