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This is a 15 point quiz comprising single choice MCQs and EMQs suitable for those preparing for the ACEM Fellowship exam.
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Question 1 of 10
1. Question
According to the International League Against Epilepsy 2014 definition, epilepsy is defined as
Correct
According to the International League Against Epilepsy 2014 definition, epilepsy is defined as two or more unprovoked seizures occurring more than 24 hours apart. It is regarded as a primary idiopathic illness and excludes secondary seizures. The presence of one unprovoked seizure plus a 60% or higher likelihood of additional seizures in the next 10 years (e.g. a patient with a single seizure one month after having a stroke) is also considered as epilepsy.
Incorrect
According to the International League Against Epilepsy 2014 definition, epilepsy is defined as two or more unprovoked seizures occurring more than 24 hours apart. It is regarded as a primary idiopathic illness and excludes secondary seizures. The presence of one unprovoked seizure plus a 60% or higher likelihood of additional seizures in the next 10 years (e.g. a patient with a single seizure one month after having a stroke) is also considered as epilepsy.
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Question 2 of 10
2. Question
The potentially toxic dose of standard release paracetamol in adults in Australasia is
Correct
The potentially toxic dose of standard release paracetamol in adults in Australasia is > 10g ingested or > 200 mg/kg (whichever is less).
Incorrect
The potentially toxic dose of standard release paracetamol in adults in Australasia is > 10g ingested or > 200 mg/kg (whichever is less).
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Question 3 of 10
3. Question
The best measure of perfusion in a patient with a ventricular assist device is
Correct
Measuring perfusion in patients with ventricular assist devices is difficult as blood flow is more constant than in normal patients. As peripheral and central pulses are commonly reduced or absent and non-invasive BP measurements are often difficult to obtain, mean arterial pressure is the best measure of perfusion of the options listed.
Incorrect
Measuring perfusion in patients with ventricular assist devices is difficult as blood flow is more constant than in normal patients. As peripheral and central pulses are commonly reduced or absent and non-invasive BP measurements are often difficult to obtain, mean arterial pressure is the best measure of perfusion of the options listed.
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Question 4 of 10
4. Question
Stable, non intubated patients with traumatic intra-cranial haematomas have a risk of requiring neurosurgical intervention due to subsequent deterioration of approximately
Correct
20% of patients have radiological deterioration after initial assessment, however only 3% have clinical deterioration and only 1/3 of those require neurosurgical intervention.
Incorrect
20% of patients have radiological deterioration after initial assessment, however only 3% have clinical deterioration and only 1/3 of those require neurosurgical intervention.
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Question 5 of 10
5. Question
The manufacturer recommended inflation volume for a size 4 LMA is
Correct
The manufacturer recommended inflation volume for a size 4 LMA is 30mL, however a lower inflation volume of 15mL may actually produce a better seal.
Incorrect
The manufacturer recommended inflation volume for a size 4 LMA is 30mL, however a lower inflation volume of 15mL may actually produce a better seal.
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Question 6 of 10
6. Question
Features typical of allergic pulmonary aspergillosis include all of the following except
Correct
Allergic pulmonary aspergillosis is one of the Aspergillus related lung diseases, that also include chronic necrotizing Aspergillus pneumonia and aspergilloma. It occurs in approximately 1% of patients with asthma, usually in those with moderate or severe persistent disease. It should be considered in this group of patients who do not respond to standard therapy.
Common features include: cough productive of mucous plugs or haemoptysis; migratory pulmonary opacities; central bronchiectasis; serum Ig E levels > 1000 IU/dL; eosinophilia; and a positive skin test for A. fumigatus.Incorrect
Allergic pulmonary aspergillosis is one of the Aspergillus related lung diseases, that also include chronic necrotizing Aspergillus pneumonia and aspergilloma. It occurs in approximately 1% of patients with asthma, usually in those with moderate or severe persistent disease. It should be considered in this group of patients who do not respond to standard therapy.
Common features include: cough productive of mucous plugs or haemoptysis; migratory pulmonary opacities; central bronchiectasis; serum Ig E levels > 1000 IU/dL; eosinophilia; and a positive skin test for A. fumigatus. -
Question 7 of 10
7. Question
Which one of the following criteria is included in the Pulmonary embolism rule-out criteria (PERC)
Correct
PERC criteria include: < 50 years of age; pulse rate < 100 beats/min; SpO2 > 94% on air; no unilateral leg swelling; no haemoptysis; no surgery or trauma within 4 weeks; no previous DVT or PE; and no oral hormone use. It does not include other risk factors for PE (or detection of PE) such as family history of VTE, inherited thrombophilia, factors limiting increases in heart rate, malignancy or pregnancy.
Incorrect
PERC criteria include: < 50 years of age; pulse rate < 100 beats/min; SpO2 > 94% on air; no unilateral leg swelling; no haemoptysis; no surgery or trauma within 4 weeks; no previous DVT or PE; and no oral hormone use. It does not include other risk factors for PE (or detection of PE) such as family history of VTE, inherited thrombophilia, factors limiting increases in heart rate, malignancy or pregnancy.
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Question 8 of 10
8. Question
A factor present in the PERC criteria that is not considered by the Modified Wells score for PE is
Correct
Factors present in the Modified Wells score for PE are: DVT symptoms and signs; PE as likely as or more likely than alternative diagnosis; heart rate > 100 beats/min.; immobilisation or surgery in previous 4 weeks; previous DVT or PE; haemoptysis; malignancy.
PERC criteria are: age < 50 years; pulse rate < 100 beats/min; SpO2 > 94% on air; no unilateral leg swelling; no haemoptysis; no surgery or trauma within 4 weeks; no previous DVT or PE; no oral hormone use.Incorrect
Factors present in the Modified Wells score for PE are: DVT symptoms and signs; PE as likely as or more likely than alternative diagnosis; heart rate > 100 beats/min.; immobilisation or surgery in previous 4 weeks; previous DVT or PE; haemoptysis; malignancy.
PERC criteria are: age < 50 years; pulse rate < 100 beats/min; SpO2 > 94% on air; no unilateral leg swelling; no haemoptysis; no surgery or trauma within 4 weeks; no previous DVT or PE; no oral hormone use. -
Question 9 of 10
9. Question
The ecarin clotting time is of most use in measuring anti-coagulation due to
Correct
The primary role of the ecarin clotting time is the measurement of the activity of direct thrombin inhibitors (e.g. dabigatran).
Incorrect
The primary role of the ecarin clotting time is the measurement of the activity of direct thrombin inhibitors (e.g. dabigatran).
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Question 10 of 10
10. Question
Match each of the anti-coagulants with their expected effects on coagulation tests
Sort elements
- INR increased; APTT increased with chronic therapy; TT unchanged
- INR increased only in overanti-coagulation; APTT increased, TT highly sensitively increase.
- INR unchanged; APTT unchanged, TT increased only with over anti-coagulation.
- INR increased in over anti-coagulation; APTT increased; TT highly sensitively increase.
- INR highly variable increase; APTT mild increase within 2 hours of administration, TT unchanged.
- INR increased; APTT unchanged; TT unchanged.
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Warfarin
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Unfractionated heparin
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LMWH
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Dabigatran
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Rivaroxaban
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Apixaban
Correct 6 / 6PointsWarfarin causes: INR increased; APTT increased with chronic therapy; TT unchanged.
Unfractionated heparin causes: INR increased only in toxicity; APTT increased, TT highly sensitively increase.
LMWH causes: INR unchanged; APTT unchanged, TT increased only with over anti-coagulation.
Dabigatran causes:INR increased in over anti-coagulation; APTT increased; TT highly sensitively increase.
Rivaroxaban causes: INR highly variable increase; APTT mild increase within 2 hours of administration, TT unchanged.
Apixaban causes: INR increased; APTT unchanged; TT unchanged.Incorrect / 6 PointsWarfarin causes: INR increased; APTT increased with chronic therapy; TT unchanged.
Unfractionated heparin causes: INR increased only in toxicity; APTT increased, TT highly sensitively increase.
LMWH causes: INR unchanged; APTT unchanged, TT increased only with over anti-coagulation.
Dabigatran causes:INR increased in over anti-coagulation; APTT increased; TT highly sensitively increase.
Rivaroxaban causes: INR highly variable increase; APTT mild increase within 2 hours of administration, TT unchanged.
Apixaban causes: INR increased; APTT unchanged; TT unchanged.