SBA Revise 1

A 92-year-old man attends the emergency department complaining that his right shoulder “looks a funny shape”. He says he noticed it this morning. It is not painful but he is having difficulty raising his arm, for example when dressing or eating.

He had a couple of falls “some time ago”, but is unable to give any other history. He lives in a residential home and has no medical history other than an NSTEMI.

On examination, his shoulder appears as shown in the photograph. There is no pain on either palpation or movement of the shoulder. Internal and external rotation are well preserved, but flexion and abduction of the shoulder are limited to about 45 degrees.

On full external rotation of the shoulder, the dislocation appears to reduce, but it dislocates again once the arm is returned to a neutral position.

A x-ray of the right shoulder is performed (shown).

Taking into account the clinical information given, which of the following is the most accurate interpretation of the shoulder x-ray?

A 5-month-old child presents to the Paediatric Emergency Department with inconsolable crying. The crying episodes have become more frequent, which is why her parents decided to attended hospital, as this was very unusual for her. She has not had a fever. She has been passing urine without concern and is breastfeeding well.

On examination, her abdomen is unremarkable and is soft non tender. Mum denies any diarrhoea or vomiting. However, 30 minutes after arrival, you are called to re-examine her. She has pallor, is inconsolable and you can palpate a mass in her right upper quadrant.

What diagnosis are you most concerned with here?

A 2-year-old boy presents with a barking cough, noisy breathing and fever. On examination he has moderate chest wall recessions and intermittent stridor at rest. He is playing with his father and is swallowing his secretions.

His observations are as follows:

Temperature 38.2 oC
Heart rate 140 beats per minute
Respiratory rate 34 breaths per minute
Oxygen Saturations 95% breathing room air.

What is the most likely diagnosis?

A 70-year-old woman attends the Emergency Department with ongoing epistaxis for the last 2 hours. She has a history of pulmonary embolism and taking warfarin. She has been applying direct pressure to her nose for the last 30 minutes, with no improvement.

The examination shows profuse bleeding from both nostrils.

Her observations are:
RR 18, saturations 94% on air
HR – 115 beats per minute
BP – 105/65

You transfer her to the Resuscitation area and obtain iv access.

Which intervention is most likely to rapidly control her epistaxis?

A 43-year-old man presents to the emergency department feeling generally unwell. He has been vomiting. He complains of abdominal pain, dizziness and feels disorientated.

He has a background of Addison’s disease and recently tested positive for Covid-19.

His observations are as follows:
• Temperature: 38.3 degrees Celsius
• Heart rate: 126 beats per minute
• Blood pressure: 78/43 mmHg
• Respiratory rate: 24 breaths per minute
• Oxygen saturations: 95% breathing room air

Which of the following patterns are you most likely to find on his initial blood tests?

A 33-year-old female presented to the Emergency Department with a painful left index finger after been bitten by a pet rat while visiting a friend 4 days ago. The patient has no past medical history and no known drug allergies.

She was seen by her GP on the day of presentation who prescribed a 7-day course of co-amoxiclav. The patient’s pain progressed over the next few hours and now her pain is unbearable.

Vitals: BP 135/80 mmHg, PR 93 bpm, Temp 37.3, RR 16 bpm, O2 Saturation of 96% on air.

Which of the following is a typical clinical finding of the most likely diagnosis?

A 6-year-old child presents to the ED with acute anaphylaxis. Despite initial management with two doses of IM adrenaline 5-minutes apart, and a 10ml/kg fluid bolus, he remains hypotensive.

In anaphylaxis, when setting up a peripheral adrenaline infusion, which concentration should be administered?

A 32-year-old man attends the Emergency Department with a fever and malaise. He gives a 3 day history of fever and malaise and is feeling increasingly unwell. Today he has developed discomfort and redness over the left side of his chest. He has no respiratory, ENT, GI, GU or neurological symptoms.

He has no past medical history and is on no regular medications.

On examination his temperature is 38.2oC, heart rate 115 beats per minute, BP 140/80, RR 14, oxygen saturations 98% on air and pain score 4/10. He has diffuse mild erythema and tenderness over the left anterior chest wall, with no swelling, palpable crepitus or abscess palpable.

Which of the following statements is true regarding his risk of having necrotising fasciitis?

A 6-year-old child presents to the ED with acute onset breathing difficulties, severe wheeze and an urticarial rash after eating peanuts. He is hypotensive and tachycardic at front door triage and you are called to assist.

After requesting to move the child to resus, your first priority at triage is:

A 13-year-old child attends the Paediatric Emergency Department with his mother. Six weeks ago, he tripped whilst playing football at school and injured his left leg but was able to continue playing. Over the last few weeks, mum has noticed he has been limping and complaining of pain in his left knee.

He is tall for his age, having had a recent growth spurt, on the 90th centile for height but the 25th centile for weight. He is well in himself.

What is the most likely diagnosis?