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MCQs > MCQs remembered from Aug 2015 ACEM > Flashcards

MCQs remembered from Aug 2015 ACEM Flashcards

1
Q

Pathology:
A 40yo man is found in a coma, with a cherry red discoloration of his skin. Which of the following is most likely to have poisoned him?

A) arsenic
B) cyanide
C) carbon monoxide
D) organophosphate

A

B

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2
Q

A man has a popliteal aneurysm that is producing pain in his ankle. Which nerve is likely to be stretched by this aneurysm?

A) tibial
B) common fibular
C) lateral sural cutaneous
D) anterior interosseous

A

?

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3
Q 
Physiology EMQ - options:
A) A-alpha
B) A-beta
C) A-gamma
D) A-delta
E) B
F) C
  1. Which is to “motor muscle spindles”?
  2. Which is most susceptible to hypoxia?
A
  1. C

2. F (there is a table in Ganong, table 4.3)

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4
Q

An older man with Parkinson’s disease is brought in to ED due to 1 day of intractable vomiting. Which antiemetic is the most appropriate to prescribe?

A) domperidone
B) droperidol
C) metoclopramide
D) prochlorperazine

A

A, because although it is a dopamine antagonist (like all the other options), it is peripherally-selective.

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5
Q 
EMQ options:
A) extensor hallucis longus
B) extensor digitorum longus
C) fibularis longus
D) fibularis tertius
E) tibialis anterior
F) tibialis posterior
  1. Which muscle causes dorsiflexion of the ankle and assists in eversion?
  2. Which muscle antagonizes the medial longitudinal arch?
A
  1. ?fibularis tertius

2. ?

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6
Q 
In which position is the ankle most unstable?
A) inversion
B) eversion
C) dorsiflexion
D) plantar flexion
A

A?

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7
Q 
Which of the following is an irreversible COX inhibitor?
A) aspirin
B) clopidogrel 
C) enoxaparin 
D) tibufarin or something like that
A

A

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8
Q

EMQ options:

  • Alpha-1 and Alpha-2
  • Alpha-1, Alpha-2, Beta-1, Beta-2
  • Alpha-2
  • Beta-1 and Beta-2
  • the list goes on with all possible combinations
  1. Clonidine is an agonist
  2. Propranolol is an antagonist
  3. Adrenaline is an agonist
A
  1. Alpha-2
  2. Beta-1 and Beta-2
  3. All four
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9
Q

EMQ options:

  • peroxisome
  • nucleoli
  • nucleus
  • endoplasmic reticulum
  • Golgi body
  • centriole
  1. Most numerous and most prominent in growing cells, site of ribosome synthesis.
A
  1. I think it’s nucleoli
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10
Q

Vd = 100L, CL = 5L/hr, in a 70kg man. What is the half-life?

A

14hrs

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11
Q 
Urine PAH conc is ...mcg/ml
Plasma PAH conc is .....
Urine inulin conc is 35mg/mL
Plasma inulin conc is 0.25mg/mL
Urine production is 1mL/min
Calculate GFR.
A) 100ml/min
B) 140ml/min
C) 180ml/min
D) 200ml/min
A

B

GFR = clearance of inulin. So 35x1, divided by 0.25

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12
Q

EMQ options:

  • Churg-Strauss
  • Kawasaki
  • Thromboangiitis obliterans
  • Takayasu
  • Polyarteritis nodosa
  • Giant cell arteritis
  • Wegener
  1. A 60yo woman has weight loss, fatigue, and sudden loss of vision (?in one eye?)
  2. A 4yo boy has high fevers, gingival swelling, cervical lymph node enlargement.
A
  1. Giant cell

1. Kawasaki

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13
Q 
A lady presents with a lesion recently appearing on her forearm, with minor bleeding. She says she rarely sunbakes, but when she does she gets sunburn easily. What is the lesion most likely to be?
A) basal cell carcinoma
B) melanoma
C) squamous cell carcinoma
D) keratocanthoma?
A

B?

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14
Q

A lady with atrial fibrillation develops a chest infection. It is decided that she should be given either a penicillin or a macrolide. Which of the following is true? (The question said nothing about what meds she takes daily)

A) erythromycin affects clearance of Digoxin
B) erythromycin is the safest option
C) erythromycin causes bleeding risk due to an effect on platelets
D) something about amoxicillin

A

?

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15
Q

EMQ options:

  • Aplastic anaemia
  • Iron deficiency anaemia
  • Folate deficiency anaemia
  • Pernicious anaemia
  • Haemolytic anaemia
  • Anaemia of chronic disease
  1. A lady with pharyngitis develops anaemia after a course of penicillin
  2. A man with mycoplasma pneumonia develops anaemia and Raynaud’s phenomenon.
A
  1. ?haemolytic
  2. Haemolytic. This is the Cold agglutinin type anaemia caused by IgM antibodies that agglutinate RBCs at low temperatures.
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16
Q

What is the mechanism by which alcohol increases diuresis?

A) it inhibits release of anti-diuretic hormone
B) it… Something about aldehyde

A

?

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17
Q

Which of the following causes relaxation of the mesangial cells?

A) dopamine
B) adenosine
C) …
D) …

A

I think dopamine

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18
Q

Which of the following is most susceptible to radiation injury?

A) bladder epithelial cells
B) gastrointestinal epithelial cells
C) corneal epithelial cells
D) …

A

?b

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19
Q

A woman with breast cancer has radiation therapy and develops unilateral swelling in that arm. It is due to:

A) lymphatic obstruction
B) increased hydrostatic pressure in veins
C) something about oncotic pressure
D) …

A

?a

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20
Q

A man develops a DVT in his calf after a long flight, and there is swelling in the calf. What has caused the swelling?

A) lymphatic obstruction
B) reduced oncotic pressure
C) increased venous pressure
D) …

A

C?

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21
Q

A 19yo man has a spontaneous pneumothorax. What is the most likely type of emphysema that he has?

A) centrilobular
B) panacinar
C) distal acinar
D) irregular

A

C

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22
Q

A foreign body completely obstructs the bronchus leading to one lung segment. Which of the following increases?

A) PaCO2
B) dead space
C) ….

A

?

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23
Q

What is the normal filtration fraction in a person with normal renal function?

A) 0.1
B) 0.2
C) 0.3
D) 0.4

A

B

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24
Q

How much sodium is contained in one litre of 3% sodium chloride?

A) 467mmol/L
B) 487mmol/L
C) 513mmol/L
D) 530mmol/L

A

I think C

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25
Q

Which of the following occurs in SLE?

A) …
B) immune complex deposition
C) ….

A

B

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26
Q

A man has a snake bite and is treated with snake antivenom. A week later he presents with fever and polyarthralgia. What has happened?

A) antibody-antigen complex depositions
B) T-cell mediated effects
C) …
D) …

A

A. Serum sickness.

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27
Q

What is the osmolarity of the renal interstitium at the tip of the papilla?

A) 800mOsm/L
B) 1200mOsm/L
C) 1600mOsm/L
D) 400mOsm/L

A

B?

28
Q

How is hepatitis E contracted?

A) fecal-oral
B) parenteral
C) droplet
D) blood products ?

A

A

29
Q

Pharmacology:
Which of the following have the highest indication for hepatitis B vaccine?

A) babies older than 4months
B) those who are getting a hepatitis A vaccine
C) healthcare workers
D) recent immigrants?

A

C?

30
Q

In an ultrasound-guided procedure, you locate the proximal part of the brachial plexus (the roots & trunks between anterior scalene and middle scalene) by noticing the adjacent:

A) axillary artery
B) axillary vein
C) subclavian artery
D) subclavian vein

A

?

31
Q

How much more work does the left ventricle do than the right ventricle?

A) 3 times
B) 5 times
C) 7 times
D) 9 times

A

?

32
Q

A 45yo woman is diagnosed with frequent UTIs and frequent pyelonephritis. Which is the most common underlying cause?

A) ureteric obstruction
B) vesicoureteric reflux
C) bladder cancer
D) …?

A

B would be true for a child…. so maybe for a 45yo woman it’s A?

33
Q

During exercise, bloodflow to muscles changes. In between contractions of exercising muscle (?calf muscle?) how much can the blood flow increase?

A) 10-fold
B) 20-fold
C) 30-fold
D) 40-fold

A

?

34
Q

In a 100m sprint, what is the principle source of ATP for the muscles?

A) aerobic glycolysis
B) anaerobic glycolysis
C) phosphylcreatine something
D) ….

A

?

35
Q

A 25yo woman has abdo pain and is diagnosed with an ectopic pregnancy. What is the most common predisposing factor?

A) endometriosis
B) previous surgery
C) pelvic inflammatory disease
D) intrauterine device

A

all of them?

36
Q

EMQ options:

  • broad ligament
  • suspensory ligament of the ovary
  • uterine tubes
  • ampulla
  • cervix
  • myometrium
  • mesometrium?
  • others…
  1. Carries vessels and lymphatics? to the ovary
  2. Is the least mobile part of the uterus
A

?

37
Q

Flexor pollicis longus:

A) arises only from the humerus
B) has a flat tendon something something
C) passes beneath the flexor retinaculum in its own synovial sheath
D) …

A

C?

38
Q

The anterior boundary to the anatomical snuff box is:

A) extensor pollicis longus and abductor pollicis longus
B) extensor pollicis brevis and abductor pollicis brevis
C) extensor pollicis brevis and extensor pollicis longus
D) extensor pollicis brevis and abductor pollicis longus

A

D

39
Q

A man has a high stepping gait after a traumatic injury. What is the mechanism?

A) proximal fibula fracture

A

A

40
Q

Prednisolone is useful in patients with asthma because:

A) it has multiple routes of administration
B) it reduces bronchial reactivity
C) it has few side effects
D) …

A

B?

41
Q

EMQ options:

  • C3a
  • C3b
  • C5a
  • C5b
  • Prostaglandin
  • NO
  • Histamine
  • Serotonin
  • TNF
  1. An arachidonic acid metabolite, can be synthesized de novo, responsible for producing a febrile response
  2. A preformed vasoactive mediator, mostly released from platelets
A
  1. ?

2. Histamine?

42
Q

What is the single greatest independent risk factor for developing atherosclerosis?

A) gender
B) BMI
C) hypertension
D) ..?

A

C?

43
Q

What is the anatomical name for the shaft of a long bone?

A) metaphysis
B) diaphysis
C) physis
D) epiphysis

A

B

44
Q

A woman presents after taking an overdose of her medication. She is restless, tachycardic, with dilated pupils (and something else). What has she taken?

A) Amitriptyline
B) citalopram
C) Mirtazepine?
D) Venlafaxine

A

D?

45
Q

A man has taken an intentional overdose of organophosphate. Which of the following would he have?

A) reduced sweating
B) urinary retention
C) small pupils
D) dry eyes

A

C?

46
Q

Which is the most useful drug for an acute exacerbation of COPD?

A) ipratropium
B) salmeterol
C) …?
D) …?

A

A?

47
Q

H.pylori infection is associated with which of the following cancers?

A) gastric lymphoma
B) oesophageal
C) …
D) …

A

B?

48
Q

EMQ options:

  • Rapidly progressive Glomerulonephritis
  • acute proliferative Glomerulonephritis
  • ruptured kidney
  • urolithiasis
  • Haemolytic uremic syndrome
  • others…
  1. A man with non-Hodgkin’s lymphoma is on cyclophosphamide and develops abdominal pain, Haematuria, something…
  2. A 10yo girl had pharyngitis and then two weeks later has mild proteinuria, Haematuria, something…
  3. A 45yo man has sudden onset loin pain, hesitancy, frequency, Haematuria.
A

…

49
Q

Which of the following causes of hypoxaemia is corrected most easily by giving supplemental oxygen?

A) diffusion limitation
B) hypo ventilation
C) ventilation perfusion mismatch
D) shunt

A

?

50
Q

A baby is delivered unexpectedly in the emergency dept. the baby remains cyanosed despite supplemental oxygen. What is the most likely congenital heart defect?

A) atrial septal defect
B) patent ductus arteriosus
C) tetralogy of fallot
D) VSD

A

?

51
Q

Which of the following is LEAST likely to exacerbate digoxin toxicity?

A) amiodarone
B) calcium channel blocker
C) potassium depleting drugs
D) St. John’s wort

A

?

52
Q

Which of the following causes coronary vasodilation?

A) adenosine?
B) hypercalcaemia ?
C) hypokalaemia
D) ?

A

?

53
Q

Which of the following lies in the atrioventricular groove, and gives off the anterior interventricular artery and the circumflex artery?
- all the coronary arteries are listed

A

LCA?

54
Q

What is an effect of ketamine?

A) temporary increase in Resp rate initially
B) reduced cerebral ?bloodflow ?oxygendemand
C) cardiostimulatory effects due to a sympathetic mechanism
D) amnesia?

A

?

55
Q

Which of the following involves Neutrophil-mediated injury (or something like that with neutrophils)?

A) adult respiratory distress syndrome
B) …?

A

?

56
Q

Which of the following is a correct approximation of intracellular ion levels?

A) Cl- something like 25 ish
B) bicarbonate like 95?
C) potassium 150mmol/L
D) sodium 30mmol/L

A

C?

57
Q

Which of the following is the most appropriate screening test for a patient suspected of having myxoedema?

A) T3
B) T4
C) TSH
D) TRH

A

C?

58
Q

A lady with Graves’ disease is treated with hydrocortisone. What is the mechanism of action?

A) it reduces the synthesis of T4
B) it reduces the release of T4
C) it accelerates the breakdown of T4
D) it ?stimulates conversion of T4 to T3?

A

?

59
Q

What is true of thyroid hormones?

A) T4 is more protein bound than T3
B) T4 binds to a membrane-bound receptor
C) …

A

?

60
Q

Regarding paracetamol:

A) glutathione reserves are important in the metabolism of therapeutic doses
B) it is slightly protein-bound
C) its toxicities are increased in those with severe renal impairment
D) it has a toxic metabolite produced by glucuronidation and sulfation

A

A?

61
Q

EMQ about muscle relaxants:

  • suxamethonium
  • vecuronium
  • rocuronium
  • pancuronium
  • atracurium
  • sugammadex
  1. Used to reverse neuromuscular blockade by rocuronium
  2. Rapid onset of action, can be used for patient with severe renal failure because it is primarily hepatically cleared
  3. Can be used for induction for a patient with severe hepatic and renal failure
A
  1. Sugammadex
  2. Roc or vec?
  3. Atracurium
62
Q

Which of these has a receptor similar to those of the cytokines family?

A) growth hormone
B) insulin
C) …
D) …

A

?

63
Q

Which of the following clotting factors are tested in a Prothrombin Time test?

A) I (fibrinogen), II, IX, X
B) II, V, VII, X
C) II, VIII, IX, X
D) II, X, XI, XII

A

B?

64
Q

Which of the following influences fibrinolysis?

A) heparin
B) tranexamic acid
C) …?
D) ….? Aspirin?

A

?

65
Q

A woman has recurrent DVT. What is the most common predisposing factor of the following?

A) antithrombin III deficiency
B) Factor V mutation
C) prothrombin mutation
D) …?

A

?

MCQs (26 decks)

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