Multiple Choice Questions Flashcards
A 42 year old man attend the emergency department with palpitations. His temperature is 36.8, PR = 161 bpm, BP 123/87 mmHg, RR = 16 and O2 sats 95% RA. He is alert and oriented. ECG shows SVT with no evidence of ischaemia. Auscultation of his chest reveals no wheeze. He has good general health and is taking no regular medications.
Which is the most appropriate initial management?
A. Adenosine 6 mg IV B. DC cardioversion C. Metoprolol IV D. Nebulised salbutamol E. Refer the patient to the cardiac arrhythmia outpatient clinic
A. Adenosine 6 mg IV
Tachycardia algorithm:
https://www.resus.org.uk/sites/default/files/2021-04/Tachycardia%20Algorithm%202021.pdf
A 27 year old woman presents to the ED with SOB. She has asthma and has had several admissions to hospital within recent years. An ABG is taken on O2 4 L/min via Hudson facemask.
Which of these results is the most concerning?
A. pH = 7.32 (7.35-7.45) B. PO2 = 13.3 kPa (11.3-12.6) C. PCO2 = 6.4 kPa (4.7-6.0) D. HCO3- = 18 mmol/L (21-29) E BE = - 4 mmol/L (-2 to +2)
C. PCO2 = 6.4 kPa
Raised pCO2 –> near-fatal asthma criteria; patient tiring and requiring mechanical ventilation.
A 20 year old woman with a history of brittle asthma attends ED with an acute exacerbation of her asthma. Which statement is correct?
A. A normal CO2 level on ABG sampling is reassuring
B. Inability to complete sentences indicates severity of asthma
C. Initial management should include a bolus of IV aminophylline 50 mg/kg
D. Ipratropium bromide should be nebulised at 15-minute intervals
E. Repeated use of beta agonists may cause hyperkalaemia
B. Inability to complete sentences indicates severity of asthma.
https://www.researchgate.net/figure/1-Definitions-of-severe-and-life-threatening-asthma_tbl1_225964323
A 75 year old woman attends ED with increasing SOB but no cough. She is afebrile and responds to painful stimulus (P on AVPU). Investigations: ABG on RA.
pH = 7.22 pO2 = 5.5 kPa pCO2 = 13.7 kPa HCO2- = 36 mmol/L BE = + 4.1 mmol/L
Which of the following is correct?
A. Her GCS is 12/15
B. Initial treatment should include delivering 28% oxygen via a fixed performance delivery system and facemask
C. IV antibiotics should be given
D. She would benefit from invasive ventilation
E. The patient exhibits T1RF
B. Initial treatment should include delivering 28% oxygen via a fixed performance delivery system and a facemask
Not enough information to delineate her GCS.
No indication for antibiotics - she is afebrile.
Not enough information to know if she would benefit from invasive ventilation.
She is in type 2 respiratory failure - hypoxic and hypercapnic. If we look at her bicarbonate she is compensating. This suggests a chronic respiratory disease - with her age in mind and the partially compensated respiratory acidosis - we can presume with some certainty that this is COPD.
A 58 year old man with ankylosing spondylitis attends an anaesthetic pre-assessment clinic and undertakes PFTs. Weight = 80 kg. Here are the results:
FEV1 = 2.35 L
FVC = 2.8 L
FEV1:FVC ratio = 84%
Which of the following is correct?
A. No difficulty with laryngeal intubation would be anticipated
B. Obstructive lung disease is evident
C. Restrictive lung disease is evident
D. These values are normal for a healthy adult male
E. This patient would always benefit from inhaled corticosteroids
C. Restrictive lung disease is evident
We can see FEV1 and FVC volumes are both reduced. This has resulted in an FEV1:FVC ratio >70% - indicating a restrictive lung defect. If we also consider what we know about ankylosing spondylitis we should anticipate a restrictive defect.
A - we can anticipate C-spine fusion and inability to full extend C-spine therefore this is wrong.
B. this is not true from the data
D. the volumes are too low for a man of his age and weight
E. no
A 40 year old man presents to the ED with a decreasing level of consciousness. He has a history of insulin dependent diabetes. His temperature is 38.2, PR = 121 bpm, BP 95/40 mmHg, RR = 35 bpm, and SpO2 = 98% RA. His GCS is 12.
Investigations:
Serum Na+ = 130 mmol/L (133-146)
Serum K+ = 5.9 mmol/L (3.5-5.3)
Blood ketones = 4.2 mmol/L (<0.6 mmol/L)
Plasma glucose = 32 mmol/L
Which of the following is the most appropriate initial management?
A. Calcium gluconate 10% 10 mL IV B. Nebulised salbutamol 10 mg C. 10 units of Actrapid insulin IV D. 500 mL/hr of Hartmann's solution IV over 1 hour E. 1000 mL 0.9% saline IV over 1 hour
E. 1000 mL 0.9% saline IV over 1 hour
Dehydration more fatal than hyperglycaemia.
0.9% NaCl 1000 mL over first hour 2000 mL over next 4 hours 2000 mL over next 8 hours 1000 mL every 6 hours subsequently as needed
*Actrapid 50 units in 50 mL 0.9% NaCl at 0.1 units/kg
A 55 year old man presents to ED with sudden onset of back pain. he has a known aortic aneurysm. His temperature is 37.1, PR = 101 bpm, BP = 97/66 mmHg, cap refill >3 s, RR = 25 bpm, an SpO2 = 98% in RA.
With regards cannulation and blood sampling, which statement is correct?
A. A ‘group and hold’ sample is sufficient at this stage
B. Blood sample bottles for ‘group and hold’ or ‘cross match’ need to be handwritten
C. Cross matched blood will be available in 20 minutes
D. FFP should be given as the initial fluid of choice
E. Insert two 22-gauge IV cannula
B. Blood sample bottles for ‘group and hold’ or ‘cross match’ need to be handwritten
The same patient as the previous question. With regards to blood sampling for confirmation of ABO/D group and antibody status and for cross matching. If there is no record of ABO/D group for this patient, which statement is correct?
A. Two samples should be taken at least 5 minutes apart
B. Two samples should be taken at least 10 minutes apart
C. Two samples should be taken at least 20 minutes apart
D. Two samples should be taken at least 2 minutes apart
E. Two samples should be taken at the same time
A. Two samples should be taken at least 5 minutes apart
A 27 year old woman is in the ED with severe right iliac fossa pain and light headedness.
What would be the most appropriate initial investigation?
A. Abdominal radiograph B. CRP C. FBC D. Pregnancy test E. U&E
D. Pregnancy test
A 23 year old woman is in the ED with increasing wheeze. She has a history of nut allergy and may have consumed some nuts. Her temperature is 37.1, PR = 130 bpm, BP 80/40 mmHg, RR = 35 bpm, and SpO2 = 93% RA.
What is the most appropriate initial management?
A. Chlorphenamine 4 mg orally
B. Epinephrine (adrenaline) 1:10,000, 10 mL IV
C. Epinephrine (adrenaline) 1:1,000; 0.5 mL IM
D. Inhaled corticosteroid
E. 250 mL 0.9% saline issued over 30 minutes
C. Epinephrine (adrenaline) 1:1,000; 0.5 mL IM
You are the F1 working on the long-term rehab ward. You are called by the nursing staff to attend a patient with a tracheostomy. The tracheostomy tube has become dislodged and is lying on the bed. You use an ABCDE approach and confirm the patient’s airway is patent and they are breathing well. You delivery O2 by mask to both mouth and the stoma.
What is the most appropriate management?
A. Call for an ENT surgeon or an anaesthetist.
B. Insert an LMA
C. Insert a new tracheostomy tube of the same size
D. Perform an ABG and arrange an urgent CXR
E. Re-insert the old tracheostomy tube over a bougie
A. Call for an ENT surgeon or an anaesthetist.
A 75 year old man has fallen and sustained a large superficial laceration to his upper forearm (weigth = 70 kg). On inspection there is no evidence of vessel, nerve, or tendon injury and it is decided to close the wound with sutures. It is proposed to use Lidocaine 1% with adrenaline 1:200,000 to anaesthetise the wound.
What is the maximum volume of Lidocaine 1% with epinephrine 1:200,000 that can be used safely?
- 7 mL
- 14 mL
- 21 mL
- 49 mL
- 70 mL
- 49 mL
1% lidocaine: contains 10 mg of lidocaine per 1 mL
Maximum volume of lidocaine with adrenaline = 7 mg/kg
Therefore maximum volume this patient can receive is 490 mg
So, how many mL to get 490 mg?
490mg/10 mg/mL = 49 mL
A patient is scheduled to have a central neuraxial blockade.
Which of the following statements is correct?
A. A Tuphy needle is the needle of choice for spinal anaesthesia
B. Analgesia using an epidural is usually provided at ward level via intermittent boluses rather than infusion
C. Hypotension is a rare complication
D. Neurological injury is a common complication
E. The volume of local anaesthetic required for epidural anaesthesia is greater than that for spinal anaesthesia
E. The volume of local anaesthetic required for epidural anaesthesia is greater than that for spinal anaesthesia.
A spinal (intrathecal) injection involves placement of the drug in the intrathecal space which is filled with cerebrospinal fluid (CSF). Because CSF is in direct contact with the spinal cord it requires a very small amount of drug for a profound effect and can be associated with hypotension. An epidural or extradural injection (the needle target is the epidural space) needs a much larger dose to achieve a similar effect (5-10 times more LA). It is therefore associated with a significantly increased risk of local anaesthetic systemic toxicity (LAST).
A 60 year old woman becomes hypotensive and tachycardic in the recovery ward following a hysterectomy. Her drains reveal a markedly increased amount of blood. She has Hartmann’s solution running through an 18G cannulae.
Which of the following is the most likely to increase the rate of fluid administration?
A. Changing the fluid to a colloid
B. Increasing the length of the fluid administration tubing
C. Running fluids through a 16G cannula
D. Running fluids through a 20G cannula
E. Running the fluids through a central venous catheter
C. Running fluids through a 16G cannula
A 69 year old man is in the surgical ward following an abdominal laparotomy. The staff nurse has asked you to attend as the patient is complaining of sudden increasing abdominal pain and distension. He has an epidural in-situ, which was working well when he left the recovery ward one hour ago (block recorded as T6 both sides). He has a drain in situ. His temperature is 38.2, PR = 99 bpm, BP 112/85 mmHg, RR = 25 bpm, and SpO2 = 98% in 50% O2.
What is the most appropriate next step?
A. Administer 2 units of O - blood immediately
B. Administer 500 mL IV bolus and call for senior help
C. Call the acute pain team to rectify the problem with the epidural
D. Eliminate the bleeding as a possible cause as the drain is empty
E. Give 10 mg Morphine IV and reassess the patient in 45 minutes
B. Administer 500 mL IV bolus and call for senior help
