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Q 1

A 38 year old injecting drug user presents complaining of dyspnoea and lassitude. He also has left sided neck pain.

His vital signs are: HR 110 /min

BP 90/45 mmHg

RR 28 /min

Sats 99% RA

Temp 39.6 oC

(a) What specific features will you enquire about on history to assess this man’s airway? (3 marks)
(b) A routine chest xray is performed, and is shown. What does it show? (2 marks)


(c) The patient has a CT of the neck performed, and an image is shown.
Give 2 major abnormalities, and the likely diagnosis. (3 marks)
(d)Give 2 actions you will take to manage this patient.(2 marks)


Q 2

A 28 year old male presents to your department after being run over by a motorcycle whilst participating in motocross. The motorcycle ran directly over the patient’s abdomen, and he has tyre marks and a large bruise in the left hypochondrium.

The patient’s initial vital signs are:

HR 105 /min

BP 104/68 mmHg

RR 19 /min

Sats 99% RA

T 36.8 oC

(a) The junior surgical registrar who has attended your trauma call asks you to perform a FAST scan “to exclude abdominal injury”. What is the role of FAST scanning in this patient?(3 marks)
(b)A CT scan of the patient’s abdomen is shown. What abnormalities does it show? (2 marks)
(c) The patient’s blood pressure drops on return from CT to 65/-, and the HR increases to 120/min. The patient has already had 2 units of packed red cells in the CT scanning room. There are no other injuries discovered on the CT scan. (3 marks)
(d) What are your haemodynamic endpoints for these treatments? (2 marks)




Q 3

A 50 year old woman presents after a domestic altercation. Her partner has stabbed her in the left side of the neck with a kitchen knife.
(a)What are the anatomic boundaries of the zones of the neck? (3 marks)



(b)The stab wound is anterior to the left sternocleidomastoid muscle and above the cricoid cartilage. What are the major vascular structures at risk here? (1 mark)



(c)Give 4 features on examination would indicate injury to one of these two structures. (2 marks)



(d)What are the underlying principles of the “no zone” approach to neck trauma? (4 marks)


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