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EMI CatalogDRAFT 19 July 2010This is intended to show one example of each type of EMI. Variations can include the use of rich-text in options or items, option variants such as tables or images, item variants such as images, variations in the number of correct answer options, sequencing of options and correctness / grading of options.In all examples here, options are numbered a, b, c, … (maximum 26, i.e. a-z), and items are numbered 1, 2, 3…QuestionThemeOptions formatItems formatScoringQuick CreateEMI-1Liver diseasesPlain text listPlain text listOne correct answer for each itemYesEMI-2Embryology of the Urinary System and the Gastrointestinal TractLabelled imagePlain text listOne correct answer for each itemNoEMI-3Treatment of Mrs MPlain text listText list with formatting (e.g. bold)Some items have more than one required answer. The number of answers required is not disclosed.NoEMI-4Metabolic Derangements in DiabetesTable (rich text)Plain text listOne correct answer for each itemNoEMI-5Drug-induced liver injury.Plain text listPlain text listSome items have more than one answer required. The number of answers required for each item is disclosed.YesEMI-6Traumatology and woundsPlain text listOne image per item.Some items have more than one answer required. The number of answers required for each item is disclosed.NoEMI-7Clinical interpretation of blood gas resultsPlain text listItems are described in a table.One correct answer for each item.NoEMI-8TuberculosisPlain text listPlain text listMore than one answer required for each item. The number of answers required is disclosed. The number of correct options for each item is greater than the number of required answers.YesEMI-1Notes: Both options and items are plain text.Only 1 correct answer for each item. THEME: Liver diseasesOPTIONS:a.??? Acute haemolysisb.??? Hepatic encephalopathy (liver failure affecting CNS)c.??? CA head of pancreasd.??? Primary liver cancere.??? Liver metastasis from primary colon CAf.??? 48h after paracetamol overdoseg.??? Physiological neonatal jaundiceh.??? Wilson’s disease For each of the following cases, select the most likely diagnosis.____1) This patient’s biochemistry reveals a Plasma total bilirubin 200?mol/l (Normal <17), conjugated b) bilirubin of 7?mol/l, and a normal LD____2) This patient’s plasma α-fetoprotein is 350 000ng/ml (Normal <5)____3) This patient is not jaundiced, has a normal plasma bilirubin, AST and ALT, and markedly increased γ-GT and ALP____4) This patient is pale and his biochemistry reveals urine urobilinogen +++; plasma haptoglobin <0.2g/l (Normal is 1.6-3.0)____5) This patient’s biochemistry shows increased AST (16 400) and ALT (7 900). Normal values for both markers are <40)____6) This patient is deeply jaundiced. His plasma total bilirubin is 560?mol/l (Normal<17), conjugated bilirubin is 550?mol/l, AST & ALT is normal, and ALP and γ-GT is markedly increased.____7) This patient’s biochemistry shows decreased plasma caeruloplasmin and increased liver copper____8) This patient’s biochemistry reveals a plasma ammonia of 1200?mol/l (Normal is<50) and INR 10.2 (Normal is 0.8-1.2)EMI-2Notes: This EMI uses an image as the option list. There is only 1 correct answer for each item.THEME: Embryology of the Urinary System and the Gastrointestinal Tract OPTIONS:For each of the following statements choose an option from the above diagram that matches it BEST. There is only one best answer for each of the items below, but each option may be used once, more than once, or not at all in order to answer all of the items.____1. This lays down the initial ductile system of the developing kidney____2. This induces the metanephric blastema to form the metanephric kidney____3. This forms the penile urethra____4. This forms the physiological umbilical hernia____5. This is supplied by the inferior mesenteric artery____6. This connects the urogenital sinus to the allantois____7. The allantoic cavity is immediately continuous with this structureEMI-3Notes: Options are plain-text. Items are rich-text (e.g. formatting in item 2). Some items have more than one required answer, but number of answers required is not disclosed (e.g. item 2).Theme: Treatment of Mrs MHistory: Mrs JM,a 52 yr old woman, diabetic (well-controlled on metformin) and hypertensive (on ACE-inhibitor)Current complaints: shortness of breath, tired and dizzy since that morning Examination: cold and clammy. BP 90/60, pulse rate 42 beats /minute, saturation on room air 95%.Special investigations: ECG: Inferior ST-elevation infarct with second degree type II heart block. V4R suggestive of R ventricle infarctOptions:Oxygen via nasal canulaAspirin 75 mg chewed and swallowedSublingual nitrate tablet, up to three tabletsNitro-glycerine IV infusionPercutaneous Coronary Intervention (PCI)Morphine 2mg IVIAtenolol 5 mg per mouthSubcutaneous (Low molecular weight) Heparin ClopidogrelStreptokinaseGlycoprotein IIa/IIIb inhibitorHMG Co A reductase inhibitor ACE-inhibitorIV fluid bolus 200mlAnswer the following questions regarding Mrs JM’s management by selecting from the list of options. More than one option can be selected per question, unless only one option is specified.1. Select the therapeutic options which should be administered to Mrs JM in the first 10 minutes of presenting in casualty (More than one option can be selected) 2. Which therapeutic options are contra-indicated at this stage as they could worsen her condition? (More than one option can be selected)3. If Mrs JM was allergic to aspirin, which therapeutic option could be administered instead? 4. Assuming that Mrs JM has no other relevant medical history, which therapeutic option represents the MOST APPROPRIATE definitive management? 5. Which therapeutic option is of value in the remodelling of the heart muscle after an infarct in a patient with Left Ventricular dysfunction, so should routinely be prescribed in the first 24 hours following an infarct? 6. If Mrs JM had been given streptokinase for a previous infarct 6 months ago, which therapeutic option would specifically be contra-indicated?EMI-4Notes: Example using a table for the options list.THEME: METABOLIC DERANGEMENTS IN DIABETESOPTIONS:Blood chemistry result:Glucosemmol/lpHPCO2kPaHCO3mmol/lketonesNormal range5-77.38-7.425.0-5.522-26A307.052.244+B607.365.023-C27.012.651+D17.395.425-E107.122.86-F47.354.8221+For each one of the following clinical conditions, choose the appropriate blood chemistry result.B1. A patient with DM Type 2 presents in a hyperosmolar non-ketotic coma (HONK)D2. An otherwise well-controlled diabetic accidentally overdoses on insulin F3. An otherwise healthy subject fasts for a prolonged period of timeEMI-5Notes: example of pick N options.THEME: Drug-induced liver injury.OPTIONS:Prednisone Enalapril (an ACE-inhibitor)Propranolol (a Beta-blocker) Rifampicin Erythromycin (a macrolide antibiotic)Nevirapine Oral contraceptives ParacetamolCo-trimoxazole (sulphamethoxazole/trimethoprim)Chlorpromazine (a phenothiazine)ValproateAllopurinolFor each of the following statements relating to drug-induced liver injury, select?the correct?drug from the options list. Each option may be used more than once. Where stated, there is more than one correct answer.1. These TWO (2) drugs may cause cholestatic hepatitis2. These TWO (2) drugs may cause hepatitis as a component of systemic hypersensitivity3. This drug may cause hepatic steatosis (fatty liver)4. These TWO (2) drugs may cause idiosyncratic hepatitis (hepatocellular damage)EMI-6Notes: Example of using images in the item list. Theme: Traumatology and woundsOptions:AxeSjambokWhipKnifePangaHeavy stickBooted footRough floor surfaceLook at the photographs and choose the most likely object(s) which could have caused the injuries:(pic for item 1)(pic for item 2)(pic for item 3)etc.EMI-7THEME: CLINICAL INTERPRETATION OF BLOOD GAS RESULTSOPTIONS:a. Acute exposure to high altitude before acclimatisationb. Chronic exposure to hypoxia (e.g. living high up in the Andes above 4 000m)c. Chronic emphysema (chronic obstructive airways disease)d. A patient with chronic emphysema, immediately after being placed on assisted mechanical ventilatione. Acute severe asthmatic attackf. Diabetic keto-acidosisg. Chronic renal failureh. Acute renal failureFor each one of the following blood gas results 1 to 5, choose the clinical scenario which most likely caused the result.??????Acid/base investigation:???pH?PCO2?HCO3?HCO3????kPa?actual?standard?????mmol/l?mmol/l??normal range?7.38-7.42?5.0-5.5?22-26?22-26{E}?Result 1?7.15?9.5?26?24{A}?Result 2?7.32?9.5?40?38{E}?Result 3?7.62?5.3?38?38{B}?Result 4?7.65?2.8?22?24{H}?Result 5?7.48?2.8?16?18EMI-8THEME: TUBERCULOSISOPTIONS:A. fixed dose combination (FDC)B. heavy alcohol consumptionC. intermittent (2 to 3 times a week) dosing of antituberculosis treatmentD. pregnancyE. highly active combination antiretroviral therapyF. malnutritionG. HIV-infectionH. Directly Observed Treatment (DOTS)In treating a TB patient, select which factors (from the list of options) are important considerations for each of the following cases. Please note that each of these questions require more than one correct answer.A|C|F|G|Ha.?These 4 factors increase the risk of developing peripheral neuropathyA|C|E|Hb.?These 2 factors decrease the risk of tuberculosis relapse after treatment completionB|Dc.?This factor increases the risk of developing drug resistance ................
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