MCQs on emergency medicine

ASSESSMENT Of 30 mcqs

FPSC No : 55
MCQs on EMERGENCY MEDICINE
Submission deadline : 19 NOVEMBER 2013 12 NOON

INSTRUCTIONS
• To submit answers to the following multiple choice questions, you are required to log on to the
College On-line Portal (www.cfps2online.org).
• Attempt ALL the following multiple choice questions.
• There is only ONE correct answer for each question.
• The answers should be submitted to the College of Family Physicians Singapore via the College
On-line Portal before the submission deadline stated above.

1. The total volume of attendances at the restructured evacuation. Which of the following is the LEAST
hospitals’ emergency departments has been LIKLELY reason for doing this?
increasing since 2003. What is the projected number (A) To perform a wireless ECG.
in 2014? (B) To follow the protocol that has been set for the paramedic
(A) Over a third of a million attendances. (C) To ensure due diligence is performed for each patient.
(B) Over half a million attendances. (D) To counter check on the need for referral.
(C) Over three quarters of a million attendances. (E) To have a baseline of the clinical status of the patient
(D) Over a million attendances.
(E) Over a million and a quarter attendances. 5. For a patient with early stroke, what is the
therapeutic window between onset to thrombolysis
2. In Singapore, for a newly diagnosed ST elevation for intravenous tPA to be used?
myocardial infarction, what is the upper limit of the (A) 3.0-hour window.
“door to balloon time” that has been set? (B) 3.5-hour window.
(A) 1 00 minutes. (C) 4.0-hour window.
(B) 90 minutes. (D) 4.5-hour window.
(C) 80 minutes. (E) 5.0-hour window.
(D) 70 minutes.
(E) 60 minutes.
6. A 35-year-old patient is suspected to have acute
coronary syndrome. Which of the following
3. The appropriate use of the Emergency Medical
statements is INCORRECT?
Service ambulance is necessary. Which of the
(A) Epigastric pain can be a presentation.
following patient has the LEAST need to be sent to
(B) Nausea can be present.
the Emergency Department this way?
(C) Syncope can be present.
(A) 24-year-old patient with pregnancy, abdominal pain and
(D) Diaphoresis is a clinical feature.
syncope.
(E) A normal 12-lead ECG rules out the diagnosis.
(B) 20-year-old patient with isolated left facial numbness for 2
days.
(C) 18-year-old patient with “worst ever headache”. 7. A 41-year-old patient with acute chest pain is
(D) 48-year-old patient with chest pain and history of balloon diagnosed to have acute coronary syndrome.
angioplasty a year ago. Which of the following about initial treatment is
(E) 62-year-old patient with ischemic heart disease and fainting. INCORRECT?
(A) GTN may be given sublingually for relief of pain.
4. A paramedic arrives with Emergency Medical (B) GTN patch can be used for relief of pain.
Service ambulance to pick up a patient with acute (C) Aspirin 300 mg is given before arrival at the hospital.
chest pain. She proceeds to perform a standard (D) Clopidogrel 75 mg can be given while waiting for the
patient assessment with history taking, physical ambulance.
examination, the measurement of vital signs, and (E) If aspirin is given, a written record should accompany the
repeats the ECG before instituting treatment and patient.

T h e S i n g a p o r e F a m i l y P h y s i c i a n V o l 39 N o 3 J u l -S e p 2013 : 51
MCQs on emergency medicine

8. About the factors that may cause a delay of 13. With regards to training of cardiopulmonary
presentation of a patient with myocardial ischaemia resuscitation (CPR), which of the following is
to the emergency department, which of the following CORRECT?
is the LEAST likely? (A) Teaching hands only CPR to lay rescuers is adequate.
(A) A feeling of fatigue rather than chest pain. (B) Both chest compressions and mouth-to-mouth ventilation
should be taught to lay rescuers.
(B) Decision by the patient to self treat symptoms.
(C) Mouth-to-mouth ventilation is more important than chest
(C) Diaphoresis as a presenting symptom.
compression.
(D) Decision by the patient to see primary care facilities rather
(D) Pulse check is routinely included in teaching lay rescuers.
than call for emergency medical service ambulance.
(E) Pulse check is mandatory to be taught to healthcare
(E) Epigastric discomfort instead of chest pain.
workers.

9. To minimize transfer times and maximize neurological 14. With regards to cardiac arrest, which of the following
outcomes, the American Stroke Association has is the most common rhythm at onset of arrest?
described the stroke “Chain of Survival”. Which of (A) Ventricular tachycardia.
the following is NOT in this “Chain of Survival”? (B) Rapid atrial fibrillation.
(A) Rapid recognition and reaction to stroke warning signs. (C) Ventricular asystole.
(B) Rapid emergency medical service ambulance dispatch. (D) Complete heart block.
(C) Pre-arrival notification to the receiving facility. (E) Coarse ventricular fibrillation.
(D) Rapid diagnosis and treatment in hospital.
(E) Aspirin is given before arrival at the hospital. 15. In cardiopulmonary resuscitation, after defibrillation
is done, what is the next step?
10. The mother of a 5-year-old boy complains that (A) Check ECG for cardiac rhythm before more chest compression.
(B) Continue uninterrupted CPR of 1 minute.
since this morning her son is noted to be drooling,
(C) Continue uninterrupted CPR of 1-2 minutes.
preferring to sit up, and also has noisy breathing.
(D) Continue uninterrupted CPR of 2-3 minutes.
Which of the following is the MOST likely diagnosis?
(E) Continue uninterrupted CPR of 3-4 minutes.
(A) Bronchial asthma.
(B) Acute bronchiolitis.
16. A 35-year-old man complains of acute breathlessness
(C) Acute epiglottitis. since 3 hours ago. Which of the following statements
(D) Interstitial lung disease. is INCORRECT?
(E) Diabetic keto-acidosis. (A) A patient with metabolic acidosis can present with
breathlessness.
11. The chain of survival for cardiac arrest consists (B) Pulmonary embolism can present with chest pain and
of 4 links: early access, early cardio-pulmonary breathlessness.
resuscitation (CPR), early defibrillation, and early (C) A normal pulse oximeter reading rules out respiratory
advanced life support. In this context, which of the failure.
following CORRECTLY describes what is included (D) Anxiety should only be considered as the diagnosis after
in basic cardiac life support? careful exclusion of other life threatening causes.
(A) Early access, early CPR. (E) Pneumothorax can present with chest pain and
breathlessness.
(B) Early access.
(C) Early CPR.
17. A 36-year-old woman complains of headache lasting
(D) Early defibrillation.
3 hours. Which of the following statements is
(E) Early access, early CPR, and early defibrillation.
INCORRECT?
(A) Meningitis can be present even though the classical triad of
12. In cardio pulmonary resuscitation (CPR), what is the fever, neck stiffness and altered mental state is not complete.
desired rate of cardiac compressions per minute? (B) A change in headache pattern can be a clue to a life threatening
(A) 100. cause.
(B) 90. (C) Pre-eclampsia can present as acute headache.
(C) 80. (D) Acute angle closure glaucoma can present as acute headache.
(D) 70. (E) There is a correlation between high blood pressure and
(E) 60. headache.

T h e S i n g a p o r e F a m i l y P h y s i c i a n V o l 39 N o 3 J u l -S e p 2013 : 52
 MCQS on EMERGENCY MEDICINE

18. A 75-year-old man presents with acute abdominal 22. A 29-year-old driver is involved in head-on collision.
pain lasting for 4 hours. He has a history of atrial Which of the following indicates that airway
fibrillation for 10 years. Which of the following obstruction is present?
statements is INCORRECT? (A) Presence of stridor.
(A) Normal abdominal examination findings rules out mesenteric (B) Ability to answer and speak normally.
ischaemia as a cause for the pain. (C) Loss of consciousness.
(B) The possibility of acute coronary syndrome needs to be (D) Facial trauma.
considered. (E) Oral bleeding.
(C) A leaking abdominal aortic aneurysm can be a cause for the
pain.
(D) Acute appendicitis needs to be considered. 23. About airway management in the patient with
(E) A perforated gastric ulcer can present this way. major trauma, which of the following statement is
CORRECT?
(A) Laryngeal masks (LMAs) prevent “hands-free” bagging.
19. A 65-year-old man complains of backache lasting for (B) Oropharygeal airway is ineffective in securing a patent
four weeks. He now has urinary urgency for a week. airway.
A straight X-ray of the back is reported as normal (C) If breathing is absent, bag mask ventilation (BMV) is the action
apart from osteoarthritic changes. Which of the to take.
(D) Laryngeal masks (LMAs) prevent aspiration.
following statements is INCORRECT?
(E) Intubation is superior in outcome compared to bag mask
(A) Upper back pain can be the first symptom of acute coronary
ventilation (BMV).
syndrome from posterior myocardial ischaemia.
(B) The normal X-ray of the back rules out myelopathy from cord
compression.
24. A 45-year-old man construction work sustained
(C) Leaking abdominal aortic aneurysm can present with low
a blunt injury to the chest when he slipped on a
back pain.
slippery floor and fell onto a concrete slab. He is
(D) Abdominal aortic aneurysm can present with chest pain
suspected to have a tension pneumothorax. Which
radiating to the back.
of the following clinical feature is NOT consistent
(E) Spinal stenosis causes back pain that is relieved by bending
with such a diagnosis?
forward.
(A) Distended neck veins.
(B) Unilateral decreased chest movement.
(C) Shifting of trachea contralateral to the side with decreased
20. About wounds and injuries encountered in the
chest movement.
ambulatory care setting, which of the following
(D) Hypotension.
statement is CORRECT?
(E) Paradoxical chest movement.
(A) Surgical implants have normal risk of infection in people with
diabetes.
(C) Glass fragments as retained foreign bodies will be picked up
25. A 23-year-old construction worker falls from a
by plain X-rays as they are uniformly radio-opaque.
height and lands on his feet. Which of the following
(D) A dog bite is more prone to infection than a cat bite.
(E) Human bite sustained from a fight is more prone to infection is the most sensitive sign that he is suffering from
than a cat bite. an exsanguinating haemorrhage from a ruptured
viscus?
(A) Tachycardia.
21. A targeted systematic survey performed in a set (B) Cool extremities.
order which searches for injuries that pose the (C) Confusion.
most immediate threats to life is set out in the (D) Delayed capillary refill more than 2 seconds.
Advanced Trauma Life Support (ATLS) course can (E) Pallor.
be remembered as A,B,C,D, and E. Which of the
following is INCORRECT?
(A) A = Airway assessment. 26. About the practical anatomical and physiological
(B) B = Breathing assessment. characteristics of the paediatric airway, which of the
(C) C = Circulation assessment. following statements is CORRECT?
(D) D = Danger assessment. (A) In the infant and young child, the lower airways are larger but
(E) E = Exposure and environmental control. the supporting cartilage are less well developed.

T H E S I N G A P O R E F A M I L Y P H Y S I C I A N V O L 39 N O 3 J U L -S E P 2013 : 53
MCQS on EMERGENCY MEDICINE

(B) The relatively large head flexes the neck and results in airway 29. Kawasaki disease is great mimic of many febrile
obstruction in the unconscious child. conditions. What is the reason for admitting such a
(C) The tidal volume in the young child is more dependent on the child with this condition to hospital?
intercostal muscle function than the diaphragmatic function. (A) Treatment of dehydration.
(D) Children have higher metabolic rates, with an oxygen (B) Treatment of renal complications.
consumption of 10-12 mil/kg/min compared to 3-4 ml/kg/min (C) Intravenous immunoglobulin therapy.
in the adult. (D) Monitoring of cardiac complications.
(E) The ribs are less pliable and complaint in the child compared (E) Treatment of fever.
to the adult.

30. A 5-year-old girl presents with fever without source.

27. The correct dosage of paediatric medications is often The triage temperature is 39 degree Celsius. The
weight dependent. The weight of the child can be total white count is 20,000. Based on the findings of
estimated by a formula if a weighing machine is not a retrospective study, what is the likelihood she has
available. Using this formula, which of the following an occult pneumonia?
is the correct estimated weight in a 5-year-old (A) 12%.
child? (B) 16%.
(A) 12 kg. (C) 22%.
(B) 18 kg. (D) 26%.
(C) 17 kg. (E) 32%.
(D) 19 kg.
(E) 21 kg.

28. Fever is a common presentation of the sick child. As

a rule, which of following groups of children needs
referral to the hospital routinely for further care
and management?
(A) Less than 3 months old.
(B) Less than 6 months old.
(C) Less than 9 months old.
(D) Less than 12 months old.
(E) Less than 15 months old.

T H E S I N G A P O R E F A M I L Y P H Y S I C I A N V O L 39 N O 3 J U L -S E P 2013 : 54