Acem Fellowship Mcq April 2013

Front 1

In regards to Paediatric ECG, which is incorrect?
A. Upright T waves in the anterior precordial leads of an otherwise healthy child can be a sign of RVH.
B. The most common arrhythmia is SVT
C. Axis deviation is a common indication of underlying structural heart disease.
D. Left axis deviation is normal in healthy neonates.

Back 1

D. LAD not normally seen - RAD normally present.

Front 2

Which of the following is not a high risk fracture for NAI in the Paediatric population?
A. Rib
B. tranverse-type
C. femoral
D. metaphyseal

Back 2

B. spiral (oblique)

Front 3

Which is incorrect regarding Acute mesenteric ischaemia?
A. Abdominal CT findings include bowel wall thickening. B. Early Abdominal CT findings include and pneumatosis intestinalis (gas in portal venous system)
C. Mortality is 70%
D. Elevated lactate is usually a late finding.( present in 100% bowel infarction).

Back 3

B. Specific for bowel ischaemia-but usually a late finding - usually when infarction has occurred.

Front 4

In regards to third Trimester liver abnormalities, which is correct?
A. Acute Fatty Liver of pregnancy (AFLP) is common
B. The HELLP Syndrome is less common than AFLP
C. Hepatitis is the most common cause of liver disease in pregnancy, and the clinical course is typically benign.
D. Cholecystitis is the most common Surgical Emergency of pregnancy.

Back 4

C.

HELLP more common than AFLP
Cholecystitis second most common Surgical Emergency in pregnancy.

Front 5

Which is correct regarding Overdose? ( J Roberts-In focus- 2011)
A. Calcium Channel overdose causes hypoglycaemia
B. Beta Blocker overdose causes hyperglycaemia
C. Naloxone will not reverse cardiac arrest from an opioid.
D. Death from an overdose is quite common.

Back 5

C.

Front 6

Which is correct regarding overdose? ( In Focus- J Roberts 2011 )
A. In severe overdose, cocaine has sodium channel blockade activity.
B. Beta blockers are beneficial in cocaine overdose.
C. Hyperkalaemia greater than 6 mmol/L is a clue / Hallmark of acute digoxin toxicity.
D. Calcium channel blocker overdose causes hypoglycaemia.

Back 6

A.

Note: C - Hyperkalaemia > 5 mmol/L can be a hallmark of acute digoxin toxicity

Front 7

Which is incorrect regarding TCA overdose ( In Focus -J Roberts 2011 ).
A. Alkalinisation of the serum with Bicarbonate, to pH > 7.5, decreases protein binding of TCA
B. There is no proven method to reverse TCA-induced cardiac arrest
C. TCA are the only toxins to cause QRS widening and QT prolongation.
D. Noradrenaline should not be used in TCA induced hypotension.

Back 7

B.

Front 8

In a patient suffering smoke inhalation, who has unexplained metabolic acidosis, hypotension or coma, which toxin should be considered- and what antidote assembled?

Back 8

cyanide

1. Hydroxycobalamin
2. Sodium thiosulphate

Front 9

List the indications of intravenous lipid emulsion ( IVLE)
[ Murray]

Back 9

1. Local anaesthetic -induced cardiovascular collapse
(resistant to resuscitation protocols)
2. Considered as "rescue therapy" for refractory cardiac arrest in acute poisoning with other highly lipid soluble agents:
a. TCA
b. Propranolol
c. verapamil

Front 10

Which of the following is NOT a proposed mechanism for the action of intravenous lipid emulsion (IVLE) in cardiac arrest?
A. Increased myocardial ATP synthesis
B. Increased intracellular calcium
C. Inhibition of myocyte potassium channels
D. Drug extraction from tissue binding sites.

Back 10

C. Restoration of myocyte function by activation of calcium and potassium channels.

Front 11

Which of the following is correct in regards to IVLE therapy?
A. Initial dose is 1 mL/kg IV of 10% IVLE
B. It cannot be given as repeat boluses
C. Infusion of 0.25 mL/kg/Hr is continued until restoration of haemodynamic stability
D. The therapeutic endpoint is ROSC and stabilisation of haemodynamic parameters.

Back 11

D.

A = 20%
C = 0.25 mL/kg/MINUTE

Front 12

List the common causes of embolic stroke.

Back 12

1. Mural thrombus from previous MI
2. Atrial fibrillation
3. Fragment dislodgment from valvular vegetations
4. Atherosclerotic plaques in major arteries

Front 13

Which of the following signs is unlikely due a Non-dominant hemisphere stroke?
A. Inattention
B. Aphasia (expressive / receptive)
C. Neglect
D. Dysarthria

Back 13

B.

Front 14

Which of the following symptoms / signs are not due to middle cerebral artery Stroke?
A. Gaze towards the infarct side
B. Homonymous hemianopia
C. Contralateral weakness : Leg > arm
D. Contralateral hemiplegia

Back 14

C. Arms > legs

Front 15

Which of the following is incorrect regarding Stroke?
A. > 2/3 of middle cerebral artery territory is considered severe.
B. The aim of thrombolysis is to salvage the ischaemic penumbra.
C. The majority of strokes involve the MCA territory .
D. The face and arms usually are involved in a non -dominant MCA territory infarct.

Back 15

A. 1/3

Front 16

Which is correct regarding posterior circulation strokes?
A. Occipital headache is an uncommon symptom
B. Symptoms are usually unilateral
C. Homonymous hemianopia can occur with both posterior cerebral artery or middle cerebral artery occlusion.
D. Direct involvement of the pons is the reason for altered level of consciousness.

Back 16

C.

A = most common symptom
B = can be unilateral or bilateral
D = medulla

Front 17

The ABCD2 risk assesses Stroke risk in patients with TIA over the course of 2,7 and 90 days.
List the components assessed.

Back 17

1. Age > 60
2. BP > 140/90
3. Clinical features : speech deficit +/- weakness
4. Duration
5. Diabetes

Front 18

List the scores for low, moderate and high risk for the ABCD2 scoring system for TIA.

Back 18

1. Low risk = 1-3
2. Moderate = 4-5
3. high = 6-7

Front 19

List the stroke risk factors in young adults.

Back 19

1. Smoking
2. Recreational drug use ( cocaine ; sympathomimetics)
3. Migraine with aura
4. Pregnancy: late 3rd Trimester and 6 weeks post partum

Front 20

Which is incorrect regarding Retrobubar haematoma?
A. It can occur from bleeding from the ophthalmic artery and vein
B. It is managed acutely via lateral canthotomy.
C. Clinical findings include enophthalmos, reduced extraocular movements, and progressive visual loss.
D. Ischaemic necrosis of the optic nerve occurs.

Back 20

C. Proptosis

Front 21

Which is correct regarding Paediatric myocarditis?
A. The most common arrhythmia is supraventricular tachycardia (SVT)
B. Troponin levels demonstrate high sensitivity and specificity .
C. The most likely aetiology is bacterial mediated
D.Patients can present with vague generalised malaise.

Back 21

D. Spectrum from generalised malaise to flulminant heart failure or sudden death

A. Sinus tachycardia
B. Sensitivity = 34% / specificity = 82%
C. Viral: coxsackie / influenza /adenovirus

Front 22

Which is correct regarding Electrical injury?
A. For a given voltage, Direct Current (DC) is more dangerous than Alternating current (AC)
B. High voltage Electrical injuries should be treated like "Crush injuries".
C. Asystole is the most common cardiac arrest arrhythmia .
D. > 25% of patients experiencing low voltage electrical injury develop a cardiac arrhythmia.

Back 22

B.

A. AC > DC
C. VF
D. < 10%

Front 23

In regards to CLuster Headaches, which is correct?
A. The pain is usually bilateral
B. Females are more affected than males.
C. The Ophthalmic division (V1) of the trigeminal nerve is typically affected.
D. The headaches usually occur 2-3 times daily, over 2-3 weeks , with a remission of 2-3 months per year.

Back 23

C.

A. Unilateral
B. Males > Females
D. Average 1 hour , 2-3 times daily, over 6-12 weeks, with a remission typically lasting 12 months.

Front 24

Which is correct regarding the drug of choice for UTI and third trimester pregnancy, in a penicillin -anaphylaxis patient ?
A. Nitrofurantoin
B. Sulfonamides
C. Flouroquinolones
D. cephalexin

Back 24

A. The drugs of choice usually are :

B = neonatal haemolysis
C = Congenital defects

Front 25

Which is correct regarding pertussis infection?
A. Prophylaxis with a macrolide is usually unnecessary in individuals who have had contact with a patient that has been symptomatic > 3 weeks.
B. Vaccines for B. pertussis give immunity for an average 15 years
C. The cellular ADT booster given in the ED trauma setting is recommended for all adults under age 65.
D. The mean duration of illness in adults is 100 days.

Back 25

A.

B = 4-8 years
C = Acellular vaccine
D = 36 - 48 days

Front 26

What is the order of complications for anterior shoulder dislocation, in decreasing frequency?
A. Glenoid rim disruption, axillary nerve injury, humeral head fracture
B. Humeral head fracture , Glenoid rim disruption, axillary nerve injury
C. Axillary nerve injury, humeral head fracture, glenoid rim disruption
D. Axillary nerve and glenoid rim disruption equally, followed by humeral head fracture.

Back 26

C.

Axillary nerve injury = deltoid anaesthesia
Humeral head fracture = Hillman-Sachs deformity
Glenoid rim disruption = Bankart lesion.

Front 27

Which is incorrect regarding Botulism?
A. It is a disorder of the Neuromuscular Junction, and involves inhibition of the release of Acetylcholine.
B. Classical presentation is with a descending, symmetric paralysis.
C. Onset of symptoms is 2-4 hours after ingestion of Botulinum toxin
D. The Bulbar muscles are commonly affected, with dysarthria, diplopia and dysphagia.

Back 27

D. 6-24 hours

Front 28

Which is incorrect regarding Botulinum toxin?
A. It binds reversibly to the presynsaptic membrane of both peripheral and cranial nerves.
B. It inhibits the release of acetylcholine.
C. It does produce ANTICHOLINERGIC symptoms.
D. Dilated, unreactive pupils differentiate it from Myasthenia Gravis.

Back 28

A. Irreversibly binds.

Front 29

True or False: The swan neck deformity of Rheumatoid arthritis involves PIPJ flexion and DIPJ extension.

Back 29

False: PIPJ hyperextension and DIPJ flexion

Front 30

Which is incorrect regarding Lisfranc injuries?
A. XR commonly reveals misalignment of the second metatarsal and the medial border of the middle cuneiform.
B. Trauma to the dorsalis pedis artery can occur.
C. Operative repair prevents degenerative arthritis
D. They can occur from high-energy trauma, and may also occur from axial loading on a plantar-flexed foot.

Back 30

C> High rate of degenerative arthritis, even in setting of operative repair.

Front 31

Which is incorrect regarding pulmonary Anthrax infection?
A. It is a gram negative organism
B. A pneumonia-like picture develops 1 week after inhalation of anthrax spores.
C. First line therapy is with flouroquinolones: ciprofloxacin.
D. It has the highest risk of weaponisation and transmission.

Back 31

A. Gram + Organism.

Front 32

Which of the following is incorrect regarding ARDS?
A. Sepsis is the most common risk factor / condition, leading to ARDS.
B. The Clinical definition includes a PaO2 : FiO2 ratio < 200
C. CXR usually reveals diffuse bilateral pulmonary infiltrates.
D. The difference between ARDS and Cardiogenic pulmonary oedema is the former has a pulmonary wedge pressure > 20mmHg, whilst the latter is < 18mmHg.

Back 32

D. ARDS = PCWP < 18 mmHg

Front 33

In regards to Clinically significant blunt cardiac injury, Which is the most useful and sensitive screening test available in the ED?
A. CXR
B. Ck-MB
C. ECG
D. Troponin

Back 33

C.

Front 34

Which of the following is not an indication for endocarditis prophylaxis for patients with prosthetic / damaged cardiac valves?
A. ERCP
B. Vaginal delivery
C. Dental cleaning
D. Cystoscopy

Back 34

B.

Following procedures are an indication:
1. ERCP
2. Cystoscopy
3. Rigid bronchoscopy
4. Dental cleaning

Front 35

Which of the following is not an indication for Tube thoracostomy, in the setting of Pneumonia + parapneumonic effusion / empyema?
A. Presence of frank pus in pleural space
B. pH < 7.2
C. Positive gram stain
D. LDH > 1000

Back 35

D.

pH< 7.2 = parapneumonic effusion
pH < 7.0 = frank pus.

Front 36

Which of the following risk factors for abruptio placentae is the most significant?
A. Cigarette smoking
B. Preeclampsia
C. Trauma
D. Cocaine use

Back 36

B.

Other Risk Factors :
1. Increased Maternal age
2. Twin /Multiple gestations
3. Chorioamnionitis
4. Oligohydramnios
5. Thrombophilias

Front 37

In regards to Upper GI Bleeding, which is incorrect ?
A. Extended gastric lavage with cold solutions does NOT improve haemostasis.
B. There is NO evidence that passage of an NGT in a patient with oesophageal varices results in increased bleeding or variceal trauma.
C. Bleeding from Oesophageal and stomach varices is the 4th most common cause of upper GI bleeding.
D. 50% of variceal bleeds stop spontaneously

Back 37

C. 3rd most common.

1. Peptic ulcer 40%
2. Erosive Gastritis 25%
3. Varices 20%
4. Mallor Weiss Tear 5%