Question 1

A 22-year-old lady attended Accident and Emergency Department for drowsiness and pyrexia. GCS E3V4M5 Blood pressure 138/70mmHg Pulse rate 118beats per minute. Temperature 38.3 degree Celsius. Blood sugar level was 6.5mmol/L. Patient’s mother stated patient was unhappy and took 50 tabs of sertraline.

1. What is the most probable diagnosis?

2. Name 3 important differential diagnoses

3. Name 5 important physical signs to look for

4. What is the diagnostic criteria?

5. Name one physical sign that helps you differentiate from neuroleptic malignant syndrome

6. How do you manage the patient?7.

Question 2

A 59-year-old lady attended Accident and Emergency Department for right foot sprain 2 days ago. She is able to walk at triage station.

1. Name 2 important findings on the X-rays

2. What is the diagnosis?

3. Describe the pathology of the injury

4. Name one pathognomonic physical finding

5. How do you classify the injury?

6. How do you increase sensitivity of plain radiographs?

7. Name one preferred investigation modality

8. How do you dispose the patient?

9. Name 4 complications

Question 3

A 35-year-old ambulanceman attended Accident and Emergency Department for right knee pain. He had sustained right knee contusion during a basketball game 4 weeks ago. Physical examination revealed tenderness over medial side of right knee and decreased range of movement.

1. Describe the X-rays

2. What is the lesion called and what is your diagnosis?

3. How is the lesion formed?

4. What is the management for patients with severe and refractory symptoms?

5. What other important structural injuries are associated?

Question 4

A 70 years old lady attended Accident and Emergency Department for dizziness and palpitation for 1 day. Her blood pressure was 80/40 mmHg, blood sugar level was 5 mmol/L. ECG was then performed.

1. What is the ECG diagnosis?

2. Name 3 causes of such ECG phenomenon

3. If the patient visited a herbalist one day before, what is the most likely cause?

4a .If the patient has history of congestive heart failure and atrial fibrillation and is regularly followed up in out-patient clinic, what is the most likely cause?

4b. What specific treatment can be given for this patient? 4c. Which specific test(s) will you order?

Question 5

A 53 years old gentleman attended Accident and Emergency Department for chest pain. A stranger had just stabbed his chest wall by scissors. On arrival, his blood pressure was 121/80 mmHg, pulse rate was 125 beats per minute. Oxygen saturation was 98% room air. X-rays were taken.

1. What is the most alarming finding in the X-rays?

2. Name 3 other causes of this condition.

3. The patient suddenly became very breathless and his blood pressure became 70/40, pulse rate was 150 beats per minute and oxygen saturation was 82% on 2L of oxygen. His jugular vein was elevated. What is the most likely diagnosis?

4. What immediate treatment can be done for this patient?