MCEM Original Practice MCQs No2

8/10/2019 MCEM Original Practice MCQs No2

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2006 mcem.org.uk MCEM Part A - Original practice MCQs No.2

MCEM PART A - ORIGINAL PRACTICE MCQs No.2

1 Substances known to cause SIADH include

A. Tri-cyclic antidepressantsB. CarbamazepineC. DemeclocyclineD. Lithium

2 When considering a Biers block for regional anaesthesia A. Raynaud's syndrome is a contraindicationB. It is commonly used in childrenC. An appropriate local anaesthetic dose for most adults is 40mL of 1% plain prilocaineD. Requires the presence of at least two members of trained staff

3 Regarding ketamine for use for sedation and analgesia A. It has analgesic, hypnotic and amnesic propertiesB. 500mg is an appropriate oral dose for adultsC. It may precipitate hallucinationsD. Ketamine crosses the placenta

4 Regarding P.falciparum malaria A. The incubation period is usually 7-14 daysB. It is commonly the result of travel in the Indian subcontinent

C. Lymphadenopathy is a common featureD. Chloroquine is the initial drug treatment of choice

5 When examining an arterial line waveform A. It can be used to estimate cardiac outputB. The slope of the upstroke of the wave reflects myocardial contractility (dP/dt)C. A low dicrotic notch is seen in hypovolaemic patientsD. A fast sloping diastolic decay indicates vasoconstriction

6 Regarding fracture classifications

A. The Neer classification refers to distal radial fracturesB. The Frykman classification refers to proximal humeral fracturesC. The Schatzker classification refers to tibial plateau fracturesD. Type II is the most common type of Salter-Harris fracture presentations

7 In the assessment of a limping child localising pain to the hip joint A. Slipped upper femoral epiphysis is most common in the 3-10 year old age groupB. Perthes disease affects boys more often than girls at a ratio of 4:1C. Interruption of Shentons line is suggestive of a slipped upper femoral epiphysisD. Radiographic appearances are usually normal in transient synovitis


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8 Regarding bleeding disorders A. Von Willebrands disease involves factor VIII deficiency with coagulant activity and

abnormal platelet functionB. Haemophilia B involves a deficiency of factor VIII activityC. The INR, APTT and fibrinogen levels are all raised in disseminated intravascular

coagulation (DIC)D. Severe haemorrhage due to a high INR on warfarin therapy may be treated with

Beriplex and vitamin K

9 Diabetes insipidus may be caused by A. Sheehans syndromeB. ToxoplasmosisC. LithiumD. Wegeners granulomatosis

10 The following eponymous osteochondritis conditions are correctly matched to theirrespective bony sites

A. Freibergs diseaseTibial tuberosityB. Khlers diseaseNavicularC. Kienbocks disease..ScaphoidD. Perthes diseaseFemoral head

11 With regard to compartment syndrome A. It may occur as a result of excessive alcohol intakeB. Loss of distal arterial pulsation is an early signC. The absence of myoglobinuria rules out rhabdomyolysisD. Fasciotomy is indicated if the difference between intra-compartmental and diastolic

blood pressure is


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15 Acute iritis (acute uveitis) A. Is commonly relapsingB. Slit lamp examination may reveal hypopyonC. Talbots test is positive when pain is increased in the affected eye by shining a light into

the good eyeD. Reduced visual acuity, epiphoria and floaters are common symptoms

16 Regarding traction apophysitis A. Osgood-Schlatters disease is most commonly seen in boy aged over 15 yearsB. Johansson-Larsens disease affects the calcaneal attachment of the Achilles tendonC. Most settle completely with rest and NSAIDsD. The pathophysiology relates to inflammation of a tendon attachment to a fused

apophysis

17 When obtaining intraosseous access A. The proximal tibial site is located 2.5cm below the tibial tuberosity on the flat

anteromedial surface

B. Contraindications for intraosseous access include osteopetrosisC. Negative aspiration on insertion indicates incorrect positioning of the needleD. Other insertion sites include the distal femur 3cm above the medial lower femoral

condyle

18 Regarding needlestick injuries A. Possible transmissible infective agents include DiptheriaB. The risk of acquiring hepatitis B from a carrier is around 3-10%C. Transmission risk is increased with hollow needles more than with solid needlesD. The risk of acquiring HIV from a carrier is related to the volume of injected material

19 Respiratory physiology A. In zone 2 of the lung blood flow is determined by the difference between arterial and

alveolar pressures (P a > P A > P v)B. Normal anatomical dead space in the adult is around 150mLC. The flow rate is high in relation to lung volume with flow-volume curves in obstructive

pulmonary diseaseD. Bradykinin is unaffected by its passage through the pulmonary circulation

20 With regard to airway management in the emergency department

A. An uncuffed size 5 (5mm internal diameter) endotracheal tube is appropriate for a 4-year-old male.

B. A size 4 laryngeal mask airway cuff should be inflated with a 50mL volume of airfollowing correct positioning

C. The best head and neck position for direct laryngoscopy is extension of the neck withmaximal flexion at the occipito-atlantal joint

D. Sellicks manoeuvre is used to prevent aspiration when the patient is vomiting duringattempted endotracheal intubation


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21 Entonox A. Is a gas mixture of 50% nitrous oxide and 50% airB. Its use is associated with significant hypotensionC. Is an appropriate method of analgesia soon after scuba divingD. Is unsuitable for use in very cold conditions (under -6C)

22 The following clinical features are more suggestive of acute epiglottitis than croup

A. Slow onsetB. High fever >38.5CC. Increased drooling of salivaD. Age over 5 years

23 Regarding the Mental Health Act (England and Wales, 1983) A. Section 4 forms can be signed by any registered medical practitionerB. Emergency detention under Section 4 lasts for 48 hoursC. Section 2 is used for emergency psychiatric assessment for a period of 28 daysD. The mental health act applies in the emergency department

24 A prolonged QTc (rate corrected QT interval) A. Can result from Quinidine therapyB. Occurs during sleepC. May predispose to torsades de pointesD. Is seen in digoxin toxicity

25 Ransons severity criteria on admission for acute pancreatitis include A. Glucose 350 IU/LC. Amylase >2500D. PaO 2 < 8kPa

26 Gelofusine 500mL contains A. The same amount of sodium per litre as 0.9% salineB. Has a pH of 7.4C. The average gelatine molecular weight is 60,000D. The osmolarity is 284 mOsm/L

27 Regarding renal physiology A. 80% of the blood plasma arriving at the nephron is filtered at the glomerulusB. Around two-thirds of the sodium contained in the glomerular filtrate is reabsorbed in

the proximal tubule under normal conditionsC. Plasma creatinine only starts to increase substantially when around 50% of renal

function (GFR) has been lostD. Aminoglycosides are not excreted by the kidney

28 The standard childhood immunisation schedule includes A. DTP, polio and Hib at 2,3 and 4 monthsB. DTP booster at 2 yearsC. BCG at 10-14 yearsD. MMR at 12-15 months


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29 Regarding the modified SAD PERSON score in assessing suicide risk A. A total score 8 probably requires hospital admissionC. The age range that indicates an increased suicide risk is 19 - 45 yearsD. Excessive alcohol or drug use is one of the risk factors

30 Parathyroid hormone (PTH) A. Is an 84 amino acid peptideB. Reduces both calcium and phosphate reabsorption in the kidneyC. Suppresses osteoclastic activityD. Decreases production of 1,25-dihydroxycholelcalciferol in the kidney


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ANSWERS

1 A. TB. TC. F (Demeclocycline is a drug treatment for SIADH)D. F (Lithium causes Diabetes Insipidus)

2 A. TB. F (Biers block is rarely used in children and contraindicated below the age of 7 years)C. F (The normal local anaesthetic dose is 40mL of 0.5% prilocaine in adults)D. T (Biers block requires staff competent to deal with severe toxic reactions and have

equipment/training to carry out advanced resuscitation)

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A. TB. T (Also, in severe pain a loading dose of 0.5-1.0mg/kg IM may be given)C. T (For this reason it is usually administered with a benzodiazepine)D. T (Ketamine crosses the placenta and also increases salivation, intracranial pressure

and intraocular pressure)

4 A. T (There are often paroxysms of malaise, fever and headache lasting 8-12 hours

followed by severe sweating)B. F ( P.falciparum is more common in Africa, South-east Asia and Central and South

America, P.vivax is common in the Indian subcontinent)

C. F (Haemolytic anaemia with splenomegaly and jaundice may occur butlymphadenopathy is not a feature)

D. F (Quinine is the drug of choice with P.Falciparum , given orally or IV. Chloroquine isusually effective in P.vivax , ovale and malariae )

5

A. T (The stroke volume can be calculated by measuring the area from the beginning ofthe upstroke to the dicrotic notch. If this is multiplied by the heart rate, then cardiacoutput can be estimated)

B. T

C. TD. F (The slope of the diastolic decay indicates resistance to outflow. A slow fall is seen in

vasoconstriction)

6

A. F (The Neer classification refers to proximal humeral fractures)B. F (The Frykman classification refers to distal radial fractures)C. TD. T


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7 A. F (Perthes is more common in the 3-10 year old age group, while slipped upper femoral

epiphysis is more common in the 10-16 year age group)B. T (Slipped upper femoral epiphysis is also more common in boys than girls, at a ratio of

3:1)C. F (Shentons line applies to the AP view of the pelvis and continues from the inferior

border of the femoral neck to the inferior border of the pubic ramus it is disrupted

with fracture neck of femur. Trethowans sign is a line drawn along the superior borderof the femoral neck which should normally cut through the femoral epiphysis. If not,this may indicate a slipped upper femoral epiphysis)

D. T

8 A. TB. F (Haemophilia B involves deficiency of factor IX activity)C. F (Platelet count and fibrinogen levels fall while INR, APTT and fibrin degradation

products rise)

D. T (Beriplex is a prothombin complex concentrate of factors II, VII, IX and X and can beused instead of FFP along with vitamin K to reverse high INR from warfarin therapy)

9 A. TB. TC. TD. T

10

A. F (Freibergs affects the second metatarsal head, Osgood-Schlatters disease affects thetibial tuberosity)

B. TC. F (Kienbocks disease affects the lunate, not the scaphoid)D. T

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A. T (Often due to unconsciousness and then lying on a hard surface for a significant time)B. F (Loss of arterial pulses is a relatively late sign)C. F (Myoglobinuria depends upon myoglobin release rate into plasma and the degree of

protein binding, GFR and urine flow therefore its absence does not necessarily rule outrhabdomyolysis)D. T

12 A. TB. F (Early radiological signs include soft tissue swelling. Punched out lesions appear later)C. F (Initial therapy does not include allopurinol. NSAIDs or colchicine are used in acute

gout)D. T


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13 A. F (Elimination half-life of CO is around 4 hours with normal room air, around 1 hour

with 100% oxygen and 23 minutes at 3 atmospheres pressure)B. F (COHb levels correlate poorly with clinical features. Serum CO and mitochondrial

enzyme levels are better indicators of severity)C. T (Cherry-red skin colouring is sometimes seen in very severe and fatal poisoning)D. F (Hyperbaric oxygen therapy is unproven after CO poisoning. However, severe

poisoning with COHb levels >40%, in pregnant women or with cardiac or neurologicalcomplications may warrant hyperbaric therapy)

14

A. F (Diphtheria usually has an incubation period of 2 5 days)B. TC. F (Hepatitis A usually has an incubation period of around 4 weeks)D. T

15 A. TB. T (Hypopyon refers to pus in the anterior chamber)C. F (This is a sign of acute iritis. However, Talbots test is positive when there is an

increase in pain with eye convergence and pupil reaction to accommodation)D. T (Other common symptoms are acute onset pain and photophobia)

16

A. F (Osgood-Schlatters disease is most common in boys aged 10-15)B. F (Traction apophysitis of the calcaneal attachment of the Achilles tendon is called

Severs disease. Johansson-Larsens disease involves the lower pole of the patella inyoung adolescents)

C. T (Orthopaedic follow-up should be arranged but conservative treatment is appropriatein almost all cases)

D. F (Pathophysiology involves damage to an unfused apophysis by strong pull on itstendonous attachment. E.g. tibial attachment of patella tendon at the tibial tuberosity inOsgood-Schlatters disease)

17 A. T (This is the first choice site)

B. T (Infection or fracture at, or proximal to, the insertion site and osteogenesisimperfecta are also contraindications)

C. F (Despite negative aspiration the needle may still be correctly positioned. The positionmay still be verified by injecting 10mL 0.9 saline under sterile conditions. If flushing iseasy and there is no local swelling then the position should be satisfactory)

D. F (The correct distal femoral position is 3cm above the lateral lower femoral condyle onthe anterolateral surface. Others include the distal tibia proximal to the medial malleolusor the sternum, which is also useful in adults)


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18 A. TB. F (The risk of acquiring hepatitis B has been estimated to be 2-40%. Risk of hepatitis C

transmission from a carrier is around 3-10%. In contrast, HIV risk is much lower around 0.2-0.5%)

C. TD. T (Risk of HIV transmission is increased if significant volumes have been injected)

19 A. TB. T (Anatomical dead space is the volume of the conducting airways)C. F (The reverse is true. In obstructive disease the flow rates are very low in relation to

lung volume and may show a scooped-out appearance following the point of maximumflow on a flow-volume curve)

D. F (Bradykinin is largely inactivated, around 80%, by angiotensin-converting enzyme inthe lungs)

20 A. T (The formula for endotracheal tube sizing in children is the age divided by 4 then add

4 in mm. Uncuffed tubes should be used up until the age of 12 as the narrowest part ofthe upper airway is the cricoid ring until puberty)

B. F (The recommended volume is 30mL. The general formula for this is the size of theLMA minus 1 times 10 in mL)

C. F (The most effective position is with flexion of the neck and extension at the occipito-atlantal joint the so called sniffing the morning air position)

D. F (Cricoid pressure should be released if the patient is actively vomiting otherwise anoesophageal rupture may occur)

21

A. F (It is a mixture of 50% nitrous oxide and 50% oxygen. It is stored in blue cylinderswith a white and blue top)

B. F (Entonox produces little physiological change which is why it is a popular and safemethod of analgesia for pre-hospital use)

C. F (While a good method of analgesia for minor procedures and initial pain relief it is notappropriate following diving as entonox will diffuse more rapidly than nitrogen and maytherefore increase the risk of decompression sickness)

D. T (The gases may separate at very low temperatures and therefore there is a risk of

inadvertent administration of a hypoxic gas mixture)22

A. F (Acute epiglottitis has a rapid onset while croup tends to be preceded by a coryzalillness)

B. T (High fever is a common finding in acute epiglottitis. Children with croup tend to beapyrexial or have a mild fever only)

C. F (Drooling of saliva is a non-specific sign of upper airway obstruction and may occurwith both severe croup and acute epiglottitis)

D. T (Croup is uncommon above the age of 5 years while acute epiglottitis occurs childrenup to age 7 and occasionally in older children and adults)


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23 A. T (Application can be made by a nearest relative or a specially trained approved social

worker)B. F (Section 4 lasts for a period of 72 hours and remains in force until the patient is

discharged or detained further under Section 2 or 3, or stays voluntarily)C. TD. F (Patients seen in the emergency department are not legally in-patients until admitted

to a ward and therefore detention for emergency treatment of psychiatric or physicalillness can only be carried out under common law)

24

A. T (Other drugs that may prolong the QTc include tri-cyclic antidepressants)B. T (It may also be due to acute MI, hypothermia or hypocalcaemia)C. T (Torsades de pointes is an uncommon form of polymorphic VT with a constantly

changing electrical axis resulting in a constantly changing QRS complex amplitudes,associated with hypokalaemia or hypomagnesaemia with a prolonged QT interval)

D. F (Digoxin and hypercalcaemia shorten the QTc)

25

A. F (Glucose >11.0 mmol/L)B. T (Others include age > 55years, WCC >16.0, AST >250 U/L and glucose >11.0)C. F (Amylase is not one of Ransons criteria)D. F (This is a one of the criteria at 48 hours, along with PCV decrease >10%, urea

increase >1.8 mmol/L, Ca 2+ 4 mmol/L and Fluid sequestration >6L)

26

A. T (Both contain 154 mmol/L of sodium)

B. TC. F (The average molecular weight is 30,000)D. F (The osmolarity is 274 mOsm/L)

27

A. F (Of the plasma flow arriving at each nephron, around 20% becomes glomerularfiltrate while the remaining 80% is carried by the postglomerular capillaries fortransport exchanges with that, and adjacent, nephron tubules)

B. T (25% of the remaining sodium is reabsorbed in the Loop of Henle and the remainderin the distal tubule and collecting duct)

C. TD. F (Aminoglycosides are almost entirely excreted by the kidney, hence the increased riskof nephrotoxicity and ototoxicity in renal impairment / failure)

28 A. TB. F (DTP booster is given at 4-5 years)C. TD. T


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29 A. F (A score

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MCEM Original Practice MCQs No2