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This is a 15 question, one best answer of 4 options MCQ quiz of ACEM Fellowship standard. There is no time limit for this quiz.
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Question 1 of 15
1. Question
1 pointsThe most commonly abused opioid in Australia is:
Correct
Due to its widespread prescription (which is often diverted to illicit use) oxycodone is now the most frequently abused of the opioids in Australia. (Link)
Incorrect
Due to its widespread prescription (which is often diverted to illicit use) oxycodone is now the most frequently abused of the opioids in Australia. (Link)
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Question 2 of 15
2. Question
1 pointsApproximately what percentage of patients with self reported penicillin allergy will have an allergic reaction when administered oral cephalosporins?
Correct
The cross reaction rate (i.e. clinical reaction) is estimated to be 0.3%. This is lower than the cross reactivity rate (from skin testing) of 5%. (Link)
Incorrect
The cross reaction rate (i.e. clinical reaction) is estimated to be 0.3%. This is lower than the cross reactivity rate (from skin testing) of 5%. (Link)
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Question 3 of 15
3. Question
1 pointsWhich one of the following statements regarding anisocoria is correct.
Correct
Anisocoria is unequal pupillary size in each eye. When it is when greater in the dark, it suggests physiologic anisocoria if it dilates and sympathetic system disease, such as Horner’s syndrome if it does not dilate. When greater in bright light it indicates a parasympathetic problem, usually due to third nerve palsy or Holmes Adie (tonic) pupil. A Marcus Gunn pupil does not cause anisocoria. (link)
Incorrect
Anisocoria is unequal pupillary size in each eye. When it is when greater in the dark, it suggests physiologic anisocoria if it dilates and sympathetic system disease, such as Horner’s syndrome if it does not dilate. When greater in bright light it indicates a parasympathetic problem, usually due to third nerve palsy or Holmes Adie (tonic) pupil. A Marcus Gunn pupil does not cause anisocoria. (link)
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Question 4 of 15
4. Question
1 pointsWhich one of the following conditions is the most likely to cause massive hepatomegaly
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Question 5 of 15
5. Question
1 pointsThe approximately percentage of post partum women who have a palpable spleen is
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Question 6 of 15
6. Question
1 pointsWhich one of the following is not a quality dimension
Correct
Variability is not a quality dimension
Incorrect
Variability is not a quality dimension
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Question 7 of 15
7. Question
1 pointsThe best place to position a pulse oximetry sensor on a sick neonate is the
Correct
The right upper arm is the preferred position as blood flowing to the right upper arm is least diluted by the shunt, if a patent ductus arteriosus is present. (Link)
Incorrect
The right upper arm is the preferred position as blood flowing to the right upper arm is least diluted by the shunt, if a patent ductus arteriosus is present. (Link)
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Question 8 of 15
8. Question
1 pointsAppropriate management of a mammalian bite might include all the following except
Correct
All mammalian bites should have copious wound irrigation under pressure for up to 20 minutes with large quantities of normal saline (0.9%). This can be achieved by using an 18-19G cannula (with the needle removed) attached to a 20mL syringe. Primary closure can then follow if the injury is < 6 hours old. Prophylactic antibiotics are indicated for high risk wounds that include: >8 hours from time of injury; cat bites; human bites; rat bites; other bites unable to be adequately irrigated; in the immunocompromised patient; bites involving the hand, head and neck, face, genitals, ligaments, vessels, or joints. Severe established infection requires IV piperacillin+tazobactam 4+0.5 g or ticarcillin+clavulanate 3+0.1 g or amoxycillin + clavulanate 1.2g IV 6/24. Amoxycillin-clavulanate can also be used orally for less severe infections and prophylaxis (875+125 mg (child 2 months or older: 22.5+3.2 mg/kg up to 875+125 mg) orally, 12-hourly for 3-5 days). Oral penicillin has inadequate strength and coverage for all likely pathogens. (Link)
Incorrect
All mammalian bites should have copious wound irrigation under pressure for up to 20 minutes with large quantities of normal saline (0.9%). This can be achieved by using an 18-19G cannula (with the needle removed) attached to a 20mL syringe. Primary closure can then follow if the injury is < 6 hours old. Prophylactic antibiotics are indicated for high risk wounds that include: >8 hours from time of injury; cat bites; human bites; rat bites; other bites unable to be adequately irrigated; in the immunocompromised patient; bites involving the hand, head and neck, face, genitals, ligaments, vessels, or joints. Severe established infection requires IV piperacillin+tazobactam 4+0.5 g or ticarcillin+clavulanate 3+0.1 g or amoxycillin + clavulanate 1.2g IV 6/24. Amoxycillin-clavulanate can also be used orally for less severe infections and prophylaxis (875+125 mg (child 2 months or older: 22.5+3.2 mg/kg up to 875+125 mg) orally, 12-hourly for 3-5 days). Oral penicillin has inadequate strength and coverage for all likely pathogens. (Link)
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Question 9 of 15
9. Question
1 pointsSystemic anticoagulation for superficial thromobophlebitis is not indicated in the following situations
Correct
Indications for systemic anticoagulation in patients with superficial thrombophlebitis include: the presence of a DVT; an affected vein segment ≥ 5 cm in length; thrombosis close to the saphenofemoral/saphenopopliteal junction; ongoing risk factors for thrombosis. However it is not required for superficial thrombophlebitis of the long saphenous vein following endovenous ablation therapy due to lower risk of thromboembolism than from spontaneous thrombosis in this group of patients. (Link).
Incorrect
Indications for systemic anticoagulation in patients with superficial thrombophlebitis include: the presence of a DVT; an affected vein segment ≥ 5 cm in length; thrombosis close to the saphenofemoral/saphenopopliteal junction; ongoing risk factors for thrombosis. However it is not required for superficial thrombophlebitis of the long saphenous vein following endovenous ablation therapy due to lower risk of thromboembolism than from spontaneous thrombosis in this group of patients. (Link).
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Question 10 of 15
10. Question
1 pointsApproximately what percentage of patients following cardiac arrest have an acute coronary artery thrombosis despite not having ECG features of STEMI?
Correct
ECG changes of STEMI are absent in 25-40% of post arrest patients with acute coronary occlusions, but many of these will have STEMI equivalents. Also 80% of all post arrest patients > 45 years of age have an acute coronary occlusion. Although this suggests that all patients should have an urgent coronary angiogram, evidence suggests that only those with ECG features of acute ischaemia (AOMI) at 10 minutes post arrest who are not comatose will benefit. (Link)
Incorrect
ECG changes of STEMI are absent in 25-40% of post arrest patients with acute coronary occlusions, but many of these will have STEMI equivalents. Also 80% of all post arrest patients > 45 years of age have an acute coronary occlusion. Although this suggests that all patients should have an urgent coronary angiogram, evidence suggests that only those with ECG features of acute ischaemia (AOMI) at 10 minutes post arrest who are not comatose will benefit. (Link)
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Question 11 of 15
11. Question
1 pointsThe upper limit of normal of the total WCC/mm3 in a 3 month old is
Correct
The total WCC can normally be as high as 30,000 in the first month of life, but drops to 15,000 by 12 months. At 3 months, the normal range is ,6000 – 1,7500. (link)
Incorrect
The total WCC can normally be as high as 30,000 in the first month of life, but drops to 15,000 by 12 months. At 3 months, the normal range is ,6000 – 1,7500. (link)
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Question 12 of 15
12. Question
1 pointsIndications for drainage of a parapneumonic effusion include all of the following except
Correct
Indications for drainage of a parapneumonic effusion include: height > 1/3 hemithorax; pleural fluid pH < 7.2, LDH > 1,000 U/L or glucose < 3.3 mmol/L; loculated effusions; WCC > 100,000 mm3 or ongoing sepsis despite antibiotic therapy. (link)
Incorrect
Indications for drainage of a parapneumonic effusion include: height > 1/3 hemithorax; pleural fluid pH < 7.2, LDH > 1,000 U/L or glucose < 3.3 mmol/L; loculated effusions; WCC > 100,000 mm3 or ongoing sepsis despite antibiotic therapy. (link)
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Question 13 of 15
13. Question
1 pointsWhich one of the following findings would you least expect in a patient with DKA
Correct
Beta-hydroxybutyrate levels are high in DKA and are measured by bedside blood analysis but not bedside urinalysis. Only acetoacetate is measured in bedside urinalysis. Serum ketones are usually > 3mmol/L, HCO3 is usually < 15 mmol/L and glucose > 11mmol/L (or known diabetic). Measured serum sodium is depressed by about 3.5 mmol/L for every increase in serum glucose of 10mmol/L above 5mmol/L, so a Na around 130 is common. (link)
Incorrect
Beta-hydroxybutyrate levels are high in DKA and are measured by bedside blood analysis but not bedside urinalysis. Only acetoacetate is measured in bedside urinalysis. Serum ketones are usually > 3mmol/L, HCO3 is usually < 15 mmol/L and glucose > 11mmol/L (or known diabetic). Measured serum sodium is depressed by about 3.5 mmol/L for every increase in serum glucose of 10mmol/L above 5mmol/L, so a Na around 130 is common. (link)
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Question 14 of 15
14. Question
1 pointsThe opioid least likely to cause complications in a 1 month old an infant breast feeding from a mother receiving the drug is
Correct
Fentanyl and morphine are considered safe during lactation as are methadone, buprenorphine and naltrexone as their serum concentrations are usually < 3% of maternal concentrations. There is some potential for sedation and withdrawal with codeine and hydroxymorphone. Oxycodone (CNS depression in 20%), pentazocine, propoxyphene, and pethidine should be avoided. (link)
Incorrect
Fentanyl and morphine are considered safe during lactation as are methadone, buprenorphine and naltrexone as their serum concentrations are usually < 3% of maternal concentrations. There is some potential for sedation and withdrawal with codeine and hydroxymorphone. Oxycodone (CNS depression in 20%), pentazocine, propoxyphene, and pethidine should be avoided. (link)
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Question 15 of 15
15. Question
1 pointsWhich one of the following features is least suggestive of pertussis infection
Correct
Pertussis infection usually has a 1-2 week catarrhal phase with a clear nasal discharge. The cough is usually non productive and there is an absence of significant fever, despite the ongoing symptoms. (link)
Incorrect
Pertussis infection usually has a 1-2 week catarrhal phase with a clear nasal discharge. The cough is usually non productive and there is an absence of significant fever, despite the ongoing symptoms. (link)