Trial SAQ exam: 'trial exam' by Michael Devlin

You are taking part in a trial exam created by Michael Devlin. There are 30 SAQs in this exam (180 minutes).

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This SAQ is worth 26 marks

A 10 year old girl with a known history of asthma presents to your department with marked respiratory distress. She weighs 30kg.

Question 2.
In the table below, compare the differences between six (6) clinical signs for a moderate-to-severe and a life-threatening asthma attack.
(12 marks)

      Clinical Sign in Moderate Asthma Clinical Sign in Life-threatening Asthma
1    
2    
3    
4    
5    
6    



Question 2.
List five (5) initial pharmacological treatments with dose ranges and routes of administration for her life threatening attack.
(5 marks)

      Initial Pharmacological Treatments
1  
2  
3  
4  
5  



Question 1.
Complete the table provided with regard to intubating this patient. (3 marks)

ETT size:                                                                           
Induction agent and dose  
Relaxant agent and dose  



Question 2.
List three (3) causes for hypotension post intubation, and one (1) intervention to treat each of them. (6 marks)

      Causes of hypotension post intubation Intervention
1                                                              
2    
3    



 

This SAQ is worth 26 marks

A 10 year old girl with a known history of asthma presents to your department with marked respiratory distress. She weighs 30kg.

Question 2.
In the table below, compare the differences between six (6) clinical signs for a moderate-to-severe and a life-threatening asthma attack.
(12 marks)

Regarding clinical assessment, candidates who did not perform well, did so as a result of:

  • Listing non clinical aspects e.g. pCO2 values
  • Listing signs which were non-discriminatory e.g. pulsus paradoxus, blood pressure
  • Performing bedside tests which were considered either dangerous or non-discriminatory e.g. Peak flow, FEV1
  • Inability to list the same clinical sign side by side
  • E.g. putting signs of increased work of breathing on one side next to speech. Then putting speech in the box underneath and comparing it to blood pressure
  • Leaving boxes empty.

 



Question 2.
List five (5) initial pharmacological treatments with dose ranges and routes of administration for her life threatening attack.
(5 marks)

  • SalbutamoI via and MDI or spacer was considered to be a fatal error and would score a section score of 0
  • Oral prednisolone, although not a fatal error was considered to be inappropriate
  • Candidates were given a wide range of allowed dosing of medication, and were given positive marks if giving smaller but not dangerous doses than usually recommended. SalbutamoI IV was considered a fatal dose if given at greater than double the usual dose.
  • A common error was that MgSO4 was given in mmol/kg for the mg /kg dose and vice versa.
  • It was also considered inappropriate that candidates considered RSI medication e.g. sux and an induction dose of ketamine as their initial treatment for this patient.


Question 1.
Complete the table provided with regard to intubating this patient. (3 marks)

  • It was considered inappropriate for thiopentone in full induction doses to be used as the sole induction agent as more appropriate and commonly used medication is freely available.
  • A wide range of ETT size was allowed. However, it was considered that an ETT of <5.0 was inappropriate and considered to be dangerous practice and a fatal error. If the sizing was wrong but the working out of the size was correct, the answer was marked as correct. If the size was dangerous and wrong and there was no working, the answer was marked wrong and given a section score of “0.”


Question 2.
List three (3) causes for hypotension post intubation, and one (1) intervention to treat each of them. (6 marks)

The fourth question asked for immediate post intubation complications and their initial management. Hypotension secondary to dehydration or due to RSI medication was considered appropriate, whereas it was unlikely that hypotension during the initial intubation was due to sepsis and showed lack of clinical judgement.

Sputum plugging/ ETT obstruction and hypoxia would not be causes of immediate hypotension following intubation and were marked as incorrect. Treating hypotension secondary to medication and dehydration without giving a fluid bolus was also considered to be incorrect. Answers were also marked as incorrect if generic and without giving doses.