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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