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
12 July 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 34-year-old male patient presents to your emergency centre with a priapism
i) What is the definition of priapism? (2)
ii) Differentiate between low-flow and high-flow priapism. (4)
iii) Write short notes on the emergency centre management of a patient with a low-
flow priapism. (3)
b) A mother brings her 14-year-old son to your emergency centre. He has been
complaining of a sore throat and fever for the past 2 days
i) What is the name of the scoring system used to estimate the probability that the
pharyngitis is likely to be bacterial in origin? (1)
ii) List the components of the scoring system referred to in the question above. (2)
iii) Describe your treatment of a patient with confirmed Group A streptococcal
pharyngitis. (3)
c) Define the following principles of biomedical ethics and give examples as to how these
principles are applied in the emergency centre setting (6)
i) Beneficence.
ii) Non-maleficence.
iii) Social (distributive) justice.
d) A 35-year-old patient has a massive subarachnoid haemorrhage confirmed on CTB. His
GCS is 2T/15. You have ruled out all irreversible causes and have done all the brain
stem tests which have indicated that he is brain dead. Write short notes on the
discussion you will now have with his family. (4)
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2 a) A 50-year-old male patient presents with jaundice. You are concerned he has
ascending cholangitis
i) What signs and symptoms would assist you in confirming this diagnosis? (2)
ii) Write short notes on the emergency centre management of this condition. (5)
b) List 6 complications of acute pancreatitis. (6)
PTO/Page 2 Question 2c)…
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c) You treat a patient with an extensive laceration that needs stitches. You decided that
you will be able to insert the stitches under local anaesthesia in the emergency centre
i) Write short notes on the mechanism of action of lignocaine. (2)
ii) Why is adrenaline occasionally added to lignocaine? (2)
iii) This laceration was sustained in the face. You decided to make use of a
superficial nerve block to locally anaesthetise the face in order to suture the
laceration. Write short notes on a frontal nerve block, with particular attention to
the landmarks for injection, the nerve(s) ideally blocked as well as the area
anaesthetised. (4)
iv) Your patient develops Local Anaesthetic Systemic Toxicity (LAST) after injection
of the local anaesthetic
Give three reasons for development of this complication. (3)
What is the immediate specific treatment as well as dosage/s for circulatory
collapse after the initial principles of resuscitation have been applied? (1)
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3 a) Regarding hypothermia
i) Define mild, moderate and severe hypothermia (3)
ii) What are the types of rewarming techniques? Briefly describe how one would
perform these in the emergency centre. (7)
b) A 7-year-old child is brought in to the emergency centre after he was bitten by a snake
an hour ago. His father identified the snake as a Mozambique spitting cobra. The child
is fully awake, all vitals are normal and he complains of pain on his leg. You notice the
fang marks on his distal foot, as well as the swollen foot and leg up to his midleg
i) What are the indications for giving antivenom in a patient bitten by this type of
snake? (4)
ii) Describe your emergency centre management of this child. Include specific
management as well as dosages for any medication given. (6)
c) Name 5 differential diagnoses that may mimic heat stroke. (5)
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4 a) A 28-year-old male patient is caught up in an attempted hijacking and sustains a single
stab wound to the left chest wall
i) List three goals of emergency centre thoracotomy. (3)
ii) Give 3 important signs of life seen in a trauma patient that have been associated
with increased thoracotomy survival rates. (3)
b) You are working in a rural hospital. A 28-year-old man is carried into the emergency
centre by the local population. He was knocked over while crossing the road on his way
to work. His vitals are: pulse125, BP 80/50, RR 36 bpm, SATS 85% on room air, blood
sugar 5,6mmol, and a GCS 6/15 with blood oozing from his right ear. He is moving all
his limbs. You notice no external wounds or limb deformities
i) List five clinical signs of a base of skull fracture. (5)
ii) What is traumatic mydriasis? Name two common causes. (3)
iii) How would you maintain cerebral perfusion pressure in this patient? (6)
iv) You need to transfer this patient to your referral hospital. Provide 5 differences
between fixed wing and rotor wing modalities of transport when using them to
transfer sick patients. (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
13 July 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 46-year-old man known with alcohol and drug use presents to the emergency centre (EC)
with a history of new onset agitation, aggression, and behavioural changes. According to the
South African Triage Scale (SATS) the patient is triaged as priority Orange and you are
called to urgently assess the patient in the EC. His blood pressure is 132/71 mmHg, heart
rate is 127 beats/minute, oxygen saturation 96% on room air, temperature 38.4C,
respiratory rate 34 breaths/minute
a) Other than substance intoxication, list 5 medical causes that may manifest as violent
behaviour. (5)
b) List five pharmacologic agents (medications) prescribed in the emergency centre that
may cause acute psychosis. (5)
c) Chemical restraint is selected to manage the patient’s acute psychosis
i) Write short notes on the mechanism of action of benzodiazepines. (2)
ii) List 4 major side effects of Haloperidol. (4)
d) Based on collateral history, acetylsalicylic acid (ASA) toxicity is a possible differential
diagnosis in this patient. What would the indications be for haemodialysis in ASA
toxicity? (4)
e) D-lysergic acid diethylamide (LSD) was found in the patient’s possession. Give five life-
threatening effects associated with hallucinogens. (5)
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2 a) A 25-year-old patient who is unbooked presents to the emergency centre in the
advanced stages of labour. The fetal head is delivered, but the anterior shoulder
doesn’t deliver and appears stuck. No amount of gentle traction changes this. You
suspect a shoulder dystocia
i) Define the three stages of labour. (3)
ii) List 2 risk factors for this complication of labour (shoulder dystocia) to develop. (2)
iii) Write short notes on the management of this patient in the emergency centre. (7)
iv) List 2 complications to the fetus following shoulder dystocia. (2)
PTO/Page 2 Question 2b)…
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b) A mother brings her 3-month-old son into the emergency centre with a history of getting
tired when feeding and turning blue after crying
i) Give 3 possible diagnoses that must be considered. (3)
ii) What is the acute management of this infant if he becomes blue in the emergency
centre? (8)
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3 A 60-year-old male patient with a 20 pack year smoking history presents to the emergency
centre with acute onset dyspnoea. A diagnosis of acute exacerbation of chronic obstructive
pulmonary disease (COPD) is made
a) Regarding bronchodilator therapy in COPD, describe your choice of agents and the
mechanism of action of each, as it is used in COPD. (6)
b) What is the role of non-invasive ventilation in COPD? (4)
c) What ventilator principles would apply to invasive mechanical ventilation in this patient?
(5)
d) What is humidified high-flow nasal oxygen therapy (HFNO2)? (3)
e) List 3 conditions in which HFNO2 might be beneficial. (3)
f) Write short notes on how pulse oximetry works and explain the changes that occur
during Methaemoglobinaemia. (4)
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4 a) South Africa is currently experiencing an outbreak of Listeriosis
i) Write short notes on the clinical presentation of patients with possible Listeriosis.
(5)
ii) Describe your treatment in an 18-year-old male with confirmed Listeria
Monocytogenes Meningitis. (2)
b) A 6-year-old child presents in a tripod position, with drooling, stridor and fever
i) What is the diagnosis? (1)
ii) Name 2 of the causative organisms. (2)
iii) What it is the treatment of this condition? (5)
c) List 4 drugs that are not absorbed by activated charcoal? (4)
d) Describe the expected Arterial Blood Gas picture and mention the antidote/s of acute
toxicity with the following agents
i) Methanol. (3)
ii) Cyanide. (3)
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