Question 1

60 years old man was brought in to ED unconscious. Cardiac monitor was attached to the patient
and the rhythm is as above. Picture of asystole on monitor
1. hat is your immediate action to confirm the rhythm !"#ar$s%
Flat line protocol
a. : Check monitor display for sensitivity or "gain"
b. : Check LEAD SELEC
c. : Check po!er to both defibrillator and monitor
d. : Check all connections: devicecables" cablespatient" devicepaddles"
paddlepatient
&. 'fter completing the immediate action as above the EC( rhythm remained the same.
hat is your EC( diagnosis !1#ar$%
Asystole
). Enumerate your immediate actions after confirming the diagnosis. !*#ar$s%
a# Assess for responsiveness
b# Assess air!ay" breathing" circ$lation" %&' !ith man$al res$scitator
c# Chest compression: ventilation ():*
d# Complete + cycles of C: & and re,assess" -& dr$gs of adrenaline and atropine in
bet!een cycle
e# Look for ca$se of asystole ./0s and +0s
Question &
+n one of your night shift in Emergency Department you received a "* year old man,
brought in by the paramedics following a motor vehicle crash in which he was at the front
seat, restrained passenger. -he driver of the car died at the scene.
-he following are the findings during .uic$ primary survey
Picture of car crash
Air!ay: Clear
%reathing: 1espiratory 1ate 211#: *34min" L$ng: e.ual air entry bilaterally
Circ$lation: C1: 5* sec. Pulse /00min, 1P 1200110
Dysf$nction: (lasgow Coma 3core * !E141#)%. 5eft pupils dilated
E6pos$re: 6o other obvious in7uries
1. hat is the triage you should give to this patient base on the above information8
!& #ar$s%
riage 7 21ed#
&. hat is the resuscitation principle in your management of this patient8 !6#ar$s%
a# 8pen air!ay and C spine control
b# 9rovide 86ygenation and ventilation
c# 'aintain good circ$lation,-& access
d# look o$t for severe hemorrhage2open or conceal#
e# e6pose and environment control
f# immediate C 18 brain in:$ry
). 6ame the clinical state that give rise to above vital signs findings !&#ar$s%
C$shing 1efle6
Question )
9/ y.o. lady who is hypertensive and diabetic, was brought in by a relative to the ED. the relative
informed that the patient has been acting :strangely:, not ta$ing her brea$fast this morning and
also having generali;ed wea$ness.
7. 5ist ) component of Cincinnati Prehospital stro$e scale !6 #ar$s%
a. arm drift
b. facial asymmetry
c. sl$rred speech
*. 5ist ) most li$ely differential diagnosis !) #ar$s%
a# /ypoglycemia
b# //S
c# Stroke" C&A
d# Dementia
e# Sepsis
). 6ame one important immediate bed side test that should be done in Emergency
Department for this patient !1 #ar$%
a# ;l$cometer
b# EC;
c# A%;
Question "
#r. 5im <. C, && year old man, presents to the emergency department with severe abdominal
pain after being involved in a motor vehicle accident.
=is 4ital are as follows> =?> 1&/0min, ??> &"0min, 31P> 9/mm=g, (C3> 1*01*, 6o obvious
e@ternal hemorrhage was noted. =is peripheries are cold and peripheries veins are collapsed.
'd7unct to primary survey revealed free fluid in the abdominal cavity via A'3-.
Picture of Pelvic 'P @ ray
1. Describe the @ ray findings. !& #ar$s%
a# Left and lateral p$bic ram$s <
b# 9rotr$sion acetab$l$m4 acetabel$m fract$re
&. 6ame patient clinical state. ! & #ar$s%
a# /ypovolemic shock
). 6ame three sites for insertion of B4 access8 !) #ar$s%
a# Antec$bital fossa
b# Femoral vein
c# -=&
". hat is the reason for choosing the above sites8 !& #ar$s%
a# Collapsed peripheries
b# Aim for large bore vein
*. 6ame & other alternative available if you failed to get B4 access !&#ar$s%
a# -ntraosseo$s 2-8#
b# &eno$s 0c$t do!n0
c# E
6. 6ame ) types of fluids that can be used for fluid resuscitation in trauma !) #ar$s%
a# Crystalloid
b# Colloid
c# %lood
Question *
Picture shown is the commonly used e.uipment in Emergency department
1. 6ame the item ',1,C and D. !&#ar$s%
a. '> E--
b. 1> +P'
c. C> 6P'
d. D> 5#'
&. Describe correct way to insert item 1 !"mar$s%
a. Place the oropharyngeal airway along the outside of the casualty:s 7aw with one
end of the airway at the bottom tip of the casualty:s ear.
b. -he airway should reach from the bottom tip of his ear to the corner of his mouth.
Patient in supine position
c. Place your thumb and inde@ finger of one hand on the casualty:s upper and lower
teeth near a corner of his mouth so the thumb and finger will cross when the
casualty:s mouth is opened.
d. Place the tip end of the airway into the casualty:s mouth. #a$e sure the tip is on
top of the tongue.
e. Point t he tip of t he airway toward t he roof of t he patient: s mout h to
prevent t he tongue from being pushed into t he bac$ of t he throat.
f. 3lide t he airway along t he roof of t he mouth, following t he natural
curvature of t he tongue, past t he soft palate.
g. rotate t he airway 1/0 degrees as t he tip reaches t he bac$ of t he tongue
). Bndication when to use item D !"#ar$s%
a. 3ituations involving a difficult mas$ !14#% fit.
b. #ay be used as a bac$Cup device where endotracheal intubation is not successful.
c. #ay be used as a DsecondClastCditchE airway where a surgical airway is the only
remaining option.
Question 6
E.uipment showed commonly used in Emergency department.
1. hat is the name of the e.uipment shown8 !& #ar$s%
Ad:$stable traction splint4/are traction splint
&. 5ist two of its functions8! " #ar$s%
a. raction
b. immobili>ation
hese !ill red$ce pain and bleeding
). 1riefly describe the principle by which it reduces bleeding in closed fracture. !" #ar$s%
Convert a spherical vol$me into a cylindrical vol$me thereby red$cing the hemorrhage
Question 9
6/ years old lady found unconscious with no breathing and no pulse. <ou are at the scene. <ou
decided to help her. Picture of 'ED
1. 5ist the initial steps of cardio pulmonary resuscitation.
a. Assess responsiveness" if $nresponsive
b. Activate emergency response system
c. Call for the defibrillator
d. %egin primary A%CD s$rvey
i. A: Assess breathing2open air!ay" look" listen" and feel#
ii. %:;ive * slo! breaths
iii. C: assess p$lse" if no p$lse
iv. Start chest compressions
v. Complete + cycles and attached AED !hen available.
&. -he help arrived with above e.uipment. 6ame the above e.uipment
a. 6ame> A$tomatic E6ternal Defibrillator
b. F$nction: An AED is a device $sed to administer an electric shock thro$gh the chest
!all to the heart. A microprocessor inside the defibrillator analy>es the victim0s
heart rhythm thro$gh electrodes attached to the patient?s chest. he defibrillator then
determines !hether or not defibrillation is indicated based on the rhythm the heart is
in. AEDs advise a shock !hen the patient is in &,Fib
). Describe how to operate the above e.uipment
a. S!itch on the on4off b$tton
b. Attached pad to chest and then cable to machine as advised
c. 9ress shock b$tton as advised after AED analy>ed rhythm
Question /
EC( 3-E#B

6)Cyear old man presented with central chest pain of two hours duration. +n e@amination his
blood pressure was 20060 mm =g, he had a wea$ pulse, distended nec$ veins with elevated
7ugular venous pressure, normal first and second heart sounds and lung fields were clear on
auscultation
1. Describe the EC( findings !) #ar$s%
a. S elevation on lead --" ---" a&F"
&. hat is your diagnosis8 !&#ar$s%
a. -nferior '-
). Describe the principle of management in Emergency Department. !* #ar$s%
a. A%CD of res$scitation
b. '8@A
c. hrombolysis
d. 9roper 1eferral4disposition
+3CE 2
"* years old man arrived to Emergency department with chest discomfort and palpitation and
about to faint. <our paramedic immediately pushed this patient to resuscitation room. -he nurse
attached cardiac monitor to this patient and the rhythm as shown.
Picture of 4- rhythm on monitor

1. Describe the EC( above. !) #ar$s%
a. &entric$lar rate 57))4min: typically 7*),*+)4min
b. @o atrial activity seen
c. @one6istent 91
d. A1S comple6: !ide bi>arre" 9&C,like comple6es5).7* sec" large !ave of opposite
polarity from A1S
&. <our diagnosis !& #ar$s%
a. &
). 6ame one important step before you start your treatment to this condition. !& #ar$s%
a. Check for p$lse
4. Fsing a biphasic defibrillator machine available, what is the current dosage recommended.
!)#ar$s%
a. *))=
Question 10
&& years old female came to emergency department with shortness of breathing. +ne of the items
used to assess her condition shown in the picture.
Picture of pea$ flow meter
1. 6ame the e.uipment above. !1 #ar$%
9eak E6piratory Flo! 'eter
&. Describe the techni.ue would you tell the patient before using the above e.uipment.
!6mar$s%
a. Bero the indicator
b. Attach the disposable paper mo$th piece to eC$ipment
c. -nstr$ct her to take the deep breath and e6hale
d. @o! instr$ct her to take deep breath again" hold and p$t eC$ipment to mo$th
e. E6hale as strong and as fast as possible
f. 1epeat three times and gate the average reading.
). 5ist three signs which indicate that she is having a severe attac$. !)#ar$s%
a. Dnable to complete sentences
b. 9F' E(+F
c. Silent chest
d. Cyanosis
e. drop in Sp8*
f. breathing $sing accessory m$scles
Question 11
<ou 7ust about to finish doing A'3- e@amination to your trauma patient, when a &/ years old
single female, arrived with severe lower abdominal pain for the past one day. 6o history of
trauma to her abdomen. 3he also e@perience pain over her shoulder when ta$ing deep breathing.
=er vital> ?espiratory rate &60min, Pulse rate 1100min, 1lood pressure 1100//mm=g, capillary
refill time & sec., -emperature> )9.*
0
C, pain score 2010 and full (C3. 3he is pin$ and not
7aundice.
E@amination to her abdomen revealed soft, not distended abdomen, no tenderness on palpation,
her bowel sound present but sluggish.
1. hat is the triage of this patient8 !& mar$s%
't least -riage &
&. 5ist three, your differential diagnosis. !) #ar$s%
a. 1$pt$red ectopic pregnancy
b. Early Appendicitis
c. D-
d. 9elvic -nflammatory Disease
). 5ist three important .uestions in the history you would li$e to as$ the patient8 !)#ar$s%
a. L@'9
b. Se6$al interco$rse history
c. 9& bleeding" other gynecological symptoms prior to this episodes 18 9-D
d. 9ain f$rther history character" radiation" severity" onset" etc
". -wo bed side test that you would li$e to order8 !& #ar$s%
a. D9
b. Dltraso$nd e6amination.
c. Drine dipstick
Question 1&
1* years boy was brought by his mother to emergency department. =e was stung by an insect
half an hour agoG they managed to $ill the insect and brought it along !shown above%.
-he child appeared flush and uncomfortable.
=is vital> Pulse rate 1))0min, ?espiratory rate )&0min, 3ystolic blood pressure /0mm=g, 3p+&
2/H on air. Picture of bee
1. hat is the name of the insect shown !1#ar$%
1ee
&. hat is your wor$ing diagnosis at this point.!&#ar$s%
'llergic reaction with anaphylactic shoc$
3. 5ist other four clinical features of this conditions that you would li$e to loo$ for!&#ar$s%
a. 3wollen face0periorbital
b. 3tridor
c. Difficulty in breathing
d. ' red rash, with welts, that usually is itchy.
e. 3wollen throat or swollen areas of the body.
f. hee;ing !breathing that sounds li$e whistling from your chest%.
g. 5+C
h. Chest tightness.
i. ' hoarse voice.
7. -rouble swallowing.
$. 4omiting.
l. Diarrhea.
m. 'bdominal cramping.
". Describe the management of this conditions.!*#ar$s%
a. '1CD of resuscitation
b. 'drenalin
c. Piritoin0antihistamine
d. =ydrocortisone
Question 1)
' warehouses and nearby tire factory are on fire. Estimated more than )0 wor$ers were wor$ing
when the li.uid petroleum cylinder tan$ e@ploded. <ou were as$ed to dispatch your Prehospital
team to that scene to help potential survivors.

1. 6ame the principle of Prehospital care emergency management!" mar$s%
a. 3cene si;eCup
b. -riage
c. -reatment
d. -ransport
&. Describe how would you do the scene si;eCup!" #ar$s%
F, =, E, 6, -, ' and # !universal safety precaution, ha;ard, e@tra help, no. of pts,
type of in7ury, accessibility, #echanism +f Bn7ury %
). 5ist four ha;ards you should be loo$ing for in above picture.!& #ar$s%
a. Smoke4particles
b. /eat
c. Collapse b$ilding
d. ;as e6plosion
e. Electrical danger
Question 1"
66 years old patient was brought to emergency department by his son with complain of mild
headache for the past & days. =e was reviewed by an emergency medicine medical officer and
later discharged home with paracetamol for his headache.
-en days later the same patient was brought in unconscious, reviewed and investigation revealed
he had sustained subarachnoid hemorrhage.
-he son was not happy with new findings and wanted to ta$e legal action to previous doctor and
to the hospital, giving reason why the initial doctor didnIt performed early C- scan to his father.
1. Defined negligence.!& mar$s%
-he breach of legal duty to ta$e care which results in damage, undesired by the defendant, to
the plaintiffE C infield
DJ Bt properly connotes the comple@ concept of duty, breach and damage thereby suffered
by the person to whom the duty was owingE
C 5ord right
#edical negligence is concerned with the tort of negligence applied in specific conte@t of the
provision of healthcare
&. 6ame the four elements that must be establish before a claim of medical negligence can
raised
a. D$ty to act
b. %reach of the d$ty
c. 9resence of harm
d. he harm arose from the breach of d$ty
). hat should be done by the initial doctor to avoid claim of negligence in the case
a. ;ood doc$mentation
b. 9roper4appropriate cons$ltation to emergency specialist or to respective team
Question 1*
+bserve the PictureG
1. hat is the ha;ard in shown in this picture8 !& mar$s%
Aloods0 heavy rains0typhoon0monsoon rains
&. hat are the health ris$s8 3tate ) conditions !) mar$s%
ater borne illnesses, drowning, hypothermia !immersion syndrome%, trauma, fractures, head
in7uries, death
). 3tate ) steps to be done after this ha;ard impact to decrease vulnerability of this community
to this ha;ard. !) mar$s%
?ehabilitation, return to normal living, preparedness activities, reCengineering waterways
". 3tate & things a hospital can do to prepare for this ha;ard. !& mar$s%
Develop early warning systems, emergency planning, response drills and e@ercises, rescue
capabilities li$e water rescue, and develop evacuation areas in high place which are not flood
prone