Exit MCQ Pegawai Perubatan Siswazah 2020

30 Questions | Total Attempts: 15

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Exit MCQ Pegawai Perubatan Siswazah 2020

There are 30 questions. You have to answer all questions. The passing marks 25. There is no negative marking. You have 40minutes to answer all questions.


Questions and Answers
  • 1. 
    Which statement is true regarding preoxygenation during Rapid Sequence Intubation?
    • A. 

      A. It should not delay the act of intubation when adequate oxygenation cannot be achieved due lack of patient cooperation

    • B. 

      B. The aim is to replace all the nitrogen in the lungs with oxygen and to increase the arterial pressure of Oxygen before the apnoeic period.

    • C. 

      C. Tools to improve preoxygenation in every patient include increasing tidal volume and respiratory rate.

    • D. 

      D. If performed properly preoxygenation can prevent the development of respiratory acidosis during the apnoeic period.

  • 2. 
    A 22-year old is brought to the emergency department following a motor vehicle collision with a GCS of 6. Full spinal precautions are in place. You initiate the RSI protocol. Which is the best position to achieve maximum preoxygenation in this patient?
    • A. 

      A. Patient flat on the gurney at chest level of intubating clinician with head in sniffing position

    • B. 

      B. Patient in Trendelenberg position with inline neck airway manoeuvres

    • C. 

      C. Head elevated using a 10cm cushion placed under the occiput with neck slightly flexed.

    • D. 

      D. Patient in reverse Trendelenberg with neck in neutral position.

  • 3. 
    Which of the patients below has received adequate preoxygenation and is ready for induction and paralysis of RSI?
    • A. 

      A. A neck stab wound patient with an expanding hematoma and a saturation of 100% on a nasal cannula, asked to breathe for 3 minutes after adding an NRM

    • B. 

      B. A 30-year-old presenting with SAH and decreasing levels of consciousness with a saturation of 98% on room air asked to take 8 deep breaths in room air

    • C. 

      C. An agitated asthmatic patient with an oxygen saturation of 85% despite attempts at nasal cannula and NRM complicated by the patient’s lack of compliance

    • D. 

      D. A COPD patient with worsening clinical presentation and unresponsive to bronchodilators with a saturation of 75% in whom good face seal cannot be achieved with PP masks.

  • 4. 
    You are evaluating a child in your emergency department who presents with posterior rib fractures. You are suspicious of non-accidental trauma. Which of the following is NOT a feature that should raise suspicion of non-accidental trauma?
    • A. 

      A. Vague or inconsistent stories regarding the mechanism of traumatic injury.

    • B. 

      B. Delays in presentation.

    • C. 

      C. Injuries inconsistent with the developmental age of the child.

    • D. 

      D. Bruising in toddlers and young school-aged children around the shins.

    • E. 

      E. All of the above are concerning for non-accidental trauma

  • 5. 
    A 67-year-old man is brought to the ED by emergency medical service (EMS). His wife states that the patient was doing his usual chores around the house when all of a sudden he started complaining of severe abdominal pain. He has a past medical history of coronary artery disease and hypertension. His BP is 85/70 mm Hg, HR is 105 beats per minute, temperature is 37.2°C, and his RR is 18 breaths per minute. On physical examination, he is diaphoretic and in obvious pain. Upon palpating his abdomen, you feel a large pulsatile mass. An electrocardiogram (ECG) reveals sinus tachycardia. You place the patient on a monitor, administer oxygen, insert two large-bore IVs, and send his blood to the laboratory. His BP does not improve after a 1-L fluid bolus. Which of the following is the most appropriate next step in management?
    • A. 

      A. Order a CT scan to evaluate his aorta.

    • B. 

      B. Call the angiography suite and have them prepare the room for the patient.

    • C. 

      C. Order a portable abdominal radiograph.

    • D. 

      D. Call surgery and have them prepare the operating room (OR) for an exploratory laparotomy.

    • E. 

      E. Call the cardiac catheterization laboratory to prepare for stent insertion.

  • 6. 
    A 41-year-old woman presents to the ED complaining of pain in her RUQ that is steady but gets worse with eating over the past 2 days. The pain also radiates to the right side of her midback. She denies vomiting. Her only medication is an oral contraceptive. Her BP is 140/75 mm Hg, HR is 80 beats per minute, temperature is 37°C, and RR is 16 breaths per minute. Laboratory tests are within normal limits. An abdominal ultrasound reveals stones in her gallbladder, but no thickened wall or pericholecystic fluid. What is the most likely diagnosis?
    • A. 

      A. Cholangitis

    • B. 

      B. Urolithiasis

    • C. 

      C. Cholecystitis

    • D. 

      D. Biliary colic

    • E. 

      E. Peptic ulcer disease

  • 7. 
    A 29-year-old man presents to the ED complaining of RLQ pain for 24 hours. He states that the pain first began as a dull feeling around his umbilicus and slowly migrated to his right side. He has no appetite, is nauseated, and vomited twice. His BP is 130/75 mm Hg, HR is 95 beats per minute, temperature is 38.3°C, and his RR is 16 breaths per minute. His WBC is 14,000/μL. As you palpate the LLQ of the patient’s abdomen, he states that his RLQ is painful. What is the name of this sign?
    • A. 

      A. Blumberg sign

    • B. 

      B. Psoas sign

    • C. 

      C. Obturator sign

    • D. 

      D. Raynaud sign

    • E. 

      E. Rovsing sign

  • 8. 
    A 47-year-old man is brought to the ED by EMS after being found wandering in the street mumbling. His BP is 150/75 mm Hg, HR is 110 beats perminute, temperatureis 38°C,RRis16breathsperminute,oxygensaturation is 99% on room air, and fingerstick glucose is 98 mg/dL. On examination, the patient is confused with mumbling speech. His pupils are dilated and face is flushed. His mucous membranes and skin are dry. Which of the following toxic syndromes is this patient exhibiting?
    • A. 

      A. Sympathomimetic syndrome

    • B. 

      B. Anticholinergic syndrome

    • C. 

      C. Cholinergic syndrome

    • D. 

      D. Opioid syndrome

    • E. 

      E. Ethanol syndrome

  • 9. 
    You are notified that emergency medical service (EMS) is bringing in a patient who collapsed 5 minutes ago in his house and was intubated at the scene by paramedics. On arrival to the ED, you confirm ET placement and continue cardiopulmonary resuscitation (CPR). You connect the patient to the cardiac monitor and see the rhythm below. Which of the following is the most appropriate next step in management?
    • A. 

      A. Perform synchronized cardioversion at 100 J.

    • B. 

      B. Immediately defibrillate at 200 J.

    • C. 

      C. Confirm the rhythm in two leads, begin CPR, then defibrillate at 200 J.

    • D. 

      D. Confirm the rhythm in two leads, begin CPR, then administer amiodarone.

    • E. 

      E. Confirm the rhythm in two leads, begin CPR, then administer epinephrine and atropine.

  • 10. 
    You are caring for a 54-year-old woman with a history of schizophrenia and coronary artery disease who presents to the ED for chest pain. Her vital signs are within normal limits and her ECG is normal sinus rhythm with nonspecific ST/T wave changes. Her first troponin is sent to the laboratory and you are planning to admit her to the hospital for a complete acute coronary syndrome (ACS) evaluation. She receives aspirin and nitroglycerin and her chest pain resolves. A few minutes later, the nurse alerts you that the patient has become unconscious. You go to the bedside and find the patient awake and alert. You review the rhythm strip below. What is your next step in management?
    • A. 

      A. Start CPR

    • B. 

      B. IV Magnesium sulphate stat

    • C. 

      C. Defibrillate patient with monophasic defibrillator 200J with sedation

    • D. 

      D. Defibrillate patient with biphasic defibrillator 200J without sedation

    • E. 

      E. Synchronize cardiovert patient 120J

  • 11. 
    An 82-year-old man presents to the ED feeling weak and dizzy. He has a past medical history of hypertension and diabetes and both are well controlled on hydrochlorothiazide, benazepril, atenolol, and metformin. On review of systems, he denies chest pain, gastrointestinal (GI) bleeding, and syncope, but states that he feels short of breath. His temperature is 37°C orally, BP is 86/60 mm Hg, HR is 44 beats per minute, RR is 18 breaths per minute, oxygen saturation is 98% on room air, and glucose is 116 mg/dL. He is immediately connected to the cardiac monitor. Which of the following choices best describes the ECG seen below?
    • A. 

      A. Normal sinus rhythm

    • B. 

      B. First-degree AV block

    • C. 

      C. Second-degree Mobitz I (Wenckebach) AV block

    • D. 

      D. Second-degree Mobitz II AV block

    • E. 

      E. Third-degree AV block

  • 12. 
    You are called to the bedside of a hypotensive patient with altered mental status. The nurse hands you an ECG which shows atrial flutter at 150 beats per minute with 2:1 arteriovenous (AV) block. You feel that the patient is unstable and elect to perform emergency cardioversion. You attach the monitor leads to the patient. What is the critical next step in electrical cardioversion?
    • A. 

      A. Set the appropriate energy level

    • B. 

      B. Position conductor pads or paddles on patient

    • C. 

      C. Charge the defibrillator

    • D. 

      D. Turn on the synchronization mode

    • E. 

      E. Administer 25μg of fentanyl IV

  • 13. 
    A 55-year-old man presents to the ED with fever, drooling, trismus, and a swollen neck. He reports a foul taste in his mouth since a tooth extraction 2 days ago. On physical examination, the patient appears anxious. He has bilateral submandibular swelling and elevation and protrusion of the tongue. He appears “bull-necked” with tense and markedly tender oedema and brawny induration of the upper neck, and he is tender over the lower second and third molars. There is no cervical lymphadenopathy. His vital signs are: HR 105 beats per minute, BP 140/85 mm Hg, RR 26 breaths per minute, and temperature 38.9°C. Which of the following is the most appropriate next step in management?
    • A. 

      A. Administer a dose of IV antibiotics and obtain a soft-tissue radiograph of the neck.

    • B. 

      B. Administer a dose of IV antibiotics then perform an incision and drainage at the bedside.

    • C. 

      C. Begin steroids to decrease inflammation and obtain an ear, nose, and throat (ENT) consult.

    • D. 

      D. Discharge the patient with oral antibiotics and ENT follow-up.

    • E. 

      E. Secure his airway, start IV antibiotics, and obtain an ENT consult.

  • 14. 
    Paramedics bring a 44-year-old man to the ED. He was found in the middle of the street after being struck by a car. His systolic BP is 70 mm Hg; a diastolic BP cannot be obtained. The heart rate is 125 beats per minute, and oxygen saturation is 89% on room air. The patient’s eyes are closed. You ask the patient his name and he doesn’t respond. There is no response when you ask him to move his limbs. You notice that his left foot is severely deformed and there is a large laceration to his right arm. Which of the following is the most appropriate next step in management?
    • A. 

      A. Prepare for emergent orotracheal intubation.

    • B. 

      B. Begin aggressive fluid resuscitation and administer morphine for pain.

    • C. 

      C. Apply a tourniquet just above his left foot and begin fluid resuscitation.

    • D. 

      D. Apply pressure to the laceration, splint the left foot, and order a radiograph.

    • E. 

      E. Administer packed RBCs and bring him to the CT scanner for a pan-scan.

  • 15. 
    An 87-year-old man is brought to the ED on a long board and in a cervical collar after falling down a flight of steps. He denies losing consciousness. On arrival, his vital signs include a HR of 99 beats per minute, BP of 160/90 mm Hg, and RR of 16 breaths per minute. He is alert and speaking in full sentences. Breath sounds are equal bilaterally. Despite an obvious right arm fracture, his radial pulses are 2+ and symmetric. When examining his cervical spine, he denies tenderness to palpation and you do not feel any bony deformities. Which of the following is a true statement?
    • A. 

      A. Epidural hematomas are very common in the elderly age population.

    • B. 

      B. Cerebral atrophy in the elderly population provides protection against subdural hematomas.

    • C. 

      C. Increased elasticity of their lungs, allows elderly patients to recover from thoracic trauma more quickly than younger patients.

    • D. 

      D. The most common cervical spine fracture in this age group is a wedge fracture of the sixth cervical vertebra.

    • E. 

      E. Despite lack of cervical spine tenderness, imaging of his cervical spine is warranted.

  • 16. 
    A 20-year-old man was found on the ground next to his car after it hit a tree on the side of the road. Bystanders state that the man got out of his car after the collision but collapsed within a few minutes. Paramedics subsequently found the man unconscious on the side of the road. In the ED, his BP is 175/90 mm Hg, HR is 65 beats per minute, temperature is 37.3°C, RR is 12 breaths per minute, and oxygen saturation is 97% on room air. Physi- cal examination reveals a right-sided fixed and dilated pupil. A head CT is shown below. Which of the following is the most likely diagnosis?
    • A. 

      A. Epidural hematoma

    • B. 

      B. Subdural hematoma

    • C. 

      C. Subarachnoid hemorrhage (SAH)

    • D. 

      D. Intracerebral hematoma

    • E. 

      E. Cerebral contusion

  • 17. 
    A 49-year-old woman presents to the ED with difficulty breathing after a morning jog. Her initial vitals include a HR of 60 beats per minute, a BP of 120/55 mm Hg, and an RR of 20 breaths per minute with an oxygen saturation of 94% on room air. Upon physical examination, the patient appears to be in mild distress with audible wheezing. She is able to speak in partial sentences and states that she occasionally uses an inhaler. Given this patient’s history and physical examination, which of the following measures should be taken next?
    • A. 

      A. Peak expiratory flow

    • B. 

      B. Chest radiograph

    • C. 

      C. β-Natriuretic peptide level

    • D. 

      D. Rectal temperature

    • E. 

      E. ABG

  • 18. 
    A 76-year-old man presents to the ED in acute respiratory distress, gasping for breath while on face mask. Paramedics state that he was found on a bench outside of his apartment in respiratory distress. Initial vitals include a HR of 90 beats per minute, a BP of 170/90 mm Hg, and an RR of 33 breaths per minute with an oxygen saturation of 90%. Upon physical examination, the patient is coughing up pink, frothy sputum, has rales two-thirds of the way up both lung fields, and has pitting oedema of his lower extremities. A chest radiograph reveals bilateral perihilar infiltrates, an enlarged cardiac silhouette, and a small right-sided pleural effusion. After obtaining IV access and placing the patient on a monitor, which of the following medical interventions is most appropriate?
    • A. 

      A. Morphine sulfate only

    • B. 

      B. Nitroglycerin only

    • C. 

      C. Nitroglycerin and a loop diuretic

    • D. 

      D. Aspirin

    • E. 

      E. Antibiotics

  • 19. 
    A 55-year-old man with hypertension and a one-pack-per-day smoking history presents to the ED complaining of three episodes of severe heavy chest pain this morning that radiated to his left shoulder. In the past, he experienced chest discomfort after walking 20 minutes that resolved with rest. The episodes of chest pain this morning occurred while he was reading the newspaper. His BP is 155/80 mm Hg, HR 76 beats per minute, RR 15 breaths per minute. He does not have chest pain in the ED. An ECG reveals sinus rhythm with a rate of 72. A troponin I is negative. Which of the following best describes this patient’s diagnosis?
    • A. 

      A. Variant angina

    • B. 

      B. Stable angina

    • C. 

      C. Unstable angina

    • D. 

      D. Non–ST-elevation MI

    • E. 

      E. ST-elevation MI

  • 20. 
    A 68-year-old woman with recently diagnosed uterine cancer is brought to the ED by her daughter. The patient complains of acute onset right-sided chest pain that is sharp in character and worse with inspiration. Her BP is 135/85 mm Hg, HR 107 beats per minute, RR 20 breaths per minute, and oxygen saturation 97% on room air. Physical examination reveals a swollen and tender right calf. ECG is sinus tachycardia. Which of the following is the most appropriate next step in management?
    • A. 

      A. Start heparin therapy prior to diagnostic study

    • B. 

      B. Administer thrombolytics

    • C. 

      C. Order a ventilation-perfusion scan

    • D. 

      D. Order a CT angiogram

    • E. 

      E. Order a D-dimer

  • 21. 
    A 54-year-old woman presents to the ED because of a change in behaviour at home. For the past 3 years she has end-stage renal disease requiring dialysis. Her daughter states that the patient has been increasingly tired and occasionally confused for the past 3 days and has not been eating her usual diet. On examination, the patient is alert and oriented to person only. The remainder of her examination is normal. An initial 12-lead ECG is per- formed as seen below. Which of the following electrolyte abnormalities best explains these findings?
    • A. 

      A. Hypokalaemia

    • B. 

      B. Hyperkalaemia

    • C. 

      C. Hypocalcaemia

    • D. 

      D. Hypercalcemia

    • E. 

      E. Hyponatremia

  • 22. 
    A29-year-old tall, thin man presents to the ED after feeling short of breath for 2 days. In the ED, he is in no acute distress. His BP is 115/70 mm Hg, HR is 81 beats per minute, RR is 16 breaths per minute, and oxygen saturation is 98% on room air. Cardiac, lung, and abdominal examinations are normal. An ECG reveals sinus rhythm at a rate of 79. A chest radiograph shows a small right-sided (less than 10% of the hemithorax) spontaneous pneumothorax. A repeat chest x-ray 6 hours later reveals a decreased pneumothorax. Which of the following is the most appropriate next step in management?
    • A. 

      A. Discharge the patient with follow-up in 24 hours

    • B. 

      B. Perform needle decompression in the second intercostal space, midclavicular line

    • C. 

      C. Insert a 20F chest tube into right hemithorax

    • D. 

      D. Observe for another 6 hours

    • E. 

      E. Admit for pleurodesis

  • 23. 
    A 75-year-old man presents to the ED with a depressed level of consciousness. His wife is at the bedside and states he was stacking heavy boxes when he complained of a sudden intense headache. He subsequently sat down on the couch and progressively lost consciousness. She states that he had a headache the previous week that was also sudden but not as intense. He had gone to visit his primary-care physician who sent him to have a CT scan of the brain, which was normal. Over the course of the past week, he complained of intermittent pulsating headaches for which he took sumatriptan. In the ED, you intubate the patient and obtain the non-contrast head CT seen below. The scan is most consistent with which diagnosis?
    • A. 

      A. Meningoencephalitis

    • B. 

      B. SAH

    • C. 

      C. Normal pressure hydrocephalus

    • D. 

      D. Epidural hematoma

    • E. 

      E. Subdural hematoma

  • 24. 
    A 78-year-old man presents to the emergency department (ED) com- plaining of left arm weakness that started 10 minutes ago in the clinic. The patient states that he has a history of hypertension and diabetes, but has never had similar symptoms in the past. He is feeling well otherwise. His blood pressure (BP) is 157/85 mm Hg, heart rate (HR) is 87 beats per minute, temperature is 37.1°C, and respiratory rate (RR) is 14 breaths per minute. His neurologic examination is unremarkable and the patient embarrassingly states that his left arm is no longer weak. Which of the following is the most likely diagnosis?
    • A. 

      A. Thrombotic stroke

    • B. 

      B. Conversion disorder

    • C. 

      C. Migraine with focal neurologic deficit

    • D. 

      D. Transient ischemic attack (TIA)

    • E. 

      E. Todd paralysis

  • 25. 
    17 years old boy alledged fall from bicycle 2 days ago. He complained of pain over the right elbow. He went to GP for treatment. Imaging was done and he was discharged home with analgesic. However, he turned up to hospital again as the pain get worse and he was unable to move his right elbow.  Xray of the right elbow was reviewed again. Which one is true based on this xray.
    • A. 

      Anterior fat pad sign is always pathological

    • B. 

      Posterior fat sign is absent in normal patient

    • C. 

      Posterior fat pad sign is always pathological

    • D. 

      Sailor sign will present if the posterior fat pad sign abnormal

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