Dip PEC(SA)
THE COLLEGES OF MEDICINE OF SOUTH AFRICA
Incorporated Association not for gain
Reg No 1955/000003/08
Examination for the Diploma in Primary Emergency Care of the
College of Emergency Medicine of South Africa
8 February 2018
Paper 1 (3 hours)
All questions 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 a) A 12-year-old patient presents to your emergency centre having been stung by a
scorpion, identified to be Parabuthus granulatus
i) Write short notes on the pathophysiology of the toxin produced by this scorpion.
(2)
ii) Discuss the management of this patient in the emergency centre. (6)
b) With regards to diving related injuries, describe the pathophysiology of the injuries
below. Use the gas laws, where relevant, to assist in your explanation
i) Barotrauma. (4)
ii) Nitrogen narcosis. (2)
iii) Decompression sickness. (3)
c) Communication is often cited as a challenge during major incidents. Write short notes
on four methods of communication that may be utilised during a major incident and at
least two challenges faced when utilising each of these methods. (8)
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2 a) A 49-year-old male construction worker falls from a 4m height and is transported to your
hospital by emergency medical services. His vital signs are BP 60/40, Pulse 42, Temp
37°C, RR 16. Clinically he has a normal level of consciousness with no visible injuries
and has warm peripheries
i) What is the most likely cause of his hypotension? (1)
ii) Explain the pathophysiology of this condition. (4)
iii) Name 3 drug options together with their doses to treat this condition. (3)
b) With regards to blunt facial trauma describe the following
i) Tripod fracture. (3)
ii) Teardrop sign. (2)
iii) Tongue blade test. (4)
c) Discuss various neuroprotective strategies you would apply in the emergency centre
to treat a patient with severe traumatic brain injury. (8)
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PTO/Page 2 Question 3…
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3 a) A 25-year-old male patient presents to your emergency centre with acute right iliac
fossa pain, anorexia, and vomiting. His vital signs are BP 120/80, Pulse 110, Temp
38.5°C. You suspect acute appendicitis.
i) List other surgical conditions that form part of the differential diagnosis for acute
appendicitis. (5)
ii) The Alvarado scoring system is frequently used in the diagnosis of acute
appendicitis. List the elements that make up this scoring system. (4)
iii) Complete the table below, describing how to elicit the following clinical signs
(3)
Sign Description of how to perform
1 Rovsing’s sign
2 Psoas sign
3 Obturator sign
iv) Discuss the management of the above patient, who is suffering from
uncomplicated appendicitis. (3)
b) A 17-year-old rugby player was taken off the field with suspected concussion after he
knocked his head and lost consciousness during a tackle. He is brought to your
emergency centre
i) Define the following
Concussion. (1)
Secondary brain injury. (1)
ii) Briefly discuss the pathophysiology of raised intracranial pressure in a head injury
patient. (3)
iii) What advice would you give the family and coach of this patient, diagnosed with
concussion, regarding “return to activity guidelines”? (5)
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4 a) A 5-year-old child presents to hospital with an acute abdomen. She is accompanied by
her mother. The surgical team wish to perform an urgent laparotomy. Consent is to be
obtained from the mother
i) Define medical competence. (2)
ii) List the three components of medical competence. (3)
iii) What are the requirements for obtaining legal consent in this patient? (4)
iv) What information should be conveyed when obtaining consent for this procedure?
(4)
v) What is the legal age of consent in South Africa for
Termination of pregnancy? (1)
Medical treatment? (1)
b) Describe the specific mechanism by which the following chemicals cause skin injury
and name the specific treatment
i) Hydrofluoric acid. (5)
ii) Wet cement. (5)
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Dip PEC(SA)
THE COLLEGES OF MEDICINE OF SOUTH AFRICA
Incorporated Association not for gain
Reg No 1955/000003/08
Examination for the Diploma in Primary Emergency Care of the
College of Emergency Medicine of South Africa
9 February 2018
Paper 2 (3 hours)
All questions 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 a) In a patient presenting with urinary tract calculi, what high risk features would mandate
early discussion with a urologist? (5)
b) List the typical clinical and biochemical features of an adrenal insufficiency (Addisonian)
crisis. (5)
c) Outline your management of a patient with an adrenal insufficiency crisis. (5)
d) A 24-year-old woman presents to your emergency centre one week after returning from
a backpacker holiday to Madagascar. She states that she doesn’t feel well, and is
concerned she may have contracted Plague
i) List and briefly describe the three primary clinical syndromes associated with
Plague. (6)
ii) Outline the management of a patient with Plague. (4)
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2 a) A mother brings her 3-year-old child to the emergency centre 30 minutes after he
sustained hot water burns to his torso and lower limbs. The child is hysterical and
screaming in pain
i) Describe your immediate management of this patient. (4)
You ascertain that the young boy has sustained 16% superficial partial thickness burns.
His estimated weight is 15kg
ii) Detail your fluid management for this patient. Include all formulas and calculations
used in your answer. (6)
You elect to give the child ketamine as part of your procedural sedation when scrubbing
his burns
iii) Write short notes on ketamine using the following headings
Routes of administration and corresponding doses.
Mechanism of action.
Adverse effects. (5)
b) Children who present with dehydration almost always qualify for initial rapid rehydration
over four hours. List 5 conditions/situations that would mandate slower rehydration. (5)
PTO/Page 2 Question 2c)…
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c) An 11-month-old boy presents with fast breathing, wheezing and a mild cough,
preceded by three days of what the parents describe as a cold. You suspect
bronchiolitis. What features may indicate a high risk for developing severe disease? (5)
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3 a) A 4-year-old boy accidentally ingests "Mr Muscle" sink and drain cleaner thinking it was
juice in the bottle. He presents to the emergency centre complaining of mouth pain and
you notice excessive drooling. You immediately remember it contains sodium hydroxide
which is a corrosive
i) What is the mechanism of toxicity of corrosive agents? (3)
ii) Which clinical features would you look for, that suggest serious corrosive injury?
(4)
iii) What are the complications of corrosive injury to the gastrointestinal tract? (3)
iv) Describe your approach to the management of this child. (5)
b) A 28-year-old man is brought to the emergency centre after drinking a bottle of
pesticide in a suicide attempt. He presents with diarrhoea, vomiting, increased
secretions, and a depressed level of consciousness
i) What is the most likely diagnosis? (1)
ii) Name the toxidrome. (1)
iii) How would you manage this patient? Include supportive treatment and specific
drug treatment, with dosages. (5)
iv) What are your clinical end points when managing this patient? (3)
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4 a) A 25-year-old female presents with a 2-day history of a cough and fever. Upon arrival,
she is drowsy and confused. Her vital signs are BP 75/40, Pulse 130, Temp 39°C, RR
30. You assess her to be in septic shock
i) Within the first hour of her arrival into the emergency centre, what are your
immediate management principles and priorities? (10)
b) With respect to haemodynamic monitoring in a critically ill patient, define the term fluid
responsiveness. (2)
c) List the “big 5” leading causes of maternal mortality in South Africa, according to the
“Saving Mothers Report”. (5)
d) Briefly outline the difficulties associated with the diagnosis of sepsis during late
pregnancy and labour. (3)
e) Outline the important clinical features of an amniotic fluid embolism. (5)
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