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Objective Question on Emergency Medicine
1. A woman with history of recurrent abortion present with isolated increase in APTT most likely cause Is –
(1) Lupus anti-coagulant
(2) Factor VI
(3) VWF disease
(4) Haemophilia A
2. Acute coronary syndrome which encompasses all, EXCEPT –
(1) Unstable Angina
(2) Stable Angina
3. An 18-year-old boy presents to the ED with a burn to his left hand while trying to light a campfire. The intern thinks he has a deep partial thickness burn. Which of the following features is NOT consistent with a deep partial thickness bum?
(1) Skin is red and mottled
(2) Skin is blistered
(3) Skin blanches with pressure
(4) Skin is painful to touch
4. The most specific and important laboratory finding in X — linked Adrenoleukodystrophy (ALD) is elevated level of –
(4) Very long chain fatty acid
5. Which of the following is not a component of diagnostic criteria for nephrotic syndrome in children?
(3) 24 hour urine protein > 50 mg/kg
(4) Serum albumin < 25 gm/L
6. Above what level, correction of hypernatremia is associated with osmotic demyelination –
(1) 6 mEq/24 hr
(2) 8 mEq/24 hr
(3) 12 mEq/24 hr
(4) 10 mEq/24 hr
7. A30-year-male presents to emergency with a deep wound over hand, which is looking dirty & soiled. He does not remember about his tetanus immunisation. What is recommended?
(1) Tetanus toxoid only
(2) Tetanus immune globin only
(3) Both tetanus toxoid & immune globin
(4) No need, only local care is needed
8. A 35-year-old is rushed to the ED with stab injury in the chest 10 minutes ago. Resuscitation in initiated. His primary survey findings are : Airway — talking anxious, breathing — tachypnoea, equal air entry, equal chest expansion, 2 cm wound noted at the left sternal edge at the level of the 5th – 6th intercostal space circulation — tachycardia, hypotension, soft abdomen, distended neck veins disability -GCS 15. What is the single most likely diagnosis based on these primary survey findings?
(1) Tension pneumothorax
(2) Massive haemothorax
(3) Blunt cardiac trauma
(4) Cardiac tamponade
9. Squamous cell carcinoma characterized by –
(1) Indurated area of hyperkeratotic lesion
(2) Red brown macule as papule
(3) Papule with pearly
(4) Telangiectatic borders on sun damaged skin
10. A 4-year-old boy is brought to the physician by his mother because of a rash on his hands and feet for the past two weeks. The rash is intensely pruritic, especially at night. He has not had fever, headache or diarrhoea. His mother has a history of eczema. The child was due for an appointment later in the week to follow up on any potentially missing vaccinations. His temperature is 37.8°C (100.1 °F). Examination shows a maculopapular rash with linear patterns affecting the interdigital spaces of the fingers and toes. The remainder of the examination shows no abnormalities. Which of the following is the most effective intervention for this patient’s skin lesion?
(1) Oral acyclovir
(2) Supportive care
(3) Oral diphenhydramine
(4) Topical permethrin
11. Contraindication of wounds closure primarily are all, EXCEPT –
(1) Redness at wound site
(2) Warmth at wound site
(3) Swelling at wound site
(4) Clean and clear wound site
12. Which of the following is the MOST frequent presenting complaint of mitral stenosis?
(1) Atrial fibrillation
(2) Exertional dyspnea
(4) Paroxysmal nocturnal dyspnea
13. All of the following are clinical features of opioid intoxication, EXCEPT –
(2) Respiratory depression
(4) Hyper motility of G.I. tract
14. All are true for Crohn’s disease, EXCEPT –
(1) Appendectomy protective
(2) Dizygotic twins 47 concordance
(3) Oral contraceptive hazard ratio 2.82
(4) Smoking may cause disease (odds ratio 1.76)
15. Which among the following are contra indications for lumbar puncture?
(a) Platelet count 60,000µmm
(c) Administration of LMWH in past 24 hr.
(d) Skin infection near L.P. site
(1) (a), (b)
(2) (a), (b), (c)
(3) (a), (b), (d)
(4) (b), (c), (d)
16. Correct sequence of events during managing a patient with cardiac arrest and initial rhythm ventricular fibrillation –
(1) CPR — Defibrillation – Amiodarone — Epinephrine
(2) Defibrillation – CPR — Epinephrine — Amiodarone
(3) Epinephrine — Defibrillation – CPR — Amiodarone
(4) Amiodarone — Defibrillation — CPR ~ Epinephrine
17. All of the following are differential diagnosis of tetanus in emergency department, except –
(1) Strychnine poisoning
(2) Hypocalcemic tetani
(3) Bacterial meningitis
(4) Myasthenia gravis
18. An elderly female presents to emergency with history of road traffic accident. On examination, the pelvic compression test is positive. FAST exam was performed and came out negative on proper history the mechanism of injury was dangerous. Which of the following is not true about the further management?
(1) If patient become hemodynamically unstable, angiography should be considered.
(2) Retroperitoneal bleeds can complicate this with a loss of upto 4 L blood.
(3) Further CT scans are not needed as the FAST is negative.
(4) False positive FAST can be upto 30% in pelvic ring disruption.
19. In the settings of natural disasters, such as tsunamis and earthquakes, which bacterial infection is common?
(1) Acinetobacter baumannii
(2) E. Coli
(3) H. Pylori
(4) H. Influenzae
20. Which of the following organ systems is most sensitive to the effects of ionizing radiation?
21. According to DSM-IV-TR guidelines, a substance abuse diagnosis requires one of four symptoms in the preceding 12 months. Which of the following is NOT one of those qualifying symptoms?
(1) Failure to fulfill major obligations
(3) Recurrent substance use in physically hazardous situations
(4) Recurrent substance related legal problems
22. Syncope is described as all, EXCEPT –
(1) Posture at onset — usually erect
(2) Duration of unconsciousness minutes
(3) Duration of tonic or clonic movement never more than 15 sec.
(4) Aching of muscles after events sometimes
23. A 43-year-old man is brought to the emergency department after being found unresponsive by his wife. She says he was in his usual state of health when she left home a few hours ago. The patient has a history of depression and type 2 diabetes mellitus. He was recently laid off from work. Blood pressure is 100/60mm Hg and pulse is 64/min. On physical examination, the patient is responsive to deep sternal rub and has mildly dry mucous membranes. Arterial blood gas analysis revels the following: pH 7.22; PaCO2 60mm Hg; HCO3 24 mEq/L. Which of the following is the most likely current acid-base status in this patient?
(1) Acute respiratory acidosis
(2) Chronic respiratory acidosis
(3) Acute on chronic respiratory acidosis
(4) Metabolic acidosis
24. An 85-year-old woman is brought to the ED after she slipped on a wet floor and fell. During primary survey you suspect a neck of femur fracture. A hip and pelvis x-ray is performed. Which of the following would you expect to see on the x-ray?
(1) Disrupted Letournel lines
(2) Throckmorton sign
(3) Trethowan sign
(4) Disrupted Shenton’s line
25. All are the sign of pneumothorax, EXCEPT –
(1) Abolishing of lung sliding
(2) Absence of b lines
(3) Absence of lung pulse
(4) Absence of lung point
26. While examining the neck pain in a patient, the patient complain of electric shock like sensation an neck flexion. What does it indicate?
(1) Nerve root compression
(2) Spondylolisthesis of cervical bones
(3) Involvement of ligaments
(4) Indicate possible card compression
27. Reentry tachyarrhythmia are all, EXCEPT –
(3) TdP in long QT syndrome
(4) Scar related VT
28. Rigid chest syndrome is associated with which of the following?
29. Management of High Altitude Pulmonary Edema (HAPE) all, EXCEPT –
(1) Treatment with acetazolamide 250 mg gq 12 hrs.
(2) Immediate descent
(3) Minimization of exertion
(4) Nifedipine 30 mg extended release q 12 hrs.
30. According to the classification of Hemorrhage in trauma patient, class II] Hemorrhage is defined as blood loss of around –
(1) >2000 ml
(2) 750-1500 ml
(3) 1500-2000 ml
(4) Upto 40% of blood loss
31. TIMI risk score for NSE-ACS are all, EXCEPT –
(1) Age> 65 years
(2) ST deviation > 0.5mm on presenting ECG
(3) Normal cardiac marker
(4) Prior Angina
32. Which one is false about Guillain Barre Syndrome?
(1) Ascending symmetrical areflexic weakness
(2) High CSF protein level with CSF WBC count < 10 cells/umm
(3) Single breath count is helpful in establishing respiratory status
(4) If intubation is needed, succinylcholine is the ideal neuromuscular blocker
33. First line drug for generalized onset tonic-clonic seizure –
34. Typical manifestation of classic heat stroke –
(1) Central nervous system dysfunction
(3) Marked lactic acidosis
(4) Hypoglycemia/ Calcemia
35. Patients placed on an alpha — adrenergic receptor blocker for the treatment of urinary retention need to be warned of what possible side effect?
(2) Erectile dysfunction
36. Which of the following is not a part of diagnostic criteria for obesity hypoventilation syndrome?
(1) Body mass index > 30 kg/m2
(2) Day time PaCO2 > 35 mm Hg
(3) Associated obstructive sleep apnea
(4) Absence of neuromuscular disorders
37. A 28-year-old lady is brought to the Emergency Department after fainting at work following severe worsening pelvic pain for the last few hours. On examination she is tender in the left iliac fossa with rebound tenderness. She is apyrexial, her blood pressure is 95/50 mmHg and her heart rate is 105 beats per minute. What investigation should be performed first in the management of this patient?
(1) Urine pregnancy test
(2) Cervical cultures
(3) Full blood count
(4) Abdominal x — ray
38. Lateral medullary syndrome includes all, EXCEPT –
(1) On side of lesion pain numbness
(2) Ataxia of limb falling to side of lesion
(3) Horner’s syndrome
(4) Paralysis with atrophy of one —half of tongue
39. Psoriasis is described as all, EXCEPT –
(1) Common distribution elbow knee
(2) Silvery scale
(3) Grouped vesicles progressing to crusted erosion
(4) Nail have pits
40. The ratio of the intracellular fluid volume to the extracellular fluid volume approach as adult levels at the age of –
(1) 1 yr
(3) 3 yr
41. FDA approved therapies for the treatment of pulmonary arterial hypertension intravenous therapy –
42. Which of the following is least likely to be present in a 5 — year — old child with the diagnosis of Henoch — Schonlein purpura (HSP)?
(1) Abdominal pain
(4) Testicular torsion
43. The following disorders are associated with a large anterior fontanelle, EXCEPT –
(1) Congenital rubella syndrome
(3) Apert syndrome
(4) Vitamin A deficiency
44. In Goal directed therapy of Brain injury, the target mean arterial blood pressure is –
(2) ≥70 mmHg
(3) ≥90 mmHg
(4) ≥60 mmHg
45. Which of the following presentation need not require pacing in emergency department?
(1) Sick sinus syndrome with maximum pause of 1.5 seconds
(2) Mobitz type IT
(3) Torsade de pointes
(4) Hemodynamically unstable bradycardia