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Question 1
Incorrect
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A 17-year-old boy presents to the emergency after being involved in a fight outside a club and being beaten with a baseball bat. Under observation his GCS deteriorates, and he becomes comatose. Which of the following parameters are most likely to be present during this condition?
Your Answer: Hypotension and bradycardia
Correct Answer: Hypertension and bradycardia
Explanation:Cushing reflex is a physiological nervous system response to increased intracranial pressure (ICP) that results in Cushing’s triad of increased blood pressure, irregular breathing, and bradycardia. It is usually seen in the terminal stages of acute head injury and may indicate imminent brain herniation. It can also be seen after the intravenous administration of epinephrine and similar drugs.
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This question is part of the following fields:
- Emergency Medicine
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Question 2
Correct
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A 5 year old boy falls into the swimming pool whilst playing and almost drowns. His parents start BLS and transfer him to the emergency department. You attach him to the cardiac monitoring and you notice ventricular fibrillation. You immediately start on CRP algorithm for shockable rhythms. Which of the following may result in a poor defibrillation response?
Your Answer: Hypothermia
Explanation:Guidelines suggest that when hypothermia manifests in the context of a shockable rhythm, it might get harder to defibrillate. Therefore, defibrillation is recommended to occur at temperatures below 30°C, and to be limited in three shocks.
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This question is part of the following fields:
- Emergency Medicine
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Question 3
Correct
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A 14 year old boy is suspected of having CSF rhinorrhoea after sustaining a basal skull fracture. Which laboratory test would be able to accurately detect the presence of CSF?
Your Answer: Beta 2 transferrin assay
Explanation:Answer: Beta 2 transferrin assayBeta-2-transferrin is a protein found only in CSF and perilymph. Since 1979, beta-2-transferrin has been used extensively by otolaryngologists in the diagnosis of CSF rhinorrhoea and skull-base cerebrospinal fluid fistulas. With sensitivity of 94% – 100%, and specificity of 98% – 100%, this assay has become the gold standard in detection of CSF leakage. CSF rhinorrhoea is characterized by clear or xanthochromic watery rhinorrhoea that may not become apparent until nasal packing is removed.
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This question is part of the following fields:
- Emergency Medicine
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Question 4
Correct
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What is the most probable diagnosis for an infant presenting with prolonged neonatal jaundice, dark urine, and pale stools?
Your Answer: Biliary atresia
Explanation:Biliary atresia is a rare condition that causes obstructive jaundice. Without surgical treatment, e.g. Roux-en-Y, Kasai procedure or liver transplantation, death is likely by 2 years of age. The aetiology of biliary atresia is unknown. Theories suggest a multitude of etiological and causative factors that are both genetic and acquired.The other conditions do not cause a conjugated hyperbilirubinemia.
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This question is part of the following fields:
- Emergency Medicine
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Question 5
Correct
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An 8-year-old girl was bought immediately to the emergency department. She is fully conscious but has stridor, is wheezing and has a generalised erythematous rash. She has known allergies. What is the single immediate management?
Your Answer: Give 0.3ml in 1000 adrenaline by IM injection
Explanation:This is a case of an anaphylactic reaction that requires immediate intervention. IM adrenaline dose for 6-12 year old children is 300 micrograms IM.
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This question is part of the following fields:
- Emergency Medicine
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Question 6
Incorrect
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A 12-year-old boy sustains a fracture to the medial third of his clavicle following a fall from his bicycle.Which vessel is at the highest risk of injury?
Your Answer: Subclavian artery
Correct Answer: Subclavian vein
Explanation:Being anatomically situated immediately posterior to the subclavius muscle and the medial part of the clavicle, the subclavian vein is at the highest risk of injury in the above patient.As a direct tributary of the brachiocephalic vein, it’s injury poses a high risk of massive bleeding.The brachiocephalic vein rests on the first rib, below and in front of the third part of the subclavian artery, and then on scalenus anterior which separates it from the second part of the artery (posteriorly).Anatomy of the clavicle:The clavicle extends from the sternum to the acromion and helps prevent the shoulder falling forwards and downwards.
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This question is part of the following fields:
- Emergency Medicine
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Question 7
Correct
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A severe asthma exacerbation according to the British Thoracic Society suggests an oxygen saturation that is less than:
Your Answer: 92%
Explanation:In an acute and severe asthma attack the child cannot complete sentences in one breath because they are too breathless. The O2 saturation is less than 92% and PEF is between 33-50% best or predicted. In children that are 2-5 years old, HR is more than 140 bpm and more than 125 bpm in those older than 5 years old. The RR in children between 2-5 years old is more than 40/min, and more than 30/min in those older than 5 years old.
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This question is part of the following fields:
- Emergency Medicine
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Question 8
Correct
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A 16 year old dies in a road traffic accident. What is the mortality proportion attributed to accidents in this age group?
Your Answer: 40-50%
Explanation:Deaths by age group: 60% <1 year – due mainly to congenital, neonatal, and infection related problems.10% 1-4 years – due to accident (15%), cancer (15%), or congenital problems (14%)18% 15-19 years – accidental (42%) accidents reflect increased risk taking
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This question is part of the following fields:
- Emergency Medicine
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Question 9
Correct
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A 10-month-old infant is brought to the hospital with a 3-day history of frequent watery stools and vomiting. On examination, she is found to be dehydrated and is refusing to drink in the emergency department.What would be the most appropriate course of action for this child?
Your Answer: Admit for enteral rehydration via a nasogastric tube
Explanation:The most appropriate step in this patient would be to admit the patient for enteral rehydration via a nasogastric tube.Enteral rehydration:Oral rehydration is the most preferred way of rehydrating children. If a child is not tolerating small-frequent-feeds, then nasogastric rehydration is an underused next best step. The fluid can be run through a continuous pump so that it is better tolerated. Note:Intravenous fluids are effective but can have profound effects on the serum electrolyte balance if not monitored closely. Most children will tolerate fluids in an emergency department, but failure to take fluids orally is not an indication for intravenous therapy.
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This question is part of the following fields:
- Emergency Medicine
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Question 10
Correct
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A 2-year-old boy was admitted in the A&E with a history of a 38.4°C fever and 15 minute tonic clonic seizure episode at home. However, he is conscious now, his temperature is normal and the fit has stopped. What is the most likely diagnosis?
Your Answer: Febrile convulsion
Explanation:Febrile seizures are convulsions that can happen when a child, most often between the ages of six months and three years, has a fever. They usually last for less than five minutes and although the child may lose consciousness, they are relatively harmless. However, sometimes they can last for up to 15 minutes and when they are termed complex febrile seizures.
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This question is part of the following fields:
- Emergency Medicine
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SESSION STATS - PERFORMANCE PER SPECIALTY
