What are the RECOMMENDATIONS to IMPROVE the Training Program on Practical Aspects for the Internship for Pre-Intern Medical Officers, Please reduce repetition of similar topics MCQs in Paed Total Marks = 50 X_ 1. You attempt to deliver a breach through a mask in a 8 years old child *0/5 but it does not go in, What is the next step? KH to maintain sniffing position © . Discard mask and use mouth-to-mouth © c.Reposition the airway to neutral position ©@ 4. Hyperextend the neck x O e.Blow harderY 2. Ayears old child requires intubation and ventilation for an altered “5/5 level of GCS, What is the appropriate size of the endotracheal tube for this patient? O a25mm O b.3mm O c4mm © 4.5mm vw O e&6mm Y 3. Youare alone and find a 10 years old child lying ina park. Child *10r10 does not seems to be moving, What is your next step after checking for responsiveness? © a-ensure scene safety © b. Begin chest compressions © c. Open airway and give 2 breaths @ adial 1990 v O e.check for pulse4 Whatis the shockable rhythm * © a. pulseless electrical activity © b-asystole © c. bradycardia ©@ 4.SVT with no palpable pulse O e. Ventricular tachycardia 5. Whatis the shockable rhythm * © a. pulseless electrical activity © b-asystole © c. bradycardia © .sv7 with no palpable pulse CO «. Ventricular tachycardia 5/5 5/5X 6. Indications of chest compression in a flat baby during newborn *0/5 resuscitation include ©@ a. blue baby at birth x © b. Baby not breathing at birth © c-heart rate of 65 beats per minute at birth © 4. poor chest expansion during breathing SZ 5 era sennanaron wn haan aca oees ports 7. Which of the following statement is true of "maximum oxygen flow *10/10 that can be given through a device" © a.1U min through a nasal prongs ©@ b.10L/min through a simple face mask a © 151smin through a ventrui mask © 4.10 L/imn through a non re-breathing mask © e.40 L/min through a high flow nasal prongs vis high flow deviceY 8. Which of the following would you consider in deciding the number of *5/5 ‘oxygen cylinders during a transfer? © a. Oxygen saturation of the patient O b- Respiratory rate © ©. Litres of oxygen given to the patient v © 4. Arterial blood gas report © ecchest expansion Mc in Emergency Medicine 60 of 70 points Total Marks = 70 1, Which of the following can be administered via the intraosseous *5/5, route? O a.Nsaline O ». Midazolam O «Adrenaline ©@ 4.Allofthe above vX 2. The Glasgow coma score is useful in all of the following EXCEPT* —o/5 © a.Head injury ©® b-Post seizure x O ©. Post successful defibrittion WV 4. Post procedural sedation 3. Management of a patient with dysponea doses NOT include * 5/5 © a. Nursing in the supine position v © b. Oxygen administration © Reassessing © 4. Auscultation of the chest Y 4 Compression rates to ventilation rates in adult CPR is * 5/5 O as2 O b.152 © «.302 v O 41545. Immediate life-threatening chest condition includes EXCEPT * © a.Cardiac tamponade @ b-Rib fracture © . Tension pneumothorax © 4. Massive haemothorax Y 6. The failed airway algorithm does NOT include * O a.Repesitioning © b. Bimanual positioning O © Surgical airway ©@ 4. Repeated attempts Y 7. Signs of a tension pneumothorax include * © a. Ipsilateral deviation of the trachea © b- Contralateral absent breath sounds © -psiateral hyperresonance on percussion © 4.Hammans erunch 5/5 5/5 5/5\Y 8 Management of a patient with an ST elevation Myocardial infarction *5/5 does NOT in generally include ©@ 2. Lignocaine infusion v CO b- Reperfusion strategies © cc. Continual reassessment © GAspirin VY 9 Treatment of septic shock does NOT include * 5/5 © a. Early targeted antibiotics © brdrainage of ebscesses © c. Waiting for a urine result before starting therapy v © 4. Fuia therapy 10. The most appropriate drug in management of anaphylaxis is * 5/8 © 4. Antihistamine CO b. Steroids @ ©. Adrenaline v O 4 Fuids11. Which of the following is NOT an antidote * 5/5 O a. Oxygen © b. Methylene blue © «Naloxone @© 4. Predinisotone re 12. The most appropriate fluid in the initial management of hypovolemic *5/5 shock is © a.Colloid © ». Packed cells © c oyrystatioid sf O 4.50% dextrose X13. Synchronized DC Cardio-version is NOT indicated for * os CO, SVT resistant to pharmacological treatment b. Ventricular fibrillaic n © ©. VT where the patient is compromised but still has a cardiac output x © 4. AF that fails to respond to pharmacological therapy14, The most dangerous part of a patients’ journey in hospital is * 5/5 © a.Inradiolagy © b.inthe ward © c. Transfer to intensive care unit v © 4G. inthe Emergency Department Mc in Psychiatry 40 of 50 points Total Marks = 50 X 1) A45year-old labourer is admitted to the surgical ward following a *or10 fall and fracture of the humerus. On the third day of admission he is confused, has coarse tremors and says there are snakes everywhere in the ward. Which of the following are accepted management options in this patient? A) IM Chlorpromazine 8) IMMidazolam _C) Oral Chlordiazepoxide D) IMHaloperidol_£) Psychotherapy © 1-Allotthe above x O 2.4,8,CONLY v O 4¢,0,€0ny B,C,D ONLY © 5.None of the AboveY 2) 23-year-old patient with diagnosed schizophrenia is admitted *10/10 with a covid infection. Following admission, he becornes paranoid and accuses the ward staff of plotting to steal his inventions. What management options would you consider? _A) Oral Olanzapine 5mg stat B) Psychiatry referral C) IMHaloperidol 5mg stat D) Inform security E) Obtain help of family member to deescalate situation 1. Allof the Above v 2..A,8,0 Only 3.B,C,D Only 4.0,£, F Only oO000®@ None of the Above S 3) Regarding post-partum depression? A) Itisasevereformof — *10/10 postpartum blues 8) Antidepressants are not safe in breast feeding ©) It can result in infanticide) It can result in infanticide E) A referral to psychiatry is essential © 1-Allofthe Above O 2.4,8,Conly © 2.8,¢,pony @ 4.¢,0,E only ¥v CO 5.None of the AboveY 4) A 17-year-old girl has been admitted to the medical ward following an overdose of 20 tablets of Paracetamol, Which of the following is/are important in assessing suicidal risk? A) Presence of a suicidal note 8) Informing friends following the act C) How she feels about the overdasenow D) Her future plans _£) Previous attempts to end her life @ 1.Allof the Above O 2.A.8,conly O 3.¢,0,£0nly O 4.06 F only © 5.None of the Above v5) An80-year-old female with fever is admitted to the medical ward. She appears confused and thinks she is in a temple and not the hospital. She is trying to get down from her bed and leave the ward. The family says she has no past psychiatric illnesses and she was cognitively intact till 3 days ago. Her husband passed away 2 months ago. What is the Diagnosis? © 1. Adult-onset psychosis © 2.Complex partial seizures ©@ 3. Delirium O 4. dementia © 5. Pathological grief reaction MCQs in Anaesthesia and Critical 50 of 50 “1010 “ori0 pointsTotal Marks = 50 S OoO0o0@0 Oo@m@~oo°o 1) Please select the CORRECT statements Regarding the fluid oni management in ICU A) Balanced crystalloids are preferred over colloids for resuscitation in ICU B) Excessive infusion of Ringer's lactate solution risks hyperchloremic metabolicacidosis. C) The preferred way to assess the fluid responsiveness is passive leg raising test. D) Preferred dose of fluid bolus in patients with sepsis is 30 mi/kg. ) 5% Dextrose is a suitable fluid for resuscitation. A.BC A,C,D weft B,D CDE All of the Above 2) Please select the CORRECT statements. Due to over inflation of the *10/10 endotracheal tube cuff, which of the following would likely occur? A) Airleakage. B)Laryngospasm C) Silent aspiration. D) Mucosal ischemia. £) Tracheal stenosis A,B,C ACD B,C,D CDE v All of the AboveY 3) Please select the CORRECT statements. Which one of the following *10/10 are included in the Oxygen delivery equation. A) Pa02. B)CVP. C) Cardiac out put. D) Oxyhaemglobin. £) Paco2 Ons Osc @ac v Ocp One 4) Please select the CORRECT statements. Regarding infection control *10/10 in critically il, A) The three elements must be present for an infection to occur are source, transmission and host. 8) Hand hygiene is the single most important effective action to minimize transmission of infection. C) Removal of used needle from the syringe by hand is a safe methad of handling of sharps. D) Implement of all the elements of a care bundle has a better outcome than if performed each element individually. £) Cardiopulmonary resuscitation is not an aerosol generating procedure. @ aso a O 8.60 Oacp Ocpe O BoeY 5) Please select the CORRECT statements. A) Leadillis the most “10/10 regularly monitored ECG lead in the ICU, as itis the best lead to monitor for arthythrnias _B) Ina patient with labile blood pressure on two inotropes in ICU the best way to monitor blood pressure is to do automated non invasive blood pressure measurements with 3 min intervals C) Arterial lines can be used to give emergency medication toa critically il patient) You would expect to maintain a urine output above 0.5mi/kg/h in a critically ill patient £) Measuring ETCO2 will allow you to detect critical events such as severe hypotension and pulmonary embolism early Oas Ose Oop @ ve v © None of the Above MCQs in Internal Medicine 45 of 80 points Total Marks = 80VY 1)Please indicate the correct statement in relation to below questions in *5/5 Maternal Medicine 1. Nausea and Vomiting in Pregnancy with the triad of more than 3% pre-pregnancy weight loss, dehydration and electrolyte imbalance is defined as Hyperemesis gravidarum. 2. In hyperglycaemia in Pregnancy, target Fasting Blood Sugar value is less than 1126 mg/dL. and the 2 hour Post Prandial Blood Sugar value is less than 140 mg/dl. 3. Aspirin 1.50 mg daily should tbe added to all pregnant women with type 2 diabetes mellitus, if there are no contraindications. 4.V diazepam is the drug of choice for eclamptic fits during pregnancy. oo0@ 0 0 5. ACE inhibitors can be continued for chronic hypertension in pregnancy. x 2) Following parameters are suggestive of septic shock according to. *0/10 the quick sequential organ failure assessment A) Systolic blood pressure of 105mmHg 8) Respiratory rate 26/ minute ©) Pulse rate of 110/minute D) Temperature of 101F £) —_ Altered level of consciousness © A. True B. True C. True D. True E. True CO A-Falsee, True ©. True D, True E, True @ A False 8, Tue C. False D. True E. True x aS A. False B, True C. False D. False E. True © A. False B, False C, False D. False E. False®©®oOoo0o°0 < OoO®o00°0 3) 75 years old man taking warfarin following aortic valve replacement *10/10, presents with melaena. His systolic BP 105 mmHg, pulse 104, heamaglobin 90 g/L and and INR of 9. The following is the appropriate management Vitamin K, Fresh Frozen Plasma and observe Emergency endoscopy treatment if major stigmata present, Fresh Frozen Plasma to optimize Prothrombin Time followed by elective endoscopy but avoidance of endoscopic therapy. Fresh Frozen Plasma, Vitamin K followed by therapeutic endoscopy Fresh Frozen Plasma followed by endoscopy within 24hours and endoscopic 7 ‘therapy given if major stigmata of bleeding present 4) Seizures can be caused by: * 5/5 A. Brain injury that left scar tissue or other damage B. Infection that left scar tissue in or caused other damage to the brain C. Exposure to a toxic substance D. Malfunctioning gene v E.Allof the aboveY 5) 445 year old farmer is admitted to your unit. You are the medical *20/20 officer in the ward. He is found unconscious in the paddy field, one hour earlier. He is on treatment for a psychiatric illness but relatives are unaware about the medications. He is sweating profusely. Airway is not patent. There is lot of oral secretions. Saturation 91% on room ait, respiratory rate is 10/min, Examination of lungs reveal wheezing and bilateral crepitation. Pulse 50/min, BP 80/60 mmHg. GCS 5/15, no convulsions, Pupils are 1mm in size bilaterally, lower limb reflexes are normal His CBS: 150 mg/dL. What are the next steps in the immediate Management? 1) Arrange CT brain 2) Perform Gastric lavage 3) Arrange WBCT 4) Give Activated Charcoal 5) Atropine IV © A. True B. True C. True D. True E. True © A-FalseB, True ©. True D. Tue E. True © A False B. True ©. False D. True E. True rg © A. False B. True C. False D. False E. True © A. False B. False C. False D. False E. FalseX_ 6) A 60-year-old patient is admitted to the emergency department with “0/20 worsening dyspnoea for 36 hours. Initial assessment shows $02 on room air 95%, Blood pressure 100/70 mmHg, Pulse rate 110 beats/per/minute regular, Random blood glucose 170 mg/dL, Pitting ‘oedema up to just above ankle, Fine crepitations up to mid zones in both lungs, He weighs about 50kg, His medical records shows that he is currently on Aspirin 75mg nocte, Atorvastatin 20mg Nocte, Enalapril 5mg mane, Carvedilol 6.25mg BD, Metformin 500mg BD, Frusemide 40mg mane. His was HbA1c 7.5% and creatinine was 1.0mg/dl one month ago. The initial management for this patient should include A) Oxygen by face mask to keep Sp02 above 97% 8) Intravenous frusemide 40mg BD — C) Dobutamine 100,1g/minute intravenous infusion _D) Noradrinaline 1 0ug/minute intravenous infusion —E) Metformin 500mg BD @ A. Te B. True C. True D. True E. True * © A False. True ©. True D. True E. True © A. False B. True ©. False D. True E. True wa. False B, True ©. False D. False E. True © A False 8. False ©. False D. False E. False Feedback Incorrect,x 7) Whats the CORRECT statement regarding Acute Headache * ons 1. Thunderclap headache is always due to a serious pathology 2. Commonest primary headache is Migraine x 3. Lumbar puncture cannot be done without CT brain in suspected Meningitis patient oo0o@0 4. Notpaal CT brain always excludes sinister pathology IRI Headache protocol is a time consuming procedure than CT brain % 8) Whatis the INCORRECT statement regarding Leptospirosis *5/5 followings are True or False? 1 Early rise in S. Creatinine helps to differentiate leptospirosis from other causes of acute febrile ilinesses. 2. Mortality due to pulmonary hemorrhage is low. v 4, Pulmonary hemorrhage is a result of immune mediated injury rather than 3° © © 2.oten severe leptospirosis mimics features of bacterial sepsis, ° coagulopathy. Oo 5. Early use of antibiotics is beneficial in improving outcome. nistration and N 3 Total Marks = 50S Oo@o00°0 S ®©o0oo0od0 1) What is the INCORRECT statement regarding the rules and regulations. *5/5 of the Internship Internship is a training attachment Intern is under the disciplinary control of Sri Lanka Medical Council Intern is under the adrministrative control of Head of the Institution Can engage in Private Practice we Should maintain a diary as a proof of attendance 2) What is the INCORRECT statement regarding the leave duringthe *5/ Internship. Leave is entitled for total of 14 days during the year (2 days per month) In an illness, leave should be covered by a medical certificate and approved by sLMC Arrangement for cover-up and approval from the supervisor and the Head of the institution is a must Minimum period of Maternity Leave of 28 days MUST be obtained SLMC Full Registration will NOT be delayed for any kind of approved leave beyond 14 daysoO 3) Which of the Following Statements are CORRECT? * 5/5 Urgent, but NOT important work Must be done by yourself for efficient Time Management When ordering investigations, you can easily request pre-determined set of investigations for each condition Once you get your MBBS degree, you can finish learning, unless you want to do a Post Graduate Exam If any practical problem arises it is OK to ask from a supportive staff, who were im the ward before you. Patient Safety Incidents can be prevented by Root Cause Analysis and will NOT. happen in Good Healthcare Systems 4) What is the INCORRECT statement regarding the Disciplinary Matters * 5/5 with the Initiation of an inquiry Deprivation of ALL PRIVILEGES until investigation is over If the Punishment given, you will be deprived of a SATISFACTORY Service Interns must be abide by the government (Establishment Code, Financial Regulations, Circulars etc..) Not adhering to Circular on Maintaining the Diary is One of the commonest method of entangling with a disciplinary inquiry for a Medical Officer Once you are on inquiry or given a punishment following an inquiry, stil you are V7 entitled for the Vehicle PermitoOo 0 08 S @o0o00o0o 5) What is the INCORRECT statement regarding the Medico-Legal duties *5/5 during the Internship Can issue Medical Certificates for any person EVEN outside your care / ward = In proper documentation, writing the Date and Time is a MUST MUST issue a Diagnosis Card and X-Rays even to Patients Leaving Against Medical Advice MUST INFORM all the suspected Medico Legal Cases to Police, as you are NOT the investigator MUST record Dying Declaration in presence of a witness and handed over to the Head of the institution in a sealed cover, in the absence of Police 6) Out of the following Cases, which are NOT required to inform the *5/5 Police WITHOUT DELAY ‘Accused Persons of Crime (abortion, drunken people) Victims of Road Traffic Injuries Victims of Domestic Violence Vietims of Crime (Child Abuse, Elderly Abuse, Sexual Abuse, Assaults) ‘Surviving Patients with attempted suicide YvX_ 7) Out of the following deaths, which are NOT required to order an inquest Oo Deaths in suspicious circumstances Deaths occurring within 24 hours of admission Suspected Medical Negligence On the request of relatives Suicidal Deaths @oo 33 8) When writing the "Cause of Death’ * Modes of deaths such as "Cardio-Respiratory Arrest" can be written cause Should be written in WHO format (ia, ib and Il) in 833 Format cause can be given oO0o@o 0 Death When Cause of Death is NOT known, no need to order an inquest and probable “ors 5/5 When writing the ill defined cases such as "Sepsis", No need to write the underlying v It is recommended to write ill-defined cause such as “Liver Failure” as the Cause of9) Whatis the INCORRECT statement regarding "Preventive Health Care"* 0/5 Divisional level authority of the Preventive Health Care is the "Medical Officer of th" Oo otification Form (H544) must be filled and send after the confirmation of a Notifiable Disease in a Patient Public Health Midwife is responsible for field level Maternal and Child Health >< care Oo © Public Health Inspector is responsible for surveillance of Communicable Diseases Hospitals will get referrals from MOH Central Clinic, Field Clinic as well as domiciliary care Oo < 10) What are the probable referrals, that Hospitals will get from the *5/5 “Preventive Health Care", which you should attend and provide services. Please state the INCORRECT referral From Ante Natal Clinic for a Pregnant Mother with High Blood Pressure From Vaccination Clinic for child with a Adverse Events Following Immunization From School Medical Inspection for a School child with Suspected Cardiac Murmur From Well Women Clinic for a woman with a Suspected Breast Lump From Healthy Life Style Clinic for a 22 year old man with acute NCD suchas Road Traffic Injuries ®@®@ooo0oo ‘This content is neither created nor endorsed by Google. -Terms of Service Privacy Policy Google Forms