-
Question 1
Incorrect
-
Large numbers of casualties are observed after a suspected CBRN (chemical, biological, radiological, and nuclear) incident. It is believed that sarin gas is the responsible agent. Which combination of clinical features is most likely to be present?
Your Answer: Blistering skin lesions and burning sensation in nose, throat and eyes
Correct Answer: Miosis, bronchorrhoea, salivation and muscle weakness
Explanation:The nerve agents, also known as nerve gases, are a group of highly toxic chemical warfare agents that were initially developed just before and during World War II.
The first compounds to be created are called the G agents (G stands for German, as they were discovered and synthesized by German scientists). These include Tabun (GA), Sarin (GB), and Soman (GD).
In the 1950s, the V agents (V stands for venomous) were synthesized and are approximately 10 times more poisonous than sarin. These include Venomous agent X (VX), Venomous agent E (VE), Venomous agent G (VG), and Venomous agent M (VM).
One of the most well-known incidents involving the use of a nerve agent was the March 1995 Tokyo subway sarin attack. During this attack, Sarin was released into the Tokyo subway system during rush hour. As a result, over 5,000 people sought medical attention. Among them, 984 were moderately poisoned, 54 were severely poisoned, and 12 died.
Nerve agents are organophosphorus esters that are chemically related to organophosphorus insecticides. They work by inhibiting acetylcholinesterase (AChE), an enzyme that breaks down the neurotransmitter acetylcholine (ACh). This leads to an accumulation of ACh at both muscarinic and nicotinic cholinergic receptors.
Nerve agents can be absorbed through any body surface. When dispersed as a spray or aerosol, they can be absorbed through the skin, eyes, and respiratory tract. When dispersed as a vapor, they are primarily absorbed through the respiratory tract and eyes. If a sufficient amount of agent is absorbed, local effects are followed by generalized systemic effects.
The clinical features observed after exposure are a result of a combination of muscarinic, nicotinic, and central nervous system effects.
Muscarinic effects (DUMBBELS):
– Diarrhea
– Urination
– Miosis
– Bronchorrhea
– Bronchospasm
– Emesis
– Lacrimation
– Salivation
Plus bradycardia and hypotension.Nicotinic effects:
– Sweating
– Tremor
– Fasciculations
– Muscle weakness
– Flaccid paralysisCentral nervous system effects:
– Agitation and irritability
– Amnesia
– Ataxia
– Respiratory -
This question is part of the following fields:
- Major Incident Management & PHEM
-
-
Question 2
Correct
-
There are numerous casualties reported after a suspected CBRN (chemical, biological, radiological and nuclear) incident, with a high likelihood of sarin gas being the responsible agent. In the management of this situation, certain casualties are administered pralidoxime as an antidote.
What is the mode of action of pralidoxime?Your Answer: Reactivating acetylcholinesterase
Explanation:The primary approach to managing nerve gas exposure through medication involves the repeated administration of antidotes. The two antidotes utilized for this purpose are atropine and pralidoxime.
Atropine is the standard anticholinergic medication employed to address the symptoms associated with nerve agent poisoning. It functions as an antagonist for muscarinic acetylcholine receptors, effectively blocking the effects caused by excessive acetylcholine. Initially, a 1.2 mg intravenous bolus of atropine is administered. This dosage is then repeated and doubled every 2-3 minutes until excessive bronchial secretion ceases and miosis (excessive constriction of the pupil) resolves. In some cases, as much as 100 mg of atropine may be necessary.
Pralidoxime (2-PAMCl) is the standard oxime used in the treatment of nerve agent poisoning. Its mechanism of action involves reactivating acetylcholinesterase by scavenging the phosphoryl group attached to the functional hydroxyl group of the enzyme, thereby counteracting the effects of the nerve agent itself. For patients who are moderately or severely poisoned, pralidoxime should be administered intravenously at a dosage of 30 mg/kg of body weight (or 2 g in the case of an adult) over a period of four minutes.
-
This question is part of the following fields:
- Major Incident Management & PHEM
-
-
Question 3
Incorrect
-
In the aftermath of a suspected CBRN (chemical, biological, radiological, and nuclear) incident, where sarin gas is believed to be the responsible agent, healthcare workers are faced with a significant number of casualties. What is the primary focus for healthcare workers when responding to the scene of a CBRN event?
Your Answer: Early skin decontamination
Correct Answer: The wearing of adequate personal protective equipment
Explanation:Healthcare workers responding to contaminated casualties must prioritize their own safety by wearing appropriate personal protective equipment. This is crucial because secondary contamination can occur. Additionally, if working in contaminated areas, healthcare workers should maximize ventilation and use breathing equipment. Ensuring the safety of healthcare workers is essential as they cannot effectively help the casualties without it.
The first step in managing contaminated casualties is early skin decontamination. It is important to move the casualties to a safe area and remove all contaminated clothing to minimize further exposure. The skin should then be thoroughly rinsed with water to physically remove the nerve agent. After rinsing, it should be washed with an alkaline solution of soap and water or a 0.5% hypochlorite solution to chemically neutralize the nerve agent. To prevent ongoing absorption through the eyes, contact lenses should be removed and the eyes irrigated.
Resuscitation should be initiated using an ABCDE approach, and casualties should be supported and transferred to the hospital as quickly as possible. Ventilation may be necessary in some cases. Nerve agent antidote autoinjectors can be utilized, and the use of these should be guided by local policy for prehospital personnel.
-
This question is part of the following fields:
- Major Incident Management & PHEM
-
-
Question 4
Incorrect
-
A 40-year-old man has a history of a severe headache, high fever, and worsening drowsiness. He recently had flu-like symptoms but his condition deteriorated this morning, prompting his partner to call the GP for a home visit. The man exhibits significant neck stiffness and sensitivity to light, and the GP observes the presence of a petechial rash on his arms and legs. The GP contacts you to arrange for the patient to be transferred to the Emergency Department and requests an ambulance.
What is the MOST appropriate next step for the GP to take in managing this patient?Your Answer: Give oral penicillin V 1000 mg
Correct Answer: Give IM benzylpenicillin 1.2 g
Explanation:This woman is displaying symptoms and signs that are consistent with a diagnosis of meningococcal septicaemia. In the United Kingdom, the majority of cases of meningococcal septicaemia are caused by Neisseria meningitidis group B.
In the prehospital setting, the most suitable medication and method of administration is intramuscular benzylpenicillin 1.2 g. This medication is commonly carried by most General Practitioners and is easier to administer than an intravenous drug in these circumstances.
For close household contacts, prophylaxis can be provided in the form of oral rifampicin 600 mg twice daily for two days.
-
This question is part of the following fields:
- Major Incident Management & PHEM
-
-
Question 5
Incorrect
-
A suspected CBRN (chemical, biological, radiological, and nuclear) event has resulted in a significant number of casualties. The primary clinical manifestations observed include restlessness, nausea and diarrhea, constricted airways, excessive production of saliva, profuse sweating, loss of muscle control, and seizures. Which of the following agents is the most probable cause for these symptoms?
Your Answer: Anthrax
Correct Answer: VX gas
Explanation:The symptoms observed in the casualties of this CBRN event strongly indicate exposure to a nerve agent. Among the options provided, VX gas is the only nerve agent listed, making it the most likely culprit.
Nerve agents, also known as nerve gases, are a highly toxic group of chemical warfare agents that were developed just before and during World War II. The initial compounds in this category, known as the G agents, were discovered and synthesized by German scientists. They include Tabun (GA), Sarin (GB), and Soman (GD). In the 1950s, the V agents, which are approximately 10 times more poisonous than Sarin, were synthesized. These include Venomous agent X (VX), Venomous agent E (VE), Venomous agent G (VG), and Venomous agent M (VM).
One of the most well-known incidents involving a nerve agent was the Tokyo subway sarin attack in March 1995. During this attack, Sarin was released into the Tokyo subway system during rush hour, resulting in over 5,000 people seeking medical attention. Among them, 984 were moderately poisoned, 54 were severely poisoned, and 12 lost their lives.
Nerve agents are organophosphorus esters that are chemically related to organophosphorus insecticides. They work by inhibiting acetylcholinesterase (AChE), an enzyme responsible for breaking down the neurotransmitter acetylcholine (ACh). This inhibition leads to an accumulation of ACh at both muscarinic and nicotinic cholinergic receptors.
Nerve agents can be absorbed through any body surface. When dispersed as a spray or aerosol, they can enter the body through the skin, eyes, and respiratory tract. In vapor form, they are primarily absorbed through the respiratory tract and eyes. If a sufficient amount of the agent is absorbed, it can cause local effects followed by systemic effects throughout the body.
The clinical symptoms observed after exposure to nerve agents are a result of the combined effects on the muscarinic, nicotinic, and central nervous systems. Muscarinic effects, often remembered using the acronym DUMBBELS, include diarrhea, urination, miosis (constriction of the pupils), bronchorrhea (excessive mucus production in the airways), bronchospasm (narrowing of the airways), emesis (vomiting), lacrimation (excessive tearing), and salivation.
-
This question is part of the following fields:
- Major Incident Management & PHEM
-
-
Question 6
Correct
-
Which of the following organizations is classified as a Category 2 entity according to the Civil Contingencies Act 2004 in the UK?
Your Answer: The Health and Safety Executive
Explanation:The Civil Contingencies Act 2004 establishes a framework for civil protection in the United Kingdom. This legislation categorizes local responders to major incidents into two groups, each with their own set of responsibilities.
Category 1 responders consist of organizations that play a central role in responding to most emergencies, such as the emergency services, local authorities, and NHS bodies. These Category 1 responders are obligated to fulfill a comprehensive range of civil protection duties. These duties include assessing the likelihood of emergencies occurring and using this information to inform contingency planning. They must also develop emergency plans, establish business continuity management arrangements, and ensure that information regarding civil protection matters is readily available to the public. Additionally, Category 1 responders are responsible for maintaining systems to warn, inform, and advise the public in the event of an emergency. They are expected to share information with other local responders to enhance coordination and efficiency. Furthermore, local authorities within this category are required to provide guidance and support to businesses and voluntary organizations regarding business continuity management.
On the other hand, Category 2 organizations, such as the Health and Safety Executive, transport companies, and utility companies, are considered co-operating bodies. While they may not be directly involved in the core planning work, they play a crucial role in incidents that impact their respective sectors. Category 2 responders have a more limited set of duties, primarily focused on cooperating and sharing relevant information with both Category 1 and Category 2 responders.
For more information on this topic, please refer to the Civil Contingencies Act 2004.
-
This question is part of the following fields:
- Major Incident Management & PHEM
-
-
Question 7
Incorrect
-
There is a high number of casualties reported after a suspected CBRN (chemical, biological, radiological, and nuclear) incident. It is believed that sarin gas is the responsible agent. Which of the following antidotes can be administered for sarin gas exposure?
Your Answer: Pyridoxine
Correct Answer: Pralidoxime
Explanation:The primary approach to managing nerve gas exposure through medication involves the repeated administration of antidotes. The two antidotes utilized for this purpose are atropine and pralidoxime.
Atropine is the standard anticholinergic medication employed to address the symptoms associated with nerve agent poisoning. It functions as an antagonist for muscarinic acetylcholine receptors, effectively blocking the effects caused by excessive acetylcholine. Initially, a 1.2 mg intravenous bolus of atropine is administered. This dosage is then repeated and doubled every 2-3 minutes until excessive bronchial secretion ceases and miosis (excessive constriction of the pupil) resolves. In some cases, as much as 100 mg of atropine may be necessary.
Pralidoxime (2-PAMCl) is the standard oxime used in the treatment of nerve agent poisoning. Its mechanism of action involves reactivating acetylcholinesterase by scavenging the phosphoryl group attached to the functional hydroxyl group of the enzyme, thereby counteracting the effects of the nerve agent itself. For patients who are moderately or severely poisoned, pralidoxime should be administered intravenously at a dosage of 30 mg/kg of body weight (or 2 g in the case of an adult) over a period of four minutes.
-
This question is part of the following fields:
- Major Incident Management & PHEM
-
-
Question 8
Incorrect
-
There has been a car accident involving multiple individuals near the hospital where you are currently employed. You are part of the team responsible for initial assessment at the scene of the incident.
Who among the following patients would be classified as P3 status?Your Answer: A patient with a fractured femur that requires significant medical intervention
Correct Answer: A ‘walking wounded’ patient with minor injuries requiring treatment
Explanation:Triage is a crucial process that involves determining the priority of patients’ treatment based on the severity of their condition and their chances of recovery. Its purpose is to ensure that limited resources are used efficiently, maximizing the number of lives saved. During a major incident, primary triage takes place in the bronze area, which is located within the inner cordon.
In the context of a major incident, priorities are assigned numbers from 1 to 3, with 1 being the highest priority. These priorities are also color-coded for easy identification:
– P1: Immediate priority. This category includes patients who require immediate life-saving intervention to prevent death. They are color-coded red.
– P2: Intermediate priority. Patients in this group also require significant interventions, but their treatment can be delayed for a few hours. They are color-coded yellow.
– P3: Delayed priority. Patients in this category require medical treatment, but it can be safely delayed. This category also includes walking wounded individuals. The classification as P3 is based on the motor score of the Glasgow Coma Scale, which predicts a favorable outcome. They are color-coded green.The fourth classification is for deceased individuals. It is important to identify and classify them to prevent the unnecessary use of limited resources on those who cannot be helped. Dead bodies should be left in their current location, both to avoid wasting resources and because the area may be considered a crime scene. Deceased individuals are color-coded black.
-
This question is part of the following fields:
- Major Incident Management & PHEM
-
-
Question 9
Correct
-
There are numerous casualties reported after a suspected CBRN (chemical, biological, radiological and nuclear) incident, with indications pointing towards sarin gas as the responsible agent. In the management of this situation, certain casualties are administered atropine as an antidote.
What is the mode of action of atropine?Your Answer: Muscarinic acetylcholine receptor antagonist
Explanation:The primary approach to managing nerve gas exposure through medication involves the repeated administration of antidotes. The two antidotes utilized for this purpose are atropine and pralidoxime.
Atropine is the standard anticholinergic medication employed to address the symptoms associated with nerve agent poisoning. It functions as an antagonist for muscarinic acetylcholine receptors, effectively blocking the effects caused by excessive acetylcholine. Initially, a 1.2 mg intravenous bolus of atropine is administered. This dosage is then repeated and doubled every 2-3 minutes until excessive bronchial secretion ceases and miosis (excessive constriction of the pupil) resolves. In some cases, as much as 100 mg of atropine may be necessary.
Pralidoxime (2-PAMCl) is the standard oxime used in the treatment of nerve agent poisoning. Its mechanism of action involves reactivating acetylcholinesterase by scavenging the phosphoryl group attached to the functional hydroxyl group of the enzyme, thereby counteracting the effects of the nerve agent itself. For patients who are moderately or severely poisoned, pralidoxime should be administered intravenously at a dosage of 30 mg/kg of body weight (or 2 g in the case of an adult) over a period of four minutes.
-
This question is part of the following fields:
- Major Incident Management & PHEM
-
-
Question 10
Incorrect
-
There has been a car accident involving multiple individuals near the school where you are currently teaching. You are working as part of the team conducting initial triage at the scene of the incident.
Which of the following statements about initial triage at the scene of a major incident is accurate?Your Answer:
Correct Answer: P3 patients will need medical treatment, but this can safely be delayed
Explanation:Triage is a crucial process that involves determining the priority of patients’ treatment based on the severity of their condition and their chances of recovery. Its purpose is to ensure that limited resources are used efficiently, maximizing the number of lives saved. During a major incident, primary triage takes place in the bronze area, which is located within the inner cordon.
In the context of a major incident, priorities are assigned numbers from 1 to 3, with 1 being the highest priority. These priorities are also color-coded for easy identification:
– P1: Immediate priority. This category includes patients who require immediate life-saving intervention to prevent death. They are color-coded red.
– P2: Intermediate priority. Patients in this group also require significant interventions, but their treatment can be delayed for a few hours. They are color-coded yellow.
– P3: Delayed priority. Patients in this category require medical treatment, but it can be safely delayed. This category also includes walking wounded individuals. The classification as P3 is based on the motor score of the Glasgow Coma Scale, which predicts a favorable outcome. They are color-coded green.The fourth classification is for deceased individuals. It is important to identify and classify them to prevent the unnecessary use of limited resources on those who cannot be helped. Dead bodies should be left in their current location, both to avoid wasting resources and because the area may be considered a crime scene. Deceased individuals are color-coded black.
-
This question is part of the following fields:
- Major Incident Management & PHEM
-
00
Correct
00
Incorrect
00
:
00
:
00
Session Time
00
:
00
Average Question Time (
Secs)