Fracture of femur, shock (899/1700)

A young male met with a RTA and is suspected to have a femur fx. His BP is 90/60mmHg. What is the next immediate action?

a. XR
b. IV fluids
c. Put leg splint
d. Send bloods for inv
e. US

Indications for IV fluids (784/1700)

A 2yo girl prv well presents with a hx of vomiting and diarrhea for 4hrs. What is the most
suitable indication for IV fluid administration?
a. Capillary refill time >4s
b. HR >90bpm
c. Increased RR
d. Stool >10x/d
e. Weight of child = 10kgs

Scrotal swelling (701/1700)

A 17yo boy while playing football got a kick and now he is complaining of severe pain and
swelling of the left side of his scrotum. What inv is the most appropriate to dx?
a. Needle aspiration of scrotum
b. US scrotum
c. MSU
d. Surgical exploration of scrotum
e. Urine test for hematuria

Swollen fingers after accident (1563/1700)

A man got his hand caught in machinery at work. The fingers are swollen but the XR shows no fx. What is the most appropriate management?

a. Splint
b. Put in plaster
c. Broad arm sling for 1wk
d. Elevate in high sling for 2d
e. Neighbor strapping

Severe asthma (1488/1700)

A child came to the ED with severe asthma and not responding to salbutamol nebulizer and vomiting many times. What is the most appropriate management?

a. Salmetrol
b. Montelukast
c. Prednisolone
d. Budesonide inhaler
e. Oxygen
f. IV salbutamol

Head trauma (650/1700)

An employer sent his worker to the ED after having hit his head on a machine. Exam: normal.
What is the single most likely inv you would do?
a. Skull XR
b. CT head
c. MRI head
d. Reassure

Projectile Vomiting in an infant (648/1700)

 A 6wk child with profuse projectile vomiting. What is the first thing you will do?
a. US
b. Check serum K+ level
c. ABG
d. NG tube
e. IV fluids

Hyperkalemia (1523/1700)

 A 63yo male undergoes abdominal surgery. On Monday morning, 3d post-op, repeat samples confirm serum K+=7.1mmol/l. His ECG shows broad QRS complexes. Which one of the following can be used as an effective tx for this pt’s hyperkalemia?

a. Calcium chloride IV
b. Calcium gluconate IV
c. Insulin subcutaneously
d. Furosemide IV

Leg pain (1206/1700)

A 45yo man is admitted to ED with excruciating pain in the right leg. Exam: limb is pale and
dorsalis pedis and posterior tibial pulses are absent. Pulse=88bpm, irregular and he has a
pansystolic murmur at apex. What is the most probable dx?
a. Thromboangitis Obliterans
b. Sciatica
c. DVT
d. Atherosclerosis
e. Embolus

ST elevation MI, next step? (561/1700)

A 48yo presents with severe chest pain since the last 40mins. In the ED he is given oxygen, GTN,
morphine. ECG=ST elevation. Bloods=increased troponin levels. What is the next step of
management?
a. Beta blockers
b. Percutaneous angiography
c. Anticoagulant & heparin
d. Clopidogrel
e. Aspirin

Overdose pt refusing treatment (526/1700)

A 34yo man with MS has taken an OD of 100 tablets of paracetamol with intent to end his life.
He has been brought to the ED for tx but is refusing all intervention.
a. Assessment
b. Evaluate pt’s capacity to refuse tx
c. Establish if pt has a prv mental illness

Sudden onset severe back pain (878/1700)

A 20yo fit man suddenly developed severe lower back pain as getting up from bed. What is the single most probable dx?
a. Paget’s disease
b. Multiple myeloma
c. PID
d. AS
e. Spondylosis

Boy with Asthma (522/1700)

An 8yo boy has longstanding asthma. He has admitted with a severe episode and is tired and
drowsy. He has not improved on oxygen, inhaled B2 agonist and IV hydrocortisone. CXR shows
bilateral hyperinflation. He is too breathless to use a peakflow meter and is O2 sat <90%. What
is the single most appropriate inv?

a. CBG
b. CXR
c. CT chest
d. Pulse oximetry
e. Spirometry

Recurrent episodes of hyperventilation (521/1700)

A 22yo man has rushed into the ED asking for help. He describes recurrent episodes of
fearfulness, palpitations, faintness, hyperventilation, dryness of the mouth with peri-oral
tingling and cramping of the hands. His symptoms last 5-10 mins and have worsened since their
onset 3months ago. He is worried he may be having a heart attack. An ECG shows sinus
tachycardia. What is the single most appropriate immediate intervention?
a. High flow oxygen
b. IV sedation
c. Rebreathe into a paper bag
d. Refer for anxiety management course
e. Refer for urgent cardiology opinion

Sudden chest pain in a diabetic (520/1700)

A 50yo man with DM suddenly develops persistent crushing central chest pain radiating to the
neck. What is the single most appropriate dx?
a. Angina
b. Costochondritis (tietz’s disease)
c. Dissecting aneurysm
d. MI
e. Pulmonary embolism

Acute back pain following car journey (517/1700)

A 60yo woman presents with acute onset of bone and back pain following a rough journey in a
car. Exam: tenderness at mid-thoracic vertebra with spasm, she feels better once she bends
forward. What is the single most probable dx?
a. Osteoporotic fx verterbra
b. Myofascial pain
c. Whiplash injury
d. MI
e. Pancreatitis

Shoulder tip pain (832/1700)

An 80yo woman suffering from RA presents with severe epigastric pain and vomiting. She also
complains of shoulder tip pain. What is the single most discriminatory inv?

a. US Abdomen
b. Sigmoidoscopy
c. Colonscopy
d. Barium meal
e. Upper GI endoscopy
f. Erect CXR

Fracture with cast, now limb swelling (829/1700)

A 10yo child who presented with fx of the radius which was treated with a plaster cast,
complains of pain. Exam: limb is swollen but warm and well perfused, pulses are present. What
should you do next?
a. Send for repeat XR
b. Remove cast
c. Replace cast with more padding
d. Give analgesic

Paediatric fluid resuscitation (760/1700)

A 3yo child with severe diarrhea and vomiting, looks lethargic, has sunken eyes and a feeble cry.
What is the choice of fluids?
a. 0.9%NS
b. 0.9%NS + 5%Dextrose
c. 0.45%NS + 5%Dextrose
d. 0.45%NS

Chest pain - Normal ECG (510/1700)

A 45yo manual worker presented with a 2h hx of chest pain radiating to his left arm. His ECG is
normal. What is the single most appropriate inv?
a. Cardiac enzymes
b. CXR
c. CT
d. ECG
e. V/Q scan