MCEM Pathophysiology MCQ Review

MCEM Pathophysiology MCQ
1. Pancreatitis (a) Because the pancreas is located in the retroperitoneal space with a capsule, inflammation cannot spread easily. Because the pancreas is located in the retroperitoneal space with no capsule, inflammation can spread easily. (b) The inflammatory process can cause systemic effects because of the presence of cytokines, such as bradykinins and phospholipase A. The inflammatory process can cause systemic effects because of the presence of cytokines, such as bradykinins and phospholipase A. (c) Fat necrosis may cause hypercalcemia Fat necrosis may cause hypocalcemia. (d) The incidence of acute pancreatitis is about 100 per 100,000 population. The incidence of acute pancreatitis ranges between 5 and 80 per 100,000 population. (e) Mild edematous pancreatitis occurs in about 80% of presentations, and the mortality rate is about 10%. Mild edematous pancreatitis occurs in about 80% of presentations, and the mortality rate is below 1%. http://www.emedicine.com/emerg/topic354.htm 2. The differential diagnosis for tetanus includes... (a) Dental infection. (b) Jaw infection. (c) Gastroenteritis. (d) Hysteria. (e) Drug reaction. The differential diagnosis for tetanus is dental or jaw infection, hysteria or drug reaction. The presenting symptom of generalised tetanus in more than half of patients is trismus (lockjaw). Patients with generalized tetanus typically have symptoms of autonomic overactivity. Patients with generalized tetanus characteristically have tonic contraction of their skeletal muscles and intermittent intense muscular spasms. Patients with tetanus have no impairment of consciousness or awareness, both the tonic contractions and spasms are intensely painful. Tetanic spasms may be triggered by loud noises or other sensory stimuli such as physical contact or light. Classic clinical findings of tetanus include dysphagia, stiff neck, opisthotonus, risus sardonicus, board-like rigidity and apnea. 3. Alcohol withdrawal syndrome: (a) Autonomic hyperactivity peaks after 24-48 hours. In alcohol withdrawal syndrome autonomic hyperactivity peaks after 24-48 hours. (b) Mydriasis is not a feature. (c) Seizures usually occur between 2 and 3 days after stopping drinking. Seizures usually 6-48 hours after stopping drinking. (d) Delerium tremens has a mortality rate even when treated of 20%. The treated mortality rate of delerium tremens is 5-15%. The untreated mortality Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e
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rate of delerium tremens is 35%. (e) 15% of people in ethanol withdrawal go on to develop delirium tremens. 5% of people in ethanol withdrawal go on to develop delirium tremens. 4. Cardiac enlargement on CXR: (a) Is usually found in cases of multiple valve lesions. (b) The chest X Ray would show cardiothoracic ratio less than 1:2. A cardiothoracic ratio less than 1:2 is normal. (c) ) Clinically cardiomegaly is suggested if the apex beat is more than 10cm from the midline. Clinically cardiomegaly is suggested if the apex beat is more than 10cm from the midline. (d) Is a characteristic finding in pericardial effusion. Cardiac enlargement on CXR is a characteristic finding in pericardial effusion. (e) May be a finding in cases of cardiomyopathy. Cardiac enlargement on CXR may be a finding in cases of cardiomyopathy. Clinically cardiomegaly is suggested if the apex beat is more than 10cm from the midline or if the apex beat is lateral to the mid clavicular line. 5. The Mechanical Process of Respiration: (a) The ribs move upwards and outwards on inspiration because of the diaphragm. The ribs move upwards and outwards on inspiration under the influence of the intercostal muscles. (b) The inspiratory capacity is the tidal volume and the inspiratory reserve volume. The inspiratory capacity is the tidal volume and the inspiratory reserve volume. (c) At the end of forced expiration the volume in the lungs is known as the functional residual capacity At the end of quiet expiration the volume in the lungs is known as the functional residual capacity. (d) The vital capacity is the inspiratory reserve volume and the tidal volume. The vital capacity is the inspiratory reserve volume, the tidal volume and the expiratory reserve volume. (e) Lung compliance is the change in lung pressure brought about by a unit change in transpulmonary pressure ( L/kPa). Lung compliance is the change in lung volume brought about by a unit change in transpulmonary pressure ( L/kPa) 6. The following are causes of hyperkalaemia: (a) Conn's syndrome. Conn's syndrome is characterised by overproduction of aldosterone leading to sodium retention and potassium excretion. (b) Amiloride. Amiloride is a recognised cause of hyperkalaemia. (c) Suxamethonium. Suxamethonium is a recognised cause of hyperkalaemia. (d) Loop Diuretics. Diuretics are associated with hypokalaemia via secondary hyperaldosteronism. Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e Tru e Fals e
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7. Thrombolysis: (a) Streptokinase has more fibrin specificity than tissue plasminogen activator. Streptokinase has less specificity for fibrin than tissue plasminogen activator. (b) Tenecteplase can be given as a single bolus dose. Reteplase is given in 2 doses, 30 minutes apart. Tenecteplase can be given as a single bolus dose. Reteplase is given in 2 doses, 30 minutes apart. (c) Hypertension is a common side effect of streptokinase therapy. Hypotension is a common side effect of streptokinase therapy and occurs in about 10-15%. The infusion should be slowed. (d) Streptokinase activates plasminogen. Streptokinase activates plasminogen (e) Streptokinase is a polypeptide made from gamma-hemolytic Streptococcus cultures. Streptokinase is a polypeptide made from beta-hemolytic Streptococcus cultures. 8. IV lines infusion: (a) If pressure of approximately 300mmHg is added to a bag of fluids which is running through an 18G cannula then the rate of fluids is approximately 120180ml/min. If pressure of approximately 300mmHg is added to a bag of fluids which is running through an 18G cannula then the rate of fluids is approximately 120-180ml/min. (b) If pressure of approximately 300mmHg is added to a bag of fluids which is running through an 16G cannula then the rate of fluids is approximately 200250ml/min. If pressure of approximately 300mmHg is added to a bag of fluids which is running through an 16G cannula then the rate of fluids is approximately 200-250ml/min. (c) If pressure of approximately 300mmHg is added to a bag of fluids which is running through an 14G cannula then the rate of fluids is approximately 250300ml/min. If pressure of approximately 300mmHg is added to a bag of fluids which is running through an 14G cannula then the rate of fluids is approximately 250-300ml/min. (d) If a pressure of approximately 300mmHg is added to a bag of fluids which is running through an 8.5 Fr central venous line up to 500ml of fluid can be infused per minute. If a pressure of approximately 300mmHg is added to a bag of fluids which is running through an 8.5 Fr central venous line up to 500ml of fluid can be infused per minute. (e) If no pressure apart from gravity is added to a bag of fluids which is running through an 8.5 Fr central venous line about 200ml/min can be infused. If no pressure apart from gravity is added to a bag of fluids which is running through an 8.5 Fr central venous line about 200ml/min can be infused. 9. Healing will be delayed in the following circumstances. (a) ) Vitamin D deficiency. (b) Vitamin C deficiency. (c) ) Vitamin k deficiency. (d) ) Zinc deficiency. Mild zinc deficiency is associated with depressed immunity, impaired taste and smell, onset of night blindness, and decreased spermatogenesis. Severe zinc deficiency is characterized by severely depressed immune function, frequent
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infections, bullous pustular dermatitis, diarrhea, and alopecia. (e) Copper deficiency. Other factors delaying healing include chronic steroid therapy, poorly controlled diabetes mellitus, smoking, malignant disease, low protein, chemotherapy and radiotherapy. 10. Complications of tetanus infection include... (a) Hypertension. Patients with generalized tetanus typically have symptoms of autonomic overactivity that may manifest in the early phases as irritability, restlessness, sweating and tachycardia. In later phases of illness, profuse sweating, cardiac arrhythmias, labile hypertension or hypotension, and fever are often present. (b) Cardiac Arrhythmias. Patients with generalized tetanus typically have symptoms of autonomic overactivity that may manifest in the early phases as irritability, restlessness, sweating and tachycardia. In later phases of illness, profuse sweating, cardiac arrhythmias, labile hypertension or hypotension, and fever are often present. (c) ) Sweating. (d) Salivation. (e) Urinary retention. False The incubation period of tetanus can be as short as one to three days or as long as several months, with a median of 7 to 8 days .Hypertension, cardiac arrhythmias, sweating and salivation are possible complications of tetanus. Control with benzodiazepines, opiates and occasionally beta-blockers. Death is due to cardiac arrest, cerebral haemorrhage, stress haematemesis and malaena, bronchopneumonia and pulmonary embolus. 11. In restrictive lung disease: (a) An example is COPD. COPD is an example of obstructive lung disease. (b) The FEV1 is decreased. In restrictive lung disease the FEV1 is decreased. (c) The FVC is normal or increased. In restrictive lung disease the FVC is reduced. (d) The total lung capacity (TLC) is increased. In restrictive lung disease the TLC is reduced. (e) The TLC in decreased. The TLC in decreased. Examples of interstitial lung disease include sarcoidosis and fibrotic lung disease. FEV1 is decreased,FVC is decreased, TLC and RV are reduced.KCO is also reduced. 12. The following situations often lead to delayed fracture healing: (a) Fractures where the joint is involved. This may be partly due to dilution of the fracture haematoma by synovial fluid. (b) Fractures of osteoporotic bone. Tru e Tru Fals e Fals Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e Tru e Fals e Tru e Fals e
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e (c) Fractures of the elderly. (d) Compound fractures. Compound fractures often lead to delayed fracture healing. (e) Excessive mobility at the fracture site. Excessive mobility at the fracture site often lead to delayed fracture healing. 13. Causes of respiratory acidosis: (a) Obesity. Obesity may cause respiratory acidosis. (b) Thoracic wall deformities. Thoracic wall deformities may cause respiratory acidosis. (c) Neuromuscular disorders. Neuromuscular disorders may cause respiratory acidosis. (d) COPD. COPD may cause respiratory acidosis. (e) Acute asthma. Acute asthma may cause respiratory acidosis. Hypoventilation from any cause eg obesity, thoracic wall deformities, COPD, acute asthma may cause respiratory acidosis. 14. Clinical signs of pneumothorax(non-tension): (a) Hyper-resonance of percussion note. Hyper-resonance of percussion note is a clinical sign of pneumothorax. (b) Decreased chest excursion. Decreased chest excursion is a clinical sign of pneumothorax. (c) Decreased breath sounds. Decreased breath sounds is a clinical sign of pneumothorax. (d) Auscultatory clicks. (e) Hypotension. Hypotension is associated with tension pneumothorax due to obstruction to venous return. 15. Chest X ray findings in pulmonary embolus(PE): (a) Normal chest X rays are rare if a patient has a PE. In many cases the chest X Ray appears normal. (b) Raised hemidiaphragm. A raised hemidiaphragm may be found in PE. (c) Abnormally decreased lucency due to increased vessels distal to the embolus. May occasionally see abnormally increased lucency due to reduced vessels distal to the embolus. Tru e Tru e Tru e Fals e Fals e Fals e Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e Tru e Tru e Tru e e Fals e Fals e Fals e

(d) 'Rat tail' appearance of pulmonary vessels on unaffected side. 'Rat tail' appearance of pulmonary vessels on affected side. This is because of an abrupt cut off of pulmonary vessels. (e) Pleural effusion. Other late features include linear or wedge shaped shadows due to infarction of lung. Occasionally infarcts may cavitate. 16. Theory of pulse oximetry (a) The principle of pulse oximetry is based on the red and infrared light absorption characteristics of oxygenated and deoxygenated haemoglobin. The principle of pulse oximetry is based on the red and infrared light absorption characteristics of oxygenated and deoxygenated haemoglobin. (b) Oxygenated hemoglobin absorbs more infrared light and allows more red light to pass through Oxygenated hemoglobin absorbs more infrared light and allows more red light to pass through (c) Deoxygenated (or reduced) hemoglobin absorbs more red light and allows more infrared light to pass through. Deoxygenated (or reduced) hemoglobin absorbs more red light and allows more infrared light to pass through. (d) Typically a R/IR ratio of 0.5 equates to approximately 100% SpO2 Typically a R/IR ratio of 0.5 equates to approximately 100% SpO2 (e) There are two methods of sending light through the measuring site: transmission and reflectance There are two methods of sending light through the measuring site: transmission and reflectance.The transmission method is the most common type. 17. High altitude medical problems: (a) Acute mountain sickness is usually seen in unacclimated people making a rapid ascent to over 1000m ( 3300 ft ) above sea level. Acute mountain sickness is usually seen in unacclimated people making a rapid ascent to over 2000m ( 6600 ft ) above sea level. (b) The earliest symptom of acute mountain sickness is vomiting. The earliest symptom of acute mountain sickness is light-headedness and mild breathlessness. (c) Symptoms usually present at about 12 hours after arrival at altitude. Symptoms similar to a hangover may present within 6 hours after arrival at altitude but may be delayed as long as 1 day. (d) Mild cerebral oedema occurs secondary to electrolyte disturbance. Mild cerebral oedema may occur secondary to increased capillary hydrostatic pressure and increased permeability of capillaries as a result of inflammatory endothelial activation. (e) Hypoxaemia blunts the sympathetic nervous system response. Hypoxaemia elevates sympathetic nervous system activity 18. Theory of pulse oximetry (a) The principle of pulse oximetry is based on the red and infrared light absorption characteristics of oxygenated and deoxygenated hemoglobin. The principle of pulse oximetry is based on the red and infrared light absorption characteristics of oxygenated and deoxygenated hemoglobin (b) Infant sites are the foot or palm of the hand and the big toe or thumb. Infant sites are the foot or palm of the hand and the big toe or thumb (c) Oxygenated Hb absorbs more infrared light and allows more red light through. Tru e Tru e Fals e Fals e
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e Oxygenated Hb absorbs more infrared light and allows more red light through. (d) Deoxygenated (or reduced) hemoglobin absorbs more red light and allows more infrared light to pass through Deoxygenated (or reduced) hemoglobin absorbs more red light and allows more infrared light to pass through (e) Typically a Red/InfraRed ratio of 0.5 equates to approximately 100% SpO2 Typically a R/IR ratio of 0.5 equates to approximately 100% SpO2 19. In exopthalmos due to graves disease: (a) May be unilateral. May be both unilateral or bilateral. (b) Exopthalmos is present in the majority of patients with graves disease. About 85% of patients with thyrotoxicosis have exopthalmos. (c) Lid retraction is a characteristic finding. Lid retraction in which the sclera are visible above the iris is a characteristic finding in exopthalmos. (d) May be present in euthyroid patients. The patient may be euthyroid, hypothyroid or hyperthyroid. (e) Over 90% of patients steadily improve without treatment. False Often persists despite therapy. 20. Peritonsillar abscess: (a) Aspiration treats 85% of people effectively. Aspiration treats 85% of people effectively. (b) Aspiration treats 100% of people. (c) Puncture of the carotid artery is a known complication. Puncture of the carotid artery is a known complication. (d) Puncture of the vertebral artery is a known complication. (e) Carotid artery is behind and medial to peritonsillar abscess. Carotid artery is behind and lateral to peritonsillar abscess Peritonsillar abscess, also known as quinsy, is a suppurative complication of acute tonsillitis with extension into the peritonsillar space. Peritonsillar abscesses may affect patients of all ages but are most common among young adults between the ages of 15 and 30 years.The patient appears ill with fever, sore throat, dysphagia, trismus, pooling of saliva, and a muffled voice. The abscess is usually unilateral and often associated with prominent tender cervical lymphadenitis. Examination of the pharynx in the majority of cases reveals swelling of the anterior pillar and the soft palate. 21. Prostatitis: (a) Acute prostatits can usually be managed as an out-patient. Usually managed as an inpatient with IV gentamicin and ampicillin or a quinolone. (b) Chronic prostatitis requires anti-biotics for at least 10 days. Usually 1 month treatment with a quinolone. Tru e Tru e Fals e Fals e Tru e Tru e e Fals e Fals e

(c) Co-amoxyclav is the first choice antibiotic for chronic prostatitis. Usually a quinolone for 1 month. (d) Acute prostatitis is more common in younger men while chronic prostatitis is more common in older men. Acute prostatitis is more common in younger men while chronic prostatitis is more common in older men. (e) On PR exam(DRE exam) it is usual to massage the prostate when considering a diagnosis of prostatitis. Do not massage prostate as this may cause a bacteraemia The prostate is described as feeling boggy in prostatitis. 22. The following are true with regard to non-cardiogenic pulmonary oedema in adults: (a) The pulmonary capillary wedge pressure is usually >18 mmHg In non-cardiogenic pulmonary oedema the pulmonary capillary wedge pressure is usually less than 18 mmHg while in cardiogenic pulmonary oedema the pulmonary capillary wedge pressure is >18mmHg. (b) Hypoalbuminaemia alone is not a cause of pulmonary oedema Hypoalbuminaemia alone is not a cause of pulmonary oedema (c) In patients with ARDS the protein percentage in the interstitiium of the lung parenchyma is greater than 60% of the plasma value. In patients with ARDS the protein percentage in the interstitiium of the lung parenchyma is greater than 60% of the plasma value. (d) The onset of ARDS is often within 2 hours of the precipitating event. The onset of ARDS is often within 2 hours of the precipitating event.However the onset can be delayed up to three days. The common causes of non cadiogenic pulmonary oedema are adult respiratory distress syndrome and high altitude. 23. Total Paracentesis: (a) There is a decrease in cardiac output in the first 3-6 hours of paracentesis. There is an increase in cardiac output in the first 3-6 hours of paracentesis. (b) There is an increase in systemic vascular resistance in the first 3-6 hours of paracentesis. There is an decrease in systemic vascular resistance in the first 3-6 hours of paracentesis and a modest fall in mean arterial pressure ( 5-10mmHg ) (c) If the ascites is tense then the right atrial pressure may be elevated. If the ascites is tense then the right atrial pressure may be elevated by the transmitted intra-abdominal pressure and RAP may fall acutely by 3-5 cm of water after paracentesis. (d) When drainage is complete the patient should lie with the drainage site lowermost for at least 4 hours. When drainage is complete the patient should lie with the drainage site uppermost for at least 4 hours. 24. Epistaxis: (a) Posterior epistaxis represents the vast majority of nose bleeds. Anterior epistaxis represents the vast majority of nose bleeds and the majority of these are from little's area. (b) Hereditary Haemorrhagic Telangiectasia ( HHT ) is a rare cause of anterior epistaxis. Tru e Fals e Tru e Tru e Tru e Fals e Fals e Fals e Tru e Tru e Tru e Fals e Fals e Fals e
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Hereditary Haemorrhagic Telangiectasia ( HHT ) is a rare cause of anterior epistaxis. (c) Direct pressure is usually all that is required for paediatric epistaxis. Direct pressure is usually all that is required for paediatric epistaxis. (d) Anterior epistaxis is usually bilateral. Anterior epistaxis is usually unilateral. (e) The sensation of blood in the back of the throat is more frequently associated with posterior epistaxis. The sensation of blood in the back of the throat is more frequently associated with posterior epistaxis. 25. Cerebral blood flow: (a) Is approximately 50ml/100 g/min. Cerebral blood flow is approximately 50ml/100g/min.Cerebral blood flow is approximately 12% of cardiac output(CO). (b) Is subject to autoregulation. Cerebral blood flow is subject to autoregulation. (c) Decreases with hyperkalaemia. Hyperkalaemia results in dilatation of cerebral blood vessels. (d) Is increased by 4% for each 0.1 kPa rise in PCO2. Cerebral blood flow is increased by 4% for each 0.1 kPa rise in PCO2. (e) May be measured clinically by transcranial doppler measurement. Cerebral blood flow may be measured clinically by transcranial doppler measurement. 26. Pulmonary Embolus(PE): a) Normal ABG excludes PE. Features on an ABG to suggest PE include low PCO2 (secondary to hyperventilation) and low PO2. (b) Low PaCO2 is a frequent finding. This occurs because a patient with a PE is tachynoeic and 'blowing off' their CO2. (c) Mild metabolic acidosis is frequent. Because of underperfusion mild metabolic acidosis is frequent (d) ECG usually shows an S wave in lead I, a Q wave in lead III and an inverted T wave in lead III. This is clasical but uncommon. (e) Sinus tachycardia is frequently present on the ECG. Sinus tachycardia is frequently present on the ECG. 27. Hand infection: (a) Staphylococcus and Streptococcus are the most common pathogens. Staphylococcus and Streptococcus are the most common pathogens. (b) Eikenella corrodens may infect human bite wounds. Eikenella corrodens may infect human bite wounds. (c) Pasturella multocida may infect animal bite wounds. Pasturella multocida may infect animal bite wounds (d) Abcesses sometimes require surgical drainage. Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e
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e Abscesses almost always require surgical drainage. (e) Staphylococcus aureus may be the pathogen in IV drug users. Staphylococcus aureus may be the pathogen in IV drug users. Staphylococcus and Streptococcus are the most common pathogens in hand infections. Eikenella corrodens may infect human bite wounds. Pasturella multocida may infect animal bite wounds. Staphylococcus aureus may be the pathogen in IV drug users. 28. Ischaemic heart disease: (a) Troponin T will reliably return to the normal range 24 hours after a myocardial infarction. Troponin T may stay elevated for 10-14 days. (b) CK is elevated in stable angina. CK is normal in stable angina. (c) With stable angina there will be regional wall motion abnormality on an ECHO scan. With stable angina there will be no new regional wall motion abnormality on an ECHO scan. (d) With a posterior infarction a tall R wave is seen in V1 and ST depression in leads V1-V3. With a posterior infarction a tall R wave is seen in V1 and ST depression in leads V1-V3. (e) A majority of posterior infarcts are due to right coronary artery disease. 60% of posterior infarcts are due to right coronary artery disease. 29. The following would suggest pericarditis (Vs AMI) in a patient presenting with chest pain with ST segment elevation: (a) ST segments are saddle shaped. (b) PR segment is isoelectric. (c) ST segment elevation >5mm. (d) Mild reciprocal changes in VI and AVR only. (e) ST segments diffuse over most leads. Differentiation of pericarditis and AMI is critical because of the urgency for thrombolysis in AMI and the possible complication of tamponade if the patient with pericarditis is thrombolized. 1) The descriptive nature of the pain 2)The ECG. In pericarditis the ST changes are diffuse over most leads while in AMI the ST changes are mostly confined to the involved heart muscle. There is PR segment depression in pericarditis while in AMI the PR segment is isoelectric. The ST segment elevation is usually less than < 5 mm in pericarditis while in AMI the ST segment elevation is often greater than > 5 mm. 3) Cardiac enzymes there may be mild elevations in perimyocarditis but much less than is seen in AMI 4) Echocardiography, pericarditis may show pericardial effusion whereas AMI will show region wall motion abnormalities. 30. Blood Grouping and Blood Products: (a) Type O Rhesus negative blood does not have any ( ABO ) blood group antigens. Tru Fals Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e Tru e e Fals e

e Type O Rhesus negative blood does not have any ( ABO ) blood group antigens. (b) Most patients can be typed ,ABO and Rhesus blood group type, in about 45 minutes. Most patients can be typed ,ABO and Rhesus blood group type, within 15 minutes. (c) It takes approximately 1 hour to crossmatch the blood against that intended for transfusion. True It takes approximately 1 hour to crossmatch the blood against that intended for transfusion. (d) The volume of blood in 1 unit of Red Cells ( RCC ) is 300ml. The volume of blood in 1 unit of Red Cells ( RCC ) is 250ml. (e) Transfused platelets should survive 2 days unless there is an ongoing pathological process of destruction. Transfused platelets should survive 3 to 5 days unless there is an ongoing pathological process of destruction. 31.Gangrene: (a) Is most commonly because of the failure of blood supply to the tissues. Gangrene is most commonly because of the failure of blood supply to the tissues. (b) Can result from trauma. Gangrene can result from trauma. (c) Infection is the cause in gangrenous appendicitis. Infection is the cause in gangrenous appendicitis. (d) Dry gangrene spreads rapidly. (e) There is almost always infection in wet gangrene. There is almost always infection in wet gangrene. Gangrene is necrosis with putrefaction(the decomposition of animal protein usually by anaerobic organisms giving a putrid odor). It may be vascular, traumatic(strangulated hernia), physical/thermal(frostbite) or infective in origin. 32. In coronary heart disease in women: (a) Exercise ECG is more likely to give a false positive result than in men. Exercise ECG is more likely to give a false positive result in women. (b) Regular exercise will reduce the risk. Moderate excercise of about 30min on most days of the week is needed. (c) Smoking is the leading preventable cause. Risk disappears 3 to 5 years after stopping smoking. (d) Isolated systolic elevation is not a risk factor. Treating systolic blood pressure of greater than 160 reduces the risk by 25%. (e) The oral contraceptive pill is a major risk factor. No evidence that it increases the risk of coronary artery disease. 33. Serum urea level is increased by: (a) Infection Infection increases catabolism and this increases production of urea. (b) Tetracyclines Tru e Tru e Fals e Fals e Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e Tru e Tru e Tru e Tru e e Fals e Fals e Fals e Fals e

Tetracyclines increase production of urea. (c) Old Age Old Age is a form of reduced catabolism and this decreases urea production. (d) Dehydration In dehydration there is a decreased renal blood flow (e) Hypotension In hypotension there is a decreased renal blood flow. 34. Swallowed Foreign Body: (a) About 10% of swallowed objects require intervention. About 10% of swallowed objects require intervention. (b) Most paediatric obstructions occur in the proximal oesophagus. Most paediatric obstructions occur in the proximal oesophagus. (c) The majority of adults presenting with foreign bodies are also caught in the proximal oesophagus. The majority of adults presenting with foreign bodies are caught in the distal oesophagus (d) The majority of adults who present with meat stuck in the oesophagus have normal oesophagus. The majority of adults who present with meat stuck in the oesophagus have an abnormal oesophagus secondary to a pathological process. (e) Objects are likely to have the most difficulty traversing the pylorus Objects are likely to have the most difficulty traversing the pylorus 35. Transudate ascites: (a) Have <30g protein/litre fluid. Transudate ascites have <30g protein/litre fluid. (b) Are caused by cirrhosis. Transudate ascites may be caused by cirrhosis among other causes including hypoalbuminaemia, hypothyroidism, and heart failure. (c) Are caused by malignant diseases such as bowel or gynaecological malignancies. (d) Are caused by hypoalbuminaemia. (e) Are caused by pancreatitis. Tru e Tru e Tru e Tru e Tru e Fals e Fals e Fals e Fals e Fals e Tru e Tru e Tru e Fals e Fals e Fals e
Transudate ascites are <30g protein/litre of fluid and are caused by cirrhosis and portal hypertension, congestive heart failure and constrictive pericarditis, hypoalbuminaemia eg nephrotic syndrome and Meig's syndrome. 36. Hand Infection (a) The hand position of function for splinting includes the wrist being at 15 degrees of flexion. The hand position of function for splinting includes the wrist being at 15 degrees of extension. (b) The hand position of function for splinting includes the MCP joints being at 180 degrees. The hand position of function for splinting includes the MCP joint being at 50 to 90 degrees flexion. Tru e Tru e Fals e Fals e

(c) The hand position of function for splinting includes PIP joints in 10 to 15 degrees of extension. The hand position of function for splinting includes PIP joints in 10 to 15 degrees of flexion. (d) The hand position of function for splinting includes the DIP joints being at 10 to 15 degrees extension. The hand position of function for splinting includes the DIP joints being at 10 to 15 degrees flexion. (e) Eikenella corrodens may infect human bite wounds Tru e Tru e Tru e Fals e Fals e Fals e
Staphylococcus and Streptococcus are the most common pathogens in hand infections. Eikenella corrodens may infect human bite wounds. Pasturella multocida may infect animal bite wounds. Staphylococcus aureus may be the pathogen in IV drug users. The hand position of function for splinting includes the wrist being at 15 degrees of extension. The hand position of function for splinting includes the MCP joint being at 50 to 90 degrees flexion. The hand position of function for splinting includes PIP joints in 10 to 15 degrees of flexion. The hand position of function for splinting includes the DIP joints being at 10 to 15 degrees flexion.

MCEM Pathophysiology MCQ Review

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MCEM Pathophysiology MCQ Review

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MCEM Pathophysiology MCQ

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