Curriculum Quiz: ACCS Acute

Question 1 of 30

1. Question

Which one of the following statements best explains the cause of pain in renal colic patients?

Obstruction to flow along the ureter

Correct Incorrect Correct answer

Ureteric spasm

Correct Incorrect Correct answer

Increased diuresis that occurs in these patients

Correct Incorrect Correct answer

The pain is due to several factors including those listed above

Correct Incorrect Correct answer

Question 2 of 30

2. Question

You are seeing an 18-year-old male who has presented to the ED with a 48-hour history of central abdominal pain. He is finding it difficult to describe his symptoms. The pain appears to be poorly localised, and constant.

With regards to the mechanism of this patient’s abdominal pain, which of the following statements is true?

Parietal pain localises to the embryonic site of the affected organ

Correct Incorrect Correct answer

Pain such as this is likely mediate by the autonomic nervous system

Correct Incorrect Correct answer

Organs developed from the hindgut tend to cause central abdominal pain

Correct Incorrect Correct answer

Visceral pain is normally well localised

Correct Incorrect Correct answer

Constant pain, such as this, suggests a hollow organ is affected

Correct Incorrect Correct answer

Question 3 of 30

3. Question

A 55-year-old male, who has a known heavy alcohol intake, presents to the ED with epigastric pain and vomiting.

With regards to clinical examination of a patient with pancreatitis, which of the following statements is correct?

Signs of localised peritonism are normally marked

Correct Incorrect Correct answer

Abdominal distension, if present, is normally caused by haemorrhage from a necrotic pancreas

Correct Incorrect Correct answer

Jaundice is often present

Correct Incorrect Correct answer

A positive Chvostek's sign suggests hypocalcaemia

Correct Incorrect Correct answer

Grey Turner's sign is due to bruising around the umbilicus

Correct Incorrect Correct answer

Question 4 of 30

4. Question

A confused elderly lady is brought in from a nursing home with a history of severe abdominal pain, vomiting and distension of the abdomen. Looking at the abdominal x-ray, which one of the following statements is true?

Click on the x-ray to enlarge.

There is isolated small bowel obstruction

Correct Incorrect Correct answer

There is large bowel obstruction due to faecal impaction

Correct Incorrect Correct answer

This is a sigmoid volvulus

Correct Incorrect Correct answer

This is a caecal volvulus

Correct Incorrect Correct answer

The appearance of the bowel is within normal limits

Correct Incorrect Correct answer

Question 5 of 30

5. Question

Which of the following statements concerning the prognosis of acute back pain is NOT correct?

Almost all patients are fully better within 3 months

Correct Incorrect Correct answer

There is likely to be significant improvement of pain within a few weeks

Correct Incorrect Correct answer

Most patients return to work within 1 month

Correct Incorrect Correct answer

There is a significant risk of recurrence

Correct Incorrect Correct answer

The prognosis for acute sciatica is no worse than the prognosis for acute non-specific back pain

Correct Incorrect Correct answer

Question 6 of 30

6. Question

A patient was admitted to the ED three days ago following an intoxicated head injury. She has been treated for AWS with symptom triggered diazepam. She has ongoing confusion and bruises of varying ages over her arms, trunk and head.

What is the next appropriate investigation?

MMSE

Correct Incorrect Correct answer

CT head

Correct Incorrect Correct answer

MSSU

Correct Incorrect Correct answer

Blood culture

Correct Incorrect Correct answer

CXR

Correct Incorrect Correct answer

Question 7 of 30

7. Question

Which of the following is the accepted term in the UK for patients presenting with aggression and agitation, acidosis and hyperadrenergic autonomic dysregulation?

Excited delirium

Correct Incorrect Correct answer

Cocaine toxicity

Correct Incorrect Correct answer

Acute behavioural disturbance

Correct Incorrect Correct answer

Extreme agitation

Correct Incorrect Correct answer

Psychomotor agitation

Correct Incorrect Correct answer

Question 8 of 30

8. Question

What is the correct definition of delirium?

Acute disorder of the mental processes accompanying organic disease

Correct Incorrect Correct answer

Global impairment of brain functioning due to structural abnormality

Correct Incorrect Correct answer

Alteration of mental state in which insight and contact with reality are lost

Correct Incorrect Correct answer

Disorder of the mental processes associated with pyrexia

Correct Incorrect Correct answer

Global impairment of brain functions with impairment of cognition and an insidious course

Correct Incorrect Correct answer

Question 9 of 30

9. Question

What are the red-flags to look out for on an ECG of a patient who presents with syncope?

Prolonged QT interval

Correct Incorrect Correct answer

Paced rhythm

Correct Incorrect Correct answer

Left ventricular hypertrophy

Correct Incorrect Correct answer

All options listed

Correct Incorrect Correct answer

Question 10 of 30

10. Question

A 36-year-old man presents with severe headache while he was bench pressing at the gym. He describes the onset as abrupt reaching maximum intensity within a few seconds. He is neurologically normal and the pain relief given at triage 1 hour ago has completely resolved his headache. Which of the following would be the best course of action?

The patient should be referred for urgent CT scan of the brain

Correct Incorrect Correct answer

The patient has an exercise induced headache and can be discharged home with out-patient follow up

Correct Incorrect Correct answer

If he had a family history of a grandparent who had a SAH this should alter your decision making

Correct Incorrect Correct answer

You should observe him for another 2 hours before making your decision

Correct Incorrect Correct answer

You should ask for a neurology opinion

Correct Incorrect Correct answer

Question 11 of 30

11. Question

Concerning the pathophysiology of vertigo, which is the most accurate statement?

Benign paroxysmal positional vertigo (BPPV) is most commonly due to the presence of canaliths in the anterior semicircular canal, and can be treated with the Epley manoeuvre.

Correct Incorrect Correct answer

Vestibular neuritis is often associated with post-viral hearing loss, or tinnitus.

Correct Incorrect Correct answer

Vertigo is an early feature of acoustic neuroma (vestibular schwannoma) because of the dysfunction of the vestibular nerve and expansion in the cerebellar pontine angle.

Correct Incorrect Correct answer

Isolated vertigo can be a feature of central cerebellar infarction and can be a presenting feature of multiple sclerosis.

Correct Incorrect Correct answer

Meniere’s disease is caused by endolymphatic hydrops (dilated labyrinth) and results in slowly-progressive, unilateral hearing loss.

Correct Incorrect Correct answer

Question 12 of 30

12. Question

Which of the following is NOT considered a major risk factor for PE?

Oral contraceptive pill use

Correct Incorrect Correct answer

Acute medical illness

Correct Incorrect Correct answer

Malignancy

Correct Incorrect Correct answer

Varicose veins

Correct Incorrect Correct answer

Previous venous thrombo-embolism (VTE)

Correct Incorrect Correct answer

Question 13 of 30

13. Question

Which one of the following is NOT a high risk feature for acute pericarditis?

Large pericardial effusion

Correct Incorrect Correct answer

Oral anticoagulants

Correct Incorrect Correct answer

Raised CRP

Correct Incorrect Correct answer

Temperature > 38 degrees centigrade

Correct Incorrect Correct answer

Acute trauma

Correct Incorrect Correct answer

Question 14 of 30

14. Question

A 52-year-old man attends the emergency department acutely unwell. He had an episode of chest pain lasting 40 minutes 3 days ago, which he self treated with antacids, bed rest and fasting. In the last 3 hours he has become acutely SOB. His BP is 90/45 and his CXR shows pulmonary oedema. His ECG shows a completed inferior MI.

What is the most likely explanation of his presentation?

He has developed a pulmonary embolism secondary to immobilisation

Correct Incorrect Correct answer

He has acute papillary muscle rupture and has developed acute mitral regurgitation

Correct Incorrect Correct answer

He has fluid overloaded secondary to salt and water retention

Correct Incorrect Correct answer

His infarct has extended

Correct Incorrect Correct answer

He has developed an aspiration pneumonia

Correct Incorrect Correct answer

Question 15 of 30

15. Question

Regarding endocarditis, which one of the following statements is correct?

Loeffler’s (eosinophilic) endocarditis responds well to hydroxyurea treatment

Correct Incorrect Correct answer

NBTE (Non Bacterial Thrombotic Endocarditis) is related to Patent Ductus Arteriosus (PDA) and Atrial Septal Defect (ASD)

Correct Incorrect Correct answer

Antibiotic treatment reduces embolic phenomenon in infective endocarditis by half after three weeks of treatment

Correct Incorrect Correct answer

Trans oesophageal echocardiography has a false negative rate of less than 5%

Correct Incorrect Correct answer

Even with appropriate treatment, 5 year mortality for Injected drug users with right sided endocarditis is the highest

Correct Incorrect Correct answer

Question 16 of 30

16. Question

Which of the following symptoms may indicate a diagnosis of COPD?

Exertional breathlessness

Correct Incorrect Correct answer

Sputum production

Correct Incorrect Correct answer

Wheeze

Correct Incorrect Correct answer

Frequent winter bronchitis

Correct Incorrect Correct answer

All options listed

Correct Incorrect Correct answer

Question 17 of 30

17. Question

Which of the following is not a risk factor for necrotising fasciitis?

Age >35

Correct Incorrect Correct answer

PMHx of type 2 diabetes

Correct Incorrect Correct answer

Obesity

Correct Incorrect Correct answer

Immunosuppression

Correct Incorrect Correct answer

IV drug abuse

Correct Incorrect Correct answer

Question 18 of 30

18. Question

Which of the following statements concerning status epilepticus (SE) is correct?

Hypotension is common during the early stages of SE, but blood pressure commonly rises as the seizure continues

Correct Incorrect Correct answer

An acidosis is commonly seen in SE having both metabolic and respiratory components

Correct Incorrect Correct answer

A neutrophil leukocytosis in conjunction with the presence of white cells in the CSF suggests an infective aetiology

Correct Incorrect Correct answer

The use of the drug phenobarbitone is associated with a high incidence of visual field defects

Correct Incorrect Correct answer

Question 19 of 30

19. Question

A 28-year-old man presents to the ED with an acute severe headache. Which of the following is not a typical feature of a cluster headache?

The pain lasts several days and they occur in clusters

Correct Incorrect Correct answer

They occur more commonly in men

Correct Incorrect Correct answer

Pain is localised to the temporal region

Correct Incorrect Correct answer

Patients appear agitated during attacks

Correct Incorrect Correct answer

Episodes typically last an hour

Correct Incorrect Correct answer

Question 20 of 30

20. Question

In phaeochromocytoma, the highest sensitivity test is?

Plasma metanephrine level

Correct Incorrect Correct answer

Plasma cortisol level

Correct Incorrect Correct answer

Serum adrenaline level

Correct Incorrect Correct answer

Urine serotonin level

Correct Incorrect Correct answer

Urine VMA level

Correct Incorrect Correct answer

Question 21 of 30

21. Question

Which investigation would you choose to look for a cervical artery dissection?

Contrast CT head and neck

Correct Incorrect Correct answer

Non-contrast CT head and neck

Correct Incorrect Correct answer

MRI head and neck

Correct Incorrect Correct answer

MRA head and neck

Correct Incorrect Correct answer

Transcranial Doppler

Correct Incorrect Correct answer

Question 22 of 30

22. Question

Which of the following statements is correct with regard to N-acetylcysteine in patients with acute liver failure?

It should be administered immediately until paracetamol levels are back

Correct Incorrect Correct answer

It should be administered to all patients when the cause is unknown

Correct Incorrect Correct answer

It is contraindicated in patients who have previously had an allergic reaction

Correct Incorrect Correct answer

It is only indicated if commenced within the first 24 hours since paracetamol ingestion

Correct Incorrect Correct answer

It should only be administered once the paracetamol levels are back to normal

Correct Incorrect Correct answer

Question 23 of 30

23. Question

Which of the following does NOT cause obstructive jaundice?

Pancreatic carcinoma

Correct Incorrect Correct answer

Cholangiocarcinoma

Correct Incorrect Correct answer

Pancreatitis

Correct Incorrect Correct answer

Primary biliary cirrhosis

Correct Incorrect Correct answer

Primary sclerosing cholangitis

Correct Incorrect Correct answer

Question 24 of 30

24. Question

A 67-year-old male presents with an acutely ischaemic right leg.

Which one of the following findings on examination indicate irreversible ischaemia?

Loss of sensation in the toes on his right leg

Correct Incorrect Correct answer

No audible arterial Doppler signal in his right foot

Correct Incorrect Correct answer

Fixed mottling of the skin

Correct Incorrect Correct answer

Pain at rest in his right foot

Correct Incorrect Correct answer

No palpable femoral pulse

Correct Incorrect Correct answer

Question 25 of 30

25. Question

Regarding the tibial nerve, which of the following statements is correct?

The tibial nerve is a branch of the common peroneal nerve

Correct Incorrect Correct answer

The tibial nerve has sensory and motor branches

Correct Incorrect Correct answer

The tibial nerve is related to the lateral malleolus at the ankle joint

Correct Incorrect Correct answer

Tibial nerve compression syndrome is the commonest lower limb entrapment syndrome

Correct Incorrect Correct answer

Question 26 of 30

26. Question

Which one of the following statements is true regarding Wells criteria risk assessment?

It can be used instead of radiological investigation

Correct Incorrect Correct answer

It is appropriate for use in pregnant patients

Correct Incorrect Correct answer

A low score precludes the need for further investigation

Correct Incorrect Correct answer

A high score is an indication for D-dimer assay

Correct Incorrect Correct answer

There is clinician subjectivity required in applying the Wells criteria to achieve a risk score

Correct Incorrect Correct answer

Question 27 of 30

27. Question

Which one of the following characterises paroxysmal atrial fibrillation (AF)?

Restoration to sinus rhythm with treatment

Correct Incorrect Correct answer

Self-limiting episodes of AF

Correct Incorrect Correct answer

Infrequent episodes of AF

Correct Incorrect Correct answer

Brief episodes of AF

Correct Incorrect Correct answer

Question 28 of 30

28. Question

A 32-year-old man presents to the ED following an episode of palpitations which had lasted several minutes about an hour previously associated with minimal dizziness and feeling vaguely unwell. By the time of presentations his palpitations have resolved and his examination is normal.

Which one of the following is likely to be the least useful investigation?

12 lead ECG

Correct Incorrect Correct answer

Bedside glucose management

Correct Incorrect Correct answer

Urea and electrolytes

Correct Incorrect Correct answer

Full Blood Count

Correct Incorrect Correct answer

Chest X-ray

Correct Incorrect Correct answer

Question 29 of 30

29. Question

An 18-year-old man presents to the emergency department complaining of palpitations. Which one of the following factors in the history most strongly suggests an arrhythmia?

Chest pain

Correct Incorrect Correct answer

Tingling in both hands

Correct Incorrect Correct answer

Sudden onset

Correct Incorrect Correct answer

Previous episodes

Correct Incorrect Correct answer

Shortness of breath

Correct Incorrect Correct answer

Question 30 of 30

30. Question

Which factor is known to improve stroke outcome?

Permissive hypotension

Correct Incorrect Correct answer

Temperature >38oC

Correct Incorrect Correct answer

Admission to a stroke unit

Correct Incorrect Correct answer

Diabetes

Correct Incorrect Correct answer

Curriculum Quiz: ACCS Acute

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