FCEM(SA) Part I THE COLLEGES OF MEDICINE OF SOUTH AFRICA Incorporated Association not for gain Reg No 1955/000003/08 Part

I Examination for the Fellowship of the College of Emergency Medicine of South Africa 26 August 2013 Paper 1 (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)

a) b) c) d)

Write short notes on the effects of beta-blockers with reference to its main indications. (8) Discuss Virchow's Triad with regards to hypercoagulability. (7) Write a short description of the nerve supply of the hand. (5) Draw a sketch to show the events at the neuromuscular junction that lead to an action potential in the muscle fibre plasma membrane. (5) [25] With the aid of a diagram show the control of glucocorticoid production in the human body. Label areas of the body and the hormones involved. (4) Discuss the effects of adrenaline and noradrenaline on the circulatory system, once released by the adrenal medulla. (6) Using a table, compare hydrocortisone, prednisone and dexamethasone with regards to sodium-retaining potency, anti-inflammatory potency, half-life and comparative doses. (6) i) Write short notes on the blood supply to and from the liver. (3) ii) Describe the structures which make up the pelvic outlet. (3) iii) Name the anatomical relations to the spleen. (3) [25]

a) b) c)

d)

A patient presents to the Emergency Department with epistaxis a) Name the arteries that supply the nasal cavity. b) Draw a flow diagram of the clotting cascade. c) Name the clotting factors found in Haemosolvex. d) Discuss the pharmacology of tranexamic acid. e) Tabulate the electrolyte contents of the following intravenous solutions i) Ringers lactate. ii) 0.9% normal saline. iii) 5% hypertonic saline.

(5) (10) (1) (4)

(5) [25]

PTO/Page 2 Question 4

-24 A 2-year-old child diagnosed with multilobar pneumonia is brought to the Emergency Department in severe respiratory distress a) Discuss the pathophysiology of hypoxaemia. (8) b) Draw the oxyhaemoglobin dissociation curve and discuss the factors that influence oxygen delivery to the tissues. (8) c) Discuss the anatomical and physiological differences between the adult and paediatric airway. (9) [25]

FCEM(SA) Part I THE COLLEGES OF MEDICINE OF SOUTH AFRICA Incorporated Association not for gain Reg No 1955/000003/08 Part I Examination for the Fellowship of the College of Emergency Medicine of South Africa 27 August 2013 Paper 2 (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)

1.1

a) b) c) a) b)

Name the two major actions of digitalis. Name the contra-indications for the use of digitalis. Name the factors that predispose to digitalis toxicity. Write short notes on the actions of aldosterone. Describe the actions of parathyroid hormone.

(2) (5) (3) (5) (5) (5) [25]

1.2

1.3

Name the muscles that move the eyeball, including their nerve supply.

2.1

Write short notes on the following drugs with regards to i) Mechanism of action. ii) Indications. iii) Preparation and dose of drug. iv) Side-effects. a) Lignocaine. b) Rocuronium. c) Midazolam. a) b) Explain the mechanism of referred pain and give a typical example. Explain the mechanism of visceral pain and give a typical example.

(4) (4) (4) (3) (3) (7) [25]

2.2

2.3

Describe the anatomical pathway of the vagus nerve.

A 25-year-old male patient known to have sickle cell disease presents to the Emergency Department with priapism a) Draw the anatomy of a cross section through the mid-shaft of the penis. (8) b) Discuss the pathophysiology of sickle cell disease. (8) c) List 4 causes of priapism besides sickle cell disease. (4) d) Write short notes on the pharmacology of adrenaline and phenylephrine in the treatment of priapism. (5) [25] PTO/Page 2 Question 4

-24 A 60-year-old patient presents to the Emergency Department in cardiogenic shock and is diagnosed with an inferior myocardial infarct a) Describe the coronary artery anatomy of the heart, including the structures supplied. (10) b) Illustrate and describe the conducting system of the heart. (5) c) Discuss the pathophysiology of cardiogenic shock. (6) d) Outline the pathophysiological processes behind the production of lactate. (4) [25]