Curriculum Quiz: ACCS Acute

Question 1 of 30

1. Question

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

Obstruction to flow along the ureter
Ureteric spasm
Increased diuresis that occurs in these patients
The pain is due to several factors including those listed above

Question 2 of 30

2. Question

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

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

Parietal pain localises to the embryonic site of the affected organ
Pain such as this is likely mediate by the autonomic nervous system
Organs developed from the hindgut tend to cause central abdominal pain
Visceral pain is normally well localised
Constant pain, such as this, suggests a hollow organ is affected

Question 3 of 30

3. Question

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

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

Signs of localised peritonism are normally marked
Abdominal distension, if present, is normally caused by haemorrhage from a necrotic pancreas
Jaundice is often present
A positive Chvostek's sign suggests hypocalcaemia
Grey Turner's sign is due to bruising around the umbilicus

Question 4 of 30

4. Question

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

Click on the x-ray to enlarge.

There is isolated small bowel obstruction
There is large bowel obstruction due to faecal impaction
This is a sigmoid volvulus
This is a caecal volvulus
The appearance of the bowel is within normal limits

Question 5 of 30

5. Question

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

Almost all patients are fully better within 3 months
There is likely to be significant improvement of pain within a few weeks
Most patients return to work within 1 month
There is a significant risk of recurrence
The prognosis for acute sciatica is no worse than the prognosis for acute non-specific back pain

Question 6 of 30

6. Question

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

What is the next appropriate investigation?

MMSE
CT head
MSSU
Blood culture
CXR

Question 7 of 30

7. Question

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

Excited delirium
Cocaine toxicity
Acute behavioural disturbance
Extreme agitation
Psychomotor agitation

Question 8 of 30

8. Question

What is the correct definition of delirium?

Acute disorder of the mental processes accompanying organic disease
Global impairment of brain functioning due to structural abnormality
Alteration of mental state in which insight and contact with reality are lost
Disorder of the mental processes associated with pyrexia
Global impairment of brain functions with impairment of cognition and an insidious course

Question 9 of 30

9. Question

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

Prolonged QT interval
Paced rhythm
Left ventricular hypertrophy
All options listed

Question 10 of 30

10. Question

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

The patient should be referred for urgent CT scan of the brain
The patient has an exercise induced headache and can be discharged home with out-patient follow up
If he had a family history of a grandparent who had a SAH this should alter your decision making
You should observe him for another 2 hours before making your decision
You should ask for a neurology opinion

Question 11 of 30

11. Question

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

Benign paroxysmal positional vertigo (BPPV) is most commonly due to the presence of canaliths in the anterior semicircular canal, and can be treated with the Epley manoeuvre
Vestibular neuritis is often associated with post-viral hearing loss, or tinnitus
Vertigo is an early feature of acoustic neuroma (vestibular schwannoma) because of the dysfunction of the vestibular nerve and expansion in the cerebellar pontine angle
Isolated vertigo is a feature of central cerebellar infarction and can be a presenting feature of multiple sclerosis
Meniere’s disease is caused by endolymphatic hydrops (dilated labyrinth) and results in slowly-progressive, unilateral hearing loss

Question 12 of 30

12. Question

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

Oral contraceptive pill use
Acute medical illness
Malignancy
Varicose veins
Previous venous thrombo-embolism (VTE)

Question 13 of 30

13. Question

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

Large pericardial effusion
Oral anticoagulants
Raised CRP
Temperature > 38 degrees centigrade
Acute trauma

Question 14 of 30

14. Question

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

What is the most likely explanation of his presentation?

He has developed a pulmonary embolism secondary to immobilisation
He has acute papillary muscle rupture and has developed acute mitral regurgitation
He has fluid overloaded secondary to salt and water retention
His infarct has extended
He has developed an aspiration pneumonia

Question 15 of 30

15. Question

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

Loeffler’s (eosinophilic) endocarditis responds well to hydroxyurea treatment
NBTE (Non Bacterial Thrombotic Endocarditis) is related to Patent Ductus Arteriosus (PDA) and Atrial Septal Defect (ASD)
Antibiotic treatment reduces embolic phenomenon in infective endocarditis by half after three weeks of treatment
Trans oesophageal echocardiography has a false negative rate of less than 5%
Even with appropriate treatment, 5 year mortality for Injected drug users with right sided endocarditis is the highest

Question 16 of 30

16. Question

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

Exertional breathlessness
Sputum production
Wheeze
Frequent winter bronchitis
All options listed

Question 17 of 30

17. Question

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

Age >35
PMHx of type 2 diabetes
Obesity
Immunosuppression
IV drug abuse

Question 18 of 30

18. Question

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

Hypotension is common during the early stages of SE, but blood pressure commonly rises as the seizure continues
An acidosis is commonly seen in SE having both metabolic and respiratory components
A neutrophil leukocytosis in conjunction with the presence of white cells in the CSF suggests an infective aetiology
The use of the drug phenobarbitone is associated with a high incidence of visual field defects

Question 19 of 30

19. Question

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

The pain lasts several days and they occur in clusters
They occur more commonly in men
Pain is localised to the temporal region
Patients appear agitated during attacks
Episodes typically last an hour

Question 20 of 30

20. Question

In phaeochromocytoma, the highest sensitivity test is?

Plasma metanephrine level
Plasma cortisol level
Serum adrenaline level
Urine serotonin level
Urine VMA level

Question 21 of 30

21. Question

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

Contrast CT head and neck
Non-contrast CT head and neck
MRI head and neck
MRA head and neck
Transcranial Doppler

Question 22 of 30

22. Question

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

It should be administered immediately until paracetamol levels are back
It should be administered to all patients when the cause is unknown
It is contraindicated in patients who have previously had an allergic reaction
It is only indicated if commenced within the first 24 hours since paracetamol ingestion
It should only be administered once the paracetamol levels are back to normal

Question 23 of 30

23. Question

Which of the following does NOT cause obstructive jaundice?

Pancreatic carcinoma
Cholangiocarcinoma
Pancreatitis
Primary biliary cirrhosis
Primary sclerosing cholangitis

Question 24 of 30

24. Question

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

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

Loss of sensation in the toes on his right leg
No audible arterial Doppler signal in his right foot
Fixed mottling of the skin
Pain at rest in his right foot
No palpable femoral pulse

Question 25 of 30

25. Question

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

The tibial nerve is a branch of the common peroneal nerve
The tibial nerve has sensory and motor branches
The tibial nerve is related to the lateral malleolus at the ankle joint
Tibial nerve compression syndrome is the commonest lower limb entrapment syndrome

Question 26 of 30

26. Question

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

It can be used instead of radiological investigation
It is appropriate for use in pregnant patients
A low score precludes the need for further investigation
A high score is an indication for D-dimer assay
There is clinician subjectivity required in applying the Wells criteria to achieve a risk score

Question 27 of 30

27. Question

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

Restoration to sinus rhythm with treatment
Self-limiting episodes of AF
Infrequent episodes of AF
Brief episodes of AF

Question 28 of 30

28. Question

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

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

12 lead ECG
Bedside glucose management
Urea and electrolytes
Full Blood Count
Chest X-ray

Question 29 of 30

29. Question

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

Chest pain
Tingling in both hands
Sudden onset
Previous episodes
Shortness of breath

Question 30 of 30

30. Question

Which factor is known to improve stroke outcome?

Permissive hypotension
Temperature >38oC
Admission to a stroke unit
Diabetes