Reading Part B Practice Set Part B In this part of the test, there are six short extracts relating to the work of health professionals. For questions 1 to 6, choose the answer (A, B or C) which you think fits best according to the text. 1. Preparation of Injection Lidocaine is a local anesthetic that is often injected subcutaneously before minor medical procedures such as laceration repair, excisional biopsy, and hormone implantation. A key step to prepare for this procedure is clearing a suitable workspace and obtaining any necessary supplies. First, be sure to check with your provider about the concentration and mixture of Lidocaine to be used. Epinephrine is often included to constrict local blood vessels for longer duration, but can increase the risk of causing ischemia in areas with poor blood supply (fingers, ears, toes). Sodium bicarbonate can also be added to avoid pain during injection due to Lidocaine’s acidic pH. Be sure to obtain the proper sized needle and syringe, which will be dependent onthe location of the injection and the size of the area requiring anesthesia, respectively.Why is epinephrine added to Lidocaine injections? (A) to numb the area (B) to prolong the effects © to reduce patient discomfort 2. | Policy Reminder: Collecting Collateral Information Collateral information is an important factor in determining appropriate disposition for psychiatric patients in the Emergency Department. Often, patients with psychiatric complaints are unable to accurately or thoroughly describe their medical history, baseline condition, or events leading up to their arrival at the hospital. Thus, it becomes imperative to contact those who might know the patient best or were in the patient’s company prior to their arrival. Contact information can be obtained from the patient themselves, persons accompanying the patient, or the medical record. When initiating contact, confirm the other person’s identity before revealing the patient’s name or the reason you are speaking with them. If you reach voicemail and the answering machine does not clearly identify the person youare looking for, do not reveal any information about the patient — simply state your name, number, position, and whom you are requesting a callback from.The policy document on collateral information offers advice to staff about how to (A) gather information from colleagues about specific patients. (B) collect information about patients from their friends and relatives. (c) inform patients and their carers about recent diagnoses over the phone. 3. | Assessing and Managing Peripheral Arterial Disease Staff should assess patients who have symptoms suggestive of peripheral arterial disease or diabetes with non-healing wounds for the presence of peripheral arterial disease. * Ask about the presence of intermittent claudication and critical limb ischaemia « Examine the lower limbs for evidence of critical limb ischaemia * Examine pulses in the lower limbs: femoral, popliteal and feet© Measure the ankle brachial pressure index Imaging is possible for patients with peripheral arterial disease: duplex ultrasound is the first-line imaging technique. If patients require additional imaging, contrast-enhanced magnetic resonance angiography is used. If this is contraindicated or not possible, use computed tomography angiography instead. Lifestyle changes are the first-line treatment for peripheral arterial disease, this includes: smoking cessation, better control of diabetes, better management of hypertension, management of high cholesterol, in combination with antiplatelet drugs. Finally, regular exercise has shown to beneficially revascularise tissues in those with claudication.When dealing with patients with symptoms of peripheral arterial disease, staff should (A) look for signs of swelling in the upper body. () confirm that the patient has a history of poor diet. © identify the cause through physical examination and tests. 4. Guidelines: Alcohol Withdrawal TreatmentAlcohol withdrawal can present as a life-threatening emergency and requires treatment at a hospital. Providers use algorithms to determine when and how much medication to administer for a safe and optimal outcome. A key component of this assessment is determining the severity of alcohol withdrawal using the Clinical Institute Withdrawal Assessment for Alcohol (CIWA- Ar). The scale contains 10 subjective and objective items that can be queried and scored in minutes. Symptoms asked about include nausea, vomiting, tremors, sweating, anxiety, agitation, tactile/auditory/visual disturbances, headache, and cognitive dysfunction. Every hospital has different cutoffs for treatment, but as a general rule, treatment with benzodiazepines begin starting at a score 8-10, with higher scoring indicating increasing amount and frequency of medication.The guidelines on alcohol withdrawal treatment informs healthcare professionals about (A) determining the quantity of medication required. (8) reducing the dosage as the symptoms improve, © various types of drugs to prescribe to patients. 5. For the attention of all staff: RE: AGITATED PATIENTSAgitated patients are a common occurrence in the Emergency Department. There are many reasons for agitation, ranging from medical conditions, substance intoxication, psychiatric illness, and distressing circumstances. While both physical and chemical restraints are available to providers, these are items of last resort as their use creates significant risk to the patient, staff, and other persons in the area. Verbal de-escalation is a proven, effective technique that can be used to calm a patient down and promote a safe treatment environment. When de-escalating, designate one person to speak for the group. Agitated patients can be easily confused by multiple speakers and a unified message must be presented. Respect personal space to prevent the patient from feeling ‘trapped’ and maintain sufficient distance to avoid any resultant physical aggression. Remember to introduce yourself and your role on the treatment team to the patient. Use their name and orient them to their surroundings and why they are here in the hospital.The memo is advising staff dealing with agitated patients on how to (a) identify the cause of the agitation. (:)) avoid adding to the feelings of agitation. © deal with violent behaviour caused by the agitation.Extract from Appropriate Treatment for Pain Pain is one of the most common complaints that will be brought toa physician’s attention. This section will cover treatment of mild to moderate pain without the use of opioids. More severe pain may require judicious use of short-acting opioid medications or a consult to pain medicine. For most patients, the first line medications for pain are acetaminophen and ibuprofen. Maximum daily dosage of acetaminophen is suggested to be 4 grams, reduced to under 2 grams for patients with liver issues such as a cirrhosis. Ibuprofen is particularly effective in patients whose pain is caused by inflammation, though caution is urged in elderly patients, patients with diagnosed bleeding issues (especially gastrointestinal bleeds), or any cardiac issues. Maximum daily dosage suggested is 2.4 grams. A combination of acetaminophen and ibuprofen can be used if either one used alone is not sufficient. For more localised pain relief, consider using lidocaine dermal patches over non-broken areas of skin.‘The guidelines advise that patients with heart problems (A) may need to avoid ibuprofen. (B) should be given lidocaine for pain relief. © must receive a lower dose of acetaminophen.