EM Quiz 7

EM Quiz 7

EM Quiz 7 EM Quiz 7

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EM Quiz 7 Summary – review your personal results below.

To learn more about any of the topics covered in this Revision Block – see the following RCEMLearning content listed:

Q1: Gastroenteritis In Children Under 5 Years Of Age – Learning Session

Q2: Vertigo in the ED – Learning Session

Q3: Anorectal Disease – Learning Session

Q4: Acute Facial Palsy – Learning Session

Q5: Exacerbation of Chronic Obstructive Pulmonary Disease – Learning Session

Q6: Sudden Visual Loss – Learning Session

Q7: Uncommon Nerve Entrapment Syndromes – Learning Session

Q8: Acute Limb Ischaemia – Learning Session

Q9: Jaundice – Learning Session

Q10: Soft Tissue and Bony Injuries in Children – Learning Session

Why not try another RCEMLearning – EM Quiz and see how you do

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Question 1 of 10

1. Question
A 3-year-old child (weight 16 kg) presents with a 24-hour history of fever, diarrhoea and vomiting. His parents report a “tummy bug” has affected several of the children at nursery, they have not been overseas and his urine output is unchanged.

At triage he appears unwell and is tachycardic but normotensive. On examination he is pink, has warm extremities and a CRT of 2 seconds. His eyes appear sunken and he has a dry tongue.

According to NICE guidelines, which of the following management options is the most appropriate?
- Discharge home with verbal advice (encourage oral intake, return if symptoms or signs of dehydration develop)
- Prescribe a course of amoxycillin in case he has an infection elsewhere (i.e. ears, urine, throat)
- Oral rehydration (aim to replace 10 ml every 10 mins)
- Oral rehydration (aim to replace a 50 ml/kg deficit and maintenance over 4 hours)
- Give 10ml/kg 0.9% saline followed by IV fluids to replace both deficit (100 ml/kg) and maintenance requirements
Correct

Incorrect
Question 2 of 10

2. Question
Regarding treatments for vertigo, which statement is most accurate:
- Diazepam may be used as an alternative to Prochlorperazine
- There is no proven benefit from the use of corticosteroids in patients with vestibular neuritis
- Vestibular rehabilitation therapies have yet to be proven in randomised clinical trials
- Bed rest should be advised until symptoms have largely settled
- Vestibular suppressants may be required for some weeks to treat labyrinthitis
Correct

Incorrect
Question 3 of 10

3. Question
With regard to the anatomy of the anorectum, which one of the following is correct?
- The internal sphincter is made up of three parts: deep, superficial and subcutaneous
- The epithelium of the anus is columnar in type
- The levator ani has no part in the maintenance of continence
- The external sphincter is formed by an extension of the puborectalis
- The anal columns are found at the recto-sigmoid junction
Correct

Incorrect
Question 4 of 10

4. Question
When considering the presentation of Bell’s palsy to the emergency department (ED), which one of the following statements is correct?
- Bell's palsy is defined as an acute idiopathic upper motor neurone facial paresis
- An average sized UK ED will see approximately 500 cases of Bell's palsy per year
- More than 75% of patients with Bell's palsy will recover fully without treatment
- Motor synkinesis is a recognised complication of Bell's palsy and crocodile tears syndrome is one example of this phenomenon
- Bell's palsy can be diagnosed once a central cause for facial weakness has been excluded
Correct

Incorrect
Question 5 of 10

5. Question
Which of the following combinations may be considered maximal initial medical treatment of COPD?
- Oxygen to target saturations of 94-98%, 5 mg nebulised salbutamol, 500 mcg nebulised ipatropium bromide and antibiotics
- Oxygen to target saturations of 88-92%, 5 mg nebulised salbutamol, 500 mcg nebulised ipatropium bromide and antibiotics
- Oxygen to target saturations of 94-98%, 5 mg nebulised salbutamol, 500 mcg nebulised ipatropium bromide, 30 mg prednisolone and antibiotics only if indicated
- Oxygen to target saturations of 88-92%, 5 mg nebulised salbutamol, 500 mcg nebulised ipatropium bromide, 30 mg prednisolone and antibiotics
- Oxygen to target saturations of 88-92%, 5 mg nebulised salbutamol, 500 mcg nebulised ipatropium bromide, 30 mg prednisolone and antibiotics only if indicated
Correct

Incorrect
Question 6 of 10

6. Question
A patient with multiple sclerosis (MS) presents with a painful left eye and reduced visual acuity. The eye appears macroscopically normal and no abnormalities are seen on fundoscopy. She is apyrexial and inflammatory markers are within normal limits.

Which one of the following therapeutic options is correct?
- Low dose immunosuppressants are indicated
- Oral prednisolone 1 mg/kg/day should be commenced immediately
- Corticosteroids will not improve time to return of normal visual acuity
- Beta interferon should be considered in the ED
- Anterior chamber paracentesis should be considered
Correct

Incorrect
Question 7 of 10

7. Question
Who is most at risk of damaging their suprascapular nerve?
- Construction workers
- Bus drivers
- Athletes
- Shop workers
Correct

Incorrect
Question 8 of 10

8. Question
An obese 80-year-old female presents with a 6-hour history of a cold, painful left leg. On examination, she is found to have an irregular pulse, her left leg is white with a palpable weak femoral pulse, but no pulses palpable distal to this. Her right leg is slightly warmer and she has palpable pedal pulses on that side.

What is the most likely underlying pathology?
- Atheromatous embolus from an abdominal aortic aneurysm
- Platelet embolus of cardiac origin
- Occluded femoral artery due to atherosclerosis
- Deep vein thrombosis with paradoxical embolus via patent foramen ovale
- Occluded common femoral artery aneurysm
Correct

Incorrect
Question 9 of 10

9. Question
Which one of the following is true in jaundice caused by cholangiocarcinoma?
- Urinary bilirubin is absent
- Serum total bilirubin is increased with conjugated bilirubin reduced
- Faecal stercobilinogen is reduced
- Urobilinogen is increased in the urine
- Serum unconjugated bilirubin is increased
Correct

Incorrect
Question 10 of 10

10. Question
Ryan is a 3 year old boy who was playing in the garden with his older sister when a cry was heard. His parents rushed outside to find he was holding his left arm down straight and his older sister states that she was simply trying to pull him away from the paddling pool because she thought it was dangerous.

In this situation, x-ray:
- Of the full forearm is required showing both the wrist joint and the elbow joint
- Is likely to show the only abnormality to be a positive (raised) anterior fat pad at the elbow
- Of the elbow, if performed, will appear normal and is actually unnecessary
- Will possibly show a supracondylar fracture of the elbow as the mechanism and assessment clinically do not exclude it
- Is required prior to any attempted reduction of a dislocation
Correct

Incorrect

5 Comments

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Dr Syed Shahbaz Ahmer September 26, 2022 at 1:42 pm

Good learning quiz

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Carla December 29, 2022 at 11:59 am

Great

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Rabia Rauf February 21, 2023 at 9:17 am

Interesting questions

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[email protected] April 19, 2023 at 1:29 pm

Great quiz

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Dr Abhishek Chetankumar Shah August 17, 2023 at 12:04 pm

interesting and great EM Quiz

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