Curriculum Quiz: ACCS Major

Question 1 of 30

1. Question

Which of the following statements is true about anaphylaxis?

It is a type I hypersensitivity reaction
It is a type II hypersensitivity reaction
It is a type III hypersensitivity reaction
It is a type IV hypersensitivity reaction
It is a type V hypersensitivity reaction

Question 2 of 30

2. Question

What is considered optimal pre-oxygenation time/parameter prior to intubation?

1 minute of pre-oxygenation
3 minutes of pre-oxygenation or end-tidal O2 of >85%
End-tidal O2 of >70%
Oxygen saturation of >85%
Bag-valve mask assisted ventilation for 2 minutes

Question 3 of 30

3. Question

A 64-year-old suffered an out-of-hospital cardiac arrest post-MI. Following defibrillation, they now have a pulse but their non-invasive blood pressure is 60/30mmHg.

Which of the following options is your first management step?

Site a naso- or oro-gastric tube to relieve gastric distension
Give a 250ml fluid challenge and then immediately recheck the blood pressure
Site an arterial line for closer monitoring of their blood pressure
Provide inotropic support urgently

Question 4 of 30

4. Question

Which of the following statements regarding chest drain insertion in Emergency Department are false? (Select all that apply)

Monitoring of patient is not necessary for insertion of a chest drain
Seldinger insertion has replaced open chest drain insertion in trauma
The patient should be pre-oxygenated on 15L reservoir bag mask
IV access and O negative blood availability is essential in all cases of chest drain insertion

Question 5 of 30

5. Question

Whilst waiting for the ambulance to arrive for the transfer, your patients MAP begins to drop, and he loses consciousness. What is your priority now?

Start CPR early
Give 300mg IV amiodarone
Give 2g IV magnesium
Cardioversion
Give a 20ml/Kg fluid challenge

Question 6 of 30

6. Question

All of the following statements regarding drugs and fluids in cardiac arrest are true except one.

Which one is false?

There is no evidence that vasopressin is superior to adrenaline as a vasopressor
Sodium bicarbonate should be reserved for the treatment of tricyclic antidepressant overdose
5% dextrose should be avoided as the fluid agent of choice in hypovolaemia
10% calcium chloride is preferable to 10% calcium gluconate as it provides a higher available calcium dose
CPR should be continued for at least 60 minutes if thrombolysis is given for suspected massive pulmonary embolus

Question 7 of 30

7. Question

The key treatment for anaphylaxis is?

Adrenaline
Oxygen
IV fluids
IV H1 antagonists e.g. chlorpheniramine
IV steroids

Question 8 of 30

8. Question

Which of the following is not a sign of absent brain stem reflexes?

Fixed and dilated pupils
Preserved corneal reflex
No cough reflex
No motor responses within the cranial nerve distribution
Absent oculo-vestibular reflex

Question 9 of 30

9. Question

Which one of the following is typical of severe hypothermia?

Thrombocytopaenia
Reduced haematocrit
Hyperkalaemia
Normal clotting
Reduced creatinine

Question 10 of 30

10. Question

Which one of the following patients has clear indication for chest drain insertion in the ED?

A 19-year-old man stabbed in the right side of his chest posteriorly with a moderate sized pneumothorax
A 35-year-old man who has fallen 8m with fractured ribs 5-7 on the left side. His chest x-ray is otherwise unremarkable. The injury appears isolated, though he does have respiratory distress, possibly because of pain
A 26-year-old male with a small haemothorax secondary to a rib#, detected on CT
A 46-year-old woman with an occult pneumothorax detected on CT. There is no current plan for her to be ventilated
A 74-year-old woman with a small isolated traumatic pneumothorax following a road traffic accident

Question 11 of 30

11. Question

In major trauma, a FAST scan is ideally carried out under which of the following circumstances?

Rapidly and repeatedly
After the primary survey
By a radiologist
Once only
While waiting for a CT

Question 12 of 30

12. Question

A 20-year-old man has fallen from a third-floor window. Which of the following statements regarding the diagnosis of aortic injury is correct?

The incidence is highest in young males
If he complains of chest pain, this is likely to be due to an aortic injury
A BP difference between both arms is likely if he has an aortic injury
A normal, good quality erect chest x-ray in his case effectively rules out the diagnosis
A thoracic CT scan with IV contrast demonstrating a mediastinal haematoma confirms the diagnosis

Question 13 of 30

13. Question

Which of the following statements regarding haemorrhagic shock in otherwise healthy adults is true?

Blood pressure starts to fall after the loss of about 5-10% of circulating volume
Conscious level will drop after the loss of about 20% circulating volume
Pulse pressure will not decrease until loss of about 40% of circulating volume
Systolic blood pressure usually increases until about 30% of circulating volume is lost
Pulse pressure will decrease before systolic blood pressure

Question 14 of 30

14. Question

Raised intracranial pressure (ICP) is most likely to cause:

Oculomotor nerve (CN III) and facial nerve (CN VII) palsy
Oculomotor (CN III) and abducens (CN VI) nerve palsy
Optic (CN II) and abducens (CN VI) nerve palsy
Optic (CN II) and oculomotor (CN III) nerve palsy

Question 15 of 30

15. Question

Which of the following is not an indication for recompression therapy?

Decompression sickness
Arterial gas embolism
Carbon monoxide poisoning
Immersion pulmonary oedema
Crush injury

Question 16 of 30

16. Question

In which one of the following scenarios is clamping the chest drain appropriate?

Sudden deterioration in oxygen saturation
Patient transfer
Chest drain not swinging
Abrupt and continuous blood loss resulting in profound clinical deterioration
Contrast phase of CT imaging

Question 17 of 30

17. Question

How is necrotising fasciitis diagnosed?

Using LRINEC
On CT
On MRI
Clinical diagnosis (confirmed at operation with gram stain and culture of tissue)
On plain XR

Question 18 of 30

18. Question

A 24-year-old male is brought into ED with an acute onset of headache. He has a low grade fever and is photophobic. His GCS is 15 and he has no focal neurology. The headache does not settle with simple analgesia. Which of the following is true?

A Lumbar puncture should never be performed prior to first obtaining a CT head
There is a very low risk of cerebral herniation from an LP even if ICP is raised
Performing an LP is likely to cause meningitis
In viral meningitis you would expect CSF glucose and protein to be low and the white cells to be predominantly lymphocytes

Question 19 of 30

19. Question

Which one of the following drugs are not removed from the circulation by dialysis?

Ethylene glycol
Lithium
Aspirin
Paraquat
Tricyclics

Question 20 of 30

20. Question

Which of the following statements is true about intrapleural pressure under normal conditions?

It is always positive
It is negative during inhalation; positive during exhalation
It is positive during inhalation; negative during exhalation
It is always negative

Question 21 of 30

21. Question

In which of the following patients is the instigation of inotropic support indicated?

A 26-year-old thrown from horse. T4 sensory level and paraplegia. BP 75/40, HR 120
A 36-year-old with a stab wound to the chest. BP 60/40, HR 140
A 73-year-old with an inferior myocardial infarction. BP 90/60, HR 80
A 36-year-old with sudden onset urticaria and abdominal pain. BP 70/40, HR 120
A 68-year-old with a pulsatile abdominal mass and back pain. BP 80/50, HR 130

Question 22 of 30

22. Question

If the patient develops hypoxia post-intubation, what are possible considerations that should be taken into account?

Displaced endotracheal tube
Developing pneumothorax
Obstructed tube due to secretions/kinked
Inadequate sedation/paralysis
All of the above

Question 23 of 30

23. Question

Which one of the following drugs are helpful in patients with anaphylaxis who are also taking beta-blockers and do not respond to adrenaline?

Dobtamine
Isoprenaline
Glucagon
Metoprolol
Insulin

Question 24 of 30

24. Question

Which of the following statements regarding mortality in shock is correct?

Severe sepsis has a mortality of about 60%
Cardiogenic shock has a mortality of about 30%
Worldwide, about 2 million children under 5 years die each year from hypovolaemic shock secondary to diarrhoea
About 250 children under 5 years die each year in the UK as a result of diarrhoeal illness
About 200 people die of anaphylactic shock in the UK each year

Question 25 of 30

25. Question

Which of the following statements regarding open insertion of chest drain is correct?

Both ends of the drain clamped with forceps on insertion
Only the distal end of the drain clamped with forceps on insertion
Drains inserted for haemothorax should be directed posteriorly and superiorly
Bubbling of fluid in the chest drain is a sign the tube is positioned incorrectly

Question 26 of 30

26. Question

A 67-year-old diver learnt to dive whilst on holiday in Egypt. He did not dive deeper than 18 m and had no problems on his dives. He returned 7 days ago. Today, he has been unable to move his right arm and so attends the emergency department. When taking a history he seems to be slightly slurring his words.

What is the most likely diagnosis?

Decompression sickness
Arterial gas embolism
SAH
A trapped nerve
Stroke

Question 27 of 30

27. Question

A 50-year-old man with an inferior myocardial infarction has been thrombolysed in the resuscitation room. He is awaiting a coronary care bed when he is witnessed to groan, turn pale and become unconscious. His rhythm shows ventricular fibrillation.

Which is the most appropriate next move?

Start CPR
Check his pulse
Deliver a precordial thump
Defibrillation
Intubation

Question 28 of 30

28. Question

Which one of the following is a reliable marker of futility in primary hypothermic cardiac arrest?

A K+ of >10 mmol/L
Frozen peripheries
Fixed dilated pupils
Failure to achieve defibrillation after 3 shocks
Core temperature <20oC

Question 29 of 30

29. Question

A 45-year-old man has regained spontaneous circulation following an out-of-hospital arrest.

Which one of the following statements regarding the role of thrombolysis is true?

Thrombolysis should be given if massive pulmonary embolus is suspected
Confirmation of clinical suspicion (by echocardiography or CT pulmonary angiogram (CTPA) is required before thrombolysing suspected PE in the post–ROSC patient
Thrombolysis should routinely be given following ROSC after out of hospital cardiac arrest
If MI is suspected as the cause, thrombolysis is preferred to primary angioplasty (even if angioplasty is immediately available)

Question 30 of 30

30. Question

With regard to prognosis following neck sprain injury, which one of the following is associated with a better outcome?

Female gender
Instruction of a solicitor for the purposes of personal injury litigation
Younger age
Early use of a cervical collar
The presence of neck pain and headache following injury