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Intermediate examination RCEM

Intermediate examination RCEM. Was MCEM B SAQ. Reading. Adult textbook of Emergency Medicine – Toxicology OHAEM OHCM ATLS , ALS, APLS/EPLS USMLE – Board series prep for Anatomy, Physiology and Biochemistry. Useful websites. http://www.collemergencymed.ac.uk http://www.nice.org.uk/

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Intermediate examination RCEM

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  1. Intermediate examination RCEM Was MCEM B SAQ

  2. Reading • Adult textbook of Emergency Medicine – Toxicology • OHAEM • OHCM • ATLS , ALS, APLS/EPLS • USMLE – Board series prep for Anatomy, Physiology and Biochemistry

  3. Useful websites • http://www.collemergencymed.ac.uk • http://www.nice.org.uk/ • http://www.brit-thoracic.org.uk/default.aspx • http://www.das.uk.com/ ( Difficult airway society) • http://www.bashh.org/ ( Sexual health – Chlamydia, Gonorrhoea, etc) • http://www.sign.ac.uk/ • http://www.bcshguidelines.com/index.html (Haematology) • RCOG, Infectious disease society, European society of cardiology, etc

  4. Guidelines - NICE • Hip fracture • Epilepsy • Therapeutic Hypothermia • NSTEMI • COPD • Chest pain • Loss of consciousness • Stroke and TIA • Respiratory tract infections • Head Injury • AF • Rapid Tranquilization • Falls • Self harm

  5. SIGN • Acute Upper and Lower GI bleed • Suspected bacterial UTI in adults

  6. CEM • Sexual assault – statement • Ketamine sedation • Domestic violence • Pain – Adults and Children • Biers Block • First fit – flow chart • Tricyclics poisoning • Allergic reaction • Headache • Safeguarding Children • Antidote

  7. BTS • Pneumothorax • Pneumonia • Oxygen • NIV – COPD and respiratory failure • Diving • PE • Chest drain

  8. Paediatrics • Meningitis - NICE • Sedation – NICE • Maltreatment – NICE • NAI – NICE • Gastroenteritis – NICE • UTI – NICE • Bronchiolitis – SIGN • Limping child • Discitis • Kawasaki’s • Perthe’s • SUFE • Accidental ingestion

  9. Other European Society Haematology Massive bleeding Sickle cell crisis – mgt DVT and D dimer • NSTEMI management • Syncope • STEMI • Heart failure • PE • Aortic Dissection

  10. Other Infectious Disease RCOG Maternal collapse Chicken pox Rhesus prophylaxis BASHH PID PEP – HIV Epididymo – orchitis Viral Hepatitis Arthritis • Tetanus • Sepsis • Malaria • Septic Arthritis • Meningitis

  11. Exam Prep Resources • www.mcem.org.uk • http://www.mcemcourses.org/ (Bromley) • www.youtube.com – use search terms such as • Bromley MCEM • Medical examination videos • Medical OSCE • www.passmcem.com • http://www.mcemexamprep.co.uk/mcema.php • http://www.mcemexam.com/

  12. http://www.rcem.ac.uk/Training-Exams/Exams/Resources%20for%20exam%20preparationhttp://www.rcem.ac.uk/Training-Exams/Exams/Resources%20for%20exam%20preparation

  13. Regulations and Information Pack FRCEM Intermediate Certificate Examinations Applicable from 1 August 2016 The FRCEM Intermediate Certificate Examinations is conducted in English and candidates are advised that IELTS Level 7 is the expected standard for completion of the FRCEM examinations.

  14. Intermediate SAQ (= part B MRCEM) • 60 questions • 3 hours • Data interpretation • Problem solving skills • Clinical scenario and may have clinical data including radiographs, CT scans, ECGs, blood test results and clinical photographs. • The pass mark is ? It is set independently.

  15. Common competences 7Qs

  16. Core presentations 18 Qs

  17. Core presentations 18 Qs continued

  18. Anaesthetic competences 4Qs

  19. Anaesthetic competences 4Qs

  20. ICM in ACCS 2Qs

  21. Acute presentations 6Qs

  22. Paediatric presentations 11Qs

  23. Paediatric presentations 11Qs

  24. Practical procedure 12Qs

  25. Practical procedure 12Qs

  26. Practical procedure 12Qs

  27. General advice • Be on time • Check the venue • Listen to the instructions • Read the questions • Read the question to the end May be some clue in 2nd 3rd part • Stop writing when told People have been disqualified

  28. SAQ intermediate • No trick questions. • Straight forward. • Read the question. • Each question may not be interrelated. • Most SAQ’s are predictable – Rash, toxicology, etc • Even if you don't know the diagnosis – you can still answer some of the questions. • Time is of essence • 3 minutes per Q • If you don't know skip and come back later

  29. An 11 year old boy presents with his parents to the ED having developed a limp over the last week. • What is the abnormality on the x-ray? (1 mark) • Name and describe the radiological sign associated with this abnormality? (1 mark) • Name one complication associated with this condition. (1 mark)

  30. A 45 year old lady presents to the ED with a two day history of abdominal pain. Abdominal examination confirms generalised tenderness. • What is the diagnosis? (1 mark) • Name two other symptoms which the patient may complain of? (1 mark) • What would be your first two steps in your early management of this patient? (1 mark)

  31. A 37 year old male is brought to the ED following a house fire. He is GCS 10 and agitated on arrival with a pulse of 120 and BP 105-85. He has sooty deposits around his face and mouth but no burns elsewhere on his body. He appears cyanosed and is receiving 10 L/min of oxygen through a face mask. On oxygen 10 litres: pH 7.15 Na 145 mmol/L PaCO2 6.0 kPa K+ 3.5 mmol/L Pa O2 7.5 kPa Urea 3 mmol/L O2 sats 98% Cl 90 mmol/L

  32. • Calculate the anion gap including your workings (1 mark) • What is the explanation for this result in this patient? (1 mark) • What empirical treatment might you consider? (1 mark)

  33. A 17 year old male attend the ED complaining of a rash. He describes having a cold sore one week ago followed by the abrupt onset of a rash. The rash started peripherally and spread centrally. He is now unwell, febrile, tachycardic and is complaining of a headache. He also complains of a sore mouth and gritty eyes. He has haematuria on urine dipstick testing. • Describe the key feature of this rash? (1 mark) • What is the likely diagnosis? (1 mark) • What is the most likely infective agent that has precipitated the rash? (1 mark)

  34. A 57 year old man has two hour history of palpitations. On examination he is sweaty and has a BP of 100/50 but denies chest pain or breathlessness. • Name two diagnoses which would explain this ECG picture?(2 marks) • He then drops his BP to 80/60. What treatment is required? (1 mark)

  35. A 60 year old male plumber attends with a painful and swollen right knee. He has been sent to the ED by his boss as he is finding it difficult working. • What is the diagnosis (1) • What is the main complication this patient may develop? (1) • Outline two aspects of your treatment (1)

  36. Paediatrics • A 4 year old boy presents with 2 days diarrhoea, dry cough and fever. His mother says he has been unwell for 0ne month. o/e He is pale, lethargic has a sore mouth, jaundice and a palpable liver and spleen. He has a non blanching rash and obvious palpable cervical lymph nodes. ENT examination is unremarkable. He has no signs of meningism. No PMH and no prior hospital admissions • Temp 39.5 Hb 8.6g/dl • HR 150 WBC 0.6 x 109 / L • Cap refill 3 secs Platelets 58 109 / L • O2 sats 92% on air Neutrophils 0.45 x 109 / L • R 40 • BM 5.2 • Wt 15 kg

  37. Given the clinical scenario and blood results, what is the most likely immediate problem (1 mark). Your SHO requests the following blood tests. Justify each.(1/2 mark each up to 2 marks) Coagulation screen LFTs meningococcal/pneumococcal pcr U & Es

  38. Q 1 Given the clinical scenario and blood results, what is the most likely clinical diagnosis? (1 mark). Septicaemia secondary to bacterial infection with DIC (1 mark) Your SHO requests the following blood tests. Justify each.(1/2 mark each up to 2 marks) • Coagulation screen or DIC screen because of high fever and bruising. • LFTs because of palpable liver and jaundice • meningococcal/pneumococcal pcr because of fever and rash • U & Es to assess renal function

  39. A 16 yr old attends ED with a painful shoulder. She is a known epileptic. She has woken up from sleep with this. She holds her arm against her chest and has very little movement and is in pain. An x-ray has been carried out

  40. Random internet pictures

  41. Q 1 Name the most likely diagnosis? (1 marks) Q 2 What is the most likely reason for the shoulder injury? (1 mark) Q 3. What two questions would you consider relevant in the medical history in this patient? (1 marks)

  42. Q 1 Likely Posterior shoulder dislocation Q 2 What is the most likely reason for the shoulder injury? (1 mark) •  Epileptic seizure while asleep Q 3. What two questions would you consider relevant in the medical history in this patient? (2 marks) • Medication history • Compliance (are you taking your anti-epileptics) • Alcohol history • Seizure history • Previous history of shoulder dislocation

  43. A 62 yr old woman brought to ed by ambulance. She states she has taken 50 cocodamol (8/500) a few days ago. She has not eaten for 48 hours. O/E she is pale and very dehydrated. She is vomiting. Her vital signs are normal apart from HR 108. She is clinically jaundiced. No other findings Na 135 Hb 15.4 K 4.3 WC 14.8 U 9 Plat 255 Cr 276 INR 3.5 Glu 2 Sal < 0.1 ALT 2306 Para < 0.15 Alk P 132 Bili 64 Cor calcium 2.24 Phos 2.14 Bicarb 18

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