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1. A neonate is delivered in your emergency department. His first observations are: centrally pink but peripherally blue; heart rate 90 bpm; weak cry; some motion with stimulation and is limp.

His APGAR score is

a) 5

b) 4

c) 6

d) 3

e) 2

2. Which ONE of the following is NOT diagnostic criterion for simple febrile convulsion:

a) temperature > 37.5 degrees celsius

b) age 6 months to 5 years

c) seizure lasts < 15 minutes

d) no past history of afebrile seizures

e) more than 1 seizure in 24 hours

3. Which ONE of the following signs is NOT pathognomonic for its accompanying diagnosis:

a) Hutchinson’s sign for Herpes Zoster opthalmicus

b) perilimbic injection and anterior uveitis/ iritis

c) retinal flame haemorrhages for retinal vein occlusion

d) ptosis and mydriasis for Horner’s syndrome

e) swollen optic disc and decreased visual acuity for anterior ischaemic optic neuropathy

4. Early Goal Directed Therapy in severe sepsis and septic shock (Rivers et al) does NOT recommend:

a) hydrocortisone 100mg QID

b) maintaining mixed venous oxygen saturation measurement >70%

c) maintaining CVP between 8-12mmHg

d) using ionotropes to keep MAP > 65mmHg 16,000 cells/microlitre

d) serum LDH > 350 IU/L

e) serum glucose > 10mmol/L

7. With regard to higher centre dysfunction, which ONE of the following is TRUE:

a) dysphasia is dominant temporal lobe dysfunction

b) expressive dysphasia is frontal lobe dysfunction

c) receptive dysphasia is dominant temporal lobe dysfunction

d) alexia is frontal lobe dysfunction

e) Anosmia is temporal lobe dysfunction

8. Dysfunction of the posterior part of the first temporal gyrus (Wernicke’s area) causes which ONE of the following:

a) receptive dysphasia

b) expressive dysphasia

c) nominal dysphasia

d) conductive dysphasia

e) dysarthria

9. Regarding non-judicial hangings, which ONE of the following is FALSE:

a) patients who have lost consciousness and have had a significant injury should be observed in the hospital for 24 hours even if they appear stable at the time of presentation

b) cervical immobilisation should occur until clinical and/or radiological clearing of the cervical spine has occurred

c) cervical fractures, such as the Hangman’s fracture, commonly occur

d) the difficult intubation kit should be available when intubating these patients

e) cerebral oedema may occur

10. Which ONE of the following statements is TRUE, regarding Emergency Department thoracotomy:

a) it is indicated in blunt trauma to the thorax

b) it is indicated for patients without signs of life from the outset (ie start of pre-hospital care)

c) it is usually done via median sternotomy

d) it is more successful (for immediate survival) for stab wounds compared with gunshot wounds

e) it carries a success (for immediate survival) rate of less than 10%

11. With respect to paediatric injuries, which ONE of the following is FALSE:

a) Seizures following traumatic head injury occur in 5% of hospitalised patients

b) The spleen is the most commonly injured solid organ

c) The duodenum is the part of the intestine most commonly injured in seat belt injuries

d) Children are more prone to high cervical injuries than adults

e) Isolated chest trauma carries a 4 – 12 % mortality rate

12. Spinal shock is characterised by which ONE of the following:

a) Flaccid areflexia

b) Hypotension and bradycardia

c) Hypovolaemia

d) Diaphragmatic injury

e) Priapism

13. A baby at 38 weeks gestation is delivered in the ED. She is floppy and cyanosed, with a heart rate of 50bpm. Which ONE of the following statements is TRUE about the subsequent management:

a) Suctioning of the nose and pharynx should be sufficient treatment

b) Cardiac compressions should be commenced if there is no change after 30 seconds of ventilatory support.

c) Oxygen administration should be delayed to see if the child responds to suctioning

d) The child should be placed on the mother’s abdomen immediately after birth

e) Ventilation and cardiac massage should be synchronised with a 1:5 ratio

14. Which ONE of the following is TRUE, regarding ectopic pregnancy:

a) 15% of all pregnancies are ectopic

b) Up to 50% of pregnancies following tubal sterilisation are ectopic

c) A 19 yo girl with abdominal pain who denies she’s pregnant does NOT need a pregnancy test

d) Rhesus negative women with ectopic pregnancies do not need anti D immune globulin

e) Most patients with ectopic pregnancy present to ED with haemodynmamic instability

15. Regarding Amanita Phylloides mushroom toxicity, which ONE of the following is FALSE:

a) Large doses of penicillin IV may be useful

b) Silybinin, a milk thistle extract, may inhibit hepatic uptake of Amatoxin

c) Multiple dose charcoal is indicated

d) Haemoperfusion may be useful if utilised within 48 hours of ingestion

e) Symptoms typically occur within the first 4 hours of ingestion

16. Which ONE of the following toxins does NOT cause a syndrome comprising mydriasis, thirst, tachycardia, and urinary retention:

a) Tricyclic antidepressants

b) Trumpet lily

c) Scopolamine

d) Organophosphates

e) Antihistamines

17. Which ONE of the following is the most important treatment for high altitude cerebral oedema:

a) Thiazide diuretics

b) Acetazolamide

c) Descent to a lower altitude

d) Antiemetics

e) Head elevation 30 degrees

18. Resuscitative efforts on an adult with hypothermia and cardio-pulmonary arrest should continue until the patient’s core temperature (Celsius) is at least:

a) 28 degrees

b) 37 degrees

c) 32 degrees

d) 35 degrees

e) None of the above

19. Which ONE of the following is the most sensitive area in the nervous system to heat stroke:

a) The hippocampus

b) The spinal cord

c) The medulla oblongata

d) The basal ganglia

e) The cerebellum

20. Which ONE of the following statements is TRUE regarding the management of a snakebite in a child:

a) There is a lower incidence of serum sickness post treatment as compared with an adult

b) The dose of antivenom should be given as a dose of 0.1 mg/kg

c) The same dose of antivenom should be given as for an adult case

d) The bite site is the best ‘sample’ to check for envenomation

e) Urine testing for envenomation is not useful

21. Which ONE of the following is consistent with scarlet fever:

a) Punctate rash on neck and trunk

b) Circumoral erythema

c) Geographic tongue

d) Only occurs in association with streptococcal pharyngitis

e) Resolution without desquamation

22. Which ONE of the following is TRUE, regarding Hypertropic Pulmonary Osteoarthropathy:

a) It is usually caused by small cell lung carcinoma

b) It usually occurs without clubbing

c) It is characterised by swelling and pain in the wrists

d) It affects the proximal end of long bones

e) It is diagnosed on plain x-ray

23. Massive haemoptysis is an occasional complication of (which ONE of the following):

a) aortic stenosis

b) aortic incompetence

c) mitral stenosis

d) mitral incompetence

e) right sided valve lesions

24. Clubbing is NOT commonly associated with (which ONE of the following):

a) bronchiectasis

b) asbestosis

c) Chronic Obstructive Airway Disease

d) Cyanotic congenital heart disease

e) idiopathic pulmonary fibrosis

25. Pleural exudates are characterised by which ONE of the following:

a) protein > 50% serum

b) LDH > 60% serum

c) cholesterol > 30% serum

d) pleural fluid cholesterol >1.5 mmol/L

e) all of the above

26. Regarding lung volumes, which ONE of the following is TRUE:

a) Total Lung Capacity = Vital Capacity + Tidal Volume

b) Inspiratory Reserve = TV + Residual Volume

c) Tidal Volume = 1L in 70kg male

d) Vital Capacity = 5L in 70 kg male

e) none of the above

27. Common causes of lower lobe pulmonary fibrosis include which ONE of the following:

a) bronchiectasis

b) silicosis

c) coalminer’s lung

d) allergic alveolitis

e) Tuberculosis

28. An afferent pupillary defect may be present in which ONE of the following:

a) Central Retinal Artery Occlusion

b) Central Retinal Vein Occlusion

c) Optic Neuritis

d) Acute Angle Closure Glaucoma

e) all of the above

29. Drug treatment of acute angle closure glaucoma should NOT include (which ONE of the following):

a) acetazolamide

b) topical β-blockers

c) frusemide

d) mannitol

e) topical pilocarpine

30. Acute iritis is NOT associated with (which ONE of the following):

a) Inflammatory Bowel Disease

b) Ankylosing Spondylitis

c) Marfan’s Syndrome

d) Juvenille Rheumatoid Arthritis

e) Sarcoidosis

31. Regarding a Stanford type A thoracic aortic dissection, which ONE of the following is TRUE:

a) involves the ascending aorta

b) makes up 25% of all thoracic aortic dissections

c) causes acute back pain as the commonest symptom

d) always ends at the bifurcation of the aorta

e) all of the above

32. Complications of thoracic aortic dissection include which ONE of the following:

a) acute aortic regurgitation in 30% (with S3 & Austin Flint murmur)

b) pericardial tamponade in 25%

c) acute stroke in 3%

d) acute limb ischaemia in 16%

e) all of the above

33. A 1mm renal calculi in the ureter will most likely impact at (which ONE of the following):

a) the pelvi-ureteric junction

b) the vesico-ureteric junction

c) the pelvic brim

d) the bladder orifice

e) all of the above

34. Which ONE of the following is the commonest type of ureteric calculus:

a) calcium oxalate

b) triple phosphate

c) urate

d) cysteine

e) granite

35. Which ONE of the following is TRUE, regarding hidradenitis suppurativa:

a) it affects the apocrine sweat glands

b) it occurs in the axillae & groins

c) Flucloxacillin is the choice for empiric antibiotic therapy

d) it usually requires incision and drainage

e) all of the above

36. Which ONE of the following is TRUE, regarding Malignant Melanoma:

a) it comprises approximately15% of all dermatological cancers

b) it metastasizes to liver, brain, lung, skin and retina

c) it is commonly diagnosed before puberty

d) it is more common in people with dark skin than people with fair skin

e) it should be treated with local radiotherapy following initial diagnosis

37. Which ONE of the following V/Q findings -coupled with the clinical description- is LEAST suggestive of pulmonary embolism?

a) Multiple matched defects between ventilation and perfusion scans with a low clinical index of suspicion.

b) One moderately sized mismatch defect between ventilation and perfusion scans with a low clinical index of suspicion.

c) Bilateral mismatched defects between ventilation and perfusion scans with a moderate clinical index of suspicion.

d) A low-probability scan with a high clinical index of suspicion.

e) An intermediate probability scan with a low clinical index of suspicion.

38. Which ONE of the following indicates severe asthma?

a) Pulsus paradoxus < 20 mmHg

b) Pulsus paradoxus < 10 mmHg

c) Pulsus paradoxus > 20 mmHg

d) Pulsus paradoxus > 10 mmHg

e) Pulsus paradoxus < 30 mmHg

39. Which ONE of the following does NOT cause hyponatraemia:

a) Low plasma proteins

b) Osmotic substances

c) Hypovolaemia

d) Water retention

e) Salt loss

40. Regarding investigation and treatment of hyponatraemia, which ONE of the following is FALSE:

a) Serum osmolality >280 mmol/L suggests a true rather than spurious cause

b) Urine osmolality 100 mmol/Lsuggests hypovolaemia

d) Urinary chloride ................
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