FACEM VAQ 2006.2 Examiners Report

VISUAL AID QUESTIONS

• 48/57 (84.2%) candidates passed the VAQ section of the exam.
• A candidate has to pass 5 or more of the 8 questions with a total mark of at least 40/80.
• The grade frequencies were:

Question 1

A 78 year old man is brought to your emergency department after being found on the floor of his home. His only past medical history is of congestive cardiac failure, and he is unable to remember his medications. An ECG has been taken.

• ECG showing Mobitz type 2 AV block ( 2:1 ) with RBBB and R axis deviation.
• The overall pass rate for this question was 41/57 (71.9%).
• The examiners felt that this question was not well done by the candidates overall, especially as this was regarded as a straight forward ECG. In order to pass, candidates needed to exhibit a systematic approach to ECG interpretation and identify pass/fail criteria of 2:1 AV Block, Right BBB and Right Axis Deviation plus a number of secondary changes. Better candidates were able to put the ECG findings into the given clinical context.
• Candidates who scored poorly failed to meet the basic pass/fail criteria above.

Question 2

A 47 year old man is brought to the emergency department with fever, throat pain and difficulty swallowing.

• Lateral neck X-ray showing significant pre-vertebral soft tissue swelling.
• The overall pass rate for this question was 55/57 (96.5%).
• The examiners felt that this was a fairly easy question at this level. The diagnosis of a pre-vertebral swelling was straight forward and most candidates recognised this and suggested reasonable diagnostic possibilities. Part (b) required a consultant level discussion of airway management options and antibiotic choices.
• Candidates who failed to score well mostly did so because of a poor discussion of the airway options.

Question 3

A 69 year old woman is sent to your emergency department by her LMO after a one day febrile illness.

• Her chest X-ray reveals lobar pneumonia.
• The overall pass rate for this question was 44/57 (77.2%).
• The examiners felt that this was a very appropriate question however few candidates did very well.
• A number of candidates passed part (a) but failed part (b).
• Pass/fail criteria were based on a descriptive of the severity of the abnormalities, putting forward an adequate interpretation (differential diagnosis) and a reasonable choice of antibiotics.

Question 4

A 30 year old man has had his right leg run over by a car. Resulting in isolated right lower limb injuries. He is in considerable pain. There are open wounds at his right ankle and his right foot is pale.

• X-ray of complex fracture dislocation of ankle.
• Overall pass rate for this question was 48/57 (84.2%)
• The examiners felt this was a good question. Pass/fail resolved around a detailed descriptive of the fractures, plus management of vascular insufficiency of the open wounds, and analgesic/antibiotic issues.

Question 5

An 8 year old boy has been brought to the emergency department with a fever of 38 degrees Celsius and a painful right ear.

• Clinical photograph of unilateral facial swelling and erythema around mastoid region.
• The overall pass rate for this question was 51/57 (89.5%).
• The examiners felt that this was an adequate question but with low discriminating capacity.
• Pass/fail criteria were a detailed description of the involved region and a focused examination related to the possible differential diagnosis.

Question 6

A 70 year old diabetic man presents to the emergency department complaining of painful feet.

• Clinical photograph of diabetic feet showing changes consistent with infection and vascular insufficiency.
• Overall pass rate for this question was 42/57 (73.7%).
• The examiners felt this question was based on an excellent image.
• Pass/fail criteria were recognition of likely vascular insufficiency plus necrotising infection plus likely underlying causes.

Question 7

A 64 year old woman presents with acute chest pain, dyspnoea at rest and palpitations.

• ECG showing paced rhythm.
• Overall pass rate for this question was 40/57 (70.2%).
• The examiners felt this was a challenging question and was an excellent discriminator.
• Pass/fail criteria were a reassured description of paced rhythm and comprehensive approach to hypotension in the setting of paced rhythm.

Question 8

A 15 month old girl is brought to your emergency department by her nanny with burns isolated to the area shown in this photograph. The history is that the toddler accidentally pulled a cup of hot coffee from the bench down on herself.

• Clinical photograph of burns of variable thickness to arm and shoulder of child.
• Overall pass rate for this question was 43/57 (75.4%).
• The examiners were surprised that a fairly straightforward, appropriate burns question was answered poorly by a large number of candidates.
• Pass/fail criteria included an assessment of burns depth and area plus a standard approach to burns management

Related posts: