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Royal New Zealand College of Urgent Care

(RNZCUC)

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ABOUT URGENT CARE
FELLOWSHIP OR TRAINING PATHWAYS
COMPLETING THE TRAINING PROGRAMME
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CLINICS AND TRAINING FACILITIES
- Accredited urgent care clinics
- Approved Training Facilities
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General medical quiz

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General medical quiz

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Read the following case and answer the questions that follow.

A 66-year-old woman presents to the A&M Clinic with chief complaint of “heart racing, chest pain, and shaking for the past 3-4 days”. She has been unable to sleep for days and generally feels unwell with diffuse body aches. She does not have a regular doctor and frequents multiple A&M’s for her medical care. She tells you she has a history of anxiety, depression, chronic back pain, and sciatica but cannot recall the names of any of her medications that she takes for these conditions. She has 3-4 alcoholic drinks 1-2 times a week. She states she drank a glass of wine earlier today to “calm my nerves.” Upon further questioning, she states that she ran out of her prescription medications 1 week ago.

Vital signs show tachycardia (115 beats per minute), mildly elevated blood pressure (135/85), tachypnoea (23 respirations per minute), with normal oxygenation saturation. She is afebrile.Physical examination shows a very anxious, dishevelled woman with a noticeable tremor, tachycardia, mild diaphoresis, and tachypnoea. She is alert and oriented at the time of examination but keeps commenting that everything in the room “looks weird” to her. When pressed further about this, she states “nothing is straight, everything is wavy.” The remainder of the exam is normal.

1. A 33-year-old carpenter was working on a construction project to build a new house. When using a high-pressure paint gun, he inadvertently injected his left index finger. On arrival to the clinic, he complains of intense hand pain. On examination, you note a 2-mm wound over the second proximal phalange. He has full range of motion and brisk capillary refill. Radiographs of the finger show soft tissue swelling, a small amount of subcutaneous air, but no fracture. His tetanus is up to date. Which of the following is the most appropriate disposition for this patient?

Place the hand in a radial gutter splint and have the patient follow up with an orthopedic surgeon in 1 week.

Discharge home with pain medication and have the patient return for repeat radiographs in 1 week.

Order an X Ray of the finger to confirm that there is no fracture before discharging the patient home.

Place the hand in a radial gutter splint, prescribe a 10-day course of antibiotics, and have the patient follow up with an orthopedic surgeon in 1 week.

Place the hand in a radial gutter splint, administer broad-spectrum antibiotics, and admit the orthopedic service for operative debridement.

2. A 29-year-old man is 2.5m up on a ladder, painting his barn ceiling when he loses his balance and falls off the ladder, landing on both of his feet and then falling to the ground. He is brought to the clinic by his family members. On examination there are no obvious deformities, but you note swelling, tenderness, and ecchymosis of the right hindfoot. He has full range of motion at the ankle, knee, and hip. There is mild tenderness over his lumbar spine. Hs neurovascular status is normal. Radio- graphs confirm the diagnosis. Which of the following statements regarding this type of injury is true?

This injury is the second most commonly fractured tarsal bone.

10% are associated with compression fractures of the dorsolumbar spine.

90% are bilateral.

The mechanism of injury is usually secondary to rotational force at the subtalar joint.

These fractures require operative repair to avoid gait defects.

3. A 39-year-old woman is brought to the your clinic by paramedics. The primary survey is unremarkable. However, the secondary survey reveals a deformity of the right arm involving the upper arm and elbow. Which of the following associations are paired incorrectly?

Olecranon fracture and ulnar nerve injury

Posterior elbow dislocation and ulnar and median nerve injury

Anterior elbow dislocation and brachial artery injury

Supracondylar fracture and brachial artery and median nerve injury

Humeral shaft fracture and axillary nerve injury

4. A 19-year-old man is brought into the clinic after a head-on cycling accident. The patient was not wearing a helmet. Upon presentation his BP is 125/75 mm Hg, PR is 105 beats per minute, RR is 19 breaths per minute, and oxygen saturation is 100%. His eyes are closed but open to command. He can move his arms and legs on command. When you ask him questions, he is disoriented but able to converse. What is this patient’s GCS score?

11

12

13

14

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