Emergency medicine selection examination 2019

1.Radical nerve damage at neck of the radius, clinical features

1) wrist drop
2)loss of metacarpophalangeal extension
3)loss of inter phalangeal extension
4) sensory impairment in dorsum of hand
5)loss of Thumb abduction

2. A 50 year old woman came with abdominal trauma to ETU. CT abdomen showed trauma
to a structure in transpyloric plain. What is the most likely structure damaged?
1. Neck of pancreas
2 Right suprarenal gland
3. Origin of right colic artery
4. Splenic artery
5. 3rd part of duodenum

3. Femoral artery lies on which muscle as it pass behind inguinal ligament

A.Psoas
B.Illiacus
C. Pectineus
D.Adductor longus
E. Satorius

4. A 60 year old man is developed pancreatic pseudocyst following acute pancreatitis

What is the anterior relation of it
a) Spleen
b) spleenic flexure of colon
c) anterior wall of stomach
d) 2nd part of dudenoum
e) caudate lobe of the liver

5. A 60 year old patient found to have L5/S1 disk herniation. What's the movement affected?
A. Dorsiflexion of ankle
B. Hip extension
C. Inversion of foot
D. Knee extension
E. Plantar flexion of foot

6.substans × is freely filterd by glomerulus 50%reabsorbed, secreted by tubules and

fullyexcreted in urine. the substance is
1.creatinine
2PAH
3Na
4K
5urea
7.A 50 yrs old female presented to A & E with dizziness and feeling unwell for 2hrs duration.
She has a history of loin pain, dysuria & fever for 2 days. Blood pressure 80/45mmHg, Heart
rate 90/min, CVP 12cm H2O.
Most appropriate treatment to correct hypotension is..
A.adrenalin
B.Vasopressin
C.dopamine
D.dobutaminr
E.noradrinaline

8.GIVING GLYCERYL TRI NITRATE TO A PATIENT WITH acute coronary event with sub
lingual form is due to the...
A.less distance from buccal mucosa to the coronary artery.
B.more enters the enterohepatic circulation.
C.oral form dietary is resistance.
D.pre systemic elmination.
E. destroy by gastric acid.

9. which of the following ecg rhythm is essentially irregular

A. Atrial flutter
B. First degree bheart block
C. Mobitz type 1
D. Thyrotoxicosis
E. Complete heart block

10. Transporting a patient after trauma .GCS6/15.vetilated.. patent has history of myocardial
infarction 2yrs back. Which of the following monitoring is important
A. Etco2
B. Arterial blood pressure
C. Blood pressure on monitor
D. Urine out put
E. Pulse oxymetery

11.disaster definition is an event

A. Exceeding the capacity of the pertiular community
B. Exhausting the response capacity of local health institute
C. Can be Man made or natural

12.rupture of ulcer in posterior wall of duodenum .source of bleeding

A. Gastrodeodenal ar
B. R.gastric ar
C. L.gasrtic ar
D. R.gastroepiploic ar
E. Splenic ar
13.man fall from a height , concious , cannot move lower limbs. Which of the following is a
feature of cervical spine injury
A. Bp 80/6
B. cough reflex poor
C. Bradycardia HR <40
D. SpO2 92%

14.Hypokalaemia effect on membrane potentials,

1) Ach release impairment
2) hyperpolarization of neurilema
3)Na k atpase dysfunction.
4) increase in action potential amplitude
5)reduction in threshold potential

15.Aminoglycaside is effective as a once daily dose.

Pharmacodynamic reason?
a)High concentration endolic
b)time dependant killing
C)Synergism
d)Post antibiotic effect
e)High bactericidal effect

16.young patient presenting after RTA. diagnose to have SDH.Responsible vessel

A)Anterior cerebral artery
B)emissory veins
C)middle meningeal vein
D)middle meningeal artery
E)superior cerebral vein

17. A 4 yr old girl has presented to the A&E after an accidental ingestion of 4-5 fruits from a
tree. She had developed vomiting, diarrhoea and difficulty in breathing. On examination she
is drowsy, and has bradycardia, pinpoint pupils and bilateral rhonchi. What is the likely active
ingredient in the fruits she has ingested?
A. Cardiac glycosides
B. Cholinomimetics
C. Opioids
D. Beta adrenergic blocker
E. Antimuscarinic

18.What is the most important ethical consideration in developing a randomised controlled

double-blind study regarding a new chemical entity?
A. Beneficence
B. Fair subject selection
C. Justice
D. Patient autonomy
E. Confidentiality
19. A 37 year old woman had developed lower limb DVT after undergoing a dilatation and
curettage after 3rd miscarriage. On investigation she was found to have valvular vegetations
in the echocardiogram. What is the most likely underlying condition?
A. Antithrombin III deficiency
B. Von willebrand disease
C. Antiphospholipid antibody syndrome
D. Warfarin therapy
E. Surgery

20. An 8 year old boy was admitted with fever and right lower abdominal pain. He was
diagnosed to have acute appendicitis and underwent surgery. Which of the following would
be best evidence for appendicitis?
A. congetion of seroma of the appendix
B. Oedematous appendix observed during surgery
C. Faecolith in the appendicular lumen
D. Neutrophil inflammation in the wall
E. Elevated Acute phase proteins

21. A 37 year old pt with history of breast cA presents with ovarian CA.her siblings has
lymphoma and sarcoma. Probable Gene abnormality
A. DNA mutation repair gene
B.BCL2
C. P53
D.BRACA1
E.her2/neu

22. A 35 yrs old female presents with fever n fits

Hb 8
Plt 20000
WBC 5000
APTT ,PT ,TT all normal.
Serum LDH 1000
Blood picture micro angiopathic haemolysis with thrombocytopenic

USS abd n pelvis normal

1. Acute liver cell necrosis

2. Dengue haemorrhagic fever
3. Disseminated intravascular coagulopathy
4. Leptospirosis
5.Thrombotic thromocytopenic purpura

23.A 30yr old male presented to the Emergency Department with acute poison and
treatment with methylene blue.His mucus membrane becomes blue after a few hours of
treatment.ABG shows PaO2 112mmhg with Fio2 0.6 and SpO2 87%
Most likely reasons for low reading in the Pulse Oximeter.
A.Deposition of methylene blue in the skin
B. Hypotension due to myocardial suppression
C. Malfunction of the pulse oximeter in the presence of methylene blue
D. Methylene blue interfering with the absorption of red light
E. Poor Peripheral Circulation

24. Coronary artery angiogram of a 55 year old patient shows post stenotic dialatation.
Principle explain this phenomenon?
A. Bournollie’ principle
B. Law of Laplace
C. Law of inertia
D. Newton’s third law
E. Hagen poiseuille law

25.patent with COPD present to EM spo2 84% most appropriate method to administer o2
A.O2 via nasal prong 4l
B.intubation and ventilate with fio260%
C.o2 via hudson mask 8l
D. Venturi mask 24%
E. Venturi mask 60%

26. During a mass disaster, who is responsible for securing the scene, rescuing the victims
and providing wound care?
A. All the citizens
B. Police and forces
C. Local health care provider
D. Experienced disaster and emergency professional team
E. 1st responders

27.patient with chronic cough smoker presented with fever cough for a week. spirometry
done FvC 3.4 (normal) FEV1 2.2(lower limit 2.4)FEV1,/FVC 68% PEFR reduced
Next step to diagnose disease
A.Bronchodilator therapy and repeat spirometry
B.repeat spirometry after antibiotic treatment 1wk
C.repeat after giving methocholine
D.ABG
E.HRCT chest

28.patent with breast CA.histological features to suggest breast CA

High mitotic activity
Stromal invasion
Large nuclei
Prominent nucleoli
Central necrosis
29.A man found unconscious in garage..listing to songs inside vehicle..engin on.skin cherry
pink in colour.treatment
Hyperbaric o2
Methylene blue
High flow o2
Intubate and ventilate

30.70yr old pt with pneumonia.mild renal impairment.hx of allergy to penicillin.physician

prescribe levofloxacin.reason to give levoflox
A.levoflox better than cipro for strep pneumonia
B.levoflox better choice in elderly
C.levoflox better in renal impairment
D.less chance of tendon rupture
E.cipro has cross sensitivity in penicillin allergy

31.70 yr old women with nof # and bone pain serum calcium high 7.4 urine calcium low
50..parathyroid hormone norma 20l(normal).Serum phosphate low
A.hypovitaminosis D
B.pseudohyperparathyroidism
C.secondary hyperparathyroidism
D.osteoporosis
E.primary hyperparathyroidism

32.young man after 10min workout in gym .which suggest he did isotonic exercise not
isometric
Diastolic BP 66
HR 110
RR30
Spo2 99
SBP 154

33.paralysis of tongue.deviation to R side.lesion

A.left hypoglossal
B.R genioglossus
C.R hyoglossus
D R stylogossus
E.R palatoglossus

34.location of great saphenous vein for a venous cutdown

A.anterior to lateral malleolus
B. anterior to medial malleolus
C.between medial and lateral malle
D.bw medial malleolus and heel
Ebw lateral mall and heel

35.surface marking of sciatic nerve as it emerge in gluteal region

A.midway bw highest point i illiac creat and ischial tuberosity
B.midway bw posterior SIS and Ish tuberosity
C.one third bw.highest point of illiac crest and ischial tuberosity
D.one third bw.PSIS and ischial tuberosity
E.⅔ bw PSIS and ischial tuberosity

36.man given a drug.increase cardiac contractility.reduce HR.diastolic BP not changed.drug

A.Digoxin
B.adrenalin
C.noradrenalin
D.milrinone

37.hartman given to a pt in heat stroke.reason to give hartman

A.prevent acidosis induced by large amount of 0.9 saline
Bco tains electrolytes similar composition to plasma
c.PH close to plasma
D.stay in plasma compartment more than saline
E. to replace potassium

38.Inferior shoulder dislocation more common than posterior.reason

A.capsule attached to shaft
B.rotator cuff attached posteriorly
C.capsule lax inferiorly
D.biceps tendon superiorly
E coracohumeral ligament superiorly

39.strangulated indirect inguinal hernia.immediate structure found outside hernial sac during
Surgery
A.fascia transversalis
B.external spermatic fascia
C.internal spermatic fascia
D.peritoneum
E.extraperitoneal tissueextraperitoneal tissue

40.pt with bleeding.PT.,APTT prolonged.plt low,fibrin degradation products increased

A.TTP
B.DIC

41.decision to give a loading dose of a drug depends on

A. T half
B. Presystemic elimination
C. Bioavailability

42.a 35 years old woman on carbimazole what is your best advice on safety point of view
1.when she develop sore throat come to hospital earlier
2.if she has idea to become a pregnant stop carbimazole
43.RTA patient. Intra Abdominal bleeding suspected.initial assessment includes,
a) Peritoneal lavage
b) USS by low frequency probe
c) CT abdomen
d) Lateral decubitus X ray-
e) Hb

44. Adrenaline is given in anaphylaxis to reverse effect of histamine due to what

pharmacokinetic quality
a) pharmacological antagonism
b) Physiological antagonist
c) Vosoconstriction
d) Increased cvp
e) Increase myocardial contractility

45.pr with allergy reaction .low BP.adrenalin given.what contibute to rise in BP most
A.increase stroke volume
B.total periphereal resistance
C.heart rate
D.increase contractility
E.increased cvp

46.admitted following fall from height.loss of vibration,proprioception, two point discimination.

Lesion in
A.lateral spinothalamic
B.dorsal column
C.rubrospinal
D.anterior spinothalamic tract

47.pt underwent endoscopy.ulcer with everted edges,necrotic center

Aacute inflammation
Chronic inflamation
Neoplasm
Metaplasia

48.long term treatment with NSAIDS developped peptic ulcer disease.reason

A.damage to mucosal barreir
B.increased acid production
C. Reduce blood flow
D.
E.

49.patent with low BP.how GFR maintained

A.renin angiotensin system
B.tubulo glomerular feed back
C.eeferent arteriolar constriction more than afferent
D.?aldostetone
E.

50.pt on long term treatment with salbutamol for asthma.effect reduce with long term tr
A.desensitisation of receptors
B.down regulation of b2R
C.Up regulation of receptors
D.down regulation of b1 receptors
E.

51.pt on long term glucocoticoids.na high.k low high bp

A.increased glucocorcoid receptor no
B.increased production of cortisone
C.aldostetone production
D. 2ry hyperaldosteronism
E.increase minaralocorticoid receptors
F. Reduced minaralocorticoid

52.cut injury in wrist.structure imm medial to radial artery

A.flexor carpi radialis
B.flexor digitorum longus
C.flexor digitorum suoerficialis
D.palmaris longus

53.know Rheumatoid arthritis pt came with sob and fever

A. Pulmonary fibrosis with infection

54. A 18 years old known BA boy got sports injury on his ankle what is the drug of choice for
analgesia
1.Carbamezapine
2. Codine
3. PCM
4. Tramadol
5. Ibuprofen

55.Best treatment modality for 4 Yr old child for control of asthma.

1. Spacer and MDI
2. Multi use dry powder inhaler
3. Single use dry powder inhaler
4.MDI without spacer

56.ultrasonic nebulizer more efficient in delivering drugs than gas driven nebulizer
1. Less than 1 mic particles producing
2. Only uses ultrasonic....... and other uses gas

57. Selecting empirical antibiotic on meningitis patient

A.lipid solubility
B.minimum inhibitory concentration

58. Transducer pisition of aterial bp monitoring

A. level of Mid axillary line
B.level of anterior axilary line
C. At the 4th intercostal space at mid clavucular line
D. Between anterior axillary line and mid axillary line
E.no need of leveling

59.What is the best place to give intercostal nerve block

1. Angle of rib
2. Posterior axillary line
3. Mid axillary line
4. Anterior axillary line
5. Between anterior and mid axillary line.

60.Patient presented with left sides face, arm and leg weakness.. blood pressure
210/130mmhg. Medical registrar wants to lower the blood pressure suddenly.. what will be
the adverse outcome of sudden reduction in blood pressure.
A.myocardial ischeamia
B.