Selection Exam 88y imkk hh jhfdl.

PodsMD - Emergency Medicine 2020

September

1. Young man presented to A&E with history of trauma following RTA. Chest was compressed
anteroposteriorly. On admission he was found to have 5,6 th rib fractures. What is the most
possible site of rib fracture.
A. Angle of rib
B. costochondral junction
C. posterior costovertebral junction
D. neck of the rib
E. body of the rib

2.​ ​Injuryto right sided neck following RTAdeveloped right sided lower neck and upper chest
hematoma,CT shows right sided subclavian artery damage with a bone fracture at the inlet
.what is the most damaged bone?

A. 1st rib
B. 2 nd rib
C. clavicle
D. sternum
E. Scapula

3.​ ​10yr old child fell down from bicycle and got bicycle handle hit on the epigastrium in the

midline. most possible part affected

A. body of the pancreas

B. head of the pancreas
C. uncinate process of pancreas
D. second part of duodenum
E. fourth part of duodenum

4.​ ​A Patient with abdominal trauma.CT shows collection anterior to pancreas. What structure

forms part of the anterior border of this.

 A. Fundus of stomach
B. Lesser omentum
C. Spleen
D. 2nd part of duodenum
E. Transverse colon

5. A young man sustained injury to the upper limb, there was weakness in wrist
extension.extension at the mcp joints is lost. elbow extension was normal. There was no
sensory loss.likely site of lesion,

A. at the axillary
B. at the spiral groove
C. at the lateral epicondyle
D. within the supinator muscle
E. deep In the extensor compartment of forearm

6.To assess the function of the masseter muscle.. Patient has been asked to clench the teeth

The pathway of voluntary signal travels in order

A. Anterior limb of internal capsule --- anterior cerebellar peduncle --- in front of substantia nigra
---- lower motor nuclei of trigeminal nerve

B. Posterior limb of internal capsule--- anterior cerebellar peduncle --- in front of substantia nigra
---- lower motor nuclei of trigeminal nerve

C. Genu of internal capsule---anterior cerebellar peduncle --- in front of substantia nigra ----
lower motor nuclei of trigeminal nerve

D. Anterior limb of internal capsule --- anterior cerebellar peduncle --- in front of substantia nigra
---- lower motor nuclei of facial nerve

E.posterior limb of internal capsule --- anterior cerebellar peduncle --- in front of substantia nigra
---- lower motor nuclei of facial nerve

7. 53 year old pt met with an accident 3months back and now presents with clawing of medial
two fingers. with no sensory loss.most possible structure damaged

A. deep branch of ulnar nerve

B. superficial branch of ulnar nerve
C. recurrent median nerve
D. Long extensors of the two fingers.
 E. Palmar aponeurosis

8 A young woman with a history of atrial fibrillation, presented with sudden onset abdominal
pain, was found to have a necrotic part of the ileum,at which branch of the SMA is suspected to
have the thrombus?

A. Jejunal and ileal branches of SMA

B. After giving Ileocolic branch of SMA
C. After giving Right colic branch of SMA
D. After giving Middle colic branch of SMA
E. At the Origin of SMA

9)Hair got caught in a mill and presented with Scalp degloving injury and profuse bleeding. Most
likely plane of separation is between the layers :

A. Areolar tissue and pericranium

B. Aponeurosis and pericranium
C. Aponeurosis and areolar tissue
D. Skin and aponeurosis
E. Skin and superficial fascia

10.a woman was admitted to ED with stab injury to left side of the neck.stab was at c4 vertebra
level anteriorly.what is the most likely structure damage

A. bifurcation of common carotid

B. origin of esophagus
C. thyroid gland
D. vocal cords
E. Cricoid

11.25 year old male presented with blunt trauma to perineum.has superficial extravasation of
urine.

Likely structure damaged

A. Bulbar urethra
B. external urethral sphincter
C. Internal urethral sphincter
D. Penile urethra
E. Membranous urethra.

12. Two drugs X and Y. Clearance of both drugs are similar. But elimination half life is higher in
X than Y . What explains the above observation best.

A. X drug has a slowly releasing formula than Y

 B. Bioavailability of X is more than Y
C. Bioavailability of Y more than X
D. Vd is higher in X than Y
E. Vd is lower in X than Y

13.20 yr old female patient had a twisting injury to R ankle. Found to have tenderness and pain
over mid lateral ankle. Diagnosed to have 5th metatarsal avulsion fracture. The tendon attached
is?

A. abductor digiti minimi

B. flexor digiti minimi
C. peroneus longus
D. peroneus brevis
E. peroneus tertius

14. Elderly unconscious patient coming with breathlessness after several episodes of vomiting
while on supine position.

What is the most possible site of aspiration.

A. L/Main bronchus
B. R/Main bronchus
C. L/lower lobe
D. R/lower lobe
E. R/Middle lobe

15. Patient presented following a Knee injury . A structure lying on oblique popliteal ligament is
damaged. What is the structure.

A. Popliteal artery
B. Popliteal vein
C. Tibial nerve
D. Common peroneal nerve
E. Small saphenous vein

16) Young, healthy female. Serial blood pressure monitoring after high carbohydrate meal.
Following shows blood glucose values,

After 15 minutes - 140mg/dL

after 20 minutes - 160mg/dL

after 25 minutes - 180mg/dL

after 30 minutes - 200mg/dL

What best explains the renal handling of these findings

A. Clearance increase progressively

B. Glucose excretion increases and decreases
C. Glucose filtration increases progressively
D. Glucose absorption increase linearly
E. Tm increases linearly

17. 58. Inferior shoulder dislocation is more common than posterior dislocation. What is the
most probable reason to this.

A. Joint capsule lax inferiorly

B. Strong superior ligament??
C. Coracoacromial ligament prevent superior dislocation
D. Long head of biceps prevents superior dislocation

18. A substance is administered to a healthy person caused a change in cardiac contractility by

increasing production of cAMP level in cardiac myocytes.

What substance most likely to have been administered?

A. Digoxin
B. Noradrenaline
C. Procainamide
D. Quinidine
E. Theophylline

19 . 60 year old man who underwent coronary angiogram developed bradycardia and
hypotension. He also noted to have brief period of apnea followed by rapid shallow breathing.

Which of the following best explain the above findings.

A. Baroreceptor inhibition by RVL medulla

B. baroreceptor stimulation by dorsal nucleus of vagus.
C. Direct stimulation of Caudal Venterolateral Medulla
D. Chemosensitive vagal c fibers
E. by hypoxia
20. In systemic circulation following changes have occured.

Flow rate - gradually decreased

Pressure - gradually decreased

Resistance- sharply decreased

Cross sectional area - sharply increased

Which of the area of the circulation better described above?

A. The aorta to artery

B. The arteries to arteriole
C. The arteriole to capillary
D. The capillary to venule
E. The venule to vein

21. 30 yr old female presented with faintishness,

Hb – 6

Retic count 4%

Serum haptoglobin 30 (reduced)

MCV 83

Presence of which of the following substance in urine helps to achieve at a definitive diagnosis?

A. Bile salts
B. bilirubin
C. Haemoglobin
D. Urobilin
E. Myoglobin

22. The following chart shows the salivary cortisol values fluctuating during the day

Time salivary cortisol level

7am - 7ng/l

11am- 4ng/l
3pm- 3ng/l

7pm- 1ng/l

The statement which explains the above trend

A. Salivary cortisol increases with the level of stress

B. Salivary cortisol increases with the temperature
C. Salivary cortisol fluctuates according to acth secretion
D. Salivary cortisol fluctuates according to serum cortisol level
E. Salivary cortisol level fluctuates according to the availability of the substances to
synthesize it.

23.increased negativity inside nerve cell membrane due to

A. Hyperchloremia
B. Hypomagnesemia
C. Hyponatreimia
D. Hypokalemia
E. Hypocalcemia

24. Man following fallen from height. Spinal cord injury is suspected. Bilateral knee jerks absent.
What is the mechanism of this presentation?

A. Muscle spindle insensitivity??

B. Muscle membrane hyperpolarization
C. Absence of brian control on gamma motor neurons
D. Disruption of alfa motor neuron?
E. Damage to the dorsal root of Spinal nerve.

25. female with progressive breathlessness for the past 18 months. Diagnosed to have
pulmonary fibrosis.
Reduction of which parameter best support the diagnosis

A. FEV1
B. FEV1/FVC
C. Forced vital capacity
D. FRC
E. TV

26.Patient having profuse watery diarrhoea. And ORS given. What is the action of ORS here

A. Increase in Na dependent glucose transport to gut

B. Increased water reabsorption by microvilli
C.

27. A drug has similar Vd to plasma. What is the most likely feature of the drug to have a similar
Vd as plasma volume.

A. High lipid solubility

B. High water solubility ??
C.
D. High tissue protein binding ability
E. Large molecular weight

28. 45 yrs old DM patient came with vomiting, abdominal pain, fever, dysuria for 5
days.Dehydrater and not taken drugs. BP 90/70. PR 100 bpm, rapid deep breathing. CBS 400,
pH low, HCO3- low. Ketones positive.

What is the 1st step in initial management

A iv crystalloid bolus

B s/c insulin

C iv broad-spectrum antibiotic

D iv vasopressin

E iv HCO3-
29.17 yr old presented with acute flaccid paralysis following eating canned food. He also had
diarrhoea and ?? Vomiting??.

What is the mechanism of getting flaccid paralysis in this condition?

A. Inhibition of acetylcholine esterase

B. Inhibition of Ca2+ entry into terminal button.
C. Inhibition of acetyl choline entry / release ??..
D. Inhibit binding of acetyl choline vesicles to presynaptic membrane
E. Interference with receptor binding

30. Elderly individuals are more prone to adverse drug reactions. This is due to,

A. Poly pharmacy
B. Impaired renal functions
C. Impaired liver functions
D. Less body fat
E. Increased drug interactions

31. A 14 year old girl who was hyperventilating after an argument with her parents, brought to
the hospital with carpopedal Spasm . After giving a paper bag for rebreathing her symptoms
were relieved .. what is the appropriate physiological explanation for rebreathing and symptom
relief

A. Reducing the threshold for action potential in excitable tissue

B. increase the entry of Ca into the neuromuscular junction
C. increase the entry of Ca into the sarcoplasmic reticulum
D. Vasodilation relieving the ischemia.
E. Releasing the plasma protein bound ionised Ca into the plasma

32. Atropine is given for organophosphate poisoning. What is the pharmacological basis of its
efficacy.

A. It acts on autonomic ganglia

B. It acts on neuromuscular junction
C. It acts on muscarinic receptors
D. It can be given intravenously
E. quick onset of action
33. Receptors are considered as suitable targets for action of drugs due to,

A. Glycoprotein structure
B. Reversible binding to the receptor
C. Quick regeneration
D. Selectivity
E. Presence over the cell surface.

34. DM patient presented with fever , toe gangrene. BP 80/50 , and bounding pulse. What is
the drug you start on him for resuscitation ??

A. Noradrenaline
B. Dopamine
C. Dobutamine
D. Vasopressin
E. Adrenalin

35. What is the parameter which assess therapeutic effect of a drug against the toxic effect

A. Bio availability
B. Potency
C. Efficacy
D. clearance
E. Therapeutic Index

36. Patient with severe acute asthma.

ABG- PaO2 - 70mmhg, PaCO2 60mmhg.

what pathological condition has caused above

A. Diffusion abnormality in alveolar membrane

B. V/Q ??
C. Respiratory tract infection
D. Respiratory muscle fatigue
37. Benzodiazepines act on benzodiazepines receptor and reduce anxiety, sedation, reduces
seizure and beta carboline binds on same receptor and causes exactly opposite effects. what is
the mechanism of action pharmacologically.

A. inverse agonist
B. pharmacological antagonist
C. physiological antagonist
D. inverse agonist
E. full agonist

38. 11 yrs boy with Hx of BA. had salbutamol inhaler once or twice last month. Played cricket
well after using inhaler.No sleep interruptions at night. FEV1/FVC 88%

What is the change of drug you’ll do at clinic review

A. No changes
B. Add beclomethasone
C. add fluticasone
D. add salmatrole
E. Add montelukast

39) 55 year old man with heart failure, presented to the Emergency department with difficulty of
breathing for 2 days duration.he has 170/100 mmhg and in ECG and sinus tachycardia .heart
rate is 110bpm.

Troponin I negative .he is already on frusemide 40mg and aspirin 75mg.

What will be the drug you will be starting next on him?

A. Digoxin
B. Enalapril
C. Ivabradine
D. Propranolol
E. Spironolactone

40) 70yrs lady with Rh arthritis, on hydroxychloroquine and sulfazalasine, occurred pin point
pupil and drowsiness after new drug added by GP. drug overdose is suspected. What is the
drug;

A. amitriptyline
B. codaine
C. diclofinac
D. diazepam
E. fluoxetine
41. Patient with a hx of heart failure , known DM . What is the best oral hypoglycaemic with a
cardioprotective effect (you will start on him before discharge .)

A. Enfaglifozin
B. Gliclazide
C. Metformin
D. Sitagliptin
E. Pioglitazone

42. 30 yr old woman with menorrhagia ,presented with faintishness. childhood history of easy
bruising.

Hb -6

PT- Normal

APTT- 46 (high)

TT 12( upper limit of normal)

Plt - Normal

A. Bernard Solier syndrome

B. Haemophilia A
C. Haemophilia B
D. Haemophilia C
E. VonWillebrand disease

43. 75 year old man presented with intestinal obstruction. He is dehydrated, serum potassium
2.5.echo shows normal left ventricular function. He was given 2Lof hartman. Use of hartman is
better than normal saline because,

A. Hartman is more physiologically similar to plasma.

B. Hartman produces less allergic reaction compared to colloids.
C. Corrects potassium deficit.
D. Hartman is less likely to cause metabolic acidosis when compared to similar volume of
normal saline
E. Hartman remains within plasma than normal saline

44. Man presented to ETU following a RTA. His blood pressure dropped from 150/90 to 90/50.
The change observed in his filtration fraction is due to
 A. Increase in circulating Aldosterone
B. Increase in Vasopressin
C. Reduction in Glomerular filtration
D. Reduction in efferent arteriolar diameter.
E. Reduction in renal blood flow

45. 70 yr old woman coming with hx of fever and cough with purulent sputum. X ray shows R./ S
encysted pleural effusion .what is the most likely finding in pleural fluid.

A. Blood stained with inflammatory cells.

B. Clear fluid with high protein.
C. Fibrinous fluid with.....
D. high protein with inflammatory cells
E. yellow coloured fluid with inflammatory cells

46) A 43 yrs old patient presented to opd with hx of non healing wound for 3 months following
RTA. Here pathology best explained by

A. Interruption of triple response.

B. Continuous injury and healing.
C. Infiltration of lymphocytes and plasma cells.
D. Presence of low virulent organism.
E. Presence of multi nucleated giant cells.

47. 45 yrs old previously healthy patient developed acute onset right side body weakness. CT
shows no features of haemorrhage . what is the most likely primary pathophysiological cause..

A. aortic aneurysm
B. Atherosclerosis
C. venous thrombosis
D. mural thrombosis
E. valvular vegetation

48. 26yr old boy developed localized swelling and erythema of hand following insect bite. Best
mechanism for the swelling

A. Altered plasma oncotic pressure

B. Increased arterial hydrostatic pressure
C. Increased vascular permeability
D. Lymphatic obstruction
E. Venous obstruction
49. 14yr old boy presented to hospital 18hrs after onset of acute scrotal pain. He had Nausea
and vomiting. Absent cremasteric reflex.

Pathological basis

A. inflammation
B. Congestion
C. odema
D. ischemia
E. Venous infarction

50. PPH following normal vaginal delivery. 8 pints of blood transfused ABG

PH 7.49

PO2 98

PCO2 45

HCO3 35

LAC 1.8

Cause for this ABG

A. Hypovolemia
B. tissue ischemia
C. hypothermia
D. citrated blood
E. dilutional hypokalemia

51. Patient underwent a small bowel resection. He is complaining of passing large amount of
pale coloured stool which are difficult to be flushed away. He is on regular Vit A andD. What is
the pathophysiology behind this presentation

A. Increased gut transit time.

B. Altered enterohepatic circulation.
C. Taking Vit A and D
D. Lactose intolerance
E. Bacterial activity
52. What is the basis of using HME for humidification

A. it doesn’t use electricity to warm air

B. It incorporates a viral filter
C. it humidifies inspired air by using condensed water vapors from expired air
D. it condenses a surface area of ......

53.Which of the following affects the reliability of capnography most??

A. Rise time
B. Transit time
C. Size of chamber
D. Wavelength of infrared
E. Flow rate

54. Patient with hypovolemic shock state was started on crystalloids. What of the following
method cause the maximum increase in flow rate of giving fluid,

A. Increase cannula diameter twice

B. Increase pressure difference of cannula and fluid twice
C. Reduce cannula length by half
D. Reduce fluid viscosity by half
E. Reduce fluid density by half.

55. 34y male presented with op poisoning to A&E. Most likely reason for using Wright’s
spirometer in this patient is,

A. To set up ventilator
B. To monitor his peak flow rate
C. To monitor vital capacity
D. To monitor minute volume
E. To monitor respiratory rate

56. Patient presented following accident to a local hospital. On admission his Spo2 97% while
on 60% FiO2 , BP 90/60, GCS 6/15. After the initial management and intubation It was decided
to transfer the patient for definitive management to the nearest A&E center.

What of the following parameter is best to monitor the patient during transport.

A. continuous cardiac monitoring

B. ET co2
 C. saturation
D. Non invasive blood pressure monitoring
E. uop
F. Arterial Bp monitoring

57. Suspected perineal bleeding following trauma, investigation to confirm at ED :

A. Uss with low frequency probe

B. Diagnostic Peritoneal lavage
C. Contrast CT abdomen
D. MRI
E. Lateral decubitus abdominal XRAY??

58.Male sustained a RTA, GCS 5/15, CT scan shows cerebral oedema.what is the best method
of ICP monitoring

A. monitoring with intraparenchymal probe

B. monitoring catheter in ventricles transducer in right atrium
C. transcranial ultrasound with Doppler
D. lumbar CSF pressure
E. catheter in the ventricle with a strain gauge transducer

59. What should be the order of transporting following patients to the nearest emergency
treatment unit.

A. 30 yr old woman screaming with pain and fracture in the thigh. pulse rate 100??

B. 30 yr old man with open abdomen carrying his bowels in hand. ??

C. 4 yr old boy having deformity in the leg . No distal pulses.

D.70 yr old man with pulse 160, distended abdomen.

E. 90 yr old man with pulse 110, silent chest ? Absent breath sounds, resonance to percussion
on one side of the chest.

C eacab
D edcba

60. You are appointed as medical officer in disaster management by hospital authority.

What is the correct sequence of steps you are taking when arranging disaster management
plan,

a.mitigation, risk assessment, prevention, response, recovery

b.

c.prevention, mitigation, preparedness, response, recovery

d. Risk assessment, prevention, mitigation, response, recovery

e. Prevention, risk assessment, mitigation, response, recovery.