Scenario
An 80 year old man presents with pain in his right axilla and arm four days after the elective insertion of a permanent pacemaker.
Question
Describe and interpret her photograph (100%)
Answer
FACEM VAQ Exam 2008.1 – Question 6
- Clinical photograph of a bruised and swollen right upper arm plus subcutaneous pacemaker box swelling in pectoral region.
- The overall pass rate for this question was 47/62 (75.8%).
- This was thought to be an excellent question by the two examiners.
- A satisfactory answer required identification of the old bruising around the PPM box surgical site plus description of the separate upper arm swelling and bruising.
- Interpretation included possibilities of subclavian/axillary vein thrombosis, infection, arterial injury and haemorrhage.
- Poor answers failed to identify the swollen upper arm or put forward a poor differential diagnosis.
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