1



MCQ: 60 questions, 90 minutes (90 sec per q), 1 best answer, +ve marking

1/3 MED, 1/3 SURG + O&G, 1/3 the rest. 25% PAEDS.

These MCQs are from a variety of sources. No responsibility is accepted for mistakes or inaccuracies. Use and share them freely but at your own risk.

Apologies for missing/nonsense/repeat questions, and remember to read the question carefully in the real exam, because different variations of the same questions occur. Also note that syllabuses, textbooks and question banks change with time, so some of these questions may now be obsolete.

1. A 68-year-old woman presents to ED with “blue skin”, headache and nausea. She denies chest pain, dyspnea or syncope. She recently started taking isosorbide dinitrate (40mg qid). BP = 135/80, RR18/min, PR 88/min, T = 37˚C. O/E The patient is markedly cyanotic, has laboured respirations and speaks in full sentences. Lungs are clear to auscultation. Administration of 100% oxygen does not change her cyanosis or clinical condition. Arterial and venous blood are a chocolate brown colour. Which of the following is the most likely diagnosis:

a. Carbon monoxide poisoning

b. Cyanide toxicity

c. Methaemoglobinaemia

d. Myocardial infacrction

e. Pulmonary embolism

2. Which of the following treatments is indicated for a 19-year-old male with acute spinal cord transaction at L1 and normal vital signs:

a. Clonidine

b. Dopamine

c. Hyperbaric oxygen

d. Methylprednisolone

e. Naloxone

1. Question about LP results:

130 Neutrophils

20 Lymphocytes

30 Monocytes

Gram positive rods

Answer is Listeria

Gram stains:

Strep pneumonia: gram +ve diplococcus

Meningococcal: gram –ve diplococcus

E Coli: gram –ve rods

Listeria: GP rods

2. 24year female with syncope and abdo pain

Which exludes ectopic

a) Negative betaHCG

b) USS with intrauterine sac

c) Absence of shoulder tip pain

d) ?

e) None of the above

3. Warfarin, Which is true

a) Barbituarates decrease anticoagulant effect

b) Absorbed erractically

c) Factor II half life 5/7

Decrease: barbiturates, rifampicin, diuretics, hypothyroidism

Increase: amiodarone, metronidazole, trimethoprim-selfamethoxazole, aspirin, cephalosporines, hyperthyroidism

Factor Half lives VII, IX, X, II are 6, 24, 40, 60 hrs respectively

100% bioavailability

“PILATES”

Pesticides & Petroleum products

Ionic compounds for example

Lithium

Arsenic & Cyanide

Toxic Alcohols for example

Ethylene Glycol & Methanol

Strong Acids and Alkalias

5. 30yr NZ man goes to PNG, takes 300mg chloroquine weekly for 2 weeks prior and 4 weeks post his trip. 3/12 later gets febrile/sweats/maleana with malaria parasites on film. The following is true

a) He took ½ the normal dose of chloroquine

b) If he took primaquine for 2/52 this wouldn’t have happened

c) Assume chloroquine resistance and treat accordingly

d) This is probably p. falciparum

e) ?

Prophlylaxis: short stay chlorquine sensitive area: 250mg, weekly, 1/52 prior & 4/52 post

Chloroquine resistant area: mefloqine 250mg, weekly, 1/52 prior, 4/52 post

Areas of resistence: East Africa, PNG, Thailand, Vietnam, Philippines

If severe assume p. falciparum

Severe = ALOC, jaundice, oliguria, severe anaemia, severe hypoglycaemia, vomiting, acidosis, level > 10%

6. In a mass casualty incident, which would NOT be a high priority?

a) GCS 5 & head injury

b) Bilateral closed femur#

c) Penetrating abdomen injury

d) ?

e) none of the above

7. 22 year old paraplegic presents with headache/sweating/BP 220/140

? options

Autonomic dysreflexia

HTN, Headache, sweating/blotchy skin above spinal level, cold/clammy skin below level, nasal stuffiness, nausea, bradycardia

Precipitants: bladder, bowel, skin, sex, acute abdo, #

Treatment – relieve cause, control BP (GTN, hydralazine), prevent stimulation (lignocaine jelly for pr), monitor 2hrs once relieved

8. 6 year old with septic arthritis

a) BC seldom positive

b) H. Infl is commonest cause

c) Treatment is instillation of Abs into joint

d) Treatment is Abs and surgical drainage

e) Usually spreads from adjacent OM

Children: S. aureus, Grp A Strep (Grp B in neonates), H. Influ

Adults: Gonorrhoeae & Staph

Older adults: Staph, Gram –ve, Grp A Strep

BC positive in 50%

Haematogenous seeding most common

Direct spread from trauma less common

Diclox for treatment + surgical drainage

9. 34/40 with abdo pain, PV bleeding, BP 90/-

Which is wrong?

a) Praevia unlikely

b) PV should be done

c) Blood loss leg

Contralateral hemiplegia, hemisensory loss

Eyes deviated to side of lesion

Speech and comprehension preserved if non-dominant lobe

Posterior inferior cerebellar artery CVA/vertebrobasilar infarction

Cranial nerves

Cerebellar signs

Nausea & vomiting

Visual neglect

Crossed deficits

19. Most common manifestation of phenytoin toxicity

? nystagmus

CNS: dizziness, tremor, nystagmus, agitation, confusion, coma

PNS: peripheral neuropathy, urinary incontinence

Hypersensitivity reactions: eosinophilia, rash

GIT: n&v

Skin: hirsutism, acne, steven johnsons

Other: gingival hyperplasia, coarsening of facial features

Propylene glycol (dilutent): vasodilator, myocardial depressant, hyperosmolality, lactic acidosis

20. Half life of 5% albumin

5 days * correct answer

Albumin 5%

T ½ = 5 days

140mmol Na, 125mmol Cl, 0.12 nnik J

Haemaccel/Gelofusine

Na 145, Cl 145, K 5.1, Ca 6.25 - so watch for increased K & Ca

T ½ 4 hours

2/3 remains intravascular

85% renal excretion

0.14% risk of allergy

Hartmanns

Na 131, Cl 111, K 5, Ca 2, lactate 29, pH 6.9, so watch out for lactic acidosis, increase Ca & K

Theoretical risk of clot formation with blood transfusion.

4% Dextrose with 1/5 N/Sal

Na 30, Cl 30, dextrose 40g,

N/Sal

Na 150, Cl 150, pH 5.3

3% Saline

100ml = 50mmol Na

21. Kidney stones

a) 90% pass spontaneously in one month *correct answer

90% radioopaque

50% recurrence in 5 years

rare to present for first time > 60yrs

admit: obstruction, failure, pain, infection

22. C7 on T1 subluxation you would see

a) Hunching of shoulders Accessory CN, C1-5

b) Horner’s (sympathetic supply, cervical C8, T1, T2)

c) Numbness of back of forearm and wrist T1

23. Burns: ½ head, ½ of one arm and leg ? %

Head 9%

Arm 9%

Leg 18%

Front & Back Thorax/Abdomen 18% each

24. Drug metabolism

a) Polar molecules cross mucous membrane easily

b) Drug metabolism tends to make molecules more polar

c) A base is less ionized in an acidic environment

This is a toxicology question in disguise! Has to do with enhanced elimination in toxicology.

Metabolism tends to make lipolphilic drugs more polar (more excretable by the kidney) as ionized drug aren’t reabsorbed.

Bases (ie most drugs), more ionized in acid environment so they are ‘trapped’ in acid urine and not reabsorbed. And acid drugs are more ionized in alkaline environment

Polar molecules tend not to cross mucous membranes

25. Typical causes of nephrotic syndrome…

Not sure what the list was but causes include

Nephrotic

Minimal Change Ds

Membranous GN

Focal Glomerulosclerosis

Membranoproliferative GN

Diabetic nephropathy

Rare: SLE, amyloid, gold, captopril, bacterial endocarditis, malaria, malignancy, allergic reactions

Nephritic

Acute post strep GN

Post infectious GN

Multisystem Ds: HSP, Goodpastures, vasculitis, SLE

Primary Glomerular Ds: IgA nephropathy

Guillian Barre Syndrome

26. Plasma volume and Plasma:RBC ratio is 70kg

a) 70ml/kg; 45:55

b) 78ml/kg; 50:50

c) 63ml/kg; 50:50

d) 78ml/kg; 45:55

TBW 60% of body weight

Plasma volume 5% of body weight = 70ml/kg

Or blood volume is approx 5.5L in 70 kg = 78ml/kg!

Haematocrit is the packed cell volume= 0.45, Plasma volume = 1 – Hct = 0.55

27. Pt with tender painful neck & numbness in fingers. First Action

a) X-ray

b) Neuro evaluation

c) Immobilize/stabilize neck ** of course!!

28. Nitrous oxide. Why is it rapidly acting?

solubility

29. Nitrous oxide. Properties

a) Colourless

b) Odourless

c) Contraindicated in severe COAD

d) Contradindicated in pregnancy (only in prolonged use)

e) All of the above **

30. Cavitating lesion

TB

Staph

Anaerobes

Cancer

If multiple think bacterial endocarditis

Bronchial obstruction

Aspergillosis

31. Pt was exposed to 300 rad (3 Gy) you would expect to see

a) Nausea

b) Nausea and vomiting

c) Nausea, vomiting & Diarrhea

d) Nothing

Probably d)

32. Inability to touch the base of the little finger with the thumb implies damage to which nerves

a) Radius

b) Ulna

c) Median

d) Median & ulna

Median is thumb to little finger and adductor pollicis

Radius is wrist extension

Ulna is little finger Abduction

33. Patient with decreased reflexes in legs, UL weakness. Features against Amyotrophic Lateral Sclerosis?

Clinical features include:

Mixed UMN & LMN signs

LMN: weakness, atrophy, fasiculations, dysarthria, dysphasia,

UMN: limb spasticity, Babinski sign, hyperreflexia Brisk jaw jerk

MCQs

1. A 43 year old man is receiving positive pressure ventilation on a respirator following a road traffic crash. His ABG shows a pH 7.54, PC02 28mmHg, P02 87mmHg, Bic 16 mmol/L.

This blood gas shows:

a) pure respiratory alkalosis

b) respiratory alkalosis and hypoxaemia

c) respiratory alkalosis and metabolic acidosis ?

d) mixed respiratory and metabolic alkalosis

e) metabolic alkalosis with partial respiratory compensation

2. All of the following can be used in the management of stable VT EXCEPT:

a) Lignocaine

b) Isoprenaline ?

c) Adenosine

d) Sotalol

e) Amiodarone

3. Formation of acetone occurs in poisoning with:

a) ethanol

b) methanol

c) Ethyleneglycol ?

d) isopranolol

e) acetaminophen x

4. In statistics an alpha level of 0.001 means:

a) the study is overpowered

b) the study is underpowered

c) that it is very likely that a type 11 error has occurred

d) the probability of incorrectly accepting the null hypothesis is 1 in

1,000

e) the probability of incorrectly rejecting the null hypothesis is 1 in

1,000

5. In clinical trials the method of CPR with the best clinical outcome is:

a) conventional CPR

b) simultaneous compression ventilation CPR ?

c) active compression decompression CPR

d) interposed abdominal compression CPR

e) none of the above is better than the others

6. Uncuffed endotracheal tubes should be used for:

a) tube sizes less than 6mm ?

b) acute epiglottis

c) blind nasotracheal intubation

d) intubations with a Macintosh blade

e) known fractured base of skull

7. Cricoid pressure was first described by:

a) Mendelson

b) Danzi

c) Sellick ?

d)Tintinalli

e)Meller

8. Homozygous pseudocholinesterase deficiency occurs in:

a) 1 in 150

b) 1 in 500

c) 1 in 1,000

d) 1 in 3,000 ?

e) only those of Anglo Saxon descent

9. All of the following drugs can be used in rapid sequence induction EXCEPT:

a) atropine

b) fentanyl

c) isoflurane

d) atracurium ?

e) ketamine

10. The likely intact survival rate in paediatric cardiac arrest is:

a) less than 1 %

b) less than 10%

c) less than 25% ?

d) greater than 50%

e) worse if there is associated respiratory arrest

11. In paediatric resuscitation:

a) endotracheal is the preferred route of drug administration x

b) the dose of adrenaline is up to . 1 mg/kg x

c) sodium bicarbonate is used at a dose of 5meq/kg x

d) the airway will be improved by neck flexion x

e) defibrillation is at a dose of 0.5 joules/kg ?

12. The following blood gases pH 7.17, PC02 59, Bic 21, P02 130 are most

likely to be consistent with:

a) diabetic ketoacidosis

b) diuretic overdose

c) premature twin baby

d) camphor ingestion with seizures

e) oliguria and renal failure

13. Normal saline contains sodium at:

a) 162 mEq/L

b) 154 mEq/L ?

c) 145 mEq/L

d) 130 mEq/L

e) 110 mEq/L

14. All of the following are reactions to blood transfusion EXCEPT:

a) hypercalcaemia ??

b) hyperkalaemia

c) increased haemoglobin oxygen affinity

d) haemolysis

e) hypothermia

15. One of the differences between morphine and pethidine relates to:

a) analgesic efficacy

b) route of metabolism

c) ability to suppress cough

d) histamine release effects

e) abuse potential ?

16. Nitrous oxide can be safely used in a patient with:

a) joint pain after diving x

b) severe COAD x

c) paralytic ileus x

d) penetrating chest trauma x

e) traumatic retinal detachment ?

17. A one year old child would be expected to have a pulse of:

a) 150

b) 140

c) 130

d) 120 ?

e) 110

18. For blood pressure determination in a 6 year old child the cuff width should be:

a) 3cms

b) 4cms

c) 5cms

d) 6cms ?

e) 7cms

19. During pregnancy:

a) CVP gradually decreases

b) oxygen reserve increases by about 20%

c) diastolic blood pressure rises in the first trimester x

d) gastrointestinal motif ity increases ?

e) blood volume increases by about 20% by term x

20. The strongest wound suture is:

a) silk ?

b) prolene

c) chromic cat gut

d) nylon

e) mersilene

21. Tetanus:

a) typically has an incubation period of 2-3 days

b) immunization status is particularly poor in elderly women ?

c) toxoid is more effective by S.C. injection

d) IgG will provide passive protection for about a week

e) immunisation is not safe in pregnancy

22. Oesophageal foreign bodies can be treated with all of the following

EXCEPT:

a) foley catheter

b) sodium bicarbonate

c) papain

d) glucagon

e) tartaric acid ?

23. The Glasgow Coma Scale:

a) is a poor predictor of survival in head injury

b) allocates a score of 3 to pain withdrawal response x

c) is the major component of the Revised Trauma Score ?

d) is not suitable for use by trained first aiders

e) was developed in the New England regional trauma system

24. The commonest site of mandibular fracture is:

a) coronoid process

b) symphysis

c) condyle

d) ramus ?

e) body ?

25. With regard to spinal injuries:

a) the Jefferson fracture is a vertical compression injury ?

b) the Jefferson fracture is usually stable x

c) the Clay Shovelers fracture is unstable x

d) the Hangmans fracture is an extension tear drop injury x

e) the Chance fracture typically occurs at the cervicothoracic junction x

26. In spinal injuries the central cord syndrome:

a) is a result of forced hyperflexion ?

b) occurs typically in those with degenerative arthritis

c) will be more clinically apparent in the lower limbs x

d) will produce ipsi lateral motor paralysis x

e) will have position and vibration sense preserved x

27. In attempted self hanging:

a) cervical fractures are common x

b) death usually occurs from arterial obstruction

c) steroids will prevent delayed cerebral oedema

d) ARDS may often be seen in survivors ?

e) long-term injury is rarely seen in survivors

28. Sternal fractures:

a) are more likely in the over 65 age group ?

b) have a 25% associated mortality

c) mandate 24 hours of cardiac monitoring

d) do not develop flail segments

e) are prevented by seat belt use

29. Pericardial tamponade:

a) will lower CVP below 5cm of water x

b) is common with severe blunt chest trauma x

c) may produce pulsus paradoxus ?

d) usually presents as Becks triad x

e) produces RBBB on the ECG x

30. Major pancreatic injury:

a) will be excluded by a normal serum amylase

b) presents with minimal abdominal signs initially ?

c) will nearly always be detected by peritoneal lavage

d) is the second most common organ injury in penetrating trauma

e) is the third most common organ injury in penetrating trauma

31. Peritoneal lavage:

a) is absolutely contraindicated in pregnancy

b) requires a RBC count of >100,000 per mm3 to be considered positive

c) has a complication rate of 5 - 10%

d) has a high sensitivity for renal injuries ?

e) has a false positive rate of 2 - 5%

32. With regard to orthopaedic injuries:

a) the Salter Barns system classify metaphyseal injuries

b) the Lis Franc injury is a tarso metatarsal fracture dislocation ?

c) the Chance fracture is usually unstable x

d) the Chauffeurs fracture involves the ulna styloid x radial styloid

e) the Barton fracture involves the distal articular surface of the ulna x anterior radius

33. Colles fracture:

a) results from forced flexion of the wrist x

b) will often involve the articular surface of the radius

c) is the reverse of a Smith’s fracture ?

d) is more common in men x post menopausal women

e) is associated with fractured ulna styloid in about 20% of cases

34. A posterior elbow dislocation:

a) is reduced by traction and extension x traction and flexion

b) will frequently cause neurovascular compromise x rare

c) is mobilised at 3 - 5 days post injury x 2 – 3 weeks

d) rarely reduces spontaneously ?

e) is caused by a fall on a supinated hand x extended abducted

35. Paediatric septic arthritis:

a) is usually due to haemophilus influenzae x probably not any more

b) is empirically treated with ceftriaxone or cefotaxime alone

c) will show a joint aspirate cell count of > 10,000 mm3 ?

d) will show a joint aspirate with increased viscosity x low

e) can often be diagnosed on plan radiography x

36. Toxic shock syndrome:

a) will often manifest without fever x fever >38.9

b) is a misnomer because BP is often maintained x hypotension or orthostatic hypotension

c) is caused by pseudomonas species x staph

d) often produces elevated creatinine kinase

e) produces a discrete papular rash ?

37. Positive predictive value is:

a) true positives divided by true positives plus false positives

b) true negatives divided by false negatives plus true negatives

c) false positives divided by false positives plus true negatives

d) true positives divided by true positives plus false negatives ?

e) test positives divided by true positives

38. Erysipelas

a) responds to erythromycin ?

b) is caused strep pneumoniae ?

c) results from microorganism exotoxin production x

d) typically occurs on the neck x

e) shares a similar aetiology to toxic epidermal necrolysis x

39. Appropriate first aid management of brown snake envenomation includes:

a) arterial tourniquet

b) suction drainage of the wound

c) wound incision

d) aspirin 300mg orally

e) splinting of the joint above the injury ?

40. Box jellyfish envenomation:

a) can be treated prehospital with IV antivenom ?

b) involves tetrodotoxin like blue ringed octopus x

c) is minimised by washing of nematocysts with fresh water x vinegar

d) can occur as far south as Sydney in mid summer x north qld

e) causes death by fulminant hepatic failure x

41. Using the Parkland formula in burns management:

a) metabolic acidosis is allowed to persist

b) SSD cream is applied at the rate 2gm / % area burnt

c) skin grafting can be predicted for burns >10% surface area

d) 4ml / kg / % body surface burn is per day burns replacement ?

e) half the total requirement is given in the first 4 hours

42. In hypothermia:

a) J waves are best seen in leads Ill and AVF x precordial

b) atrial fibrillation is the commonest rhythm below 320C ?

c) insulin at reduced dose is the treatment of choice for hyperglycaemia

d) alcohol is to a degree thermoprotective x

e) rewarming with bypass carries the highest risk of core after drop

43. The most effective method of cooling in heatstroke is:

a) IV dantrolene x

b) cold IV fluids

c) cooling blankets

d) ice packs in the groin and axillae

e) fan and sponge with tepid water ?

44. The following drugs can be used in the treatment of true heat stroke:

a) chlorpromazine ? to inhibit shivering

b) phenobarbitone ? for seizures

c) mannitol ? for ICP

d) NaHC03 ? if rhabdo

e) all of the above ?

45. In lightning injury:

a) in a mass casualty situation the apparently dead nearly always die x priority is those in arrest

b) in an arrested patient cardiac massage is the highest priority x

c) tympanic membrane rupture is common ?

d) the classic skin burn resembles an inverted pine tree pattern x feathering

e) myoglobinuric renal failure is a common sequelae

46. In near drowning:

a) fresh water immersion is treated with hypertonic saline 101

b) altered mental status on ED arrival is a grave prognostic sign

c) those who die usually aspirate less than 20ml / kg

d) sudden death on immersion is due to vocal cord spasm

e) prophylactic antibiotics (e.g. ceftriaxone) are used routinely

47. In asthma:

a) the white blood cell count will often be elevated

b) the ECG may show signs of acute left heart strain

c) a CXR should be routine in all patients admitted

d) blood gas results correlate well with pulmonary function testing

e) theophylline dosing needs to be increased if erythromycin is given

48. In a patient with COAD and cor pulmonale, a rapid irregular tachycardia:

a) could be empirically treated with digoxin

b) is well managed with titrated IV beta blocker

c) will be improved by inducing alkalosis

d) nifedipine may provide useful rate control

e) ipratropium is unlikely to increase the heart rate

49. Regarding pleural effusion all of the following are true EXCEPT:

a) can be tapped to make a diagnosis of pancreatitis

b) can be detected radiographically when 10 ml of fluid is present

c) is most commonly caused by congestive cardiac failure

d) can result from rheumatoid arthritis

e) will not produce mediastinal shift

50. Sore throat is caused by all of the following

a) neisseria gonorrheae

b) mycoplasma pneumoniae

c) bacteroides fragilis

d) cytomegalovirus

e) corynebacterium diptheriae

51. Regarding empiric antibiotic therapy in pneumonia:

a) cetazidime is used for atypical pneumonia

b) clindamycin is used for aspiration pneumonia

c) acyclovir is used for post influenza pneumonia

d) erythromycin is used for PCP pneumonia

e) amoxycillin alone is used for neonates with pneumonia

52. Use of amiodarone:

a) causes long term corneal deposits commonly

b) causes hypertension when used acutely

c) is contraindicated in WPW syndrome

d) is likely to decrease digoxin levels

e) has efficacy similar to esmolol in PSVT

53. With regard to pulmonary embolism:

a) pleuritic chest pain is the most common symptom

b) cigarette smokers are at increased risk

c) fever is infrequent

d) thrombolysis is achieved with SK 100,000 units stat

e) the commonest ECG change is right axis deviation

54. ST segment elevation in V6 on a 12 lead ECG could be due to all of the following EXCEPT:

a) a pericardiocentesis needle

b) LBBB

c) hyperkalaemia

d) hypothermia

e) subarachnoid haemorrhage

55. The strongest indication for pacing a patient with AM] is:

a) new RBBB with 1st degree AV block

b) new LBBB with lst degree AV block

c) pre-existing bifascicular block with 1st degree AV block

d) new bifascicular block

e) pre-existing LBBB

56. The clinical trial that showed that patients with acute myocardial infarction manifesting as ST depression on ECG do worse with thrombolysis was:

a) TIMI - 1

b) ISIS-1

c) ISIS - l

d) GISSI

e) GUSTO

57. In a patient presenting with possible thoracic aortic dissection the investigation with the best sensitivity and specificity is:

a) transthoracic echocardiography

b) transoesophageal echocardiography

c) CT scan

d) aortography

e) MRI

58. Henoch - Schonlein purpura:

a) represents a vasculitis of large arteries

b) is most common in spring

c) is usually most obvious on the head and neck

d) will not involve abdominal organs

e) typically occurs in adolescents

59. Axillary vein thrombosis:

a) causes pulmonary embolism in 1 - 2% of patients

b) is best diagnosed by colour flow doppler study

c) has no associated genetic predisposition

d) does not respond to thrombolytic therapy

e) is associated with IV drug abuse

60. The major Jones criteria for rheumatic fever include:

a) chorea

b) erythema marginatum

c) subcutaneous nodules

d) St Vitus dance

e) all of the above

61. A footballer has suffered an injury to one of his upper incisor teeth. On examination there is severe pain and a pinkish tinge visible when fractured tooth is wiped clean. This represents an:

a) Ellis class 1 injury

b) Ellis class 11 injury

c) Ellis class Ill injury

d) Ellis class IV injury

e) Ellis class V injury

62. Cytomegalovirus causes:

a) infantile bronchiolitis

b) retinitis

c) chronic

d) neonatal encephalitis

e) Kaposi’s sarcoma

63. To reduce a temporomandibular joint dislocation:

a) the jaw is gently rocked from side to side

b) the predominate movement required is protraction

c) typically sedation with midazolam or diazepam is required

d) the joint capsule is infiltrated with local anaesthetic

e) the jaw is pushed down and back

64. Toxic epidermal necrolysis:

a) is caused by aspirin

b) is treated with high dose steroids

c) is caused by staph aureus

d) produces a positive Niklosky’s sign

e) all of the above

65. The most common cause of erythema multiforme is:

a) rheumatoid arthritis

b) sarcoidosis

c) tuberculosis

d) herpes simplex

e) pediculosis

66. Traumatic hyphaema:

a) is treated with the patient lying flat

b) may require treatment with IV mannitol

c) rebleed in less than 5% of cases

d) usually leads to glaucoma later in life

e) all of the above

67. A sudden painless loss of vision in a 62 year old male could be treated with:

a) a number 11 scalpel blade

b) nitrous oxide inhalation

c) aminocaproic acid

d) high dose steroids

e) all of the above

68. All of the following substances bind well to activated charcoal EXCEPT:

a) thioridazine

b) atenolol

c) cyanide

d) benztropine

e) tetrahydrocannabinol (THC)

69. In paracetamol poisoning:

a) there are theoretical advantages to giving the antidote at 2 hours post ingestion

b) toxicity is less likely in children than adults

c) the initial dose of N-acetylcysteine is given over 5 minutes

d) N-acetylcysteine is not indicated more than 20 hours post ingestion

e) activated charcoal is not used more than 1 hour after ingestion

70. A patient who presents psychotically disturbed, hot, sweating, and tachycardic is most likely to be poisoned with:

a) promethazine

b) chlorpheniramine

c) dexamphetamine

d) trumpet lillies

e) all of the above

71. Digoxin specific antibodies:

a) can be used to treat oleander poisoning

b) should be used if serum digoxin is >4meq/L

c) are indicated if profound first degree heart block is present

d) should be used if serum potassium is >4.5mmol/L

e) all of the above

72. The best predictor of serious toxicity in TCA poisoning is:

a) drug plasma levels

b) GCS less than 8

c) estimates of ingested drug dose

d) rightward deviation of the QRS vector

e) QRS duration of >100msec

73. Lithium poisoning:

a) is treatable with multidose activated charcoal

b) presents usually as cardiac arrhythmias

c) is treated in part with frusemide

d) is more dangerous if due to chronic poisoning

e) produces ECG changes similar to hyperkalaemia

74. The safest and most efficacious therapy for cyanide poisoning is:

a) sodium thiosulphate

b) amylnitrite

c) sodium nitrite

d) cobalt EDTA

e) hydroxycobalamin

All of the following are major criteria for Kawasaki syndrome EXCEPT:

a) fever > 38.5oC for at least 5 days

b) bilateral conjunctivitis

c) erythematous palms and soles

d) marked cervical lymphadenopathy

e) congestive heart failure

76. A newly born who is limp and non responsive, pale and in which pulses and breathing cannot be easily detected has an APGAR of:

a) 0

b) 1

c) 2 or 3

d) 3 or 4

e) 4

77. The most common cause of death in infants aged 6 to 12 months is:

a) road traffic crashes

b) SIDS

c) Homicide

d) congenital tumours

e) infectious diseases

78. The most common neurologic manifestation of child abuse is:

a) retinal haemorrhage

b) brainstem infarction

c) subdural haematoma

d) brain stem haemorrhage

e) extradural haematoma

79. Epiglottitis:

a) is most common in the third year of life

b) shares a similar aetiology to bacterial tracheitis

c) is more common in males

d) is first manifest by signs of airway narrowing

e) produces a cough in 30% of cases

80. Nebulised adrenaline when used for croup:

a) mandates overnight admission

b) is more efficacious if the racemic mixture is used

c) is reserved for life threatening obstruction

d) is given in 50 times the usual IM dose

e) produces VT in 5% of cases

81. Mycoplasma pneumoniae is the most common causes of pneumonia in:

a) 1 - 4 month olds

b) 4 - 12 month olds

c) 1 - 5 year olds

d) 5 - 10 year olds

e) all of the above

82. Jervell Lange - Nielsen syndrome links:

a) deafness and sudden death

b) VSD and right ventricular hypertrophy

c) PSVT and accessory pathways

d) severe rigors and Lyme disease

e) aganglionosis and colonic dilatation

83. The sensory innervation of the heel can be blocked by local anaesthetic injected:

a) behind the medial malleolus

b) in front of the medial malleolus

c) behind the lateral malleolus

d) in front of the lateral malleolus

e) just lateral to the flexor hallucis longus tendon

84. The daily IV fluid replacement of a 25kg child is:

a) 1200 mls

b) 1400 mls

c) 1600 mls

d) 2100 mls

e) 2600 mls

85. The patient with these electrolytes:

Na+ 144 mmol/L

K+ 4 mmol/L

HCO3 26mmol/L

Cl- 100 mmol/L

could be suffering from all of the following EXCEPT:

a) acute renal failure

b) methanol poisoning

c) lower limb crush injury

d) salicylate poisoning

e) severe diarrhoea

86. The patient with normal lungs and pulmonary gas exchange breathing 40% oxygen at sea level and breathing normally could be expected to achieve an arterial oxygen tension of about:

a) 180 mm Hg

b) 210 mm Hg

c) 235 mm Hg

d) 260 mm Hg

e) 290 mm Hg

87. Hypercalcaemia can be treated with all of the following therapies EXCEPT:

a) IV N saline

b) frusemide

c) chlorothiazide

d) hydrocortisone

e) calcitonin

88. The use of adenosine is contraindicated in a patient:

a) in apparent ventricular tachycardia

b) already treated with beta blockers

c) with sick sinus syndrome in PSVT

d) taking regular theophylline

e) in a patient with a PB of 70/R

89. A patient with an acute AMI, basal crepitations and a third heart sound:

a) fails into Class II in the Killip - Kimball classification

b) has a 5 - 8% expected in hospital mortality

c) is likely to have a cardiac index of 80%

b. Chrons disease involves the terminal ileum most commonly

c.

d.

e.

6) With respect to the 2000 ILCOR guidelines which is most correct

a. Resuscitation in adults and children should be at least 100 compression a minute

b. Newly born neonate compression to ventilation ration is 5:1

c. Health care workers should not assess for a pulse before commencing CPR

d. Initial assessment is in the recovery position

e.

7) Regarding glenohumeral shoulder dislocation

a. Commonest subglenoid

b. Posterior shoulder dislocation occurs in 10%

c. Posterior shoulder dislocation involves compromise of the axillary nerve

d. Hillsachs deformity involves posterior-lateral humeral head fracture

e.

8) Patient sustains a laceration to the volar aspect of the forearm and is unable to adduct thumb and fingers, the most likely nerves injured are

a. Ulna

b. Radial

c. Median

d. Ulna and radial

e. Median and ulna

9) With respect to fluid administration in paediatrics

a. Hypoglycaemia is treated with 1ml/kg 10% dextrose

b. Milk and water administration is at the same volume

c.

d.

e.

10) Regarding acute cholecystitis which is false

a. 2-12% are Acalculus

b. In penicillin allergy it is appropriate to treat with cefotaxime only

c. Is commonly associated with mild jaundice

d. Is associated with cystic duct obstruction

e. Commonly cultured organisms are GN and anaerobes

11) Regarding aspiration pneumonitis which is true

a. Should be treated with high dose IV steroids

b. Commonest organisms involved in community acquired are anaerobes and GNB

c.

d.

e.

12) Regarding transient synovitis

a. Usually have a fever

b. Usually associated with respiratory infection

c. Involves infection of the affected joint

d.

e.

13) Regarding the care of croup with airway obstruction

a. Adrenaline shortens the course of the illness

b. Commonest cause in RSV

c. Steroids modify the illness

d.

e.

14) Regarding PID

a. Trichomonas and Gardnella are commonest organisms

b. Associated with irregular menstruation

c. Absence of fever and cervical excitation excludes diagnosis

d.

e.

15) Regarding bronchiolitis

a. Crepitations are rarely heard

b. Bronchodilators are contraindicated as they increase hypoxaemia

c. Adenovirus infection is more severe than RSV

d. Steroids modify the disease

e.

16) In a patient with epistaxis which is false

a. Nasal packing is contraindicated in children

b. Commonest area involved is Littles area

c. May involve terminal branches of internal & external carotid

d.

e.

17) Regarding intracerebral haemorrhage which is true

a. Cerebellum is most common area

b. Increased incidence at night

c. Increased incidence with alcohol

d.

e.

18) Regarding the tiger snake bite which is false

a. Causes ptosis and respiratory symptoms

b. Rhabdomyolysis

c. Renal failure

d. Coagulopathy

e. Rapid cardiovascular collapse

19) Which of the following is not associated with cystic fibrosis

a. Haematemesis

b. Rectal prolapse

c. Pancreatitis

d.

e.

20) In the treatment of eclampsia, which is most true

a. Magnesium is >90% effective

b. LSCS must be urgently booked in all cases

c. Phenytoin is ineffective

d.

e.

21) Burns admission criteria include all of the following EXCEPT

a. 20% first degree burns

b. Chemical burns to hands, feet and mouth

c. Underlying medical condition which would affect burns management

d. Severe electrical burns

e. Following lightning strike

22) With respect to lightning strike

a. VF is commonest presenting arrhythmia

b. Less than 50% mortality

c. Associated with severe burns

d.

e.

23) Patient presents with HOCM, (pansystolic murmer, split S2, quiet S1, rapid rising pulse, LV hypertrophy)which is correct

a. Propanolol is the treatment of choice

b. Nitrates improve LVF

c. Consistent with severe mitral stenosis

d. Consistent with ? tricuspid regurg

e.

24) Which of the following is least likely to be a cause of abdominal pain in 6-11 year olds

a. HSP

b. Gut malrotation

c. DKA

d. Inflammatory bowel disease

e. Appendicitis

25) Regarding a febrile oncology patient, which is true

a. Increased risk of bacterial infection if neutrophils >500mm3

b. Increased risk of fungal infection with broad spectrum antibiotic administration

c. Line sepsis is most common source

d.

e.

26) Regarding GI bleed, which is true

a. 60% associated with PUD

b. Octreotide is of no additive benefit to sclerotherapy in banding

c.

d.

e.

27) In a 13kg child with iron overdose of 700mg elemental iron which is true

a. AXR will show tablets in over 80% of cases

b. Must wait for all the lab results and TIBG before commencing Desferoximine

c. Something to do with vin rose urine in treatment

d. Something about dialysis clearing desferroximine

e.

28) Regarding acute renal failure

a. Pre-renal renal failure is the commonest cause

b. They cannot have renal failure if they are passing urine

c.

d.

e.

29) Regarding thyroid disease

a. Graves disease is the commonest cause of thyrotoxicosis

b. Hypothyroid patients are heat intolerant and overweight

c.

d.

e.

30) Something to do with overdoses, which is incorrect

a. Ipecuac is not cardiotoxic

b. Paracetamol less toxic in children

c.

d.

e.

31) Regarding otitis externa

a. Pseudomonas is commonest

b. Staph epidermis is commonest

c. Associated with otitis media in many cases

d. Fungal infection causes severe pruritis but minimal pain

e.

32) Regarding hyphema

a. Re-bleeding most commonly occurs day 2-5

b. Admit and lie supine

c.

d.

e.

33) Regarding increased risk of epilepsy in a child with a febrile convulsion, which of the following has the lowest association with developing epilepsy

a. Family history of epilepsy

b. 2 febrile seizures in 24 hours

c. Further febrile seizure in 6 months time

d. Prolonged status with presenting seizure >25 minutes

e. Focal seizure

34) 6 year old has a rose thorn wound. Immunised with DTPz at 2, 4, 6, months, but no more, what is the best form of treatment in ED

a. CDT (no pertussis)

b. DTPa only

c. DTPa and tetanus immunoglobulin

d. Need no further immunization

e.

35) Regarding bone ossification times which is true

a. Lateral epicondyle age 7-9

b. Radial head aged 3-5

c. Medial epicondyle aged 1-3

d.

e.

36) Regarding trauma triage which of the following requires the least immediate transfer to hospital

a. Flail chest

b. 50% burns

c. GCS 5 head injury

d. Closed bilateral lower limb long bone fractures

e. Penetrating abdominal trauma

37) Regarding EDH with is false

a. Less common than SADH in major head trauma

b. Biconvex hyperdensity on CT scan

c. Associated with a lucid period

d. Has close to zero mortality if conscious at time of diagnosis

e. Uncommon in elderly

38) Regarding methanol intoxication which is true

a. ‘Snowstorm’ appearance in visual fields is unique to methanol

b. ethanol is contraindicated in treatment if dialysis is considered

c.

d.

e.

39) Regarding the diagnosis of heat stroke which is true

a. Requires altered level of consciousness for the diagnosis

b. Classic heat stroke is due to overexertion in hot environment

c.

d.

e.

40) Which of the following is an indication not to perform a CT in a child following multi-trauma

a. Unstable

b.

c.

d.

e.

41) Which of the following is most likely to result in a non therapeutic laparotomy following stab wound to the anterior abdomen

a. Generalised peritonitis

b. Fresh blood in the NGT

c. Diaphragm involvement

d. Extravasation of contrast on CT in the upper GI region

e.

42) Regarding CSF which is true

a. Serum to CSF ration of glucose 5 minutes

d. IIb/IIIa has been shown to have no affect on mortality

e. TPA has a higher risk of ICH than SK

45) Which of the following represents a stable c-spine fracture

a. Clay shovellers

b.

c.

d.

e.

46) Which of the following is true with respect to the spinal cord

a. Central cord syndrome

b. Anterior cord syndrome is associated with anterior spinal artery stenosis

c. Anterior cord syndrome is assoc with leg sx > arm sx

d.

e.

47) Regarding amphetamines which is false

a. Associated with early mydriasis

b. May have hypertension and bradycardia

c. Not associated with a withdrawal syndrome

d. Haloperidol is useful for choreoathetosis

e.

48) Regarding arterial thrombi which of the following is false

a. Associated with early paraesthesia

b. Associated with early pain

c. Most thrombi arise form the aorta

d. Commonest site of aneurysm is popliteal

e.

49) Regarding differentiation of dementia with depression which of the following is useful

a. Early loss of short term memory loss

b. Answers all questions with ‘don’t know’

c. Loss of autonomy at home

d.

e.

50) With respect to schizophrenia which is false

a. An associated delusional disorder is characteristic

b. Olfactory hallucinations are common

c.

d.

e.

51) With respect to anal fissures

a. They often point away from the anal verge

b. Originate at anal valves

c. Situated between internal & external shincters

d.

e.

52) With respect to large bowel obstruction

a. Often associated with diverticulitis in the elderly

b. Associated with sigmoid volvulus in children under 2

c.

d.

e.

53) With regards to anaphylaxis which is true

a. Hymenoptera exert effect by direct histamine release

b. Angioedema with pitting oedema differentiates it from anaphylaxis

c. Pruritis is invariably present

d.

e.

54) In the management of narrow complex SVT which is true

a. Calcium channel blockers are contraindicated in WPW

b.

c.

d.

e.

55) Which of the following is true of COPD

a. Associated with decreased compliance

b. Associated with low output cardiac failure

c. Associated with reduced FVC but normal FEV1

d.

e.

ANSWERS

1) The ACHS set of guidelines for emergency department performance indicators include all the following except

? b **audit all missed c-spine fractures or E complaints

2) With regard to abdominal hernias

a. Femoral hernias are more common than inguinal hernias in women. – Femoral hernias are more common in women vs men but they are still less frequent than inguinal hernias in women.

b. Saphena varinx and femoral hernia can only be distinguished at operation. – crap just use a colour flow Doppler

c. Umbilical hernias rarely strangulate. Crap – they frequently complicate in adults but rarely complicate in children less than 4 years old.

d. ** Inguinal hernias may transilluminate – unlikely but not impossible, they need to be fluid filled to transilluminate and this is more common with hydrocoele.

3) Regarding a patient with severe aortic stenosis, diagnosed a long time ago, which of the following is most correct?

a. Will have underlying coronary vessel disease. – Not necessarily

b. **In the event of cardiac arrest will need treatment with fluid. – Preload is important for perfusion pressures

c. Something about ionotropes

d. *Nitrates are absolutely contraindicated. Will cause cardiovascular collapse by decreasing preload but there are no absolutes.

4) Regarding infective endocarditis in an IVDU

a. *Usually presents with fever and respiratory symptoms. – Commonly right sided valvular lesions which embolise to lung.

b. Usually involves mitral valve. Crap – usually invoves tricuspid

c. Commonest organism is staph epi. Crap – staph aueus or strep viridans

d. Negative blood cultures exclude the diagnosis. Crap – they are usually positive but not always especially if bacterial showers are missed.

5) Inflammatory bowel disease, which is correct

a. *Ulcerative colitis needs operation in >80%. Often responds to medical management however risk of colon cancer quite high

b. **Crohns involves terminal ileum most often.

6) With respect to the ILCOR guidelines which is most correct

a. **Resuscitation in adults and children should be at least 100bpm

b. New born compression to ventilation rate is 1:5. Crap its 1:3

c. Health care workers should not assess for pulse before commencing CPR. Crap – this rule is for lay people

d. Initial assessment is in the recovery position. Crap – lie supine and look, listen and feel for breathing

7) Regarding glenohumeral joint dislocation

a. Commonest subglenoid. Crap – commonest anterior and subachromion/subcoracoid

b. Posterior shoulder dislocation occurs in 10%. Crap – it’s about 1%

c. Posterior dislocation involves compramise to the axillary nerve. Crap- posterior dislocations rarely cause any neurological problem. Much more common with anterior dislocations.

d. *Hillsachs deformity involves postero-lat humeral head #. True and reverse Hillsachs is an anteromedial #. A Bancharts lesion is # inferior glenoid margin

8) Patient sustains lac to volar aspect of forearm and is unable to adduct the thumb and fingers. The most likely injured nerves are

a. Ulna – supplies flexor carpi ulnaris, medial ½ flexor digitorom profundis and all the small muscles of the hand except

L lateral lumbricals

O opponens pollisis

A abductor pollicis brevis

F flexor pollisis brevis

9) With respect to fluid administration in paediatrics

a. Hypoglycaemia is treated with 1ml/kg of 10% dextrose. Crap – 10mls/kg 10% dextrose

b. *Milk and water administration is at the same volume

10) Regarding acute cholecystitis which is false

a. 2-12% acalculus. Tintanelli syas 5-10%

b. In penicillin allergy it is appropriate to treat with cefotaxime as a single agent. True – antibiotic guidelines say that anaerobic infection is rare. Recommends Amoxy + gent or cefotaxime/ceftriaxone as single agents

c. Is commonly associated with mild jaundice – true

d. Is associated with cystic duct obstruction. True

e. *Commonly cultured organisms are GN and anaerobes. False – anaerobes rare, gram negs common

11) Regarding aspiration pneumonitis

a. Should be treated with high dose steroids. Can’t find evidence for this

b. *Commonest organisms are GNB and anaerobes. Staph aureus also common in mouth but more so in aspirated saliva than vomit

12) Regarding transient synovitis

a. Usually have fever. Crap – if febrile be suspicious of septic arthritis

b. *Usually associated with respiratory infection. True often occur soon after URTI

c. Involves infection of affected joint. Crap – aseptic transudate

13) Regarding the care of croup with airway obstruction

a. Adrenaline shortens the course of the illness. – Crap, can reduce the risk of need for intubation but doesn’t alter duration

b. Commonest cause is RSV. Crap – mostly paraflu, then RSV

c. *Steroid modify illness. True decreases mortality and need for intubation

14) Regarding PID

a. Trich and gardenerlla are most common. Crap – chlamydia and gonorrhoea. Gardenerella is an STD but not invasive – has clue cells. Trichamonus is an STD with a fishy smell

b. Associated with irregular menses. Bosh

c. *Absence of fever and cervical excitation excludes diagnosis. True seeing as these are criterion of inclusion for diagnosis but known to be notoriously inaccurate

15) Regarding bronchiloitis

a. Creps rarely heard. Bosh – heard frequently and generalized

b. Bronchodilators are contraindicated as they cause hypoxemia. Bosh – but they rarely improve bronchospasm from bronchiolitis – same with atrovent. Neither are proven

c. *Adenovirus infection id more severe than RSV. True – adenovirus is rare but causes severe obliterative disease

d. Steroids modify the disease. Bosh – no proof of this

16) In a patient with epistaxis which is false

a. *Nasal packing is contraindicated in children. Bosh but will need sedation and will pull it out!

b. Commonest area involved is littles – true

c. May involve terminal branches of internal and external carotid – true

17) Regarding intracerebral haemorrhage which is true

a. Cerebellum is most common area. Bosh. Putamen> thalamus> pons> cerebellum

b. *Increased incidence at night. Don’t know but more likely with trauma and increases in BP which are more likely to occur during day

c. **Increased incidense with ETOH. True – cerebral atrophy + increased risk of accident + coagulopathic

18) Regarding tiger snake bite which is false

a. Causes ptosis and respiratory symptoms. True causes paralysis and coagulopathy

b. Rhabdomyalysis. True – can be severe with tiger snake

c. Renal failure – tru due to rabdo

d. Coagulopathy – true

e. *Rapid cardiovasc collapse. Bosh none of the snake bites do this – it is more typical of anaphylaxis

19) Which of the following is not associated with cystic fibrosis

a. *Haematemasis. – why would this occur. Haemoptysis common

b. Rectal prolapse – 20% untreated infants and toddlers

c. Pancreatitis – not common but due to sludging in pancreatic duct can lead to autodigestion. The reasoning for pancreatic suppliaments is due to blockage rather than lack of production

20) In the treatment of eclampsia which is true

a. *Magnesium is >90% effective – sounds about right

b. LUSCS must be urgently booked in all cases. Bosh – never all

c. Phenytoin is ineffective. Bosh- it is effective but considered second line

21) Burns admission criteria include all the following except

a. *20% first degree burns. Superficial burn >25% may require admission

Indications to admit = >5% full thickness, >10% partial thickness, circumferential, airway, mouth, hands, feret and genitalia, chemical burns, comobidities, electrical and lightening strikes

22) With respect to lightening strike

a. VF is commonest presenting arrythmia. Bosh – they get asystole first up. AC can cause fibrillation but large DC usually causes asystole

b. *Less than 50% mortality. Definitely less than 50 Dunn says 500/mm – no < 500

b. *Increased risk of fungal infection with broad spectrum antiobiotics – this is true for any one but especially immunocompromised

c. Line sepsis is most common source – false, it can be a source but it is more frequently due to UTI> chest

26) Regarding GIT bleed which is true?

a. *60% associated with PUD – true according to tintanelli

b. Octreotide is of no added benefit to sclerotherapy in banding – I presume this is talking about oesophageal varacies where octreotide has a proven and important role either alone or in combination with other treatments

27) In a 13kg child with an iron OD 700mg elemental iron which is true.

50mg/kg is a moderate OD (proteus >aspegillus

b. Staph epi is commonest – bosh staph aureus is 2nd most common

c. Associated with otitis media in many cases – this is rare, 2 different mechanisms involved

d. Fungal infection causes severe pruritis but minimal pain = otomycosis 10%, often immunocomp. No difference in presentation

32) Regarding hyphaema

a. *Rebleeding most commonly btn day 2-5. True esp in kids

b. Admit and lie supine. False – lie at 30 degrees

33) Regarding increased risk of epilepsy, which of the following has the lowest association with developing it?

a. Family history = increased risk

b. **2 febrile seizures in 24 hours = slightly increased risk – would make you a little suspicious

c. *Further febrile seizure in 6 months = cant find this in the books, maybe?

d. Prolonged status = red flag – not a simple febrile seizure may have CNS infection

e. Focal seizure = red flag – something else going on

34) A 6yo has a rose thorn wound. Immunized DTP at 2, 4 and 6 months but no more, what is the best form of treatment in ED

IG only if hasn’t had 3 at some point in life – otherwise just a tet tox

If >5 years and dirty wound DTP (kids 8

If > 10 years boosters for all

a. CDT only

b. **DTPa only

c. DTPa + IG

d. Nil needed

35) Regarding bone ossification times

CRITOE 1,3,5,7,9,11

a. Lateral epicondyle 7-9. No 11

b. **Radial head 3-5. sounds right

c. Medial epicondyle 1-3. No 5

36) Regarding trauma triage which of the following requires the least immediate hospital transfer

a. Flail chest = life threat

b. **50% burns = no immediated life threat, takes a while for fluid loss. Depends where they are

c. GCS 5 = life threat

d. *Closed bilateral long bone # = high priority, could wait but limb threatening

e. Penetrating abdo trauma = needs urgent theatre

37) Regarding extradural haemorrhage which is false

a. Less common than subdural in major head trauma. Incidence SDH 30% vs EDH 0.5%. Subarach = 40% and IC bleed = 40%

b. Biconvex hyperdensity on CT = true

c. Associated with lucid period. = true

d. *Has zero mortality if lucid at time of diagnosis = almost true

e. Uncommon in the elderly = true dura firmly attatched to skull

38) Regarding methanol intoxication which is true

a. **Snow storm in visual fields is unique to methanol. Formaldehyde/Formic acid with wide osmolar gap and wide agap metabolic acidosis

b. Ethanol contraindicated if dialysis is considered. False – dialysis will take off the ETOH but is not contraindicated

Other stuff – can use 4 methyl pyrazole as antidote

Ethylene glycol – glycoaldehyde-glyoxylic acid – oxilic ascid and formic acid. Nephrotoxic + hypocalcaemia

39) Regarding the diagnosis of heat stroke which is true

a. *Requires an altered level of consciousness for diagnosis. True also temp >41

b. Classically caused by overexertion in hot environment. Flase this is typical of heat exhaustion. Heat stroke is usually due to defective thermoregulation.

40) Which of the following is an indication not to perform CT in a child

a. Unstable

41) Which of the following is most likely to result in a non theraputic laparotmy following a stab wound to the anterior abdomen

a. Generalized peritonitis. True

b. *Fresh blood in NGT. Possible but maybe from nose bleed/trauma of putting in NGT

c. Diaphragm involvement. True

d. Extravasation of contrast on CT in the upper GI region. True

42) Regarding CSF which is true

a. Serum : CSF glucose < 0.4 = pathognomic of bacterial infection. Flase – similar in fungal

b. *Viral infection associated with increased protein. Correct – can be normal or high

43) Regarding meningitis

a. *Penicillin may be omitted in the 12mth to 15 year age range. Vanc and gent to cover strep and menningococcus

b. Always associated with peticheal rash. Bosh

44) Which of the following is an indication for thrombolytic therapy?

a. New onset RBBB with chest pain. False – LBBB +chest pain

b. ST elevation with no chest pain – false but contentious in diabetics

c. *Following CPR even if >5 mins. True if you think the cause is MI or PE - up to 30mins CPR.

d. IIb/IIIa has been shown to have no effect on mortality

e. *TPA has a higher risk of ICH than SK = true

Absolute CI – aortic dissection, acute pericarditis, active bleeding, known AVM/aneurysm/tumour in head

Relative CI = HPT, surg or GIT bleed in last 10d, CNS surg or CVA in last 2 mth, coagulop, pregnancy B1 for TPA, C for others

Prolonged CPR OK

45) Which of the following represents a stable c- spine #

a. Clay shovellers = # spinous process C7/T1 due to flexion inj

46) Which of the following is true with respect to the spinal cord

a. Central cord syndrome. False – causes weakness/paraesthesia in arms>legs and is caused by crush

b. **Anterior cord syndrome associated with anterior spinal artery stenosis

c. anterior cord associated with leg>arm – not typical

47) Regarding amphetamines which is false

a. Associated with early mydriasis – true

b. *May have hypertension and bradycardia. True but usually hypertensive due to tachy

c. Not associated with withdrawal. True

d. **Haloperidol useful for coreoathetosis. False don’t use antipsychotics – just BZD

48) Regarding arterial thrombi which of the following is false

a. Associated with early paraesthesia = true

b. Associated with early pain = true

c. Most thrombi arise from aorta – sounds right

d. **Commonest site of aneurysm popliteal. False AAA> pop

49) Regarding the differences between dementia and depression which is most useful

a. Early loss of STM = same

b. *Answers all questions with don’t know = more typical of depression, demented patients either ramble or make an attempt

c. Loss of autonomy at home – both

50) With respect to schizophrenia which is false

a. An associated delusional disorder is characteristic = true

b. *Olfactory hallucinations are common – false, auditory are common, visual, tactile and olfactory suggest organic brain syndrome

51) With respect to anal fissures

a. **They often point away from the anal verge. True

b. Originate at anal valves. False – originate in skin and rarely extend to valves. Usually valses spasm causing more pain

c. Situated btn internal and external valves. Bosh

52) With respect to large bowel obstruction

a. Often associated with diverticulitis in the elderly. More often Ca

b. *Associated with sigmoid volvulus in under 2

53) With regard to anaphylaxis which is true

a. Hymenoptera exert effect by direct histamine release. False bees ants and wasps cause type I hypersensitivity and need a sensitized subject

b. Angioedema pitts differentiating it from anaphylaxis. Bosh

c. Pruritis is invariable present. Flase

54) In the management of narrow complex SVT which is true

a. **Calcium channel blockers are CI in WPW = true esp antedromic – any AV blockers are CI. In fact only fleccanide procainamide and amiodarone are OK

55) Which of the following is true of COPD

a. Associated with decreased compliance – false….increased compliance

b. *Associated with low output CCF. Pulmonary HPT with RV hypertrophy and then dilation with cor pulmonale (LVF) and low LV output

c. Associated with decreased FVC but normal FEV1. both reduced FEV1 > FVC

1) With respect to treating contacts of a confirmed meningococcus case allergic to rifampicin which of the following is the best agent?

a. Timentin

b. Ciprofloxacin

c.

d.

2) Concerning abdominal aortic aneurysm which of the following is TRUE?

a. Abdominal aortic aneurysms cannot be ruptured if there is no pain

b.

c.

d.

e. Aorto-enteric fistula is a recognised complication of endo-luminal grafts

3) With respect to the diagnosis of subarachnoid haemorrhage which of the following is TRUE?

a. Xanthochromia is almost always positive after 12 hours

b. LP is not always indicated if CT scan is negative even with good clinical signs of SAH

c.

d.

4) Regarding paediatric intussusception which of the following is TRUE?

a. Recurrence following barium enema reduction is up to 20%

b. Intussusception is associated with HSP, lymphoma and cystic fibrosis

c.

d.

5) Regarding acid base balance

a. Hypoglycaemia is not associated with alcoholic ketoacidosis

b.

c.

d.

6) Regarding CXR in paediatrics which of the following is false

a. Normal neonatal CXR cardiothoracic ratio can be up to 0.65

b. Atrial double shadows are associated with atrial dilatation

c. Lateral right ventricle lies directly under the sternum

d. The mediastinal shadow is larger in AP rather than PA films

e. As

7) In a female patient at 10 weeks gestation presenting with PV bleeding and an open cervical os which of the following best describes the situation

a. Threatened miscarriage

b. Complete miscarriage

c. Missed miscarriage

d. Incomplete miscarriage

e.

8) Regarding congenital heart disease which of the following is FALSE?

a. ASD is the most common defect

b. Most VSD abnormalities present in the first year

c. The components of tetralogy comprise……

d.

e.

9) Regarding skin xanthems which of the following is TRUE?

a. Scarlet fever has a rough texture

b. Hand foot and mouth disease is caused by herpes

c. Rubella

d.

e.

10) Regarding eye injuries which of the following are TRUE?

a. Hyphaema often re-bleeds at 2-5 days

b. …..is the time taken for a corneal ulcer to heal

c. the normal IOP is…

d.

e.

11) Which of the following is TRUE regarding sinusitis?

a. Wegeners granulomatosis involves the sinuses

b. Pain with eye movements is an associated feature of paediatric ethmoidal sinusitis

c. Ethmoid sinusitis is the most common site of sinusitis in kids

d. Routine antibiotics must cover staphylococcus aureus

e.

12) Regarding SIADH which of the following is FALSE?

a.

b.

c.

d. Urinary sodium is low

e.

13) With respect to tooth injuries which of the following is FALSE?

a. Deciduous teeth when avulsed should be replaced

b. The correct storage medium for an avulsed tooth is saline

c. Avulsed teeth should be vigorously cleaned prior to replacement

d. Fractures of teeth involving the dentine are of clinical importance

e.

14) Regarding pancreatitis which of the following is TRUE?

a. Amylase is negative in 50% of cases

b.

c.

d.

e.

15) With respect to the diagnosis of appendicitis

a.

b.

c.

d. WCC is greater than 10,000 in 70% of cases

e.

16) With respect to cervical spine injuries

a.

b.

c.

d.

e.

17) Which of the following is TRUE concerning pelvic fractures

a. All fractures of the pelvic ring benefit form external fixation

b. Pelvic fractures involving the SIJ are unstable

c. Venous bleeding can be emnbolised

d.

e.

18) Which of the following statements concerning shoulder dislocation is TRUE?

a. The greater tuberosity is commonly avulsed with dislocation

b. Associated rotator cuff tears are commoner with increasing age

c. Recurrence rates of dislocation are higher in the elderly

d.

e.

19) Regarding the case of a young male presenting with first episode of spontaneous pneumothorax which of the following statements is TRUE?

a. Commonly associated with the underlying presence of septal bullae

b. The recurrence rate is 5%

c. Large pneumothoraces are more likely to fail simple aspiration procedures

d.

e.

20) Regarding paediatric trauma

a. The liver is the most commonly injured organ

b. Rib fractures are not associated with significant pulmonary contusion

c. SCIWORA is commonest in kids

d.

e.

21) Which of the following substances if ingested has the most toxic effect on a 5 year old

a. Mineral oil

b. Camphor

c.

d.

e.

22) Which of the following is TRUE concerning resuscitation

a. Venous valves

b. Cough CPR

c. Active compression and Cardiac output

d.

e.

23) Which of the following drugs is associated with hypoglycaemia

a. Verapamil

b. Propanolol

c.

d.

e.

24) What is the total body area burnt in a male with burns affecting the whole of the left leg, half the head and ……….

a. 32.5%

b. 27%

c.

d.

e.

25) What is the total fluid requirement of a 30kg child whoc is 5% dehydrated

a. 2400ml

b. 3200ml

c.

d.

e.

26) With respect to abdominal hernias which of the following statements is TRUE?

a. Hydrocele is the commonest testicular abnormality in kids

b. Inguinal hernias are commonest in premature infants

c. Male and female ratio of femoral hernias

d.

e.

27) Regarding neonatal sepsis which of the following is TREU?

a. Pneumococcus is a common cause of sepsis

b.

c.

d.

e.

28) Regarding blood transfusions

a. Hypotension is a feature of transfusion reactions

b. Cryoprecipitate doesn’t have enough factors for the treatment of haemophilia

c. Patients to receive FFP must be type specific

d.

e.

29) All of the following are true in determining the severity of aortic stenosis EXCEPT

a.

b.

c. thrill

d.

e.

30) Regarding the treatment of snake bite victims which of the following is TRUE?

a. Polyvalent antivenom has a mixture of antivenmoms for the four commonest snake varieties

b. The allergy rate for polyvalent is less than 6%

c. In treating an envenomated patient from unknown snake source polyvalent antivenom is always the first line of treatment

d.

e.

31) Regarding the diagnosis of schizophrenia which of the following is TRUE?

a. According to DSM IV criteria all patients with the diagnosis of schizophrenia must have hallucinations

b. 10% of patients have a 1st degree relative with the condition

c. Drugs can cause schizophrenia

d. As

e. As

32) Which of the following is ICORRECT regarding marijuana?

a. The most common side effect is nausea

b. Oral ingestion may be associated with drowsiness

c. There are no reported deaths in the literature

d. The serum level accurately reflects the degree of intoxication

e.

33) With respect to the insertion of central lines which of the following statements is TRUE?

a. Subclavian lines are relatively contraindicated in children10,000 in 70%. WCC >10,000/ul is 70-90% sensitive but specificity is very low

16) With respect to C spine #

Stable =

clay shovellers – flexion injury - spinous process C6, 7 or T1

Peg type I – tip

Wedge compression – flexion

Unilateral facet joint dislocation – distractive/flexion with rotation, although stable needs urgent reduction

Unstable =

Jeffersons – axial compression of C1 ant + post arches

Hang mans – hyper extension injury with bilat # of neural arch C2

Peg – types II (through base) and III through body of C2

Tear drop – flexion injury involves all 3 columns with anteroinferior # or tear drop and retropulsion of the vertebral body

Burst – axial compression causes explosion of body – muliple segments which may protrude posteriorly into canal

Chance – distraction inj (usually of thoracolumbar spine) horizontal # through body and posterior elements

17) Which of the following is true regarding pelvic fractures

a. All # of the pelvic ring benefit from external fixation. False – never say all

b. *Pelvic # involving the SIJ are unstable. True – ring disruption seen with lateral compression or verticle shear forces (malgaigne #)

c. Venous bleeding can be embolised. False only arterial bleeding can. For venous use activated VII.

18) Which of the following regarding shoulder dislocation is true?

a. The greater tuberosity is commonly avulsed. Uncommon

b. **Associated rotator cuff tears are commoner with increasing age. True >80% in the >60year olds

c. Recurrence is higher in the elderly. Lower 14% if age >40 vs 90% in age 20% will need aspiration

20) Regarding paediatric trauma

a. The liver is the most commonly injured organ. False spleen

b. Rib fractures are not associated with significant pulmonary contusion. False – more so than adults

c. *SCIWORA is commonest in kids. True more common in kids due to laxity of ligaments

21) Which of the following substances has the most toxic effect on a 5 year old?

a. Mineral oil. Pretty harmless – used as laxative

b. **camphor. Very toxic. 100% eucalyptus also quite toxic

22) Which of the following is true regarding resus

a. Venous valves…..- prevent back flow of blood during ECC

b. Cough CPR. Only relevant in conscious patients with arrythmias. Coughing increases cardiac output for a few seconds until arrythmia resolves

c. Active compression and cardiac output – ECC = 10-20% of cardiac output if done well. Aortic valve opens at the end of a compression, mitral valve opens during relaxation

23) Which of the following drugs is associated with hypoglycaemia

a. Verapamil

b. **propranolol. Catacholamines increase glucose beta blockers block this process and also block the warning signs of tachycardia and tremor

24) What is the total body surface area burnt in a male with burns to………

Rule of nines

Head = 9

Leg = 18

Front= 18

Back = 18

Arm = 9

Childs head is 18% and legs are 14% take 1% off for each year above 1 and add it to the legs

25) What is the total fluid requirement for a 30kg child who is 5% dehydrated?

a. 2400ml

b. **3200ml

0.05 X 30 (rehydration)+ (maintenance) 100 X 10 + 100 X 50 + 100 X 25

26) With respect to abdominal hernias

a. Hydrocoele is the commonest abnormality in kids. Hernias probably more common than hydrocoeles and can be difficult to distinguish.

b. **Inguinal hernias are commonest in prems

c. Male:female ratio of fem hernias = 5:1

27) Regarding neonatal sepsis which is true

a. Pneumococcus is a common cause of sepsis. True but need to consider gp B strep, listeria, Hib, clamydia and ghonococcus

28) Regarding blood transfusion

a. *Hypotension is a feature of transfusion reactions. Features in severe reactions but not mild or moderate. It’s presence = stop transfusion. Temperature is a more common feature

b. Cryo doesn’t have enough factors to treat haemophilia. Contains a little FFP + factor VIII + XIII + VWF + fibrinogen. Have to give large volumes in order to get enough factor VIII. Better to use recombinant factor VIII > prothrombin X> activated factor VII

c. **Patients to receive FFP must be type specific. True must be ABO compatible. Platelets are not ABO specific

29) All the following are true regarding severity of aortic stenosis except

a. Thrill

According to talley and oconnor severe aortic stenosis plateau pulse, thrill, long murmur paradoxical splitting of S2 with soft A2

Others S3 + S4 common. Murmur may get softer with increasing severity

30) Regarding the treatment of snake bite victims

a. Polyvalent antivenom contains four of the commonest snake varieties. Flase contains 5 – brown, black, tiger, tiapan and death adder

b. **The allergy rate for polyvalent is TIBC (60micromol/l) and clinical symptoms dictate use of desferrioxamine

Oral desferrioxamine should be used prior to IV no role for oral (IV or IM)

normal WCC and normal glucose exclude significant poisoning false. WCC > 15 and Glucose > 8 correlate with toxicity

Normal examination at 6h means can be safely discharged TRUE, with non-toxic levels

2. In TCA overdose

QRS < 0.14 not associated with seizures > 0.12 seizure likely

10mg/kg can be fatal 10 – 20mg/kg – severe toxicity

bicarbonate should be used as first line antiarrhythmic bicarbonate is first line antiarrythmic

3. Acute Liver failure

Paracetamol most common cause hepatitis B with D according to Rosen, viral hepatitis according to ICU manual but in the UK paracetamol poisoning is the most common. UK and USA is paracetamol (google)

4. In childhood pneumonia

Chlamydia can present around 2 weeks of age due to colonisation from birth one week to four months. Usually 3-12 weeks, slow onset. Conjunctivitis is 10-14 days.

Cefotaxime may be used as empiric antibiotic cover in neonatal infection Benzyl penicillin and gentamycin

In neonatal pneumonia, Hemophilus influenza B, Neiserria meningitidis and pnemococcus are the commonest organisms. GBS, E.coli, Klebsiella most commmon

Commonest cause of pneumonia in over 5yo is pneumococcus TRUE

5. Use of tocolytics in pregnancy is indicated in which of the following

Distressed fetus

22/40

34/40 For preterm labour between 24 weeks and 36 weeks TRUE

chorioamnionitis

pain from protracted contraction

6. With regard to blood transfusion

If there is conjugated hyperbilirubinemia after blood transfusion, another cause should be sought TRUE – heamolysis and transfusion reactions cause an unconjugated hyperbilirubinaemia

CMV is a rare cause of mononucleosis probably true

Most transfusions fevers are cause by reaction to leucocytes (antileukocyte and antiplatelet antibodies)

ABO compatibility occurs in 5% cross matched blood should be 100%

There is a higher concentration of sodium in packed cells than in blood

7. In childhood gastroenteritis

Bloody diarrhoea occurs in 10% of gastroenteritis 1 – 4% in tintinali, 20

% in Rosen arghh!!!!

The commonest cause is adenovirus rotavirus 60% < 2 years, commonest under 5 years

Antibiotics are indicated in all salmonella infections if less than 6 months, toxic, bacteraemic, chronic GIT disease, haemoglobinopathy

IV fluid is indicated in all cases with >5% dehydration can have ORH

Diet should consist of free fluid for 24h can be restarted after four hour rehydration, definitely no longer than 24hours

8. Regarding abdominal pain in children

Normal feeding b/w pain excludes significant pathology false

Appendix perforation rate is higher in 38 occurs in less than 10% x 43%

Abnormal ECG occurs in < 10% x 44% have tachycardia

PaO2 less than 80 occurs in more than 80% x most have normal PaO2

17. Which feature on chest xray suggest non-cardiogenic pulmonary oedema rather than cardiogenic pulmonary oedema?

Pleural effusion ……….in cardiac and non-cardiac (emedicine)

Air bronchogram more suggestive of non-cardiac (Wikipedia, Ware, NEJM, 2005)

Peribronchial cuffing

Cardiomegaly – cardiac only (emedicine)

Upper lobe vascular diversion – more cardiac (Wikipaedia, Ware, NEJM 2005)

18. Reliable signs of Compartment Syndrome include all the following except

Paresthesia

Pain on passive extension of digits ALL RELIABLE

Tense and hard muscle compartments

Loss of arterial pulses UNRELIABLE, PLUS COLOUR, TEMP, CAP REFILL

19. A young female presents after a syncopal episode and is still pre-syncopal on sitting up. The following exclude ectopic pregnancy:

Tubal ligation

Past history of PID

USS demonstrating intrauterine sac

Urine HCG < 25

None of the above

20. Regarding atrial fibrillation, all the following are true except

There is a risk of 1-2% arterial embolism with cardioversion 3 (in chronic, 6 in acute - depends on acute v chronic)

CCF with established anuric RF

Symptomatic hyperphosphatemia x life threatening hyperphosphataemia

Hepatorenal syndrome

22. Regarding the issue of overcrowding in ED, all of the following are true except

It is a national problem that needs a multisystem approach

Increasing ED staff can fix problem

Decreased number of inpatient beds is the single main cause is a cause

23. Improved mortality has been demonstrated with which of the following strategies?

Pre-hospital IV fluids in penetrating trauma permissive hypotension study

Doctors in helicopters instead of paramedics

Early notification by ambulance of need for thrombolytics

Use of 100mcg/kg adrenaline in cardiac arrest x 10mcg/kg

24. Regarding aneurysms

Carotid aneurysms are rare

Hepatic artery aneurysms can mimic cholelithiasis

AAA under 6cm have low risk of rupture x > 5cm have risk of rupture outweighing risk of OT

25. Roseola infantum/herpes virus 6

Is associated with coryzal symptoms – cough, pharangitis

Onset of rash occurs with fever rash after fever, day 3-5 as child improves

Most common in late winter and early spring no seasonal preponderance (Tintinalli)

26. Regarding kidney disease in children

Glomerulonephritis may be managed with fluid restriction Supportive, nephrotic managed with prednisolone

Thrombocytopenia is a characteristic finding in HUS True

Incidental microscopic hematuria is considered benign if examination and renal function are normal - TRUE, (but need US and referral to nephrologist if persistant)

27. After a febrile seizure, there is increased risk of epilepsy in children with all except:

First degree relative with epilepsy

Focal features in seizure

Incomplete recovery between seizures

Multiple seizures in same febrile illness (increased risk)

Duration does not affect risk of epilepsy (prolonged increases risk, RCH guidelines)

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