SAQ Stack

Short Answer Questions for ED Fellowship Study

Case: Myxoedema coma

A 60 year old female with known hypothyroidism presents with acute confusion. She is on thyroxine only. Vital signs:

  • Temp 36.0 C
  • HR 40 bpm
  • BP 60/40 mmHg
O2 sats 86% on room air
  • GCS 13
ABG on FiO2 0.4: pH 7.20 pO2 55 mmHg pCO2 60 mmHg HCO3 10 mmol/L Na 130 mmol/L K 6.0 mmol/L Cl 100 mmol/L Glucose 2.2 mmol/L

1. Complete the table below regarding the (2) main acid-base abnormalities in the ABG. Include your calculations. 4 marks

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2. List (2) other abnormalities and (1) likely cause for each in this patient. 4 marks

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Supportive treatment has been started, including supplemental O2, IV fluids and inotropes.

3. List (4) other specific treatments that should be given. 4 marks

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This case forms part of a collaborative marking project designed to support fellowship preparation. In the week leading up to each tutorial, you can contribute answers to any active case. If you contribute, your answers may be reviewed, marked, and used to refine the model answers during the weekly fellowship teaching sessions.

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