Preamble

In this written assessment, you will be presented with a simulated case and asked to write an essay exploring the diagnostic information provided and link this information to the patient presentation, pathophysiology, and possible treatment, with clinical reasoning.

Task Description

You are presented with a 78yo male found unrousable. He is usually independent, looking after himself and undertaking all his own activities of daily living. He has been unwell for the last two weeks with a chest infection, which has been treated with 7-days of antibiotics by his GP. It appears the treatment has been ineffective, as in the past few days he has become increasingly lethargic, drowsy, and more inclined to sleep. He had bloods taken two hours ago, at which point he was still ‘reasonably alert’.

Past medical history: Type 2 diabetes, hypertension, TIA

Social history: no alcohol, ex-smoker, lives alone

Medications: metformin, gliclazide, ramipril, aspirin, simvastatin

His estimated weight is 80kg.

Observations are:

• GCS 8 (E 1 V 2 M 5); pupils equal and reactive to light, at 5mm
• Temperature 38°C
• Heart rate 104/minute
• ECG – sinus tachycardia
• Respiratory rate 30/minute
• Blood pressure 98/60mmHg
• Oxygen saturation 92% on room air
• Blood glucose level 37 mmol/L

Physical examination reveals:

• Dry mucosal membranes
• Normal heart sounds
• Nil elevated JVP
• Cool peripherally
• Breath sounds – inspiratory crackles & diminished air entry to the right base
• Normal reflexes
• Abdomen soft and non-tender
• Urinalysis: +++ glucose, + protein, no blood, no nitrites or leucocytes, trace ketones 

With initial treatment implemented, you elect to undertake an iStat (arterial), and you find the following (on room air): 

• pH                           7.31
• PCO2                       25 mmHg
• PO2                         61 mmHg
• HCO3                      18 mmHg
• Lactate                    2.2 mmol/L
• Glucose                   37 mmol/L

You access his electronic records and find the following blood results:

• White cells                            19 x 109/L
• Neutrophils                           16 x 109/L
• Haemoglobin                        170 g/L
• Platelets                                 350 x 109/L
• Sodium                                  156 mmol/L
• Potassium                              6.1 mmol/L
• Urea                                       18 mmol/L
• Chloride                                 95 mmol/L
• Creatinine                              210 µmol/L
• C-reactive protein                  288 mg/L
• Bilirubin                                 15 µmol/L
• Alanine aminotransferase      34 IU/L
• Alkaline phosphatase            79 IU/L
• Albumin                                 56 g/L
• Glucose                                  34 mmol/L

You are to write an essay addressing the following components:

1. Articulate your initial impression and provisional diagnosis based on the information provided.
2. Discuss how the pathophysiology of the case relates to the presenting diagnostic values (either why they are still within normal range or not).
3. Discuss your planned treatment and how you anticipate your management will impact the patient's overall clinical picture, with specific reference to the pertinent diagnostic values.

The expected word count for your written assessment is 3000 words, excluding references. You will be assessed in accordance with the rubric provided on the unit Moodle page. Criteria include:

Overall presentation

• Organisation of paper.
• Writing mechanics.
• Appropriate word count.

Content

• Initial impression and provisional diagnosis.
• Pathophysiology related to presenting diagnostic values.
• Planned treatment and impact of management.
• Supports discussion/arguments with relevant evidence-based material.

References

• Use of Harvard style of in-text referencing.
• Reference list.

This assessment is worth 60% of your overall mark for this unit.

During the compulsory residential school, you will undertake an assessment task designed to explore your practical and declarative knowledge regarding prehospital diagnostics learned throughout this unit, including (but not limited to) ultrasound and iStat.

A marking rubric for this assessment task will be provided on the unit Moodle page. Students will have a maximum of two (2) attempts for each component assessed. The assessment will be based on marking criteria covering the following key points:

• Successful completion of each component of the assessment.
• Demonstration of each component in a timely manner.
• Ability to minimise missed steps or minor errors.

You must achieve a pass mark for each component of this assessment. This assessment is a PASS/FAIL task.

You will be required to complete two (2) online quizzes; the first will close at the end of Week 5; the second at the end of Week 12. The quizzes will open on the Friday of the preceding week to when the quiz is due, and each will have a specific time limit imposed.

The quizzes will be made up of multiple choice questions exploring content based upon the previous weeks of content (including lecture materials, online modules, links and required readings). Quizzes are cumulative and content will aggregate across the term. The quiz will assess your ability to integrate clinical history and assessment with physiological systems and distinguish between pathologies and pathophysiology within a clinical context.

You will be required to answer each question to receive the marks allocated to that question. Non-attempts will score a zero mark. Quizzes may not be reattempted. This is an individual assessment with no collaboration allowed.

Each quiz is worth 20% of your overall mark for this unit. The first quiz must be completed by 2345hrs AEST on the Friday of Week 5; the second quiz must be completed by 2345hrs AEST on the Friday of Week 12. In the absence of an approved extension, there will be no opportunity to complete the task after this date, and there will be no opportunity to apply a late penalty of five percent per day.