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2006 mcem.org.uk MCEM Part A - Original practice MCQs No.

2


MCEM PART A - ORIGINAL PRACTICE MCQs No.2

1 Substances known to cause SIADH include
A. Tri-cyclic antidepressants
B. Carbamazepine
C. Demeclocycline
D. Lithium

2 When considering a Biers block for regional anaesthesia
A. Raynaud's syndrome is a contraindication
B. It is commonly used in children
C. An appropriate local anaesthetic dose for most adults is 40mL of 1% plain prilocaine
D. Requires the presence of at least two members of trained staff

3 Regarding ketamine for use for sedation and analgesia
A. It has analgesic, hypnotic and amnesic properties
B. 500mg is an appropriate oral dose for adults
C. It may precipitate hallucinations
D. Ketamine crosses the placenta

4 Regarding P.falciparum malaria
A. The incubation period is usually 7-14 days
B. It is commonly the result of travel in the Indian subcontinent
C. Lymphadenopathy is a common feature
D. Chloroquine is the initial drug treatment of choice

5 When examining an arterial line waveform
A. It can be used to estimate cardiac output
B. The slope of the upstroke of the wave reflects myocardial contractility (dP/dt)
C. A low dicrotic notch is seen in hypovolaemic patients
D. A fast sloping diastolic decay indicates vasoconstriction

6 Regarding fracture classifications
A. The Neer classification refers to distal radial fractures
B. The Frykman classification refers to proximal humeral fractures
C. The Schatzker classification refers to tibial plateau fractures
D. Type II is the most common type of Salter-Harris fracture presentations

7 In the assessment of a limping child localising pain to the hip joint
A. Slipped upper femoral epiphysis is most common in the 3-10 year old age group
B. Perthes disease affects boys more often than girls at a ratio of 4:1
C. Interruption of Shentons line is suggestive of a slipped upper femoral epiphysis
D. Radiographic appearances are usually normal in transient synovitis


2006 mcem.org.uk MCEM Part A - Original practice MCQs No.2
8 Regarding bleeding disorders
A. Von Willebrands disease involves factor VIII deficiency with coagulant activity and
abnormal platelet function
B. Haemophilia B involves a deficiency of factor VIII activity
C. The I NR, APTT and fibrinogen levels are all raised in disseminated intravascular
coagulation (DIC)
D. Severe haemorrhage due to a high INR on warfarin therapy may be treated with
Beriplex and vitamin K

9 Diabetes insipidus may be caused by
A. Sheehans syndrome
B. Toxoplasmosis
C. Lithium
D. Wegeners granulomatosis

10 The following eponymous osteochondritis conditions are correctly matched to their
respective bony sites
A. Freibergs diseaseTibial tuberosity
B. Khlers diseaseNavicular
C. Kienbocks disease..Scaphoid
D. Perthes diseaseFemoral head

11 With regard to compartment syndrome
A. It may occur as a result of excessive alcohol intake
B. Loss of distal arterial pulsation is an early sign
C. The absence of myoglobinuria rules out rhabdomyolysis
D. Fasciotomy is indicated if the difference between intra-compartmental and diastolic
blood pressure is <30mmHg

12 Acute gout
A. Is associated with negatively birefringent crystals in joint aspirate
B. Early radiological signs include punched out lesions in the periarticular bone
C. Is treated with allopurinol and NSAI Ds
D. Most commonly affects the 1
st
MTP joint of the foot in men

13 In carbon monoxide (CO) poisoning
A. Elimination half-life of CO is around 4 hours when breathing 100% oxygen
B. COHb levels correlate well with clinical features
C. Cherry-red skin colouring is an uncommon finding in severe poisoning
D. Hyperbaric oxygen therapy is contraindicated in pregnancy

14 The following infectious diseases usually have an incubation period of 1 3 weeks
A. Diphtheria
B. Mumps
C. Hepatitis A
D. Chickenpox



2006 mcem.org.uk MCEM Part A - Original practice MCQs No.2
15 Acute iritis (acute uveitis)
A. Is commonly relapsing
B. Slit lamp examination may reveal hypopyon
C. Talbots test is positive when pain is increased in the affected eye by shining a light into
the good eye
D. Reduced visual acuity, epiphoria and floaters are common symptoms

16 Regarding traction apophysitis
A. Osgood-Schlatters disease is most commonly seen in boy aged over 15 years
B. J ohansson-Larsens disease affects the calcaneal attachment of the Achilles tendon
C. Most settle completely with rest and NSAIDs
D. The pathophysiology relates to inflammation of a tendon attachment to a fused
apophysis

17 When obtaining intraosseous access
A. The proximal tibial site is located 2.5cm below the tibial tuberosity on the flat
anteromedial surface
B. Contraindications for intraosseous access include osteopetrosis
C. Negative aspiration on insertion indicates incorrect positioning of the needle
D. Other insertion sites include the distal femur 3cm above the medial lower femoral
condyle

18 Regarding needlestick injuries
A. Possible transmissible infective agents include Diptheria
B. The risk of acquiring hepatitis B from a carrier is around 3-10%
C. Transmission risk is increased with hollow needles more than with solid needles
D. The risk of acquiring HIV from a carrier is related to the volume of injected material

19 Respiratory physiology
A. In zone 2 of the lung blood flow is determined by the difference between arterial and
alveolar pressures (P
a
> P
A
> P
v
)
B. Normal anatomical dead space in the adult is around 150mL
C. The flow rate is high in relation to lung volume with flow-volume curves in obstructive
pulmonary disease
D. Bradykinin is unaffected by its passage through the pulmonary circulation

20 With regard to airway management in the emergency department
A. An uncuffed size 5 (5mm internal diameter) endotracheal tube is appropriate for a 4-
year-old male.
B. A size 4 laryngeal mask airway cuff should be inflated with a 50mL volume of air
following correct positioning
C. The best head and neck position for direct laryngoscopy is extension of the neck with
maximal flexion at the occipito-atlantal joint
D. Sellicks manoeuvre is used to prevent aspiration when the patient is vomiting during
attempted endotracheal intubation





2006 mcem.org.uk MCEM Part A - Original practice MCQs No.2
21 Entonox
A. Is a gas mixture of 50% nitrous oxide and 50% air
B. Its use is associated with significant hypotension
C. Is an appropriate method of analgesia soon after scuba diving
D. Is unsuitable for use in very cold conditions (under -6C)

22 The following clinical features are more suggestive of acute epiglottitis than croup
A. Slow onset
B. High fever >38.5C
C. Increased drooling of saliva
D. Age over 5 years

23 Regarding the Mental Health Act (England and Wales, 1983)
A. Section 4 forms can be signed by any registered medical practitioner
B. Emergency detention under Section 4 lasts for 48 hours
C. Section 2 is used for emergency psychiatric assessment for a period of 28 days
D. The mental health act applies in the emergency department

24 A prolonged QTc (rate corrected QT interval)
A. Can result from Quinidine therapy
B. Occurs during sleep
C. May predispose to torsades de pointes
D. Is seen in digoxin toxicity

25 Ransons severity criteria on admission for acute pancreatitis include
A. Glucose <11.0 mmol/L
B. LDH >350 I U/L
C. Amylase >2500
D. PaO
2
< 8kPa

26 Gelofusine 500mL contains
A. The same amount of sodium per litre as 0.9% saline
B. Has a pH of 7.4
C. The average gelatine molecular weight is 60,000
D. The osmolarity is 284 mOsm/L

27 Regarding renal physiology
A. 80% of the blood plasma arriving at the nephron is filtered at the glomerulus
B. Around two-thirds of the sodium contained in the glomerular filtrate is reabsorbed in
the proximal tubule under normal conditions
C. Plasma creatinine only starts to increase substantially when around 50% of renal
function (GFR) has been lost
D. Aminoglycosides are not excreted by the kidney

28 The standard childhood immunisation schedule includes
A. DTP, polio and Hib at 2,3 and 4 months
B. DTP booster at 2 years
C. BCG at 10-14 years
D. MMR at 12-15 months
2006 mcem.org.uk MCEM Part A - Original practice MCQs No.2

29 Regarding the modified SAD PERSON score in assessing suicide risk
A. A total score <8 indicates that it may be safe to discharge the patient
B. A total score >8 probably requires hospital admission
C. The age range that indicates an increased suicide risk is 19 - 45 years
D. Excessive alcohol or drug use is one of the risk factors

30 Parathyroid hormone (PTH)
A. Is an 84 amino acid peptide
B. Reduces both calcium and phosphate reabsorption in the kidney
C. Suppresses osteoclastic activity
D. Decreases production of 1,25-dihydroxycholelcalciferol in the kidney






































2006 mcem.org.uk MCEM Part A - Original practice MCQs No.2
ANSWERS

1
A. T
B. T
C. F (Demeclocycline is a drug treatment for SIADH)
D. F (Lithium causes Diabetes Insipidus)

2
A. T
B. F (Biers block is rarely used in children and contraindicated below the age of 7 years)
C. F (The normal local anaesthetic dose is 40mL of 0.5% prilocaine in adults)
D. T (Biers block requires staff competent to deal with severe toxic reactions and have
equipment/training to carry out advanced resuscitation)

3
A. T
B. T (Also, in severe pain a loading dose of 0.5-1.0mg/kg IM may be given)
C. T (For this reason it is usually administered with a benzodiazepine)
D. T (Ketamine crosses the placenta and also increases salivation, intracranial pressure
and intraocular pressure)

4
A. T (There are often paroxysms of malaise, fever and headache lasting 8-12 hours
followed by severe sweating)
B. F (P.falciparum is more common in Africa, South-east Asia and Central and South
America, P.vivax is common in the Indian subcontinent)
C. F (Haemolytic anaemia with splenomegaly and jaundice may occur but
lymphadenopathy is not a feature)
D. F (Quinine is the drug of choice with P.Falciparum, given orally or IV. Chloroquine is
usually effective in P.vivax, ovale and malariae)

5
A. T (The stroke volume can be calculated by measuring the area from the beginning of
the upstroke to the dicrotic notch. If this is multiplied by the heart rate, then cardiac
output can be estimated)
B. T
C. T
D. F (The slope of the diastolic decay indicates resistance to outflow. A slow fall is seen in
vasoconstriction)

6
A. F (The Neer classification refers to proximal humeral fractures)
B. F (The Frykman classification refers to distal radial fractures)
C. T
D. T




2006 mcem.org.uk MCEM Part A - Original practice MCQs No.2
7
A. F (Perthes is more common in the 3-10 year old age group, while slipped upper femoral
epiphysis is more common in the 10-16 year age group)
B. T (Slipped upper femoral epiphysis is also more common in boys than girls, at a ratio of
3:1)
C. F (Shentons line applies to the AP view of the pelvis and continues from the inferior
border of the femoral neck to the inferior border of the pubic ramus it is disrupted
with fracture neck of femur. Trethowans sign is a line drawn along the superior border
of the femoral neck which should normally cut through the femoral epiphysis. If not,
this may indicate a slipped upper femoral epiphysis)
D. T

8
A. T
B. F (Haemophilia B involves deficiency of factor IX activity)
C. F (Platelet count and fibrinogen levels fall while INR, APTT and fibrin degradation
products rise)
D. T (Beriplex is a prothombin complex concentrate of factors II, VII, IX and X and can be
used instead of FFP along with vitamin K to reverse high INR from warfarin therapy)

9
A. T
B. T
C. T
D. T

10
A. F (Freibergs affects the second metatarsal head, Osgood-Schlatters disease affects the
tibial tuberosity)
B. T
C. F (Kienbocks disease affects the lunate, not the scaphoid)
D. T

11
A. T (Often due to unconsciousness and then lying on a hard surface for a significant time)
B. F (Loss of arterial pulses is a relatively late sign)
C. F (Myoglobinuria depends upon myoglobin release rate into plasma and the degree of
protein binding, GFR and urine flow therefore its absence does not necessarily rule out
rhabdomyolysis)
D. T

12
A. T
B. F (Early radiological signs include soft tissue swelling. Punched out lesions appear later)
C. F (Initial therapy does not include allopurinol. NSAIDs or colchicine are used in acute
gout)
D. T



2006 mcem.org.uk MCEM Part A - Original practice MCQs No.2
13
A. F (Elimination half-life of CO is around 4 hours with normal room air, around 1 hour
with 100% oxygen and 23 minutes at 3 atmospheres pressure)
B. F (COHb levels correlate poorly with clinical features. Serum CO and mitochondrial
enzyme levels are better indicators of severity)
C. T (Cherry-red skin colouring is sometimes seen in very severe and fatal poisoning)
D. F (Hyperbaric oxygen therapy is unproven after CO poisoning. However, severe
poisoning with COHb levels >40%, in pregnant women or with cardiac or neurological
complications may warrant hyperbaric therapy)

14
A. F (Diphtheria usually has an incubation period of 2 5 days)
B. T
C. F (Hepatitis A usually has an incubation period of around 4 weeks)
D. T


15
A. T
B. T (Hypopyon refers to pus in the anterior chamber)
C. F (This is a sign of acute iritis. However, Talbots test is positive when there is an
increase in pain with eye convergence and pupil reaction to accommodation)
D. T (Other common symptoms are acute onset pain and photophobia)

16
A. F (Osgood-Schlatters disease is most common in boys aged 10-15)
B. F (Traction apophysitis of the calcaneal attachment of the Achilles tendon is called
Severs disease. J ohansson-Larsens disease involves the lower pole of the patella in
young adolescents)
C. T (Orthopaedic follow-up should be arranged but conservative treatment is appropriate
in almost all cases)
D. F (Pathophysiology involves damage to an unfused apophysis by strong pull on its
tendonous attachment. E.g. tibial attachment of patella tendon at the tibial tuberosity in
Osgood-Schlatters disease)

17
A. T (This is the first choice site)
B. T (Infection or fracture at, or proximal to, the insertion site and osteogenesis
imperfecta are also contraindications)
C. F (Despite negative aspiration the needle may still be correctly positioned. The position
may still be verified by injecting 10mL 0.9 saline under sterile conditions. If flushing is
easy and there is no local swelling then the position should be satisfactory)
D. F (The correct distal femoral position is 3cm above the lateral lower femoral condyle on
the anterolateral surface. Others include the distal tibia proximal to the medial malleolus
or the sternum, which is also useful in adults)





2006 mcem.org.uk MCEM Part A - Original practice MCQs No.2
18
A. T
B. F (The risk of acquiring hepatitis B has been estimated to be 2-40%. Risk of hepatitis C
transmission from a carrier is around 3-10%. In contrast, HIV risk is much lower
around 0.2-0.5%)
C. T
D. T (Risk of HIV transmission is increased if significant volumes have been injected)

19
A. T
B. T (Anatomical dead space is the volume of the conducting airways)
C. F (The reverse is true. In obstructive disease the flow rates are very low in relation to
lung volume and may show a scooped-out appearance following the point of maximum
flow on a flow-volume curve)
D. F (Bradykinin is largely inactivated, around 80%, by angiotensin-converting enzyme in
the lungs)

20
A. T (The formula for endotracheal tube sizing in children is the age divided by 4 then add
4 in mm. Uncuffed tubes should be used up until the age of 12 as the narrowest part of
the upper airway is the cricoid ring until puberty)
B. F (The recommended volume is 30mL. The general formula for this is the size of the
LMA minus 1 times 10 in mL)
C. F (The most effective position is with flexion of the neck and extension at the occipito-
atlantal joint the so called sniffing the morning air position)
D. F (Cricoid pressure should be released if the patient is actively vomiting otherwise an
oesophageal rupture may occur)

21
A. F (It is a mixture of 50% nitrous oxide and 50% oxygen. It is stored in blue cylinders
with a white and blue top)
B. F (Entonox produces little physiological change which is why it is a popular and safe
method of analgesia for pre-hospital use)
C. F (While a good method of analgesia for minor procedures and initial pain relief it is not
appropriate following diving as entonox will diffuse more rapidly than nitrogen and may
therefore increase the risk of decompression sickness)
D. T (The gases may separate at very low temperatures and therefore there is a risk of
inadvertent administration of a hypoxic gas mixture)

22
A. F (Acute epiglottitis has a rapid onset while croup tends to be preceded by a coryzal
illness)
B. T (High fever is a common finding in acute epiglottitis. Children with croup tend to be
apyrexial or have a mild fever only)
C. F (Drooling of saliva is a non-specific sign of upper airway obstruction and may occur
with both severe croup and acute epiglottitis)
D. T (Croup is uncommon above the age of 5 years while acute epiglottitis occurs children
up to age 7 and occasionally in older children and adults)


2006 mcem.org.uk MCEM Part A - Original practice MCQs No.2
23
A. T (Application can be made by a nearest relative or a specially trained approved social
worker)
B. F (Section 4 lasts for a period of 72 hours and remains in force until the patient is
discharged or detained further under Section 2 or 3, or stays voluntarily)
C. T
D. F (Patients seen in the emergency department are not legally in-patients until admitted
to a ward and therefore detention for emergency treatment of psychiatric or physical
illness can only be carried out under common law)

24
A. T (Other drugs that may prolong the QTc include tri-cyclic antidepressants)
B. T (It may also be due to acute MI, hypothermia or hypocalcaemia)
C. T (Torsades de pointes is an uncommon form of polymorphic VT with a constantly
changing electrical axis resulting in a constantly changing QRS complex amplitudes,
associated with hypokalaemia or hypomagnesaemia with a prolonged QT interval)
D. F (Digoxin and hypercalcaemia shorten the QTc)

25
A. F (Glucose >11.0 mmol/L)
B. T (Others include age > 55years, WCC >16.0, AST >250 U/L and glucose >11.0)
C. F (Amylase is not one of Ransons criteria)
D. F (This is a one of the criteria at 48 hours, along with PCV decrease >10%, urea
increase >1.8 mmol/L, Ca
2+
<2 mmol/L, BE >4 mmol/L and Fluid sequestration >6L)

26
A. T (Both contain 154 mmol/L of sodium)
B. T
C. F (The average molecular weight is 30,000)
D. F (The osmolarity is 274 mOsm/L)

27
A. F (Of the plasma flow arriving at each nephron, around 20% becomes glomerular
filtrate while the remaining 80% is carried by the postglomerular capillaries for
transport exchanges with that, and adjacent, nephron tubules)
B. T (25% of the remaining sodium is reabsorbed in the Loop of Henle and the remainder
in the distal tubule and collecting duct)
C. T
D. F (Aminoglycosides are almost entirely excreted by the kidney, hence the increased risk
of nephrotoxicity and ototoxicity in renal impairment / failure)

28
A. T
B. F (DTP booster is given at 4-5 years)
C. T
D. T




2006 mcem.org.uk MCEM Part A - Original practice MCQs No.2
29
A. F (A score <6 may suggest safe discharge while a score 6 8 indicates that psychiatric
consultation should be arranged)
B. T
C. F (The high risk age group includes those aged <19 years or >45 years)
D. T (Risk factors also include: Male gender, age <19 or >45 years, depression or feeling
of hopelessness, previous suicide attempts or psychiatric care, loss of rational thinking,
separated/widowed/divorced, organised or serious attempt, lack of social support and
stated future intent)

30
A. T (PTH is produced in the chief cells of the parathyroid glands. It is synthesized on a
continuous basis; there is no storage)
B. F (PTH promotes phosphate excretion in the kidney by restricting tubular reabsorption
and conserves calcium by increasing reabsorption)
C. F (PTH stimulates an increase in osteoclastic activity in bone and hence bone
reabsorption, which also results in a raised serum calcium)
D. F (PTH increases the renal production of the active form of vitamin D - 1,25-
dihydroxycholelcalciferol - and hence an increased intestinal absorption of calcium)