Curriculum Quiz: Resus

Question 1 of 30

1. Question

You receive a telephone call from an ambulance crew. They are bringing in a 5-year-old child with a previous allergic reaction to nuts. Whilst at a party he ate a cupcake and now has stridor, facial swelling, a respiratory rate of 50/ minute and is pale with an urticaral rash.

The first pharmacological treatment that you should give is:

Intramuscular adrenaline 150 mcg of a 1:1,000 solution
High-flow oxygen
Intravenous chlorphenamine 2.5 mg
Intravenous hydrocortisone 50 mg
Intravenous adrenaline 1 mcg/kg

Question 2 of 30

2. Question

Which of the following airway items is the most important to have in the resuscitation room?

Surgical airway kit
Laryngeal mask airway (LMA)
Fibreoptic scope
McCoy laryngoscope
Gum elastic bougie

Question 3 of 30

3. Question

Which one of the following statements regarding basic airway management is true?

Fogging of the oxygen mask indicates adequate ventilation
A pillow placed under the occiput effectively flexes the neck in relation to the torso
Obese unconscious patients are likely to require more than one pillow under the occiput to enhance airway patency
A chin-lift manoeuvre should not be attempted in patients with a fixed neck deformity

Question 4 of 30

4. Question

Which one of the following broad group of triggers of anaphylaxis, is most likely to cause breathing difficulties leading to cardiac arrest?

Foodstuffs
Venom
Oral medication
IV medication
Latex

Question 5 of 30

5. Question

What is the absolute contraindication for the administration of adrenaline in anaphylaxis?

Coronary artery disease
Uncontrolled hypertension
Serious ventricular arrhythmias
Second stage of labor
None of the above

Question 6 of 30

6. Question

In the presence of the echographic finding of LV standstill during cardiac arrest, which of the following is the expected percentage of failure to regain spontaneous circulation.

Select one option from the answers below.

30%
50%
80%
90%
>95%

Question 7 of 30

7. Question

Your junior is assisting you in stabilising a patient post-return of spontaneous circulation (ROSC) post-cardiac arrest. They check a BM and it is 18. They ask if they need to act on this.

What is the appropriate response?

No, it is not going to affect the patient's outcome
Yes, give a standard sliding scale and 4 units of Actrapid prior to commencing it – tight glycaemic control is important in this group
No, this is just a 'stress response' immediately post-cardiac arrest, check it again in a couple of hours
Yes, let us start a 'cautious' sliding scale and monitor BM half hourly – glycaemic control is important in this group

Question 8 of 30

8. Question

A 75-year-old man presents with abdominal pain. It is central but radiates to the left loin. He has a history of hypertension and angina. The pain is constant but he has not vomited and his bowels are opening normally. He is tachycardic and pale with a BP of 100/70. Looking at his abdominal x-ray, which of the following statements are true? Select one or more options.

Click on the x-ray to enlarge.

The bowel gas pattern is unremarkable
There are left side ureteric stones visible
There is degenerative change in the lumbar spine
Renal calcification is shown
There is vascular calcification suspicious of an aortic aneurysm

Question 9 of 30

9. Question

Which of the following factors should alert the emergency physician to an increased likelihood of the presence of primary blast injury?

A suicide bombing
The presence of flash burns
An open-air bombing
Wearing personal protective equipment (PPE)
An underwater explosion

Question 10 of 30

10. Question

A 52-year-old front seat passenger presents following a head on collision. His airbag was deployed. He has since walked and now complains of anterior chest pain only. You detect decreased breath sounds at the right apex. He is not short of breath and appears otherwise well. His chest x-ray is as demonstrated (image, right). Aside from addressing his analgesic requirements, which of the following management options is most sensible?

Needle thoracocentesis right, second intercostal space
Seldinger chest drain insertion right, fifth intercostal space, midaxillary line
Traditional chest drain insertion right, fifth intercostal space, midaxillary line
Further radiological assessment
Observation on a thoracic surgical ward

Question 11 of 30

11. Question

Whilst taking a handover from the pre-hospital team for the major trauma patient, what should you do? (Select all that apply)

Start obtaining IV access and gaining observations
Maintain a hands-off handover unless there is clinical urgency
Ensure the entire team is listening to the handover
Repeat the key points back once they have finished to ensure the transfer of information was correct
Designate a scribe to document the handover

Question 12 of 30

12. Question

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

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

Question 13 of 30

13. Question

A 55-year-old man presents with dyspnoea of sudden onset associated with left sided chest pain. On examination, he is clearly in significant respiratory distress with tachypnoea, tachycardia, pallor and peripheral cyanosis.

Which of the following investigations is not immediately indicated in this patient?

Pulse oximetry
D-Dimer
ECG
Chest X-ray
Arterial Blood Gas analysis

Question 14 of 30

14. Question

A 46-year-old man undergoing chemotherapy for acute myeloid leukaemia has suspected neutropenic sepsis.

His heart rate is 120/min, BP 95/50, his oxygen saturation is 91% on 4 l of oxygen, his haemoglobin is 6.8 g/dl, temperature 40.1oC.

Which of the following interventions will increase oxygen delivery to the tissues the most within the next 2 hours?

Transfusing to an Hb of 9g/dl
Titrating noradrenaline to a MAP of 65mmHg
Reducing temp to <38oC with antipyretics
Increasing oxygen saturation to >98%
Commencing broad spectrum intravenous antibiotics

Question 15 of 30

15. Question

A 12-month-old child presents with a reduced level of consciousness. The child’s coma score is 4/15 and BM is 18.0 mmol/L. There is no history of trauma or significant past medical history. The following is also seen:

HR: 70
CR: 3 sec
RR: 7
Sats 84% (10 L/min of O2)
Temp 36.6oC

Regarding the management of this patient, which of the following statements is correct?

Pupil size can be reliably used to assess the need for immediate IV naloxone at 10 mcg/kg
Intubation should be immediately performed
Intensive care/anaesthesia team should be contacted if hypoventilation cannot be reversed or >40 mls/kg fluid required.
Serum toxicology screen is necessary only if a positive history of drug ingestion/parental drug use is obtained
This child has diabetes

Question 16 of 30

16. Question

A 43-year-old unconscious patient has a capillary blood glucose of 2.4mmol/L. He appears thin and unkempt. There is no past medical history available. He was found in a doorway.

The most appropriate treatment is which of the following?

50 ml of 50% dextrose IV
1 microgram glucagon IV
1 milligram glucagon IM
150-200mls 10% dextrose IV
Continuous IV infusion 5% dextrose

Question 17 of 30

17. Question

A 33-year-old woman presents with breathlessness; on examination she is tachypnoeic and tachycardic. You suspect that she may not have a primary cardiovascular or respiratory pathology.

Which one of the following is most likely to support your suspicion of a non-cardiorespiratory cause for her presentation?

A clear chest on auscultation
A raised lactate on ABG analysis
A normal CXR
A reduced PaCO2 with a normal PaO2 on ABG analysis
An ECG revealing only a sinus tachycardia

Question 18 of 30

18. Question

Which of the following statements regarding shock resistant ventricular fibrillation is the most appropriate?

Amiodarone 150 mg intravenously is the drug of choice
Lignocaine 100 mg intravenously is a suitable drug
Magnesium 2 mg intravenously should be given if there is a history of ischaemic heart disease or renal disease
Adrenaline 1 mg should be given before each shock
A precordial thump is worth trying

Question 19 of 30

19. Question

Which of the following is most likely to cause respiratory acidosis?

Moving from high altitude to sea level
Untreated diabetes mellitus (DM)
Kidney failure
Vomiting
Hypoventilation

Question 20 of 30

20. Question

Which one of the following episodes is likely to fit the definition for a BRUE?

A 10-month-old, previously well child who presents with an episode of drowsiness and floppiness when picked up from his cot after a nap. He has a fever, runny nose and cough.
An 8-month-old child with a fever who had an episode of going stiff and jerking lasting 1 minute. She is still very drowsy.
A healthy, 6-month-old infant born at term who appeared to go blue and stop breathing whilst crying. He quickly recovered after mum blew on his face and examines normally
An 11-month-old who stopped breathing and went pale after bumping his head. He has vomited a few times since being in the department.

Question 21 of 30

21. Question

A 23-year-old has been involved in a car crash. He requires intubation for respiratory failure secondary to pulmonary contusions. Following one failed attempt at intubation, his saturations have dropped from 98% to 92%.

What is the most appropriate course of action?

Insertion of an LMA and ventilation
Attempt to re-oxygenate with BVM ventilation, prior to a second intubation attempt
Creation of some form of surgical airway, for example, cricothyroidotomy
Release of manual in-line stabilisation to allow better positioning prior to a second intubation attempt
Attempt to re-oxygenate with BVM ventilation, while awaiting the return of spontaneous ventilation

Question 22 of 30

22. Question

Which of the following features would classify a child of being high-risk of having a serious underlying diagnosis or a recurrent event? Select all that apply.

Born at 37 weeks’ gestation
Family history of sudden cardiac death
6-week-old
Male
Recent attendance to ED with similar episode

Question 23 of 30

23. Question

Which of the following statements regarding airway assessment is correct?

An edentulous, elderly patient is likely to be easy to ventilate using the bag-valve-mask system
Recent facial trauma can make an airway more difficult to manage
Patient obesity is unlikely to be significant
The presence of a beard or other facial hair makes it easier to obtain a good seal with a well fitted face mask
Assessment of the patient's neck mobility is unimportant prior to sedation

Question 24 of 30

24. Question

Which one of the following statements regarding chest compressions in hypothermic cardiac arrest is correct?

The chest compression rate should be reduced to 60/minute
Chest compressions may well be harder because of increased chest wall rigidity
There is no role for mechanical compression devices
Chest compressions should be avoided until absence of cardiac output has been determined by Doppler techniques, if the appropriate equipment is available

Question 25 of 30

25. Question

Which of the following pre-cardiac arrest risk factors is associated with adverse outcome?

Increasing Age
No co-morbidities
increased BMI
Caucasian race
witnessed Event

Question 26 of 30

26. Question

A 12-week-old is brought in to the Emergency Department having been found unresponsive. There are clear signs of rigor mortis and the crew haven’t been able to get an airway. The rhythm has been asystole throughout. CPR has been ongoing for 25 mins.

Which of the following is the most appropriate management?

Continue doing CPR at the parent’s request until they feel comfortable for the team to stop.
Alert paediatrics, continue CPR whilst you gather information from the crew/parents and make a team decision to stop once lack of reversible causes is established.
Stop as soon as you do your first signs of life check, as CPR is clearly futile.
Alert paediatrics and call the anaesthetic team to establish an airway, continue CPR whilst you gather information from the crew/parents and make a team decision to stop once lack of reversible causes is established.
There is no black and white rule about when to stop CPR although ERC recommends that CPR should be withdrawn after 20 minutes of asystole, in the absence of a reversible cause [17].

Question 27 of 30

27. Question

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

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

Question 28 of 30

28. Question

Which one of the following statements regarding hypothermic peri-arrest and cardiac arrest situations is true?

Sinus bradycardia should be aggressively treated to improve tissue oxygen perfusion
Malignant arrhythmias are unlikely to be a result of hypothermia if the core temperature is above 32°C
The absence of J waves on the ECG effectively rules out hypothermia as the cause of any malignant arrhythmias
Fluid replacement must be cautious as renal vasoconstriction results in fluid retention

Question 29 of 30

29. 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 30 of 30

30. 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