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Quiz on Emergency Medicine
1. A 65-year-old woman with chronic obstructive pulmonary disease comes to the office for a follow-up appointment. The patient reports increasing shortness of breath that is not relieved by her inhalers. Her other medical conditions include osteoarthritis. She is a former smoker with a 45-pack-year history. Blood pressure is 120/70 mm Hg, pulse is 75/min, and respirations are 22/min. Oxygen saturation on room air is 91% at rest. On physical examination, jugular venous pressure is elevated. There is increased intensity of the pulmonic component of S2. Breath sounds are decreased bilaterally with scattered wheezes nut no crackles. There is 2+ lower extremity edema. Which of the following hemodynamic parameters is most likely to be increased in this patient?
(1) Left ventricular preload
(2) Pulmonary arterial compliance
(3) Pulmonary capillary wedge pressure
(4) Right ventricular afterload
2. A 50-year-old male presented to the ED with acute shortness of breath. Which of the following descriptions matches correctly with the MMRC grade of dyspnea?
(1) Patient symptomatic on walking uphill: grade 1
(2) Patient unable to dress without symptoms: grade 3
(3) Patient short of breath while hurrying: grade 0
(4) Patient unable to leave home due to symptoms: grade 5
3. Class I antiarrhythmic drug –
4. Which of the following is not a component CURB -— 65 criteria in community acquired pneumonia?
(2) Respiratory rate > 22/min
(3) Diastolic B. P. < 60 mmHg
(4) Blood urea > 7 mmol/L
5. A 27-year-old male presented to emergency with sudden onset palpitations and breathlessness. On artival he is hemodynamically unstable and cardioversion is required. Which of the following procedural sedation is applicable?
6. Which of the following is not the components of HEART score?
7. A 54-year-old man presents to the Emergency Department with severe epigastric pain. He has a history of alcohol misuse. You suspect pancreatitis. Which of the following examination findings is NOT typically associated with acute pancreatitis?
(1) Cullen’s sign
(2) Murphy’s sign
(3) Abdominal distension
8. A 60-year-old male, chronic smoker and a past history of tuberculosis with incomplete treatment present to ED with complain of excessive blood coming out while coughing he tells loss of around 500 ml blood at home. On examination blood pressure is 76/50 mmHg. What should be the next step?
(1) Immediately consult interventional radiologist and shift to CT room
(2) Urgent chest x — ray
(3) Secure airway
(4) Transfuse PRBC
9. Commonest complication of extracapsular fracture of neck of femur is –
(1) Non union
(2) Ischemic necrosis
(4) AT pulmonary complication
10. According to RIFLE, criteria for acute kidney injury, which of the following is considered as failure?
(1) Urine output 0.3 mli/kg/hr for 24 hour
(2) Urine output 0.5 mi/kg/hr for 12 hour
(3) Urine output 0.3 ml/kg/hr for 12 hour
(4) Urine output 0.5 ml/kg/hr for 6 hour
11. Internal fixation is done in all fracture, EXCEPT –
(3) Elderly person
(4) None of the above
12. A 2-year-old boy is brought to the ED by his parents. They tell you that the child has stopped using his right arm. Any attempt to approach the right arm causes the child to cry. There are no signs of abuse and the child is playing using his left upper limb without any problem. On further questioning parents say that they were swinging the child by holding his hands. The child did not cry or seem in pain at the time. What is the next step in management for this patient?
(1) Elbow joint aspiration
(2) Closed reduction in ED
(3) Apply POP and refer to orthopaedics
(4) Apply sling and discharge with outpatient follow up
13. A 30-year-old male was brought unresponsive to the ED. On undressing the chest, you notice fern-shaped burn marks. This pattern is typical of which condition?
(1) Scald burn
(2) High voltage electric burn
(3) Lightening injury
(4) Chemical burns from hydrofluoric acid
14. What kind of injury is expected when a patient comes to emergency with a history of striking the knee against the dashboard in a high speed collision?
(1) Patellar fracture
(2) Femur fracture
(3) Knee joint dislocation
(4) Posterior dislocation of hip
15. A 54-year-old man presents with acute substernal chest pain. His ECG has 4 mm acute ST segment elevation in lead III and 2mm ST-segment elevation in lead If. Which of the following is the most likely vessel occluded?
(1) Left anterior descending artery
(2) Left circumflex artery
(3) Left main coronary artery
(4) Right coronary artery
16. Clinical finding of acute HIV syndromes are all, EXCEPT –
(3) Mucocutaneous ulceration
(4) Multiple foot ulcer
17. Which are the territories supplied by MCA?
(1) Frontoparietal lobe
(2) Anterotemporal lobe
(3) Brain stem
(4) Both (1) & (2)
18. A near-term but low-birth-weight new born has received tactile stimulation and blow by oxygen for a heart rate of 80. After 30 seconds of blow by oxygen, there has been no improvement. No meconium was noted. What is the next step?
(1) Chest compressions
(2) ET intubation and aspiration for meconium
(3) LMA and ventilation
(4) Positive pressure ventilation with a bag-mask, at a rate of 40 — 60 breaths/min
19. Which fibrinolytic agent is given as a weight based bolus dose in Acute myocardial infarction?
20. For adults with septic shock without any cardiac dysfunction, which agent should be added after norepinephrine if mean arterial blood pressure is not maintained?
21. What is the role of octreotide in upper Gastrointestinal bleed?
(1) It improves coagulopathy
(2) It causes splanchnic vasodilation
(3) Itreduces gastric acid secretion
(4) It improves blood pressure in shock state
22. Comet tail and sliding sign on thoracic ultrasound are features of –
(3) Pleural effusion
(4) Normal lung
23. In paediatric population, PECARN rules is used for –
(1) Abdominal trauma
(2) Thoracic trauma
(3) Minor head injury
(4) Airway management
24. Which of the following pair syndrome is aggravated/ associated with immobilisation or disuse of limbs?
(2) Chronic regional pain syndrome type I
(3) Post stroke pain
(4) Chronic regional pain syndrome type U
25. Common causes of primary Headache all, EXCEPT –
(3) Vascular disorder
(4) Tension type
26. A 22-year-old male patient presented in emergency with 5 days history of abdominal pain followed by back and extremity pain followed by ascending limb weakness which started in lower limb and now has progressed to upper limbs. What is your diagnosis?
(2) Fabry disease
(4) Refsum disease
27. Manifestation of Cerebral Arterial Gas Embolism (CAGE) are all, EXCEPT –
(3) Visual disturbance
28. Periarticular apatite crystal deposition is –
(1) Bursitis and tendinitis
(2) Acute synovitis
(3) Chronic destructive arthropathy
(4) Milwaukee shoulder
29. Drugs to be avoided in myasthenia gravis, all except –
30. Principal features of tamponade (Beck’s triad) are all, EXCEPT –
(2) Prominent — x (early systolic) descent
(3) Absent — y (early diastolic) descent
31. A 20-year-old female known case of sickle cell disease, presents to emergency with complain of sudden and severe pain in the fingers since yesterday. Which of the following agent is preferred in combination with opioids in this case?
32. A 70-year-old male patient has high vitamin b12 levels. What is the underlying causes?
(1) Liver disease
(2) Renal disease
(3) Myeloproliferative disorder
(4) All of the above
33. Following are the components of modified duke’s criteria, EXCEPT –
(1) Positive blood culture
(2) Evidence of endocardial involvement
(3) Vascular phenomenon
(4) Fever> 102
34. A 3-week-old baby brought to emergency with respiratory distress. A noisy breathing was present which you diagnosed as stridor. Which of the following is the most common cause of this condition in infants?
(1) Choanal atresia
(3) Tracheal stenosis
35. Causes of respiratory distress with hypercapnia include all, EXCEPT –
(1) Guillain-Barre syndrome
(2) Pulmonary edema
(3) O.P. Poisoning
(4) Morbid obesity
36. Which of the following is the most common complication of gallstone disease?
(1) Biliary colic
(2) Acalculous cholecystitis
37. If a male person sustained deep partial thickness burns to approximately 40% of his total body surface area and weighs 70 kg, what should be target urine output during resuscitation?
(1) 0.5 ml/kg/hr
(2) 1 ml/kg/hr
(3) 1.5 ml/kg/hr
(4) 2 ml/kg/hr
38. I-GEL is a supraglottic airway device for maintaining airway. Which statement is false about I-GEL?
(1) It provides seal of perilaryngeal structures without inflammation.
(2) Cannot be used in pediatric/ infant patients.
(3) Does not require inflation of cuff.
(4) Better than endotracheal intubation in out of hospital cardiac arrest.
39. An old age patient presents to emergency department with complains of increased coughing and breathlessness since 2 days. He is a known case of COPD on ABG, the PaCO2 is 30 mmHg higher than normal. In case of acute respiratory acidosis, how much rise in bicarbonate is expected?
(1) 1 mEq/L
(2) 6 mEq/L
(3) 3 mEq/L
(4) 1.5 mEq/L
40. A 25-year-old man presents to the ED complaining of worsening pain and paraesthesia in his lower leg. He was only discharged yesterday in a plaster cast following a tibial shaft fracture. The cast has been removed by the nursing staff but he is still complaining of severe pain, despite regular analgesia. You note altered sensation in his foot. What is the most useful investigation in this patient?
(1) X-ray of limb
(2) Compartment pressure measurement
(3) Serum creatine kinase
(4) Doppler ultrasound
41. Which of the following risk factor is not a criteria for complicated urinary tract infection?
(1) Culture proven UTI in male
(2) Recurrent UTI alone
(4) Advanced neurological disease
42. A 60-year-old man presents to the ED with acute onset of chest pain and dyspnea for the past 20 minutes. He has a past medical history of adult onset diabetes mellitus. ECG indicates acute STEMI. Vital signs are BP 90/74, HR 123, RR 26 and room air SaQ2 94%. Physical examination shows an ashen, diaphoretic, tachypneic man. He has cool mottled skin, JVP, rales, and a new harsh apical systolic murmur that begins with the first heart sound but ends before the second. Prior medical records do not document any murmurs. Which of the following is the MOST likely diagnosis?
(1) Aortic insufficiency
(2) Ortic stenosis
(3) Mitral regurgitation
(4) Tricuspid regurgitation
43. Most common causes of bacteremia/ sepsis in infants < 3 months are all, EXCEPT –
(2) Group B streptococcus
(3) E. Coli
(4) Listeria monocytogenes
44. A young male patient is presented to emergency with history of syncope. Which of the following auscultation finding is expected if a valvular pathology is present?
(1) Mid diastolic murmur in Right second intercostal space
(2) Late peaking systolic murmur in Right second intercostal space
(3) Pansystolic murmur in mitral area
(4) Pansystolic murmur in tricuspid area
45. What clinical manifestation should alert the doctor to possible carbon monoxide poisoning in a client who experienced a burn injury during a house fire?
(1) Pulse oximetry reading of 80%
(2) Expiratory stridor and nasal flaring
(3) Cherry red color to the mucous membranes
(4) Presence of carbonaceous particles in the mouth