Q1. A 3 year old child has been brought with facial lacerations. On examination he has some cuts over his right cheek and under the eye. The GCS on initial evaluation is 15. What is the appropriate next investigation?
Facial X ray
CT scan
Observation
Skull XR
MRI
the answer is Facial X ray,Normal GCS makes intracranial lesion less likely. As there is facial injury to exclude any facial bone fracture we do facial X-ray
Q2. A 24 year old biker has been rescued after being trapped under rocks for almost 12 hours. He complains of reddish brown urine. His creatinine is 3.9mg/dl(normal range 0.6-1.1mg/dL) and his urea is 270mg/dL
(normal range 6 to 24 mg/dL). What is the most important step in the management of this patient?
Dialysis
IV furosemide
IV N/S
IV dextrose
IV KCl
answer is iv normal salineIt is a case of rhabdomyolysis which is initially treated with IV NS.
Q3. A man brought into the emergency department after being stabbed in the chest. Chest is bilaterally clear with muffled heart sounds. BP is 60/nil. Pulse is 124bpm. Jagular Vein Pressure(JVP) raised.the most likely diagnosis?
Pneumothorax
Pulmonary embolism
Hemothorax
Cardiac tamponade
Pericardial effusion
answer is Cardiac tamponadedont forget becks triad 1-low bp , raised jvp , muffled heart sound ,Chest clear so there is no pneumothorax(absent or decreased breath sound of area affected) or pleural effusion. Muffled heart sound is due to fluid in pericardial space, low BP from reduced chamber expansion due to pericardial fluid’s pressure and restricted right heart expansion causes raised JVP.
Q4. A 25 young man is brought to the emergency department after RTA. His GCS on initial evaluation is 6. What is the most appropriate next step?
MRI
Secure airway
Skull XR
IV fluids
CT scan
answer is Secure airway as the ABC is the most important first step
Q5. A butcher stabbed accidently his groin. He bled so much that the towel was soaked in blood and BP 80/50mmHg, pulse 130bpm. What % of circulatory blood did he lose?
40-50%
more than 50%
less than 15%
15-30%
30-40%
answer is 30-40%
Class 1(750ml) up to 15% of blood volume lost: pulse less than 100 , systolic BP normal, pulse pressure normal; Respiratory rate 14-20; urine output greater than 30 ml/hour.
Class 2(750-1500ml) 15%-30% blood volume lost: pulse 100-120; systolic blood pressure normal; pulse pressure decreased; respiratory rate 20-30; urine output 20-30 ml/hour.
Class 3(1500-2000ml) 30%-40% blood volume lost: pulse 120-140; systolic BP decreased; pulse pressure decreased, respiratory rate 30-40; urine output 5-15 ml/hr
Class 4(more than 2L >2000ml) blood loss of greater than 40%: pulse rate >140; systolic BP decreased; pulse pressure decreased’ respiratory rate >35; urine output negligible.
Q6. A girl with history of allergies visited a friend’s farm. She got stridor, wheeze and erythematous rash. What is the most appropriate treatment?
0.5ml of 1:10,000
0.25ml PO adrenaline
0.25ml IM adrenaline
0.25ml IV adrenaline
IV chlorphearamine
answer is 0.25ml IM adrenaline when there are stridor and wheeze this suggest anaphylaxis and treatment option is intramuscular adrenaline(IM)
Q7. A 23 year old man has been stabbed in the back and has SOB. The trachea is not deviated, he has engorged neck veins and absent breath sounds on the right. What is the most appropriate diagnosis?
Pleural effusion
Hemothorax
Tension pneumothorax
Cardiac tamponade
Simple pneumothorax
answer is Tension pneumothoraxPoints in favour:
1- Stab wound in the back
2- SOB
3- Engorged neck vein
4- Absent breath sound.
Q8. A 23 year old male has a tonic clonic seizure whilst at college. His GCS is 12, BP 120/77mmHg,HR 99bpm. What is the most appropriate investigation for his condition?
CT
MRI
Serum blood glucose
Serum electrolyte
Serum drug levels
answer is Serum blood glucose,it is also possible that he may have taken drug, even though first we have to do serum glucose as low blood glucose can be very easily managed and it needs urgent management to save life. If it is excluded then we can look for other causes which may be not fatal in short time as hypoglycaemia
Q9. A young footballer has collapsed during a game. During initial evaluation: RR 14/min, Pulse 88bpm, BP 110/70mmHg. He seems to be sweating and muttering some incomprehensible words. What is the most important next step?
CT
MRI
Serum blood glucose
IV fluid
Body temp
answer is Serum blood glucose,Normal vital signs, sweating and collapse during exercise gives suspicion of hypoglycemia which is very easy to treat but fatal if left unrecognized. So most important next step is to check the blood sugar
Q10. A 47 year old man met with a RTA. He has multiple injuries. Pelvic fracture is confirmed. He has not passed urine in the last 4 hrs. What is the next appropriate management for this patient?
Suprapubic catheter
Insulin
Urethral catheter
IV furosemide
IV fluids
answer is Suprapubic catheter,In pelvic fracture there is chance of urethral rupture and hence displacement of urethral catheter is likely while try to place it
Q11. A 27 year old woman has hit her neck in an RTA without complains of tingling or motor loss. What is the next most appropriate investigation?
Diagonal XR
CT cervical
MRI
XR
answer is XR,there is no neurological deficit we can exclude any fracture by x-ray first,Diagonal x ray mean oblique view of cervical spine By this view we can assess facet joint arthopathy. This doesn't related to RTA
Q12. A man has discharge from his left ear after a fight. Where is the discharge coming from?
CSF
Inner ear
Brain
Outer ear
answer is CSF,probable skull base fracture
Q13. 29 year old male brought to emergency department in unconscious state. There is no significant past history. Which of the following should be done as the initial investigation?
ABG
MRI
Blood glucose
CBC
CT
answer is Blood glucose
Q14. 72 year old lady staying at a nursing home for a few years, a known Hypertensive on regular treatment presented with sudden dysphagia while eating with drooling of saliva and require urgent investigation. What would be your next step?
Endoscopy
Ba swallow
Chest CT
Laryngoscopy
CXR
Endoscopy with biopsy
answer is Endoscopy,Probable impacted food bolus (usually meat)which can be visualized and removed with the aid of endoscopy
Q15. 34 year old man after a car crash is in the emergency department and deteriorating. His GCS has fallen from 13 to 7. What is the most appropriate next step?
IV fluids
intubation
MRI
Burr hole
CT
answer is intubation,ABC protocol
Q16. 34 year old man was brought to the emergency department after a RTA (road traffic accident). BP 50/0mmHg and chest wall not moving symmetrically, respiratory rate:34bpm . What would be initial action?
Intubation and ventilation
IV fluid infusion
CT chest
Transfer to ITU
answer is Intubation and ventilation,ABC protocol
Q17. A young man who was held by the police was punched while in custody. He is now cyanosed and unresponsive. What is the 1st thing you would do?
Turn pt and put in recovery position
IV fluids
Clear airway
Give 100% oxygen
Intubate and ventilate
answer is Clear airway,ABC protocol
Q18. 16 year old teenager was brought to the emergency department after being stabbed on the upper right side of his back. Erect CXR revealed homogenous opacity on the lower right lung, trachea was centrally placed. What is the most probable explanation for the X-ray findings?
Hemothorax
Empyema
Tension pneumothorax
Pneumothorax
answer is Hemothorax,In blunt trauma there may be hemo-pneumothorax but in sharp wound like stabbing there may occur only hemothorax
Q19. 14 year old boy fell and hit his head in the playground school. He didn’t lose consciousness. He has swelling and tenderness of the right cheek with a subconjuctival hemorrhage on his right eye. What is the most appropriate initial investigation?
skull Xray
Brain CT
MRI
Facial Xray
answer is Facial Xray,There is no sign of basal fracture (Panda sign is suggestive of basal fracture, not subconjunctival hemorrhage- unless posterior border of hemorrhage is not visible) and no indication of CT scan (there are some criteria for CT scan which are not fulfilled here
Q20. patient was admitted to the emergency department after a head injury. When examined on arrival his GCS was 15 and then at night his GCS deteriorated to 12. What investigation should be done?
XR skull
CT head
Shift to OR
Drill a burr hole
IV mannitol
answer is CT head,Initial GCS 15 followed by later GCS 12 are suggestive of intracranial haemorrhage. So the best investigation to be done is CT head
Q21. A 32 year old miner is rescued after being trapped under a fallen rock for 3hr. After applying a bladder catether, 10-15ml of reddish brown urine was obtained. HR 120bpm, SBP 100mmHg. What would be the next appropriate step?
Dopamine IV
Fluid challenge
20% Mannitol IV
Furosemide IV
answer is Fluid challenge,The diagnosis is rhabdomyolysis. So IV fluid is the next appropriate step
Q22. 27 year old man presents to the emergency department after an RTA, his foot was stuck under a truck for several hours. He now has swelling on the foot. Examination: foot tenderness, loss of sense in the space between the 3rd metatarsal and big toe and his dorsalis pedis is not felt. What is the most likely diagnosis?
Fibular fracture
Arterial embolus
Compartment syndrome
Arterial rupture
answer is Compartment syndrome,Acute compartment syndrome occurs after a traumatic injury such as a car crash. The trauma causes a severe high pressure in the compartment which results in insufficient blood supply to muscles and nerves. Acute compartment syndrome is a medical emergency that requires surgery to correct. If untreated, the lack of blood supply leads to permanent muscle and nerve damage and can result in the loss of function of the limb
Q23. A man presents with abdominal pain, vomiting, pulse 120bpm, BP 90/60mmHg and a rigid abdomen. His chest is clear. What is the immediate management?
Call radiology
Admit to medical ward
Urgent admission to ITU (Intensive Therapy Unit)
the answer is Urgent admission to ITU
Q24. A 34 year old man was involved in a RTA and whilst in the ambulance his GCS deteriorated and RR increased from 30-48. What is the most appropriate management for this patient?
Needle decompression
100% oxygen
Portable XR
IV fluid
answer is 100% oxygen
Q25. A 27 year young was trying to move his wardrobe but it fell on his thigh. It was there for a very long time before someone was able to remove it. When he was seen in ED he had Casts in his urine but no RBCs. Other investigations showed hypocalcemia and elevated serum creatinine. What is the cause for his renal failure?
Myotroponin
Acetyl acetate
Myoglobin
Acetylcholine
uremia
answer is Myoglobindiagnosis likely is Rhabdomyolysis where renal failure occurs due to myoglobin (myoglobins are released after breakdown of skeletal muscles
Q26. 21 young female had a RTA and is suspected to have a femur fracture. Her BP is 90/60mmHg. What is the first immediate action?
IV fluids
XR
splinting
Send bloods for invenstigation
US
answer is IV fluids
Q27. A 31 year old patient met with road traffic accident. While the nasogastric tube is passing, bowel sounds are heard in the chest. CXR shows NGT curled. What is the diagnosis?
Bowel rupture
Liver rupture
Splenic rupture
Aortic rupture
Diaphragm rupture
answer is Diaphragm rupture
Q28. A young man was knocked down during a fight in the waiting room of the emergency department. He is now unconscious and unresponsive. What is the 1st thing you would do?
Start CPR
Endotracheal intubation
Assess GCS
Put airway
answer is Put airway ABC protocol
Q29. A 48 year old heroin addict was involved in a car crash and is now paraplegic. During the 1st week of hospital stay he cried everyday because he couldn’t remember the accident. What is the most likely diagnosis?
Severe depression
Organic brain damage
Post-traumatic stress disorder
answer is Organic brain damage
Q30. 29 year old man after an RTA brought to the emergency department. BP is 50/0mmHg with asymmetrical chest movement, RR 34bpm. What would be the initial action?
Transfer to ITU
IV fluid infusion
Intubation and ventilation
CT chest
answer is Intubation and ventilation
Q31. 51 year old female comes to the emergency department while having a generalized tonic clonic seizure and she has having difficulty breathing and is cyanosed. What is the Causal treatment for her?
Secure airways
Oxygen mask
IV phenytoin
IV diazepam
answer is Secure airway,Breathing difficulty with cyanosis may indicate saliva, blood, foreign body (as denture), fall back of tongue etc. for which 1st action is to secure airway
Q32. 70 year old female presented with sudden onset of dysphagia. She is neither able to swallow liquid nor solid, he recently had a denture fitting. What is the most probable diagnosis?
Achalasia cardia
Plummer vinson syndrome
Foreign body
Esophageal rupture
Esophageal cancer-stage1
answer is Foreign body,Sudden onset of dysphagia to both liquid and solid and recent history of fitting denture suggests foreign body (denture) in oesophagus
Q33. A patient unresponsive and cyanosed. What is the 1st step in management?
Check airway
Recovery position
Chest compressions
Mouth to mouth breath
answer is Check airway
Q34. An 81 year old woman with a history of HTN develop acute breathlessness, respiratory rate 32bpm, widespread lung crackles, pulse 120bpm, BP 160/90mmHg and elevated venous pressure. Her peripheral O2 saturation is 85%. What is the single most appropriate initial management?
IV furosemide
Nitrate infusion
100% oxygen
IV antibiotics
Nebulizer Salbutamol
answer is 100% oxygen,Oxygen saturation is low. So we have to give oxygen initially.
Q35. A man got his hand caught in machinery at work. The fingers are swollen but the XR shows no fracture. What is the most appropriate management?
Splint
Put in plaster
Elevate in high sling for 2 days
Neighbor strapping
Broad arm sling for 1 week
answer is Elevate in high sling for 2 days, Extravasetion of blood caused this swelling along with inflammation for which best option is elevate in high sling for 2 days which will help improve symptom by gravitational shift of fluid from hand
Q36. A 13 year old boy fallen from a tree and injured his right chest. He has pain and difficulty breathing. He is tachypenic and tender with an area of paradoxical chest wall movement on the right side. What is most likely diagnosis?
Hemothorax
Fracture ribs
Diaphragmatic rupture
Tension pneumothorax
Flial chest
answer is Flial chest,In flial chest multiple adjacent ribs are broken in multiple places, separating a segment, so a part of the chest wall moves independently. Pain, difficulty breathing, tachypnea and tender area of chest wall movement suggest flial chest
Q37. A 54 year old woman has injured her right lower chest in road traffic accident. BP=80/50mmHg, pulse=120bpm. Auscultation finding (of chest) reveal bowel sounds . What is the most likely diagnosis?
Rib fracture
Flail chest
Ruptured esophagus
Diaphragmatic rupture
tension pneumothorax
answer is Diaphragmatic rupture,Bowel sound present on auscultation of chest following RTA causing lower chest injury is suggestive of diaphragmatic rupture
Q38. A 38 year old worker has fallen off a roof. He is shocked and has chest pain. on examination there is radiofemoral pulse delay. His CXR show widening of the mediastinum. What is the most likely diagnosis?
Cardiac tamponade
Traumatic rupture of aorta
Tension pneumothorax
Diaphragmatic rupture
answer is Traumatic rupture of aorta,traumatic aortic disruption is caused by a rapid acceleration (or deceleration) causing a tear in the aorta. Normally this is immediately fatal, but those who survive may show a widened mediastinum on CXR. This can be confirmed with CT scan or angiography of the aorta and requires prompt surgical correction. Stable the haemodynamics and surgical correction. Note: pts with diaphragmatic rupture usually presents days after trauma with vague symptoms, history is vital
Q39. A 60 year old man is brought to the emergency department in an agitated state. He is lashing out violently. which drug of choic to treat agitation in this patient in low dose have relative lack of autonomic side effect?
Clozapine
Chlorpromazine
Haloperidol
Diazepam
Fluoxetine
answer is Diazepam,Haloperidol has autonomic side effects
Q40. A 44 year old man skidded on a wet road while riding his motorbike at a speed of 90km\h. He has a large hematoma on temporal scalp, some bruises on chest wall and abdomen and a deformed thigh. GCS 11. High flow oxygen via mask given. Most immediate radiological inv required during initial resuscitation phase?
CT brain
CT abdomin
CXR
XR femur
answer is CXR,CXR may reveal possible chest structure trauma requiring urgent attention which may be life saving while brain lesion need time consuming CT and fracture femur may be managed taking more time