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SAQ – Three hours. 60 questions, 3 marks each Data interpretation Problem solving skills Clinical scenarios may have data including radiographs, CT scans, ECGs, blood test results and clinical photographs. The pass mark is usually between 68-70% and it is set independently for each diet.
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SAQ – Three hours 60 questions, 3 marks each Data interpretation Problem solving skills Clinical scenarios may have data including radiographs, CT scans, ECGs, blood test results and clinical photographs. The pass mark is usually between 68-70% and it is set independently for each diet.
General advice • Be on time • Check the venue • Listen to the instructions • Read the questions • Read the question to the end • Ask yourself - What’s the question about • Guideline, topic covered what are they getting at?
General advice • Answer only the number of questions • no points for extras • Keep it brief • Bullet points • Links where asked • eg what antibiotic what bacteria • Remember the obvious • analgesia, move to resus, safety netting
SAQ • No trick questions. • Straight forward. • Read the question. • Each question may not be interrelated. • Most SAQ’s are predictable – Rash, toxicology, etc • Even if you don't know the diagnosis – you can still answer some of the questions. • Time is of essence • If you don't know skip and come back later • Every point counts 4
Or heeoe Look at samples on the website under regulations and information:http://www.rcem.ac.uk/docs/Exams/FRCEM%20Final%20Information%20Pack%20(updated%20June%202017).pdf
An 11 year old boy presents with his parents to the ED having developed a limp over the last week. • What is the abnormality on the x-ray? (1 mark) • Name and describe the radiological sign associated with this abnormality? (1 mark) • Name one complication associated with this condition. (1 mark)
A 45 year old lady presents to the ED with a two day history of abdominal pain. Abdominal examination confirms generalised tenderness. • What is the diagnosis? (1 mark) • Name two other symptoms which the patient may complain of? (1 mark) • What would be your first two steps in your early management of this patient? (1 mark)
A 37 year old male is brought to the ED following a house fire. He is GCS 10 and agitated on arrival with a pulse of 120 and BP 105-85. He has sooty deposits around his face and mouth but no burns elsewhere on his body. He appears cyanosed and is receiving 10 L/min of oxygen through a face mask. On oxygen 10 litres: pH 7.15 Na 145 mmol/L PaCO2 6.0 kPa K+ 3.5 mmol/L Pa O2 7.5 kPa Urea 3 mmol/L O2 sats 98% Cl 90 mmol/L
• Calculate the anion gap including your workings (1 mark) • What is the explanation for this result in this patient? (1 mark) • What empirical treatment might you consider? (1 mark) ([Na+]+[K+] ) - ( [Cl-]+[HCO3-] )
A 17 year old male attend the ED complaining of a rash. He describes having a cold sore one week ago followed by the abrupt onset of a rash. The rash started peripherally and spread centrally. He is now unwell, febrile, tachycardic and is complaining of a headache. He also complains of a sore mouth and gritty eyes. He has haematuria on urine dipstick testing. • Describe the key feature of this rash? (1 mark) • What is the likely diagnosis? (1 mark) • What is the most likely infective agent that has precipitated the rash? (1 mark) Note Q 3 may give clue to Q 1 & 2 read to the end
A 60 year old male plumber attends with a painful and swollen right knee. He has been sent to the ED by his boss as he is finding it difficult working. • What is the diagnosis (1) • What is the main complication this patient may develop? (1) • Outline two aspects of your treatment (1)
Revise Read the questions Answer the question asked Summary
Reading • Adult textbook of Emergency Medicine – Toxicology • OHAEM • OHCM • ATLS , ALS, APLS/EPLS • USMLE – Board series prep for Anatomy, Physiology and Biochemistry 19
Useful websites • http://www.collemergencymed.ac.uk • http://www.nice.org.uk/ • http://www.brit-thoracic.org.uk/default.aspx • http://www.das.uk.com/ ( Difficult airway society) • http://www.bashh.org/ ( Sexual health – Chlamydia, Gonorrhoea, etc) • http://www.sign.ac.uk/ • http://www.bcshguidelines.com/index.html (Haematology) • RCOG, Infectious disease society, European society of cardiology, etc 21
Guidelines - NICE • Hip fracture • Epilepsy • Therapeutic Hypothermia • NSTEMI • COPD • Chest pain • Loss of consciousness • Stroke and TIA • Respiratory tract infections • Head Injury • AF • Rapid Tranquilization • Falls • Self harm 22
SIGN • Acute Upper and Lower GI bleed • Suspected bacterial UTI in adults 23
CEM • Sexual assault – statement • Ketamine sedation • Domestic violence • Pain – Adults and Children • Biers Block • First fit – flow chart • Tricyclics poisoning • Allergic reaction • Headache • Safeguarding Children • Antidote 24
BTS • Pneumothorax • Pneumonia • Oxygen • NIV – COPD and respiratory failure • Diving • PE • Chest drain 25
Paediatrics • Meningitis - NICE • Sedation – NICE • Maltreatment – NICE • NAI – NICE • Gastroenteritis – NICE • UTI – NICE • Bronchiolitis – SIGN • Limping child • Discitis • Kawasaki’s • Perthe’s • SUFE • Accidental ingestion 26
Other European Society Haematology • NSTEMI management • Syncope • STEMI • Heart failure • PE • Aortic Dissection • Massive bleeding • Sickle cell crisis – mgt • DVT and D dimer 27
Other Infectious Disease RCOG • Tetanus • Sepsis • Malaria • Septic Arthritis • Meningitis • Maternal collapse • Chicken pox • Rhesus prophylaxis • BASHH • PID • PEP – HIV • Epididymo – orchitis • Viral Hepatitis • Arthritis 28
Exam Prep Resources • www.mcem.org.uk • http://www.mcemcourses.org/ (Bromley) • www.youtube.com – use search terms such as • Bromley MCEM • Medical examination videos • Medical OSCE • www.passmcem.com • http://www.mcemexamprep.co.uk/mcema.php • http://www.mcemexam.com/ 29
http://www.rcem.ac.uk/Training-Exams/Exams/Resources%20for%20exam%20preparationhttp://www.rcem.ac.uk/Training-Exams/Exams/Resources%20for%20exam%20preparation
Regulations and Information Pack FRCEM Intermediate Certificate Examinations Applicable from 1 August 2016 The FRCEM Intermediate Certificate Examinations is conducted in English and candidates are advised that IELTS Level 7 is the expected standard for completion of the FRCEM examinations.
