Emergency Medicine

·      Initial Patient Management ER02-ER06.

1.    Rapid Primary Survey.

???) The first to be managed in multi-injured patient is:

A.    Shock

B.     Intracranial hematoma

C.     Respiratory problems

D.    Open fracture of long bones

E.     Crushed contaminated wounds

Answer: 3* Respiratory problems

???) Which of the following has got the priority in trauma management

Breathing

Airway

Circulation

Exposure

Disability

Answer: 2* Airway

???) Patient presented to emergency department with severe blunt neck injury and hypotension, best next step is:

Blood transfusion

Intravenous line

Surgical exploration

Secure airway

Heart circulation

Answer: 4* Secure airway

???) In a patient with head injury which of the following Glasgow coma scale scores carry the worst prognosis:

A.    14

B.     10

C.     8

D.    4

E.     12

Answer: 4* 4

·      Traumatology ER06-ER19.

1.    Head Trauma.

???) A 35 years old man involved in road traffic accident presented to you in deep coma, pin pointed pupils. High fever and spastic rigidity of both upper and lower limbs, this man has:

A.    Frontal lobe injury

B.     Extradural hemorrhage

C.     Subdural hemorrhage

D.    Brain stem injury

E.     Cerebellar injury

Answer: 4* Brain stem injury

???) In head injury all of the following are true, except:

A.    Skull X-ray is a useful method of showing the site of skull fracture

B.     CT scan is an excellent method of showing intracranial injuries and lesions

C.     Hyperventilation is an excellent method of reducing the intracranial pressure

D.    Patient with Glasgow coma scale of 14 carries a bad prognosis

E.     Extradural hematoma mat produce contralateral hemiparesis

Answer: 4* Patient with Glasgow coma scale of 14 carries a bad prognosis

???) Scalp hematoma which is small, very painful and tend is:

A.    Subgaleal

B.     Subcutaneous

C.     Subpericranial

D.    Intramuscular

E.     Epidural

Answer: 2* Subcutaneous

???) In the 30 year old patient with head injury, the first to be considered is:

Airway, breathing, circulation

Level of consciousness

Pupillary reaction

Asymmetry of movements in limbs

Subdoral hematoma on CT scan

Answer: 2* Level of consciousness

2.    Spine and Spinal Cord Trauma.

???) The most commonly injured structure in blunt neck injury is:

Cervical spine

Left carotid artery

Right carotid artery

Left jugular vein

Right jugular vein

Answer: 1* Cervical spine

3.    Chest Trauma.

???) Manifestations of rupture one major bronchi include all the following except:

Uncontrolled pneumothorax

Progressive mediastinal and subcutaneous emphysema

Hemothorax

Hematemeais

All of the above

Answer: 4* Hematemeais

???) Which of the following approaches is currently acceptable for the management of large traumatic pneumothorax:

Chest tube insertion alone is enough for the majority of cases

Medical observation is enough

Thoracoscopic surgery and pleurodesis should be used

Thoracotomy and pleurodesis should be used

Operation on presentation for all patients

Answer: 1* Chest tube insertion alone is enough for the majority of cases

???) Tracheostomy is beneficial in one of the following chest injuries:

Rib contusion

Flail chest

Traumatic hemothorax

Traumatic pneumothorax

Sucking wound of the chest wall

Answer: 2* Flail chest

???) Which of the following thoracic emergencies require most urgent treatment:

A.    Closed pneumothorax

B.     Open pneumothorax

C.     Tension pneumothorax

D.    Fracture ribs

E.     Hemothorax

Answer: 3* Tension pneumothorax

4.    Abdominal Trauma.

???) The best investigation to identify air under diaphragm in trauma patients is:

Supine Chest X-Ray

Standing Chest X-Ray

Supine Abdominal X-Ray

Standing Abdominal X-Ray

Abdominal US

Answer: 2 * Standing Chest X-Ray

???) All the following are characteristics of diagnostic peritoneal lavage in abdominal trauma except:

Sensitivity of 30%

Does not discriminate well between affected organs

Its role in trauma evaluation decreased these days due to advancement in radiological techniques

Fluid obtained should be examined for red cell amount, chemistries and gram stain

Pelvic fractures may cause false positive results

Answer: 1* Sensitivity of 30%

???) All of the following data are considered positive peritoneal lavage after blunt abdominal trauma, except:

Amylase positive in the lavage fluid

Bile positive in the lavage fluid

Red blood cell count 100 000/ml

Albumin of 5g/l

Gram stain positive for bacteria in the lavage fluid

Answer: 4* Albumin of 5g/l

???) One of the following is the most informative in evaluation of diaphragmatic injury:

Supine Abdominal X-Ray

Abdominal US

Abdominal CT scan

Diagnostic peritoneal lavage

Diagnostic Laproscopy

Answer: 5* Diagnostic Laproscopy

???) The most commonly injured organ in a patient with seat belt sign is:

Liver

Spleen

Colon

Pancreas

Small intestine

Answer: 5* Small intestine

???) Abdominal trauma secondary to one of the following is not considered iatrogenic:

Liver biopsy

Peritoneal dialysis

External cardiac massage

Road traffic accidents

Paracentesis

Answer: 4* Road traffic accidents

·      Medical Emergencies ER30-ER39.

1.    Anaphylaxis.

***) Emergency drugs in anaphylaxis include all of the following, except:

A.    Adrenaline

B.     Aminophylline

C.     Corticosteroids

D.    Oxygen

E.     Chlorphenamine

Answer: E* Chlorphenamine

·      Environmental Injuries ER44-ER48.

1.    Bites.

???) Useful methods of local treatment for snake bites include alt of the following, except:

A.    Immobilization

B.     Tourniquet

C.     Incision and suction

D.    Excision

E.     Cryotherapy

Answer: 3* Incision and suction

???) All of the following are usually accepted in the treatment of poisonous snake bite, except:

A.    Tourniquet placed above the bite area

B.     Immobilization of involved extremity

C.     Applying ice to the wound

D.    Incision and suction at the site of bite

E.     Fasciotomy is sometimes indicated

Answer: 4* Incision and suction at the site of bite

1.    Sepsis and Septic Shock.

???) In septic shock all the following occur at an early stage except:

Decreased peripheral vascular resistance

Decreased cardiac output

Increased metabolic demand

Impaired oxygen uptake at tissue level

Warm peripheries

Answer: 2* Decreased cardiac output

???) End toxic shock causes the following except:

Systemic arterial hypertension

Low cardiac output

Oliguria

Systemic hypotension

Metabolic acidosis

Answer: 1* Systemic arterial hypertension