MCEM Pathology MCQ 1. Cervical Spine Fractures (a) A hangmans fracture is a fracture through the odontoid peg. A hangmans fracture implies bilateral fractures through the pedicles of C2 due to hyperextension. (b) A hangmans fracture is almost always associated with spinal injury. It is seldom associated with spinal injury, since the anteroposterior diameter of the spinal canal is greatest at this level. (c) A jefferson fracture is caused by a hyperextension injury. This fracture is caused by a compressive compressive downward downward force that is transmitted evenly through the occipital condyles to the superior articular surfaces of the lateral masses of C1, it is also called a burst fracture. (d) In a jeffer jefferson son fractu fracture re the radiog radiograp raph h is charac character terize ized d by bilate bilateral ral latera laterall displacement of the articular masses of C1. In a jefferson fracture the radiograph i s characterized by bilateral lateral displacement of the articular masses of C1. (e) Type III odontoid fracture occurs when the fracture line extends into the body of the axis. Type I-odontoid I-odontoid fracture is an avulsion of the tip of the dens. dens. Type II-occur at the base of the dens. Type III-the fracture line extends into the body of the axis 2. The following factors shift the oxygen-haemoglobin dissociation curve to the right: (a) Decrease in temperature A decrease in temperature shifts the curve to the left. (b) An increase in 2,3-DPG An increase in 2,3-DPG will shift the oxygen-haemoglobin dissociation dissociation curve to the right. (c) An increase in pH An increase in pH will shift the oxygen-haemoglobin dissociation curve to the left. (d) An increase in Carbon Monoxide Carbon Monoxide will shift the curve to the left. (e) An increase in Methemoglobinemia
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Methemoglobinemia will shift the curve to the left. An increase in H+ ions, temperature and 2,3-DPG will shift the curve to the right. A decrease in H+ ions, temperature and 2,3-DPG will shift the curve to the left along with an increase in CO and methemoglobinemia. 3. Airway Management (a) Suxamethonium (Succinylcholine) is a non-depolarising neuromuscular blocker.
Suxamethonium (Succinylcholine) is a depolarising (non-competitive) neuromuscular blocker which produces profound paralysis within 30-45 seconds of an intravenous injection of 1.5-2 mg/kg. Tru (b) The normal dose of suxamethonium (succinylcholine) is 10-20 mg/kg. e The normal dose of suxamethonium suxamethonium (succinylcholine) is 1.5-2 1.5-2 mg/kg. Tru (c) Suxamethonium is associated with bradycardia. e Suxamethonium is associated with bradycardia especially in children who are particularly sensitive to the muscarinic effects of suxamethonium. Tru (d) Ketamine is a bronchodilator
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MCEM Pathology MCQ Ketamine is a bronchodilator. The normal induction dose is 1-2mg/kg, the onset of anaesthesia is 15-30 seconds, the recovery time is 15-30 minutes and it has minimal cardiovascular depression. (e) Propofol is not associated with cardiovascular depression.
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Propofol is associated with cardiovascular depression, pain on injection and involuntary movements on induction. 4. The following anti-dotes and poisons are correctly paired: (a) Ethylene Glycol: Ethanol/Fomepizole Ethanol and Fomepizole are anti-dotes for Ethylene Glycol poinoning. (b) B-Blockers: Glucagon/Atropine Glucagon and Atropine are anti-dotes for B-Blockers. (c) Cyanide: Sodium Nitrite/Sodium Thiosulphate/Dicobalt Thiosulphate/Dicobalt Edetate Edetate Sodium Nitrite/Sodium Thiosulphate/Dicobalt Edetate are anti-dotes for Cyanide. (d) Methanol:Ethanol/Fo Methanol:Ethanol/Fomepizole mepizole Ethanol and Fomepizole are anti-dotes for methanol. (e) Organophosphates:Fo Organophosphates:Fomepizole mepizole Organophosphates:Atropine/Pralidoxime 5. Tetanus (a) Tetanospasmin is produced by an aerobic spore forming gram negative bacillus. Tetanospasmin is produced produced by an anaerobic spore forming gram positive positive bacillus. (b) Animal bite wounds are not considered tetanus prone. Animal bite wounds, puncture wounds, devitalised tissue, and heavily contaminated wounds are considered tetanus prone. (c) Pregnancy is a contraindication for giving tetanus prophylaxis Pregnancy is not a contraindication for giving tetanus prophylaxis. (d) The usual dose of human anti-tetanus immunoglobulin (HATI) is 250-500 units IM. The usual dose of human human anti-tetanus immunoglobulin (HATI) is 250-500 units IM. (e) A burn is not a potential portal of entry for tetanus. Any wound, including a burn is a potential portal of entry for tetanus. 6. Leukaemia ? classification; acute and chronic lymphoblastic leukaemia; acute and chronic myeloid leukaemia: (a) Anaemia and thrombocytopenia are late developments in CLL. Anaemia and thrombocytopenia are late developments in CLL. (b) There is a mean survival of 1 year in CGL. There is a mean survival of 4 years in CGL. (c) In ALL there is a up to 75% cure rate in children aged 2-9 years. In ALL there is a up to 75% cure rate in children aged 2-9 years. (d) Secondary autoimmune haemolytic anaemia develops in 10% of patients with CLL. Secondary autoimmune haemolytic anaemia develops in 10% of patients with CLL. (e) In CLL the leucocytosis is usually from the T helper lymphocytes. In CLL the leucocytosis is usually from the B lymphocytes.
MCEM Pathology MCQ Ketamine is a bronchodilator. The normal induction dose is 1-2mg/kg, the onset of anaesthesia is 15-30 seconds, the recovery time is 15-30 minutes and it has minimal cardiovascular depression. (e) Propofol is not associated with cardiovascular depression.
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Propofol is associated with cardiovascular depression, pain on injection and involuntary movements on induction. 4. The following anti-dotes and poisons are correctly paired: (a) Ethylene Glycol: Ethanol/Fomepizole Ethanol and Fomepizole are anti-dotes for Ethylene Glycol poinoning. (b) B-Blockers: Glucagon/Atropine Glucagon and Atropine are anti-dotes for B-Blockers. (c) Cyanide: Sodium Nitrite/Sodium Thiosulphate/Dicobalt Thiosulphate/Dicobalt Edetate Edetate Sodium Nitrite/Sodium Thiosulphate/Dicobalt Edetate are anti-dotes for Cyanide. (d) Methanol:Ethanol/Fo Methanol:Ethanol/Fomepizole mepizole Ethanol and Fomepizole are anti-dotes for methanol. (e) Organophosphates:Fo Organophosphates:Fomepizole mepizole Organophosphates:Atropine/Pralidoxime 5. Tetanus (a) Tetanospasmin is produced by an aerobic spore forming gram negative bacillus. Tetanospasmin is produced produced by an anaerobic spore forming gram positive positive bacillus. (b) Animal bite wounds are not considered tetanus prone. Animal bite wounds, puncture wounds, devitalised tissue, and heavily contaminated wounds are considered tetanus prone. (c) Pregnancy is a contraindication for giving tetanus prophylaxis Pregnancy is not a contraindication for giving tetanus prophylaxis. (d) The usual dose of human anti-tetanus immunoglobulin (HATI) is 250-500 units IM. The usual dose of human human anti-tetanus immunoglobulin (HATI) is 250-500 units IM. (e) A burn is not a potential portal of entry for tetanus. Any wound, including a burn is a potential portal of entry for tetanus. 6. Leukaemia ? classification; acute and chronic lymphoblastic leukaemia; acute and chronic myeloid leukaemia: (a) Anaemia and thrombocytopenia are late developments in CLL. Anaemia and thrombocytopenia are late developments in CLL. (b) There is a mean survival of 1 year in CGL. There is a mean survival of 4 years in CGL. (c) In ALL there is a up to 75% cure rate in children aged 2-9 years. In ALL there is a up to 75% cure rate in children aged 2-9 years. (d) Secondary autoimmune haemolytic anaemia develops in 10% of patients with CLL. Secondary autoimmune haemolytic anaemia develops in 10% of patients with CLL. (e) In CLL the leucocytosis is usually from the T helper lymphocytes. In CLL the leucocytosis is usually from the B lymphocytes.
MCEM Pathology MCQ 7. Basal metabolic rate:
(a) Is increased by propofol. All sedatives decrease metabolic rate. (b) Is increased by 1.4% for every 1 degree rise in temperature. BMR is increased by 14% for every 1 degree rise in temperature. (c) Remains unaffected by excercise.
(d) Is unaffected by age. BMR falls with age. (e) Is increased with pain.
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BMR is increased with pain and anxiety. 8. The following factors suggest a central cause of vertigo(rather than a peripheral): (a) Less intense. Central causes of vertigo are less intense than peripheral causes. (b) The onset is usually more sudden in central causes. The onset is usually more more sudden in peripheral causes while the onset onset is more gradual in central causes. (c) A central cause is likely to be constant whereas a peripheral cause is likely to be intermittent. A central cause is likely to be constant whereas a peripheral cause is likely to be intermittent. (d) There is more commonly associated nausea and diaphoresis with peripheral causes. There is more commonly commonly associated nausea and diaphoresis diaphoresis with central causes. (e) Hearing loss more commonly occurs with central causes of vertigo. Hearing loss more commonly occurs with peripheral causes of vertigo. 9. ECG abnormalities... (a) Non pathological q waves are usually more than one small square in width. Non pathological q waves are usually less than one small square in width.One small square is 40ms or 0.04s. (b) Non pathological q waves are usually more than 2mm in depth. Non pathological q waves are usually less than 2mm in depth. (c) The T wave is usually inverted in V1. And VR( and in V2 in young people and also in V3 in some black people). (d) Digoxin treatment may cause inverted T waves Digoxin treatment may cause inverted T waves. (e) Bundle branch block may cause inverted T waves. Bundle branch block may cause inverted T waves. The most common abnormality abnormality of the ECG is T wave inversion. inversion. This is seen in normality, ischaemia, ventricular hypertrophy, bundle branch block, and digoxin treatment. statements about white blood cells are are true: 10. The following statements
MCEM Pathology MCQ (a) Leucopenia in severe pyogenic infection augurs a poor prognosis.
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(b) Infants often respond to a bacterial infection with a lymphocytosis.
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(c) Monocytosis is a recognised feature of malaria and tuberculosis.
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(d) Eosinophilia is a characteristic finding in brucellosis.
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(b) Dysuria.
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(c) Urgency.
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(d) Low Back Pain.
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(e) Pelvic Girdle myalgia.
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Eosinophils, normally present in small numbers (less than 5% of white cells), are recognized by their vibrant orange granules and a characteristic bilobed nucleus . Increased numbers of eosinophils can be a clue to an underlying allergic state, parasitic infection, or other conditions. (e) Myelocytes in the peripheral blood are pathognomonic of leukaemia. Metamyelocytes, and rarely myelocytes, may be seen during infections, pregnancy, leukemoid reactions, and recovery from myelosuppression. 11. The following are true with regard to retinal vein occlusions:
(a) Retinal vein occlusions associated with high intraocular pressure. Retinal vein occlusions associated with high intraocular pressure. (b) Characteristically present with a storm of floaters in the eye.
(c) Fundal examination shows multiple flame haemorrhages. Fundal examination shows multiple flame haemorrhages. (d) Patients should have an ESR measured to exclude temporal arteritis.
(e) Demand referral to an opthalmologist
Are associated with high intraocular pressure,DM, hypertension and diseases that increase blood viscosity. Visual loss occurs suddenly with retinal vein occlusions. Floaters suggest retinal detachment or vitreous haemorrhage.Fundal examination shows multiple flame haemorrhages with disc oedema.Patients should have an ESR if they have retinal artery occlusion. 12. The following are often found in acute prostatitis: (a) Groin pain.
The typical signs and symptoms of acute prostatitis include spiking fever, chills, malaise, myalgia, dysuria, pelvic or perineal pain, and cloudy urine. Acute cystitis does not commonly occur in men, the vast majority of lower UTIs are due to
MCEM Pathology MCQ prostatitis.A variety of antimicrobials may be used for treatment of acute prostatitis and treatment depends on the causative organism. 13. The pressure...
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(d) DNA is cleaved by endonucleases.
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(e) Results in an inflammatory response.
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(a) Drop along major veins is similar to that along major arteries. Both offer little resistance to flow. (b) Drop across the hepatic portal bed is similar to that across the splenic vascular bed. The drop is much larger across the splenic vascular bed: it includes normal systemic arteriolar resistance. (c) In the hepatic portal vein exceeds that in the inferior vena cava. Otherwise blood would not flow through the portal bed. (d) Drop across the vascular bed in the foot is less when standing than when lying down. When standing the column of blood from heart increases arterial and venous pressure equally. (e) In venules in the foot is lower when walking rather than standing. The muscle pump in the leg reduces venous pressure. 14. Apoptosis:
(a) Is only a pathological process. Apoptosis can be either a pathological or physiological process. (b) Occurs in groups of cells. Single cells are usually involved. (c) Results in cell shrinkage and fragmentation.
There is no inflammatory response. Apoptosis, or physiologic cell death, differs substantially from necrosis, or pathologic cell death. Unlike necrosis, apoptosis is essential for morphogenesis during embryonic development ,normal cell renewal , and elimination of immune effector cells that proliferate in response to microbial i nfection. The morphological features of include cytoplasmic and nuclear condensation, fragmentation of nuclei into membrane enclosed "apoptotic bodies," and surface expression of opsonic receptors that allow neighboring parenchymal cells to rapidly phagocytose and digest the corpse . A key feature of this physiologic death process is the preservation of plasma membrane integrity. Rapid digestion of the contained apoptotic corpse avoids the recruitment of inflammatory cells which typically cause significant "collateral damage" to surrounding normal tissues. 15. Haematuria:
(a) Bergers disease is a common cause. Bergers disease is an uncommon cause of haematuria. A recent upper respiratory infection, raises the possibility of postinfectious glomerulonephritis or IgA nephropathy. (b) Vasculitis is a possible cause.
(c) SLE is a possible cause.
MCEM Pathology MCQ SLE may cause glomerulonephritis. (d) Prostatis may cause haematuria. The causes vary with age with the most common being inflammation or infection of the prostate or bladder, stones, and, in older patients, a kidney or urinary tract malignancy or benign prostatic hyperplasia (e) Henoch-Schonlein purpura may cause haematuria.
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Recent vigorous exercise or trauma may also cause haematuria. 16. Atrial Flutter:Treatment: (a) Patients with atrial flutter do not require anticoagulation. Patients with atrial flutter require anticoagulation. (b) Unstable patients require transoesophageal echocardiogram prior to cardioversion. For unstable patients or those with onset less than 48 hours prior to presentation, low energy synchronized cardioversion(25-50j) can convert more than 90% of patients into sinus rhythm. (c) If a patient has stable atrial flutter of greater than 48 hours duration they always require at least 3 weeks of anticoagulation prior to cardioversion. A TOE can be performed to outrule thrombus and a patient cardioverted almost immediately. (d) Digoxin should not be used in patients with impaired cardiac function. Digoxin is positively inotropic. Patients with left ventricular systolic dysfunction (LVEF <40 percent) who continue to have NYHA functional class II, III and IV symptoms despite optimal therapy (eg, ACE inhibitor or ARB, beta blocker, and, if necessary for fluid control, a diuretic) should be started on digoxin. (e) Amiodarone should not be used in patients with impaired cardiac function. Amiodarone has very little negative inotropic effect. As such, the drug may be used safely in most patients with prior diagnosis of heart failure. 17. UTI: (a) A positive MSU sample has 10 to the power of 5 colony forming units per milliliter of urine. A positive MSU sample has 10 to the power of 5 colony forming units per milliliter of urine. (b) Klebsiella is the responsible pathogen in the majority of UTIs. E-Coli is the responsible pathogen in a majority of UTIs. (c) Asymptomatic bacteriuria occurs in up to 10 percent of pregnant women. Asymptomatic bacteriuria occurs in up to 30 percent of pregnant women. (d) Asymptomatic bacteriuria occurs in up to 40% of elderly nursing home residents. Asymptomatic bacteriuria occurs in up to 40% of elderly nursing home residents. (e) In healthy asymptomatic sexually active non-pregnant women asymptomatic bacteriuria occurs in 15%. In healthy asymptomatic sexually active non-pregnant women asymptomatic bacteriuria occurs in 5%. 18. Wound Healing: (a) The type of healing process depends on the extent of tissue damage.
(b) In first intention healing the margins are unapposed.
MCEM Pathology MCQ In first intention healing the margins are closely apposed. (c) In first intention healing the wound is finally covered by epidermal growth.
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(d) In second intention healing the margins are apposed.
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(e) Scar formation is associated with second intention healing.
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19. Vestibulocochlear nerve testing: (a) Normally air conduction is geater than bone conduction. Normally air conduction is geater than bone conduction. (b) Middle ear infection is a common cause of conduction deafness. In conduction deafness the air conduction component is reduced to a greater degree than the bone conduction deafness. (c) In webers test the noise is usually heard centrally. In webers test the noise is usually heard centrally. (d) In webers test the noise lateralises to the normal side in sensorineural deafness. In webers test the noise lateralises to the normal side in sensorineural deafness. (e) In webers test the noise lateralises to the deaf side in conduction deafness. In webers test the noise lateralises to the deaf side in conduction deafness. 20. Patellar Fractures: (a) May occur from forceful contraction of the quadriceps tendon Or from direct trauma. (b) The most common fracture is avulsion type. The most common fracture is transverse. Other fractures include comminuted and avulsion type. (c) There is often a palpable defect in the patella. There is often a palpable defect in the patella. (d) All patellar fractures require operative intervention. Non-displaced patellar fractures with intact extensor mechanisms are treated with knee immobilisation, ice, analgesics, elevation and casting. (e) Fractures of 2 mm displacement require operative repair. Fractures of 3 mm displacement require operative repair. Or those associated with disruption of the extensor mechanism or open fractures. 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.
MCEM Pathology MCQ 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.
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(d) The commonest site of the underlying infection is the mid thoracic spine.
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(e) Successful culture of infected pus taken from a psoas abscess is likely in more than 90 per cent of cases.
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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: (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.
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
MCEM Pathology MCQ 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.
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Autoregulation refers to maintenance of constant cerebral blood flow. 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.
MCEM Pathology MCQ (e) Prosthetic valve endocarditis is defined as early if within the first 9 months post surgery. Prosthetic valve endocarditis is defined as early i f within 6 months of surgery. Staph epidermidis is associated with early disease. 28. The following 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. 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. C5. (e) Wrist flexors are supplied by C6.
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Wrist flexors are supplied by C7. Wrist extensors are supplied by C6. C 6. simple ankle strain(with damage to a few fibres of a ligament only)
(a) Slight Slight swelling swelling True Slight swelling may develop almost immediately after injury. (b) Bruising False Bruising is associated with more severe injuries. (c) Joint Joint instability 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 immediately but settles to a large extent within a few hours.Bruising 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 Pathology 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 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 of the 5th metacarpal. metacarpal. False ?Base of the 5th metatarsal tenderness is an indication for X Ray. http://www.bmj.com/cgi/content/full/ http://www.bmj.com/cgi/content/full/326/7386 326/7386/417#F1 /417#F1
MCEM Pathology 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 Pathology MCQ Eye Emergencies
(a) Herpes Simplex Virus can involve eyelids, conjunctiva and cornea. True ?HSV classically causes a dendritic epithelial defect. Treatment 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 concurrent iritis. (c) Hyphema is not associated with rebleeding. False ?Rebleeding can occur about 3-5 days following the initial injury. (d) Peri-orbital Peri-orbital cellulitis is associated associated with painful eye movements. movements. False ?Orbital cellulitis is but peri-orbital cellulitis is not.
MCEM Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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 Pathology 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
