Scenario
An 83 year old woman presents with a three day history of malaise and polyuria. She has a past history of Type 1 Diabetes and Hypertension.
Her observations are:
Question
Describe and interpret her investigations (100%)
Serum biochemistry
Answer
FACEM VAQ Exam 2008.2 – Question 3
- The overall pass rate for this question was 58/81 (71.6%).
- The examiners felt that this was a good question testing core knowledge of metabolic emergencies.
- Good answers identified the primary abnormalities, made appropriate secondary calculations and committed to a diagnosis of DKA with renal failure and hyperkalaemia.
- Failed answers did not undertake secondary calculations and synthesised the abnormalities poorly.
It is of concern to the FEC that one examiner failed candidates if they if they “failed to give calcium and bicarbonate” when the question asked the candidates to “describe and interpret” the biochemistry.
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About the potassium: as this is DKA the adjusted true potassium is likely within normal limits or may even be low.
The exam report is worrying that people were marked down (?failed?!!) for not treating a spurious result.
The examiner seems to be employing dangerous practice in marking and possibly treating patients!
Pretty scary