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Questions and Answers on Emergency Medicine
1. Which of the following type of pelvic fracture is associated with maximum chances of severe haemorrhage?
(1) Vertical shear fracture
(2) Later compression fracture
(3) Open book fracture
(4) Isolated fracture of anterior superior iliac spine
2. Respiratory Alkalosis includes all, EXCEPT –
(2) HCO3- low
(3) PaCO2 low
(4) PaCO2 high
3. A 7-year-old boy is brought to the ED by his parents several minutes after he fell through a window. He is bleeding profusely from a 6 cm wound in his medial right thigh. Immediate management of the wound should consist of –
(1) Applying a tourniquet
(2) Applying direct pressure on the wound
(3) Packing the wound with gauze
(4) Applying direct pressure on the femoral artery at the groin
4. In a child less than 3 years, the diagnosis of failure to thrive (FTT) is considered, if –
(1) Weight is below the 3rd percentile
(2) Weight drops down more than 2 major percentile lines
(3) Weight for height is less than the 10 percentile
(4) Midarm circumference < 12 cm
5. Which of the following bedside maneuvers increases the systolic ejection murmur of hypertrophic cardiomyopathy (HCM)?
(1) Passive leg raise in supine position
(4) Sustained isometric handgrip
6. A 21-year-old female presents to the Emergency Department complaining of acute severe pelvic pain. She reports she has not had a period for 6 weeks – her menstrual cycle is usually 28 days. A urine pregnancy test is positive and you suspect an ectopic pregnancy. Which of the following is the most common site of an ectopic pregnancy?
(2) Ampulla of the fallopian tube
(3) Isthmus of the fallopian tube
7. A 26-year-old is brought to the ED after sustaining a knee injury during a football match. He is holding the knee in a flexed position, and you note a prominence laterally. What is the most likely diagnosis?
(1) Tibial plateau fracture
(2) Knee dislocation
(3) Patellar dislocation
(4) Acute haemarthrosis
8. An 85-year-old woman is brought to the ED by paramedics. She fell in a bathroom and you suspect a neck of femur fracture. Which of the following clinical findings would you expect to see?
(1) Internally rotated leg within ability to straight leg raise
(2) Bony deformity seen over hip
(3) Shortened and externally rotated leg
(4) Leg held in abduction and externally rotated
9. Which one of the following is an antidote for toxicity of nitrites?
(2) Sodium Bicarbonate
(3) Methylene blue
10. The organ that can be spared in mitochondrial disorders is –
(3) Small intestine
11. A 27-year-old man presents to the ED complaining of leg pain following a fall from a height while painting house. X-ray shows a proximal fibular fracture. On examination the patient has decreased sensation over the lateral aspect of the forefoot. Which structure has been damaged?
(1) Common peroneal nerve
(2) Tibial nerve
(3) Saphenous nerve
(4) Deep peroneal nerve
12. Which of the following factor is most closely correlated with digoxin toxicity?
(1) Digoxin levels
13. A 55-year-old male diver begins complaining or back pain and urinary retention 1 hour after a dive. What is the MOST likely diagnosis?
(1) Barotrauma to the bladder
(2) Neurotoxin from a marine envenomation
(3) Nitrogen narcosis
(4) Decompression sickness
14. An infant is brought in for poor feeding and constipation. The child is afebrile with hoarse cry. Two noticeable findings on exam are a large anterior fontanelle and decreased body tone for age. What test is warranted?
(1) Barium enema
(2) Botulism toxin assay
(3) Rectal biopsy
(4) Thyroid studies
15. All of the following are criteria’s to consider systemic thrombolysis in pulmonary embolism, EXCEPT –
(1) Severe hypoxemia (SPO2< 90%) despite oxygen administration
(2) Cardiac arrest
(3) Left sided heart strain on echocardiography
(4) Raised levels of troponin T or I
16. Commercial air travel is contraindicated for all, EXCEPT –
(1) Severe sinusitis
(2) Large obstructive polyps
(3) Severe recurrent epistaxis
(4) Allergic rhinitis
17. The Kings College criteria for consideration of liver transplantation in acetaminophen poisoning with acute liver failure (Stage 3) include al 1 the following, EXCEPT –
(1) Coagulopathy (INR > 6)
(2) Acidemia (serum pH < 7.3)
(3) Serum lactic acid > 3 mmol/L
(4) Grade Il or IV hepatic encephalopathy
18. Which one of the following is not a part of severe iron toxicity management with systemic symptoms?
(1) Deferoxamine infusion with a total adult dose of 1000 mg
(2) Gastric lavage with activated charcoal
(3) Obtain serum iron levels within 4-6 hour after ingestion
(4) IV iron chelators is preferred over oral
19. <A 85-year-old woman is brought to the ED complaining of neck pain following a fall. She is complaining of muscles weakness bilaterally, particularly in her arms and hand and a buming sensation in her upper limbs. On examination you note symmetrical motor loss, greater in the distal upper limb than the proximal upper limb, and grater in the upper limb than the lower limb. Which of the following spinal cord lesions is most likely?
(1) Brown-Sequard syndrome
(2) Central cord syndrome
(3) Anterior cord syndrome
(4) Lateral cord syndrome
20. The effectiveness of CPR can be estimated by –
(1) Arterial diastolic blood pressure
(2) Quantitative waveform capnography
(3) Central venous oxygen saturation
(4) All of the above
21. In a woman presenting with amenorrhea headache, blurred vision and galactorrhea appropriate investigation –
(1) Prolactin Level
22. A 30-year-old male patient has presented with fever with muscle rigidity, incontinence on examination there is changes in mental slaves’ tachycardia, hypertension tachypnea, tremor, incontinences, increased CPK levels, leucocytosis and metabolic acidosis. What is your diagnosis?
(1) Neuroleptic malignant syndrome
(2) Viral encephalin
(3) Thyroid storm
23. Indication for suture repair of laceration of tongue –
(1) Deep laceration on the lateral border of the tongue.
(2) Non-gaping laceration on the dorsum of the tongue.
(3) Gaping laceration on the dorsum of the tongue that are less than 2 cm.
(4) Gaping laceration but come together when the tongue is at rest in the mouth.
24. All of the following are class III Antiarrhythmic, EXCEPT –
25. Which of the following is NOT a risk factor for severity of illness in a dehydrated diabetic child?
(1) Acidosis in a type I diabetic
26. A 23-year-old professional skateboarder presents to the ED complaining of pain to the right wrist following a fall. On examination you elicit tenderness in the anatomical snuffbox. Which of the following tendons forms the ulnar border of the anatomical snuffbox?
(1) Flexor pollicis longus
(2) Extensor pollicis longus
(3) Adductor pollicis longus
(4) Extensor pollicis brevis
27. Which of the following statement regarding the control of bleeding through a would is not correct?
(1) Tranexamic acid tablets can be mixed in sterile water and applied
(2) Local anaesthetic with epinephrine help control bleeding
(3) ‘Figure of 8” stitches are used for longer lacerations
(4) Cellulose reacts with blood to form an artificial clot
28. The most important factor in fracture healing is –
(1) Good alignment
(2) Organization of blood clot
(3) Accurate reduction
29. A 32-year female presents to the ED complaining of weakness in her left arm. She gives history of fracture to this arm about 2 months ago. Examination reveals loss of left wrist extension and weakness of grasp. Extension at the elbow joint is normal, and there is no loss of sensation. Which of the following nerves is most likely affected?
(1) Recurrent branch of the median nerve
(2) Posterior interosseous nerve
(3) Superficial branch of the radial nerve
(4) Anterior interosseous nerve
30. Which of the following statements regarding neurogenic shock is not correct?
(1) Relative bradycardia is present
(2) Hypotension in trauma should not be presumed due to neurogenic shock early
(3) Cold peripheries
(4) Lesion through T1 to T4 cause loss of sympathetic innervation to heart
31. Rome IV diagnostic criteria for IBS are all, EXCEPT –
(1) Recurrent abdominal pain at least 1 day per week in the last 3 month
(2) Associated with a change in frequency of stool
(3) Without change in form of stool
(4) Related to defecation
32. Bronchial intubation of the right or left main stem bronchus can easily occur during infant endotracheal intubation, because –
(1) The trachea is relatively short.
(2) The use of cuffed endotracheal tubes eliminates this issue.
(3) The main stem bronchi are less angulated in their relation to the trachea.
(4) Little friction exists between the endotracheal tube and the wall of the trachea.
33. A 25-year-old male wrestler presents to the ED after a match. On examination he is unable to flex his index and middle fingers at the metacarpophalangeal or interphalangeal joints and is unable to flex the distal phalanx of his thumb. He has loss of sensation over the lateral palm and fingers. Which of the following nerves has most likely been injured, and at what level?
(1) Anterior interosseous nerve in the proximal forearm
(2) Median nerve at the cubital fossa
(3) Median nerve at the wrist
(4) Ulnar nerve at the elbow
34. March fracture affects –
(1) Neck of 2nd metatarsal
(2) Body of 2nd metatarsal
(3) Neck of 1st metatarsal
(4) Fracture of lower end of tibia
35. A 5-year-old child is brought to ED by parent for headache, vomiting and dyspnea but no fever. The parents have similar but milder symptoms. They have been staying in their mountain cabin that is heated by a propane heater. Which of the following tests is most likely to be abnormal?
(1) COHb level
(2) Chest radiograph
(3) CT of the brain
(4) Pulse oximetry
36. An anxious 50-year-old female drug user with a 10 cm thigh abscess from skin popping is given midazolam (Versed) to facilitate incision and drainage. She remains calm but with her eyes open and cooperative and verbal throughout the procedure. What type of sedation is this called?
(1) Deep sedation
(3) General anaesthesia
(4) Minimal sedation
37. The most common opportunistic infection in renal transplant recipients below 1 month –
(2) Pneumocystis carinii
(3) Herpes virus
38. Which of the following combination of intracranial injuries & CT findings is correctly matched?
(1) Subdural — Biconvex hematoma
(2) Subarachnoid — Blood in Basal cistern
(3) Epidural — Crescent shaped hematoma
(4) Contusion — Blood in fissures
39. Raynaud’s phenomenon describe as all, EXCEPT –
(1) Persistent digital ischemia
(3) Rubor of the finger or toe after cold exposure
(4) Emotional stress may also precipitate
40. High risk of recurrent venous thromboembolism after discontinuing anticoagulation –
(1) Antiphospholipid syndrome
(2) Major surgery trauma
(4) Long haul flight
41. What is the first line management in patients with suspected cases of chlamydia?
(1) Azithromycin 1gm single dose
42. Which of the following WHO drug regimen in preferred in uncomplicated MDR — TB?
(1) Bedaquiline, pretomanid, linezolid
(2) Fluoroquinolone, rifampicin, isoniazid
(3) Amoxicillin, rifampicin, ethambutol
43. Enzymes replacement therapy are available for the following disorders, EXCEPT –
(1) Wolman disease
(2) Gaucher disease
(3) Fabry disease
(4) Mucopolysaccharidosis type VI
44. Which of the following drugs causes tubular injury, EXCEPT?
(1) Aminoglycoside antibiotic
45. Which of the following is true regarding airway management in pregnancy?
(1) Aspiration risk is decreased in pregnancy.
(2) A respiratory acidosis is normal in pregnancy.
(3) Because of difficult airway anatomy, intubation should be avoided if possible.
(4) Rapid sequence medications, including paralytics, cross the placenta.