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Information
This is a 60 question, best one of 4 choice MCQ quiz of ACEM fellowship standard. Each question is worth one mark and there is no negative marking. You have 100 minutes to complete it and the time remaining is displayed at the top of the screen. A navigation bar just below the time bar shows you which question you are on and which ones you have answered. You can skip to any particular question by clicking on its number. When you are finished, click on the ‘Quiz summary’ button, then the ‘Finish quiz’ button.
The quiz will be then be graded according to the ACEM scoring template. Your results will be displayed as a percentage followed by your mark as if this was the ACEM Fellowship exam.
Answers to most of the questions are also available at the end of the quiz (and somewhere in the contents of the manual). You can repeat the quiz as many times as you like, but you cannot pause it. Good luck!
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- Bone and joint - Fellowship 0%
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ACEM score: 5 – borderline pass
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ACEM score: 4 – borderline fail
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ACEM score: 10 – you are a gun!
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ACEM score: 9 – excellent work
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ACEM score: 8 – very well done
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ACEM score: 7 – a good pass
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ACEM score: 6 – a solid pass
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ACEM score: 3 – clear fail
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ACEM score: 2 – very clear fail
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ACEM score: 1 – very clear fail
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- Answered
- Review
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Question 1 of 60
1. Question
The most likely mechanism of injury for a metaphyseal corner fracture of the humerus in a young child is:
Correct
Incorrect
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Question 2 of 60
2. Question
According to the Salter Harris classification of epiphyseal fractures in children, a Type III fracture is
Correct
Incorrect
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Question 3 of 60
3. Question
Oleander
Correct
Incorrect
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Question 4 of 60
4. Question
Venomous Australian snakes
Correct
Incorrect
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Question 5 of 60
5. Question
When giving antivenom for envenomation by an Australian snake, which one of the following statements is correct?
Correct
Incorrect
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Question 6 of 60
6. Question
Specific antivenoms are available to all of the following except
Correct
Incorrect
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Question 7 of 60
7. Question
Which one of the folowing statements is correct regarding viral infections in children
Correct
Incorrect
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Question 8 of 60
8. Question
Which of the following statments about facial cellulitis in children is most correct?
Correct
Incorrect
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Question 9 of 60
9. Question
Characteristics of infantile botulism include all of the following except
Correct
Incorrect
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Question 10 of 60
10. Question
Concerning diarrhoea in the patient with known AIDS
Correct
Incorrect
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Question 11 of 60
11. Question
In empiric antibiotic treatment of the febrile neonate the following should be considered
Correct
Incorrect
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Question 12 of 60
12. Question
Concerning cardiac tamponade
Correct
Incorrect
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Question 13 of 60
13. Question
Comparing thrombolytic therapy with anticoagulation for venous thromboembolism
Correct
Incorrect
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Question 14 of 60
14. Question
Concerning subarachnoid haemorrhage, which of the following statements is NOT true
Correct
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Question 15 of 60
15. Question
All the following drugs may abort an attack of migraine EXCEPT
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Incorrect
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Question 16 of 60
16. Question
Resuscitation drugs should be administered to children via the following routes, in the order of preference of:
Correct
Incorrect
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Question 17 of 60
17. Question
Which of the following is most helpful In distinguishing peripheral from central causes of vertigo?
Correct
Incorrect
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Question 18 of 60
18. Question
Which one of the following methods of wound closure is associated with the lowest rate of infection?
Correct
Incorrect
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Question 19 of 60
19. Question
What is the Glasgow Coma Score of a head injured patient who presents with a pulse of 126, closed eyes that do not open to pain, a withdrawal response to pain and who keeps repeating ‘You mongrel’
Correct
Although an unusual mix of E,M,V scores, he scores: E = 1 for no eye opening, M = 4 for flexion withdrawal, and V = 3 for inappropriate (we hope) words, This gives him a GCS of 8.
Incorrect
Although an unusual mix of E,M,V scores, he scores: E = 1 for no eye opening, M = 4 for flexion withdrawal, and V = 3 for inappropriate (we hope) words, This gives him a GCS of 8.
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Question 20 of 60
20. Question
Pain and numbness in the left upper extremity, extending down to the ring and little fingers, together with Horner’s syndrome, are suggestive of:-
Correct
Incorrect
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Question 21 of 60
21. Question
Which one of the following statements regarding carbon monoxide poisoning is most correct
Correct
Incorrect
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Question 22 of 60
22. Question
Regarding dislocations of the shoulder joint, which one of the following statements is least correct
Correct
Dislocations associated with motor vehicle crashes have approximately a 20% incidence of associated fractures.
Incorrect
Dislocations associated with motor vehicle crashes have approximately a 20% incidence of associated fractures.
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Question 23 of 60
23. Question
Which one of the following statements regarding the use of C1 esterase inhibitor concentrate is not correct
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Question 24 of 60
24. Question
Which one of the following statements regarding appendicitis in pregnancy is most correct
Correct
Appendicitis occurs in approximately 0.1% of pregnancies, is most common in the second and third trimesters, ruptures 2-3 times more commonly in pregnancy and is displaced above Mc Burneys point after the first trimester.
Incorrect
Appendicitis occurs in approximately 0.1% of pregnancies, is most common in the second and third trimesters, ruptures 2-3 times more commonly in pregnancy and is displaced above Mc Burneys point after the first trimester.
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Question 25 of 60
25. Question
Which one of the following statements regarding the Kleihauer -Betke test is least correct
Correct
It is a semi quantitative test not a qualitative test.
Incorrect
It is a semi quantitative test not a qualitative test.
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Question 26 of 60
26. Question
Which one of the following statements regarding spider naevi is least correct
Correct
Less than 5 spider naevi may be normal in non pregant patients. More may be normal in pregnancy.
Incorrect
Less than 5 spider naevi may be normal in non pregant patients. More may be normal in pregnancy.
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Question 27 of 60
27. Question
Regarding unifasicular VT in children, which one of the following statements is least correct
Correct
It usually does not respond to adenosine or standard anti VT therapy, but does respond to verapamil..
Incorrect
It usually does not respond to adenosine or standard anti VT therapy, but does respond to verapamil..
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Question 28 of 60
28. Question
Regarding haemolysis rates which one of the following statements is least correct
Correct
Incorrect
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Question 29 of 60
29. Question
Which one of the following statements regarding Mastocytosis is least correct
Correct
Angioedema without urticaria is caused by ACE inhibitors, C1 esterase inhibitory deficiency, angioedema associated with malignancy and idiopathic angioedema. Urticaria occurs with all histamine related angioedema.
Incorrect
Angioedema without urticaria is caused by ACE inhibitors, C1 esterase inhibitory deficiency, angioedema associated with malignancy and idiopathic angioedema. Urticaria occurs with all histamine related angioedema.
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Question 30 of 60
30. Question
Which one of the following statements regarding emergent umbilical vein catheterization is incorrect
Correct
An emergent umbilical catheter should usually be inserted 5-6 cm + the stump length.
Incorrect
An emergent umbilical catheter should usually be inserted 5-6 cm + the stump length.
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Question 31 of 60
31. Question
The following define perinatal asphyxia except
Correct
1 minute Apgar score is not in the definition of perinatal asphyxia, a 5 minute score of < 4 is.
Incorrect
1 minute Apgar score is not in the definition of perinatal asphyxia, a 5 minute score of < 4 is.
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Question 32 of 60
32. Question
What is the approximate spontaneous passage rate of a 5mm diameter renal calculus
Correct
Incorrect
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Question 33 of 60
33. Question
Complete ureteric obstruction is likely to cause some irreversible renal damage if unrelieved within
Correct
Incorrect
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Question 34 of 60
34. Question
Which one of the following statements regarding prevention of infection is not correct
Correct
Incorrect
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Question 35 of 60
35. Question
Which one of the following is least likely to cause secondary diabetes
Correct
Incorrect
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Question 36 of 60
36. Question
Which one of the following statements regarding the blood film is least correct
Correct
Poikilocytosis is always present with anisocytosis.
Incorrect
Poikilocytosis is always present with anisocytosis.
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Question 37 of 60
37. Question
Which one of the following statements regarding skin folds mimicking pneumothorax on CXR is incorrect
Correct
Skin folds and folded clothing lines usually do not run parallel to the the chest wall.
Incorrect
Skin folds and folded clothing lines usually do not run parallel to the the chest wall.
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Question 38 of 60
38. Question
Which of the following spirometry values would be most consistent with a restrictive pattern of pulmonary disease
Correct
A normal or high FEV1/VC ratio is expected in restrictive disease. The VC is usually low as are the RV/TLC and FRC/TLC ratios. An FEV1 of 2.5L in a female would be considered abnormal and not useful alone in determining the presence of restrictive disease.
Incorrect
A normal or high FEV1/VC ratio is expected in restrictive disease. The VC is usually low as are the RV/TLC and FRC/TLC ratios. An FEV1 of 2.5L in a female would be considered abnormal and not useful alone in determining the presence of restrictive disease.
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Question 39 of 60
39. Question
According to the PORT Community Acquired pneumonia severity score, which one of the following risk factors contributes the most to the score
Correct
The presence of neoplastic disease scores 30 points, the others score 10 points each.
Incorrect
The presence of neoplastic disease scores 30 points, the others score 10 points each.
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Question 40 of 60
40. Question
The most reliable examination finding of a small area of unilateral lung collapse is
Correct
Whispering pectoriloquy and increased tactile fremitus are less reliable signs of collapse than comparative dullness to percussion. The effect of collapse on breath sounds is variable, depending on whether the bronchus is obstructed or not. The trachea will be displaced to the ipsilateral side only if the collapse is large.
Incorrect
Whispering pectoriloquy and increased tactile fremitus are less reliable signs of collapse than comparative dullness to percussion. The effect of collapse on breath sounds is variable, depending on whether the bronchus is obstructed or not. The trachea will be displaced to the ipsilateral side only if the collapse is large.
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Question 41 of 60
41. Question
Which of the following would you least expect to see in a normal lateral CXR
Correct
Usually the second thoracic vertebra is the highest vertebra seen on the lateral
Incorrect
Usually the second thoracic vertebra is the highest vertebra seen on the lateral
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Question 42 of 60
42. Question
The correct normal upper limit of normal for arterial lactate is
Correct
Incorrect
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Question 43 of 60
43. Question
Indications for head CT in children < 1 year of age include all of the following except
Correct
Incorrect
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Question 44 of 60
44. Question
Imipenem is least likely to be effective in treating infections caused by which of the following organisms
Correct
Imipenem is active against Staph aureus, but not usually against MRSA
Incorrect
Imipenem is active against Staph aureus, but not usually against MRSA
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Question 45 of 60
45. Question
If a = the number of exposed cases with the disease, b = the number of non exposed cases with the disease, c = the number of exposed cases without the disease, d = the number of non exposed cases without the disease, which one of the following is the best measure of the odds ratio.
Correct
Incorrect
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Question 46 of 60
46. Question
When describing skin lesions, which one of the following statements best describes nodules
Correct
Papules are < 5mm in diameter and palpable. Vesicles are filled with clear fluid and pustules are filled with yellowish fluid. Nodules are > 5mm in diameter and palpable. Macules are visible alterations of a circumscribed area of skin that are not palpable.
Incorrect
Papules are < 5mm in diameter and palpable. Vesicles are filled with clear fluid and pustules are filled with yellowish fluid. Nodules are > 5mm in diameter and palpable. Macules are visible alterations of a circumscribed area of skin that are not palpable.
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Question 47 of 60
47. Question
Which of the following statements regarding serum urate is most correct
Correct
5% of the normal population have a serum urate level > 420 µmol/L, therefore a single concentration measured above this level is suggestive, but not absolutely diagnostic for gout. Preventative treatment with allopurinol is not usually considered unless the serum urate is markedly elevated (eg > 600 µmol/L). The normal range for premenopausal women is < 350 µmol/L – this is significant as serum urate is usually elevated in pre-eclampsia.(link)
Incorrect
5% of the normal population have a serum urate level > 420 µmol/L, therefore a single concentration measured above this level is suggestive, but not absolutely diagnostic for gout. Preventative treatment with allopurinol is not usually considered unless the serum urate is markedly elevated (eg > 600 µmol/L). The normal range for premenopausal women is < 350 µmol/L – this is significant as serum urate is usually elevated in pre-eclampsia.(link)
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Question 48 of 60
48. Question
Which one of the following features is most closely associated with an antisocial personality disorder?
Correct
Inappropriate sense of self importance is suggestive of a narcissitic personality disorder. Dramatic attention seeking behaviour is more consistent with a histrionic personality disorder. Inability to maintain employment is correct and also associated with aggression, substance abuse, legal problems. Antisocial personality disorder is more common in males and there is a diminished capacity to experience guilt.
Incorrect
Inappropriate sense of self importance is suggestive of a narcissitic personality disorder. Dramatic attention seeking behaviour is more consistent with a histrionic personality disorder. Inability to maintain employment is correct and also associated with aggression, substance abuse, legal problems. Antisocial personality disorder is more common in males and there is a diminished capacity to experience guilt.
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Question 49 of 60
49. Question
Which one of the following statements regarding elements of the mental state examination is true?
Correct
Pressure of speech refers to difficulty interrupting the flow. Mood describes a patient’s pervasive and sustained emotion whereas affect is the behaviour that expresses the current feeling state. Auditory hallucinations are most common in schizophrenia, visual hallucinations occur more frequently in organic illness. Patients exhibiting flight of ideas move quickly from topic to topic but there is a logical thread compared with loose associations where there is absence of logical thought progression.
Incorrect
Pressure of speech refers to difficulty interrupting the flow. Mood describes a patient’s pervasive and sustained emotion whereas affect is the behaviour that expresses the current feeling state. Auditory hallucinations are most common in schizophrenia, visual hallucinations occur more frequently in organic illness. Patients exhibiting flight of ideas move quickly from topic to topic but there is a logical thread compared with loose associations where there is absence of logical thought progression.
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Question 50 of 60
50. Question
Indications for laparotomy in bowel obstruction include all of the following except
Correct
Incorrect
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Question 51 of 60
51. Question
Which of the following situations is the strongest indication for transcutaneous pacing
Correct
Incorrect
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Question 52 of 60
52. Question
The feature least predictive of a true positive blood culture in adults is
Correct
Rigors has a +LR of a true positive blood culture of approximately 14 whilst chills, renal failure and thrombocyopenia have +LRs of approximately 6. T > 38.5C is less strongly predictive as a T > 39.5C only has a +LR of 2.7
Incorrect
Rigors has a +LR of a true positive blood culture of approximately 14 whilst chills, renal failure and thrombocyopenia have +LRs of approximately 6. T > 38.5C is less strongly predictive as a T > 39.5C only has a +LR of 2.7
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Question 53 of 60
53. Question
Which one of the following statements regarding statistical power is correct.
Correct
Incorrect
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Question 54 of 60
54. Question
The structure most sensitive to blast injury is the
Correct
Incorrect
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Question 55 of 60
55. Question
Which one of the following statements is most correct regarding the difference in height between the anterior and posterior ends of the vertebral body on a lateral cervical spine xray in an adult?
Correct
Incorrect
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Question 56 of 60
56. Question
Which one of the following pairs is least correct
Correct
Carvedilol causes diarrhoea not constipation.
Incorrect
Carvedilol causes diarrhoea not constipation.
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Question 57 of 60
57. Question
Which one of the following statements regarding local anaesthesia of the teeth is most correct
Correct
Local infiltration is only effective for maxillary teeth and the mandibular teeth from canine to canine. An inferior alveolar nerve block is required for anaesthesia of the mandibular premolars and molars.
Incorrect
Local infiltration is only effective for maxillary teeth and the mandibular teeth from canine to canine. An inferior alveolar nerve block is required for anaesthesia of the mandibular premolars and molars.
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Question 58 of 60
58. Question
A patient has a high frequency tremor that only involves the arms. It is most likely to be
Correct
Physiological tremor is the only high frequency tremor of the choices given it is postural and only affects the arms. Parkinsonian tremor is a low frequency tremor that affects the arms to a greater extent than the legs and face. Cerebellar tremor is also low frequency and affects the arms and trunk, more than the legs. Essential tremor is a low frequency tremor that affects the arms more than the head and legs. Neuropathic tremor is also low frequency and difficult to differentiate from essential tremor.
Incorrect
Physiological tremor is the only high frequency tremor of the choices given it is postural and only affects the arms. Parkinsonian tremor is a low frequency tremor that affects the arms to a greater extent than the legs and face. Cerebellar tremor is also low frequency and affects the arms and trunk, more than the legs. Essential tremor is a low frequency tremor that affects the arms more than the head and legs. Neuropathic tremor is also low frequency and difficult to differentiate from essential tremor.
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Question 59 of 60
59. Question
What is the minimum acceptable pressure that should be applied to the chest wall with manual defibrillator paddles when defibrillating a patient?
Correct
Incorrect
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Question 60 of 60
60. Question
Which of the following pairs is incorrect when considering the slit lamp appearance of a corneal section?
Correct
The layers visible on corneal section using the slit lamp (from superficial to deep) are: bright zone- the surface of the tears; dark gray line – epithelium; bright thin line – Bowman’s membrane; grey wider granular area – the stroma; bright inner zone – the endothelium.
Incorrect
The layers visible on corneal section using the slit lamp (from superficial to deep) are: bright zone- the surface of the tears; dark gray line – epithelium; bright thin line – Bowman’s membrane; grey wider granular area – the stroma; bright inner zone – the endothelium.