Curriculum Quiz: Adult Acute

Question 1 of 30

1. Question

A 64-year-old woman has fallen off her horse. You elicit crepitus over her left ribs laterally. Her chest x-ray confirms fractured left fifth and sixth ribs with an associated moderate haemopneumothorax.

Which of the following are safe landmarks for chest drain insertion given this information.

Second intercostal space, mid clavicular line
Fourth intercostal space midaxillary line
Fifth intercostal space more anteriorly
Seventh intercostal space mid axillary line
No landmark is required. Opt for conservative management, observing her carefully

Question 2 of 30

2. Question

Examine this chest x-ray.

Which of the following statements are correct?

The drain is clearly within the pleural cavity
The drain appears appropriately placed in order to drain the haemothorax
The drain lies within a fissure
The drain appears to have been inserted to the appropriate length
The drain is not within the pleural cavity

Question 3 of 30

3. Question

Which of the following statements regarding antibiotic cover following chest drain insertion in injured patients are correct?

The empyema rate following chest drain insertion in injured patients without antibiotic cover is between 5 and 10%
24-hour IV cephalosporin cover provides statistical, but not clinically relevant effect
24-hour IV cephalosporin cover reduces the empyema rate to <1% with an NNT <6
24-hour IV cephalosporin cover reduces the empyema rate to <1% with an NNT 10-40
24-hour IV cephalosporin cover reduces the empyema rate to <1% with a NNT >40

Question 4 of 30

4. Question

A young man presents to the ED with a stab wound to the left side of the abdomen approximately 5cm above the iliac crest.

What is the deepest muscle that the knife penetrated before puncturing the peritoneum?

External oblique
Internal oblique
Rectus abdominis
Serratus anterior
Transversus abdominis

Question 5 of 30

5. Question

A 23 year old man attends the ED with abdominal pain. He has a history of Crohn’s disease and has had a previous resection of his terminal ileum.

Which of the following is most likely to be deficient due to the absence of the terminal ileum?

Dietary carbohydrate
Dietary protein
Vitamin C
Vitamin D
Zinc

Question 6 of 30

6. Question

With regard to prognosis following neck sprain injury, which one of the following is associated with a better outcome?

Female gender
Instruction of a solicitor for the purposes of personal injury litigation
Younger age
Early use of a cervical collar
The presence of neck pain and headache following injury

Question 7 of 30

7. Question

Which one of the following statements about imaging modalities of the cervical spine is FALSE?

MRI scanning is indicated when there is still significant clinical suspicion of injury despite normal plain x-rays
MRI scanning is more sensitive for visualising soft tissue injury than CT scanning
CT scanning is the primary imaging modality for unconscious patients
Flexion / extension views should not be performed on unconscious patients.
Plain radiographs are not adequate to exclude significant spinal injury in unconscious patients.

Question 8 of 30

8. Question

Urgent MRI often has a role to play in spinal disorders, once assessment is complete. An 86-year-old woman is brought to the emergency department (ED), unable to cope at home. Neighbours say she is neglecting herself. Examination reveals weakness in both upper limbs, wasting of her hand muscles and reduced mobility in her neck. After examination you arrange an MRI scan of her neck (click on the scan to enlarge).

Which of the following statements are true? (Select all that apply)

The upper image shows a T1-weighted scan of the cervical spine in the mid-sagittal plane
The lower image shows a T1-weighted scan of the cervical spine in the mid-sagittal plane
The lower image shows central prolapse of the intervertebral disc at the level of C3 and C4
Both scans demonstrate evidence of cervical spondylosis
Urgent orthopaedic or neurosurgical advice is required

Question 9 of 30

9. Question

Regarding the magnetic field in a MR scanning room:

The presence of a retained metallic foreign body always precludes scanning
All patients and staff must undergo a rigorous screening exercise before admission to the room
Medical instruments may, in emergencies, be allowed in for monitoring purposes
Scanning may induce lightheadedness in patients
MRI is safe for patients with pacemakers and implantable defibrillators

Question 10 of 30

10. Question

Which of the following is classed as a high-risk feature for the presence of a cervical spine fracture in alert, stable patients presenting with traumatic neck pain?

Axial load to head
Age >50 years
Age <10 years
Pre-hospital cervical spine immobilisation
Midline tenderness

Question 11 of 30

11. Question

A 45-year-old man is brought to the resuscitation room having crashed his motorbike. He has a GCS of 15 and a compound fracture of his right tibia. X-rays are taken of his cervical spine.

What do they demonstrate?

Normal cervical spine series
Wedge fracture C4
Unifacet dislocation C5/6
Clay shoveller's fracture C7
Fracture transverse process C7

Question 12 of 30

12. Question

A 23 year old woman presents to the ED claiming to have been assaulted that evening and has sustained an injury to her face. In making the initial assessment of this patient and taking a history, one of these statements is true – which one is it?

You can ignore the possibility of an intracranial injury if she has a GCS of 15 and no neurological deficit
Examination findings that do not match the history given are usually due to the patient being drunk and forgetting what has happened
Fewer than 0.1% of facial fractures are associated with a significant cervical spine injury and therefore cervical spine assessment is rarely indicated
Difficulty moving the jaw can indicate a zygomatic arch fracture
A history of epistaxis is highly suggestive of a displaced fracture or new deformity of the nose

Question 13 of 30

13. Question

A 19 year old student presents to the ED having been assaulted last night. Facial x-ray confirms a fracture of the ZMC on the left side. Which one of the following statements is correct regarding the management of ZMC fracture?

All patients should be referred urgently to the on-call maxillofacial surgeon
Diplopia is a common symptom found in ZMC fracture and should be managed expectantly
Patients with a ZMC fracture should be advised not to blow their nose, as this may lead to the development of surgical emphysema
All patients should be prescribed a course of antibiotics as the vast majority of fractures are open
ZMC fracture is commonly complicated by the development of orbital cellulitis

Question 14 of 30

14. Question

When taking a history from a patient who has sustained a traumatic mandibular problem, which one of the following statements is correct?

A downward blow to a partially open mouth is a typical traumatic cause of anterior TMJ dislocation
A fall onto the point of the chin typically fractures the body of the mandible
Loss of consciousness rarely occurs in mandibular fracture
Patients with a connective tissue disorder are less likely to dislocate their TMJ, due to a greater range and freedom of joint movement
A lateral blow, usually as a result of interpersonal violence, typically causes fracture of the mandibular condyle

Question 15 of 30

15. Question

You diagnose a mandibular fracture in a 35 year old man who has attended the ED following an alleged assault. Which one of the following statements is true regarding his management?

A bilateral mandibular body fracture is a potential airway problem as anterior tongue support may be lost
Most patients with mandibular fracture can be discharged with follow up arranged in the maxillofacial outpatients clinic two weeks later
Antibiotics are not indicated in patients with fractures of the mandible
All patients with a flail fracture of the mandible must have the fracture reduced immediately by pulling it forwards
The location of the fracture is immaterial in the decision how to manage it, as all mandibular fractures are internally fixed

Question 16 of 30

16. Question

Which of the following statements are true regarding the epidemiology of electrical injuries?

Electrical injuries follow a bimodal age distribution pattern
Electrical injuries occur with an equal incidence in males and females
Young children are more commonly injured by high voltage sources
The incidence of fatal electrocution is probably underestimated
Electrical burns account for 10% of admissions to burns units

Question 17 of 30

17. Question

Which of the following can result from Rhabdomyolysis caused by electrical current?

Hyperkalaemia
Hypercalcaemia
Renal failure
Hyperphosphataemia
Brown discolouration of the urine

Question 18 of 30

18. Question

In the context of burns pathophysiology, the outermost zone of a burns injury in the Jackson model is the:

Zone of Stasis
Zone of Coagulation
Zone of Hyperaemia
Zone of Fibrinolysis

Question 19 of 30

19. Question

In discussing the prognosis of hip fracture, which of the following statements is true?

In-hospital 30 day mortality is 20%
The incidence of pulmonary embolus (PE) is 10-14%
The 12 month mortality is 50%
After an intracapsular fracture, infection rates are lower after arthroplasty than screw fixation
After an intracapsular fracture, re-operation rate is higher after arthroplasty than screw fixation

Question 20 of 30

20. Question

Which of the following is NOT a risk factor for osteoporosis?

Smoking
Early menopause
BMI >25
Maternal history of hip fracture
Previous low trauma fracture after the age of 50

Question 21 of 30

21. Question

In the assessment and treatment of fractured neck of femur in the older patient, which of the following are recommended?

Chest x-ray
Thromboprophylaxis with heparin (unless already taking warfarin)
If a patient is taking warfarin, deferring surgery until the INR <1.2
If a patient is on clopidogrel, surgery should be postponed for 7 days
Surgery within 16 hours

Question 22 of 30

22. Question

You are exploring a wrist laceration and note the flexor retinaculum is intact. However, you are concerned that some of the structures passing on the top of the retinaculum might have been injured.

Which structure is most at risk of damage?

Cutaneous branch of ulnar nerve
Flexor digitorum superficialis
Flexor pollicus longus
Main trunk of median nerve
Radial artery

Question 23 of 30

23. Question

A 25 year old man is stabbed in the abdomen with a kitchen knife. A CT demonstrates a diaphragmatic injury involving the oesophageal hiatus.

Which structure is most likely to be damaged?

Aorta
Azygos vein
Inferior vena cava
Thoracic duct
Vagus nerve

Question 24 of 30

24. Question

An 18 year old man falls onto an outstretched arm while playing rugby. His elbow is painful and deformed. An x-ray confirms posterior dislocation of the elbow joint.

What is most likely to be fractured in this case?

Capitellum
Coronoid process
Head of radius
Olecranon
Trochlea

Question 25 of 30

25. Question

A 22 year old man has dislocated his shoulder. He will need procedural sedation and you are considering whether the risks of sedation outweigh the benefits because he is not fasted.

Which factor is most likely to increase gastric emptying?

Antral distension
Cholecystokinin release
Duodenal distension
Hyperosmotic gastric contents
Secretin release

Question 26 of 30

26. Question

When examining the elbow, which one of the following statements is correct?

It is best to assess the joint from the front
The radial head is best palpated with the index finger while flexing the joint
Ability to extend excludes a fracture
It is also important to examine the distal radius and ulnar for associated injury
Presence of effusion is pathognomic of a fracture

Question 27 of 30

27. Question

Which one of the following statements is correct regarding elbow injuries?

Anterior dislocations account for the majority of elbow joint dislocations
Fracture of the radial head is the most common adult elbow fracture
Supracondylar fractures tend to be seen more commonly in adults than children
Volkmann’s ischaemic contracture is associated with olecranon fractures
The radial nerve is the most likely to be injured in fractures of the elbow

Question 28 of 30

28. Question

Which of the following anatomical structures is not contained within the spermatic cord?

testicular artery
cremasteric artery
vas deferens
lymphatic vessels of the testis
lymphatic vessels of the scrotum

Question 29 of 30

29. Question

The presence of which structural abnormality predisposes to testicular torsion?

A patent tunica vaginalis
A testicular appendix
Bell clapper deformity
Crypto-orchidism
Hypogonadism

Question 30 of 30

30. Question

Which reflex is typically absent in testicular torsion?

Bulbocavernosus reflex
Cremasteric reflex
Osinski reflex
Inguinal reflex
Dartos reflex