Pre-Fellowship Course
MCQs
November 2013
1
1.
Regarding paediatric abdominal pain
a.
b.
c.
d.
2.
A patient with mydriasis, thirst, tachycardia and urinary retention could
have ingested all of the following EXCEPT
a.
b.
c.
d.
3.
a.
Pain, tearing, photophobia and foreign body sensation typically
occur 18 – 24 hours after unprotected ocular exposure to
welding.
b.
c.
Any full thickness eyelid laceration >0.5mm needs repair.
Visual acuity should be checked first before irrigating an eye
with a chemical injury.
Rebleeding can occur 3 – 5 days later in up to 30% of cases of
hyphaema.
Which of the following is NOT compatible with the diagnosis of SIADH?
a.
b.
c.
d.
5.
Tricyclic antidepressants
Scopolamine
Organophosphates
Antihistamines
Regarding ocular trauma
d.
4.
Intussusception is the most common cause of intestinal
obstruction in patients between 5 months and 3 years of age.
In children inguinal herniae are almost always direct.
Peak age incidence for appendicitis in children is 4 – 7 years.
In the pre-school and school aged child – the commonest
cause of abdominal pain is mesenteric adenitis.
Low urinary sodium (typically <20mmol/L).
Normal adrenal, renal, cardiac, hepatic and thyroid function.
Clinical euvolaemia.
Hypotonic hyponatraemia.
The presence of all of the following should prompt a search for organic
causes in the violent patient EXCEPT for
a.
b.
c.
d.
Age greater than 40, no past psychiatric history
Abnormal vital signs
Disorientation
Auditory hallucinations
2
6.
Regarding Kawasaki Disease – the general order of development of
symptoms is
a.
b.
c.
d.
7.
Which of the following statements is correct when regarding spine
injuries?
a.
b.
c.
d.
8.
prolonged fever  cervical node enlargement  oral mucosal
changes  widespread rash.
Cervical node enlargement  rash  fever  oral mucosal
changes.
Prolonged fever  dilation of conjunctival vessels  widespread
rash  oral mucosal changes.
Prolonged fever  widespread rash  cervical node
enlargement  oral mucosal changes.
Bilateral fact joint dislocation is generally the result of a
hyperextension injury.
Anterior cord syndrome occurs commonly in the elderly when a
hyperextension injury causes buckling of the ligamentum flavum
into the cord.
Patients with neurogenic shock lose all reflex activities.
A chance fracture is caused by a flexion round an axis anterior
to the anterior spinal longitudinal ligament.
Regarding lightning injuries
a.
b.
c.
d.
The immediate cause of death is prolonged apnoea.
There is a lot of evidence to suggest that foetal monitoring after
lightning strike prevents foetal demise.
Myoglobinuria is very common and requires cautious fluid
management early in the course of the injury.
Lichtenberg figures are considered pathognomonic for lightning
strike.
9.
The first compensatory mechanism for hypoxaemia is
10.
a.
Pulmonary arterial vasoconstriction
b.
Increased heart rate
c.
Increased sympathetic tone
d.
Increased minute ventilation
With regards to transcutaneous pacemakers
a.
b.
c.
d.
Electrical capture is characterised by a widening of the QRS
complex and broad T waves
Chest compressions cannot be given while the device is still
attempting to pace
If used in standby mode – a trial of electrical capture is NOT
recommended
The average current for capture is 5 – 10 mA
3
11.
Which of the following argues against a monoarticular arthritis being
pseudogout?
a.
b.
c.
d.
12.
With respect to multiple sclerosis – all of the following are true EXCEPT
a.
b.
c.
d.
13.
Valsalva manoeuvre
Dynamic handgrip
Standing
ß agonist administration
Regarding regional anaesthesia
a.
b.
c.
d.
15.
MS is exacerbated by states of hyperthermia.
Relapse rate is decreased in post partum women.
Acute symptoms involving the sensory system and/or cranial
nerves have a more favourable prognosis than symptoms
involving the motor system/cerebellum.
Vesicourethral disease is a common cause of morbidity and
mortality in MS.
All of the following would be expected to increase the murmur intensity
or duration in a patient with hypertrophic obstruction cardiomyopathy
(HOCM) EXCEPT
a.
b.
c.
d.
14.
Knee involvement
Negatively birefringent crystals
Crystals which are described as “yellow rhomboids”
Cell count of joint fluids = 5000 WBC/mm3
The sural nerve can be blocked by passing a 30g needle
between the tendons of EDL and EHL.
2ml/kg of 0.5% bupivacaine in children blocks the femoral nerve
well and is a safe dose to give.
The saphenous nerve can be blocked posterior to the medial
malleolus.
Blocking the tibial nerve will anaesthetise the medial aspect of
the sole of the foot.
Regarding seizures in children
a.
b.
c.
d.
Around 50% of children with one febrile seizure will have a
recurrence.
CT scan of the brain is the investigation of choice in patients with
non-traumatic seizures.
It is recommended that all children with first afebrile seizures
should have glucose, FBC, electrolytes, calcium, magnesium
and phosphate levels.
Juvenile myoclonic epilepsy usually develops in the early
childhood years – ages 4 – 6 being the peak age of onset.
4
16.
All of the following potentiate or increase susceptibility to digoxin
toxicity EXCEPT
a.
b.
c.
d.
17.
A 3 day old baby born at term presents to you with bilious vomiting and
abdominal distension. The MOST likely diagnosis is
a.
b.
c.
d.
18.
b.
c.
d.
Lateral epicondyle
Olecranon
Radial head
Trochlea
Regarding head injuries
a.
b.
c.
d.
21.
Extraperitoneal bladder rupture is usually a burst injury of a full
bladder resulting in a laceration in the dome posteriorly.
In adult patients with blunt trauma – the degree of haematuria
corresponds to the degree of injury.
Paediatric patients with <50 RBC/hpf in urine do not appear to
have significant injuries from blunt trauma.
Posterior urethral injuries require immediate surgical repair.
Which ossification centre of the elbow appears at age 10 – 12?
a.
b.
c.
d.
20.
Pyloric stenosis
Intussusception
Necrotising enterocolitis
Volvulus
Knowledge of the management of patients with genitourinary trauma
is important in ED. Which of the following statements is correct?
a.
19.
Hypokalaemia
Renal dysfunction
Hypermagnesaemia
Quinidine
Use of prophylactic anticonvulsants after head injury is
supported by the literature.
Epidural haematomas appear biconcave on CT.
Cerebral contusions most commonly occur in the anterior
temporal or posterior frontal lobe.
Children younger than 2 years are at increased risk of epidural
haematomata compared with subdural haematomata.
Haematological emergencies in children are rare but important to
recognise. Which of the following statements is correct?
a.
b.
c.
d.
Sulphonamides should be avoided in patients with G6PD.
Haemophiliacs have prolonged APTT and prothrombin ratios.
The first stage of iron deficiency is decreased serum iron levels.
Extravascular haemolysis is a Coomb’s test positive process.
5
22.
Poisonings and overdoses are very common presentations to ED.
Which of the following statements is correct?
a.
b.
c.
d.
23.
Urinary alkalinisation should strongly be considered for
theophylline overdoses.
Charcoal should be given as soon as possible in lead poisoned
patients.
Pyridoxine 70mg/kg IV to maximum of 5g IV is the antidote to
isoniazid poisoning.
Haemoperfusion is commonly recommended for patients
presenting with severe Phenytoin overdoses.
A patient has the following blood profile:
Hyponatraemia
Hyperkalaemia
Hypoglycaemia
Normal anion gap metabolic acidosis
The most likely diagnosis here is:
a.
b.
c.
d.
24.
Heat stroke is a medical emergency.
statements is correct?
a.
b.
c.
d.
25.
Which of the following
Cooling efforts should be discontinued when rectal temperature
reached 37˚
Hyperkalaemia and hypocalcaemia may be seen as delayed
complications of heat stroke.
Immersion cooling is the technique of choice for quickly cooling
heat stroke victims.
The cerebellum is resistant to heat, so ataxia is a late finding.
Amyotrophic lateral sclerosis
a.
b.
c.
d.
26.
Nephrotic syndrome
Addison’s disease
SIADH
Vomiting and diarrhoea
Predominantly affects lower motor neurons
Predominantly affects upper motor neurons
Predominantly affects the sensory system
Is associated with cognitive deficits
SIRS defining criteria include
a.
b.
c.
d.
Temperature greater than 40° or less than 36°
Heart rate greater than 120/minute.
Respiratory rate greater than 20 breaths/minute.
WBC in peripheral blood greater than 20x106.
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27.
A man is pulled from a house fire. Both upper and lower legs are
blistered, charred and pale. The rest of his body appears unscathed.
He is coughing but maintaining his airway.
a.
b.
c.
d.
28.
By which percentage does aspirin (when given as the sole medication)
reduce cardiovascular mortality when given in the early stages of
coronary occlusion?
a.
b.
c.
d.
29.
Psoas sign
Guarding
Jump test
Rebound tenderness test
What clinical feature differentiates rabies and tetanus
a.
b.
c.
d.
32.
A Slater Harris 2 injury is a fracture through the epiphysis itself.
Scaphoid fractures are rare in children under eight years of age.
The medial epicondyle ossifies at approximately age 10.
A midshaft femoral fracture will heal in around 12 weeks in an
infant.
The sign with the most specificity in appendicitis is
a.
b.
c.
d.
31.
5%
10%
20%
30%
Regarding paediatric fractures
a.
b.
c.
d.
30.
Carbon monoxide poisoning is only a concern with industrial
fires.
Blisters over joints should not be debrided.
He should be intubated early in the piece to prevent the
development of ARDs.
You estimate his percentage burn to be approximately 36%.
Altered mental state
Paralysis
Limb pain
Nuchal rigidity
Which of the following is true regarding renal calculi?
a.
b.
c.
d.
They are more common in females.
Renal calculi 5mm in size have a 50% chance of spontaneous
passage.
Struvite stones are associated with short bowel syndrome.
Painless haematuria may be the only symptom in 80% of children
with renal calculi.
7
33.
Regarding chest trauma
a.
c.
c.
d.
34.
All of the following are contraindicated in pregnancy EXCEPT
a.
b.
d.
e.
35.
Implies structural damage to the AV node.
Can be seen in digoxin toxicity.
Does not respond to atropine.
Is often transient associated with acute anterior MI.
Paediatric septic arthritis and osteomyelitis are diagnoses that should
not be missed as the consequences can be devastating. Which of the
following statements is correct?
a.
b.
c.
d.
37.
Ondansetron
Erythromycin estolate
ACE inhibitors
Fluoroquinolones
Second degree Mobitz type one block
a.
b.
c.
d.
36.
A massive haemothorax in an adult is defined as 500ml or more.
A sternal fracture is often an indicator of significant blunt
myocardial injury.
Up to 80% of rib fractures may not be apparent on xray.
The main cause of the hypoxaemia of flail chest is the underlying
lung contusion.
The sensitivity of a raised WBC (>12 x 109/L) for the identification
of septic arthritis has been assessed as 85 – 90%.
Xrays may remain normal for 10-14 days after infection onset.
Aspiration of the affected joint will suffice to diagnose and treat
septic arthritis of the hip.
Neonates are at lowest risk of complications from septic
arthritis/osteomyelitis because they have an immature immune
system.
Peritoneal dialysis related peritonitis is commonly due to which
organism?
a.
b.
c.
d.
Staphylococcus epidermidis
E coli
Staphylococcus aureus
Anaerobic bacteria
8
38.
Regarding CSF shunts – which is true?
a.
b.
c.
d.
39.
Ingestion of caustic agents has significant morbidity associated. Which
of the following statements is correct?
a.
b.
c.
d.
40.
Cataracts
Episcleritis
Iritis
Scleromalacia perforans
Regarding the management of DKA in children.
a.
b.
c.
d.
42.
Steroids are useful in treatment of Grade 2a upper GI lesions.
NG tube placement and aspiration of gastric contents is the
chief means of decontamination in alkali ingestion.
Increased risk for oesophageal malignancy is up to 50 times
greater in patients with a history of caustic ingestion.
Follow up endoscopy examination should be avoided between
days 5 – 15.
Which of the following eye conditions is NOT associated with
rheumatoid arthritis?
a.
b.
c.
d.
41.
Obstruction is most commonly in the valve chamber.
Distal obstruction is most commonly encountered in shunts which
have been in place longer than 2 years.
Slit ventricle syndrome is becoming more common.
Changer refill within 3 seconds after compression excludes a
proximal obstruction.
Insulin infusion should commence at 1 unit/kg/hour.
The fluid deficit should be replaced within 8 hours of arrival in ED.
Potassium deficits are usually minimal and potassium
replacement should not commence until serum potassium is
<3.0mmol/L.
Glucose usually corrects faster than the ketoacidosis.
The commonest ECG finding in patients with pulmonary emboli is
a.
b.
c.
d.
Right axis deviation
S1Q3T3
Sinus tachycardia
Right bundle branch block
9
43.
You intubate a 30 year old patient with penetrating chest trauma prior
to taking him for a CT abdomen to investigate for solid organ injury. He
has had a simple pneumothorax treated adequately with intercostal
drainage.
Suddenly he has a cardiac arrest and resuscitation is unsuccessful.
The most likely cause of the cardiac arrest is
a.
b.
c.
d.
44.
Which is the most common overall bacterial cause of pneumonia in
childhood?
a.
b.
c.
d.
45.
Retinal haemorrhages
Transverse fracture of ulna
Chip fractures of metaphyses/epiphyses
Spiral fractures of the tibia
Jervell-Lange-Nielsen Syndrome links
a.
b.
c.
d.
47.
Mycoplasma pneumonia
Strep pneumoniae
Staph aureus
Klebsiella pneumoniae
The following injuries suggest child abuse is the MOST likely diagnosis in
a 3 year old EXCEPT
a.
b.
c.
d.
46.
Haemothorax
Cardiac tamponade
Tension pneumothorax
Systemic air embolism
Deafness and sudden death
VSD and RV hypertrophy
PSVT and accessory pathways
Aganglionosis and colonic dilation
Regarding groin lumps – which of the following are true?
a.
b.
c.
d.
Indirect inguinal herniae protrude directly through the
transversalis fascia.
Femoral herniae are more common in women.
Indirect inguinal herniae rarely incarcerate.
Femoral herniae lie inferior to the inguinal ligament and lateral
to the femoral artery.
10
48.
The most common extrapulmonary presentation of Tb in children is
a.
b.
c.
d.
49.
The most common cause of erythema multiforme is
a.
b.
c.
d.
50.
b.
c.
d.
Low barometric pressure with barotrauma is usually a factor that
needs to be considered.
The literature suggests that the addition of a physician to the
crew adds a significantly higher level of care.
Despatch of a helicopter should be considered if the time for
transport to a trauma centre by ground ambulance is greater
than 30 minutes.
Only 11% of patients benefit from interfacility helicopter
transport.
Regarding cocaine induced myocardial ischaemia
a.
b.
c.
d.
52.
Rheumatoid arthritis
Sarcoidosis
Tuberculosis
Herpes simplex
Regarding helicopter transport
a.
51.
Meningitis
Bony involvement
Cervical lymphadenitis
Joint involvement
ß blockers are useful in BP control.
Up to 43% of patients with cocaine associated chest pain
without MI met TIMI criteria for thrombolysis.
Diazepam should be avoided in management as there is high
risk of respiratory compromise.
Phentolamine is absolutely contraindicated in treatment of
cocaine induced myocardial ischaemia as it causes
hypotension.
Regarding swallowed foreign bodies
a.
b.
c.
d.
15-35% of ingested open safety pins or razor blades will cause
intestinal perforation.
The most common site of foreign body oesophageal obstruction
in the paediatric patient is at the level of the aortic arch.
Coins in the oesophagus lie in the sagittal plan on xray.
Button batteries lodged in the oesophagus can be treated by
watching and waiting for them to pass.
11
53.
Which of the following conditions causes
predominantly in the LOWER lobes of the lung?
a.
b.
c.
d.
54.
b.
c.
d.
b.
c.
d.
Needle cricothyroidotomy is the preferred emergent surgical
airway access technique in the paediatric population.
An infant’s larynx is situated at C5 level in the neck.
The narrowest portion of the paediatric larynx is at the glottis.
A laryngeal mask size 2.0 should be used if needed in an infant
weighing 5 – 10kg.
For native valve endocarditis in the developed world – mitral
valve prolapse is now the most commonly recognised
predisposing cardiac lesion for endocarditis.
Roth spots and Osler’s nodes are major criteria used in the Duke
criteria for diagnosing endocarditis.
Antibiotic prophylaxis against endocarditis is recommended in
patients with prosthetic heart valves undergoing laceration
suturing.
Anticoagulation for native valve endocarditis has been shown
to be beneficial.
Regarding lung abscesses
a.
b.
c.
d.
57.
Ankylosing spondylitis
Histiocytosis
Scleroderma
Coal workers’ pneumoconiosis
Infective endocarditis is sometimes hard to diagnose in ED. Which of
the following statements is correct?
a.
56.
fibrosis
Regarding paediatric airway management
a.
55.
pulmonary
Anaerobic bacteria are the most common isolates from lung
abscesses in immunocompromised patients.
Cancer causes 8 – 18% of lung abscesses in patients over 45
years of age.
CXR findings of lung abscesses on average take more than 2
months to resolve.
Mortality is higher for community acquired lung abscesses
compared with hospital acquired abscesses.
Rotaviral gastroenteritis in children is a common presentation to ED.
Indications for stool analysis include
a.
b.
c.
d.
All patients with diarrhoea to exclude/include rotavirus as a
cause.
Fever > 38°
Blood in stool.
Diarrhoea > 3 days duration.
12
58.
The treatment of asthma is controversial.
statements is CORRECT?
a.
b.
c.
d.
59.
Salbutamol cannot be given via continuous nebulisation
because of risks of toxicity.
Salmeterol is an excellent choice for treating acute
exacerbations of asthma.
Steroids are contraindicated in pregnant patients.
The usefulness of IV magnesium in mild – moderate asthma has
not been established.
Regarding the use of radiologic studies in patients with maxillofacial
trauma
a.
c.
d.
e.
60.
Which of the following
Use of the Towne view is mandatory for evaluating the
mandibular ramus and condyles.
The Waters view is the single most valuable study of the midface
In the case of clinically obvious complex facial injuries – plain
films may be eliminated and CT performed directly.
All of the above are correct.
Regarding “low risk” chest pain patients in ED – which of the following is
correct?
a.
b.
c.
d.
History alone can often exclude the presence of acute
ischaemia.
ED based chest pain units have not been shown to save costs or
improve patient safety.
Normal ECGs and myocardial markers preclude the presence of
other acute coronary syndromes (eg unstable angina).
The “miss” rate for AMI in patients seen in ED using history,
physical exam, ECG and serum markers is currently around 2%.
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