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Question 1 of 22
Which of the following does not have a role in the management of
chronic cancer pain?
(Please select 1 option)
Carbamazepine
Clodronate
Dexamethasone
Nifedipine
 Incorrect answer selected
Pinaverium
 This is the correct answer
Pinaverium is used to reduce the pain duration in irritable

bowel syndrome (IBS).
Carbamazepine is in use for the treatment of neuropathic pain of

malignancy, diabetes and other
disorders.
Clodronate inhibits osteoclastic bone resorption and is used to

treat malignant bone pain and the
associated hypercalcaemia.
The corticosteroids are used to treat pain from central nervous

system tumours. Reducing the
inflammation and oedema relieves the
pain caused by neural compression.
Nifedipine helps relieve painful oesophageal spasm and tenesmus

associated with gastrointestinal
tumours.
Painful bladder spasm may be relieved by oxybutynin.

Next question Go to summary
Answer Statistics
1 11%
2 8%
3 7%
4 56%
5 18%
Times answered: 8539
Test Analysis
CorrectIncorrectPartially
Correct
Score: 0%
Total Answered: 1
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Question 2 of 22
An 18-year-old woman sustains severe head injuries in a road
traffic accident.
The following day her investigations show:
Sodium 160 mmol/L (137-144)
Potassium 3.7 mmol/L (3.5-4.9)
Chloride 120 mmol/L (95-107)
Urea 3.0 mmol/L (2.5-7.5)
Creatinine 90 µmol/L (60- 110)
Which one of the following statements is correct?
Rapid rehydration with 5% dextrose is indicated
She has the syndrome of inappropriate antidiuretic hormone secretion (SIADH)
She should be treated with sodium restriction
She will have a hypercholraemic acidosis
Urine osmolality will be low

 Correct
There is a marked hypernatraemia with elevated chloride but

normal potassium and urea in a patient
with severe head
injuries.
The likely cause of this presentation is diabetes insipidus. Urine osmolality is

therefore likely to be
low.
You cannot say that she has a hyperchloraemic acidosis as you do

not have her bicarbonate
concentration but if you assume that the
anion gap would be normal, that is 10-12, then this would
suggest
that the bicarbonate is elevated, suggesting either a metabolic
alkalosis or respiratory
acidosis with compensation.
Although restoration of normal volaemia and osmolality is

required, giving 5% dextrose may
exacerbate any cerebral oedema and
so correction should be gradual.
Answer Statistics
1 12%
2 19%
3 16%
4 16%
5 37%
Test Analysis
Correct
Score: 50%
Total Answered: 2
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Question 3 of 22
A 14-year-old boy bangs heads with an opponent during an
unofficial football game. He is knocked
out for 30 seconds and is
amnesic for the event. He recovers quickly and continues
playing.
Two hours later he complains of headache, begins vomiting, then

loses consciousness. He had a full
term normal delivery with no
neonatal complications. His immunisations are up to date. There is
no
FH/SH of note.
On examination he responds only to deep pain. He is apyrexial

with respiratory rate of 10/min
(irregular), pulse of 40/min. He
has a large bruise in the right temporal area.
Which is the most likely diagnosis?
Cerebral contusion
Contrecoup injury
Extradural haematoma
 Correct
Subdural haematoma
Tonsillar herniation
The history is of a closed head injury, followed by a lucid

period followed by decreasing level of
consciousness.
The time course suggests an extradural haematoma, where there is

arterial bleeding which
accumulates rapidly outside the dura
causing raised intracranial pressure.
Subdural haematoma in infants may accompany massive axon injury
in 'shaken baby syndrome', and
presents acutely. Retinal
haemorrages are often present. (Chronic subdurals due to birth
trauma can
present much later due to the open fontanelle.)
Epidural haematoma, typically from a torn middle meningeal

artery and associated with skull fracture,
accumulates much more
rapidly.
There may be apparent recovery from the initial concussion, but

deterioration is usually within 15-30
minutes.
© Colin Melville 2012
Answer Statistics
1 5%
2 5%
3 56%
4 26%
5 9%
Test Analysis
Correct
Score: 66.67%
Total Answered: 3
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Question 4 of 22
A 56-year-old man is admitted with epigastric pain after
drinking heavily.
He has a temperature of 36.9°C, a pulse of 95/min, a blood

pressure of 85/60 mmHg, and a
respiratory rate of 32/min.
Investigations reveal:
Haemoglobin 126 g/L (130-180)
Platelets 169 ×109/L (150-400)
White cell count 3.9 ×109/L (4-11)
Which of the following is the diagnosis?
Leaking aortic aneurysm
Multiple organ dysfunction syndrome (MODS)

Severe sepsis
Septic shock
Systemic inflammatory response syndrome (SIRS)

This patient has features of pancreatitis. He also has

hypotension, and leucopenia. He therefore fulfils
the criteria for
systemic inflammatory response syndrome. This is equivalent to
sepsis, but occurs in
the absence of infection (e.g. in
pancreatitis).
SIRS is defined as two or more of the following:
Temperature more than 38°C or less than 36°C

Heart rate more than 90 beats/min
Respiratory rate more than 20 breaths/min or PaCO2
less than 4.3 kPa
WBC count 12,000/mm3, less than 4000/mm3
, or more than 10% immature (bands) form.
A leaking aortic aneurysm is still a possibility, however a

decreased white cell count would not be
expected.
We do not have enough information to diagnose multiple organ

dysfunction. There is no evidence of
infection to make a diagnosis
of septic shock or severe sepsis. For information, sepsis is
defined as
the association of systemic inflammatory responses with
evidence of microbial origin. Severe sepsis
also has hypoperfusion
or dysfunction of at least one organ system, and septic shock is
this plus
hypotension refractory to fluid resuscitation.
Answer Statistics
1 18%
2 6%
3 23%
4 9%
5 44%
Test Analysis
Correct
Score: 50%
Total Answered: 4
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Question 5 of 22
A 56-year-old man diagnosed with systemic inflammatory response
syndrome (SIRS) secondary to
pancreatitis is admitted to the High
Dependency Unit.
He has a pulse of 109 beats/min and a blood pressure of 89/74

mmHg despite receiving IV fluids and
urine output of 25 ml/hour
after catheterisation.
Which of the following is the most appropriate course of action

for this patient?
A central line
 Correct
A CT abdomen
A surgical referral
An arterial line
Broad spectrum antibiotics
Early goal-directed therapy (EGDT) in cases of

SIRS or septic shock is becoming increasingly
recognised as
potentially beneficial. If fluids are not achieving haemodynamic
stability, and there is
indication of hypoperfusion as indicated by
oliguria or lactataemia, then vigorous resuscitation is
indicated.
EGDT aims to increase organ perfusion through restoration of

mean arterial pressure using inotropes
if necessary, maintaining
central venous pressure (CVP), maintaining oxygenation, and using
SjVO2
(jugular venous oxygen saturation) as a guide to
oxygen utilisation at the tissue level. SjVO2 higher
than 70% is indicative of organ hypoperfusion, as oxygen is not
being extracted.
Insertion of a central line above allows measurement of CVP,

SjVO2 and the use of inotropes.
Answer Statistics
1 57%
2 8%
3 6%
4 7%
5 23%
Test Analysis
Correct
Score: 60%
Total Answered: 5
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Question 6 of 22
A 64-year-old man is admitted with severe epigastric pain. He
has had the pain for 36 hours. An
abdominal x ray shows a central,
dilated small bowel loop.
His temperature is 37.0°C, pulse 130 bpm, blood pressure 80/50

mmHg, respiratory rate 29/min,
SpO2 85% on air.
His full blood count reveals:
Platelets 108 ×109/L (150-400)
MCV 105 fL (80-96)
Which of the following is the most appropriate initial treatment

of this patient?
Administer high-flow oxygen

Insert 2 × 14 gauge venflons and give 2 litres Hartmann's

solution
 Incorrect answer
selected
Intensive care
Intubation and ventilation
Invasive monitoring
This patient has systemic inflammatory response syndrome,
possibly caused by acute pancreatitis
given the finding of an
isolated dilated loop of small bowel on abdominal radiograph.
However, the
initial treatment is the same independent of the
underlying cause.
All of the above answers are reasonable, however resuscitation

of the sick patient still follows the
ABC algorithm:
Airway
Breathing
Circulation.
Airway control and oxygen to maintain normal saturations is the

first part of that algorithm.
Subsequent fluid resuscitation and
treatment of the underlying cause can then be initiated. The need
for invasive monitoring and intensive care is then assessed,
depending on the response to initial
treatment.
Answer Statistics
1 32%
2 50%
3 13%
4 3%
5 2%
Test Analysis
Correct
Score: 50%
Total Answered: 6
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Question 7 of 22
A 64-year-old man is admitted with 12 hours of central and
epigastric pain.
An abdominal x ray shows a central, dilated small bowel loop.

His temperature is 37.2°C, pulse
regular at 130 beats per min,
blood pressure 95/55 mmHg, respiratory rate 29/min, and
SpO2 90% on
air.
His admission full blood count is:
Platelets 96 ×109/L (150-400)
MCV 105 fL (80-96)
Which of the following is the most likely diagnosis?
Gall stone ileus
Ischaemic bowel
Pancreatitis
 Correct
Perforated duodenal ulcer
Small bowel obstruction

Ischaemic bowel and perforated duodenal ulcer would be high in
the differential list. However, the
history and raised mean
corpuscular volume (MCV) suggests chronic high alcohol use and the
severity of his observations would suggest a systemic inflammatory
response which is more common
with pancreatitis.
Acute pancreatitis has a mortality of 7-10%, often due to sepsis

or multiorgan failure. There are a
number of scoring systems which
can be used to guide prognosis, but they are unreliable within the
first 48 hours o f the illness. Gallstones account for 50% of
cases, with the majority of the rest being
associated with
alcohol.
Patients typically present with severe epigastric pain which

radiates to the back, and vomiting. As
seen in this example, there
is often a systemic inflammatory response (SIRS), Amylase is
markedly
raised, often in excess of four times the normal value.
Early complications include ARDS (adult
respiratory distress
syndrome), acute kidney injury and disseminated intravascular
coagulation (DIC).
Treatment is essentially supportive, and high levels of

monitoring are usually required (often in the
intensive care unit).
Those patients who are found to have gallstones should be
considered for urgent
ERCP when stable. All should have a
cholecystectomy either during the same admission or within
four
weeks depending on their clinical progress.
Answer Statistics
1 6%
2 14%
3 41%
4 14%
5 25%
Test Analysis
Correct
Score: 57.14%
Total Answered: 7
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Question 8 of 22
A 74-year-old man with ischaemic heart disease is in the
surgical high dependency unit following a
Hartmann's procedure
completed 12 hours previously.
He is in pain. He has drained 100/200/300 mls of blood into his

drains in each of the last three hours.
His blood pressure is
110/80 mmHg, his pulse 105/min. He has a respiratory rate 32/min,
SpO2
100% on oxygen by face mask.
Crossmatched blood is available.
Platelets 132 ×109/L (150-400)
Which of the following actions would be undertake as your

initial priority?
Give 1000 ml of colloid stat
Give 1000 ml of crystalloid stat
Morphine 5 mg intravenously
Return to theatre
Transfuse 2 units of packed red blood cells stat

He is still actively bleeding and haemodilution will not have
been achieved so his Hb will be lower
than the result given. It
will take at least 30-60 minutes before he is back in theatre and
anaesthetized
(CEPOD lists/emergency sections/crash calls/no porter
etc). With IHD he is at at high risk of a
perioperative MI. He
should have the blood first as crossmatched blood is available.
His observations could be caused by pain. However in the face of

a falling haemoglobin, a rising
pulse rate, and an increasing loss
into his drains this patient needs to return to theatre.
His blood pressure is not critically low and although many would
give crystalloid or colloid, it is
reasonable in an elderly man
with ischaemic heart disease to give blood if it is easily
available.
Overload with non-oxygen carrying fluid should be
avoided (although the red cells are not functional
for a
while).
Answer Statistics
1 25%
2 11%
3 10%
4 16%
5 38%
Test Analysis
Correct
Score: 50%
Total Answered: 8
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Question 9 of 22
You are asked to see a 75-year-old man post-oversew of a
duodenal ulcer. He is confused.
His SpO2 is 97 on oxygen. Pulse 110 beats per min,

blood pressure 100/50 mmHg, respiratory rate
32/min and his urine
output is 10 ml in the last hour.
Which of the following is the most appropriate treatment for

this man?
100% oxygen via face mask
Central line and arterial line
Haloperidol 2.5 mg intravenously
Noradrenaline via central line
Normal saline 500 ml stat

 Correct
Postoperative confusion is common in the elderly. However this

can be caused by a low perfusion
state.
His observations are indicative of underfilling/dehydration. (He

could also have atelectais or have
developed a chest infection.
Post-operative problems are often multifactorial.)
Of the options given a fluid bolus is appropriate. This is what

you would expect your FY1 to do while
waiting for the blood test
results and before calling you.
Some would argue that 100% oxygen comes before fluids but with
an SpO2 of 97 it is unlikely that
hypoxia is
contributing to his problems (nonetheless oxygen therapy would be
recommended).
The other options would come further down the line if initial
interventions were unsuccessful and he
deteriorated.
Answer Statistics
1 7%
2 14%
3 2%
4 2%
5 76%
Test Analysis
Correct
Score: 55.56%
Total Answered: 9
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Question 10 of 22
A 67-year-old man is three days post-operation for a sigmoid
colectomy. He has insulin dependent
diabetes mellitus. He complains
of dizziness, upper abdominal discomfort, and faintness.
His blood pressure is 110/75 mmHg, his pulse is 95 bpm, he has a

respiratory rate 24/min, and he
has SpO2 99% on air. His
blood glucose is 18 mmol/l.
His electrocardiogram shows ST depression of 2 mm in leads II,

III and AVF.
Which of the following is the initial drug therapy for this

patient?
Aspirin 300 mg
 Correct
Clexane 1 mg/kg subcutaneously
Clopidogrel 75 mg
Diamorphine 2.5 mg
Glycerol trinitrate 800 mcg sublingually
Initial treatment of an acute coronary syndrome is aspirin 300

mg. This should be safe in the post-
surgical patient with no signs
of bleeding at three days post operation. Clexane would have also
been
given pre- and post-operation.
The dose of clopidogrel is 300 mg in an acute coronary

syndrome.
Diamorphine is used to treat anxiety and pain, neither of which

is commented upon.
GTN would be reasonable to try, however the blood pressure is
low.
Remember that in the diabetic, chest pain may not be a feature

of acute coronary syndrome due to
autonomic dysfunction, and in
most post surgical patients myocardial infarct is silent.
Answer Statistics
1 59%
2 15%
3 3%
4 6%
5 17%
Test Analysis
Correct
Score: 60%
Total Answered: 10
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Question 11 of 22
A 56-year-old man with severe brain damage is apnoeic,
unsedated, and temperature 36.9°C.
He is intubated and ventilated. His biochemistry is normal.
The combination of which of the following specialists would be

able to confirm brain stem death?
Consultant/specialist trainee with one years experience

Consultant/specialist trainee with three years experience
Consultant/specialist trainee with four years experience
Consultant/specialist trainee with five years experience

Consultant/specialist trainee with two years experience
The conventional criteria previously established for clinical

death were based upon lack of
cardiorespiratory function.
The development of organ transplantation highlighted patients

who had conditions incompatible with
life, but who continued to
have some form of cardiorespiratory function with artificial
support. This led
to a code of practice for the diagnosis of brain
stem death.
This is based on the knowledge that when the brain stem is

damaged to such a degree that its
functions are irreversibly
destroyed, the heart will inevitably stop beating shortly
afterwards. When
this occurs, therefore, the patient is dead even
though respiration and circulation can be artificially
maintained.
Brain stem function is checked through set criteria, and the
findings must be agreed by at
least two senior doctors. One should
be a consultant, and the other must have at least five years post
registration who has experience in the testing of brain stem
death.
Life support should be withdrawn at this point, but

consideration should be taken as to whether the
person would be a
suitable organ donor.
Reference:
Department of Health. A code of practice for the diagnosis of brain stem
death, including guidelines
for the identification and management
of potential organ and tissue donors.
Answer Statistics
1 10%
2 28%
3 13%
4 36%
5 13%
Test Analysis
Correct
Score: 54.55%
Total Answered: 11
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Question 12 of 22
An 18-year-old male is admitted with a history of diarrhoea and
vomiting associated with weakness
and lethargy.
His motor power in the distal arms and legs is decreased and he
describes difficulty swallowing. His
forced vital capacity (FVC) is
1.5 litres.
Which of the following is the most appropriate immediate

treatment for this condition?
Cyclophosphamide
Intravenous immunoglobulin therapy (IgG) 0.5 g/kg

Intubation and ventilation

Plasmapheresis
Prednisolone 60 mg
This scenario is suggestive of Guillain-Barré syndrome

(GBS).
Dysphagia is a dangerous symptom suggestive of bulbar

involvement. However a FVC of 1.5 litres is
not an indication for
immediate ventilation (a FVC of less than 1 litre would be an
indication).
First line therapy is intravenous IgG. Plasmapheresis can also

be used but requires specialist
equipment.
Steroids are of no benefit.

Cyclophosphamide, although an immune suppressant, is a red
herring.
Answer Statistics
1 1%
2 44%
3 32%
4 15%
5 8%
Test Analysis
Correct
Score: 50%
Total Answered: 12
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Question 13 of 22
A 21-year-old male is admitted with acute onset headache and is
drowsy.
He is opening his eyes spontaneously, is disoriented but is

localising to painful stimuli.
Which of the following is the investigation of choice for this

man?
Computed tomography (CT)

 Correct
Lumbar puncture (LP)
Magnetic resonance angiography (MRA)
Magnetic resonance imaging (MRI)
Positron emission tomography (PET)
Urgent CT will confirm diagnosis in 95% of patients with subarachnoid haemorrhage.
Lumbar puncture is not usually required unless the history is

suggestive and the CT is normal.
Blood will be present in the cerebro-spinal fluid (if a bloody

tap is suspected the number of red blood
cells should fall with
each successive sample).
If the LP is performed six hours after onset of symptoms the

supernatant fluid should be examined for
xanthochromia after
centrifugation.
Answer Statistics
1 77%
2 12%
3 5%
4 5%
5 1%
Test Analysis
Correct
Score: 53.85%
Total Answered: 13
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Question 14 of 22
A 21-year-old male is admitted with acute onset headache and is
drowsy.
He is opening his eyes spontaneously, is disoriented and is

localising painful stimuli. He has a normal
computed tomography
(CT) scan.
Which of the following is the most appropriate next

investigation for this patient?
Cerebral angiography
Lumbar puncture
 Correct
Magnetic resonance angiography
Magnetic resonance imaging
No further investigations necessary
Lumbar puncture (LP) is not usually required unless the history

is suggestive and the CT is normal as
in this case.
Blood will be present in the CSF (if a bloody tap is suspected

the number of red blood cells should fall
with each successive
sample).
If the LP is performed six hours after onset of symptoms the

supernatant fluid should be examined for
xanthochromia after
centrifugation.
Answer Statistics
1 3%
2 81%
3 6%
4 6%
5 4%
Test Analysis
Correct
Score: 57.14%
Total Answered: 14
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Question 15 of 22
A 78-year-old male who presents with increasing dysphagia is
diagnosed with an inoperable
carcinoma of the distal oesophagus.
Oesophageal spasm causes food to stick after swallowing which
causes odynophagia.
Which drug would be most helpful in relieving his chronic

pain?
Clodronate
Dexamethasone
Nifedipine
 Correct
Oxybutynin
Pinaverium
Nifedipine helps relieve painful oesophageal spasm and tenesmus

associated with gastrointestinal
tumours and could be used to
relieve his odynophagia.
Clodronate inhibits osteoclastic bone resorption and is used to

treat malignant bone pain and the
associated hypercalcaemia.
Pinaverium is used to reduce the pain duration associated with

irritable bowel syndrome (IBS).
Corticosteroids are used to treat pain from central nervous

system tumours and painful bladder
spasm may be relieved by
oxybutynin.
Answer Statistics
1 3%
2 10%
3 63%
4 16%
5 7%
Test Analysis
Correct
Score: 60%
Total Answered: 15
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Work Smart Exam Themes January 2007
Question 16 of 22
Which of the following statements regarding the subclavian vein
and its relations is correct?
Begins at the lateral border of the first rib

Forms the axillary vein
Joins the superior vena cava

The thoracic duct joins the right subclavian
The subclavian vein passes posterior to scalenus anterior
The subclavian vein is a continuation of the axillary vein,

beginning at the lateral border of the first rib.
It passes anterior to scalenus anterior.
The subclavian and internal jugular vein unite to form the

brachiocephalic vein, subsequently the left
and right
brachiocephalic veins unite to form the superior vena cava.
The thoracic duct enters the left subclavian.
The brachiocephalic trunk is a branch of the aortic arch, which

divides to form the right subclavian
and right common carotid
arteries.

Answer Statistics
1 20%
2 12%
3 22%
4 34%
5 11%
Test Analysis
Correct
Score: 56.25%
Total Answered: 16
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Question 17 of 22
Which of the following statements regarding the internal jugular
vein and relations is true?
Lies lateral to the common carotid artery

Originates at the carotid canal
Passes behind the clavicle to join the superior vena cava
Passes posterior to the subclavian artery
Receives a lymphatic trunk at its union with the external jugular

vein
 Incorrect answer
selected
The internal jugular vein originates at the jugular foramen.
It initially lies posterior to the carotid artery, as it

descends in the carotid sheath it lies lateral first to
the
internal then the common carotid artery within the carotid
sheath.
It passes anterior to the subclavian artery to join the

subclavian vein and then form the
brachiocephalic vein; the left
and right brachiocephalic veins unite to form the superior vena
cava.
The internal jugular vein receives a lymphatic trunk at its

union with the subclavian vein.
The external jugular vein drains into the subclavian vein.

Answer Statistics
1 50%
2 3%
3 22%
4 13%
5 12%
Test Analysis
Correct
Score: 52.94%
Total Answered: 17
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Question 18 of 22
A 67-year-old man complains of dizziness and faintness. He has
insulin dependent diabetes mellitus
and he had a sigmoid colectomy
three days previously.
His blood pressure is 80/50 mmHg, his pulse 110 beats per min,
his respiratory rate 24/min, and he
has SpO2 99% on air.
His plasma glucose concentration is 18 mmol/L (3.0-6.0 fasting)
Which of the following is the most appropriate investigation for

this patient?
Arterial blood gas

Chest x ray
Electrocardiogram
Serum lactate
Urine ketones
This man may have a cardiac cause for his dizziness.
The highest prevalence of myocardial infarction is 72 hours post

operation. Patients with diabetes
may not have chest pain due to
autonomic dysfunction.
The differential diagnosis would include pulmonary embolus. It

may also include diabetic
ketoacidosis, but this would be unlikely
with his glucose at 18 mmol/l and would not directly explain
his
hypotension. Also, he would be expected to have a slightly higher
respiratory rate than 24/min.
Sepsis is also a possibility, but you
would expect there to be a temperature abnormality.
The most appropriate immediate investigation in this scenario
would be ECG. This would help to
confirm or exclude a cardiac
cause. Sinus tachycardia may make the differential diagnoses more
likely.
If the scenario involved a shorter postoperative time frame (up

to 48 hours), exclusion of
haemorrhage would take high
priority.
Answer Statistics
1 32%
2 3%
3 23%
4 15%
5 27%
Test Analysis
Correct
Score: 50%
Total Answered: 18
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Question 19 of 22
A patient needs central venous access for total parenteral
nutrition (TPN).
Which of the following is the cleanest site for placement?
Left femoral
Left internal jugular
Right femoral
Right internal jugular
Right subclavian
Right or left subclavian is regarded as the cleanest site for

central venous access. It also the most
tolerated by patients.
However the incidence of subclinical pneumothorax even in the

hands of experienced clinicians has
led to it falling out of
favour.
Answer Statistics
1 1%
2 8%
3 2%
4 40%
5 49%
Test Analysis
Correct
Score: 47.37%
Total Answered: 19
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Work Smart
Question 20 of 22
A 26-year-old female is admitted to ICU with severe asthma.
She is ventilated for one week and receives IV

co-amoxiclav/clarithromycin, magnesium,
prednisolone, sedatives and
muscle relaxants.
She improves gradually but two days after stopping muscle

relaxants she still is unable to be weaned
from ventilatory
support.
On examination, she is alert but has flaccid weakness of all

limbs.
Which of the following is the likely diagnosis?
Critical illness polyneuropathy

Guillain-Barré syndrome
Hypermagnesaemia
Prolonged neuromuscular blockade

Steroid induced myopathy
The history suggests prolonged neuromuscular junction (NMJ)

blockade which may be exacerbated
by both corticosteroids and
magnesium.
This condition was originally described with suxamethonium due

to hereditary reductions in plasma
cholinesterase activity.
However, drugs and electrolyte abnormalities may exacerbate
this.
Answer Statistics
1 28%
2 16%
3 13%
4 34%
5 8%
Test Analysis
Correct
Score: 45%
Total Answered: 20
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Work Smart
Question 21 of 22
A 58-year-old man with known alcoholism is admitted to the
Emergency Department following a large
upper GI haemorrhage. As far
as you are, aware he has no other significant past medical history
and
is non compliant with medications for his liver disease,
including propranolol which was started after
his last admission to
the Gastroenterology ward. On admission to the Emergency
Department, he is
drunk and aggressive
Which of the following is the likely initial reaction to blood

loss in this patient?
Aldosterone release
Angiotensin 2 production
Hypotension
Increased aquaporin 2 expression

Tachycardia
The answer is Tachycardia. Increased output of noradrenaline,

coupled with decreased vagal tone
post acute blood loss is
responsible for the initial tachycardia seen. These changes also
drive
increased myocardial contractility and vasoconstriction,
preserving blood pressure at least in the
initial period after
blood loss. Blood pressure generally only falls if the amount of
blood loss exceeds
these compensatory mechanisms (increased cardiac
output, tachycardia, and increased arterial
tone).
Aldosterone release and angiotensin 2 production are incorrect.

The renin system is activated by
blood loss, but the resultant
angiotensin 2 production with subsequent aldosterone release is
less
rapid. Aquaporin 2 expression is increased in response to more
chronic hypovolaemia, improving the
action of ADH and promoting
greater reabsorption of water in the kidney.
Answer Statistics
1 4%
2 7%
3 15%
4 4%
5 71%
Test Analysis
Correct
Score: 42.86%
Total Answered: 21
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Work Smart Core Questions
Question 22 of 22
A 24-year-old man presents with rash, lip and eye swelling, and
tachypnoea 15 minutes following a
meal at his local Chinese
restaurant. On auscultation of his chest there is widespread
wheeze.
Which treatment should be given immediately?
IM adrenaline
 Correct
IM chlorphenamine
IV adrenaline
IV atropine
IV hydrocortisone
This presentation is classical for anaphylaxis, which should be

treated immediately with IM
adrenaline. Patients known to have a
severe allergy might carry this in the form of an Epipen.
IV adrenaline should only be used in the setting of cardiac

arrest, unless in a critical care setting with
expert
supervision.
IV atropine is indicated in the management of unstable patients

with bradycardia.
Hydrocortisone and chlorphenamine are indicated in the

subsequent management of anaphylaxis, but
adrenaline should be used
first in patients with respiratory compromise.
Go to summary
Answer Statistics
1 80%
2 3%
3 6%
4 0%
5 11%
Test Analysis
Correct
Score: 45.45%
Total Answered: 22
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京ICP备15042040号-3

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(Please select 1 option)

Pinaverium is used to reduce the pain duration in irritable

Carbamazepine is in use for the treatment of neuropathic pain of

Clodronate inhibits osteoclastic bone resorption and is used to

The corticosteroids are used to treat pain from central nervous

Nifedipine helps relieve painful oesophageal spasm and tenesmus

Painful bladder spasm may be relieved by oxybutynin.

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The following day her investigations show:

Sodium 160 mmol/L (137-144)

Potassium 3.7 mmol/L (3.5-4.9)

Chloride 120 mmol/L (95-107)

Urea 3.0 mmol/L (2.5-7.5)

Creatinine 90 µmol/L (60- 110)

Which one of the following statements is correct?

(Please select 1 option)

Rapid rehydration with 5% dextrose is indicated

She has the syndrome of inappropriate antidiuretic hormone secretion (SIADH)

She should be treated with sodium restriction

She will have a hypercholraemic acidosis

Urine osmolality will be low

There is a marked hypernatraemia with elevated chloride but

The likely cause of this presentation is diabetes insipidus. Urine osmolality is

You cannot say that she has a hyperchloraemic acidosis as you do

Although restoration of normal volaemia and osmolality is

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Two hours later he complains of headache, begins vomiting, then

On examination he responds only to deep pain. He is apyrexial

Which is the most likely diagnosis?

(Please select 1 option)

The history is of a closed head injury, followed by a lucid

The time course suggests an extradural haematoma, where there is

Epidural haematoma, typically from a torn middle meningeal

There may be apparent recovery from the initial concussion, but

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He has a temperature of 36.9°C, a pulse of 95/min, a blood

Haemoglobin 126 g/L (130-180)

Platelets 169 ×109/L (150-400)

White cell count 3.9 ×109/L (4-11)

Which of the following is the diagnosis?

(Please select 1 option)

Leaking aortic aneurysm

Multiple organ dysfunction syndrome (MODS)

Systemic inflammatory response syndrome (SIRS)

This patient has features of pancreatitis. He also has

SIRS is defined as two or more of the following: