Download - SCHHS Emergency Department

1. In patients with abdominal pain, which of the following statements is MOST USEFUL in supporting
a diagnosis of pancreatitis
A.
B.
C.
D.
E.
An USS showing cholelithiasis
Calculating a Ranson score of greater than 2
A history of colicky abdominal pain radiating to the back
The finding of a Cullen sign on examination
A chest X-ray showing a left sided pleural effusion
2. With respect to herniae, which of the following is CORRECT
A
B
C
D
E
An incarcerated hernia should be reduced as soon as possible
All patients with reduced inguinal herniae are safe to be discharged with surgical follow-up
within 2 weeks
Inguinoscrotal herniae should transilluminate
The most common form of inguinal hernia in men is direct
Femoral herniae frequently incarcerate
3. In metabolic alkalosis, which of the following is TRUE
A.
B.
C.
D.
E.
Urinary chloride greater than 10 mmol/L is considered chloride responsive
May result in hyperkalaemia
Can be caused by Addison’s disease
The pCO2 should rise 1.3 mmHg for every 1 mmol/L rise in HCO3
Can be caused by chewing tobacco
4. With respect to anorectal pathology, which of the following statements is FALSE
A.
B.
C.
D.
E.
Second degree haemorrhoids commonly need reduction in the Emergency Department
Diabetics are more prone to perianal abscesses
Thrombosed external haemorrhoids should be surgically de-roofed and evacuated
Chronic perianal abscesses should be referred for colonoscopy
Acute anal fissures should be treated conservatively
5. With regard to acute myocardial infarction which of the following statements is TRUE
A.
B.
C.
D.
E.
ST segment elevation is present on initial ECG in ED in greater than 80% of patients
In the presence of underlying RBBB (right bundle branch block), AMI can not be diagnosed
by standard ST segment criteria
In the presence of pre-existing LBBB (left bundle branch block), concordant ST elevation of
>1mm is strongly suggestive of AMI
In patients presenting with AMI, availability of TnI or TnT assays renders CK/CK isoenzyme
testing redundant.
Mobitz type II 2nd degree heart block in the setting of inferior AMI is definite indication for
placement of a temporary pacing wire.
6. With regard to the management of acute myocardial infarction which of the following statements
is TRUE
A.
B.
C.
D.
E.
Patients presenting within the first hour of pain should be thrombolysed if PTCA is not
available within 1 hour of presentation
Clopidogrel should be avoided in patients receiving fibrinolysis due to increased risk of
haemorrhage
For patients presenting after 3 hours of pain, transfer for primary angioplasty is a reasonable
option if time to PTCA will not exceed 90 minutes.
Failed reperfusion after thrombolysis is suggested by failure of ST segment elevation to
resolve within 60-90 minutes after therapy
Risk of intracranial haemorrhage after TPA thrombolysis is in the region of 1 in 1000 patients
treated
7. Regarding infective endocarditis which of the following statements is FALSE
A.
B.
C.
D.
E.
The sensitivity of trans-thoracic echo is 60-70%
Blood cultures are positive in approximately 90-95% of patients who have not received
antibiotics
Staphylococcus aureus is the commonest pathogen causing native valve endocarditis in the
non-IVDU population
Embolic phenomena occur in more than 50% of patients
Fever is seen in approximately 90% of patients
8. Following avulsion of a tooth, which of the following statements is FALSE
A.
B.
C.
D.
E.
Avulsed primary anterior teeth in those younger than 5 yrs of age are not replaced
Replanted primary teeth may be associated with subsequent facial deformity
Permanent teeth should be replaced regardless of duration of avulsion
Socket blood clot may prevent replantation
Milk is an appropriate transport medium
9. With respect to Toxic Epidermal Necrolysis (TEN), which of the following statements is TRUE
A.
B.
C.
D.
E.
Nikolsky’s sign is pathognomonic
An underlying cause can be usually found
The emergency management includes the use of corticosteroids
TEN shows no gender predilection
The mortality is up to 15%
10. Which of the following statements is TRUE concerning disasters and disaster management
A.
B.
C.
D.
E.
Victoria has the highest disaster hazard risk of all the states in Australia
With earthquakes, the ration of injuries to deaths is usually 5:1
Chemical incidents are the most common cause of localised disasters
A level I disaster requires a regional response
A patient triaged as P1 or Red in a disaster should receive expectant management only
11. In patients who present with epistaxis, which of the following statements is TRUE
A.
B.
C.
D.
E.
All patients should have bloods collected for INR and cross-matching
Cocaine is a first-line treatment when simple measures fail
Silver nitrate is useful at cauterising vessels with active bleeding
All patients in whom bleeding stops with simple measures can be discharged
Oestrogen cream can be used to prevent further episodes of epistaxis in patients with
hereditary haemorrhagic telangiectasia
12. With respect to diseases of the salivary glands, which of the following statements is TRUE
A.
B.
C.
D.
E.
In sialolithiasis 50% of the stones form in the parotid gland or its duct
IV contrast does not effect the parotid gland
Hodgkins lymphoma can involve the parotid
Most salivary gland tumors are pleomorphic adenomas
Management of sialolithiasis involved a clear fluid diet
13. With regard to meningococcaemia, which of the following statements is TRUE
A.
B.
C.
D.
E.
N. meningitidis is an aerobic, gram positive diplococcus
15% will have classical signs of meningococcal infection
More than 50% will have a rash
The most common complication is ARDS
Waterhouse – Friderich syndrome occurs in 40%
14. With regard to soft tissue infections, which one of the following is TRUE
A.
B.
C.
D.
E.
Perianal abscesses originate in the anal crypts
Cellulitis occurs only in areas where the skin has been breached
Erysipelas occurs most commonly in the face
Pasteurella sp. and Staphlococcus aureus are the predominant bacteria in infection
secondary to human bites
The absence of gas in the tissues excludes necrotizing fasciitis
15. With regard to calcium metabolism, which of the following statements is FALSE
A.
B.
C.
D.
E.
Hypercalcaemia potentiates digoxin toxicity
Hypocalcaemia leads to hyperreflexia
Hypercalcaemia causes hypertonia
Hypercalcaemia shortens QT interval on ECG
Hypocalcaemia prolongs the QT interval on ECG
16. Which of the following statements is TRUE regarding neonatal resuscitation
A.
B.
C.
D.
E.
15% of neonates require resuscitation post delivery
The Apgar score at 1 minute correlates with neurologic outcome
IPPV is indicated if the heart rate is below 100 beats per minute
If indicated, IPPV should be at a rate of 50-60 breaths per minute
Atropine should be given if the heart rate drops below 80 beats per minute
17. With regards to brain abscesses, which of the following statements is TRUE
A.
B.
C.
D.
E.
35% of cases occur in children under 15 years of age
Organisms reach the brain by the haematogenous route in 50% of cases
Gram negative rods, especially Bacteroides sp. are the usual pathogens in sinogenic and
odontogenic brain abscesses.
Otogenic brain abscesses are typically single and located in the temporal lobe or cerebellum
Fever and neck stiffness is present in approximately two thirds of cases
18. With regards to Cervical Spine Injuries, which of the following is TRUE
A.
B.
C.
D.
E.
Approximately 20% of patients with facial injuries have cervical spine injuries
Fractures of the posterior arch of C1 are usually very unstable
Uncinate Process fractures are usually a result of lateral flexion
Anterior vertebral subluxation of 25% or more suggests bilateral facet joint dislocation
Jefferson Fractures are usually diagnosed on the Lateral Cervical Xray
19. With regards to Hip joint dislocations, which of the following statements is TRUE
A.
B.
C.
D.
E.
Anterior Dislocations are usually associated with falls
Neurovascular compromise in anterior dislocations is uncommon
Sciatic Nerve injuries occur in up to 70% of patients with posterior dislocations
Abduction of the hip suggests posterior dislocation
Delayed reduction is reasonable in anterior dislocations
20. With regards to Musculotendinous Injuries, which of the following statements is TRUE
A.
B.
C.
D.
E.
Complete ruptures of the proximal biceps tendon are frequently managed conservatively
Active plantar flexion is absent in rupture of the tendo-achilles
Most Acute Rotator Cuff tears are associated with limited adduction and internal rotation
Ruptures of the Quadriceps Tendon usually occur in younger patients
Hamstring ruptures are usually treated surgically
21. In a patient presenting with suspected Compartment Syndrome, which of the following
statements is TRUE
A.
B.
C.
D.
E.
Tenseness and swelling is always noted on palpation
Anterior Compartment Syndrome of the leg may be associated with hypoaesthesia of the 1st
web space
Pressures greater than 15 mmHg are diagnostic in the upper limb
Compartment Syndrome does not occur in the hand
Hypoaesthesia appears before muscle weakness
22. Which of the following statements is TRUE regarding Air Medical Transport
A.
B.
C.
D.
E.
A size ‘C’ oxygen cylinder at a flow rate of 10 L/min will last approximately 49 minutes
According to the National Association of EMS Physicians, indications for helicopter scene
transport include a GCS <12
Fixed wing aircraft are preferred to helicopters for the transport of patients with spinal
injuries as they have decreased vibration
Most retrieval aircraft are able to be pressurised to 1 atmosphere
Spinal injuries are an indication for flying at the lowest cabin altitude possible
23. With regard to schizophrenia, which of the following statements is FALSE
A.
B.
C.
Auditory hallucinations are one of the DSM-IV diagnostic criteria
It affects 1% of the population
Genetic factors play a role
D.
E.
Negative symptoms are one of the DSM-IV diagnostic criteria
Symptoms must be present for 3 months to diagnose using DSM-IV
24. A principle psychiatric diagnosis is more likely than an organic diagnosis in the presence of which
ONE of the following
A.
A clear sensorium
B.
Age over 40 at first presentation
C.
Visual hallucinations
D.
Poor cognition
E.
Fluctuating consciousness
25. With respect to patients who present to Emergency Departments with Acute Renal Failure (ARF),
which of the following is CORRECT
A.
B.
C.
D.
E.
Patients with ascites have a 40% rate of ARF over 5 years
Anorexia, fatigue, pruritus and confusion are sensitive for diagnosing patients with ARF
Ureteric obstruction by tumour is a common cause of ARF in patients with known neoplastic
disease
Hypotension during cardiopulmonary resuscitation commonly leads to ARF
Low dose dopamine can improve recovery in Acute Tubular Necrosis
26. Regarding bronchiolitis which ONE of the following statements is TRUE
A.
B.
C.
D.
E.
Peak age of occurrence is between 12-18 months of age
Incidence of secondary bacterial infection in patients admitted to hospital approaches 50%
Saturations below 94% indicate a need for admission
Ability of child to sleep is most useful historical indicator of severity.
Children admitted to hospital should receive oral or intravenous steroids
27. Regarding acute asthma in children, which ONE of the following statements is FALSE
A.
B.
Severe asthma is indicated by peak expiratory flow of less than 40% predicted
6-12 puffs of Salbutamol via a spacer every 20 minutes for 1 hour is appropriate for a child
with moderately severe acute asthma
C.
D.
E.
Ipratropium Bromide is indicated for mild to moderate asthma in children
Systemic steroids are indicated for moderate or severe attacks of asthma in children
The majority of asthma deaths occur in patients with persistent asthma
28. Regarding community acquired pneumonia in adults, which of the following statements is TRUE
A.
B.
C.
D.
E.
Cavitation is common in pneumonia due to Mycoplasma pneumoniae and Haemophylis
influenzae
Legionella is the commonest cause of ‘atypical pneumonia’
Hypothermia is the clinical feature most closely associated with mortality
Pneumonia severity score (PSI) class I requires respiratory rate to be less than 40
IV Azithromycin and Ceftriaxone is appropriate empiric therapy for severe community
acquired pneumonia throughout Australia
29. Regarding patients with Chronic Obstructive Airways Disease (COAD), which of the following
statements is TRUE
A.
B.
C.
D.
E.
25% of episodes of acute respiratory failure are precipitated by heart failure
Reduction in FVC is a better predictor of severity than reduction in FEV1
Non-invasive ventilation should not be used when arterial pH is less than 7.20
In acute exacerbations anticholinergic agents such as Ipratropium Bromide provide have no
proven additional benefit to nebulised β-agonists
In patients with acute hypercapnic respiratory failure, non-invasive ventilation reduces the
need for intubation but has no proven effect on mortality
30. Regarding spontaneous pneumothorax in adults which of the following statements is TRUE
A.
B.
C.
D.
E.
Acute pleuritic pain is seen in 95%
Sensitivity of PA chest x-ray is greater than 97%
Ultrasonography has a sensitivity of approximately 60%
ST and T-wave changes are not seen in isolated pneumothorax
Aspiration of greater than 1000 ml of air suggests that simple aspiration will fail
31. In relation to smoke inhalation, which of the following statements is TRUE
A.
Signs of pulmonary injury do not present after 12 hours
B.
C.
D.
E.
Patients are asymptomatic until carboxyhaemoglobin levels are around 30%
Chest X-rays are usually abnormal early
Pulmonary oedema does not occur
Toxic gas exposure may include hydrogen chloride and phosgene
32. In patients who present with mastitis, which of the following statements is TRUE
A.
B.
C.
D.
E.
Untreated most will develop abscesses
Warm compresses and breast support are of little value in the treatment
Abscesses rarely need surgical drainage if breast feeding is continued
Clindamycin is the antibiotic of choice in patients with penicillin hypersensitivity
Breast feeding should be stopped and a breast pump used in all patients with mastiti
33. With respect to Reiter’s Syndrome, which of the following statements is FALSE
A.
B.
C.
D.
E.
There is an association with HIV
Foot pain is caused by plantar fasciitis
The conjunctivitis always occurs in both eyes
Heel pain confers a worse prognosis
Up to 50% of patients can suffer recurrent disease
34. With regards to post-traumatic tracheobronchial injuries, which of the following is FALSE
A.
B.
C.
D.
E.
Approximately 10% of patients may by asymptomatic
Most injuries occur near the carina or the origin of the lobar bronchi
May be a result of rapid deceleration
Presence of deep cervical emphysema is diagnostic
Mediastinitis is a potential complication
35. On examining a patient following blunt facial trauma, the following statements is TRUE
A.
B.
C.
D.
E.
Telecanthus suggests involvement of the lateral canthal ligament
Cerebrospinal fluid rhinorrhoea does not occur in Le Fort type 2 fractures
Enophthalmos does not occur in medial orbital wall fractures
In mandibular fractures, symphysis fractures are less common than molar fractures
Paralysis of the lower lip may be associated with mandibular fractures
36. With regards to traumatic thoracic aortic injuries, which of the following statements is TRUE
A.
B.
C.
D.
E.
Upper extremity hypotension is present
The patient may have a harsh diastolic murmur over the interscapular area
The most frequent radiologic finding is displacement of the left mainstem bronchus
Anuria is not a feature
Superior Vena Caval Syndrome may occur
37. In relation to a patient presenting with an oesophageal foreign body, which of the following
statements is TRUE
A.
B.
C.
D.
E.
The oesophageal narrowing at the level of the Aortic Arch (T4) is the most common site of
trapping
Removal of lodged button batteries may be delayed if there is no airway compromise
As many as 85% of children with coins lodged in their oesophagus will be asymptomatic
The majority of adult impactions arise in the distal oesophagus
All food Impaction requires removal within 4 hours
38. With regards to priapism in the paediatric population, which of the following statements is
CORRECT
A.
B.
C.
D.
E.
High-flow priapism is more frequent than the low-flow type
Long term complications of high-flow priapism are common and include corporal fibrosis
and erectile dysfunction
A common cause of low-flow priapism includes a groin or straddle injury
In low-flow priapism the entire penis is partially rigid and painless
Management is the same in both high flow and low flow priapism
39. With respect to Lateral Sinus Thrombosis (LST) and Otitis Media (OM), which of the following
statements is TRUE
A.
B.
C.
D.
E.
Clinical findings of LST are easy to distinguish from the clinical findings that occur in other
complications of OM
In the diagnosis of LST, CT is equivalent to MRI in sensitivity and specificity
Bacteria are can often be isolated from the sinus
IV nerve palsy is a common presentation
Initial treatment is antibiotics and many patients go on to require surgical intervention
40. With respect to electrical injuries, which of the following statements is FALSE
A.
B.
C.
D.
E.
Voltages less than 50V have not proven to be hazardous
The threshold for ventricular fibrillation is 100mA
Direct current is much more lethal than alternating current
Transthoracic current carries a 60% mortality
Patients with cardiac arrhythmias require admission to hospital until arrhythmia resolves
41. Which of the following statements with respect to hypothermia is TRUE
A.
B.
C.
D.
E.
J waves are best seen in leads III and aVF
Atrial fibrillation is the commonest arrhythmia seen below 32°C
Ventricular fibrillation should not be defibrillated
A paradoxical drop in core temperature after rewarming carries the highest risk
Insulin should be commenced to manage hyperglycaemia in hypothermia
42. With respect to snake bites which of the following statements is FALSE
A.
B.
The dose of antivenom for children and adults is the same
All patients who receive antivenom should receive a short course of oral steroids
C.
D.
E.
Prophylactic adrenalin has been shown to reduce the incidence of allergic reactions to
antivenom
Urine is preferred to serum for use of VDK for detection of snake venom
Antivenom is given as an infusion over 30mins, unless in an arrest situation
43. Which of the following drugs are NOT associated with serotonin syndrome
A.
B.
C.
D.
E.
Sertraline
Lithium
LSD
Imipramine
Chlorpromazine
44. Regarding therapeutic hypothermia post cardiac arrest, which of the following statements is
TRUE
A.
B.
C.
D.
E.
Survival outcomes were improved for all classes of arrest
Overall survival was not improved but neurologically intact outcome was.
Should be applied to all out of hospital VT/VF arrest patients who survive to hospital
Fluid loading with 30 ml/kg of 4 degree C Normal saline is effective at rapidly reducing core
temperature.
The target temperature needs to be achieved within the first hour of hospitalisation for an
outcome benefit to be anticipated.
45. Regarding the ARC guidelines for paediatric cardiorespiratory arrest which ONE of the following
is FALSE
A.
B.
C.
D.
E.
3 stacked shocks are given if the arrest is witnessed
The dose for adrenaline given via an ETT is 100 mcg/kg
Guidelines suggest that if there has been no ROSC after 20-30 minutes in a child that it is
reasonable to cease resuscitation
CPR should be initiated for heart rates below 80/min in children
The chest should be compressed by 1/3 of its depth during compressions
46. Regarding local anaesthetics which of the following statements is TRUE
A.
B.
C.
D.
E.
50 ml of 0.5% prilocaine exceeds the recommended dose for a 50 kg female receiving a
Bier’s block
Intercostal blocks commonly require higher doses of local anaesthetic due to high rate of
systemic absorption
Bupivicaine may be used for intravenous regional anaesthesia at doses of up to 2 mg/kg
A 70 kg male could safely receive peripheral infiltration of a maximum dose of 30 mls of 1 %
lignocaine with adrenaline
Seizures increase the cardiotoxicity of local anaesthetics
47. Regarding airway management in children which of the following statements is TRUE
A.
B.
C.
D.
E.
The larynx is more anterior and inferior
Suxamethonium should be avoided in children under 2 because of bradycardia
Cricothyroidotomy should be avoided in children under the age of 6
Pre-treatment with atropine 0.02 mg/kg is recommended for children under 5 years
Desaturation occurs faster than in adults
48. Seizure is a feature of all of the following drugs in overdose EXCEPT
A.
B.
C.
D.
E.
Amphetamines
Amitriptyline
Cocaine
Tramadol
Clonidine
49. The cholinergic syndrome has all the following features EXCEPT
A.
B.
C.
D.
E.
Confusion
Miosis
Constipation
Urinary retention
Blurred vision
50. Which one of the following conditions is NOT a common reversible precipitant of Hepatic
Encephalopathy?
A.
B.
C.
D.
E.
Alcohol
Large steak meal
Constipation
Oral hypnotic
IV fluids
51. Which of the following drugs is NOT commonly used in either first or second line treatment of
Helicobacter infection?
A.
B.
C.
D.
E.
Omeprazole 20mg bd for 7 days’
Amoxicillin 1gm bd for 7 days
Clarithromycin 500 mg bd for 7 days
Colloidal bismuth subcitrate 120 mg qid for7 days
Bactrim DS 800 / 160 mgs bd for 7 days
52. A 68 year old man is brought to hospital by ambulance 90 minutes after suffering a left sided
stroke with right sided weakness. Which of the following does NOT support the diagnosis of a medial
medullary syndrome?
A.
B.
C.
D.
E.
Paralysis of the right side of the tongue
Occlusion of the left vertebral artery
Paralysis of the right leg and arm
Impaired sensation of right side of the body
Lysis should be considered
53. A 55 year old man presents to the Emergency Department in shock. Addison’s disease is
considered in his differential diagnosis. Which of the following statements in relation to Addison’s
disease is FALSE?
A.
B.
C.
D.
E.
Asthenia is a cardinal symptom
Hydrocortisone is preferred over Dexamethasone as treatment as it does not interfere with
steroid assays
Sepsis can precipitate Addison’s Disease
A short tetracosactrin (“synacthen”) test should be done in ED to confirm or exclude the
diagnosis of Addison’s disease
A high K+ and a low Na+ supports the diagnosis of Addison’s Disease
54. A 34 year old woman is found to have a microcytic anaemia on a routine blood tests. Which of
the following conditions would NOT be in your differential diagnosis
A.
B.
C.
D.
E.
Sideroblastic anaemia
Dysfunctional bleeding
Beta thallasemia
Vegetarian
Large scalp laceration with approximately 800 mls blood loss
55. A 22 year old man with a history of a level 2 melanoma excised at the age of 17 presents
complaining of anorexia and feeling unwell. Which of the following organs is NOT a common site for
metastases?
A.
B.
C.
D.
E.
Cerebral hemispheres
Stomach
Lung
Liver
Femur
56. Regarding Guillain-Barre syndrome, which ONE of the following is TRUE
A.
B.
C.
D.
E.
There is a significant association with preceding E.coli gastroenteritis
Loss of distal sensation is the usual initial sign on examination
Brisk reflexes in the presence of significant weakness is the typical finding on examination
Cranial nerve involvement may occur in the absence of peripheral weakness
CSF analysis typically shows elevated protein and low glucose
57. Regarding seizures, which ONE of the following is FALSE
A.
B.
C.
D.
E.
Febrile convulsions affect approximately 3% of children
A loading dose of Phenytoin of 1 g is adequate for the majority of adults in status epilepticus
In children with an apparent febrile convulsion an LP should be performed when there is a
clinical suspicion of meningitis.
Phenobarbitone is an appropriate 2nd line drug in paediatric status epilepticus in a dose of
approximately 10-15mg/kg over 30 minutes.
Ease of termination of status epilepticus is more closely related to duration of status than
underlying cause.
58. In a patient with thyroid storm, which ONE of the following statements is TRUE
A.
B.
C.
D.
E.
Hypoglycaemia is usual
IV steroids should be given
GI symptoms are rare
Laboratory tests give definitive diagnosis
Methimazole is the mainstay of therapy
59. Focused Abdominal Sonogram in Trauma (FAST) assesses for blood in all of the following regions
EXCEPT
A.
B.
C.
D.
E.
Pericardial sac
Splenorenal pouch
Pelvis
Hepatorenal pouch
Retroperitoneum
60. Which of the following statements regarding spontaneous pneumothorax is TRUE
A.
B.
C.
D.
E.
The recurrence rate following a single episode is 10 % over the ensuing five years
Pulmonary infection is the most commonly associated condition in secondary spontaneous
pneumothorax
Hamman's sign is a pathognomonic finding
In the absence of any further air leak, a 20 % pneumothorax would be expected to reabsorb
over approximately 16 days*
Re-expansion pulmonary oedema is usually bilateral
EMQ 1
a) Adrenaline
f) Noradrenaline
b) Dobutamine
g)Vasopressin
c) Dopamine
d) Levosimendan
e) Milronone
For each pharmacological effect below chose the corresponding drug from the list above.
1. It is a phosphodiesterase III inhibitor
2. It is a non adrenergic peripheral vasoconstrictor
3. It has a potent alpha agonist with significant action at beta 1 receptors and a relative
absence of beta 2 effects
4. It is indicated in the treatment of anaphylaxis
EMQ 2
a) 0.1-0.2 mmol/kg
g)5 mcg/kg
b) 1 mmol/kg
h)10 mcg/kg
c) 1 mg/kg
i) 20 mcg/kg
d) 2 J/kg
e) 4 J/Kg
f)
5 mg/kg
Regarding paediatric cardiac arrest match the correct dosing schedule
1.
2.
3.
4.
5.
6.
Adrenaline
Magnesium
Amiodarone
Defibrillation
Atropine
Bicarbonate
EMQ 3
a)
b)
c)
d)
e)
f)
Adrenaline
Atropine
Amiodarone
Bicarbonate
Bretylium
Calcium
g)
h)
i)
j)
k)
Crystalloids
Lignocaine
Magnesium
Potassium
Lignocaine
In each of the situations below choose the drug which is most appropriate in that setting
1. A 23 year old male with a history of depression who presents via a ambulance with a
GCS of 10 who then has a generalised tonic clonic seizure followed by brief VF
arrest. They have return of circulation after one DC shock. This was their initial
ECG.
2. A 72 year old female presents to resus via ambulance having arrested during offload.
They have known ischaemic heart disease but were otherwise well. The ambulance
was called for a complaint of chest pain. CPR has been commenced and a single
shock has been given.
3. A 1 week old baby presents to resus in extremis with poor perfusion, tachypnoea with
recessions. They have a prolonged apnoea and you decide to intubate. Post
successful intubation the heart rate drops to 50, there is still a palpable pulse
4. A 64 year old is in VF arrest, they have had 2 shocks and one dose of adrenaline,
you are preparing to give the 3rd shock.
1. With regards to investigating patients with suspected PE. Which ONE of the following is TRUE
A. The most common ECG finding in PE is p-pulmonale
B. The chest x-ray in nearly half of all patients with acute PE will show an elevated dome of one
hemidiaphragm
C. 50% of patients with an acute PE will have a normal A-a gradient
D. D-dimer is highly sensitive and specific for the diagnosis of PE
E. Decreased ventilation in an area of diminished perfusion an a ventilation-perfusion lung scan is
suggestive of PE
2. In the assessment of patients presenting with suspected bacterial endocarditis. Which ONE of the
following is FALSE
A. 25-50% have haematuria
B. Evidence of vasculitis or embolic events aids clinical diagnosis
C. Two separate sets of blood cultures from different veins should be taken for aerobic, anaerobic,
and fungal cultures
D. Leucocytosis, raised CRP, and pyuria support the diagnosis
E. Normocytic anaemia supports the diagnosis
3. In differentiating between ventricular tachycardia and supraventricular tachycardia with
aberrancy. Which ONE of the following is FALSE
A.
B.
C.
D.
A constant Bundle Branch Block pattern suggests aberrancy
QRS duration longer than 0.14s is usually found in ventricular tachycardia
Vagal manoeuvres do not generally affect ventricular dysrhythmias
Age over 35 years is suggestive of ventricular tachycardia in patients with a regular wide
complex tachycardia
E. An rSR’ ( Right Bundle Branch ) pattern in V1 favours aberrancy
4. In patients following an acute myocardial infarction. Which ONE of the following is FALSE
A. Treatment with b-adrenergic blockers have shown improved survival
B. The major determinants of prognosis include age, left ventricular function, and effort tolerance
C. Use of lipid-lowering agents in patients with ischaemic heart disease have been shown to reduce
the risk of subsequent cardiovascular death
D. Clinical instability of angina is a major determinant of prognosis
E. In 25% of cases the infarct-related artery has only minimal or mild stenosis
5. A 4 week old baby presents with a two day history of dyspnoea and sweating whilst feeding.
Which ONE of the following is FALSE
A. Clinical differentiation of heart failure from non-cardiac causes in this age group is difficult.
B. Cardiomegaly on chest x-ray is usually present in congestive heart failure.
C. Patent ductus arteriosus is the most common cause of congestive heart failure at this age.
D. The incidence of congenital heart disease is 8 per 1000 live births.
E. Raised jugular venous pressure, peripheral oedema, and lung crepitations are late signs in
infants with congestive heart failure.
6. Which ONE of the following scenarios is most likely to explain the following results
Na: 131 (135 – 145)
pH 7.58
K: 2.1 (3.5 – 4.5)
pCO2 45
Cl: 76 (100-110)
pO2 51
HCO3: 40 (22 – 28)
HCO3 41
Urea 36 (3 – 9)
Creat 0.52 (0.03- 0.10)
A. A 60-year-old woman with exacerbation of COAD
B. A 10 day old boy with vomiting and constipation
C. A 15-year-old insulin dependent diabetic with altered level of consciousness
D. A 75-year-old woman on frusemide for congestive cardiac failure
E. A 23-year-old woman distressed after ingestion of amphetamines.
7. Which ONE of the following results does NOT indicate a poorer prognosis in the assessment of a
patient with acute pancreatitis
A.
B.
C.
D.
E.
BSL 15.1mmol/l
Ca at 48hrs: 1.9mmol/l
LDH 1012 iu/l
WCC 13.9x109 /litre
PO2 at 48hrs: 59mmHg
8. A 72 year-old man presents to your Emergency Department complaining of severe generalised
abdominal pain which came on suddenly 30mins prior to presentation. He was recently discharged
from hospital following an acute anterior myocardial infarct that was treated with thrombolytic
therapy.
His examination reveals:
Severely distressed man
HR 72 – regular
BP 160/90
Temp 36.6
Abdomen soft with bowel sounds present
ABG - mild respiratory alkalosis
Which ONE of the following is the most likely diagnosis
A.
B.
C.
D.
E.
Acute peritonitis due to perforated peptic ulcer
Mesenteric ischaemia due to arterial thrombosis
Acute mesenteric ischaemia due to embolism to inferior mesenteric artery
Acute mesenteric ischaemia due to embolism to superior mesenteric artery
Haemorrhagic pancreatitis
9. With respect to acute gastroenteritis, which pairing is FALSE
A.
B.
C.
D.
E.
Bloody diarrhoea - Enteroinvasive E. coli
Watery diarrhoea – Vibrio cholerae
Enteric fever responsive to ciprofloxacin – Salmonella
Dysentery – Salmonella
Responsive to large dose Ciprofloxacin - Giardia
10. With respect to acute cholecystitis, which ONE of the following is TRUE
A. Abdominal x-ray has a sensitivity of 75% for the identification of gallstones
B. Raised white cell count with RUQ pain and ultrasound proven gall stones means cholecystitis is
present
C. Raised LFT’s strongly indicates obstruction
D. Ultrasound can visualise 95% of common bile duct stones with an experienced operator
E. CT scan is very sensitive for CBD obstruction
11. Regarding a significant ingestion of mushrooms, which ONE of the following is FALSE
A. GIT symptoms are common, but often not a marker of toxicity
B. Patients with significant life threatening poisoning will present within days of their ingestion
C. Amanita phalloides mushrooms are present in Australia
D. Amanita phalloides poisoning is characterised by phases of severe GIT disturbance, apparent
recovery at 24 hours, and multi organ failure commencing on day 2 or day 3
E. Intractable grand mal seizures may be a manifestation of mushroom poisoning
12. A “tiny brownish coloured snake” has bitten a 3-year-old child on the trunk. Which ONE of the
following is TRUE
A. Juvenile brown snakes do not have adequate teeth and venom to cause significant
envenomation in humans
B. If this child lived in Tasmania, brown snakebite would still be in the differential of potential
snakes fitting that description
C. If this child lived in Western Australia, and was confirmed to have been envenomated by a
brown snake, an initial antivenom dose of two vials brown snake specific antivenom would be
considered adequate
D. Applying local direct pressure to the bite site on the trunk has been shown to be beneficial as a
form of first aid where pressure immobilisation bandages cannot be used due to the anatomical
area of the bite
E. Neurotoxicity is the most likely manifestation of envenomation with a brown snakebite.
13. Regarding the symptomatic exposure to organophosphates, which ONE of the following is FALSE
A. Pupil size is not useful clinical marker in guiding therapy
B. Organophosphates are highly lipophilic and penetrate exposed skin readily
C. Administering benzodiazepines when organophosphate related neuropathy commences can
prevent late axonal degeneration
D. Pralidoxime administration is an efficient means to preventing the ‘intermediate syndrome’
associated with organophosphate poisoning
E. When the mixed cholinesterase test is used, a value less than the mean of the two samples used
suggest more pralidoxime is required
14. A 6-year-old child presents after a viral illness, having been given paracetamol for a few days.
Which ONE of the following is FALSE
A. Chronic supratherapeutic paracetamol ingestion often presents with lethargy and fever
B. The Matthew-Rumack nomogram is not a useful tool in the setting of chronic paracetamol
poisoning
C. The loading dose of N-acetylcysteine is 100mg/kg in 100 ml 5% dextrose over 15 minutes
D. Significant poisoning occurs when a cumulative dose of 150mg/kg/day of paracetamol is
exceeded
E. Allergic manifestations to N-acetylcysteine is common, but rarely an indication to cease such
therapy
15. A child presents after a single large ingestion of iron tablets. Which ONE of the following is TRUE
A. Ferrous sulfate contains approximately 12% elemental iron
B. GIT stricture formation characterising the final stage of iron toxicity occurs approximately two
weeks after ingestion
C. Total iron binding capacity (TIBC) is a useful measure of iron toxicity
D. A maximum single dose of deferoxamine in this patient should not exceed 2 gram when given IM
E. More than 40mg/kg of ingested elemental iron is a significant ingestion with high likelihood of
toxicity.
16.
A.
B.
C.
D.
E.
F.
According to the “sad persons index” which ONE of the following is FALSE
S: sex (M>F)
A: age (>55 or youth)
D: Depression (past history)
P: plan
E: ethanol
17. With respect to predictors of increased risk of recurrence in a child who has suffered a febrile
convulsion. Which ONE of the following is FALSE
A. Repetitive seizures
B. Focal features
C. Age less than 1 year
D. Long duration between fever and onset of seizure
E. Family history of febrile convulsion
18. Which ONE of the following statements regarding Wernicke’s encephalopathy is FALSE
A.
B.
C.
D.
E.
The mental signs usually occur latest
Ocular palsies begin to improve within hours of treatment with Thiamine
It is also referred to as Dry Beriberi
Delay in treatment may lead to irreversible Korrsakoff’s psychoses
Ataxia is a late finding in the disease presentation
19. Which ONE of the following statements in relation to systemic lupus erythematosis (SLE) is
FALSE
A. Anti-dsDNA helps to confirm the clinical diagnosis of SLE
B. Systemic symptoms including fatigue, fever and weight loss occur in 95% of patients
C. Foetal loss can occur in up to 30% of pregnancies
D. Neurological manifestations are uncommon (<20%)
E. CNS lupus is treated with pulsed methylprednisolone
20. Concerning the pregnant patient, which ONE of the following statements is FALSE
A. Tilting the patient or manually displacing the uterus to the left in late pregnancy prevents aortic
compression with resultant hypotension syndrome
B. The rate of combined intrauterine and ectopic pregnancies occurring together is approximately
1:5000 in patients not receiving fertility treatment
C. Selected patients with an ectopic pregnancy may be managed with medical therapy such as
methotrexate
D. Hyperemesis is characteristic of trophoblastic disease of the uterus such as ‘molar pregnancy’
E. Rhesus-negative mothers may require anti-D Ig following trauma in pregnancy, spontaneous
abortion and ruptured ectopic pregnancy
21. Which ONE of the following conditions is NOT associated with a raised anion
gap metabolic alkalosis
A. Starvation
B. chronic diarrhoea
c.Vomiting with dehydration
D. Thiamine deficiency
E. Salicylate toxicity
22. Which ONE of the following statements is FALSE with regards diabetic
ketoacidosis
A.
B.
C.
D.
E.
Insulin should be continued until the ketosis is cleared
The half-life of intravenous insulin is short ie less then five minutes
Hypophosphataemia is common secondary to urine losses
Beta hydroxybutyrate is detected on a standard urinalysis
Hypokalaemia on presentation necessitates replacement prior to the commencement of insulin
23. Which ONE of the following statements is FALSE with respect to Addisonian crisis
A.
B.
C.
D.
Dexamethasone is the preferred corticosteroid if the diagnosis is in doubt
A serum sodium: potassium ratio of less then 25:1 is suggestive of Addison’s disease
The serum ionised calcium level is often normal
The ECG manifestations of severe hypoadrenalism include signs of slow conduction with large
voltages in the precordial leads
E. White cell count abnormalities may be seen
24. Which ONE of the following statements is FALSE with respect to hypokalaemia?
A.
B.
C.
D.
E.
Rhabdomyolysis can occur if the serum potassium is less then 3 mmol/l
The corrected QT interval is prolonged
Prolongation of the PR interval
Can be the cause of atrial fibrillation
Can lead to renal diabetes insipidus
25. Which ONE of the following is NOT used in the emergency management of
hypercalcaemia
A.
B.
C.
D.
E.
Normal Saline
Corticosteroids
Thiazide diuretics
Bisphonates
Phosphate binders
26. In prophylaxis following HIV exposure, which ONE of the following is TRUE
A. Prophylaxis is not recommended following exposure from patients with normal CD4 counts
B. Triple therapy is recommended in all cases, if prophylaxis is to be used
C. HIV testing should be continued for 12 months, following exposure
D. Prophylaxis should commence within 6 hours of exposure for maximum benefit
E. Muco-cutaneous exposure should not be considered for prophylaxis
27. With respect to febrile children, which ONE of the following statements is FALSE
A. Contamination rates of blood culture specimens with skin flora is 5-10%
B. A positive bag urine is not diagnostic of a UTI
C. Unwell, toxic children aged between 3 months and 3 years with a temperature >38 degrees
Celsius should be admitted and treated with empiric antibiotics
D. A white cell count of 10 x 106 /L in a neonatal CSF specimen is a positive result that requires
antibiotic treatment
E. Intravenous ceftriaxone can be used as empiric therapy in febrile children with a high suspicion
of bacteraemia but no identifiable source
28. With respect to upper airway obstruction, which ONE of the following statements is FALSE
A.
B.
C.
D.
In adult epiglottitis stridor is present in 60% of patients
Inability to tolerate the supine position is a sensitive sign of significant upper airway obstruction
Ludwig’s angina is the most common neck space infection in adults
In needle aspiration of a peritonsillar abscess, care must be taken to avoid puncturing the
carotid vessels
E. In clearing a foreign body upper airway obstruction in an infant abdominal thrusts should be
avoided
29. An 80-year-old female requires manual reduction of her Colle’s fracture. Which ONE of the
following statements is TRUE
A. The dose of prilocaine 0.5% for a Bier’s block is 4mg/kg
B. Prilocaine cardiac toxicity most commonly results in a ventricular tachycardia
C. The cuff for a Bier’s block should be inflated to a maximum of 50mmHg above the patient’s
systolic BP
D. A complete plaster of paris should be applied with three point moulding to maintain the position
of the reduction
E. An inability to cooperate is a major precaution to performing a Bier’s block in children
30. Select the ONE TRUE answer. Prognosis in non-traumatic coma
A. Is extremely poor when renal failure is associated with coma
B. Is better for structural lesions than hepatic encephalopathy
C. Is worse in patients with coincident shock
D. Is just as poor in drug overdose as in other causes
E. Is such that most patients go on to recover and lead an independent existence
31. A five-year-old boy has a diagnosis of post –meningitis epilepsy for which he is taking phenytoin.
He is brought to the ED by his parents who state that he is “walking funny”, and that he complains of
headache. He is afebrile with normal vital signs for age. Which ONE of the following is NOT an
immediate procedure done from the ED for this case
A. Check Serum phenytoin
B. Cranial CT
C. Administer paracetamol
D. Lumbar Puncture
E. Check Electrolytes
32. Intramuscular ketorolac could be safely used in which ONE of the following circumstances
A. Haemophilia
B. Lactation
C. Anticoagulant therapy
D. Suspected drug-seeking behaviour
E. Renal failure
33. A 35-year-old aboriginal man is brought to the ED one minute after collapsing in the hospital
foyer. He is GCS 3 with no output, asystole on monitor, and CPR is in progress. He has a dialysis
fistula present at the left wrist. Which ONE of the following medications will be LEAST likely to
increase the chance of successful resuscitation
A. Calcium
B. Bicarbonate
C. Amiodarone
D. Glucose
E. Insulin
34. A 72-year-old man presents to the ED complaining of fever and lethargy. He suffers from smallcell lung carcinoma, and is two weeks into his latest course of chemotherapy. He is febrile to 40.5
degrees centigrade, and has a peripheral WCC of 2, with Neutrophils of 0.5. Which ONE of the
following is NOT usually a drug of choice in this situation
A. Gentamicin
B. Timentin
C. Ceftazidime
D. Penicillin V
E. Vancomycin
35. A 35-year-old alcoholic man from Darwin presents to the ED complaining of dysuria and fever,
and supra-pubic abdominal pain. He is febrile to 39.5 degrees celcius with normal vital signs.
Dipstick urinalysis reveals 3+ Leucocytes, trace haemolysed blood, 2+ Protein. Investigation and
treatment should include which ONE of the following
A. Urinalysis and culture
B. Prostatic Ultrasound
C. Gentamicin
D. Blood Culture
E. All of the above
36. Which ONE of the following statements concerning soft tissue infections or wounds is FALSE
A. Patients with fasciitis manifest moderate to severe systemic toxicity, often out of proportion to the
cutaneous findings, with high fever, tachycardia, anxiety, disorientation and often frank shock.
B. Early periorbital cellulitis in an adult may be treated with oral antibiotics and followed up on an outpatient
basis, whereas orbital cellulitis requires hospitalisation and intravenous antibiotics
C. The treatment of cutaneous abscess is incision and drainage. Antibiotics are not indicated in patients with
normal host defences
D. Tetanus prophylaxis is indicated for any wound in a patient who has been fully immunised, if the time
since last vaccination is greater than five years
E. All human bites to the hand including equivalent clenched fist injuries require prophylactic treatment with
antibiotics
37. In the management of acute ischaemia of the lower limb, which ONE of the following is FALSE
A.
B.
C.
D.
Patients with microemboli are anticoagulated for up to 5 days
Urokinase is superior to streptokinase because of lower complication rates
Therapy should commence within 12 hours of onset of ischaemia
Contraindications to thrombolytic therapy are the same as those for myocardial infarction
thrombolysis
E. Embolic ischaemia is best treated by surgical intervention
38. Regarding thromboembolic disease, which one of ONE the following is TRUE
A.
B.
C.
D.
E.
D-dimer has negative predictive value only in patients with low pre-test clinical probability
Plesythmography is superior to ultrasound in diagnosis of thrombosis in the lower limb
Pulmonary emboli can arise from organised clot
50% of all fatal emboli come from thromboses in the calf
CT pulmonary angiography must be performed within 24 hours of embolisation to the lungs.
39. Concerning the indications for CT scanning in minor head injuries, which ONE of the following is
TRUE
A.
B.
C.
D.
E.
CT scanning is not recommended in children with a GCS of 10 or greater
Post traumatic amnesia is not an indicator for CT findings
Patients with a GCS of 15 don’t require CT scanning
Focal neurological deficit is an absolute indicator for CT scanning
CT is indicated in all patients over 70 years of age with dementia.
40. When investigating patients with possible subarachnoid haemorrhage, which ONE of the
following is TRUE
A. Brain CT without contrast is the initial investigation of choice
B. Xanthochromia can be reliably detected by visual inspection
C. MRI is a reliable tool for detecting small aneurysms
D. CT has a sensitivity of only 10% at 7 days post haemorrhage
E. A positive D-dimer on CSF is not diagnostic
41. In supra-condylar fractures in children, which ONE of the following is FALSE
A.
B.
C.
D.
E.
Supra-condylar fractures are more common in children than in adults
95% are displaced posteriorly
In some undisplaced fractures the fracture line may not be visible on x-ray
Displaced fractures should be treated initially by closed reduction
Neurovascular compromise is uncommon
42. Concerning painful hips in children, which ONE of the following is TRUE
A. Acute transient tenosynovitis is the commonest cause of hip pain in children less than 10 years
of age
B. Legg-Clave-Perthes disease is bilateral in 25% of cases
C. A raised ESR is diagnostic of septic arthritis
D. Slipped capital femoral epiphysis is more common in females
E. MRI is less sensitive than bone scan in detecting avascular necrosis
43. Regarding vertebral fractures, which ONE of the following is FALSE
A.
B.
C.
D.
E.
Bilateral interfacetal dislocations occur in flexion
Chance fractures are not commonly associated with abdominal injuries
Clay-shoveler fractures are the least unstable of cervical spinal fractures
Up to 40% of cervical fractures are associated with neurological injury
Wedge fractures of the lumbar spine rarely have associated neurological injury.
44. Concerning back pain, which of ONE the following is TRUE
A.
B.
C.
D.
E.
Sciatica is pain radiating from the back to above the knee
Loss of anal tone is a reliable indicator of cauda equina
Epidural abscesses are common in intravenous drug users
A positive Laseuge’s sign indicates nerve root irritation
Spondylosis is not congenital
45. Regarding injuries of the lower limb, which ONE of the following is FALSE
A.
B.
C.
D.
E.
10% of dislocations of the hip are anterior
Dislocations of the knee often reduce spontaneously
Ottawa ankle rules include tenderness along the anterior of the distal tibia
Sever’s disease is an overuse injury of the Achilles tendon insertion
Osteochondral fractures of the talus commonly occur over the medial portion