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Question 1
Incorrect
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A 58-year-old male attends a doctor's surgery to get help with quitting drinking alcohol. He expressed that he wishes to avoid the unpleasant alcohol craving experiences. From the following options, what should be prescribed to the patient?
Your Answer: Methadone
Correct Answer: Acamprosate
Explanation:Acamprosate (calcium acetyl-homotaurine) helps to restore the normal activity of glutaminergic neurons, which usually become hyperexcited following chronic alcohol exposure.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 2
Incorrect
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A 55-year-old male has complained of severe pain in the right hypochondrium - the pain has been ongoing for the past 24 hours. He describes the pain as coming in waves and it is accompanied by nausea. Nothing he has tried had relieved his pain. His temperature is within the normal range, but he feels hot and is sweating. What is the most appropriate investigation?
Your Answer: Serum amylase
Correct Answer: US Abdomen
Explanation:A US abdomen would be performed to confirm a diagnosis of biliary colic. A number of symptoms are consistent with this diagnosis: severe right hypochondria pain; pain coming in waves; nausea; no fever; and the absence of jaundice.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 3
Incorrect
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A 72-year-old female complains of difficulty breathing due to secretions. She also has end-stage lung cancer. Choose the most appropriate palliative treatment for her.
Your Answer: Tricyclic antidepressants
Correct Answer: Hyoscine butylbromide
Explanation:Hyoscine should be used to help dry the secretions – this is because it acts as an antimuscarinic agent. It also causes less sedation than hyoscine hydrobromide, however, both are administered through injection or infusion.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 4
Incorrect
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A 76-year-old woman attends the Emergency Department after knocking her shin on some furniture at home. She takes prednisolone for polymyalgia rheumatica. You examine her leg and find a pretibial laceration with a large skin flap. Which of the following is the best way to manage this?
Your Answer: Clean the laceration and apply a non adherent dressing
Correct Answer: Clean then steristrip the laceration
Explanation:In young patients with good skin, pre-tibial lacerations may be sutured, usually with non-absorbable sutures that are removed after 7-10 days. In elderly patients with thin skin, or those on warfarin or steroids, the skin is frequently too fragile to suture. For these patients the wound should be thoroughly cleaned and meticulously steristripped to best aid skin healing. A non-adherent dressing and a light bandage can be applied and the patient should be encouraged to elevate the leg. Patients should be reviewed after a week. The laceration may take many months to heal and some require skin grafting procedures.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 5
Correct
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A 12-year-old boy hit his head on a pole on the school playground. His friends noted that he lost consciousness for a few seconds. The school nurse sent him to the Emergency Department as he had a small nasal bleed that stopped spontaneously. In the intervening two hours, he has noticed a watery discharge from his nose. On examination, there is considerable bruising on his nose and forehead, he was complaining of a headache. Which is the most appropriate diagnosis?
Your Answer: Basilar skull fracture
Explanation:Orbital bone fracture: The child has sustained a head injury and subsequently describes a CSF rhinorrhoea (indicating a cerebro-spinal fluid leak). CSF rhinorrhoea can occur in skull or nasal bone fractures. Given the symptoms of loss of consciousness and headache, this child is more at risk of having suffered a skull fracture requiring emergency CT head investigation and specialist neurosurgical management. An ethmoid bone fracture may also present this way. A skull x ray would help to determine an air fluid level and indeed allow some visualisation of the nasal bones, though in children the nasal bones do not visualise well due to lack of fusion. Either way this child would need assessment in the nearest Emergency Department and the school would be expected to follow a ‘head injury’ protocol.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 6
Incorrect
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Pulmonary aspiration is the side effect of which analgesic or anaesthetic agent?
Your Answer: Epidural anaesthetic
Correct Answer: General anaesthetic
Explanation:During general anaesthesia, due to the relaxation of the respiratory muscles, the protective gag reflex is also lost. These changes increase the chances of pulmonary aspiration.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 7
Incorrect
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In an emergency bowel procedure, which among these antibiotics are indicated during anaesthetic induction?
Your Answer: Amoxicillin
Correct Answer: Metronidazole
Explanation:Antibiotic prophylaxis is utilized to avert infection and is based on the degree of contamination involved in the surgical procedure. Operations where the wound is contained with minimal risk of contamination, antibiotic prophylaxis is questionable. In this case there is a high risk of contamination.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 8
Incorrect
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A 21-year-old girl looking unkempt, agitated, malnourished, and nervous, came to the hospital asking for painkillers for her abdominal pain. She is sweating, shivering, and complains of joint pain. What could be the substance misuse here?
Your Answer: Cocaine
Correct Answer: Heroin
Explanation:The appearance and complaints of this patient are strongly indicative of heroin abuse. The other substances listed usually present differently; cocaine and ecstasy users usually have a boost of confidence, someone under the effect of LSD is usually very sociable and relaxed, alcohol abusers might have symptoms like restlessness, hallucinations, shakiness, and insomnia.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 9
Incorrect
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A 17-year-old girl, known to suffer from asthma, was admitted with dyspnoea. Usually her best PEFR is 410 L/min. Which of the following would favour the diagnosis of a severe asthma attack?
Your Answer: Blood pressure of 156/80 mmHg
Correct Answer: PEFR 200 L/min
Explanation:According to the British Thoracic Society, the inability to complete sentences, a HR>110 bpm, a RR>25/min, a PEFR=33-50% of predicted value are all indications of acute severe asthma. Life-threatening asthma would present with hypotension, silent chest, bradycardia and hypoxia.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 10
Incorrect
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A 22 year-old woman presents with a low body temperature and tremors. She reports seeing colour every time she shuts her eyes. What drug has she been using?
Your Answer: Cocaine
Correct Answer: Lysergic acid diethylamide (LSD)
Explanation:Psychedelic drugs, like LSD, are strongly associated with closed-eye hallucinations that this patient is experiencing.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 11
Incorrect
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A middle aged male arrives at the clinic due to chest pain and productive cough. The temperature is recorded to be 38CÖ¯. Radiological examination reveals lobar consolidation and pleurisy. Which of the following would be the best management plan for this patient?
Your Answer: Tetracycline
Correct Answer: Amoxicillin
Explanation:The mainstay of drug therapy for bacterial pneumonia is antibiotic treatment. The choice of agent is based on the severity of the patient’s illness, host factors (e.g., comorbidity, age), and the presumed causative agent. Lobar pneumonia is frequently associated with pneumococcus and Hemophilus infection. Amoxicillin can be effectively used in such cases.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 12
Incorrect
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A 25-year-old youth was brought to the A&E following a stab injury to the right back of the chest. On examination he was dyspnoeic, his trachea was deviated to the left side and there were engorged veins and absent breath sounds on the right side. Which of the following is the most probable diagnosis?
Your Answer:
Correct Answer: Tension pneumothorax
Explanation:History is suggestive of right sided tension pneumothorax. It can’t be a simple pneumothorax because of tracheal deviation and engorged veins.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 13
Incorrect
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A 30-year-old male underwent an urgent appendectomy. 3 hours after the procedure he developed tachycardia and fever. He was also having pain in his abdomen and shoulder area. What is the first step in the management?
Your Answer:
Correct Answer: Maintain IV access and give IV fluids
Explanation:The features mentioned in this case indicate an internal haemorrhage. This should be managed initially by passing an IV line and IV fluids.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 14
Incorrect
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A 6-year-old boy presented in the emergency department with a cough and knee swelling after falling on the road. He had a non-blanching rash on his buttocks and investigations revealed: PT=13, APTT=71, Hgb=11, WBC=8, Plt=200. Which is the most likely diagnosis?
Your Answer:
Correct Answer: Haemophilia
Explanation:From the options mentioned here, the closest diagnosis is haemophilia. This is a mixed picture, as a purpuric rash on the buttocks does not correlate with this diagnosis. However, the most appropriate diagnosis is haemophilia.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 15
Incorrect
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As the SHO of a hospital, you come across the lab report of a patient. It shows the following: glucose 4 mmol/L, K 5.2mmol/L, Na 129 mmol/L. How would you manage this patient?
Your Answer:
Correct Answer: Normal Saline 0.9%
Explanation:This patient’s blood glucose levels are within the normal range. From their lab report, they are suffering from milk hyperkalaemia and hypernatremia. Thus, normal saline 0.9 per cent is most appropriate in this case.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 16
Incorrect
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A 13-year-old patient presents in the A&E with a fracture of his left femur. He was a passenger in a car involved in a traffic accident. Upon clinical examination, his left posterior tibial and dorsalis pedis arteries are not palpable. Which of the following is most probably injured?
Your Answer:
Correct Answer: Femoral artery
Explanation:The femoral artery is the one accompanying the femoral shaft, being the most important blood supplier of the leg. Femoral artery injury during a femur shaft fracture is quite common as a result of blunt trauma.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 17
Incorrect
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A 14-year-old male was involved in a bicycle accident. He was brought to the emergency department with abdominal pain. On the CT scan of the abdomen, a hematoma was present beneath the capsule of the spleen. His BP and pulse were normal. What is the next step in his management?
Your Answer:
Correct Answer: Refer to surgeons for observation
Explanation:A surgeon will observe the patient and will decide which procedure he needs.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 18
Incorrect
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A 34-year-old known alcoholic male has been found unconscious near a pub. The paramedics that attended to him said he was sweating and surrounded by empty cans of cider. Choose the most appropriate initial investigation from the list of options.
Your Answer:
Correct Answer: Capillary blood sugar
Explanation:Capillary blood sugar should be tested as alcohol-induced hypoglycaemia can present itself in cases such as these.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 19
Incorrect
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A 12-year-old boy with emesis, dehydration, cold peripheries and deep breathing, has a blood glucose of 28 mmol/l. What would be the next best step in management?
Your Answer:
Correct Answer: Give normal saline 0.9%
Explanation:Normally blood glucose is filtered out by the kidneys, however as glucose levels exceed 180 mg/dL, the renal tubules become saturated and additional reabsorption is not possible. Glucose remains in the renal tubules, causing additional water and electrolytes to diffuse into the renal system and be excreted as urine (also known as osmotic diuresis). Excessive urine production results in electrolyte loss, and dehydration. Thus an important part of managing these patients is fluid replacement. Initially a litre of 0.9% NaCl over the 1st hour is given which may followed by either 0.45 or 0.9% NaCl, depending on the corrected serum sodium and the hemodynamic status of the patient.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 20
Incorrect
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A 55-year-old patient was diagnosed with hepatocellular carcinoma. Tramadol was prescribed to treat the pain. However, the patient is still experiencing intense pain. Which of the following would be the most appropriate treatment for this patient?
Your Answer:
Correct Answer: Escalate opioid therapy
Explanation:Because the patient’s pain is not responding to Tramadol treatment (already an opioid analgesic), opioid therapy should be escalated until there is pain relief without intolerable side effect.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 21
Incorrect
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A 60-year-old female underwent pelvic surgery. She was given low molecular weight heparin (LMWH) after the procedure. After a week, she complained of sudden chest pain and difficulty in breathing. Her ECG and CXR were normal. What is the most suitable option for her?
Your Answer:
Correct Answer: Keep on low molecular weight heparin and do CT. pulmonary angiography.
Explanation:CT pulmonary angiography will decide the proper cause of her symptoms. Until that has happened LMWP should be continued.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 22
Incorrect
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A 30-year-old male came in with chills and dilated pupils, which were withdrawal signs and symptoms of a certain drug. Which of the following can cause above presentation?
Your Answer:
Correct Answer: Heroine
Explanation:Both cocaine and heroine withdrawal cause dilated pupils. Heroine withdrawal causes chills.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 23
Incorrect
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A 25-year-old male presents to the emergency department with fever, sweating, hyperventilation and breathing difficulty. He also complains of a continuous ringing sensation in both his ears for the past couple of days. He admits to consuming a lot of over the counter painkillers for the past few days. Which of the following drugs is the most likely cause of these symptoms?
Your Answer:
Correct Answer: Aspirin
Explanation: -
This question is part of the following fields:
- Emergency & Critical Care
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Question 24
Incorrect
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A 34-year-old male has been brought to accident and emergency after being involved in a road collision. After his initial evaluation, his score on the Glasgow Coma Scale is 6. What is the most appropriate next step in his treatment?
Your Answer:
Correct Answer: Secure airway
Explanation:The appropriate next step in this patient’s treatment is to secure his airway.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 25
Incorrect
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A 74-year-old male has received his 3rd cycle of chemotherapy for malignant melanoma 3 days ago. He is presented with a productive cough with greenish sputum. Otherwise he feels well. On examination, he has scattered crepitations, more on the lower right part of the chest. He is afebrile. His labs are: Hb 12.5, TLC 0.9 *10^9 , Plt. 84*10^9. Pan culture was collected and sent. What is the most appropriate next step?
Your Answer:
Correct Answer: Broad spectrum antibiotic (intravenous)
Explanation:This is a case of hospital acquired infection in an immunocompromised patient. It should be treated vigorously. On the other hand, patients who receive chemotherapy usually have atrophic gastritis and malabsorption syndrome.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 26
Incorrect
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A 40-year-old female presented with pain and whitening of the hands on exposure to cold. She has difficulty in swallowing solid foods so she has started swallowing only liquids. She developed shortness of breath on exertion and, subsequently, at rest. Which of the following is the most likely cause for dysphagia in this patient?
Your Answer:
Correct Answer: Systemic sclerosis
Explanation:Difficulty in swallowing which improves with liquids is mainly due to an obstructive lesion in oesophagus. But pulmonary involvement (breathlessness on exertion and later on rest) and Raynaud’s phenomena can only be described by systemic sclerosis.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 27
Incorrect
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A 68-year-old female underwent surgery for a hysterectomy. 24 hours later, she is complaining of breathlessness. Upon examination, she has bibasal chest crepitations and a raised jugular venous pressure (JVP). From the list of options, which is the most likely electrolyte or fluid abnormality?
Your Answer:
Correct Answer: Fluid overload
Explanation:The raised JVP and bibasal crepitations in the patient indicate cardiac failure with fluid overload. A chest x-ray and BNP blood level analysis should be performed to confirm this diagnosis. The x-rays should be analysed for alveolar shadowing, Kerly B lines, cardiomegaly, upper lobe diversion, pleural effusion, and fluid in the fissure. If the patient doesn’t have a history of congestive cardiac failure, then this may have been iatrogenic secondary to intravenous fluids.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 28
Incorrect
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A 26-year-old male has been taken to the emergency department with chest pain and increasing shortness of breath. He revealed that he has been a heavy smoker for the last 4 years, but doesn't have any past medical history. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Pneumothorax
Explanation:Increasing shortness of breath, chest pain, and no previous medical history are consistent with a pneumothorax diagnosis. Heavy tobacco use is also a risk factor for developing this condition spontaneously.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 29
Incorrect
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A 40-year old male presented to the OPD with a history of difficulty swallowing and blood-stained vomit. History of weight loss is also present. The abdominal X-ray was normal. Which of the following should be done next?
Your Answer:
Correct Answer: Oesophagogastroduodenoscopy
Explanation:An esophagogastroduodenoscopy (OGD) should be ordered to visualize and identify the source of bleeding. This procedure can harvest tissue samples for histological analysis and can also treat varices that may be causing the bleeding.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 30
Incorrect
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A 56-year-old male has presented with visual loss on his left side and a history of right sided weakness. Where is the occlusion in this patient?
Your Answer:
Correct Answer: Carotid artery
Explanation:The carotid artery divides itself into two parts: the internal carotid and the external carotid. The internal carotid continues down as the middle cerebral and gives rise to the ophthalmic branch. For this reason, middle cerebral occlusion may give rise to partial visual loss but not complete mono-ocular blindness. Middle cerebral artery occlusion causes paralysis or weakness of contralateral face and arm (faciobracheal). It also causes sensory loss of the contralateral face and arm. Anterior cerebral artery occlusion causes paralysis or weakness of the contralateral foot and leg. Again, sensory loss is experienced at the contralateral foot and leg.
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This question is part of the following fields:
- Emergency & Critical Care
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SESSION STATS - PERFORMANCE PER SPECIALTY
