FACEM Fellowship Exam 2009.1 VAQ

The team at Life in the Fast Lane are developing a FACEM Fellowship examination assistance package. In the first instance we will be describing the Fellowship curriculum; reviewing the recommended reading and providing annotated examples of past Visual Aid Questions [VAQ].

Each year there are two sittings of the Fellowship examination. Here is the 2009.1 VAQ examination with suggested high quality clinical images. These images can magnified for review in a separate browser or downloaded to print as a mock examination. The VAQ examination takes place over 1 hour (60 minutes) which allows 7.5 minutes to answer each of the questions….Good Luck!

Question 1

A 72 year old woman is brought to your Emergency Department after a syncopal episode.

a.	Describe and interpret her ECG	(50%)
b.	Outline your disposition considerations	(50%)

Question 2

A previously well 23 year old man is brought to your Emergency Department acutely short of breath after developing left sided chest pain at work. On arrival, he appeared pale and sweaty and was hypotensive. A CXR was taken immediately after a procedure was performed to stabilise his condition. His vital signs are now normal.

a.	Describe and interpret his CXR	(30%)
b.	Outline your treatment options	(70%)

Chest Trauma

Question 3

An 86 year old woman is brought to your Emergency Department from her nursing home with two days of drowsiness and decreased oral intake.

Describe and interpret her investigations

(100%)

Haematology and biochemical results

			Reference Range
Haemoglobin	129	gm/L	115-160
WCC	15.3	x 10⁹/L	4-11
Platelets	221	x 10⁹/L	150-400
Neutrophils	11.5	x 10⁹/L	2.0-7.5

Na⁺	138	mmol/L	134-146
K⁺	5.4	mmol/L	3.4-5.0
Cl^-	94	mmol/L	98-106
HCO₃^-	24	mmol/L	22-32
Urea	25.8	mmol/L	3-8
Creatinine	352	mmol/L	45-90
Glucose	7.4	mmol/L	3.5-5.5

Total Protein	72	g/L	60-80
Albumin	15	g/L	35-50
Globulins	57	g/L	23-35
Total Bilirubin	146	μmol/L	<20
ALT	38	U/L	<35
ALP	2590	U/L	35-135
GGT	1020	U/L	<40

Question 4

This 25 year old man has been brought in to your Emergency Department after he crashed into a fence on his motorcycle. He did not sustain loss of consciousness, but has left sided chest pain and laboured breathing.

His observations are:

HR	110	/min
HR	100/70	mmHg supine
RR	28	/min
GCS	15

Describe and interpret his photograph

(30%)

Your secondary survey does not reveal any other injury

List your immediate management priorities

(70%)

Chest Trauma Photo

Question 5

A previously well 2 year old boy is brought to your Emergency Department by his mother after he ingested 1.8 g of liquid Paracetamol at 0700 that morning. Serum biochemical investigations were performed four hours after the ingestion; it is now 1200. He is asymptomatic with normal vital signs.