MCEM Toxicology MCQ

1. Features of opiate withdrawal include: (a) Yawning. (b) Dilated pupils. (c) Auditory hallucinations. (d) Visual hallucinations. (e) Vomiting. Opiate withdrawal is associated with increased blood pressure, heart rate, lacrimation, rhinorhea, yawning, goosebumps, insomnia, aches and pains. 2. Hypercapnia may be caused by: (a) Hyperventilation. Hypoventilation causes hypercapnia. (b) Brainstem lesions. Depressed central respiratory drive. (c) Tetanus. Endogenous toxins such as tetanus can cause hypercapnia. (d) Botulism. Botulism is a neuromuscular toxin which causes neuromuscular impairment. (e) Organophosphate poisoning. Organophosphates are neuromuscular toxins which cause neuromuscular impairment. 3. Emergency complications of malignancy: (a) PR examination is relatively contraindicated in neutropaenic patients. PR examination is relatively contraindicated in neutropaenic patients.PR should be withheld until anti-biotics are administered because of the risk of infection. (b) The untreated mortality of neutropaenic ( <500/ul ) febrile patients is 10% The untreated mortality of neutropaenic ( <500/ul ) febrile patients is 50%. (c) Due to an impaired inflammatory response in neutropaenic patients the usual findings of infection are not as prominent. Due to an impaired inflammatory response in neutropaenic patients the usual findings of infection are not as prominent. (d) Granulocytopenia may expediate the development of a consolidation on chest X Ray. Granulocytopenia may preclude development of a visible infiltrate on chest X Ray and so the clinician may need to rely on physical findings. (e) The incidence of meningitis is not increased with neutropenia. The incidence of meningitis is not increased with neutropenia. 4. Vomiting may be associated with: (a) Metabolic alkalosis. Tru e Fals e Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e

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MCEM Toxicology MCQ
Metabolic alkalosis is a result of loss of HCL from the stomach. (b) Alkaline urine. The urine is alkaline due to preservation of H+ ions. (c) Raised plasma chloride levels. (d) Hyperkalaemia. Vomiting is associated with hypokalaemia. (e) Elevated blood urea. Secondary to volume depletion. 5. Hypokalaemia (a) Hypokalaemia causes hyporeflexia. (b) Hypokalaemia may cause a prolongation of the QT interval, ST segment depression and U waves. (c) The most common cause of hypokalaemia is loop diuretics (d) Renal artery stenosis is a cause of hypokalaemia because of renal losses. (e) L-Dopa is a cause of hypokalaemia. Signs and symptoms of hypokalaemia usually occur at levels less than 2.5 mEq/L Hypokalaemia causes hyporeflexia. Hypokalaemia may cause ileus. Hypokalaemia may cause worsening of digoxin toxicity and dysrhythmias. Hypokalaemia may cause a prolongation of the QT interval, ST segment depression and U waves. Hypokalaemia may cause metabolic alkalosis. Hypercalcaemia may cause hypokalaemia due to renal losses of potassium. The most common cause of hypokalaemia is loop diuretics Licorice use may cause hypokalaemia. Postobstructive diuresis is a cause of hypokalaemia because of renal losses. Renal artery stenosis is a cause of hypokalaemia because of renal losses. Excessive tobacco chewing is a cause of hypokalaemia because of renal losses. Lithium is a cause of hypokalaemia. L-Dopa is a cause of hypokalaemia. No more than 40mmol of KCL should be added to 1L of IV fluids to replace potassium. 6. Hypokalaemia (a) Signs and symptoms of hypokalaemia usually occur at levels less than 2.5 mEq/L (b) Hypokalaemia may cause worsening of digoxin toxicity and dysrhythmias. (c) Hypercalcaemia may cause hypokalaemia due to renal losses of potassium (d) Postobstructive diuresis is a cause of hypokalaemia because of renal losses. (e) Lithium is a cause of hypokalaemia. Signs and symptoms of hypokalaemia usually occur at levels less than 2.5 mEq/L Hypokalaemia causes hyporeflexia. Hypokalaemia may cause ileus. Hypokalaemia Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e

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MCEM Toxicology MCQ
may cause worsening of digoxin toxicity and dysrhythmias. Hypokalaemia may cause a prolongation of the QT interval, ST segment depression and U waves. Hypokalaemia may cause metabolic alkalosis. Hypercalcaemia may cause hypokalaemia due to renal losses of potassium. The most common cause of hypokalaemia is loop diuretics Licorice use may cause hypokalaemia. Postobstructive diuresis is a cause of hypokalaemia because of renal losses. Renal artery stenosis is a cause of hypokalaemia because of renal losses. Excessive tobacco chewing is a cause of hypokalaemia because of renal losses. Lithium is a cause of hypokalaemia. L-Dopa is a cause of hypokalaemia. No more than 40mmol of KCL should be added to 1L of IV fluids to replace potassium 7. Hyponatremia (a) The clinical manifestations of hyponatremia occur when the Na drops below 120 mEq/L (b) Hyponatremia may be caused by hyperglycaemia because of the osmotic diuresis involved. (c) The most common cause is salt and water loss in the urine with replacement by oral water. (d) The most common cause of hypertonic hyponatremia is hyperglycaemia (e) True hyponatremia presents with low osmolarity. The clinical manifestations of hyponatremia occur when the Na drops below 120 mEq/L Hyponatremia may be caused by hyperglycaemia because of the osmotic diuresis involved. The most common cause is salt and water loss in the urine with replacement by oral water. The most common cause of hypertonic hyponatremia is hyperglycaemia. True hyponatremia presents with low osmolarity. Factitious hyponatremia presents with normal or high osmolarity( hypertonic or isotonic hyponatremia ) 8. The following antibiotics inhibit folic acid metabolism: (a) Penicillins. (b) Monobactams. (c) Quinolones. (d) Quinolones. Trimethoprim is used most commonly in the treatment of urinary tract infections due to susceptible strains of E. coli, P. mirabilis, K. pneumoniae, Enterobacter sp and coagulase-negative Staphylococcus including S. saprophyticus. It may be used for acute otitis media in children, acute exacerbations of chronic bronchitis in adults, in combination with other agents for treatment of toxoplasmosis, and pneumocystis carinii. (e) Sulphonamides. Hearing loss more commonly occurs with peripheral causes of vertigo. Penicillin and monobactams inhibit cell wall synthesis. Quinolones inhibit DNA gyrase. Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e

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MCEM Toxicology MCQ
9. The features of chronic lead poisoning include (a) Inhibition of delta-aminolaevulinic acid dehydratase (b) Microcytic anaemia and punctate basophilia (c) Dysgeusia,constipation and abdominal pain (d) Gout and renal tubular acidosis (e) Peripheral neuropathy which is predominantly motor in type al Khayat A, Menon NS, Alidina MR: Acute lead encephalopathy in early infancy: Clinical presentation and outcome. Ann Trop Paediatr 17:39, 1997. Young children are the most susceptible group to lead poisoning. Encephalopathy is a major cause of morbidity and mortality and may begin with seizures and coma or develop slowly over weeks to months with decreased alertness and worsening memory leading to conditions such as mania, delirium, and cerebral edema. It has developed in infants with blood lead levels (PbB) of 70 ug/dL or lower. Gastrointestinal and hematologic manifestations occur more frequently with acute than with chronic poisoning, and the colicky abdominal pains may be associated with concurrent hemolysis. The characteristic bluis-grey lead lines occur after chronic exposure.. Lead toxicity also causes constitutional symptoms, including arthralgias, generalized weakness, and weight loss.Slower mental development has been noted in children whose umbilical cord had a level of 10ug/dL of lead. Patients may be asymptomatic despite high blood lead levels. 10. The following are common causes of anaphylaxis and anaphylactoid reactions in humans: (a) Vancomycin is an antibiotic commonly associated with anaphylaxis and anaphylactoid reactions. Vancomycin is an antibiotic commonly associated with anaphylaxis and anaphylactoid reactions. (b) Trimethoprim-Sulfamethoxazole is an antibiotic commonly associated with anaphylaxis and anaphylactoid reactions. Trimethoprim-Sulfamethoxazole is an antibiotic commonly associated with anaphylaxis and anaphylactoid reactions. (c) Soybeans Soybeans are commonly associated with anaphylaxis and anaphylactoid reactions. (d) Eggs Eggs are commonly associated with anaphylaxis and anaphylactoid reactions. (e) Shellfish Shellfish are commonly associated with anaphylaxis and anaphylactoid reactions. 11. Anaphylaxis in the Emergency Department: Y (a) It is appropriate to observe patients who suffer anaphylaxis for a period of 4 hours as they may have a reoccurrence because of a second round of mediator release. It is appropriate to observe patients who suffer anaphylaxis for a period of 4 hours as they may have a reoccurrence because of a second round of mediator release. (b) In anaphylaxis mediators are released from mast cells and basophils and this reaction is dependent on IgE. In anaphylaxis mediators are released from mast cells and basophils and this reaction is dependent on IgE. Tru e Fals e Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e

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MCEM Toxicology MCQ
(c) The recurrence rate for anaphylaxis from insect stings is about 50% The recurrence rate for anaphylaxis from insect stings is about 50% (d) About 10% of anaphylactic mortality occurs within the first hour About 50% of anaphylactic mortality occurs within the first hour (e) It is unhelpful to check histamine levels post a suspected anaphylactic reaction as they are elevated for about half an hour post reaction are often returning to normal levels by the time the patient presents to the ED. It is unhelpful to check histamine levels post a suspected anaphylactic reaction as they are elevated for about half an hour post reaction are often returning to normal levels by the time the patient presents to the ED. 12. Hypoglycaemic toxicology: (a) Sulphonylureas cause release of insulin from the pancreas. (b) Sulphonylureas reduce hepatic glucose production. (c) Sulphonylureas increase peripheral insulin sensitivity. (d) Sulphonylureas can cause hypoglycaemia for up to 16 hours after ingestion. (e) Metformin suppresses glucose output by the liver. And stimulates uptake in muscle. 13. Lithium poisoning (a) Hypokalaemia is a feature (b) Acute renal failure ( ARF ) is a common complication ARF is a rare complication (c) Coma is a poor prognostic indicator Clinical features include nausea, vomiting, diarrhoea, coarse tremor, apathy, and decreased consciousness. (d) Serum lithium levels correlate well with toxicity (e) Forced alkaline diuresis is a frequently used treatment It is important to maintain an appropriate urinary output but forced urinary alkalinisation should not be used. Haemodialysis may have a role with high serum concentrations. In acute overdose there is usually a delayed onset of symptoms of more than 12 hours owing to the slow entry of lithium into the tissues. 14. Drug induced cholestasis does not occur with (a) Chlorpromazine (b) Carbamazepine (c) Erythromycin Tru e Tru e Tru Fals e Fals e Fals Tru e Tru e Tru e Fals e Fals e Fals e

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MCEM Toxicology MCQ
e (d) Sulphonylureas (e) Aspirin Tru e Tru e e Fals e Fals e

15. Paracetamol poisoning complications: (a) Hyperglycaemia. Hypoglycaemia occurs in paracetamol overdose secondary to liver failure. (b) GI bleeding. GI bleeding may occur secondary to liver failure which reduces the bodies clotting ability. (c) Lactic acidosis. Lactic acidosis may occur early or late with paracetamol overdose. (d) Pancreatitis. Pancreatitis may occur alone or with liver failure after paracetamol overdose. (e) Acute tubular necrosis. 16. Benzodiazepine overdose (a) Causes ataxia Benzodiazepine overdose account for about 40% of all drug overdosages in deliberate self poisoning (b) Causes pinpoint pupils (c) Is treated with naloxone Flumazenil is a benzodiazepine antagonist which may cause seizures in a patient dependent on benzodiazepines (d) Causes respiratory depression They potentiate the CNS depressant effects of other drugs taken with them such as alcohol (e) Is usually fatal. They produce drowsiness, dysarthria, ataxia, nystagmus, and sometimes coma Benzodiazepine overdose account for about 40% of all drug overdosages in deliberate self poisoning. They potentiate the CNS depressant effects of other drugs taken with them such as alcohol. They produce drowsiness, dysarthria, ataxia, nystagmus, and sometimes coma. Most patients recover within 24 hours. Mild hypotension and respiratory depression may occur with them. Flumazenil is a benzodiazepine antagonist which may cause seizures in a patient dependent on benzodiazepines. 17. Status Epilepticus: (a) Lorazepam 4mg Iv may only be given once. A subsequent 4mg dose may be given 5-10 min later. (b) Phenytoin infusion rates should be of the order of 50mg/min

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and localized cellulitis.cdc. Streptococcal toxic shock syndrome: (a) Portals of entry include pharynx. (e) If seizures are continuing chlormethiazole should be initiated. epigastric pain. Rash. (e) Multiorgan involvement may cause a coagulopathy. liver involvement. (d) Patients on phenytoin require ECG monitoring. 19. Multiorgan involvement is characterised by 2 or more of the following. vomiting. vagina. tinnitus. coagulopathy. mucosa and skin. and blurring of vision. 5% dextrose is not compatible with phenytoin. (creatinine level twice normal). The typical features of salicylate toxicity are sweating.MCEM Toxicology MCQ e 15-18mg/kg eg 1 g over 20 min. (d) Sweating is a typical feature (e) Tinnitus is a typical feature Aspirin is probably the commonest drug to be ingested deliberately in overdose. renal impairment. http://www.ARDS. Occassionally salicylate poisoning follows the topical application of salicylic acid in keratolytics. The cytokines cause capillary leak and tissue damage. 18. leading to shock and multiorgan failure. Probably propofol or thiopentone if patient continues to seize.htm Diagnostic Criteria for Streptococcal Toxic Shock Syndrome include hypotension. (c) Hypertension is a prominent feature. Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e Tru e Tru e Tru e e Fals e Fals e Fals e Tru e Fals e Tru e Fals e Tru e Tru e Tru e Fals e Fals e Fals e . Group A streptococcus (GAS. (b) Both hypo and hypernatraemia occur (c) Is associated frequently with significant GI bleeds Significant GI bleeds are surprisingly rare. As phenytoin may cause dysrhythmias. Group A streptococcal TSS is mediated by exotoxins (superantigens) that can activate the immune system by bypassing the usual antigen-mediated immune response sequence resulting in the release of large quantities of inflammatory cytokines.gov/ncidod/EID/vol1no3/stevens. soft tissue necrosis. (b) Is frequently associated with ARDS. Salicylate poisoning (a) Can occur as a consequence of topical application. eg. (c) 5% dextrose is not compatible with phenytoin. (d) Multiorgan involvement may present with generalised erythematous macular rash with desquamation. including necrotising fasciitis or myositis or gangrene. Streptococcus pyogenes) is an aerobic grampositive coccus that causes pharyngitis and a spectrum of skin and soft tissue infections such as impetigo. erysipelas.

or 100 parts per billion. (c) In children from eating lead based paint This is particularly a problem in older houses where the sweet-tasting lead paint is likely to chip.0. Environmental exposure to lead occurs (a) Principally from the inhalation of automobile fumes.0. (c) Amylase >2500. The following are true with regard to a psoas abscess: Tru e Tru e Tru e Fals e Fals e Fals e Tru e Tru e Fals e Fals e Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e . A virus requires cellular machinery to replicate. It can come from plumbing and fixtures that are either made of lead or have trace amounts of lead in them. Glucose >11. Ca2+ <2 mmol/L. of lead in their blood. AST >250 U/L and glucose >11. (b) Consists of a nucleic acid core and protein coat. Small children also tend to teethe and suck on painted windowsills as they look outside. Only some viruses are enveloped. 23.8 mmol/L. The presence of 1 to 3 criteria represents mild pancreatitis. A virus consists of a nucleic acid core and protein coat. 22. (b) From the contamination of food and drink supplies Lead has also been found in drinking water. the mortality rate rises significantly with four or more criteria. This is one of the criteria at 48 hours. 21.MCEM Toxicology MCQ 20. A virus: (a) Is able to replicate independently of the host. (d) From lead water pipes and storage tanks Lead has also been found in drinking water. WCC >16. but deteriorating lead-based paint can also powder and be inhaled. (b) LDH >350 IU/L. (c) Is always enveloped by host membrane. Tissue injury can occur by direct cytopathic effects. (e) Can cause pathology through the incorporation of viral genes into the host DNA. Amylase is not one of Ranson?s criteria (d) PaO2 < 8kPa. (d) Causes tissue injury by direct cytopathic effects. ppb. Can cause pathology through the incorporation of viral genes into the host DNA. Others include age > 55years. It can come from plumbing and fixtures that are either made of lead or have trace amounts of lead in them.0 mmol/L.0 mmol/L. BE >4 mmol/L and fluid sequestration >6L. (e) Environmental exposure to lead occurs normally in the UK resulting in blood lead levels of 100 ug/dL The average person has less than 10 micrograms per deciliter. urea increase >1. Ranson's severity criteria on admission for acute pancreatitis include: (a) Glucose <11. along with PCV decrease >10%.

Haemophilus influenza and Proteus mirabilis have also been reported. (e) Because the pancreas is located in the retroperitoneal space with a fibrous capsule inflammation can spread easily. Hypotensive patients tend to have a low ICP. Autoregulation refers to maintenance of constant cerebral blood flow. In a cold abscess diagnostic culture is sometimes difficult. although Escherichia coli. The following statements are true: (a) Normal intracranial pressure(ICP) is approximately 10mmHg. and the mortality rate is about 8%. inflammation can spread easily. (c) The incidence of acute pancreatitis ranges between 150-200 per 100. and the mortality rate is below 1%.000 population.000 population. The incidence of acute pancreatitis ranges between 5 and 80 per 100. Intracranial pressure above 20 mmHg considered abnormal. Late sequelae include amyloidosis(due to chronic inflammation) and sinus formation. 25.MCEM Toxicology MCQ (a) The most likely cause is potts disease. Fat necrosis may cause hypocalcemia. (b) ICP can remain normal despite a space occupying lesion ICP can remain normal despite a space occupying lesion. (b) Late sequelae include amyloidosis. (c) A psoas abscess in a patient with a normal ESR excludes tuberculosis as a cause. (c) Cerebral perfusion pressure is independent of ICP. The most likey cause of a psoas abscess is potts disease due to tuberculosis of the lumbar spine. The inflammatory process can cause systemic effects because of the presence of cytokines. Mild edematous pancreatitis occurs in about 80% of presentations. 24. such as bradykinins and phospholipase A. Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e Tru e Fals e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e . such as bradykinins and phospholipase A. Because the pancreas is located in the retroperitoneal space with no capsule. (d) Mild edematous pancreatitis occurs in about 80% of presentations. 90% of primary psoas abscesses ( not secondary to TB ) are associated with Staphylococcus aureus. (b) Fat necrosis may cause hypercalcemia. The most likey cause of a psoas abscess is potts disease due to tuberculosis of the lumbar spine. Pancreatitis: (a) The inflammatory process can cause systemic effects because of the presence of cytokines. Late sequelae include amyloidosis and sinus formation. (e) Autoregulation refers to maintenance of constant cerebral blood flow. (d) Hypotensive patients tend to have a low ICP. (e) Successful culture of infected pus taken from a psoas abscess is likely in more than 90 per cent of cases. (d) The commonest site of the underlying infection is the mid thoracic spine.

(b) Platelet transfusion should be considered for counts of less than 200. Normal endothelium is resistant to infection but turbulent flow. varicella and HIV. (e) Platelet production may be decreased by Vitamin B12 or folate deficiency.000/ul. (c) Peri-anal sensation is via the lower lumbar nerves.000/ul. IVDU associated IE is normally caused by staph aureus in over 50% of cases. Prosthetic valve endocarditis is defined as early if within 6 months of surgery. (d) The mumps virus can cause platelet destruction. Peri-anal sensation is via the sacral nerves. (b) Prosthetic valve endocarditis represents a majority of cases Native valve endocarditis represents 60-70% of IE. The line of the nipples is in the T4 dermatome. (e) Wrist flexors are supplied by C6. IVDU associated IE 10-15%. Chronic alcohol misuse is a common cause of low platelets and will often resolve if the patient abstains from drinking for a week or so. 28. along with other viruses such as measles. Infective Endocarditis: (a) The most common organism overall is staph aureus. The deltoid muscle root is C5. Acquired Platelet Disorders: (a) Low platelets due to alcohol misuse is generally irreversible. The following are true: (a) The line of the nipples is in the T4 dermatome. (e) Prosthetic valve endocarditis is defined as early if within the first 9 months post surgery. (c) Hypothermia does not affect platelets.MCEM Toxicology MCQ 26. Wrist flexors are supplied by C7. (c) Talc bombardment is thought to be responsible for endothelium injury in IVDUs. simple ankle strain(with damage to a few fibres of a ligament only) Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e . (d) Shoulder abduction is via C5. Platelet transfusion should be considered for counts of less than 10. drugs such as thiazides and oestrogens. (b) The umbilicus lies in the T10 dermatome. (d) IVDU associated IE is normally caused by strep mirabilis. The most common organism overall is staph aureus. Staph epidermidis is associated with early disease. and prosthetic valve endocarditis 15-30%. Platelet production may be decreased by viral infections. and talc bombardment may injury endothelium. The mumps virus can cause platelet destruction. Hypothermia can cause splenic sequestration of platelets. The umbilicus lies in the T10 dermatome. and Vitamin B12 or folate deficiency as well as marrow infiltration and aplastic anaemia. high pressure states. Wrist extensors are supplied by C6. 27.

False Slight swelling develops immediately but settles to a large extent within a few hours. (e) Dramatic pain relief with cold compresses. (c) Joint instability False It would require major damage to cause joint instability. . It would require major damage to produce joint instability. Cold compresses may help reduce the swelling.MCEM Toxicology MCQ (a) Slight swelling True Slight swelling may develop almost immediately after injury.Bruising occurs with a true or severe sprain. (d) Discomfort over the ligament True Discomfort over the ligament is often found with mild strains. (b) Bruising False Bruising is associated with more severe injuries.

(b) The femoral nerve is composed of L1 and L2 nerve roots. .S2 nerve roots. False ?Infeior gluteal performs hip extension.S2 nerve roots.L3 and L4. True ?Inferior gluteal nerve. (c) The inferior gluteal nerve is composed of L5.MCEM Toxicology MCQ The following are true: (a) Hip extension is performed by the femoral nerve. False ?The femoral nerve is composed of L2. True ?The inferior gluteal nerve is composed of L5. True ?Superior gluteal nerve. (e) Hip abduction is performed by gluteus medius and minimus.S1. (d) Hip extension is performed by the gluteus maximus muscle.S2 nerve roots.S1. L5.S1.

evidence of vascular injury . True ?Breach of the platysma . (d) Breach of the platysma is an indication for emergency surgical exploration. True ?Zone 1 extends from the clavicles to the cricoid cartilage (b) Penetrating injuries to the neck zone 2 extends from the cricoid cartilage to the hyoid bone. (c) Penetrating injuries to the neck zone 3 extends from the hyoid bone to the base of the skull.MCEM Toxicology MCQ With regard to neck trauma the following are true: (a) Penetrating injuries to the neck zone 1 extends from the clavicle to the cricoid cartilage.evidence of surgical emphysema and haemodynamic instability due to major bleeding from a neck wound are indications for emergency surgical exploration. False ?With regard to penetrating injuries to the neck zone 2 extends from the cricoid cartilage to the angle of the mandible. False ?With regard to penetrating injuries to the neck zone 3 extends from the angle of the mandible to the skull base. .

.MCEM Toxicology MCQ Myocardial Contusion (a) Is usually caused by blunt trauma to the chest True ?Especially with fractures to sternum or anterior ribs (b) On ECG may be represented by bundle branch block pattern True ? (c) On ECG may be represented by dysrhythmia's True ? (d) On Trans Thoracic two dimensional echo may be represented by focal or regional wall motion abnormalities True ? (e) Dysrhythmias should be managed conservatively False Manage as usual.

C5-6 (b) The biceps reflex main nerve roots are C5-6 True ? (c) The triceps is innervated by the radial nerve True ? (d) The supinator reflex is innervated by the radial nerve True ? (e) The knee jerk tests knee flexion False ?Extension/Quadriceps/L3-4 .MCEM Toxicology MCQ Tendon Reflexes (a) The biceps are innervated by the radial nerve False ?Musculocutaneous.

and trapezium. capitate. the volar ligaments along the palmar surface. False ?The scaphoid articulates with the radius. nearly the entire surface is covered by hyaline cartilage. False ?The dorsal and volar branches of the radial artery provide the blood supply to the scaphoid (e) The scaphoid lies at the ulnar border of the proximal carpal row False ?The scaphoid lies at the radial border of the proximal carpal row The scaphoid lies at the radial border of the proximal carpal row. trapezoid. trapezoid. but its elongated shape and position allow bridging between the 2 carpal rows because it acts as a stabilizing rod. The primary blood supply comes from the dorsal branch of the radial artery. The scaphoid articulates with the radius. Vessels may enter only at the sites of ligamentous attachment: the flexor retinaculum at the tubercle. The dorsal and volar branches of the radial artery provide the blood supply to the scaphoid. and trapezium (b) A small portion of the surface is covered by hyaline cartilage False ?Nearly the entire surface is covered by hyaline cartilage (c) Vessels enter away from the sites of ligamentous attachment. False ?Vessels may enter only at the sites of ligamentous attachment (d) The ulnar artery provides the blood supply to the scaphoid bone. and trapezoid. The branches course volar and proximal within the bone. supplying 70-85% of the scaphoid. As a result. which divides into 2-4 branches before entering the waist of the scaphoid along the dorsal ridge. lunate. lunate. The volar scaphoid branch also enters the bone as several perforators in the region of the tubercle. capitate. lunate. and the dorsal radiocarpal and radial collateral ligaments along the dorsal ridge. these supply the distal 20%-30% of the bone .MCEM Toxicology MCQ The scaphoid bone (a) The scaphoid only articulates with the radius. capitate.

the most common aetiologies are adenomatous polyps. the most common aetiologies are diverticular disease and angiodysplasia. (e) PUD causes about 30% of all upper GI bleeds. False ?About 10% of duodenal bleeds will re-bleed within 24 -48 hours. but may also occur secondary to sneezing (c) In lower GI bleeding. but may also occur secondary to sneezing True ?A Mallory weiss tear occurs in the distal oesophagus due to a tear in the mucosa usually from repeated vomiting. False ?PUD causes about 60% of all upper GI bleeds . (b) A Mallory weiss tear occurs in the distal oesophagus due to a tear in the mucosa usually from repeated vomiting. not from haemorrhoids. False ?Angiodysplasia is more common in patients with aortic stenosis.MCEM Toxicology MCQ Gastrointestinal Bleeding: (a) About 40% of duodenal bleeds will re-bleed within 24 -48 hours. (d) Angiodysplasia is more common in patients with aortic regurgitation. not from haemorrhoids. False ?In lower GI bleeding.

http://www. True ?Posterior edge of medial malleolus bone tenderness is an indication for X Ray. (b) Tip of lateral malleolus bone tenderness. False ?Base of the 5th metatarsal tenderness is an indication for X Ray. (d) Tip of medial malleolus bone tenderness.bmj. True ?Posterior edge of lateral malleolus bone tenderness is an indication for X Ray. True ?Tip of lateral malleolus bone tenderness is an indication for X Ray (c) Posterior edge of medial malleolus bone tenderness.MCEM Toxicology MCQ Ottawa Ankle Rules:Indication for X Ray (a) Posterior edge of lateral malleolus bone tenderness. True ?Tip of medial malleolus bone tenderness is an indication for X Ray. (e) Base of the 5th metacarpal.com/cgi/content/full/326/7386/417#F1 .

MCEM Toxicology MCQ The following are true with regard to lower vertebral levels: (a) The bifurcation of the aorta occurs at the vertebral level of L4 True ?The bifurcation of the aorta occurs at the vertebral level of L4 (b) The sacral dimples are at the vertebral levels of S2 True ?The sacral dimples are at the vertebral levels of S2 (c) The posterior superior iliac spine is at the vertebral level of S1 False ?The posterior superior iliac spine is at the vertebral level of S2 (d) The dural sac ends at the vertebral level of S1 False ?The dural sac ends at the vertebral level of S2 (e) The rectum starts at the vertebral level of S3 True ?The rectum starts at the vertebral level of S3 .

. ocular involvement and frequently involves a concurrent iritis.MCEM Toxicology MCQ Eye Emergencies (a) Herpes Simplex Virus can involve eyelids. False ?Orbital cellulitis is but peri-orbital cellulitis is not. (b) Herpes Zoster Opthalmicus frequently involves a concurrent iritis True ?Herpes Zoster Opthalmicus is shingles in the distribution of the trigeminal nerve. Treatment is with topical anti-virals. (c) Hyphema is not associated with rebleeding. True ?HSV classically causes a dendritic epithelial defect. (d) Peri-orbital cellulitis is associated with painful eye movements. conjunctiva and cornea. False ?Rebleeding can occur about 3-5 days following the initial injury.

(d) There are 4 pairs of sacral nerves.MCEM Toxicology MCQ The Spinal Cord: (a) There are 29 pairs of spinal nerves. False ?There are 5 pairs of sacral nerves. and 1 coccygeal . False ?There are 31 pairs of spinal nerves. (e) There are 4 pairs of coccygeal nerves. False ?There are 12 pairs of thoracic nerves. False ?There is usually 1 pair of coccygeal nerves. (c) There are 11 pairs of thoracic nerves. True ?There are 8 pairs of cervical nerves. (b) There are 8 pairs of cervical nerves. The spinal cord gives rise to 31 pairs of spinal nerves: 8 cervical. 12 thoracic. 5 sacral. 5 lumbar.

Corticospinal tract injury is characterised by ipsilateral motor deficits. (e) Cervical spine injuries may present with pain above but not below the clavicle True ?Cervical spine injuries may present with pain above but not below the clavicle .MCEM Toxicology MCQ Tract Dysfunction (a) Corticospinal tract injury is characterised by contralateral motor deficits False ?Ipsilateral. (c) Posterior Column injury is characterised by ipsilateral proprioception loss True ?Posterior Column injury is characterised by ipsilateral proprioception loss (d) Cervical Spine injury may present with hypotension and bradycardia True ?This is neurogenic shock due to loss of sympathetic tone.Spinothalamic tract injury is characterised by contralateral pain and temperature sensation loss. (b) Spinothalamic tract injury is characterised by ipsilateral pain and temperature sensation loss False ?Contralateral.

MCEM Toxicology MCQ Anatomical considerations: (a) The origin of the coeliac axis is at T8 False ?The origin of the coeliac axis is at T12 (b) L3 is crossed by the transpyloric plane of addison ( half way between the suprasternal notch and the symphysis pubis. True ?The aortic opening transmits the thoracic duct.) False ?L1 is crossed by the transpyloric plane of addison ( half way between the suprasternal notch and the symphysis pubis.) (c) The vagi pierce the diaphragm at T8 along with the oesophagus False ?The vagi pierce the diaphragm at T10 along with the oesophagus (d) The aortic opening in the diaphragm is anterior to the median arcuate ligament and transmits the azygous and hemiazygous veins False ?The aortic opening in the diaphragm is posterior to the median arcuate ligament and transmits the azygous and hemiazygous veins (e) The aortic opening transmits the thoracic duct. .

MCEM Toxicology MCQ Carotid Sinus Syndrome may be caused by (a) Trauma True ? (b) Carotid artery aneursym True ? (c) Posterior Communicating Artery Aneursym True ? (d) Nasopharyngeal tumor spread True ? (e) Wegeners Granulomatosis True ?Or any other cause of infection such as sinusitis or tuberculosis .

. True ?If not visible may well be palpable. but may be helpful in young athletic types. (e) The treatment of choice is surgical repair. False ?Rupture of the biceps most commonly affects 40 to 60 year olds.MCEM Toxicology MCQ The following is true with regard to rupture of the biceps tendon: (a) It most often affects 20 to 40 year old men. (b) May cause a popping sound during some activity. (c) Shoulder aching may be worse at night. False ?Of debatable value. True ?Or a sudden pain with a snapping sensation. True ?Or painful during repetitive or overhead movements (d) May cause a visible mass between the shoulder and the elbow.

(c) Non displaced fractures are almost always seen on AP views. True ?Displaced lateral 1/3rd fractures usually require operative intervention because they have a high rate of non-union. False ?Non displaced fractures may be difficult to see on AP views and may need 20 degree ( Zanca ) views or 45 degree cephalic tilt.html . Non displaced medial 1/3rd fractures are treated conservatively while displaced require orthopaedic referral. (d) Lateral 1/3 rd of the clavicle are the most common site for fracture.( Allman classification ) (e) Non displaced lateral 1/3rd clavicular fractures should be treated conservatively.MCEM Toxicology MCQ Clavicle fractures (a) Account for 1 in 20 adult fractures True ? (b) Are usually caused by a direct blow to the clavicle False ?They are usually caused by a fall onto the lateral clavicle.aafp.org/afp/20041115/1947. www. False ?Middle 1/3 rd are the most common site for fracture and represents 80% of fractured clavicles.

Class II-more anxiety. class IV.anxious and sometimes confused. confused and lethargic .MCEM Toxicology MCQ Haemorrhagic shock (a) Class I patients usually do not have any mental anxiety False ? (b) Class II shock usually do not have any mental anxiety False ? (c) Class III patients usually have some anxiety True ? (d) Class IV patients are usually alert and not confused False ? (e) Class II patients are usually confused False ? Class I-slight anxiety. Class III.

False ?The head of the epididymis lies on the upper pole of the testis where it is joined by the efferent ducts. True ?The testicular artery is a direct branch of the abdominal aorta which arises just below the renal arteries and descends in the spermatic cord to the posterior aspect of the testes. (d) A hydrocele occurs when there is watery fluid between the parietal and visceral layers of the tunica albuginea. True ?The ductus deferens ascends on the medial side of the epididymis. (c) The head of the epididymis lies on the lower pole of the testis where it is joined by the efferent ducts.MCEM Toxicology MCQ Appreciation of the gross anatomy of the testis: (a) The ductus deferens ascends on the medial side of the epididymis. True ?The epididymis is on the posterior aspect of the testes and is 6 m in length. (b) The epididymis is on the posterior aspect of the testes and is 6 m in length. False ?A hydrocele occurs when there is watery fluid between the parietal and visceral layers of the tunica vaginalis ( a serous sac of peritoneal origin ) (e) The testicular artery is a direct branch of the abdominal aorta which arises just below the renal arteries and descends in the spermatic cord to the posterior aspect of the testes. .

False ?A fixed and dilated pupil because of a epidural haematoma is a late sign.deceleration injury. of cases have this classical description. (c) A fixed and dilated pupil because of a epidural haematoma is an early sign. (d) Contralateral hemiparesis in epidural haematoma is an early sign. False ?A minority. (e) A common mechanism for subdural haematoma is an acceleration. True ?A common mechanism for subdural haematoma is an acceleration. . approximately 20%. True ?80% of cases of epidural haematoma have a skull fracture that lacerates meningeal arteries.deceleration injury. False ?Contralateral hemiparesis in epidural haematoma is a late sign.MCEM Toxicology MCQ Traumatic Brain Injury (a) The majority of cases of epidural haematoma have a loss of consciousness followed by a lucid interval followed by neurological decline. (b) 80% of cases of epidural haematoma have a skull fracture that lacerates meningeal arteries.

(b) Each disk consists of a peripheral annulus fibrosus and a central nucleus pulposus True ?Each disk consists of a peripheral annulus fibrosus and a central nucleus pulposus (c) The annulus fibrosus is composed of fibrocartilage True ?The annulus fibrosus is composed of fibrocartilage (d) The nucleus pulposus is made of water and cartilage fibers. two laminae. (e) With increasing age the proportion of fibrocartilage to fluid decreases. False ?With increasing age the porportion of fibrocartilage to water increases. . and four articular). two laminae. and seven processes (one spinous.MCEM Toxicology MCQ Vertebrae (a) The vertebral arch is made up of two pedicles. two transverse. and seven processes True ?The vertebral arch is made up of two pedicles. True ?The nucleus pulposus is made of water and cartilage fibers.

True ?The round ligament terminates in the fibrofatty tissue of the labium majus. False ?The internal spermatic fascia is derived from the transversalis fascia . Epididymis and Spermatic Cord: (a) The cremasteric fascia containing the cremasteric muscle is derived from the rectus abdominis muscle.MCEM Toxicology MCQ Testes. False ?The cremasteric fascia containing the cremasteric muscle is derived from the internal oblique muscle (b) The external spermatic fascia is derived from the aponeurosis of the transversalis fascia. (d) The deep inguinal ring transmits the genital branch of the genitofemoral nerve. False ?The external spermatic fascia is derived from the aponeurosis of the external oblique muscle (c) The round ligament terminates in the fibrofatty tissue of the labium majus. (e) The internal spermatic fascia is derived from the internal oblique. True ?The deep inguinal ring transmits the genital branch of the genitofemoral nerve.

True ?An acute rise in intracranial pressure may manifest as a central respiratory depression. Cushings response occurs with bradycardia and hypertension .MCEM Toxicology MCQ Intracranial bleeding (a) Extra dural haematoma is often due to bleeding from the anterior branch of the middle meningeal artery after a temporal bone fracture True ?The classical history of this haematoma is one of an intial loss of consciousness followed by a subsequent lucid period follwed by neurological deterioration. (e) An acute rise in intracranial pressure may manifest as a central respiratory depression. True ?Cushings response is characterised by bradycardia and hypertension. False ?Amnesia for events >30min before the head injury is an indication for CT Brain Scan. (d) Amnesia for events >15min before the head injury is an indication for CT Brain Scan. (b) An acute rise in intracranial pressure may manifest as a falling pulse rate. True ?Cushings response is characterised by bradycardia and hypertension. (c) An acute rise in intracranial pressure may manifest as a rising blood pressure.

True ?The spinal cord ends in adults at the level of L1/2. True ?The umbilicus is at the vertebral level of L3/4. True ?The renal arteries originate at the vetebral level of L1/2. (b) The spinal cord ends in adults at the level of L1/2. . (c) The azygous and hemiazygous veins are formed at L4 vertebral level.MCEM Toxicology MCQ Abdominal structures corresponding to vertebral levels: (a) The renal arteries originate at the vetebral level of L1/2. False ?The ligament of treitz is at the level of the upper border of the L2 vertebra . False ?The azygous and hemiazygous veins are formed at L2 vertebral level (d) The ligament of treitz is at the level of the upper border of the L4 vertebra. (e) The umbilicus is at the vertebral level of L3/4.

False ? (b) Solid organs such as liver resist cavitation more than softer tissues such as lung False ? (c) High velocity injuries usually have less bacterial contamination False ? (d) Abdominal gunshot wounds invariably require laparotomy. True ? . True ? (e) Cranial gunshot wounds invariably require ventilation.MCEM Toxicology MCQ Gunshot Wounds: (a) Temporary cavitation is caused by a sonic shock wave in high velocity injuries.

True The anterior half of the ear is supplied by the auriculotemporal nerve which is a branch of the mandibular portion of the trigeminal nerve. True (b) The posterior half of the ear is supplied by branch of the trigeminal nerve.MCEM Toxicology MCQ With regard to innervation of the ear (a) The anterior half of the ear is supplied by the auriculotemporal nerve which is a branch of the mandibular portion of the trigeminal nerve. False (c) The posterior part of the ear is supplied by 2 nerve branches derived from the cervical plexus. False (e) The vagus nerve supplies the external auditory canal.The position for an ear block is where the ear lobe attaches to the head. True (d) The vagus nerve has no role in the inervation of the ear.The posterior part of the ear is supplied by 2 nerve branches derived from the cervical plexus.The vagus nerve supplies the external auditory canal. .

MCEM Toxicology MCQ Elbow Dislocation (a) On lateral X Ray the radius and the ulna are most commonly displaced posteriorly. (b) The most frequent neurological injury is to the median nerve. (e) Vascular complications occur in about 10% of elbow dislocations. False ?The most frequent neurological injury is to the ulnar nerve. False ?On clinical exam the olecranon process is commonly prominent. (d) On clinical exam the elbow is commonly flexed at 90 degrees. True ?On lateral X Ray the radius and the ulna are most commonly displaced posteriorly. False ?On clinical exam the elbow is commonly flexed at 45 degrees and the olecranon is prominent. True ?The most common artery involved is the brachial artery. (c) On clinical exam the olecranon process is commonly not prominent. .

and 5 sacral vertebrae. True ?There is normally 7 cervical vertebrae. False ?Rotation of the body is least extensive in the lumbar region. 12 thoracic vertebrae.MCEM Toxicology MCQ Structure Function and Mechanics of the Vertebral Column: (a) Flexion and extension of the vertebral column is extensive in the cervical and thoracic regions but limited by the lumbar region. (d) Rotation ( twisting movement ) of the body is least extensive in the cervical region. False ?The cervical vertebrae normally have a posterior concavity while the thoracic region has a posterior convexity. and 5 sacral vertebrae. 5 lumbar vertebrae. (c) There is normally 7 cervical vertebrae. False ?Flexion and extension of the vertebral column is extensive in the cervical and lumbar regions but limited by the thoracic region because of the rib cage. and 4 coccygeal vertebrae. 5 lumbar vertebrae. 12 thoracic vertebrae. and 4 coccygeal vertebrae. (b) The cervical vertebrae normally have a posterior convexity while the thoracic region has a posterior concavity. (e) Lateral flexion of the body is restricted by the cervical section of the vertebral column False ?Lateral flexion of the body is restricted by the thoracic section of the vertebral column .

orbital floors and zygomatic arches (d) Occipitomental views are used to assess the orbital floors True ?Occiptomental views are used to assess the maxilla. orbital floors and zygomatic arches .MCEM Toxicology MCQ Maxillofacial radiographs (a) Orthopantomogram view can be used to assess the frontal bones False ?OPG is used to assess the mandible (b) Submentovertical projection is used to assess the zygomatic arch True ? (c) Occiptomental views are used to assess the maxilla True ?Occiptomental views are used to assess the maxilla. orbital floors and zygomatic arches (e) Occipitomental views are used to assess the zygomatic arches True ?Occiptomental views are used to assess the maxilla.

MCEM Toxicology MCQ Surface Anatomy: (a) The pharynx becomes the oesophagus at C6 True ?The pharynx becomes the oesophagus at C6 (b) C7 is the first clearly palpable spinous process. True ?C7 is the first clearly palpable spinous process. (c) The superior border of the scapula is at T3 False ?The superior border of the scapula is at T2 (d) The suprasternal notch is at the level of T2/3 True ?The suprasternal notch is at the level of T2/3 (e) The end of the oblique fissure of the lung is at the spine of T3 True ?The end of the oblique fissure of the lung is at the spine of T3 .

True ?The brachial artery divides into the radial and ulnar arteries just below the line of the elbow joint. (b) The radial artery lies in a groove between the flexor carpi radialis and the anterior border of the radius. True ?In the area of the wrist and hand the ulnar artery is covered by the palmer aponeurosis. (d) In the area of the wrist and hand the ulnar artery is covered by the palmer aponeurosis. True ?The radial artery lies in a groove between the flexor carpi radialis and the anterior border of the radius. (e) The pulsations of the ulnar artery are recognised lateral to the pisiform bone.MCEM Toxicology MCQ Surface Anatomy of the Anterior Forearm: (a) The brachial artery divides into the radial and ulnar arteries just below the line of the elbow joint. False ?The radial artery can be palpated on the lateral side of the scaphoid in the anatomical snuff box. (c) The radial artery can be palpated on the lateral side of the trapezium in the anatomical snuff box. The radial artery lies in a groove between the flexor carpi radialis and the anterior border of the radius. True ?The pulsations of the ulnar artery are recognised lateral to the pisiform bone .

True ?The radial head serves as a stabiliser against valgus stress. False ?Radial head fractures are usually the result of a fall on an outstretched hand causing the radial head to be driven into the capitellum. (c) The radial head serves as a stabiliser against forces away from the midline. (e) Are associated with medial epicondyle avulsion fractures. (d) Radial head fractures are usually the result of a fall on an outstretched hand causing the radial head to be driven into the trochlea. True ?This is secondary to valgus stress. .MCEM Toxicology MCQ Radial Head Fractures (a) Radial head fractures are the most common fractures of the elbow True ?Radial head fractures are the most common fractures of the elbow (b) The radial head articulates with the trochlea False ?The radial head articulates with the capitellum.

MCEM Toxicology MCQ Anatomical Considerations of the thoracic vertebrae: (a) The start of the arch of the aorta is at T4/T5 True ?The start of the arch of the aorta is at T4/T5 (b) The sternum runs from T5 to T8 True ?The sternum runs from T5 to T8 (c) The upper border of the liver is usually at T9 False ?The upper border of the liver is usually at T6 (d) The inferior angle of the scapula is at T3 False ?The inferior angle of the scapula is at T7 (e) The IVC goes through the diaphragm at T8 True ?The IVC goes through the diaphragm at T8 ( along with the right phrenic nerve ) .

(a) Palmaris brevis . (b) Opponens pollicis False ?Opponens pollicis is innervated by the median nerve. (d) Abductor pollicis brevis False ?Abductor pollicis brevis is innervated by the median nerve. True ?Palmaris brevis is innervated by the superficial terminal branch of the ulnar nerve in the hand.MCEM Toxicology MCQ the ulnar nerve is interrupted at the wrist the following muscles are not innervated. (c) Flexor pollicis brevis False ?Flexor pollicis brevis is innervated by the median nerve. . (e) Flexor carpi ulnaris False ?Flexor carpi ulnaris is innervated by a branch of the ulnar nerve in the forearm.

The crossing event is called the decussation of the pyramids (b) The cerebral peduncles largely contain motor fibers. True ?In the motor cortex. whereas the lateral side of the gyrus controls the hands and face. False ?The fibers of the pyramids cross in the medulla. False ?Motor and somatosensory information travel through the posterior limb of the internal capsule. Control of the feet lies near the midline at the top of the gyrus. (d) In the motor cortex the lateral side of the gyrus controls the hands and face. the body is mapped out across the extent of the gyrus. True ?The cerebral peduncles largely contain motor fibers.MCEM Toxicology MCQ Neuroanatomy (a) The fibers of the pyramids cross in the pons. . (c) Motor and somatosensory information travel through the anterior limb of the internal capsule.

MCEM Toxicology MCQ The following headaches usually have associated focal abnormal neurology (a) Migraine False ?Possible but not usual (b) Ca channel blocker associated headache False ? (c) Nitrates associated headache False ? (d) CO poisoning headache False ? (e) Temporal Arteritis False ? Other headaches without associated neurology include tension. and analgesic .

False ? (d) Pulse oximetry is usually unhelpful. deeply pigmented skin. venous congestion. fluorescein. heavy smokers. a falsely reassuring pulse oximetry reading may mask arterial desaturation). False ?The results of pulse oximetry should be interpreted with particular caution in the presence of abnormal haemoglobins(the pulse oximetry reading represents a summation of oxyhemoglobin and carboxyhemoglobin and in cases of carbon monoxide poisoning or in chronic. False ? (b) Cervical spine control is usually necessary. or when certain vital dyes (such as methylene blue. and isosulfan blue) are used for clinical purposes. (c) External haemorrhage should be ignored. indocyanine green. nail polish.MCEM Toxicology MCQ During initial management of a multiply injured patient: (a) Shock management is the first priority. indigo carmine. False ? . True ?Cervical spine control is usually necessary. anemia. (e) Ischaemic limbs demand immediate attention. hypoperfusion.

and is associated with significant morbidity from pulmonary contusion. True ? (d) Ruptured diaphragm. Use of noninvasive positive airway pressure by mask may obviate the need for endotracheal intubation in alert patients. creating one floating segment comprised of several rib sections and the soft tissues between them. normalfunctioning chest wall) with breathing. Initial management of flail chest consists of oxygen and close monitoring for early signs of respiratory compromise. ideally using both pulse oximetry and capnography in addition to clinical observation. it moves in the opposite direction of the uninjured. or progressively worsening respiratory function require endotracheal intubation and mechanical ventilatory support. True ? (b) Flail chest. Abnormal motion can be difficult to detect making the diagnosis difficult. Patients with severe injuries. False ? (e) Surgical emphysema. True ?Flail chest occurs when three or more adjacent ribs are each fractured in two places.MCEM Toxicology MCQ Chest drain insertion is usually indicated in patients with the following conditions: (a) Mediastinal traversing wounds. This unstable section of chest wall exhibits paradoxical motion (ie. respiratory distress. False ? . (c) Open pneumothorax.

org. making the routine screening pelvic X Ray obsolete. In the CRASH trial steroids in patients with head injury showed more harm than good.thelancet.nice.com/journals/lancet/article/PIIS0140673604171882/abstract. True ? (b) Hypertonic saline is beneficial in hypotensive patients with head injury. True ?http://www.pdf One New Zealand study of 347 children who had a pelvic X Ray found only 1 fracture and this fracture was clinically apparent. The authors recommend not X Raying. (d) Patients intubated without the need for anaesthetic drugs had a survival rate of about 2% False ? (e) A post traumatic head injury seizure is an indication to request a CT brain scan immediately according to the NICE guidelines.MCEM Toxicology MCQ Major Trauma: (a) Pelvic fractures in children are rare and clinically apparent.com/journals/lancet/article/PIIS0140673604171882/abstract .uk/nicemedia/pdf/CG56QuickRedGuide. False ? (c) Steroids are beneficial in patients with head injury and GCS <15 False ?http://www.thelancet. http://www.

.MCEM Toxicology MCQ Regarding fracture classifications: (a) The Neer classification refers to distal radial fractures. True The Schatzker classification refers to tibial plateau fractures. False The Neer classification refers to proximal humeral fractures. (c) The Schatzker classification refers to tibial plateau fractures. (b) The Frykman classification refers to proximal humeral fractures. (d) Type II is the most common type of Salter-Harris fracture presentations. True Type II is the most common type of Salter-Harris fracture presentations. False The Frykman classification refers to distal radial fractures.

. It arises in the medulla. and a sensory branch supplie the carotid sinus.MCEM Toxicology MCQ The glossopharyngeal nerve (CN IX): (a) Arises in the pons. (d) Supplies taste fibers to the anterior two-thirds of the tongue False ?Sensory fibers provide sensation to the tonsillar fossa and pharynx ( the afferent pathway of the gag reflex ) and the taste to the posterior 2/3 rd's of the tongue. autonomic fibers supply the parotid gland. True ?Motor fibers supply the stylopharyngeus muscle. (c) Is the efferent pathway of the gag reflex False ?Sensory fibers provide sensation to the tonsillar fossa and pharynx ( the afferent pathway of the gag reflex) and taste to the posterior 2/3 rd's of the tongue. (b) Leaves the skull through the jugular foramen True ?The glossopharyngeal nerve leaves the skull through the jugular foramen along with the vagus and accessory nerve. (e) Supplies the stylopharyngeal muscle. False ?The glossopharyngeal nerve is mainly sensory.

MCEM Toxicology MCQ The following statements are true (a) The median nerve supplies the interossei of the hand False ?Ulnar (b) The radial nerve supplies the abductor pollicis brevis False ?The radial nerve does not supply any of the intrinsic muscles of the hand (c) The ulnar nerve supplies sensation to the one and a half ulnar digits True ? (d) The extensor muscles of the forearm are supplied by the radial nerve True ? (e) The biceps muscle is supplied by the musculocutaneous nerve True ? .

True ?An L4 root lesion will cause sensory loss at the anteromedial shin.MCEM Toxicology MCQ The following are true in relation to common root compression syndromes produced by lumbar disc disease: (a) An S1 root lesion will produce weakness of plantar flexion of the ankle and toes. True ?An S1 root lesion will produce weakness of plantar flexion of the ankle and toes. False ?An S1 root lesion will cause loss of the ankle jerk reflex. . (b) An S1 root lesion will cause loss of the knee jerk reflex. (c) An L4 root lesion will cause sensory loss at the anteromedial shin. (d) An L5 root lesion will cause sensory loss over the sole of the foot. False ?An L5 root lesion will cause sensory loss over the dorsum of the foot and anterolateral shin while an S1 root lesion will cause sensory loss over the sole of the foot.

True ?The cochlea contains the auditory sensory receptors and the vestibular labyrinth contains the balance receptors (c) Blood supply to the inner ear is from the internal carotid artery. True ?The anterior vestibular artery provides the blood supply to the anterior and horizontal semicircular canals but not to the cochlea . (d) The anterior vestibular artery to the cochlea False ?The anterior vestibular artery provides the blood supply to the anterior and horizontal semicircular canals but not to the cochlea (e) The anterior vestibular artery provides the blood supply to the anterior and horizontal semicircular canals. True ?The cochlea contains the auditory sensory receptors and the vestibular labyrinth contains the balance receptors (b) The vestibular labyrinth contains the balance receptors. False ?Blood supply to the inner ear is from the vertebrobasilar system.MCEM Toxicology MCQ The Ear (a) The cochlea contains the auditory sensory receptors.

False ?Colles fracture is associated with extensor pollicis longus tendon rupture in the weeks following the injury.5 cm of the wrist. (b) The distal fragment is displaced anteriorly. False ?The distal fragment is displaced posteriorly and with radial displacement.MCEM Toxicology MCQ Colles Fracture (a) Is a fracture of the radius within 1 cm of the wrist.e in peole without a fracture ) (d) Colles fracture is associated with flexor pollicis longus rupture in the weeks following injury. . (c) The angulation of the distal radius normally has a 5 degree forward tilt on the poximal carpal bones as seen on the lateral X Ray ( i.e in peole without a fracture ) True ?The angulation of the distal radius normally has a 5 degree forward tilt on the poximal carpal bones as seen on the lateral X Ray ( i. False ?Colles fracture is a fracture of the radius within 2. (e) Colles fracture usually follows a fall onto a flexed wrist False ?Colles fracture usually follows a fall onto an outstretched hand. Smith's fracture usually follows a fall onto a flexed wrist.

True ?The left heart border is formed by the outer boder of the left ventricle. False ?The right heart border is formed by the outer border of the right atrium.MCEM Toxicology MCQ Radiograph Interpretation (a) The right heart border is formed by the outer border of the right ventricle. (d) Valve calcification is best seen on the AP view. . True ?A large pulmonary artery will cause hilar enlargement as will lymphadenopathy. (e) A large pulmonary artery will cause hilar enlargement. False ?Valve calcification is best seen on the lateral view as on the AP view valve calcification cannot be visualised over the spine. (b) The left heart border is formed by the outer border of the left ventricle. (c) The left margin of the right ventricle lies about a thumbs breath in from the left heart border. True ?The left margin of the right ventricle lies about a thumbs breath in from the left heart border and on the surface of the heart this is marked by the left anterior descending artery.

True ?The greater petrosal nerve contains taste fibers from the palate. .MCEM Toxicology MCQ The facial nerve (a) The nerve emerges on the anterior surface of the brain between the pons and the medulla and it enters the internal acoustic meatus with the vestibulocochlear nerve. The postganglionic fibers are secretomotor to the lacrimal gland and the glands of the nose and palate. It then passes through the posterior fossa and runs through the middle ear before emerging from the stylo-mastoid foramen and running through the parotid. (b) The greater petrosal nerve arises from the nerve at the geniculate ganglion. True ? (e) Emerges from the temporal bone through the stylo-mastoid foramen. True ? The facial nerve arises in the medulla and emerges between the pons and medulla. True ?The nerve emerges on the anterior surface of the brain between the pons and the medulla and it enters the internal acoustic meatus with the vestibulocochlear nerve. It also contains preganglionic parasympathetic fibres that synapse in the pterygopalatine ganglion. (c) Passes through the posterior fossa. True ? (d) On reaching the medial wall of the middle ear the nerve swells to form the sensory geniculate ganglion.

(b) The pulsations of the ulnar artery are recognised lateral to the lunate bone.MCEM Toxicology MCQ The Forearm: (a) The radial artery can be palpated on the medial side of the scaphoid in the anatomical snuff box. False ?The radial artery can be palpated on the lateral side of the scaphoid in the anatomical snuff box. False ?The radial artery lies in a groove between the flexor carpi radialis and the anterior border of the radius. False ?The brachial artery divides into the radial and ulnar arteries just below the line of the elbow joint. True ?In the area of the wrist and hand the ulnar artery is covered by the palmer aponeurosis. False ?The pulsations of the ulnar artery are recognised lateral to the pisiform bone (c) The radial artery lies in a groove between the flexor digitorum profundus and the anterior border of the radius. . (d) In the area of the wrist and hand the ulnar artery is covered by the palmer aponeurosis. (e) The brachial artery divides into the radial and ulnar arteries just below the distal third of the humerus.

True (e) The cervical plexus plays a role in innervation of the posterior and lateral scalp. True (b) The frontal part of the scalp is innervated by the supraorbital and supratrochlear nerves. more specifically the greater and lesser occipital nerves. True The frontal part of the scalp is innervated by the supraorbital and supratrochlear nerves which are branches of the first division of the trigeminal nerve. True (c) The posterior part of the scalp is innervated by branches of the first division of the trigeminal nerve False (d) The posterior part of the scalp is innervated by branches of the cervical plexus.MCEM Toxicology MCQ With regard to innervation of the scalp (a) The frontal part of the scalp is innervated by branches of the opthalmic part of the trigeminal nerve.The posterior part of the scalp is innervated by branches of the cervical plexus. . The cervical plexus innervates the lateral scalp through the lesser occipital nerve.

True (b) Flexor pollicis brevis is innervated by median nerve True This is usually the case however may also be innervated by the deep branch of the ulnar nerve (c) Flexor pollicis longus flexes proximal phalanx of thumb False Flexor pollicis longus flexes distal phalanx of thumb (d) Extensor pollicis longus extends the IP and MCP joints of the thumb True ? (e) Extensor pollicis brevis forms anterior border of the anatomical snuff box. . True Extensor pollicis brevis forms anterior border of the anatomical snuff box and the posterior border of the snuffbox is the tendon of the extensor pollicis longus.MCEM Toxicology MCQ Muscles of the hand (a) Flexor pollicis brevis flexes the MCP joint of the thumb.

False The arching domes of the diaphragm can reach the level of the 5th rib.If a penetrating injury is just below the level of the nipples one should be suspicious of a penetrating injury to the diaphragm .MCEM Toxicology MCQ Penetrating injuries of the diaphragm (a) The arching domes of the diaphragm highest point is the level of the 6th rib False (b) If a penetrating injury is just below the level of the nipples one should not be suspicious of a penetrating injury to the diaphragm False (c) The left dome of the diaphragm is higher than the right dome in normal people. True (e) The right dome of the diaphragm is more likely to suffer a penetrating injury. False (d) The right dome of the diaphragm is higher than the left dome in normal people.

MCEM Toxicology MCQ Occlusion of the anterior cerebral artery causes (a) Paralysis of the opposite leg True ? (b) Perseveration True ? (c) Urinary incontinence True ? (d) Grasp reflex in the opposite hand True ? (e) Wernickes(receptive/fluent) dysphasia False ? .

(b) Peritoneal lavage is indicated if the patient is unstable. .000 RBC/mm3 or 500 WBC/mm3 is considered a positive peritoneal lavage and reflects intraabdominal bleeding. True ?With FAST scanning free fluid visible in the abdomen implies at least 500ml of fluid. (e) Laparotomy is usually necessary in the shocked patient True ?The patient is likely to need a laparotomy if there has been abdominal trauma and he/she is haemodynamically unstable.MCEM Toxicology MCQ In the alert patient with evidence of blunt abdominal trauma: (a) Peritoneal lavage is helpful if the patient is stable. (c) With FAST scanning free fluid visible in the abdomen implies at least 500ml of fluid. False ?The patient is likely to need a laparotomy if there has been abdominal trauma and he/she is haemodynamically unstable. True ?100. (d) CT Scanning will visualise retroperitoneal injuries well True ?CT scanning may miss diaphragmatic injury and many visceral injuries but will detect solid organ damage or intraperitoneal blood.

True ? (e) Pregnancy is an exclusion criteria. in particular children (under the age of 18). and any one of the following: Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus Bone tenderness at the base of the fifth metatarsal (for foot injuries). Bone tenderness at the navicular bone (for foot injuries). True ?Along with children and those with diminished ability to follow the test. True ? (b) Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus True ? (c) Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus True ? (d) Bone tenderness at the navicular bone (for foot injuries). and those with diminished ability to follow the test (for example due to head injury or intoxication). X-rays are only required if there is bony pain in the malleolar or midfoot area. Certain groups are excluded. pregnant women. .MCEM Toxicology MCQ Ottawa ankle rules: The following require X Ray (a) Tenderness at the base of the 5th metatarsal. An inability to bear weight both immediately and in the emergency department for four steps.

MCEM Toxicology MCQ Mandibular Fractures (a) Usually occur on one side of the mandible only False ? (b) The most common area of fracture is the angle of the mandible True ? (c) May present with bony crepitus True ? (d) May present with malocclusion True ? (e) May present with limited ROM True ? .

MCEM Toxicology MCQ The following are true (a) Biceps is innervated by musculocutaneous True ? (b) Brachioradialis is innervated by musculocutaneous False ?By radial nerve (c) Elbow flexion is initiated by nerve roots C5 and C6 True ? (d) Triceps are innervated by C7 True ? (e) Finger flexion is mediated by the radial nerve False ?Median and ulnar .

True ?The median nerve enters the hand through the carpal tunnel. True ?To anaesthetise the median nerve local anaesthetic is injected between the tendon's of the flexpr carpi radialis and palmaris longus. (b) To anaesthetise the median nerve local anaesthetic is injected between the tendon's of the flexpr carpi radialis and palmaris longus. between the tendons of the flexor digitorum superficialis and the flexor carpi radialis. deep to the flexor retinaculum. (c) At the wrist the ulnar nerve is blocked by injecting local anaesthetic between the palmaris longus and the flexor carpi ulnaris False ?At the wrist the ulnar nerve is blocked by injecting local anaesthetic between the ulnar artery and the flexor carpi ulnaris. (e) About 5 ml's of 2% lignocaine is required to anaesthetise the ulnar nerve.MCEM Toxicology MCQ The Hand (a) The median nerve enters the hand through the carpal tunnel. deep to the flexor retinaculum. (d) The ulnar nerve supplies cutaneuos sensation to the volar surface of the middle finger. False ? . False ?The ulnar nerve supplies cutaneuos sensation to the volar surface of the little finger and the medial half of the ring finger. between the tendons of the flexor digitorum superficialis and the flexor carpi radialis.

True The left common carotid artery is a direct branch from the aortic arch. True The left common carotid artery lies anteriorly to the prevertebral fascia in the neck. False The left thyroid artery is a branch of the left thyrocervical trunk of subclavian (d) Is a direct branch from the aortic arch. (c) Gives off the left inferior thyroid artery. .MCEM Toxicology MCQ Left common carotid artery (a) Lies postero-laterally to the left vagus nerve in the neck. False The left common carotid artery lies antero-medial to the left vagus nerve in the neck (b) Lies anteriorly to the prevertebral fascia in the neck.

<140 class III. <120 class II. >140 class IV . <100 class I.MCEM Toxicology MCQ Haemorrhagic Shock (a) Pulse <100 is consistent with class I shock True ? (b) Pulse 100-120 is consistent with class II shock True ? (c) Pulse 120-140 is consistent with class III shock True ? (d) Pulse >140 is consistent with class IV shock True ? (e) Pulse 120-140 is consistent with class IV shock False ? ATLS classification.

False ?The obturator nerve originates from L2. (c) The femoral nerve supplies the skin on the posterior aspect of the leg and foot. (d) The iliohypogastric nerve supplies the cremaster muscle. L3 and L4. . False ?The genitofemoral nerve supplies the cremaster muscle. False ?The femoral nerve supplies the skin on the medial side of the leg and foot. False ?The femoral nerve supplies the skin on the anterior surface of the thigh. L3 and L4. L3 and L4 and supplies the adductor muscles of the thigh. (e) The femoral nerve supplies the skin on the medial surface of the thigh only.MCEM Toxicology MCQ The Lumbar Plexus: (a) The femoral nerve originates from the lumbar plexus from L2.The obturator nerve innervates the adductors of the thigh and the skin on the medial surface of the thigh. (b) The obturator nerve originates from L1 and L2 and supplies the adductor muscles of the thigh. True ?The femoral nerve originates from the lumbar plexus from L2.

MCEM Toxicology MCQ Lower vertebral levels: (a) The dural sac ends at the vertebral level of S3 False ?The dural sac ends at the vertebral level of S2 (b) The rectum starts at the vertebral level of S1 False ?The rectum starts at the vertebral level of S3 (c) The bifurcation of the aorta occurs at the vertebral level of L5 False ?The bifurcation of the aorta occurs at the vertebral level of L4 (d) The sacral dimples are at the vertebral levels of S1 False ?The sacral dimples are at the vertebral levels of S2 (e) The posterior superior iliac spine is at the vertebral level of S2 True ?The posterior superior iliac spine is at the vertebral level of S2 .

Passive stretching of muscles in the affected compartment will exacerbate the pain.MCEM Toxicology MCQ Compartment syndrome: (a) The pain is characteristically mild. (e) Paraesthesia is a feature before pain.Paraesthesia is a feature after pain. False ? (c) Palpation of the affected compartment will exacerbate the pain.Palpation of the affected compartment will exacerbate the pain. True ?Palpation of the affected compartment will exacerbate the pain. (d) Passive stretching of muscles in the affected compartment will exacerbate the pain. False ? The pain is severe and poorly localised. . False ? (b) The pain is characteristically well localised. True ?Passive stretching of muscles in the affected compartment will exacerbate the pain.

(a) The skin drains to the axillary lymph nodes. True (d) The posterior intercostal spaces drain to the para aortic nodes True (e) The skin on the posterior surface drains to the para-aortic nodes False The skin drains to the axillary lymph nodes. True (b) The intercostal spaces drain to the internal thoracic nodes.The intercostal spaces drain forwards to the internal thoracic nodes and backwards to the posterior intercostal nodes and the para aortic nodes. . True (c) The posterior spaces drain to the posterior intercostal nodes.MCEM Toxicology MCQ Lymphatic drainage of the thoracic wall.

False ?Subjective feeling of swelling but nothing to find on examination. False ?Not of great help. X Ray and bloods are normal. (b) Marked oedema of fingers and hand. (c) Symptoms worse at night False ?Worsen with work and improve with rest.MCEM Toxicology MCQ Characteristic features of repetitive strain injury: (a) Pain felt deep in the wrist. . (d) Raised ESR. True ?Pain felt deep in the wrist radiating to forearm and shoulder is a characteristic feature of repetitive strain injury. Pain initially clears at night but can become constant. (e) Good response to NSAIDs. False ?No clinical signs.

MCEM Toxicology MCQ The Brachial Plexus: (a) The dorsal scapular nerve is a branch of C7. (e) In the axilla the posterior divisions unite to form the lateral cord False ?In the axilla the posterior divisions unite to form the posterior cord . True ?The anterior division of the lower trunk forms the medial cord. False ?The posterior cord supplies the extensor structures on the posterior aspect of the limb. False ?The dorsal scapular nerve is a branch of C5. (c) The anterior division of the lower trunk forms the medial cord. (b) The medial cord supplies the extensor structures on the posterior aspect of the limb. (d) The posterior cord may contain neurons from all the spinal nerves contributing to the brachial plexus True ?The posterior cord may contain neurons from all the spinal nerves contributing to the brachial plexus.

(d) The cervical vertebrae normally have a posterior convexity while the thoracic region has a posterior concavity. True ?Rotation of the body is least extensive in the lumbar region. and 5 sacral vertebrae. False ?The cervical vertebrae normally have a posterior concavity while the thoracic region has a posterior convexity.MCEM Toxicology MCQ The Vertebral Column: (a) Lateral flexion of the body is restricted by the thoracic section of the vertebral column. 12 thoracic vertebrae. (b) Rotation ( twisting of the body ) of the body is least extensive in the lumbar region. and 4 coccygeal vertebrae. and 5 sacral vertebrae. 12 thoracic vertebrae. True ?There is normally 7 cervical vertebrae. and 4 coccygeal vertebrae. True ?Lateral flexion of the body is restricted by the thoracic section of the vertebral column because of the ribs. (e) There is normally 7 cervical vertebrae. . 5 lumbar vertebrae. (c) Flexion and extension of the vertebral column is extensive in the cervical and thoracic regions but limited by the lumbar region. 5 lumbar vertebrae. False ?Flexion and extension of the vertebral column is extensive in the cervical and lumbar regions but limited by the thoracic region.

(e) The thoracolumbar junction (T11-L2) is considered a transitional zone between the fixed thoracic and mobile lumbar regions True ?The thoracolumbar junction (T11-L2) is considered a transitional zone between the fixed thoracic and mobile lumbar regions . (b) The thorcic spine is the most commonly injured part of the spine. (d) When spinal cord injury does occur they are mostly neurologically complete. False ?The thoracic spine is among the least frequently injured parts of the spine. False ?The spinal canal is narrower in the thoracic spine than that found in the cervical or lumbar spine.MCEM Toxicology MCQ The thorcic spine: (a) Has an increased amount of flexibility afforded by it's articulation with the rib cage. (c) The spinal canal is wider than that found in the cervical spine. True ?Because of the high ratio of spinal cord to spinal canal in the thoracic spine when spinal cord injury does occur it is usually complete. False ?The rib cage makes the thoracic spine more inflexible and more rigid.

(b) Wrist Extensors:C6 True ?C6 is the nerve root for wrist extension.MCEM Toxicology MCQ The following muscles and nerve root supply are correctly paired: (a) Deltoid:C5 True ?C5 is the nerve root for shoulder abduction by the deltoid muscle. (d) T1:Abductor Digiti Minimi True ?T1 is the nerve root for little finger abduction by abductor digiti minimi. . (c) C7:Elbow Extension True ?C7 is the nerve root for elbow extension.

True ? (c) Non displaced neck fractures are treated with pin fixation.MCEM Toxicology MCQ Hip Fractures (a) Extracapsular fractures are more likely to compromise blood supply to the femoral head than intracapsular fractures. Hip fracture incidence doubles for each decade after 50. Non displaced neck fractures are treated with pin fixation. True ? (d) Displaced fractures are treated with open reduction or prosthesis placement. stable fractures are those which the medial cortices of the femoral neck and the femoral fragment abut. Intracapsular fractures are more likely to compromise blood supply to the femoral head than extracapsular fractures. Intracapsular hip fractures involve the femoral head and femoral neck. The affected leg in a hip fracture is classically shortened and externally rotated. Intertrochanteric fractures are classed as stable or unstable. . Isolated femoral head fractures are most commonly associated with hip dislocations. Overall mortality for intertrochanteric hip fractures is 10 to 30%. Displaced fractures are treated with open reduction or prosthesis placement. Extracapsular hip fractures may be intertrochanteric or subtrochanteric. True ? (e) Overall mortality for intertrochanteric hip fractures is 50% False ?Overall mortality for intertrochanteric hip fractures is 10 to 30%. False ? (b) Isolated femoral head fractures are most commonly associated with hip dislocations. Hip fracture incidence is 3 to 4 times higher in women than in men.

Class IV = >40% .MCEM Toxicology MCQ Classification of shock (a) Class I shock is when blood loss is <10% of blood volume False ? (b) Class II shock is when blood loss is <20% of blood volume False ? (c) Class III shock is when 20-40% of blood volume is lost False ? (d) Class IV shock is when >40% blood volume is lost True ? (e) Class V shock is when >50% of blood volume is lost False ? Class I = <15%. Class III = <40%. Class II = <30%.

(c) A suspected skull fracture is not an indication to request a CT Brain scan. False ?A suspected skull fracture is an indication to request a CT Brain scan. True ?GCS < 13 when first assessed in ED CT brain should be requested immediately (b) If GCS < 15 when assessed 2 hours after presentation in ED CT brain should be requested. True ?If GCS < 15 when assessed 2 hours after presentation in ED CT brain should be requested.MCEM Toxicology MCQ NICE Guideline: Selection of Adults for CT Brain (a) GCS < 13 when first assessed in ED CT brain should be requested immediately according to the NICE guidelines after head injury. . (d) 'Panda' eyes are not an indication to request a CT Brain scan False ?'Panda' eyes is an indication to request a CT brain scan as this is evidence of a fracture at the skull base. False ?Haemotympanum is an indication to request a CT Brain scan as this is evidence of a fracture at the skull base. (e) A collection of blood in the middle ear space is not an indication to request a CT Brain scan.

the thoracic duct. The aortic opening lies anterior to the body of T12. The oesophageal opening transmits the vagi.the thoracic duct and the azygous vein.the thoracic duct and the azygous vein.The aortic opening transmits the aorta. (c) The esophageal opening is at the level of T12 False The esophageal opening is at the level of T10.MCEM Toxicology MCQ Openings in the diaphragm (a) The aortic opening lies anterior to the body of T10 False The aortic opening lies anterior to the body of T12. and the vagus nerve. the azygous vein. (e) The caval opening transmits the inferior vena cava at the level of T8 True The caval opening transmits the inferior vena cava at the level of T8.the thoracic duct and the azygous vein (b) The aortic opening transmits the aorta. The right phrenic nerve penetrates the diaphragm with the IVC while the left phrenic nerve penetrates on it's own.The aortic opening transmits the aorta. False The aortic opening transmits the aorta. (d) The esophageal opening transmits the phrenic nerve False The esophageal opening transmits the vagi at T10.The esophageal opening transmits the vagus nerve .

From the leg they ascend in gracilis fasicles and from the arm they ascend as the cuneatus fasiciles. temperature. they are innervated by the mandibular branch. rather than in the brainstem.MCEM Toxicology MCQ With regard to the nervous system (a) Dorsal columns carry proprioception and vibration sense True Dorsal columns ( Posterior Columns ) carry proprioception and vibration sense and decussate in the brainstem. (e) The muscles of mastication are innervated by the facial nerve False The muscles of mastication are innervated by the trigeminal nerve ( CN V )More specifically.In the caudal medulla they synapse and decussate in the internal arcuate fibres. itch and crude touch to the thalamus. The posterior column-medial lemniscus pathway and corticospinal tract decussate in the brainstem.They then ascend to the ventroposterolateral(VPL) nucleas of the thalamus and from there to the sensory cortex of the parietal lobe. . False The spinothalamic tract is a sensory pathway originating in the spinal cord that transmits information about pain. or V3 The dorsal columns carry proprioception and vibration sense. (b) The dorsal columns decussate in the medulla True The dorsal columns decussate in the medulla (c) The sensory cortex is in the parietal lobe True The sensory cortex is in the parietal lobe (d) The spinothalamic tract decussates at the level of the brainstem. The pathway decussates at the level of the spinal cord.

(e) The sternal angle lies at the level of the bifurcation of the trachea. (b) The sternal angle lies at the level of the intervertebral disc between the 5th and 6th thoracic vertebrae False The sternal angle lies at the level of the intervertebral disc between the 4th and 5th thoracic vertebrae.As well as the above it lies at the junction of the superior and inferior mediastinum. False The sternal angle lies at the level of the second costal cartilage.MCEM Toxicology MCQ The sternal angle lies at the level (a) The sternal angle lies at the level of the second intercostal space. False The sternal angle lies at the level of the junction of the ascending aorta and the aortic arch ( and also the junction between the aortic arch and the descending aorta ) (d) The sternal angle lies at the level of the junction between the superior and inferior mediastinum. . (c) The sternal angle lies at the level of the junction of the ascending aorta and the aortic arch but not at the junction between the descending aorta and the aortic arch. The sternal angle lies at the level of the second costal cartilage. True The sternal angle lies at the level of the junction between the superior and inferior mediastinum. True The sternal angle lies at the level of the bifurcation of the trachea.

(e) Cannon waves are seen in ventricular tachycardia. (b) No 'a' waves are seen in A Fib. .MCEM Toxicology MCQ Abnormal JVP: (a) Giant 'v' waves are seen in tricuspid regurgitation. False ?Kussmaul's sign is seen in pericardial constriction. True ?Cannon waves are seen in ventricular tachycardia and complete heart block. True ?Pericarditis or fluid overload. tamponade and severe asthma. (d) Renal Failure may cause an abnormal JVP. True ?Giant 'v' waves are seen in tricuspid regurgitation. (c) Inspiratory filling is normal. True ?No 'a' waves are seen in A Fib.

False (e) Radiculopathy rarely recovers completely.MCEM Toxicology MCQ Cervical Spondylosis (a) When severe most commonly effects C5/C6 True (b) Causing pain in the neck requires neck immobilisation False (c) May produce symptoms of vertebrobasilar insufficiency. False Cervical Spondylosis -When severe most commonly effects C5/C6 as this is where bending the neck is greatest. Most episodes settle without treatment. .Disc protrusion may narrow the vertebral arteries and cause vertebrobasilar insufficiency. True (d) Myelopathy is best treated with manipulation.Manipulation is contraindicated in myelopathy.

True ? (e) Haematomyelia. True ? (b) Lymphoma. . Other causes include trauma. True ? Syringomyelia and Haematomyelia are causes of intramedullary spinal cord compression. and tumors. prolapsed disc.MCEM Toxicology MCQ The following are causes of spinal cord compression: (a) Spondylosis. True ? (c) Abscess. True ? (d) Syringomyelia.

(c) The cephalic vein passes upwards along the lateral border of the forearm anterior to the head of the radius True ?The cephalic vein passes upwards along the lateral border of the forearm anterior to the head of the radius (d) In the upper arm the cephalic vein ascends on the lateral aspect of the biceps brachii to the groove between the deltoid and pectoralis major True ?In the upper arm the cephalic vein ascends on the lateral aspect of the biceps brachii to the groove between the deltoid and pectoralis major (e) The basilic vein begins on the medial side of the venous network on the dorsum of the hand. True ?The basilic vein begins on the medial side of the venous network on the dorsum of the hand.MCEM Toxicology MCQ Veins of the Upper Limb: (a) All veins in the upper limb possess valves. (b) The cephalic vein originates from the medial side of the venous network on the dorsum of the hand. True ?All veins in the upper limb possess valves. . False ?The cephalic vein originates from the postero-lateral aspect of the venous network on the dorsum of the hand.

5 cm one or both of the ligaments have to be torn. False ?The urethra and bladder lie close to the pubic symphysis and are sometimes damaged by trauma to this area (In 1/5 th of cases) (b) For the pubic bones to separate by over 2. False ?In 94% of cases a correct diagnosis can be made from only AP views of the pelvis (d) The pelvic brim is often disrupted in only one place False ?The pelvic brim cannot be disrupted in only one place (e) Lateral compression fracture causes a disruption of the ala of the sacrum and a horizontal fracture of the ipsilateral pubic symphysis True ?And momentary medial displacement of the hemipelvis . True ?For the pubic bones to separate by over 2. (c) It is only possible to obtain the correct diagnosis in 50% of cases from AP views of the pelvis alone.5 cm one or both of the ligaments have to be torn.MCEM Toxicology MCQ Pelvis X Rays: (a) The urethra and bladder lie close to the pubic symphysis are damaged by a majority of traumatic injuries to this area.

(d) The subtalar joint True ?The subtalar joint is often subluxed/dislocated in ehler-danlos syndrome. .scar dystrophica and excessive bleeding. Ehlers-danlos syndrome comprises joint hypermobility. skin hyperextensibility.MCEM Toxicology MCQ The following joints are often subluxed/dislocated in ehlers-danlos syndrome: (a) Patella True ?The patella is often subluxed/dislocated in ehler-danlos syndrome (b) Shoulder Joint True ?The shoulder joint is often subluxed/dislocated in ehler-danlos syndrome. (c) The temporomandibular joint True ?The temporomandibular joint is often subluxed/dislocated in ehler-danlos syndrome.

000 cells/mm3 False ?RBC's >100. or exit of lavage fluid via chest tube or bladder catheter .MCEM Toxicology MCQ Diagnostic Peritoneal lavage is positive when (a) RBC's >1.000 cells/mm3 (b) WBC's >100 cells/mm3 False ?>500 cells/mm3 (c) Food Particles True ? (d) Bile True ? (e) Faeces True ? Also 5ml gross blood.

(b) Supinates the forearm. False Brachioradialis is innervated by the radial nerve. True ?Brachioradialis flexes the arm at the elbow. False Supination of the forearm is the action of the biceps brachii. True ?Brachioradialis brings the forearm into the midprone position. (d) Brachioradialis is innervated by ulnar nerve. (c) Brings forearm into midprone position. False ?Brachioradialis overlies the radial artery. (e) Overlies ulnar artery. .MCEM Toxicology MCQ Brachioradialis: (a) Flexes arm at the elbow.

. (e) A lower quadrant homonymous hemianopia is associated with a temporal lobe lesion.MCEM Toxicology MCQ The Optic Nerve: (a) A bitemporal hemianopia may be caused by a pituitary tumor or a sella meningioma. False ?A lower quadrant homonymous hemianopia is associated with a parietal lobe lesion. True ?A bitemporal hemianopia may be caused by a pituitary tumor or a sella meningioma (b) A homonymous hemianopia is caused by a lesion of the optic tract to the occipital cortex. (c) An incomplete lesion of the optic tract is associated with a central scotomata. True ?A homonymous hemianopia is caused by a lesion of the optic tract to the occipital cortex. False ?An incomplete lesion of the optic tract is associated with macular ( central ) vision sparing (d) An upper quadrant homonymous hemianopia is associated with a parietal lobe lesion. False ?An upper quadrant homonymous hemianopia is associated with a temporal lobe lesion.

MCEM Toxicology MCQ Thoracic vertebrae: (a) The top of the arch of the aorta is at the level of T3/4 True ?The top of the arch of the aorta is at the level of T3/4 (b) The manubrium sterni encompasses levels T3 and T4 True ?The manubrium sterni encompasses levels T3 and T4 (c) The azygous vein enters the SVC at T6 False ?The azygous vein enters the SVC at T4 (d) The angle of louis is at the level of T4/5 True ?The angle of louis is at the level of T4/5 (e) The bifurcation of the trachea is at the level of T4/T5 True ?The bifurcation of the trachea is at the level of T4/T5 .

True ? (c) Povidone-iodine based skin disinfectant should be used in the wound itslf to suppress bacterial growth. False ?Chlorhexidine based skin disinfectant should not be used in the wound itself as it may impair host defences and promote bacteria growth. False ?In well perfused tissues (e. (d) Chlorhexidine based skin disinfectant should be used in the wound itslf to suppress bacterial growth.g.MCEM Toxicology MCQ Wound Evaluation (a) Diffuse bleeding most often occurs from the subdermal plexus and superficial veins True ? Diffuse bleeding most often occurs from the subdermal plexus and superficial veins (b) Povidone-iodine based skin disinfectant suppress bacterial growth on intact skin.. scalp) wounds closed without prior hair removal heal with no apparent increase in infection . False ?Povidone-iodine based skin disinfectant should not be used in the wound itself as it may impair host defences and promote bacteria growth. scalp) wounds closed without prior hair removal heal with an increase in infection.. (e) In well perfused tissues (e.g.

MCEM Toxicology MCQ The circle of willis is supplied by (a) External carotid arteries False ?The circle of willis is supplied by the internal carotid. labyrinthine. (c) Union of vertebral arteries True ? (d) Brachial Artery False ? (e) Axillary artery False ? . superior and anterior inferior cerebellar arteries. (b) Basilar arteries True ?The basilar artery gives off the pontine.

True ? (c) Haemothorax is increased with IJV cannulation when compared to the subclavian route. this is the commonest complication of central line insertion. (b) Tension pneumothorax. True ?Can be caused if the tip of the line lies below the pericardial reflection and it perforates the vessel wall. .MCEM Toxicology MCQ Central Vein Cannulation Complications include: (a) Arterial laceration. It's least likely to happen via the internal jugular vein (e) Air Embolism. True After failure of placement. False ? (d) Cardiac Tamponade. After placement local infection or venous thrombosis can be possible complications. True ? Other complications during placement can be nerve injury.

True ? (d) Flexor tenosynovitis is suggested by tenderness over the flexor tendon sheath.MCEM Toxicology MCQ Hand Infections (a) The hand position of function for splinting includes the MCP joint being at 50 to 90 degrees flexion. True ? (b) Midpalmer space infection occurs from spread of a flexor tenosynovitis or from a penetrating wound to the palm causing infection in the radial or ulnar bursa of the hand. True ? (e) Closed fist injury ( human bite wound above the MCP joint resulting from punching an individual ) be be explored. True ? (c) Paronychia is an infection of the lateral nail fold. True ? . irrigated and allowed to heal by secondary intention.

is another important clinical finding. True ?The pupil can be constricted or dilated after sustaining trauma. These injuries occur when a blunt object strikes the globe. Infraorbital anesthesia is a more common finding and develops when the infraorbital nerve is contused by the initial trauma or when compressed by bony fragments. . Subcutaneous emphysema is pathognomonic for fracture into a sinus or nasal antrum. True ?The sensation of the inferior orbital nerve is tested below the eye and on the ipsilateral side of the nose. resulting in expansion of orbital contents and subsequent rupture through the bony floor. False ?A hyphema suggests significant ocular trauma. (b) Restricted upward gaze suggests a blow out fracture with entrapment of the inferior rectus. Blowout fractures are the most common orbital fractures.MCEM Toxicology MCQ Eye Trauma: (a) A hyphema is not a reflection on the degree of trauma sustained. Patients may have enophthalmos. particularly on upward gaze that usually indicates inferior rectus muscle entrapment. Diplopia. when a large section is ruptured. (e) The pupil can be constricted or dilated after sustaining trauma. (d) The sensation of the inferior orbital nerve is tested below the eye and on the ipsilateral side of the nose. True ?Restricted upward gaze suggests a blow out fracture with entrapment of the inferior rectus. (c) A ruptured globe is implied by a flat anterior chamber. Anesthesia of the maxillary teeth and upper lip is more reliable than numbness over the cheek. A step-off deformity may be palpated over the intraorbital rim. or sunken globe. True ?A ruptured globe is implied by a flat anterior chamber.

(c) Froments sign tests thumb adduction. True ?The ulnar nerve supplies the sensory component to the medial half of the ring finger. False ?Clawing of the hand is more pronounced with a lesion at the wrist as a lesion at or above the elbow causes loss of flexor digitorum profundus and less flexion at the IP joints. True ?This is claw-like hand pattern. True ?The patient is asked to grasp a piece of paper between the thumb and the lateral aspect of the index finger.MCEM Toxicology MCQ An ulnar nerve lesion may be represented as follows: (a) Hyperextension at the MCP joint of the little and ring fingers accompanied by flexion of the interphalangeal joints. (d) The ulnar nerve supplies the sensory component to the medial half of the ring finger.Hyperextension at the MCP joint of the little and ring fingers accompanied by flexion of the interphalangeal joints. . (b) Clawing of the hand is more pronounced with a more proximal lesion.

Knee flexion is performed by the hamstrings which are innervated by the sciatic nerve(S1). (d) The obturator nerve is composed of fibers from L2. (c) The sciatic nerve innervates the quadriceps. True ?The obturator nerve is composed of fibers from L2. False ?The hamstrings are innervated by the sciatic nerve.MCEM Toxicology MCQ The following are true: (a) Knee flexion is performed by the quadriceps. False ?Knee flexion is performed by the hamstrings! (b) The hamstrings are innervated by the obturator nerve. False ?The femoral nerve(L2/3/4) innervates the quadriceps. The obturator nerve is composed of fibers from L2.L3 and L4. (e) The sciatic nerve is responsible for ankle dorsiflexion True ?The common peroneal nerve is an extension of the sciatic nerve.L3 and L4.L3 and L4. . The sciatic nerve is responsible for ankle dorsiflexion via the common peroneal nerve.

. True ?Lymph drainage is to the lateral aortic and iliac nodes. True ?Ureteric stones frequently arrest where the renal pelvis joins the ureter. (e) Lymph drainage is to the lateral aortic and iliac nodes. (d) Are supplied in the inferior end by the renal arteries. where the ureter is kinked as it passes the pelvic brim and where the ureter pierces the bladder wall. False ?The upper end is supplied by the renal arteries. the middle is supplied by the testicular or the ovarian artery and the inferior end is supplied by the superior vesical artery. (c) Ureteric stones frequently arrest where the renal pelvis joins the ureter.MCEM Toxicology MCQ Ureters (a) Each ureter measures approximately 10cm in length False ?Each ureter measures approximately 25cm ( 10 inches ) in length (b) Pass into the anterior surface of the urinary bladder False ?Each ureter passes into the posterior surface of the urinary bladder.

L3 and L4 (e) The obturator nerve innervates the adductors of the thigh and the skin on the medial surface of the thigh. False ?The obturator nerve originates from L2. False ?The femoral nerve originates from the lumbar plexus from L2. (b) It is situated within the psoas muscle True ?It is situated within the psoas muscle (c) The femoral nerve originates from the lumbar plexus from L1 and L2. True ?The lumbar plexus is formed by the anterior rami of the upper four lumbar nerves.MCEM Toxicology MCQ Lumbar Plexus: (a) The lumbar plexus is formed by the anterior rami of the upper four lumbar nerves. L3 and L4 (d) The obturator nerve originates from L1 and L2. . True ?The obturator nerve innervates the adductors of the thigh and the skin on the medial surface of the thigh.

MCEM Toxicology MCQ
The following are correct:

(a) The oesophageal opening in the diaphragm is at the level of T8 False ?The oesophageal opening in the diaphragm is at the level of T10 (b) Branches of the right gastric vessels go through the diaphragm at T10 False ?Branches of the left gastric vessels go through the diaphragm at T10 (c) The left phrenic nerve pierces the diaphragm lateral to the central tendon at the level of T6 False ?The left phrenic nerve pierces the diaphragm lateral to the central tendon at the level of T8 (d) The right phrenic nerve pierces the diaphragm with the IVC at T6 False ?The right phrenic nerve pierces the diaphragm with the IVC at T8 (e) The sternoxiphisternal joint is at the level of T8/9 True ?The sternoxiphisternal joint is at the level of T8/9

MCEM Toxicology MCQ
The Brachial Plexus:

(a) The ulnar nerve is largely made up from C6 and C7 fibres. False ?The ulnar nerve is largely made up from C8 and T1 fibres. (b) The axillary nerve is given off by the posterior cord. True ?The axillary nerve is given off by the posterior cord. (c) The musculocutaneous nerve is made up from C5 , C6 , and C7 True ?The musculocutaneous nerve is made up from C5 , C6 , and C7 (d) The medial cord and the lateral cord form the median nerve True ?The medial cord and the lateral cord form the median nerve (e) The dorsal scapular nerve ( C5 ) supplies the serratus anterior muscle. False ?The dorsal scapular nerve ( C5 ) supplies the rhomboid muscles. Serratus Anterior is supplied by the long thoracic nerve.

MCEM Toxicology MCQ
The following are true in relation to common root compression syndromes produced by lumbar disc prolapse: (a) An L5 root lesion will cause pain from the buttock to the lateral aspect of the leg and on the dorsum of the foot. True ?An L5 root lesion will cause pain from the buttock to the lateral aspect of the leg and on the dorsum of the foot. (b) An L4 root lesion will cause pain from the lateral aspect of the thigh to the medial side of the calf. True ?An L4 root lesion will cause pain from the lateral aspect of the thigh to the medial side of the calf. (c) An S1 root lesion will cause sensory loss on the sole of the foot and the posterior calf. True ?An S1 root lesion will cause sensory loss on the sole of the foot and the posterior calf. (d) An L5 root lesion will cause sensory loss on the dorsum of the foot and anterolateral aspect of the leg. True ?An L5 root lesion will cause sensory loss on the dorsum of the foot and anterolateral aspect of the leg.

False ?The posterior cord supplies the extensor structures on the posterior aspect of the limb.MCEM Toxicology MCQ The Brachial Plexus: (a) In the axilla the posterior divisions unite to form the posterior cord True ?In the axilla the posterior divisions unite to form the posterior cord (b) The lateral cord supplies the extensor structures on the posterior aspect of the limb. False ?The anterior division of the lower trunk forms the medial cord. (c) The posterior division of the lower trunk forms the medial cord. (d) The posterior cord may contain neurons from all the spinal nerves contributing to the brachial plexus True ?The posterior cord may contain neurons from all the spinal nerves contributing to the brachial plexus (e) The dorsal scapular nerve is a branch of C5. True ?The dorsal scapular nerve is a branch of C5 .

False ?Discomfort resolves between bowel motions.MCEM Toxicology MCQ Fissure In Ano (a) Cause painless rectal bleeding False ?Is a common casue of painful rectal bleeding (b) In most cases occur in the midline anteriorly False ?In most cases occur in the midline posteriorly. (e) Patient's should increase dietary bran True ? . (c) Discomfort is constant between bowel motions. (d) Are associated with sentinel pile's True ?As a result of hypertrophied papillae.

False ?The plane of the iliac crest runs through L3-L4. Headache. True ?Other important values include WCC <5. subtract 1 WBC and 0. Post-LP headache is caused by leakage of CSF from the dura and traction on painsensitive structures.015 protein. which occurs in 10 to 30% of patients. (b) The spinal cord in the adult ends at the level of L1-2. (c) When performing a lumbar puncture the 'give' is felt when passing through the interspinous ligament. tinnitus. which is exacerbated in an upright position and improved in the supine position.15 to 0.45g/L. and visual changes. dizziness. (e) The CSF protein content is usually 0. (d) The opening pressure is usually <10 cm of CSF. False ?The opening pressure is usually 7-18cm of CSF. Associated symptoms may include nausea.MCEM Toxicology MCQ Lumbar Puncture: (a) The plane of the iliac crest runs through L1-L2. True ?The spinal cord in the adult ends at the level of L1-2. For every 1000 RBC's. is one of the most common complications following lumbar puncture (LP). vomiting. False ?The 'give' is felt when passing through the ligamentum flavum. Patients characteristically present with frontal or occipital headache within 24 to 48 hours of the procedure. .

Class II = <1. a classic trimodal distribution of deaths is seen in severe hemorrhagic shock. Another peak occurs after 1 to several hours due to progressive decompensation.htm Class I = <750ml. False Without intervention.5L. A third peak occurs days to weeks later due to sepsis and organ failure.emedicine. False Lower doses predominantly stimulate dopaminergic receptors that in turn produce renal and mesenteric vasodilation. Class III= <2L. (e) Lower doses of Dopamine predominantly stimulate dopaminergic receptors that in turn produce renal vasodilation and cardiac stimulation. Higher doses produce cardiac stimulation and renal vasodilation http://www. Class IV = >2L .MCEM Toxicology MCQ Haemorrhagic shock classification (a) Class I loss is usually <750 ml True ?Class I loss is usually <750 ml (b) Class II loss is usually < 2000 ml False ?Class II loss is usually < 1500 ml (c) Class III shock is <2. a classic bimodal distribution of deaths is seen in severe hemorrhagic shock. An initial peak of mortality occurs within minutes of hemorrhage due to immediate exsanguination.5L blood loss False ?Class III shock is <2L blood loss (d) Without intervention.com/emerg/topic531.

MCEM Toxicology MCQ .

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