MCQ March 2003 - Improving care in ED



1. Regarding redback spider envenomation:

a) most patients are bitten in the winter months

b) only the male spider is capable of envenoming humans

c) antivenom is routinely given intravenously

d) the bite from the spider is typically very painful

e) untreated, most cases resolve over hours to days

Cam 653

2. The Australasian Triage Scale

a) category 3 patient should receive medical treatment within one hour

b) assigns categories based principally on perceived clinical severity

c) was based on criteria and definitions used in the UK and Canada

d) category 2 patient is assigned the colour yellow

e) categories have been shown to relate directly to admission rate, mortality and hospital length of stay

Cam 584

3. According to the “Sad Persons” Scale used to assess suicide risk, which of the following features scores 2 points?

a) loss of rational thinking

b) excessive drug use

c) single, separated or divorced

d) male gender

e) severe personality disorder

Cam 512

4. According to ACEM standard terminology, access block:

a) occurs when the time from inpatient bed request to transfer to ward exceeds four hours

b) results when a patient is unable to gain access to any hospital service within a reasonable timeframe

c) most commonly results from a relative shortage of beds in general medicine

d) is the proportion of patients requiring formal admission whose total ED time exceeds eight hours

e) occurs when the time from initiation of treatment to transfer to ward exceeds six hours

Med J Aust. 2003; 178 (3): 99-100 and ACEM website

5. The following are Revised Jones’ Major criteria for acute rheumatic fever EXCEPT:

a) Pericarditis

b) Arthralgia

c) Subcutaneous nodules

d) Chorea

e) New cardiac murmur

Tint 917

6. A 76yo woman is incidentally found to have atrial fibrillation. She is asymptomatic, with a heart rate of approximately 80, and stable BP of 150/85. She has a history of hypertension only.

a) She has an approximate risk of 18% per year for stroke

b) Optimal thrombo-prophylactic treatment would be aspirin 150mg/day

c) She should be reverted to sinus rhythm as soon as possible

d) Aspirin provides a thrombo-prophylactic benefit that is about 10% of that for warfarin

e) Warfarin reduces the risk of stroke in this patient by 30%

Cardiovasc ther guidelines (1999) 99

7. A patient has weakness in one uper limb. Examination reveals a wasted hand plus weakness of thumb adduction and finger abduction. Biceps and triceps jerks are normal. The most likely cause of this condition is:

a) Klumpke’s Palsy

b) Carpal Tunnel syndrome

c) Injury to lower cords of the brachial plexus

d) C6-C8 nerve root compression

e) Fracture of medial humeral epicondyle

T&O 380

8. Agents used for the specific treatment of Amanita phalloides poisoning include the following, EXCEPT:

a) Vitamin C

b) Penicillin

c) Thioctic Acid

d) Hyperbaric oxygen

e) Silymarin

Tint 1321

9. Regarding ketamine in paediatric sedation:

a) The intravenous dose is 4mg/kg

b) It may cause reduced blood pressure

c) Laryngospasm may result in patients with respiratory tract infection

d) Atropine should be administered concurrently owing to induced bradycardia

e) It may be safely used in neonates

Tint 898

10. The commonest causes of large bowel obstruction in adults, in decreasing order, are:

a) diverticulitis, volvulus, neoplasm, adhesions, hernia

b) adhesions, hernia, neoplasm, diverticulitis, volvulus

c) volvulus, neoplasm, adhesions, hernia, diverticulitis

d) neoplasm, diverticulitis, volvulus, adhesions, hernia

e) volvulus, neoplasm, diverticulitis, hernia, adhesions

Cam 233

11. A patient’s arterial blood gas results are the following, on room air, at sea level:

pH 7.30

pCO2 29

pO2 80

HCO3 20

a) Bartter’s syndrome is a possible cause

b) The A-a gradient is 20

c) If the anion gap is 12, the likeliest cause is lactic acidosis

d) The corresponding venous pH would be 7.25

e) The serum [K+] would be raised by about 1 mmol/L

Cam 394

12. All of the following statements regarding fresh frozen plasma (FFP) are true EXCEPT:

a) it contains all factors

b) intravenous administration can lead to volume overload

c) viral transmission is possible with transfusion

d) it is the first line treatment for uraemic patients with bleeding

e) it is the first line treatment for bleeding patients with a coagulopathy

Tint chap 211

13. Which of the following statements about lunate fractures is FALSE?

a) the commonest mechanism is a fall on an outstretched hand

b) they are the third commonest type of carpal fracture

c) the lunate occupies two thirds of the radial articular surface

d) X-rays reliably demonstrate the fracture

e) a fracture may be associated with avascular necrosis of the lunate

Tint chap 262

14. Regarding acute theophylline toxicity:

a) theophylline has very poor oral bioavailabiility

b) metabolic complications include hyperkalaemia and hypophosphataemia

c) elimination is not increased by haemodialysis

d) signs of minor toxicity usually manifest at serum concentrations from 220 to 440 μmol/L (20 to 40mg/L)

e) phenytoin is the anticonvulsant of choice in seizures resulting from toxicity

Cam 699

15. A staff member is referred to the ED with the following results of a routine hepatitis B serology assay. He is asymptomatic, and cannot recall if he has received Hep B vaccination before.

HBs antigen: significantly positive

Anti-HBs: not detected

Anti-HBc: low titres

Select the correct statement:

a) he has received Hep B vaccination and is immune

b) he has received Hep B vaccnation, but is not immune

c) he is a highly infective chronic carrier

d) there is a 2-30% risk of seroconversion in a recipient if he was the source in a needlestick injury

e) none of the above

Cam 333

16. Aspirin therapy is indicated in all the following conditions EXCEPT:

a) Kohler disease

b) polyarticular juvenile rheumatoid arthritis

c) acute rheumatic fever

d) Henoch Schönlein purpura

e) Kawasaki disease

Tint chap 132

17. Which of the following injuries is most likely to be associated with disruption of the cruciate ligaments?

a) patellar fracture

b) femoral condyle fracture

c) avulsion of tibial tuberosity

d) tibial plateau fracture

e) tibial spine fracture

Tint chap 266

18. Examination of a patient’s cardiovascular system reveals sinus rhythm, a parasternal heave, a pansystolic murmur that is louder on inspiration and pulsatile hepatomegaly. Another clinical sign associated with the patient’s conditon would be:

a) double apex beat

b) dominant v waves

c) canon a waves

d) prolongation of murmur with Valsalva manouevre

e) an opening snap

T&O 78

19. The following are known causes of torsades de pointes EXCEPT:

a) hypocalcaemia

b) organophosphates

c) amiodarone

d) phenytoin

e) amitriptyline

Cam 161

20. A woman who is 6 weeks pregnant by dates presents with lower abdominal pain and PV bleeding. She has not had an ultrasound for this pregnancy. The βHCG level is 998 mIU/ml.

a) A transabdominal ultrasound is likely to demonstrate an intrauterine pregnancy, if present.

b) The βHCG level is concordant with dates.

c) If there is no intrauterine pregancy on transvaginal ultrasound, she is likely to have an ectopic pregnancy.

d) There is a significant risk of a hydatidiform mole.

e) An ultrasound is unlikely to provide a definitive diagnosis currently.

Tint 689-690

21. Regarding external cardiac compression( massage):

a) The lower sternum should be depressed 2-3 cm in an adult.

b) It produces about 50% of pre-arrest cardiac output.

c) Coronary perfusion occurs primarily during the systolic (compression) phase.

d) Blood is directed mostly to the lower extremities

e) Blood flow to the myocardium is reduced 20-50% of normal.

Oh 61

22. Which of the following organisms is the least likely cause of acute diffuse otitis externa?

a) Proteus species

b) Candida albicans

c) Staphylococcus aureus

d) Pseudomonas aeruginosa

e) Klebsiella species

Antibiotic Guidelines (2000) 131

23. Which of the following is NOT associated with a pro-thrombotic tendency?

a) Antithrombin III deficiency

b) Activated Protein C resistance

c) Low Homocystine

d) Prothrombin gene mutation

e) Protein S deficiency

T&O (Examination Medicine) 110

24. Scheinkestel et al from the Alfred Hospital (MJA 170:203 1999) examined the role of hyperbaric O2 (HBO) therapy in carbon monoxide poisoning. The study:

a) was a retrospective analysis of data

b) lost 50% of patients to follow up

c) concluded that HBO would be routinely beneficial to patients with CO poisoning

d) compared HBO with 24 hours of continuous 100% O2 in reducing cognitive impairment

e) was a randomised controlled blinded study

25. Schizophrenia is associated with

a) a predominant pattern of acute onset of symptoms and signs

b) blunting of emotion and lack of volition which is responsive to anti-psychotic medication

c) loosening of associations

d) psychosis of less than 4 weeks duration after a stressful trigger

e) rapid, pressurised speech

Tint 1909-1910

26. The scenario most suggestive of child abuse is

a) a 3yo who sustains a spiral fracture of the tibia while playing on a slide

b) an 18 month old with multiple bruises to the shin and forehead

c) a 3yo boy with a pulled elbow after wrestling with his 10yo brother

d) a 5 month old boy who ingests 2 of his mother’s Fe tablets

e) a 2yo who tries to hide when approached by medical staff

Tint 1951

27. An X-ray of a child’s elbow reveals ossification of the capitulum and radial head. The child’s age is likely to be

a) 1-2 years

b) 4-5 years

c) 6-7 years

d) 10-11 years

e) None of the above

McR 130

28. A 72 year old lady is found to have a serum Na of 118mmol/L and hypervolaemia. She is likely to have

a) seizures if the hyponatraemia is chronic

b) abnormal muscle tone and function

c) Syndrome of Inappropriate ADH if her urinary Na is >20mmol/L

d) Renal failure if her urinary Na is >20mmol/L

e) Congestive cardiac failure if her urinary Na is >20mmol/L

Tint 155

29. A child in your department has been diagnosed with Heamophilus influenzae type B meningitis. His 2 year old brother who lives in the same household should be treated prophylactically with

a) rifampicin 600mg orally bd for 2 days

b) rifampicin 600mg orally as a single dose

c) ciprofloxacin 500mg orally as a single dose

d) rifampicin 250mg orally, daily for 4 days

e) none of the above

Ab guidelines(2000) 41-42

30. A Focussed Abdominal Sonography in Trauma is designed to look at views of the following EXCEPT:

a) Morrison’s pouch

b) spleno-renal space

c) paracolic gutter

d) Pouch of Douglas

e) pericardial view

Tint 1978

31. The following is most likely to be associated with a Brown-Sequard lesion of the spinal cord:

a) variable motor and sensory loss in lower extremities and bowel dysfunction

b) ipsilateral spastic paresis and ipsilateral pain and temperature loss

c) quadraparesis greater in the upper extremities than lower

d) contralateral spastic paresis with ipsilateral propioception loss

e) a better prognosis than anterior cord syndrome

Tint 1648

32. An intra-venous drug user with endocarditis has a TOE and multiple blood cultures taken. He is most likely to have:

a) tricuspid valve involvement and s.aureus on blood culture

b) tricuspid valve involvement and enterococci on blood culture

c) mitral valve involvement and mixed growth on blood culture

d) tricuspid valve involvement and candida on blood culture

e) tricuspid valve involvement and negative blood cultures

Tint 1995

33. Dislocation of the patella commonly:

a) occurs medially

b) requires surgery after relocation to prevent recurrence

c) occurs in males compared to females due to higher quadriceps loading

d) causes medial capsule tearing

e) is associated with vascular compromise

Tint 1820

34. A diagnosis of hyperosmolar hyperglycaemic nonketotic syndrome would usually be associated with all except:

a) a pH of less than 7.3

b) plasma osmolarity greater than 315 mosm/kg

c) the absence of urinary ketones

d) a mortality rate of 15-35 %

e) a raised measured serum sodium

Tint 1340

35. Tetanus:

a) is caused by clostridium tetani endotoxin

b) is associated with a better prognosis if the incubation period is short

c) can be manifest by rigidity of muscles in close proximity to the area of the initial injury

d) usually presents with weakness in the extremities which then progresses to the facial muscles

e) has no effect on the autonomic nervous system

Tint 965

36. The following antibiotics are considered relatively safe in pregnancy except:

a) penicillin

b) trimethoprim

c) erythromycin

d) cephalothin

e) ceftriaxone

Tint 1028

37. Haemodialysis would increase the excretion of:

a) tricyclics

b) benzodiazepines

c) digoxin

d) lithium

e) calcium channel blockers

Tint 1062

38. All of the following laboratory results are consistent with a diagnosis of DIC except:

a) increased prothrombin time

b) low platelet count

c) low fibrinogen level

d) prolonged ATTP

e) elevated D-Dimer

Tint 1374

40. Regarding aortic dissection:

a) Stanford type B dissections are more common than type A

b) syncope is the commonest presenting symptom

c) DeBakey type 3 dissections originate in the descending aorta

d) Nitrate therapy is contra-indicated, owing to reflex tachycardia and exacerbation of the intimal tear

e) proximal dissections have a peak incidence ten years later than distal dissections

Cam 192-193

41. With regard to paediatric trauma all of the following are true except:

a) the spleen is the most commonly injured organ

b) a child with a splenic injuries is more likely to be treated non-operatively than an adult with similar injuries.

c) False negative DPL’s are common

d) Physical examination alone is unreliable in approximately 50% of cases

e) CT is preferable to DPL in a stable patient

Tint 1621

42. A compression injury of the epiphyseal plate is:

a) often missed and may be evident only after growth disturbance

b) the most common type of epiphyseal injury

c) the Salter-Harris fracture with the best prognosis

d) a Salter-Harris I fracture

e) associated with torsion mechanisms and growth plate tenderness

Tint 1745

43. An S1 lumbar nerve root compression is likely to cause all except:

a) numbness to the lateral sole of the foot

b) numbness to the posterior calf

c) a reduction in the ankle jerk reflex

d) weakness of plantar flexion of the great toe

e) difficulty ‘heel walking’

Tint 1869

44. An afebrile 3 month old infant is brought to the ED following an apparent life-threatening event (ALTE). She was apnoeic for 20-30 seconds, with associated circumoral and peripheral cyanosis, but is now normal. Which is the most appropriate management?

a) admit for further observation and investigations

b) arrange for an apnoea monitor at home and discharge

c) observe for 2 hours and discharge

d) observe for 6 hours and discharge

e) discharge with GP follow up only

Ros 1103

45. A 30 yo man is treated in the ED after being trapped in a burning house. His carboxyHb level is 50%. Which of the following statements is true?

a) Both pO2 and O2 saturations are likely to be normal

b) CarboxyHb shifts the O2 dissociation curve to the right, and therefore interferes with O2 delivery to the tissues

c) Serum carboxyHb levels correlate well with toxicity

d) Symptoms would be expected to be equivalent to those of a patient with 50% blood loss

e) None of the above

Ros 1447 –1448

46. Regarding renal colic secondary to calculi:

a) Females are more commonly affected than males

b) 50% of calculi are radio-opaque

c) It may present without haematuria

d) There is a 20% chance of recurrence by 5 years

e) A CT urogram uses radio-contrast to grade the level of renal obstruction

Ros 2249-2251

47. Pseudo-hyponatraemia results from a shift of water from the intracellular to extracellular space, caused by the presence of osotically active solutes in the ECF. Which of the following causes the most significant fluid shifts?

a) Acetone

b) Mannitol

c) Ethylene glycol

d) Ethanol

e) Urea

Ros 2432

48. A patient who has been taking a MAO Inhibitor for years presents to the ED with hyperthermia, confusion, hypertension and diaphoresis. He has no known allergies/adverse reactions. Which of the following agents should NOT be used in his management?

a) Diazepam

b) Pethidine

c) Chlorpromazine

d) Cyproheptadine

e) Methysergide

Cam chap 26.1

49. Spontaneous retinal detachment is associated with the following EXCEPT:

a) Flashing lights (photopsia)

b) Floaters

c) Myopia

d) Positive family history of the same

e) Painful vision loss

Cam chap 15.1

50. Regarding HIV/AIDS

a) Shingles, seborrhoeic dermatitis and recurrent HSV infections are typical of early infection.

b) A CD4 count of 1.0 x 109 / L is associated with late stage AIDS.

c) Pre and post test counselling for HIV serology is now no longer mandatory.

d) Pneumococcus is a more likely pathogen than TB in AIDS patients with pneumonia.

e) Toxoplasma typically causes a retinitis.

Cam chap 8.8

51. Which of the following is the commonest clinical sign associated with pulmonary embolism?

a) cyanosis

b) fever above 37° C

c) lower extremity oedema

d) lung crackles

e) tachypnoea

Ros 1777

52. According to the PIOPED study, a normal V/Q pattern will miss what percentage of pulmonary emboli?

a) 0.5%

b) 2%

c) 4%

d) 10%

e) 15%

Ros 1787

53. Re-bleeding occurs most commonly with which cause of upper gastrointestinal bleeding?

a) Oesophagitis

b) Gastritis

c) Mallory-Weiss tear

d) Peptic ulcer disease

e) Varices

Ros 1904

54. Which of the following features is a reliable indicator of amphetamine toxicity?

a) absent bowel sounds

b) miosis

c) flushing

d) diaphoresis

e) dry skin

Ros 2880

55. A 50 yo man has sudden, severe vertigo with nausea and vomiting. He reports a low pitch ringing and reduced hearing in his left ear. These symptoms have occurred before. The most likely diagnosis is:

a) Meniere’s disease

b) Acoustic neuroma

c) Vestibular neuronitis

d) Benign positional vertigo

e) Vertebrobasilar insufficiency

Ros 2170

56. Regarding Hepatitis A:

a) It is a reportable / notifiable disease in Australia.

b) It is caused by a DNA virus.

c) The incubation period is usually longer than that of Hep B.

d) Passive immunisation against Hep A is not available.

e) Chronic hepatitis often succeeds the acute infection.

Cam 332

57. The most important factor in determining foetal risk from diagnostic imaging is the amount of ionizing radiation produced by the test. Rank the following radiation exposures from lowest to highest dose of radiation.

1. Head computed tomography (CT)

2. Posteroanterior and lateral chest x-ray

3. Lumbrosacral spine series (three films)

4. Abdominal CT

5. Intravenous pyelogram (IVP)

a) 2, 3, 1, 4, 5

b) 2, 1, 3, 5, 4

c) 3, 2, 1, 5, 4

d) 1, 4, 2, 3, 5

e) 2, 1, 5, 3, 4

Tint chap 99, 102

58. What is the best position in which to place patient with massive haemoptysis?

a) Affected side up

b) Affected side down

c) Trendelenburg

d) Reverse Trendelenburg

e) None of the above

Tint chap 63

59. A 10kg child is hypotensive post resuscitation, and requires an adrenaline infusion. To set up an infusion such that 1 ml/hr delivers 0.1 mcg/kg/minute, how many milligrams of adrenaline would be added to N saline to make a final volume of 100ml?

a) 0.1

b) 0.6

c) 1

d) 6

e) 60

60. The following can cause a rise in peak inspiratory pressure (PIP) in a mechanically ventilated patient EXCEPT:

a) insufficient muscle paralysis

b) increased tidal volume

c) bronchospasm

d) pneumothorax

e) increased I:E ratio

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