Question Bank

You are the MO working in the A&E department (P2). You are seeing a 55yo Chinese lady, premorbidly ADL-I, for fever. At first you think it is a run-of-the-mill case of infection but several details begin to make you worry.

She  was last admitted for persistent vomiting and early satiety. She was diagnosed with locally advanced resectable gastric adenocarcinoma, and 2 months ago successfully underwent a total gastrectomy with Roux-En-Y reconstruction together with neoadjuvant and adjuvant chemotherapy. Her last cycle of chemotherapy was completed 2 weeks ago. She presents today to the A&E with fever Tmax 38.5 degrees in the past 1 day. You review her previous imaging and lab tests before going to see her.

You are HO currently in General Medicine. One of your patients, a 70yo Chinese gentleman admitted for an unwitnessed fall with head injury, CTSP you for ARU. He says he cannot pee and his bladder area is very pain. His past medical history is significant for T2DM (last Hba1c 7.8%), HLD, HTN, IHD (EF 45%), AF, and BPH. His chronic medications include metformin, empagliflozin, amlodipine, atorvastatin, tamsulosin, bisoprolol, and apixaban. His issues list includes mechanical unwitnessed fall cx by superficial head wound, CT brain NAD, awaiting PT to clear for home.

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It is already after exits so you go see him grumpily. His bladder is distended and RU scan shows 500mls. You quickly type out a CTSP note to insert IDC and send UFEME urine c/s. In the meantime you tell your trusty medical student to hurry up go insert so yall can go home.

You are a HO in Vascular Surgery. To your dismay, you wake up to one additional patient on your list. Apparently some medical HO had decided to stop apixaban for this patient with AF just because of a bit of haematuria, and then now the patient got an ALI. Your bosses have taken him to EOT and performed an emergent embolectomy to revascularise the limb. It is now your problem (do see medical history and patient background in our last series!)

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It is POD1 and you review the patient at AM ward rounds together with your vascular team. The patient complains of pain out of proportion upon review not improving even on opioid medications, and the skin over the affected leg is tense.

You are an MO in the A&E department. Mr Yee Ant Tee is a 50-year-old Chinese gentleman who presents with a 1-day history of epistaxis. Upon further questioning, he reveals that he was previously diagnosed with “cancer in the nose” and that he had “kissing disease” when he was younger.

You are the MO working in the A&E department (P1). A 57 year old Chinese female has been brought in by SCDF, with P1 Resus on standby for low GCS. According to the paramedics, bystanders reported that the patient had complained of a sudden-onset headache and had one episode of vomiting large amounts of secretions. Her past medical history is significant for poorly controlled hypertension, hyperlipidemia, diabetes mellitus, and atrial fibrillation. Her chronic medications are Enalapril, Atorvastatin, Metformin, Empagliflozin, and Apixaban.

You attend to her immediately upon her arrival.

You are an MO working in the A&E department (P2). You are currently seeing a 31-yo G5P4 (now turned para 5) Chinese lady. She is a case of complete birth before arrival (CBBA). She suddenly woke up around 3am with regular contractions, and called an ambulance to go to the nearest A&E. Unfortunately, she had an uneventful normal vaginal delivery of a 3.1kg boy right at the doorstep of your A&E department. The child has been stabilised and then sent via ambulance to the nearest neonatal ward.

She informs you that she feels well except for some fatigue and breathlessness. On inspection, she is pale, and breathless, and the Inco sheet is fully soaked with blood and is spilling onto the bed. Vitals show the following: T 36.3, HR 121, BP 91/59, RR 26 SPo2 92% on RA.

Mr Pan Ah Dou, 65 years old, was brought into the A&E due to suspicions that he has been overtaking panadol. His son discovered his father more drowsy than usual, and discovered an empty box of panadol on his bedside. Note that 1 whole box contains ~20 panadol tablets. Mr Pan now complains of nausea. Besides hypertension and hyperlipidemia, Mr Pan does not have any other chronic conditions. His chronic medications are Enalapril and Atorvastatin.

You are the P1 R2 in the A&E department and it has been a busy shift so far. It is 10 minutes from the end of your shift and you have begun counting down the minutes until you can leave. Just as you were about to look for the next MO or JR to handover the case to,  you hear the VHF siren say ‘Stand-by 61 year old Chinese male for low SPO2 with wheeze’. You cry a little inside but know you have to do what you have to do.

You are the MO in the A&E department. A 26 year old Chinese male, Mr Hani Bee, comes in with complaints of a sting by some unknown creature, he says he is a photographer and was walking along the shore at Sentosa when suddenly he felt a sharp pain in his calf with swelling around the sting mark. He appears slightly breathless but is otherwise well. 

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His vitals are as follows: Temperature 36.0, HR 81, BP 123/70, SpO2 98% on RA, RR 13.

You are the MO in the A&E department. A premorbidly well 78 year old Chinese female, Mdm Kah Tia, presents to the A&E. She had suffered a bad fall in the past hour in a public area, and passersby called an ambulance. She is complaining of mild leg pain after her fall. Otherwise, she insists that she is fine and that she wants to go home and watch her favourite TV show. 

You bring up her medical records. Prior to the fall, she is community ambulant, able to walk independently without a walking stick and goes for daily walks to the market. She lives alone. She has a history of HTN, DM, and HLD on oral medications and BPPV on FU with ENT.