MCEM Toxicology MCQ

MCEM Toxicology MCQ
1. Features of opiate withdrawal include: (a) Yawning. (b) Dilated pupils. (c) Auditory hallucinations. (d) Visual hallucinations. (e) Vomiting. Opiate withdrawal is associated with increased blood pressure, heart rate, lacrimation, rhinorhea, yawning, goosebumps, insomnia, aches and pains. 2. Hypercapnia may be caused by: (a) Hyperventilation. Hypoventilation causes hypercapnia. (b) Brainstem lesions. Depressed central respiratory drive. (c) Tetanus. Endogenous toxins such as tetanus can cause hypercapnia. (d) Botulism. Botulism is a neuromuscular toxin which causes neuromuscular impairment. (e) Organophosphate poisoning. Organophosphates are neuromuscular toxins which cause neuromuscular impairment. 3. Emergency complications of malignancy: (a) PR examination is relatively contraindicated in neutropaenic patients. PR examination is relatively contraindicated in neutropaenic patients.PR should be withheld until anti-biotics are administered because of the risk of infection. (b) The untreated mortality of neutropaenic ( <500/ul ) febrile patients is 10% The untreated mortality of neutropaenic ( <500/ul ) febrile patients is 50%. (c) Due to an impaired inflammatory response in neutropaenic patients the usual findings of infection are not as prominent. Due to an impaired inflammatory response in neutropaenic patients the usual findings of infection are not as prominent. (d) Granulocytopenia may expediate the development of a consolidation on chest X Ray. Granulocytopenia may preclude development of a visible infiltrate on chest X Ray and so the clinician may need to rely on physical findings. (e) The incidence of meningitis is not increased with neutropenia. The incidence of meningitis is not increased with neutropenia. 4. Vomiting may be associated with: (a) Metabolic alkalosis. Tru e Fals e Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e
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MCEM Toxicology MCQ

Metabolic alkalosis is a result of loss of HCL from the stomach. (b) Alkaline urine. The urine is alkaline due to preservation of H+ ions. (c) Raised plasma chloride levels. (d) Hyperkalaemia. Vomiting is associated with hypokalaemia. (e) Elevated blood urea. Secondary to volume depletion. 5. Hypokalaemia (a) Hypokalaemia causes hyporeflexia. (b) Hypokalaemia may cause a prolongation of the QT interval, ST segment depression and U waves. (c) The most common cause of hypokalaemia is loop diuretics (d) Renal artery stenosis is a cause of hypokalaemia because of renal losses. (e) L-Dopa is a cause of hypokalaemia. Signs and symptoms of hypokalaemia usually occur at levels less than 2.5 mEq/L Hypokalaemia causes hyporeflexia. Hypokalaemia may cause ileus. Hypokalaemia may cause worsening of digoxin toxicity and dysrhythmias. Hypokalaemia may cause a prolongation of the QT interval, ST segment depression and U waves. Hypokalaemia may cause metabolic alkalosis. Hypercalcaemia may cause hypokalaemia due to renal losses of potassium. The most common cause of hypokalaemia is loop diuretics Licorice use may cause hypokalaemia. Postobstructive diuresis is a cause of hypokalaemia because of renal losses. Renal artery stenosis is a cause of hypokalaemia because of renal losses. Excessive tobacco chewing is a cause of hypokalaemia because of renal losses. Lithium is a cause of hypokalaemia. L-Dopa is a cause of hypokalaemia. No more than 40mmol of KCL should be added to 1L of IV fluids to replace potassium. 6. Hypokalaemia (a) Signs and symptoms of hypokalaemia usually occur at levels less than 2.5 mEq/L (b) Hypokalaemia may cause worsening of digoxin toxicity and dysrhythmias. (c) Hypercalcaemia may cause hypokalaemia due to renal losses of potassium (d) Postobstructive diuresis is a cause of hypokalaemia because of renal losses. (e) Lithium is a cause of hypokalaemia. Signs and symptoms of hypokalaemia usually occur at levels less than 2.5 mEq/L Hypokalaemia causes hyporeflexia. Hypokalaemia may cause ileus. Hypokalaemia Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e
MCEM Toxicology MCQ

may cause worsening of digoxin toxicity and dysrhythmias. Hypokalaemia may cause a prolongation of the QT interval, ST segment depression and U waves. Hypokalaemia may cause metabolic alkalosis. Hypercalcaemia may cause hypokalaemia due to renal losses of potassium. The most common cause of hypokalaemia is loop diuretics Licorice use may cause hypokalaemia. Postobstructive diuresis is a cause of hypokalaemia because of renal losses. Renal artery stenosis is a cause of hypokalaemia because of renal losses. Excessive tobacco chewing is a cause of hypokalaemia because of renal losses. Lithium is a cause of hypokalaemia. L-Dopa is a cause of hypokalaemia. No more than 40mmol of KCL should be added to 1L of IV fluids to replace potassium 7. Hyponatremia (a) The clinical manifestations of hyponatremia occur when the Na drops below 120 mEq/L (b) Hyponatremia may be caused by hyperglycaemia because of the osmotic diuresis involved. (c) The most common cause is salt and water loss in the urine with replacement by oral water. (d) The most common cause of hypertonic hyponatremia is hyperglycaemia (e) True hyponatremia presents with low osmolarity. The clinical manifestations of hyponatremia occur when the Na drops below 120 mEq/L Hyponatremia may be caused by hyperglycaemia because of the osmotic diuresis involved. The most common cause is salt and water loss in the urine with replacement by oral water. The most common cause of hypertonic hyponatremia is hyperglycaemia. True hyponatremia presents with low osmolarity. Factitious hyponatremia presents with normal or high osmolarity( hypertonic or isotonic hyponatremia ) 8. The following antibiotics inhibit folic acid metabolism: (a) Penicillins. (b) Monobactams. (c) Quinolones. (d) Quinolones. Trimethoprim is used most commonly in the treatment of urinary tract infections due to susceptible strains of E. coli, P. mirabilis, K. pneumoniae, Enterobacter sp and coagulase-negative Staphylococcus including S. saprophyticus. It may be used for acute otitis media in children, acute exacerbations of chronic bronchitis in adults, in combination with other agents for treatment of toxoplasmosis, and pneumocystis carinii. (e) Sulphonamides. Hearing loss more commonly occurs with peripheral causes of vertigo. Penicillin and monobactams inhibit cell wall synthesis. Quinolones inhibit DNA gyrase. Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e
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MCEM Toxicology MCQ

9. The features of chronic lead poisoning include (a) Inhibition of delta-aminolaevulinic acid dehydratase (b) Microcytic anaemia and punctate basophilia (c) Dysgeusia,constipation and abdominal pain (d) Gout and renal tubular acidosis (e) Peripheral neuropathy which is predominantly motor in type al Khayat A, Menon NS, Alidina MR: Acute lead encephalopathy in early infancy: Clinical presentation and outcome. Ann Trop Paediatr 17:39, 1997. Young children are the most susceptible group to lead poisoning. Encephalopathy is a major cause of morbidity and mortality and may begin with seizures and coma or develop slowly over weeks to months with decreased alertness and worsening memory leading to conditions such as mania, delirium, and cerebral edema. It has developed in infants with blood lead levels (PbB) of 70 ug/dL or lower. Gastrointestinal and hematologic manifestations occur more frequently with acute than with chronic poisoning, and the colicky abdominal pains may be associated with concurrent hemolysis. The characteristic bluis-grey lead lines occur after chronic exposure.. Lead toxicity also causes constitutional symptoms, including arthralgias, generalized weakness, and weight loss.Slower mental development has been noted in children whose umbilical cord had a level of 10ug/dL of lead. Patients may be asymptomatic despite high blood lead levels. 10. The following are common causes of anaphylaxis and anaphylactoid reactions in humans: (a) Vancomycin is an antibiotic commonly associated with anaphylaxis and anaphylactoid reactions. Vancomycin is an antibiotic commonly associated with anaphylaxis and anaphylactoid reactions. (b) Trimethoprim-Sulfamethoxazole is an antibiotic commonly associated with anaphylaxis and anaphylactoid reactions. Trimethoprim-Sulfamethoxazole is an antibiotic commonly associated with anaphylaxis and anaphylactoid reactions. (c) Soybeans Soybeans are commonly associated with anaphylaxis and anaphylactoid reactions. (d) Eggs Eggs are commonly associated with anaphylaxis and anaphylactoid reactions. (e) Shellfish Shellfish are commonly associated with anaphylaxis and anaphylactoid reactions. 11. Anaphylaxis in the Emergency Department: Y (a) It is appropriate to observe patients who suffer anaphylaxis for a period of 4 hours as they may have a reoccurrence because of a second round of mediator release. It is appropriate to observe patients who suffer anaphylaxis for a period of 4 hours as they may have a reoccurrence because of a second round of mediator release. (b) In anaphylaxis mediators are released from mast cells and basophils and this reaction is dependent on IgE. In anaphylaxis mediators are released from mast cells and basophils and this reaction is dependent on IgE. Tru e Fals e Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e
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MCEM Toxicology MCQ

(c) The recurrence rate for anaphylaxis from insect stings is about 50% The recurrence rate for anaphylaxis from insect stings is about 50% (d) About 10% of anaphylactic mortality occurs within the first hour About 50% of anaphylactic mortality occurs within the first hour (e) It is unhelpful to check histamine levels post a suspected anaphylactic reaction as they are elevated for about half an hour post reaction are often returning to normal levels by the time the patient presents to the ED. It is unhelpful to check histamine levels post a suspected anaphylactic reaction as they are elevated for about half an hour post reaction are often returning to normal levels by the time the patient presents to the ED. 12. Hypoglycaemic toxicology: (a) Sulphonylureas cause release of insulin from the pancreas. (b) Sulphonylureas reduce hepatic glucose production. (c) Sulphonylureas increase peripheral insulin sensitivity. (d) Sulphonylureas can cause hypoglycaemia for up to 16 hours after ingestion. (e) Metformin suppresses glucose output by the liver. And stimulates uptake in muscle. 13. Lithium poisoning (a) Hypokalaemia is a feature (b) Acute renal failure ( ARF ) is a common complication ARF is a rare complication (c) Coma is a poor prognostic indicator Clinical features include nausea, vomiting, diarrhoea, coarse tremor, apathy, and decreased consciousness. (d) Serum lithium levels correlate well with toxicity (e) Forced alkaline diuresis is a frequently used treatment It is important to maintain an appropriate urinary output but forced urinary alkalinisation should not be used. Haemodialysis may have a role with high serum concentrations. In acute overdose there is usually a delayed onset of symptoms of more than 12 hours owing to the slow entry of lithium into the tissues. 14. Drug induced cholestasis does not occur with (a) Chlorpromazine (b) Carbamazepine (c) Erythromycin Tru e Tru e Tru Fals e Fals e Fals Tru e Tru e Tru e Fals e Fals e Fals e
MCEM Toxicology MCQ

e (d) Sulphonylureas (e) Aspirin Tru e Tru e e Fals e Fals e
15. Paracetamol poisoning complications: (a) Hyperglycaemia. Hypoglycaemia occurs in paracetamol overdose secondary to liver failure. (b) GI bleeding. GI bleeding may occur secondary to liver failure which reduces the bodies clotting ability. (c) Lactic acidosis. Lactic acidosis may occur early or late with paracetamol overdose. (d) Pancreatitis. Pancreatitis may occur alone or with liver failure after paracetamol overdose. (e) Acute tubular necrosis. 16. Benzodiazepine overdose (a) Causes ataxia Benzodiazepine overdose account for about 40% of all drug overdosages in deliberate self poisoning (b) Causes pinpoint pupils (c) Is treated with naloxone Flumazenil is a benzodiazepine antagonist which may cause seizures in a patient dependent on benzodiazepines (d) Causes respiratory depression They potentiate the CNS depressant effects of other drugs taken with them such as alcohol (e) Is usually fatal. They produce drowsiness, dysarthria, ataxia, nystagmus, and sometimes coma Benzodiazepine overdose account for about 40% of all drug overdosages in deliberate self poisoning. They potentiate the CNS depressant effects of other drugs taken with them such as alcohol. They produce drowsiness, dysarthria, ataxia, nystagmus, and sometimes coma. Most patients recover within 24 hours. Mild hypotension and respiratory depression may occur with them. Flumazenil is a benzodiazepine antagonist which may cause seizures in a patient dependent on benzodiazepines. 17. Status Epilepticus: (a) Lorazepam 4mg Iv may only be given once. A subsequent 4mg dose may be given 5-10 min later. (b) Phenytoin infusion rates should be of the order of 50mg/min
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MCEM Toxicology MCQ

e 15-18mg/kg eg 1 g over 20 min. (c) 5% dextrose is not compatible with phenytoin. 5% dextrose is not compatible with phenytoin. (d) Patients on phenytoin require ECG monitoring. As phenytoin may cause dysrhythmias. (e) If seizures are continuing chlormethiazole should be initiated. Probably propofol or thiopentone if patient continues to seize. 18. Streptococcal toxic shock syndrome: (a) Portals of entry include pharynx, vagina, mucosa and skin. Group A streptococcus (GAS, eg, Streptococcus pyogenes) is an aerobic grampositive coccus that causes pharyngitis and a spectrum of skin and soft tissue infections such as impetigo, erysipelas, and localized cellulitis. (b) Is frequently associated with ARDS. Group A streptococcal TSS is mediated by exotoxins (superantigens) that can activate the immune system by bypassing the usual antigen-mediated immune response sequence resulting in the release of large quantities of inflammatory cytokines. The cytokines cause capillary leak and tissue damage, leading to shock and multiorgan failure. (c) Hypertension is a prominent feature. (d) Multiorgan involvement may present with generalised erythematous macular rash with desquamation. (e) Multiorgan involvement may cause a coagulopathy. http://www.cdc.gov/ncidod/EID/vol1no3/stevens.htm Diagnostic Criteria for Streptococcal Toxic Shock Syndrome include hypotension. Multiorgan involvement is characterised by 2 or more of the following, renal impairment, (creatinine level twice normal), coagulopathy, liver involvement,ARDS, Rash, soft tissue necrosis, including necrotising fasciitis or myositis or gangrene. 19. Salicylate poisoning (a) Can occur as a consequence of topical application. Occassionally salicylate poisoning follows the topical application of salicylic acid in keratolytics. (b) Both hypo and hypernatraemia occur (c) Is associated frequently with significant GI bleeds Significant GI bleeds are surprisingly rare. (d) Sweating is a typical feature (e) Tinnitus is a typical feature Aspirin is probably the commonest drug to be ingested deliberately in overdose. The typical features of salicylate toxicity are sweating, vomiting, epigastric pain, tinnitus, and blurring of vision. Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e Tru e Tru e Tru e e Fals e Fals e Fals e
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MCEM Toxicology MCQ

20. Environmental exposure to lead occurs (a) Principally from the inhalation of automobile fumes. (b) From the contamination of food and drink supplies Lead has also been found in drinking water. It can come from plumbing and fixtures that are either made of lead or have trace amounts of lead in them. (c) In children from eating lead based paint This is particularly a problem in older houses where the sweet-tasting lead paint is likely to chip, but deteriorating lead-based paint can also powder and be inhaled. Small children also tend to teethe and suck on painted windowsills as they look outside. (d) From lead water pipes and storage tanks Lead has also been found in drinking water. It can come from plumbing and fixtures that are either made of lead or have trace amounts of lead in them. (e) Environmental exposure to lead occurs normally in the UK resulting in blood lead levels of 100 ug/dL The average person has less than 10 micrograms per deciliter, or 100 parts per billion, ppb, of lead in their blood. 21. A virus: (a) Is able to replicate independently of the host. A virus requires cellular machinery to replicate. (b) Consists of a nucleic acid core and protein coat. A virus consists of a nucleic acid core and protein coat. (c) Is always enveloped by host membrane. Only some viruses are enveloped. (d) Causes tissue injury by direct cytopathic effects. Tissue injury can occur by direct cytopathic effects. (e) Can cause pathology through the incorporation of viral genes into the host DNA. Can cause pathology through the incorporation of viral genes into the host DNA. 22. Ranson's severity criteria on admission for acute pancreatitis include: (a) Glucose <11.0 mmol/L. Glucose >11.0 mmol/L. (b) LDH >350 IU/L. Others include age > 55years, WCC >16.0, AST >250 U/L and glucose >11.0. (c) Amylase >2500. Amylase is not one of Ranson?s criteria (d) PaO2 < 8kPa. This is one of the criteria at 48 hours, along with PCV decrease >10%, urea increase >1.8 mmol/L, Ca2+ <2 mmol/L, BE >4 mmol/L and fluid sequestration >6L. The presence of 1 to 3 criteria represents mild pancreatitis; the mortality rate rises significantly with four or more criteria. 23. The following are true with regard to a psoas abscess:
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MCEM Toxicology MCQ

(a) The most likely cause is potts disease. The most likey cause of a psoas abscess is potts disease due to tuberculosis of the lumbar spine. 90% of primary psoas abscesses ( not secondary to TB ) are associated with Staphylococcus aureus, although Escherichia coli, Haemophilus influenza and Proteus mirabilis have also been reported. (b) Late sequelae include amyloidosis. Late sequelae include amyloidosis(due to chronic inflammation) and sinus formation. (c) A psoas abscess in a patient with a normal ESR excludes tuberculosis as a cause. (d) The commonest site of the underlying infection is the mid thoracic spine. (e) Successful culture of infected pus taken from a psoas abscess is likely in more than 90 per cent of cases. The most likey cause of a psoas abscess is potts disease due to tuberculosis of the lumbar spine. Late sequelae include amyloidosis and sinus formation. In a cold abscess diagnostic culture is sometimes difficult. 24. Pancreatitis: (a) The inflammatory process can cause systemic effects because of the presence of cytokines, such as bradykinins and phospholipase A. The inflammatory process can cause systemic effects because of the presence of cytokines, such as bradykinins and phospholipase A. (b) Fat necrosis may cause hypercalcemia. Fat necrosis may cause hypocalcemia. (c) The incidence of acute pancreatitis ranges between 150-200 per 100,000 population. The incidence of acute pancreatitis ranges between 5 and 80 per 100,000 population. (d) Mild edematous pancreatitis occurs in about 80% of presentations, and the mortality rate is about 8%. Mild edematous pancreatitis occurs in about 80% of presentations, and the mortality rate is below 1%. (e) Because the pancreas is located in the retroperitoneal space with a fibrous capsule inflammation can spread easily. Because the pancreas is located in the retroperitoneal space with no capsule, inflammation can spread easily. 25. The following statements are true: (a) Normal intracranial pressure(ICP) is approximately 10mmHg. Intracranial pressure above 20 mmHg considered abnormal. (b) ICP can remain normal despite a space occupying lesion ICP can remain normal despite a space occupying lesion. (c) Cerebral perfusion pressure is independent of ICP. (d) Hypotensive patients tend to have a low ICP. Hypotensive patients tend to have a low ICP. (e) Autoregulation refers to maintenance of constant cerebral blood flow. Autoregulation refers to maintenance of constant cerebral blood flow. Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e Tru e Fals e
MCEM Toxicology MCQ

26. Acquired Platelet Disorders: (a) Low platelets due to alcohol misuse is generally irreversible. Chronic alcohol misuse is a common cause of low platelets and will often resolve if the patient abstains from drinking for a week or so. (b) Platelet transfusion should be considered for counts of less than 200,000/ul. Platelet transfusion should be considered for counts of less than 10,000/ul. (c) Hypothermia does not affect platelets. Hypothermia can cause splenic sequestration of platelets. (d) The mumps virus can cause platelet destruction. The mumps virus can cause platelet destruction, along with other viruses such as measles, varicella and HIV. (e) Platelet production may be decreased by Vitamin B12 or folate deficiency. Platelet production may be decreased by viral infections, drugs such as thiazides and oestrogens, and Vitamin B12 or folate deficiency as well as marrow infiltration and aplastic anaemia. 27. Infective Endocarditis: (a) The most common organism overall is staph aureus. The most common organism overall is staph aureus. (b) Prosthetic valve endocarditis represents a majority of cases Native valve endocarditis represents 60-70% of IE, IVDU associated IE 10-15%, and prosthetic valve endocarditis 15-30%. (c) Talc bombardment is thought to be responsible for endothelium injury in IVDUs. Normal endothelium is resistant to infection but turbulent flow, high pressure states, and talc bombardment may injury endothelium. (d) IVDU associated IE is normally caused by strep mirabilis. IVDU associated IE is normally caused by staph aureus in over 50% of cases. (e) Prosthetic valve endocarditis is defined as early if within the first 9 months post surgery. Prosthetic valve endocarditis is defined as early if within 6 months of surgery. Staph epidermidis is associated with early disease. 28. The following are true: (a) The line of the nipples is in the T4 dermatome. The line of the nipples is in the T4 dermatome. (b) The umbilicus lies in the T10 dermatome. The umbilicus lies in the T10 dermatome. (c) Peri-anal sensation is via the lower lumbar nerves. Peri-anal sensation is via the sacral nerves. (d) Shoulder abduction is via C5. The deltoid muscle root is C5. (e) Wrist flexors are supplied by C6. Wrist flexors are supplied by C7. Wrist extensors are supplied by C6. simple ankle strain(with damage to a few fibres of a ligament only) Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e
MCEM Toxicology MCQ

(a) Slight swelling True Slight swelling may develop almost immediately after injury. (b) Bruising False Bruising is associated with more severe injuries. (c) Joint instability False It would require major damage to cause joint instability. (d) Discomfort over the ligament True Discomfort over the ligament is often found with mild strains. (e) Dramatic pain relief with cold compresses. False
Slight swelling develops immediately but settles to a large extent within a few hours.Bruising occurs with a true or severe sprain. It would require major damage to produce joint instability. Cold compresses may help reduce the swelling.
MCEM Toxicology MCQ

The following are true:
(a) Hip extension is performed by the femoral nerve. False ?Infeior gluteal performs hip extension. (b) The femoral nerve is composed of L1 and L2 nerve roots. False ?The femoral nerve is composed of L2,L3 and L4. (c) The inferior gluteal nerve is composed of L5,S1,S2 nerve roots. True ?The inferior gluteal nerve is composed of L5,S1,S2 nerve roots. (d) Hip extension is performed by the gluteus maximus muscle. True ?Inferior gluteal nerve, L5,S1,S2 nerve roots. (e) Hip abduction is performed by gluteus medius and minimus. True ?Superior gluteal nerve.
MCEM Toxicology MCQ

With regard to neck trauma the following are true:
(a) Penetrating injuries to the neck zone 1 extends from the clavicle to the cricoid cartilage. True ?Zone 1 extends from the clavicles to the cricoid cartilage (b) Penetrating injuries to the neck zone 2 extends from the cricoid cartilage to the hyoid bone. False ?With regard to penetrating injuries to the neck zone 2 extends from the cricoid cartilage to the angle of the mandible. (c) Penetrating injuries to the neck zone 3 extends from the hyoid bone to the base of the skull. False ?With regard to penetrating injuries to the neck zone 3 extends from the angle of the mandible to the skull base. (d) Breach of the platysma is an indication for emergency surgical exploration. True ?Breach of the platysma , evidence of vascular injury ,evidence of surgical emphysema and haemodynamic instability due to major bleeding from a neck wound are indications for emergency surgical exploration.
MCEM Toxicology MCQ

Myocardial Contusion
(a) Is usually caused by blunt trauma to the chest True ?Especially with fractures to sternum or anterior ribs (b) On ECG may be represented by bundle branch block pattern True ? (c) On ECG may be represented by dysrhythmia's True ? (d) On Trans Thoracic two dimensional echo may be represented by focal or regional wall motion abnormalities True ? (e) Dysrhythmias should be managed conservatively False Manage as usual.
MCEM Toxicology MCQ

Tendon Reflexes
(a) The biceps are innervated by the radial nerve False ?Musculocutaneous, C5-6 (b) The biceps reflex main nerve roots are C5-6 True ? (c) The triceps is innervated by the radial nerve True ? (d) The supinator reflex is innervated by the radial nerve True ? (e) The knee jerk tests knee flexion False ?Extension/Quadriceps/L3-4
MCEM Toxicology MCQ

The scaphoid bone
(a) The scaphoid only articulates with the radius, lunate, capitate, and trapezoid. False ?The scaphoid articulates with the radius, lunate, capitate, trapezoid, and trapezium (b) A small portion of the surface is covered by hyaline cartilage False ?Nearly the entire surface is covered by hyaline cartilage (c) Vessels enter away from the sites of ligamentous attachment. False ?Vessels may enter only at the sites of ligamentous attachment (d) The ulnar artery provides the blood supply to the scaphoid bone. False ?The dorsal and volar branches of the radial artery provide the blood supply to the scaphoid (e) The scaphoid lies at the ulnar border of the proximal carpal row False ?The scaphoid lies at the radial border of the proximal carpal row The scaphoid lies at the radial border of the proximal carpal row, but its elongated shape and position allow bridging between the 2 carpal rows because it acts as a stabilizing rod. The scaphoid articulates with the radius, lunate, capitate, trapezoid, and trapezium. As a result, nearly the entire surface is covered by hyaline cartilage. Vessels may enter only at the sites of ligamentous attachment: the flexor retinaculum at the tubercle, the volar ligaments along the palmar surface, and the dorsal radiocarpal and radial collateral ligaments along the dorsal ridge. The dorsal and volar branches of the radial artery provide the blood supply to the scaphoid. The primary blood supply comes from the dorsal branch of the radial artery, which divides into 2-4 branches before entering the waist of the scaphoid along the dorsal ridge. The branches course volar and proximal within the bone, supplying 70-85% of the scaphoid. The volar scaphoid branch also enters the bone as several perforators in the region of the tubercle; these supply the distal 20%-30% of the bone
MCEM Toxicology MCQ

Gastrointestinal Bleeding:
(a) About 40% of duodenal bleeds will re-bleed within 24 -48 hours. False ?About 10% of duodenal bleeds will re-bleed within 24 -48 hours. (b) A Mallory weiss tear occurs in the distal oesophagus due to a tear in the mucosa usually from repeated vomiting, but may also occur secondary to sneezing True ?A Mallory weiss tear occurs in the distal oesophagus due to a tear in the mucosa usually from repeated vomiting, but may also occur secondary to sneezing (c) In lower GI bleeding, not from haemorrhoids, the most common aetiologies are adenomatous polyps. False ?In lower GI bleeding, not from haemorrhoids, the most common aetiologies are diverticular disease and angiodysplasia. (d) Angiodysplasia is more common in patients with aortic regurgitation. False ?Angiodysplasia is more common in patients with aortic stenosis. (e) PUD causes about 30% of all upper GI bleeds. False ?PUD causes about 60% of all upper GI bleeds
MCEM Toxicology MCQ

Ottawa Ankle Rules:Indication for X Ray
(a) Posterior edge of lateral malleolus bone tenderness. True ?Posterior edge of lateral malleolus bone tenderness is an indication for X Ray. (b) Tip of lateral malleolus bone tenderness. True ?Tip of lateral malleolus bone tenderness is an indication for X Ray (c) Posterior edge of medial malleolus bone tenderness. True ?Posterior edge of medial malleolus bone tenderness is an indication for X Ray. (d) Tip of medial malleolus bone tenderness. True ?Tip of medial malleolus bone tenderness is an indication for X Ray. (e) Base of the 5th metacarpal. False ?Base of the 5th metatarsal tenderness is an indication for X Ray. http://www.bmj.com/cgi/content/full/326/7386/417#F1
MCEM Toxicology MCQ

The following are true with regard to lower vertebral levels:
(a) The bifurcation of the aorta occurs at the vertebral level of L4 True ?The bifurcation of the aorta occurs at the vertebral level of L4 (b) The sacral dimples are at the vertebral levels of S2 True ?The sacral dimples are at the vertebral levels of S2 (c) The posterior superior iliac spine is at the vertebral level of S1 False ?The posterior superior iliac spine is at the vertebral level of S2 (d) The dural sac ends at the vertebral level of S1 False ?The dural sac ends at the vertebral level of S2 (e) The rectum starts at the vertebral level of S3 True ?The rectum starts at the vertebral level of S3
MCEM Toxicology MCQ

Eye Emergencies
(a) Herpes Simplex Virus can involve eyelids, conjunctiva and cornea. True ?HSV classically causes a dendritic epithelial defect. Treatment is with topical anti-virals. (b) Herpes Zoster Opthalmicus frequently involves a concurrent iritis True ?Herpes Zoster Opthalmicus is shingles in the distribution of the trigeminal nerve, ocular involvement and frequently involves a concurrent iritis. (c) Hyphema is not associated with rebleeding. False ?Rebleeding can occur about 3-5 days following the initial injury. (d) Peri-orbital cellulitis is associated with painful eye movements. False ?Orbital cellulitis is but peri-orbital cellulitis is not.
MCEM Toxicology MCQ

The Spinal Cord:
(a) There are 29 pairs of spinal nerves. False ?There are 31 pairs of spinal nerves. (b) There are 8 pairs of cervical nerves. True ?There are 8 pairs of cervical nerves. (c) There are 11 pairs of thoracic nerves. False ?There are 12 pairs of thoracic nerves. (d) There are 4 pairs of sacral nerves. False ?There are 5 pairs of sacral nerves. (e) There are 4 pairs of coccygeal nerves. False ?There is usually 1 pair of coccygeal nerves. The spinal cord gives rise to 31 pairs of spinal nerves: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal
MCEM Toxicology MCQ

Tract Dysfunction
(a) Corticospinal tract injury is characterised by contralateral motor deficits False ?Ipsilateral.Corticospinal tract injury is characterised by ipsilateral motor deficits. (b) Spinothalamic tract injury is characterised by ipsilateral pain and temperature sensation loss False ?Contralateral.Spinothalamic tract injury is characterised by contralateral pain and temperature sensation loss. (c) Posterior Column injury is characterised by ipsilateral proprioception loss True ?Posterior Column injury is characterised by ipsilateral proprioception loss (d) Cervical Spine injury may present with hypotension and bradycardia True ?This is neurogenic shock due to loss of sympathetic tone. (e) Cervical spine injuries may present with pain above but not below the clavicle True ?Cervical spine injuries may present with pain above but not below the clavicle
MCEM Toxicology MCQ

Anatomical considerations:
(a) The origin of the coeliac axis is at T8 False ?The origin of the coeliac axis is at T12 (b) L3 is crossed by the transpyloric plane of addison ( half way between the suprasternal notch and the symphysis pubis.) False ?L1 is crossed by the transpyloric plane of addison ( half way between the suprasternal notch and the symphysis pubis.) (c) The vagi pierce the diaphragm at T8 along with the oesophagus False ?The vagi pierce the diaphragm at T10 along with the oesophagus (d) The aortic opening in the diaphragm is anterior to the median arcuate ligament and transmits the azygous and hemiazygous veins False ?The aortic opening in the diaphragm is posterior to the median arcuate ligament and transmits the azygous and hemiazygous veins (e) The aortic opening transmits the thoracic duct. True ?The aortic opening transmits the thoracic duct.
MCEM Toxicology MCQ

Carotid Sinus Syndrome may be caused by
(a) Trauma True ? (b) Carotid artery aneursym True ? (c) Posterior Communicating Artery Aneursym True ? (d) Nasopharyngeal tumor spread True ? (e) Wegeners Granulomatosis True ?Or any other cause of infection such as sinusitis or tuberculosis
MCEM Toxicology MCQ

The following is true with regard to rupture of the biceps tendon:
(a) It most often affects 20 to 40 year old men. False ?Rupture of the biceps most commonly affects 40 to 60 year olds. (b) May cause a popping sound during some activity. True ?Or a sudden pain with a snapping sensation. (c) Shoulder aching may be worse at night. True ?Or painful during repetitive or overhead movements (d) May cause a visible mass between the shoulder and the elbow. True ?If not visible may well be palpable. (e) The treatment of choice is surgical repair. False ?Of debatable value, but may be helpful in young athletic types.
MCEM Toxicology MCQ

Clavicle fractures
(a) Account for 1 in 20 adult fractures True ? (b) Are usually caused by a direct blow to the clavicle False ?They are usually caused by a fall onto the lateral clavicle. (c) Non displaced fractures are almost always seen on AP views. False ?Non displaced fractures may be difficult to see on AP views and may need 20 degree ( Zanca ) views or 45 degree cephalic tilt. (d) Lateral 1/3 rd of the clavicle are the most common site for fracture. False ?Middle 1/3 rd are the most common site for fracture and represents 80% of fractured clavicles.( Allman classification ) (e) Non displaced lateral 1/3rd clavicular fractures should be treated conservatively. True ?Displaced lateral 1/3rd fractures usually require operative intervention because they have a high rate of non-union. Non displaced medial 1/3rd fractures are treated conservatively while displaced require orthopaedic referral. www.aafp.org/afp/20041115/1947.html
MCEM Toxicology MCQ

Haemorrhagic shock
(a) Class I patients usually do not have any mental anxiety False ? (b) Class II shock usually do not have any mental anxiety False ? (c) Class III patients usually have some anxiety True ? (d) Class IV patients are usually alert and not confused False ? (e) Class II patients are usually confused False ? Class I-slight anxiety, Class II-more anxiety, Class III- anxious and sometimes confused, class IV, confused and lethargic
MCEM Toxicology MCQ

Appreciation of the gross anatomy of the testis:
(a) The ductus deferens ascends on the medial side of the epididymis. True ?The ductus deferens ascends on the medial side of the epididymis. (b) The epididymis is on the posterior aspect of the testes and is 6 m in length. True ?The epididymis is on the posterior aspect of the testes and is 6 m in length. (c) The head of the epididymis lies on the lower pole of the testis where it is joined by the efferent ducts. False ?The head of the epididymis lies on the upper pole of the testis where it is joined by the efferent ducts. (d) A hydrocele occurs when there is watery fluid between the parietal and visceral layers of the tunica albuginea. False ?A hydrocele occurs when there is watery fluid between the parietal and visceral layers of the tunica vaginalis ( a serous sac of peritoneal origin ) (e) The testicular artery is a direct branch of the abdominal aorta which arises just below the renal arteries and descends in the spermatic cord to the posterior aspect of the testes. True ?The testicular artery is a direct branch of the abdominal aorta which arises just below the renal arteries and descends in the spermatic cord to the posterior aspect of the testes.
MCEM Toxicology MCQ

Traumatic Brain Injury
(a) The majority of cases of epidural haematoma have a loss of consciousness followed by a lucid interval followed by neurological decline. False ?A minority, approximately 20%, of cases have this classical description. (b) 80% of cases of epidural haematoma have a skull fracture that lacerates meningeal arteries. True ?80% of cases of epidural haematoma have a skull fracture that lacerates meningeal arteries. (c) A fixed and dilated pupil because of a epidural haematoma is an early sign. False ?A fixed and dilated pupil because of a epidural haematoma is a late sign. (d) Contralateral hemiparesis in epidural haematoma is an early sign. False ?Contralateral hemiparesis in epidural haematoma is a late sign. (e) A common mechanism for subdural haematoma is an acceleration- deceleration injury. True ?A common mechanism for subdural haematoma is an acceleration- deceleration injury.
MCEM Toxicology MCQ

Vertebrae
(a) The vertebral arch is made up of two pedicles, two laminae, and seven processes True ?The vertebral arch is made up of two pedicles, two laminae, and seven processes (one spinous, two transverse, and four articular). (b) Each disk consists of a peripheral annulus fibrosus and a central nucleus pulposus True ?Each disk consists of a peripheral annulus fibrosus and a central nucleus pulposus (c) The annulus fibrosus is composed of fibrocartilage True ?The annulus fibrosus is composed of fibrocartilage (d) The nucleus pulposus is made of water and cartilage fibers. True ?The nucleus pulposus is made of water and cartilage fibers. (e) With increasing age the proportion of fibrocartilage to fluid decreases. False ?With increasing age the porportion of fibrocartilage to water increases.
MCEM Toxicology MCQ

Testes, Epididymis and Spermatic Cord:
(a) The cremasteric fascia containing the cremasteric muscle is derived from the rectus abdominis muscle. False ?The cremasteric fascia containing the cremasteric muscle is derived from the internal oblique muscle (b) The external spermatic fascia is derived from the aponeurosis of the transversalis fascia. False ?The external spermatic fascia is derived from the aponeurosis of the external oblique muscle (c) The round ligament terminates in the fibrofatty tissue of the labium majus. True ?The round ligament terminates in the fibrofatty tissue of the labium majus. (d) The deep inguinal ring transmits the genital branch of the genitofemoral nerve. True ?The deep inguinal ring transmits the genital branch of the genitofemoral nerve. (e) The internal spermatic fascia is derived from the internal oblique. False ?The internal spermatic fascia is derived from the transversalis fascia
MCEM Toxicology MCQ

Intracranial bleeding
(a) Extra dural haematoma is often due to bleeding from the anterior branch of the middle meningeal artery after a temporal bone fracture True ?The classical history of this haematoma is one of an intial loss of consciousness followed by a subsequent lucid period follwed by neurological deterioration. (b) An acute rise in intracranial pressure may manifest as a falling pulse rate. True ?Cushings response is characterised by bradycardia and hypertension. (c) An acute rise in intracranial pressure may manifest as a rising blood pressure. True ?Cushings response is characterised by bradycardia and hypertension. (d) Amnesia for events >15min before the head injury is an indication for CT Brain Scan. False ?Amnesia for events >30min before the head injury is an indication for CT Brain Scan. (e) An acute rise in intracranial pressure may manifest as a central respiratory depression. True ?An acute rise in intracranial pressure may manifest as a central respiratory depression. Cushings response occurs with bradycardia and hypertension
MCEM Toxicology MCQ

Abdominal structures corresponding to vertebral levels:
(a) The renal arteries originate at the vetebral level of L1/2. True ?The renal arteries originate at the vetebral level of L1/2. (b) The spinal cord ends in adults at the level of L1/2. True ?The spinal cord ends in adults at the level of L1/2. (c) The azygous and hemiazygous veins are formed at L4 vertebral level. False ?The azygous and hemiazygous veins are formed at L2 vertebral level (d) The ligament of treitz is at the level of the upper border of the L4 vertebra. False ?The ligament of treitz is at the level of the upper border of the L2 vertebra . (e) The umbilicus is at the vertebral level of L3/4. True ?The umbilicus is at the vertebral level of L3/4.
MCEM Toxicology MCQ

Gunshot Wounds:
(a) Temporary cavitation is caused by a sonic shock wave in high velocity injuries. False ? (b) Solid organs such as liver resist cavitation more than softer tissues such as lung False ? (c) High velocity injuries usually have less bacterial contamination False ? (d) Abdominal gunshot wounds invariably require laparotomy. True ? (e) Cranial gunshot wounds invariably require ventilation. True ?
MCEM Toxicology MCQ

With regard to innervation of the ear
(a) The anterior half of the ear is supplied by the auriculotemporal nerve which is a branch of the mandibular portion of the trigeminal nerve. True (b) The posterior half of the ear is supplied by branch of the trigeminal nerve. False (c) The posterior part of the ear is supplied by 2 nerve branches derived from the cervical plexus. True (d) The vagus nerve has no role in the inervation of the ear. False (e) The vagus nerve supplies the external auditory canal. True
The anterior half of the ear is supplied by the auriculotemporal nerve which is a branch of the mandibular portion of the trigeminal nerve.The posterior part of the ear is supplied by 2 nerve branches derived from the cervical plexus.The vagus nerve supplies the external auditory canal.The position for an ear block is where the ear lobe attaches to the head.
MCEM Toxicology MCQ

Elbow Dislocation
(a) On lateral X Ray the radius and the ulna are most commonly displaced posteriorly. True ?On lateral X Ray the radius and the ulna are most commonly displaced posteriorly. (b) The most frequent neurological injury is to the median nerve. False ?The most frequent neurological injury is to the ulnar nerve. (c) On clinical exam the olecranon process is commonly not prominent. False ?On clinical exam the olecranon process is commonly prominent. (d) On clinical exam the elbow is commonly flexed at 90 degrees. False ?On clinical exam the elbow is commonly flexed at 45 degrees and the olecranon is prominent. (e) Vascular complications occur in about 10% of elbow dislocations. True ?The most common artery involved is the brachial artery.
MCEM Toxicology MCQ

Structure Function and Mechanics of the Vertebral Column:
(a) Flexion and extension of the vertebral column is extensive in the cervical and thoracic regions but limited by the lumbar region. False ?Flexion and extension of the vertebral column is extensive in the cervical and lumbar regions but limited by the thoracic region because of the rib cage. (b) The cervical vertebrae normally have a posterior convexity while the thoracic region has a posterior concavity. False ?The cervical vertebrae normally have a posterior concavity while the thoracic region has a posterior convexity. (c) There is normally 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, and 5 sacral vertebrae, and 4 coccygeal vertebrae. True ?There is normally 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, and 5 sacral vertebrae, and 4 coccygeal vertebrae. (d) Rotation ( twisting movement ) of the body is least extensive in the cervical region. False ?Rotation of the body is least extensive in the lumbar region. (e) Lateral flexion of the body is restricted by the cervical section of the vertebral column False ?Lateral flexion of the body is restricted by the thoracic section of the vertebral column
MCEM Toxicology MCQ

Maxillofacial radiographs
(a) Orthopantomogram view can be used to assess the frontal bones False ?OPG is used to assess the mandible (b) Submentovertical projection is used to assess the zygomatic arch True ? (c) Occiptomental views are used to assess the maxilla True ?Occiptomental views are used to assess the maxilla, orbital floors and zygomatic arches (d) Occipitomental views are used to assess the orbital floors True ?Occiptomental views are used to assess the maxilla, orbital floors and zygomatic arches (e) Occipitomental views are used to assess the zygomatic arches True ?Occiptomental views are used to assess the maxilla, orbital floors and zygomatic arches
MCEM Toxicology MCQ

Surface Anatomy:
(a) The pharynx becomes the oesophagus at C6 True ?The pharynx becomes the oesophagus at C6 (b) C7 is the first clearly palpable spinous process. True ?C7 is the first clearly palpable spinous process. (c) The superior border of the scapula is at T3 False ?The superior border of the scapula is at T2 (d) The suprasternal notch is at the level of T2/3 True ?The suprasternal notch is at the level of T2/3 (e) The end of the oblique fissure of the lung is at the spine of T3 True ?The end of the oblique fissure of the lung is at the spine of T3
MCEM Toxicology MCQ

Surface Anatomy of the Anterior Forearm:
(a) The brachial artery divides into the radial and ulnar arteries just below the line of the elbow joint. True ?The brachial artery divides into the radial and ulnar arteries just below the line of the elbow joint. (b) The radial artery lies in a groove between the flexor carpi radialis and the anterior border of the radius. True ?The radial artery lies in a groove between the flexor carpi radialis and the anterior border of the radius. The radial artery lies in a groove between the flexor carpi radialis and the anterior border of the radius. (c) The radial artery can be palpated on the lateral side of the trapezium in the anatomical snuff box. False ?The radial artery can be palpated on the lateral side of the scaphoid in the anatomical snuff box. (d) In the area of the wrist and hand the ulnar artery is covered by the palmer aponeurosis. True ?In the area of the wrist and hand the ulnar artery is covered by the palmer aponeurosis. (e) The pulsations of the ulnar artery are recognised lateral to the pisiform bone. True ?The pulsations of the ulnar artery are recognised lateral to the pisiform bone
MCEM Toxicology MCQ

Radial Head Fractures
(a) Radial head fractures are the most common fractures of the elbow True ?Radial head fractures are the most common fractures of the elbow (b) The radial head articulates with the trochlea False ?The radial head articulates with the capitellum. (c) The radial head serves as a stabiliser against forces away from the midline. True ?The radial head serves as a stabiliser against valgus stress. (d) Radial head fractures are usually the result of a fall on an outstretched hand causing the radial head to be driven into the trochlea. False ?Radial head fractures are usually the result of a fall on an outstretched hand causing the radial head to be driven into the capitellum. (e) Are associated with medial epicondyle avulsion fractures. True ?This is secondary to valgus stress.
MCEM Toxicology MCQ

Anatomical Considerations of the thoracic vertebrae:
(a) The start of the arch of the aorta is at T4/T5 True ?The start of the arch of the aorta is at T4/T5 (b) The sternum runs from T5 to T8 True ?The sternum runs from T5 to T8 (c) The upper border of the liver is usually at T9 False ?The upper border of the liver is usually at T6 (d) The inferior angle of the scapula is at T3 False ?The inferior angle of the scapula is at T7 (e) The IVC goes through the diaphragm at T8 True ?The IVC goes through the diaphragm at T8 ( along with the right phrenic nerve )
MCEM Toxicology MCQ

the ulnar nerve is interrupted at the wrist the following muscles are not innervated.
(a) Palmaris brevis . True ?Palmaris brevis is innervated by the superficial terminal branch of the ulnar nerve in the hand. (b) Opponens pollicis False ?Opponens pollicis is innervated by the median nerve. (c) Flexor pollicis brevis False ?Flexor pollicis brevis is innervated by the median nerve. (d) Abductor pollicis brevis False ?Abductor pollicis brevis is innervated by the median nerve. (e) Flexor carpi ulnaris False ?Flexor carpi ulnaris is innervated by a branch of the ulnar nerve in the forearm.
MCEM Toxicology MCQ

Neuroanatomy
(a) The fibers of the pyramids cross in the pons. False ?The fibers of the pyramids cross in the medulla.The crossing event is called the decussation of the pyramids (b) The cerebral peduncles largely contain motor fibers. True ?The cerebral peduncles largely contain motor fibers. (c) Motor and somatosensory information travel through the anterior limb of the internal capsule. False ?Motor and somatosensory information travel through the posterior limb of the internal capsule. (d) In the motor cortex the lateral side of the gyrus controls the hands and face. True ?In the motor cortex, the body is mapped out across the extent of the gyrus. Control of the feet lies near the midline at the top of the gyrus, whereas the lateral side of the gyrus controls the hands and face.
MCEM Toxicology MCQ

The following headaches usually have associated focal abnormal neurology
(a) Migraine False ?Possible but not usual (b) Ca channel blocker associated headache False ? (c) Nitrates associated headache False ? (d) CO poisoning headache False ? (e) Temporal Arteritis False ? Other headaches without associated neurology include tension, and analgesic
MCEM Toxicology MCQ

During initial management of a multiply injured patient:
(a) Shock management is the first priority. False ? (b) Cervical spine control is usually necessary. True ?Cervical spine control is usually necessary. (c) External haemorrhage should be ignored. False ? (d) Pulse oximetry is usually unhelpful. False ?The results of pulse oximetry should be interpreted with particular caution in the presence of abnormal haemoglobins(the pulse oximetry reading represents a summation of oxyhemoglobin and carboxyhemoglobin and in cases of carbon monoxide poisoning or in chronic, heavy smokers, a falsely reassuring pulse oximetry reading may mask arterial desaturation), nail polish, deeply pigmented skin, hypoperfusion, anemia, venous congestion, or when certain vital dyes (such as methylene blue, indocyanine green, fluorescein, indigo carmine, and isosulfan blue) are used for clinical purposes. (e) Ischaemic limbs demand immediate attention. False ?
MCEM Toxicology MCQ

Chest drain insertion is usually indicated in patients with the following conditions:
(a) Mediastinal traversing wounds. True ? (b) Flail chest. True ?Flail chest occurs when three or more adjacent ribs are each fractured in two places, creating one floating segment comprised of several rib sections and the soft tissues between them. This unstable section of chest wall exhibits paradoxical motion (ie, it moves in the opposite direction of the uninjured, normalfunctioning chest wall) with breathing, and is associated with significant morbidity from pulmonary contusion. Abnormal motion can be difficult to detect making the diagnosis difficult. Initial management of flail chest consists of oxygen and close monitoring for early signs of respiratory compromise, ideally using both pulse oximetry and capnography in addition to clinical observation. Use of noninvasive positive airway pressure by mask may obviate the need for endotracheal intubation in alert patients. Patients with severe injuries, respiratory distress, or progressively worsening respiratory function require endotracheal intubation and mechanical ventilatory support. (c) Open pneumothorax. True ? (d) Ruptured diaphragm. False ? (e) Surgical emphysema. False ?
MCEM Toxicology MCQ

Major Trauma:
(a) Pelvic fractures in children are rare and clinically apparent, making the routine screening pelvic X Ray obsolete. True ? (b) Hypertonic saline is beneficial in hypotensive patients with head injury. False ? (c) Steroids are beneficial in patients with head injury and GCS <15 False ?http://www.thelancet.com/journals/lancet/article/PIIS0140673604171882/abstract. (d) Patients intubated without the need for anaesthetic drugs had a survival rate of about 2% False ? (e) A post traumatic head injury seizure is an indication to request a CT brain scan immediately according to the NICE guidelines. True ?http://www.nice.org.uk/nicemedia/pdf/CG56QuickRedGuide.pdf One New Zealand study of 347 children who had a pelvic X Ray found only 1 fracture and this fracture was clinically apparent. The authors recommend not X Raying. In the CRASH trial steroids in patients with head injury showed more harm than good. http://www.thelancet.com/journals/lancet/article/PIIS0140673604171882/abstract
MCEM Toxicology MCQ

Regarding fracture classifications:
(a) The Neer classification refers to distal radial fractures. False The Neer classification refers to proximal humeral fractures. (b) The Frykman classification refers to proximal humeral fractures. False The Frykman classification refers to distal radial fractures. (c) The Schatzker classification refers to tibial plateau fractures. True The Schatzker classification refers to tibial plateau fractures. (d) Type II is the most common type of Salter-Harris fracture presentations. True Type II is the most common type of Salter-Harris fracture presentations.
MCEM Toxicology MCQ

The glossopharyngeal nerve (CN IX):
(a) Arises in the pons. False ?The glossopharyngeal nerve is mainly sensory. It arises in the medulla. (b) Leaves the skull through the jugular foramen True ?The glossopharyngeal nerve leaves the skull through the jugular foramen along with the vagus and accessory nerve. (c) Is the efferent pathway of the gag reflex False ?Sensory fibers provide sensation to the tonsillar fossa and pharynx ( the afferent pathway of the gag reflex) and taste to the posterior 2/3 rd's of the tongue. (d) Supplies taste fibers to the anterior two-thirds of the tongue False ?Sensory fibers provide sensation to the tonsillar fossa and pharynx ( the afferent pathway of the gag reflex ) and the taste to the posterior 2/3 rd's of the tongue. (e) Supplies the stylopharyngeal muscle. True ?Motor fibers supply the stylopharyngeus muscle, autonomic fibers supply the parotid gland, and a sensory branch supplie the carotid sinus.
MCEM Toxicology MCQ

The following statements are true
(a) The median nerve supplies the interossei of the hand False ?Ulnar (b) The radial nerve supplies the abductor pollicis brevis False ?The radial nerve does not supply any of the intrinsic muscles of the hand (c) The ulnar nerve supplies sensation to the one and a half ulnar digits True ? (d) The extensor muscles of the forearm are supplied by the radial nerve True ? (e) The biceps muscle is supplied by the musculocutaneous nerve True ?
MCEM Toxicology MCQ

The following are true in relation to common root compression syndromes produced by lumbar disc disease:
(a) An S1 root lesion will produce weakness of plantar flexion of the ankle and toes. True ?An S1 root lesion will produce weakness of plantar flexion of the ankle and toes. (b) An S1 root lesion will cause loss of the knee jerk reflex. False ?An S1 root lesion will cause loss of the ankle jerk reflex. (c) An L4 root lesion will cause sensory loss at the anteromedial shin. True ?An L4 root lesion will cause sensory loss at the anteromedial shin. (d) An L5 root lesion will cause sensory loss over the sole of the foot. False ?An L5 root lesion will cause sensory loss over the dorsum of the foot and anterolateral shin while an S1 root lesion will cause sensory loss over the sole of the foot.
MCEM Toxicology MCQ

The Ear
(a) The cochlea contains the auditory sensory receptors. True ?The cochlea contains the auditory sensory receptors and the vestibular labyrinth contains the balance receptors (b) The vestibular labyrinth contains the balance receptors. True ?The cochlea contains the auditory sensory receptors and the vestibular labyrinth contains the balance receptors (c) Blood supply to the inner ear is from the internal carotid artery. False ?Blood supply to the inner ear is from the vertebrobasilar system. (d) The anterior vestibular artery to the cochlea False ?The anterior vestibular artery provides the blood supply to the anterior and horizontal semicircular canals but not to the cochlea (e) The anterior vestibular artery provides the blood supply to the anterior and horizontal semicircular canals. True ?The anterior vestibular artery provides the blood supply to the anterior and horizontal semicircular canals but not to the cochlea
MCEM Toxicology MCQ

Colles Fracture
(a) Is a fracture of the radius within 1 cm of the wrist. False ?Colles fracture is a fracture of the radius within 2.5 cm of the wrist. (b) The distal fragment is displaced anteriorly. False ?The distal fragment is displaced posteriorly and with radial displacement. (c) The angulation of the distal radius normally has a 5 degree forward tilt on the poximal carpal bones as seen on the lateral X Ray ( i.e in peole without a fracture ) True ?The angulation of the distal radius normally has a 5 degree forward tilt on the poximal carpal bones as seen on the lateral X Ray ( i.e in peole without a fracture ) (d) Colles fracture is associated with flexor pollicis longus rupture in the weeks following injury. False ?Colles fracture is associated with extensor pollicis longus tendon rupture in the weeks following the injury. (e) Colles fracture usually follows a fall onto a flexed wrist False ?Colles fracture usually follows a fall onto an outstretched hand. Smith's fracture usually follows a fall onto a flexed wrist.
MCEM Toxicology MCQ

Radiograph Interpretation
(a) The right heart border is formed by the outer border of the right ventricle. False ?The right heart border is formed by the outer border of the right atrium. (b) The left heart border is formed by the outer border of the left ventricle. True ?The left heart border is formed by the outer boder of the left ventricle. (c) The left margin of the right ventricle lies about a thumbs breath in from the left heart border. True ?The left margin of the right ventricle lies about a thumbs breath in from the left heart border and on the surface of the heart this is marked by the left anterior descending artery. (d) Valve calcification is best seen on the AP view. False ?Valve calcification is best seen on the lateral view as on the AP view valve calcification cannot be visualised over the spine. (e) A large pulmonary artery will cause hilar enlargement. True ?A large pulmonary artery will cause hilar enlargement as will lymphadenopathy.
MCEM Toxicology MCQ

The facial nerve
(a) The nerve emerges on the anterior surface of the brain between the pons and the medulla and it enters the internal acoustic meatus with the vestibulocochlear nerve. True ?The nerve emerges on the anterior surface of the brain between the pons and the medulla and it enters the internal acoustic meatus with the vestibulocochlear nerve. (b) The greater petrosal nerve arises from the nerve at the geniculate ganglion. True ?The greater petrosal nerve contains taste fibers from the palate. It also contains preganglionic parasympathetic fibres that synapse in the pterygopalatine ganglion. The postganglionic fibers are secretomotor to the lacrimal gland and the glands of the nose and palate. (c) Passes through the posterior fossa. True ? (d) On reaching the medial wall of the middle ear the nerve swells to form the sensory geniculate ganglion. True ? (e) Emerges from the temporal bone through the stylo-mastoid foramen. True ? The facial nerve arises in the medulla and emerges between the pons and medulla. It then passes through the posterior fossa and runs through the middle ear before emerging from the stylo-mastoid foramen and running through the parotid.
MCEM Toxicology MCQ

The Forearm:
(a) The radial artery can be palpated on the medial side of the scaphoid in the anatomical snuff box. False ?The radial artery can be palpated on the lateral side of the scaphoid in the anatomical snuff box. (b) The pulsations of the ulnar artery are recognised lateral to the lunate bone. False ?The pulsations of the ulnar artery are recognised lateral to the pisiform bone (c) The radial artery lies in a groove between the flexor digitorum profundus and the anterior border of the radius. False ?The radial artery lies in a groove between the flexor carpi radialis and the anterior border of the radius. (d) In the area of the wrist and hand the ulnar artery is covered by the palmer aponeurosis. True ?In the area of the wrist and hand the ulnar artery is covered by the palmer aponeurosis. (e) The brachial artery divides into the radial and ulnar arteries just below the distal third of the humerus. False ?The brachial artery divides into the radial and ulnar arteries just below the line of the elbow joint.
MCEM Toxicology MCQ

With regard to innervation of the scalp
(a) The frontal part of the scalp is innervated by branches of the opthalmic part of the trigeminal nerve. True (b) The frontal part of the scalp is innervated by the supraorbital and supratrochlear nerves. True (c) The posterior part of the scalp is innervated by branches of the first division of the trigeminal nerve False (d) The posterior part of the scalp is innervated by branches of the cervical plexus. True (e) The cervical plexus plays a role in innervation of the posterior and lateral scalp. True
The frontal part of the scalp is innervated by the supraorbital and supratrochlear nerves which are branches of the first division of the trigeminal nerve.The posterior part of the scalp is innervated by branches of the cervical plexus, more specifically the greater and lesser occipital nerves. The cervical plexus innervates the lateral scalp through the lesser occipital nerve.
MCEM Toxicology MCQ

Muscles of the hand
(a) Flexor pollicis brevis flexes the MCP joint of the thumb. True (b) Flexor pollicis brevis is innervated by median nerve True This is usually the case however may also be innervated by the deep branch of the ulnar nerve (c) Flexor pollicis longus flexes proximal phalanx of thumb False Flexor pollicis longus flexes distal phalanx of thumb (d) Extensor pollicis longus extends the IP and MCP joints of the thumb True ? (e) Extensor pollicis brevis forms anterior border of the anatomical snuff box. True Extensor pollicis brevis forms anterior border of the anatomical snuff box and the posterior border of the snuffbox is the tendon of the extensor pollicis longus.
MCEM Toxicology MCQ

Penetrating injuries of the diaphragm
(a) The arching domes of the diaphragm highest point is the level of the 6th rib False (b) If a penetrating injury is just below the level of the nipples one should not be suspicious of a penetrating injury to the diaphragm False (c) The left dome of the diaphragm is higher than the right dome in normal people. False (d) The right dome of the diaphragm is higher than the left dome in normal people. True (e) The right dome of the diaphragm is more likely to suffer a penetrating injury. False
The arching domes of the diaphragm can reach the level of the 5th rib.If a penetrating injury is just below the level of the nipples one should be suspicious of a penetrating injury to the diaphragm
MCEM Toxicology MCQ

Occlusion of the anterior cerebral artery causes
(a) Paralysis of the opposite leg True ? (b) Perseveration True ? (c) Urinary incontinence True ? (d) Grasp reflex in the opposite hand True ? (e) Wernickes(receptive/fluent) dysphasia False ?
MCEM Toxicology MCQ

In the alert patient with evidence of blunt abdominal trauma:
(a) Peritoneal lavage is helpful if the patient is stable. True ?100,000 RBC/mm3 or 500 WBC/mm3 is considered a positive peritoneal lavage and reflects intraabdominal bleeding. (b) Peritoneal lavage is indicated if the patient is unstable. False ?The patient is likely to need a laparotomy if there has been abdominal trauma and he/she is haemodynamically unstable. (c) With FAST scanning free fluid visible in the abdomen implies at least 500ml of fluid. True ?With FAST scanning free fluid visible in the abdomen implies at least 500ml of fluid. (d) CT Scanning will visualise retroperitoneal injuries well True ?CT scanning may miss diaphragmatic injury and many visceral injuries but will detect solid organ damage or intraperitoneal blood. (e) Laparotomy is usually necessary in the shocked patient True ?The patient is likely to need a laparotomy if there has been abdominal trauma and he/she is haemodynamically unstable.
MCEM Toxicology MCQ

Ottawa ankle rules: The following require X Ray
(a) Tenderness at the base of the 5th metatarsal. True ? (b) Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus True ? (c) Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus True ? (d) Bone tenderness at the navicular bone (for foot injuries). True ? (e) Pregnancy is an exclusion criteria. True ?Along with children and those with diminished ability to follow the test. X-rays are only required if there is bony pain in the malleolar or midfoot area, and any one of the following: Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus Bone tenderness at the base of the fifth metatarsal (for foot injuries). Bone tenderness at the navicular bone (for foot injuries). An inability to bear weight both immediately and in the emergency department for four steps. Certain groups are excluded, in particular children (under the age of 18), pregnant women, and those with diminished ability to follow the test (for example due to head injury or intoxication).
MCEM Toxicology MCQ

Mandibular Fractures
(a) Usually occur on one side of the mandible only False ? (b) The most common area of fracture is the angle of the mandible True ? (c) May present with bony crepitus True ? (d) May present with malocclusion True ? (e) May present with limited ROM True ?
MCEM Toxicology MCQ

The following are true
(a) Biceps is innervated by musculocutaneous True ? (b) Brachioradialis is innervated by musculocutaneous False ?By radial nerve (c) Elbow flexion is initiated by nerve roots C5 and C6 True ? (d) Triceps are innervated by C7 True ? (e) Finger flexion is mediated by the radial nerve False ?Median and ulnar
MCEM Toxicology MCQ

The Hand
(a) The median nerve enters the hand through the carpal tunnel, deep to the flexor retinaculum, between the tendons of the flexor digitorum superficialis and the flexor carpi radialis. True ?The median nerve enters the hand through the carpal tunnel, deep to the flexor retinaculum, between the tendons of the flexor digitorum superficialis and the flexor carpi radialis. (b) To anaesthetise the median nerve local anaesthetic is injected between the tendon's of the flexpr carpi radialis and palmaris longus. True ?To anaesthetise the median nerve local anaesthetic is injected between the tendon's of the flexpr carpi radialis and palmaris longus. (c) At the wrist the ulnar nerve is blocked by injecting local anaesthetic between the palmaris longus and the flexor carpi ulnaris False ?At the wrist the ulnar nerve is blocked by injecting local anaesthetic between the ulnar artery and the flexor carpi ulnaris. (d) The ulnar nerve supplies cutaneuos sensation to the volar surface of the middle finger. False ?The ulnar nerve supplies cutaneuos sensation to the volar surface of the little finger and the medial half of the ring finger. (e) About 5 ml's of 2% lignocaine is required to anaesthetise the ulnar nerve. False ?
MCEM Toxicology MCQ

Left common carotid artery
(a) Lies postero-laterally to the left vagus nerve in the neck. False The left common carotid artery lies antero-medial to the left vagus nerve in the neck (b) Lies anteriorly to the prevertebral fascia in the neck. True The left common carotid artery lies anteriorly to the prevertebral fascia in the neck. (c) Gives off the left inferior thyroid artery. False The left thyroid artery is a branch of the left thyrocervical trunk of subclavian (d) Is a direct branch from the aortic arch. True The left common carotid artery is a direct branch from the aortic arch.
MCEM Toxicology MCQ

Haemorrhagic Shock
(a) Pulse <100 is consistent with class I shock True ? (b) Pulse 100-120 is consistent with class II shock True ? (c) Pulse 120-140 is consistent with class III shock True ? (d) Pulse >140 is consistent with class IV shock True ? (e) Pulse 120-140 is consistent with class IV shock False ? ATLS classification. <100 class I, <120 class II, <140 class III, >140 class IV
MCEM Toxicology MCQ

The Lumbar Plexus:
(a) The femoral nerve originates from the lumbar plexus from L2, L3 and L4. True ?The femoral nerve originates from the lumbar plexus from L2, L3 and L4. (b) The obturator nerve originates from L1 and L2 and supplies the adductor muscles of the thigh. False ?The obturator nerve originates from L2, L3 and L4 and supplies the adductor muscles of the thigh. (c) The femoral nerve supplies the skin on the posterior aspect of the leg and foot. False ?The femoral nerve supplies the skin on the medial side of the leg and foot. (d) The iliohypogastric nerve supplies the cremaster muscle. False ?The genitofemoral nerve supplies the cremaster muscle. (e) The femoral nerve supplies the skin on the medial surface of the thigh only. False ?The femoral nerve supplies the skin on the anterior surface of the thigh.The obturator nerve innervates the adductors of the thigh and the skin on the medial surface of the thigh.
MCEM Toxicology MCQ

Lower vertebral levels:
(a) The dural sac ends at the vertebral level of S3 False ?The dural sac ends at the vertebral level of S2 (b) The rectum starts at the vertebral level of S1 False ?The rectum starts at the vertebral level of S3 (c) The bifurcation of the aorta occurs at the vertebral level of L5 False ?The bifurcation of the aorta occurs at the vertebral level of L4 (d) The sacral dimples are at the vertebral levels of S1 False ?The sacral dimples are at the vertebral levels of S2 (e) The posterior superior iliac spine is at the vertebral level of S2 True ?The posterior superior iliac spine is at the vertebral level of S2
MCEM Toxicology MCQ

Compartment syndrome:
(a) The pain is characteristically mild. False ? (b) The pain is characteristically well localised. False ? (c) Palpation of the affected compartment will exacerbate the pain. True ?Palpation of the affected compartment will exacerbate the pain. (d) Passive stretching of muscles in the affected compartment will exacerbate the pain. True ?Passive stretching of muscles in the affected compartment will exacerbate the pain. (e) Paraesthesia is a feature before pain. False ? The pain is severe and poorly localised.Palpation of the affected compartment will exacerbate the pain.Passive stretching of muscles in the affected compartment will exacerbate the pain.Paraesthesia is a feature after pain.
MCEM Toxicology MCQ

Lymphatic drainage of the thoracic wall.
(a) The skin drains to the axillary lymph nodes. True (b) The intercostal spaces drain to the internal thoracic nodes. True (c) The posterior spaces drain to the posterior intercostal nodes. True (d) The posterior intercostal spaces drain to the para aortic nodes True (e) The skin on the posterior surface drains to the para-aortic nodes False
The skin drains to the axillary lymph nodes.The intercostal spaces drain forwards to the internal thoracic nodes and backwards to the posterior intercostal nodes and the para aortic nodes.
MCEM Toxicology MCQ

Characteristic features of repetitive strain injury:
(a) Pain felt deep in the wrist. True ?Pain felt deep in the wrist radiating to forearm and shoulder is a characteristic feature of repetitive strain injury. (b) Marked oedema of fingers and hand. False ?Subjective feeling of swelling but nothing to find on examination. (c) Symptoms worse at night False ?Worsen with work and improve with rest. Pain initially clears at night but can become constant. (d) Raised ESR. False ?No clinical signs. X Ray and bloods are normal. (e) Good response to NSAIDs. False ?Not of great help.
MCEM Toxicology MCQ

The Brachial Plexus:
(a) The dorsal scapular nerve is a branch of C7. False ?The dorsal scapular nerve is a branch of C5. (b) The medial cord supplies the extensor structures on the posterior aspect of the limb. False ?The posterior cord supplies the extensor structures on the posterior aspect of the limb. (c) The anterior division of the lower trunk forms the medial cord. True ?The anterior division of the lower trunk forms the medial cord. (d) The posterior cord may contain neurons from all the spinal nerves contributing to the brachial plexus True ?The posterior cord may contain neurons from all the spinal nerves contributing to the brachial plexus. (e) In the axilla the posterior divisions unite to form the lateral cord False ?In the axilla the posterior divisions unite to form the posterior cord
MCEM Toxicology MCQ

The Vertebral Column:
(a) Lateral flexion of the body is restricted by the thoracic section of the vertebral column. True ?Lateral flexion of the body is restricted by the thoracic section of the vertebral column because of the ribs. (b) Rotation ( twisting of the body ) of the body is least extensive in the lumbar region. True ?Rotation of the body is least extensive in the lumbar region. (c) Flexion and extension of the vertebral column is extensive in the cervical and thoracic regions but limited by the lumbar region. False ?Flexion and extension of the vertebral column is extensive in the cervical and lumbar regions but limited by the thoracic region. (d) The cervical vertebrae normally have a posterior convexity while the thoracic region has a posterior concavity. False ?The cervical vertebrae normally have a posterior concavity while the thoracic region has a posterior convexity. (e) There is normally 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, and 5 sacral vertebrae, and 4 coccygeal vertebrae. True ?There is normally 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, and 5 sacral vertebrae, and 4 coccygeal vertebrae.
MCEM Toxicology MCQ

The thorcic spine:
(a) Has an increased amount of flexibility afforded by it's articulation with the rib cage. False ?The rib cage makes the thoracic spine more inflexible and more rigid. (b) The thorcic spine is the most commonly injured part of the spine. False ?The thoracic spine is among the least frequently injured parts of the spine. (c) The spinal canal is wider than that found in the cervical spine. False ?The spinal canal is narrower in the thoracic spine than that found in the cervical or lumbar spine. (d) When spinal cord injury does occur they are mostly neurologically complete. True ?Because of the high ratio of spinal cord to spinal canal in the thoracic spine when spinal cord injury does occur it is usually complete. (e) The thoracolumbar junction (T11-L2) is considered a transitional zone between the fixed thoracic and mobile lumbar regions True ?The thoracolumbar junction (T11-L2) is considered a transitional zone between the fixed thoracic and mobile lumbar regions
MCEM Toxicology MCQ

The following muscles and nerve root supply are correctly paired:
(a) Deltoid:C5 True ?C5 is the nerve root for shoulder abduction by the deltoid muscle. (b) Wrist Extensors:C6 True ?C6 is the nerve root for wrist extension. (c) C7:Elbow Extension True ?C7 is the nerve root for elbow extension. (d) T1:Abductor Digiti Minimi True ?T1 is the nerve root for little finger abduction by abductor digiti minimi.
MCEM Toxicology MCQ

Hip Fractures
(a) Extracapsular fractures are more likely to compromise blood supply to the femoral head than intracapsular fractures. False ? (b) Isolated femoral head fractures are most commonly associated with hip dislocations. True ? (c) Non displaced neck fractures are treated with pin fixation. True ? (d) Displaced fractures are treated with open reduction or prosthesis placement. True ? (e) Overall mortality for intertrochanteric hip fractures is 50% False ?Overall mortality for intertrochanteric hip fractures is 10 to 30%. Hip fracture incidence doubles for each decade after 50. Hip fracture incidence is 3 to 4 times higher in women than in men. The affected leg in a hip fracture is classically shortened and externally rotated. Intracapsular hip fractures involve the femoral head and femoral neck. Extracapsular hip fractures may be intertrochanteric or subtrochanteric. Intracapsular fractures are more likely to compromise blood supply to the femoral head than extracapsular fractures. Isolated femoral head fractures are most commonly associated with hip dislocations. Non displaced neck fractures are treated with pin fixation. Displaced fractures are treated with open reduction or prosthesis placement. Intertrochanteric fractures are classed as stable or unstable. stable fractures are those which the medial cortices of the femoral neck and the femoral fragment abut. Overall mortality for intertrochanteric hip fractures is 10 to 30%.
MCEM Toxicology MCQ

Classification of shock
(a) Class I shock is when blood loss is <10% of blood volume False ? (b) Class II shock is when blood loss is <20% of blood volume False ? (c) Class III shock is when 20-40% of blood volume is lost False ? (d) Class IV shock is when >40% blood volume is lost True ? (e) Class V shock is when >50% of blood volume is lost False ? Class I = <15%, Class II = <30%, Class III = <40%, Class IV = >40%
MCEM Toxicology MCQ

NICE Guideline: Selection of Adults for CT Brain
(a) GCS < 13 when first assessed in ED CT brain should be requested immediately according to the NICE guidelines after head injury. True ?GCS < 13 when first assessed in ED CT brain should be requested immediately (b) If GCS < 15 when assessed 2 hours after presentation in ED CT brain should be requested. True ?If GCS < 15 when assessed 2 hours after presentation in ED CT brain should be requested. (c) A suspected skull fracture is not an indication to request a CT Brain scan. False ?A suspected skull fracture is an indication to request a CT Brain scan. (d) 'Panda' eyes are not an indication to request a CT Brain scan False ?'Panda' eyes is an indication to request a CT brain scan as this is evidence of a fracture at the skull base. (e) A collection of blood in the middle ear space is not an indication to request a CT Brain scan. False ?Haemotympanum is an indication to request a CT Brain scan as this is evidence of a fracture at the skull base.
MCEM Toxicology MCQ

Openings in the diaphragm
(a) The aortic opening lies anterior to the body of T10 False The aortic opening lies anterior to the body of T12.The aortic opening transmits the aorta,the thoracic duct and the azygous vein (b) The aortic opening transmits the aorta,the thoracic duct, the azygous vein, and the vagus nerve. False The aortic opening transmits the aorta,the thoracic duct and the azygous vein. The oesophageal opening transmits the vagi. (c) The esophageal opening is at the level of T12 False The esophageal opening is at the level of T10. (d) The esophageal opening transmits the phrenic nerve False The esophageal opening transmits the vagi at T10. The right phrenic nerve penetrates the diaphragm with the IVC while the left phrenic nerve penetrates on it's own. (e) The caval opening transmits the inferior vena cava at the level of T8 True The caval opening transmits the inferior vena cava at the level of T8. The aortic opening lies anterior to the body of T12.The aortic opening transmits the aorta,the thoracic duct and the azygous vein.The esophageal opening transmits the vagus nerve
MCEM Toxicology MCQ

With regard to the nervous system
(a) Dorsal columns carry proprioception and vibration sense True Dorsal columns ( Posterior Columns ) carry proprioception and vibration sense and decussate in the brainstem. (b) The dorsal columns decussate in the medulla True The dorsal columns decussate in the medulla (c) The sensory cortex is in the parietal lobe True The sensory cortex is in the parietal lobe (d) The spinothalamic tract decussates at the level of the brainstem. False The spinothalamic tract is a sensory pathway originating in the spinal cord that transmits information about pain, temperature, itch and crude touch to the thalamus. The pathway decussates at the level of the spinal cord, rather than in the brainstem. The posterior column-medial lemniscus pathway and corticospinal tract decussate in the brainstem. (e) The muscles of mastication are innervated by the facial nerve False The muscles of mastication are innervated by the trigeminal nerve ( CN V )More specifically, they are innervated by the mandibular branch, or V3 The dorsal columns carry proprioception and vibration sense. From the leg they ascend in gracilis fasicles and from the arm they ascend as the cuneatus fasiciles.In the caudal medulla they synapse and decussate in the internal arcuate fibres.They then ascend to the ventroposterolateral(VPL) nucleas of the thalamus and from there to the sensory cortex of the parietal lobe.
MCEM Toxicology MCQ

The sternal angle lies at the level
(a) The sternal angle lies at the level of the second intercostal space. False The sternal angle lies at the level of the second costal cartilage. (b) The sternal angle lies at the level of the intervertebral disc between the 5th and 6th thoracic vertebrae False The sternal angle lies at the level of the intervertebral disc between the 4th and 5th thoracic vertebrae. (c) The sternal angle lies at the level of the junction of the ascending aorta and the aortic arch but not at the junction between the descending aorta and the aortic arch. False The sternal angle lies at the level of the junction of the ascending aorta and the aortic arch ( and also the junction between the aortic arch and the descending aorta ) (d) The sternal angle lies at the level of the junction between the superior and inferior mediastinum. True The sternal angle lies at the level of the junction between the superior and inferior mediastinum. (e) The sternal angle lies at the level of the bifurcation of the trachea. True The sternal angle lies at the level of the bifurcation of the trachea. The sternal angle lies at the level of the second costal cartilage.As well as the above it lies at the junction of the superior and inferior mediastinum.
MCEM Toxicology MCQ

Abnormal JVP:
(a) Giant 'v' waves are seen in tricuspid regurgitation. True ?Giant 'v' waves are seen in tricuspid regurgitation. (b) No 'a' waves are seen in A Fib. True ?No 'a' waves are seen in A Fib. (c) Inspiratory filling is normal. False ?Kussmaul's sign is seen in pericardial constriction, tamponade and severe asthma. (d) Renal Failure may cause an abnormal JVP. True ?Pericarditis or fluid overload. (e) Cannon waves are seen in ventricular tachycardia. True ?Cannon waves are seen in ventricular tachycardia and complete heart block.
MCEM Toxicology MCQ

Cervical Spondylosis
(a) When severe most commonly effects C5/C6 True (b) Causing pain in the neck requires neck immobilisation False (c) May produce symptoms of vertebrobasilar insufficiency. True (d) Myelopathy is best treated with manipulation. False (e) Radiculopathy rarely recovers completely. False
Cervical Spondylosis -When severe most commonly effects C5/C6 as this is where bending the neck is greatest. Most episodes settle without treatment.Disc protrusion may narrow the vertebral arteries and cause vertebrobasilar insufficiency.Manipulation is contraindicated in myelopathy.
MCEM Toxicology MCQ

The following are causes of spinal cord compression:
(a) Spondylosis. True ? (b) Lymphoma. True ? (c) Abscess. True ? (d) Syringomyelia. True ? (e) Haematomyelia. True ? Syringomyelia and Haematomyelia are causes of intramedullary spinal cord compression. Other causes include trauma, prolapsed disc, and tumors.
MCEM Toxicology MCQ

Veins of the Upper Limb:
(a) All veins in the upper limb possess valves. True ?All veins in the upper limb possess valves. (b) The cephalic vein originates from the medial side of the venous network on the dorsum of the hand. False ?The cephalic vein originates from the postero-lateral aspect of the venous network on the dorsum of the hand. (c) The cephalic vein passes upwards along the lateral border of the forearm anterior to the head of the radius True ?The cephalic vein passes upwards along the lateral border of the forearm anterior to the head of the radius (d) In the upper arm the cephalic vein ascends on the lateral aspect of the biceps brachii to the groove between the deltoid and pectoralis major True ?In the upper arm the cephalic vein ascends on the lateral aspect of the biceps brachii to the groove between the deltoid and pectoralis major (e) The basilic vein begins on the medial side of the venous network on the dorsum of the hand. True ?The basilic vein begins on the medial side of the venous network on the dorsum of the hand.
MCEM Toxicology MCQ

Pelvis X Rays:
(a) The urethra and bladder lie close to the pubic symphysis are damaged by a majority of traumatic injuries to this area. False ?The urethra and bladder lie close to the pubic symphysis and are sometimes damaged by trauma to this area (In 1/5 th of cases) (b) For the pubic bones to separate by over 2.5 cm one or both of the ligaments have to be torn. True ?For the pubic bones to separate by over 2.5 cm one or both of the ligaments have to be torn. (c) It is only possible to obtain the correct diagnosis in 50% of cases from AP views of the pelvis alone. False ?In 94% of cases a correct diagnosis can be made from only AP views of the pelvis (d) The pelvic brim is often disrupted in only one place False ?The pelvic brim cannot be disrupted in only one place (e) Lateral compression fracture causes a disruption of the ala of the sacrum and a horizontal fracture of the ipsilateral pubic symphysis True ?And momentary medial displacement of the hemipelvis
MCEM Toxicology MCQ

The following joints are often subluxed/dislocated in ehlers-danlos syndrome:
(a) Patella True ?The patella is often subluxed/dislocated in ehler-danlos syndrome (b) Shoulder Joint True ?The shoulder joint is often subluxed/dislocated in ehler-danlos syndrome. (c) The temporomandibular joint True ?The temporomandibular joint is often subluxed/dislocated in ehler-danlos syndrome. (d) The subtalar joint True ?The subtalar joint is often subluxed/dislocated in ehler-danlos syndrome. Ehlers-danlos syndrome comprises joint hypermobility, skin hyperextensibility,scar dystrophica and excessive bleeding.
MCEM Toxicology MCQ

Diagnostic Peritoneal lavage is positive when
(a) RBC's >1,000 cells/mm3 False ?RBC's >100,000 cells/mm3 (b) WBC's >100 cells/mm3 False ?>500 cells/mm3 (c) Food Particles True ? (d) Bile True ? (e) Faeces True ? Also 5ml gross blood, or exit of lavage fluid via chest tube or bladder catheter
MCEM Toxicology MCQ

Brachioradialis:
(a) Flexes arm at the elbow. True ?Brachioradialis flexes the arm at the elbow. (b) Supinates the forearm. False Supination of the forearm is the action of the biceps brachii. (c) Brings forearm into midprone position. True ?Brachioradialis brings the forearm into the midprone position. (d) Brachioradialis is innervated by ulnar nerve. False Brachioradialis is innervated by the radial nerve. (e) Overlies ulnar artery. False ?Brachioradialis overlies the radial artery.
MCEM Toxicology MCQ

The Optic Nerve:
(a) A bitemporal hemianopia may be caused by a pituitary tumor or a sella meningioma. True ?A bitemporal hemianopia may be caused by a pituitary tumor or a sella meningioma (b) A homonymous hemianopia is caused by a lesion of the optic tract to the occipital cortex. True ?A homonymous hemianopia is caused by a lesion of the optic tract to the occipital cortex. (c) An incomplete lesion of the optic tract is associated with a central scotomata. False ?An incomplete lesion of the optic tract is associated with macular ( central ) vision sparing (d) An upper quadrant homonymous hemianopia is associated with a parietal lobe lesion. False ?A lower quadrant homonymous hemianopia is associated with a parietal lobe lesion. (e) A lower quadrant homonymous hemianopia is associated with a temporal lobe lesion. False ?An upper quadrant homonymous hemianopia is associated with a temporal lobe lesion.
MCEM Toxicology MCQ

Thoracic vertebrae:
(a) The top of the arch of the aorta is at the level of T3/4 True ?The top of the arch of the aorta is at the level of T3/4 (b) The manubrium sterni encompasses levels T3 and T4 True ?The manubrium sterni encompasses levels T3 and T4 (c) The azygous vein enters the SVC at T6 False ?The azygous vein enters the SVC at T4 (d) The angle of louis is at the level of T4/5 True ?The angle of louis is at the level of T4/5 (e) The bifurcation of the trachea is at the level of T4/T5 True ?The bifurcation of the trachea is at the level of T4/T5
MCEM Toxicology MCQ

Wound Evaluation
(a) Diffuse bleeding most often occurs from the subdermal plexus and superficial veins True ? Diffuse bleeding most often occurs from the subdermal plexus and superficial veins (b) Povidone-iodine based skin disinfectant suppress bacterial growth on intact skin. True ? (c) Povidone-iodine based skin disinfectant should be used in the wound itslf to suppress bacterial growth. False ?Povidone-iodine based skin disinfectant should not be used in the wound itself as it may impair host defences and promote bacteria growth. (d) Chlorhexidine based skin disinfectant should be used in the wound itslf to suppress bacterial growth. False ?Chlorhexidine based skin disinfectant should not be used in the wound itself as it may impair host defences and promote bacteria growth. (e) In well perfused tissues (e.g., scalp) wounds closed without prior hair removal heal with an increase in infection. False ?In well perfused tissues (e.g., scalp) wounds closed without prior hair removal heal with no apparent increase in infection
MCEM Toxicology MCQ

The circle of willis is supplied by
(a) External carotid arteries False ?The circle of willis is supplied by the internal carotid. (b) Basilar arteries True ?The basilar artery gives off the pontine, labyrinthine, superior and anterior inferior cerebellar arteries. (c) Union of vertebral arteries True ? (d) Brachial Artery False ? (e) Axillary artery False ?
MCEM Toxicology MCQ

Central Vein Cannulation Complications include:
(a) Arterial laceration. True After failure of placement, this is the commonest complication of central line insertion. (b) Tension pneumothorax. True ? (c) Haemothorax is increased with IJV cannulation when compared to the subclavian route. False ? (d) Cardiac Tamponade. True ?Can be caused if the tip of the line lies below the pericardial reflection and it perforates the vessel wall. It's least likely to happen via the internal jugular vein (e) Air Embolism. True ? Other complications during placement can be nerve injury. After placement local infection or venous thrombosis can be possible complications.
MCEM Toxicology MCQ

Hand Infections
(a) The hand position of function for splinting includes the MCP joint being at 50 to 90 degrees flexion. True ? (b) Midpalmer space infection occurs from spread of a flexor tenosynovitis or from a penetrating wound to the palm causing infection in the radial or ulnar bursa of the hand. True ? (c) Paronychia is an infection of the lateral nail fold. True ? (d) Flexor tenosynovitis is suggested by tenderness over the flexor tendon sheath. True ? (e) Closed fist injury ( human bite wound above the MCP joint resulting from punching an individual ) be be explored, irrigated and allowed to heal by secondary intention. True ?
MCEM Toxicology MCQ

Eye Trauma:
(a) A hyphema is not a reflection on the degree of trauma sustained. False ?A hyphema suggests significant ocular trauma. (b) Restricted upward gaze suggests a blow out fracture with entrapment of the inferior rectus. True ?Restricted upward gaze suggests a blow out fracture with entrapment of the inferior rectus. (c) A ruptured globe is implied by a flat anterior chamber. True ?A ruptured globe is implied by a flat anterior chamber. (d) The sensation of the inferior orbital nerve is tested below the eye and on the ipsilateral side of the nose. True ?The sensation of the inferior orbital nerve is tested below the eye and on the ipsilateral side of the nose. (e) The pupil can be constricted or dilated after sustaining trauma. True ?The pupil can be constricted or dilated after sustaining trauma. Blowout fractures are the most common orbital fractures. These injuries occur when a blunt object strikes the globe, resulting in expansion of orbital contents and subsequent rupture through the bony floor. Patients may have enophthalmos, or sunken globe, when a large section is ruptured. Infraorbital anesthesia is a more common finding and develops when the infraorbital nerve is contused by the initial trauma or when compressed by bony fragments. Anesthesia of the maxillary teeth and upper lip is more reliable than numbness over the cheek. Diplopia, particularly on upward gaze that usually indicates inferior rectus muscle entrapment, is another important clinical finding. A step-off deformity may be palpated over the intraorbital rim. Subcutaneous emphysema is pathognomonic for fracture into a sinus or nasal antrum.
MCEM Toxicology MCQ

An ulnar nerve lesion may be represented as follows:
(a) Hyperextension at the MCP joint of the little and ring fingers accompanied by flexion of the interphalangeal joints. True ?This is claw-like hand pattern.Hyperextension at the MCP joint of the little and ring fingers accompanied by flexion of the interphalangeal joints. (b) Clawing of the hand is more pronounced with a more proximal lesion. False ?Clawing of the hand is more pronounced with a lesion at the wrist as a lesion at or above the elbow causes loss of flexor digitorum profundus and less flexion at the IP joints. (c) Froments sign tests thumb adduction. True ?The patient is asked to grasp a piece of paper between the thumb and the lateral aspect of the index finger. (d) The ulnar nerve supplies the sensory component to the medial half of the ring finger. True ?The ulnar nerve supplies the sensory component to the medial half of the ring finger.
MCEM Toxicology MCQ

The following are true:
(a) Knee flexion is performed by the quadriceps. False ?Knee flexion is performed by the hamstrings! (b) The hamstrings are innervated by the obturator nerve. False ?The hamstrings are innervated by the sciatic nerve. (c) The sciatic nerve innervates the quadriceps. False ?The femoral nerve(L2/3/4) innervates the quadriceps. (d) The obturator nerve is composed of fibers from L2,L3 and L4. True ?The obturator nerve is composed of fibers from L2,L3 and L4. (e) The sciatic nerve is responsible for ankle dorsiflexion True ?The common peroneal nerve is an extension of the sciatic nerve. Knee flexion is performed by the hamstrings which are innervated by the sciatic nerve(S1). The sciatic nerve is responsible for ankle dorsiflexion via the common peroneal nerve. The obturator nerve is composed of fibers from L2,L3 and L4.
MCEM Toxicology MCQ

Ureters
(a) Each ureter measures approximately 10cm in length False ?Each ureter measures approximately 25cm ( 10 inches ) in length (b) Pass into the anterior surface of the urinary bladder False ?Each ureter passes into the posterior surface of the urinary bladder. (c) Ureteric stones frequently arrest where the renal pelvis joins the ureter. True ?Ureteric stones frequently arrest where the renal pelvis joins the ureter, where the ureter is kinked as it passes the pelvic brim and where the ureter pierces the bladder wall. (d) Are supplied in the inferior end by the renal arteries. False ?The upper end is supplied by the renal arteries, the middle is supplied by the testicular or the ovarian artery and the inferior end is supplied by the superior vesical artery. (e) Lymph drainage is to the lateral aortic and iliac nodes. True ?Lymph drainage is to the lateral aortic and iliac nodes.
MCEM Toxicology MCQ

Lumbar Plexus:
(a) The lumbar plexus is formed by the anterior rami of the upper four lumbar nerves. True ?The lumbar plexus is formed by the anterior rami of the upper four lumbar nerves. (b) It is situated within the psoas muscle True ?It is situated within the psoas muscle (c) The femoral nerve originates from the lumbar plexus from L1 and L2. False ?The femoral nerve originates from the lumbar plexus from L2, L3 and L4 (d) The obturator nerve originates from L1 and L2. False ?The obturator nerve originates from L2, L3 and L4 (e) The obturator nerve innervates the adductors of the thigh and the skin on the medial surface of the thigh. True ?The obturator nerve innervates the adductors of the thigh and the skin on the medial surface of the thigh.
MCEM Toxicology MCQ

The following are correct:
(a) The oesophageal opening in the diaphragm is at the level of T8 False ?The oesophageal opening in the diaphragm is at the level of T10 (b) Branches of the right gastric vessels go through the diaphragm at T10 False ?Branches of the left gastric vessels go through the diaphragm at T10 (c) The left phrenic nerve pierces the diaphragm lateral to the central tendon at the level of T6 False ?The left phrenic nerve pierces the diaphragm lateral to the central tendon at the level of T8 (d) The right phrenic nerve pierces the diaphragm with the IVC at T6 False ?The right phrenic nerve pierces the diaphragm with the IVC at T8 (e) The sternoxiphisternal joint is at the level of T8/9 True ?The sternoxiphisternal joint is at the level of T8/9
MCEM Toxicology MCQ

The Brachial Plexus:
(a) The ulnar nerve is largely made up from C6 and C7 fibres. False ?The ulnar nerve is largely made up from C8 and T1 fibres. (b) The axillary nerve is given off by the posterior cord. True ?The axillary nerve is given off by the posterior cord. (c) The musculocutaneous nerve is made up from C5 , C6 , and C7 True ?The musculocutaneous nerve is made up from C5 , C6 , and C7 (d) The medial cord and the lateral cord form the median nerve True ?The medial cord and the lateral cord form the median nerve (e) The dorsal scapular nerve ( C5 ) supplies the serratus anterior muscle. False ?The dorsal scapular nerve ( C5 ) supplies the rhomboid muscles. Serratus Anterior is supplied by the long thoracic nerve.
MCEM Toxicology MCQ

The following are true in relation to common root compression syndromes produced by lumbar disc prolapse: (a) An L5 root lesion will cause pain from the buttock to the lateral aspect of the leg and on the dorsum of the foot. True ?An L5 root lesion will cause pain from the buttock to the lateral aspect of the leg and on the dorsum of the foot. (b) An L4 root lesion will cause pain from the lateral aspect of the thigh to the medial side of the calf. True ?An L4 root lesion will cause pain from the lateral aspect of the thigh to the medial side of the calf. (c) An S1 root lesion will cause sensory loss on the sole of the foot and the posterior calf. True ?An S1 root lesion will cause sensory loss on the sole of the foot and the posterior calf. (d) An L5 root lesion will cause sensory loss on the dorsum of the foot and anterolateral aspect of the leg. True ?An L5 root lesion will cause sensory loss on the dorsum of the foot and anterolateral aspect of the leg.
MCEM Toxicology MCQ

The Brachial Plexus: (a) In the axilla the posterior divisions unite to form the posterior cord True ?In the axilla the posterior divisions unite to form the posterior cord (b) The lateral cord supplies the extensor structures on the posterior aspect of the limb. False ?The posterior cord supplies the extensor structures on the posterior aspect of the limb. (c) The posterior division of the lower trunk forms the medial cord. False ?The anterior division of the lower trunk forms the medial cord. (d) The posterior cord may contain neurons from all the spinal nerves contributing to the brachial plexus True ?The posterior cord may contain neurons from all the spinal nerves contributing to the brachial plexus (e) The dorsal scapular nerve is a branch of C5. True ?The dorsal scapular nerve is a branch of C5
MCEM Toxicology MCQ

Fissure In Ano (a) Cause painless rectal bleeding False ?Is a common casue of painful rectal bleeding (b) In most cases occur in the midline anteriorly False ?In most cases occur in the midline posteriorly. (c) Discomfort is constant between bowel motions. False ?Discomfort resolves between bowel motions. (d) Are associated with sentinel pile's True ?As a result of hypertrophied papillae. (e) Patient's should increase dietary bran True ?
MCEM Toxicology MCQ

Lumbar Puncture: (a) The plane of the iliac crest runs through L1-L2. False ?The plane of the iliac crest runs through L3-L4. (b) The spinal cord in the adult ends at the level of L1-2. True ?The spinal cord in the adult ends at the level of L1-2. (c) When performing a lumbar puncture the 'give' is felt when passing through the interspinous ligament. False ?The 'give' is felt when passing through the ligamentum flavum. (d) The opening pressure is usually <10 cm of CSF. False ?The opening pressure is usually 7-18cm of CSF. (e) The CSF protein content is usually 0.15 to 0.45g/L. True ?Other important values include WCC <5. For every 1000 RBC's, subtract 1 WBC and 0.015 protein. Headache, which occurs in 10 to 30% of patients, is one of the most common complications following lumbar puncture (LP). Post-LP headache is caused by leakage of CSF from the dura and traction on painsensitive structures. Patients characteristically present with frontal or occipital headache within 24 to 48 hours of the procedure, which is exacerbated in an upright position and improved in the supine position. Associated symptoms may include nausea, vomiting, dizziness, tinnitus, and visual changes.
MCEM Toxicology MCQ

Haemorrhagic shock classification (a) Class I loss is usually <750 ml True ?Class I loss is usually <750 ml (b) Class II loss is usually < 2000 ml False ?Class II loss is usually < 1500 ml (c) Class III shock is <2.5L blood loss False ?Class III shock is <2L blood loss (d) Without intervention, a classic bimodal distribution of deaths is seen in severe hemorrhagic shock. False Without intervention, a classic trimodal distribution of deaths is seen in severe hemorrhagic shock. An initial peak of mortality occurs within minutes of hemorrhage due to immediate exsanguination. Another peak occurs after 1 to several hours due to progressive decompensation. A third peak occurs days to weeks later due to sepsis and organ failure. (e) Lower doses of Dopamine predominantly stimulate dopaminergic receptors that in turn produce renal vasodilation and cardiac stimulation. False Lower doses predominantly stimulate dopaminergic receptors that in turn produce renal and mesenteric vasodilation. Higher doses produce cardiac stimulation and renal vasodilation http://www.emedicine.com/emerg/topic531.htm Class I = <750ml, Class II = <1.5L, Class III= <2L, Class IV = >2L
MCEM Toxicology MCQ

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