Sce Acute Med Sample Qs

7/29/2019 Sce Acute Med Sample Qs

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Specialty Certificate in Acute Medicine Sample Questions

Question 141

A 50-year-old woman was admitted with sepsis secondary to pneumonia. She was treated

with oxygen, intravenous antibiotics and repeated fluid challenges to a total volume of4.5 L (equivalent to 60 mL/kg) of sodium chloride 0.9%.

On re-assessment, her pulse was 122 beats per minute, her blood pressure was82/40 mmHg (mean arterial pressure 54) and her respiratory rate was 24 breaths perminute. Oxygen saturation was 92% (9499), breathing 40% oxygen. Her central venouspressure was 12 mmHg.

In attempting to restore the blood pressure, what is the most appropriate intravenoustherapy?

A colloidB dopamineC furosemideD further crystalloidE noradrenaline (norepinephrine)


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Question 2

A 73-year-old woman was referred to the acute medical unit for assessment of herpalpitations. One hour after arriving, she complained of a return of her palpitations with acentral crushing chest pain. She became distressed and agitated. She was given aspirin

and sublingual glyceryl trinitrate. Oxygen was given at 15 L per minute via a reservoirmask.

On examination, her pulse was thready and hard to count. Her blood pressure was88/55 mmHg, her respiratory rate was 20 breaths per minute and her oxygen saturationwas 98% (9499). A cardiac monitor was attached and showed a narrow-complex irregulartachycardia with a ventricular rate between 150 and 160 beats per minute. A large-boreintravenous cannula was inserted.

What is the most appropriate next step in management?

A intravenous adenosineB intravenous digoxinC intravenous flecainideD intravenous verapamilE synchronised cardioversion


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Question 3

A 77-year-old man presented after a single episode of unilateral weakness of the left armthat lasted for 2 hours. On examination, his pulse was 80 beats per minute and regular,and his blood pressure was 170/100 mmHg. There was no neurological deficit. His ABCD2

score was 6.

He was given 300 mg of aspirin while awaiting investigations.

What is his chance of having a stroke in the first week?

A 5%B 10%C 20%D 30%E 40%


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Question 4

A 43-year-old woman was referred to hospital with a persistent headache of 4 daysduration. It had come on gradually and had not been associated with vomiting. Her generalpractitioner had found her blood pressure to be elevated at 214/118 mmHg and had

arranged emergency admission. She had no other significant medical history and wastaking no regular medication.

On examination, she appeared well. She had a round face and her body mass index was32 kg/m2 (1825). Her pulse was 90 beats per minute and her blood pressure was218/116 mmHg. Peripheral pulses were normal with no radiofemoral delay. Heart soundswere normal. Fundoscopy showed grade 2 hypertensive changes but no papilloedema.Urinalysis showed protein 2+, blood negative, nitrite negative, leucocytes negative.

Investigations:

12-lead ECG sinus rhythm with changesconsistent with left ventricularhypertrophy

What is the most likely diagnosis?

A acute glomerulonephritisB cerebral tumourC Cushings syndromeD essential hypertensionE phaeochromocytoma


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Topic: SGQuestion 5

A 42-year-old woman presented with a 1-week history of vomiting and diarrhoea. This hadbegun after she was involved in a road traffic collision. She also complained of feeling

dizzy on standing. Her family said that she had been slightly confused and slurred herwords.

On examination, her pulse was 114 beats per minute and her blood pressure was85/40mmHg.

Investigations:

haemoglobin 116 g/L (115165)

platelet count 364 109/L (150400)

serum sodium 123 mmol/L (137144)serum potassium 6.4 mmol/L (3.54.9)serum creatinine 123 mol/L (60110)random plasma glucose 2.8 mmol/L


A autoimmune adrenal failure (Addison's disease)B gastroenteritisC hypothyroidismD insulinomaE syndrome of inappropriate antidiuretic hormone


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Question 6

A 23-year-old man presented after having collapsed in a Chinese restaurant. He gave ahistory of a previous similar episode after having eaten nuts. On examination, his pulsewas 120 beats per minute and his blood pressure was 95/60 mmHg. His chest was

wheezy with an oxygen saturation of 89% (9499).

High-flow oxygen was administered and a dose of adrenaline (epinephrine) wasrequested.

In what dose and by what route should adrenaline (epinephrine) be given?

A 500 g intramuscularlyB 500 g intravenouslyC 1 mg intramuscularlyD 1 mg intravenously

E 10 mg intravenously


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Question 7

A 32-year-old man presented with a 3-week history of headaches, fever, sore throat,myalgia, anorexia and generalised non-pruritic rash. He had no other significant medicalhistory and had not been given a blood transfusion in the past.

On examination, vital signs were normal except for a temperature of 37.4C. Enlargednon-tender lymph nodes were noted in the axillae, submandibular areas and both groins.Throat examination was normal. He had no meningeal signs and detailedcardiorespiratory, abdominal and neurological examinations were normal. Generalisedmaculopapular rash was noted.

Investigations:

heterophil antibody test negative

blood film atypical lymphocytosis


A cytomegalovirus infectionB group A streptococcus infectionC HIV seroconversionD secondary syphilisE toxoplasmosis


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Question 8

A 70-year-old man was admitted to hospital with severe shortness of breath. He had ahistory of emphysema. On examination, he had diminished breath sounds over the leftside of the chest.

Investigations:

chest X-ray large left pneumothorax


A insert 14F drain immediately above a rib marginB insert 14F drain immediately below a lower rib marginC insert 14F drain in the scalene triangleD insert 28F drain immediately below a lower rib margin

E insert 28F drain in the scalene triangle


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Question 9

A 72-year-old man was admitted with community-acquired pneumonia. He had permanentatrial fibrillation and was taking digoxin. He had been treated with high-flow oxygen andintravenous benzylpenicillin and clarithromycin.

On examination, his pulse was 120 beats per minute and irregular, and his blood pressurewas 90/60 mmHg. His capillary refill time was 3 seconds. His respiratory rate was 24breaths per minute and oxygen saturation was 98% (9499), breathing 4 L/min oxygen viaa simple face mask.

What is the most appropriate management of his haemodynamic state?

A intravenous amiodaroneB intravenous digoxinC intravenous magnesium

D intravenous sodium chloride 0.9%E synchronised cardioversion


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Question 10

A 48-year-old man with a history of alcohol dependency was admitted with confusion. Onexamination, he was unkempt and showed signs of poor nutrition. He had cool peripheries.His temperature was 35.6C and his blood pressure was 86/58 mmHg. He had mild

dysdiadochokinesis but no evidence of ophthalmoplegia or nystagmus. His capillary bloodglucose concentration was 2.6 mmol/L.

Intravenous access was established and he was immediately treated with glucose 10%250 mL and vitamins B and C (Pabrinex) by intravenous infusion. His blood pressureimproved to 106/80 mmHg and his capillary glucose to 4.9 mmol/L. He became moredrowsy. His neurological condition was noted to have deteriorated by the nursing staff.They re-checked his capillary glucose, which was 3.5 mmol/L. His blood pressure was98/68 mmHg.

What is the most appropriate next management step?

A CT scan of headB intravenous co-amoxiclavC intravenous sodium chloride 0.9%D repeat intravenous glucose 10% 250 mLE repeat vitamins B and C (Pabrinex) by intravenous infusion


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Question 11

A 29-year-old woman was brought to hospital by ambulance. She had been foundunconscious by her husband with imipramine tablets by her bed. On arrival in thedepartment she had a tonicclonic seizure, which lasted for 2 minutes. She was otherwise

fit and well.

Investigations:

ECG broad-complex tachycardia

What is the most appropriate immediate treatment?

A amiodaroneB DC cardioversionC lorazepam

D phenytoinE sodium bicarbonate


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Question 12

A 72-year-old woman presented with a 4-day history of palpitations. She had notexperienced any dyspnoea or chest discomfort and was not distressed by the palpitations.Her general practitioner had noted rapid atrial fibrillation and referred her for assessment.

She had type 2 diabetes mellitus and hypertension but no other significant medical history.Her medication comprised irbesartan, gliclazide, amlodipine and simvastatin.

On examination, she was comfortable. Her pulse was 130 beats per minute, her bloodpressure was 138/82 mmHg and her respiratory rate and oxygen saturation were normal.Her heart sounds were normal and her chest was clear. She had no oedema.

Investigations:


platelet count 164 109/L (150400)

serum sodium 143 mmol/L (137144)serum potassium 4.4 mmol/L (3.54.9)serum creatinine 123 mol/L (60110)

plasma thyroid-stimulating hormone 3.2 mU/L (0.45.0)

12-lead ECG atrial fibrillation with rapid ventricularresponse


A DC cardioversionB intravenous digoxinC intravenous flecainideD oral bisoprololE oral digoxin


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Question 13

A 54-year-old man was referred to the rapid access chest pain clinic for assessment.Based on a thorough history, his likelihood of coronary artery disease was calculated to be

25%.

What is the most appropriate investigation?

A cardiac stress echocardiographyB CT coronary angiographyC CT coronary artery calcium scoringD invasive coronary angiographyE myocardial perfusion imaging


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Question 14

A 53-year-old woman was admitted to the emergency department following a tonicclinicseizure at home. Her husband, who was with her, said that she had developed a suddensevere headache while doing the washing up about 2 hours previously. She had gone to

bed because of the severity of the pain and he had found her convulsing.

On arrival, she was not convulsing but her Glasgow coma score was 10. Her temperaturewas 36.9C, her pulse was 85 beats per minute and her blood pressure was 168/93mmHg. Fundal examination was normal. Tone and reflexes in her limbs were normal.Neck stiffness was present.

Investigations:

CT scan of head see image

What is the most appropriate next investigation?

A blood culture

B CT cerebral angiography

C lumbar puncture 12 h after headache onset

D lumbar puncture immediatelyE MR cerebral angiography


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Question 15

A 67-year-old man was admitted with chest pain. He had recently returned from atransatlantic holiday. He smoked heavily and his alcohol consumption was 40 unitsweekly. He had no past medical history of note and was taking no medication.

On examination, his temperature was 37.5C, his pulse was 90 beats per minute and hisblood pressure was 160/96 mmHg. His respiratory rate was 30 breaths per minute and hisoxygen saturation was 90% (9499) breathing air. There were crackles over the right lungbase.

Investigations:

chest X-ray see image

ECG flat T waves in V1, V2, V3

He was treated with oral amoxicillin.

What is the most appropriate next step?

A assess clinical probability score for pulmonary thromboembolismB CT pulmonary angiographyC D-dimer concentrationD serum troponin I test

E ventilation/perfusion isotope scan of lung


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Question 16

A 32-year-old woman was admitted with a 7-day history of nausea, sparse bloodstaineddiarrhoea and cramping lower abdominal pains. She was feeling increasingly exhaustedand short of breath.

On examination, she appeared pale and mildly icteric, with ankle oedema. There was apetechial rash over her face. Her temperature was 37.2C, her pulse was 104 beats perminute and regular, and her blood pressure was 160/92 mmHg. No neurologicalabnormality was identified. Urinalysis was positive for blood and protein.

Investigations:


platelet count 56 109/L (150400)prothrombin time 18.0 s (11.515.5)

activated partial thromboplastin time 46 s (3040)

serum sodium 139 mmol/L (137144)serum urea 37.0 mmol/L (2.57.0)serum creatinine 440 mol/L (60110)serum total bilirubin 63 mol/L (122)serum lactate dehydrogenase 2600 U/L (10250)

What is the most likely underlying diagnosis?

A acute lymphatic leukaemiaB disseminated intravascular coagulationC haemolytic uraemic syndromeD idiopathic thrombocytopenic purpuraE thrombotic thrombocytopenic purpura


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Question 17

A 70-year-old woman was admitted with chest and upper abdominal pain associated withsweating. She described the pain as having intensity 8/10. She had been previously fit andwell.

On examination, her pulse was 82 beats per minute and her blood pressure was 168/94mmHg in the right arm and 156/88 in the left. Her respiratory rate was 15 breaths perminute and oxygen saturation was 95% (9498), breathing air. There were no heartmurmurs and the chest was clinically normal. There was epigastric tenderness.

Initial investigations showed a normal full blood count, normal electrolytes and creatinine,and normal serum C-reactive protein. Her ECG was normal. A chest X-ray was performed(see image).

A working diagnosis of dyspepsia was made. Early the following morning, she had a

cardiac arrest and died.

What is most likely to have caused her death?

A aortic dissection

B massive gastrointestinal bleedingC perforated duodenal ulcerD pulmonary embolismE tension pneumothorax


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Question 18

A 47-year-old man presented with an acutely painful right ankle, shivering and mild fever.He was unable to bear weight. He had no history of joint problems but was takingtreatment for hypertension.

On examination, his temperature was 37.4C. He was overweight and had a swollen rightankle with erythema over the joint.

What is the most important investigation?

A blood cultureB joint fluid examinationC serum C-reactive proteinD serum urateE X-ray of ankle


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Question 19

A 24-year-old woman was admitted complaining of feeling unwell. She had returned from a2-month tour of Malaysia the previous week. She complained of a severe headache, whichwas worse behind the eyes, and sore muscles, especially in her back, arms and legs. She

had also had an intermittent fever for 3 days. She had no past medical history of note, andher only medication was the combined oral contraceptive.

On examination, she was suntanned, with a temperature of 38.5C, a pulse of 76 beatsper minute and a blood pressure of 95/60 mmHg. She had some palpable lymph nodes inthe axillae and inguinal regions, but no other abnormality was detected.

Investigations:


white cell count 1.8 109/L (4.011.0)

neutrophil count 0.6 109/L (1.57.0)

lymphocyte count 0.9 109/L (1.54.0)

monocyte count 0.4 109/L (


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Question 20

A 48-year-old man presented with a short history of fever, headache and confusion. Hehad a history of type 2 diabetes mellitus.

On examination, his temperature was 40.1C, his pulse was 103 beats per minute and hisblood pressure was 87/52 mmHg. His Glasgow coma score was 9. His neck was stiff andhe had photophobia.

A CT scan of head was normal. He was given intravenous fluids.

Investigations:

cerebrospinal fluid:total protein 1.80 g/L (0.150.45)glucose 1.9 mmol/L (3.34.4)

cell count 2100/L (5)lymphocyte count 100/L (3)neutrophil count 2000/L (0)Gram stain negative

In addition to cefotaxime, what is the most appropriate treatment?

A aciclovirB amphotericinC chloramphenicolD dexamethasoneE vancomycin


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Question 21

A 40-year-old man was brought to the emergency department by his friends. He wasthought to have ingested an unknown medication in a suicide attempt.

On examination, he was disorientated in time. His temperature was 39.3C, his pulse was100 beats per minute and irregular, his blood pressure was 120/85 mmHg and hisrespiratory rate was 22 breaths per minute. His skin was flushed and dry. On physicalexamination, he was noted to have dilated pupils and muscle twitching. There was noapparent neurological abnormality.

Investigations:

arterial blood gases, breathing air:PO2 12.0 kPa (11.312.6)PCO2 4.1 kPa (4.76.0)

pH 7.36 (7.357.45)H+ 44 nmol/L (3545)bicarbonate 27 mmol/L (2129)oxygen saturation 96% (9498)

ECG sinus tachycardiaPR interval 145 ms (120200)QRS complex 128 ms (40120)

Ingestion of what substance is most likely to have resulted in these findings?

A citalopramB dosulepinC ethyl alcoholD lithium citrateE venlafaxine


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Question 22

A 74-year-old woman was admitted to hospital at 04.00 h, having suddenly woken fromsleep with a feeling of severe anxiety, breathlessness and suffocation. She felt she hadneeded to sit upright in bed and had become extremely breathless very rapidly. She had

not suffered chest pain. She had a history of an uncomplicated anterior myocardialinfarction 6 years previously. Hypertension had been diagnosed 10 years previously, andshe had occasional angina when walking up a hill on a cold day. She had mild asthma, butwas taking no regular treatment. Her treatment included aspirin, simvastatin, furosemide,ramipril and amlodipine. She needed to use a nitrate spray only once or twice a month.

On examination, she was apyrexial. She had oedema of both lower limbs to her knees.Her pulse was 35 beats per minute and irregular, and her blood pressure was 86/48mmHg. Her jugular venous pressure was elevated to the level of her earlobes while sittingat 45 degrees. There was a gallop rhythm on auscultation of the heart, and crackles wereheard at both lung bases.

Investigations:


serum sodium 129 mmol/L (137144)serum potassium 7.2 mmol/L (3.54.9)serum urea 14.9 mmol/L (2.57.0)serum creatinine 168 mol/L (60110)

ECG see images a and b

Image a


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Image b

What is the most appropriate initial treatment?

A intravenous atropineB intravenous calciumC intravenous dobutamineD intravenous insulin and glucoseE nebulised salbutamol


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Question 23

A 62-year-old man presented with chest pain. A few minutes after arrival he suffered acardiopulmonary arrest. Basic life support was started without delay. After 2 minutes ofchest compressions the cardiac rhythm was as shown (see image). Defibrillation was

attempted but there was no change in the rhythm. After a further 2 minutes of basic lifesupport there was still no palpable carotid pulse and no change in rhythm. One furthershock was delivered without beneficial effect. A further 2 minutes of basic life support wasperformed. The cardiac monitor showed that the rhythm was unchanged and there wasstill no carotid pulse.

What is the most appropriate intervention?

A further shockB intravenous adrenaline (epinephrine)C intravenous amiodaroneD intravenous magnesium sulphateE intravenous sodium bicarbonate 8.4%


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Question 24

A 19-year-old man was brought to hospital after collapsing during a national marathonrace. He had enjoyed good health in the past. There was no family history of suddencardiac death.

Attempts to resuscitate him failed. Post-mortem examination revealed the cause of death.

What is the most likely cause of death?

A anomalous coronary arteryB aortic stenosisC arrhythmogenic right ventricular dysplasiaD hypertrophic obstructive cardiomyopathyE ischaemic heart disease


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Question 25

A 23-year-old man presented to the acute medicine unit at 20.00 h with a 2-week history ofexcessive thirst, urinary frequency and some weight loss. His general practitioner hadfound his random blood glucose to be 25.0 mmol/L.

On examination, his pulse was 80 beats per minute and his blood pressure was 120/70mmHg. He had normal skin turgor and capillary refill. His abdomen was soft, and nottender. His body mass index was 22 kg/m2 (1825). Urinalysis showed ketones 1+.

Investigations:

serum sodium 143 mmol/L (137144)serum potassium 4.2 mmol/L (3.54.9)serum bicarbonate 22 mmol/L (2028)serum urea 5.2 mmol/L (2.57.0)

serum creatinine 75 mol/L (60110)random plasma glucose 26.0 mmol/L

What is the most appropriate next management step?

A intravenous insulin and admit for observationB long-acting insulin and admit for observationC long-acting insulin and discharge for review next dayD short-acting insulin and admit for observationE short-acting insulin and discharge for review next day


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Question 26

A 72-year-old man presented after having vomited bright-red blood the previous day. Hehad no significant medical history and was taking no regular medication. He was a smokerand admitted to consuming roughly 20 units of alcohol per week.

On examination, his pulse was 105 beats per minute, his blood pressure was 110/65mmHg, his heart sounds were normal and his chest was clear. His abdomen was soft butmildly tender.

Investigations:

haemoglobin 101 g/L (130180)MCV 102 fL (8096)

serum sodium 134 mmol/L (137144)

serum potassium 4.1 mmol/L (3.54.9)serum urea 8.1 mmol/L (2.57.0)serum creatinine 85 mol/L (60110)

Upper gastrointestinal endoscopy the next morning showed a gastric ulcer with adherentblood clot.

What is the likelihood of a further significant bleed?

A 7%B 14%C 25%D 35%E 55%


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Question 27

A 48-year-old man presented with vomiting followed by streaks of haematemesis. He hadbeen self-medicating with diclofenac for abdominal pain.

On examination, his pulse was 120 beats per minute and irregularly irregular, and hisblood pressure was 140/60 mmHg. The abdomen was mildly distended. Dullness over theliver was reduced. Bowel sounds were present.

Investigations:


white cell count 14.4 109/L (4.011.0)

serum sodium 145 mmol/L (137144)serum potassium 3.5 mmol/L (3.54.9)

serum chloride 104 mmol/L (95107)serum bicarbonate 20 mmol/L (2028)serum urea 12.0 mmol/L (2.57.0)serum creatinine 110 mol/L (60110)

X-ray of abdomen see image


A drug-induced gastritisB ischaemic bowelC MalloryWeiss tearD perforated viscusE volvulus


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Question 28

A 48-year-old man developed breathlessness, non-productive cough and fever with chillswithin 6 hours of starting a blood transfusion (on the second unit). He had been admittedwith gastrointestinal bleeding as a result of peptic ulcer disease. He had no significant

medical history.

On examination, his temperature was 37.8C, his pulse was 100 beats per minute andregular, his blood pressure was 90/70 mmHg and his respiratory rate was 30 breaths perminute. His oxygen saturation breathing maximal high-flow oxygen was 85%.

Investigations:

ECG sinus tachycardia; 100 beats perminute

chest X-ray bilateral nodular infiltrates with batswing pattern

The transfusion was discontinued.


A intravenous chlorphenamineB intravenous furosemideC intravenous hydrocortisoneD mechanical ventilationE non-invasive ventilation


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Question 29

A 20-year-old woman was admitted with a 2-day history of headache, photophobia andfever. There were no other symptoms and she had no other medical history. Onexamination, she had signs of meningism. She was alert, her vital signs were normal and

there was no papilloedema. A lumbar puncture was planned.

What is the most appropriate type of needle to use?

A 16G Quinckes (bevelled) needleB 18G Quinckes (bevelled) needleC 18G Sprotte (atraumatic) needleD 22G Quinckes (bevelled) needleE 22G Sprotte (atraumatic) needle


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Question 30

A 58-year-old man was admitted with a history of occipital headache of sudden onsetassociated with nausea, vomiting, vertigo, double vision and slurred speech.

On examination, he was confused and had mild dysarthria. There was no neck stiffness.He had normal tone and power in his limbs with normal reflexes. Sensation seemednormal but was hard to assess because of his confusion.

Investigations:

unenhanced CT scan of head see image

What is the most appropriate interpretation of the scan appearance?

A basilar artery thrombosisB cerebral infarctionC lacunar infarct

D no abnormalityE subarachnoid haemorrhage


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Question 31

A 43-year-old man was admitted with a 4-day history of progressive leg weakness andpoorly localised lower back pain.

On examination, he had reduced tone in both lower limbs, with grade 4 power of flexionand extension of hips and knees bilaterally, and grade 3 power of foot dorsiflexion andplantar flexion bilaterally. His deep tendon reflexes in the lower limbs were absent, and theplantar responses were flexor. There was loss of all modalities of sensation in both feet ina stocking distribution. Examination of the upper limbs was normal.

What respiratory function variable is it most important to measure regularly?

A forced expiratory volume in 1 s

B oxygen saturation

C peak expiratory flow

D respiratory rate

E vital capacity


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Question 32

A 32-year-old woman was referred with a 3-week history of a left-sided headache. Thishad not interfered with her life until the previous 2 days when she had also developedslight nausea and some weakness of her right hand.

On examination, she looked well and her temperature was 36.8C. Her pulse was 68 beatsper minute and her blood pressure was 135/75 mmHg. Cranial nerve examination wasnormal and there was no papilloedema. Power in her right arm was grade 4/5. Her rightbiceps reflex was brisker than the left, and there was reflex spread. Sensation was normal.

Investigations:

MR scan of brain (T2 weighted) see image

What is the most appropriate diagnostic investigation?

A blood cultureB HIV testC open biopsyD PETCT scanE toxoplasma serology


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Question 33

A 60-year-old woman was admitted with deterioration in her renal function. She had ahistory of type 2 diabetes mellitus, hypertension and chronic kidney disease stage 3a, withan estimated glomerular filtration rate (MDRD) of 4560 mL/min (>60). She was taking

perindopril for hypertension, and had recently started taking celecoxib for osteoarthritis.

What best describes the mechanism of her celecoxib-induced deterioration in renalfunction?

A hypersensitivity reactionB inhibition of afferent arteriole vasodilatationC interstitial nephritisD renal parenchymal infarctionE renal tubular acidosis


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Question 34

A 68-year-old man with chronic obstructive pulmonary disease presented with a 24-hourhistory of increased wheeze and breathlessness. He was treated with nebulisedsalbutamol 2.5 mg and ipratropium 500 micrograms, oral prednisolone 30 mg and 28%

oxygen via a Venturi mask.

On examination, his pulse was 84 beats per minute and his blood pressure was 146/88mmHg. His respiratory rate was 24 breaths per minute. He had polyphonic wheezethroughout both lung fields.

Investigations:

chest X-ray hyperexpanded lungs consistentwith emphysema; no consolidation orpulmonary oedema

arterial blood gases, 1 h after admission, breathing FiO2 0.28:PO2 7.4 kPaPCO2 7.1 kPa (4.76.0)pH 7.28 (7.357.45)H+ 53 nmol/L (3545)bicarbonate 24 mmol/L (2129)oxygen saturation 84%


A bilevel positive airway pressure ventilationB increase oxygen to FiO2 0.35C intravenous aminophyllineD intravenous hydrocortisoneE reduce oxygen to FiO2 0.24


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Question 35

A 74-year-old woman was admitted with an exacerbation of chronic obstructive pulmonarydisease. She had been admitted three times in the previous 9 months. She was using asalbutamol inhaler.

On examination, her oxygen saturation was 94% (9498) breathing air.

What change in her management is most likely to reduce the number of furtherexacerbations?

A addition of tiotropium bromideB long-term domiciliary oxygenC long-term low-dose prednisoloneD pneumococcal vaccineE regular nebulised salbutamol


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Question 36

A discussion took place on how to improve the management of patients presenting withdiabetic ketoacidosis and development of a diabetic ketoacidosis care bundle wassuggested.

What best describes a care bundle?

A a checklist of medical and nursing interventions designed to ensure all steps arecompleted

B a series of processes that must be completed to ensure patient safetyC a small group of evidence-based processes that, when performed collectively, improve

outcomesD a small group of interventions that define minimum care standardsE steps in patient management that must be completed sequentially within a defined timeperiod


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Question 37

A 65-year-old woman presented with an acute stroke with aphasia and flaccid paralysis ofthe left side. She had a history of heart failure. On examination, her oxygen saturation was94% (9498) breathing air.

What is the most appropriate treatment?

A 2 L oxygen via nasal cannulaeB 5 L oxygen via simple face maskC 15 L oxygen via reservoir bag maskD 28% oxygen via Venturi maskE no additional oxygenF


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Answers:

1 E2 E3 B

4 D5 A6 A7 C8 A9 D10 D11 E12. D13 C14 B

15 A16 C17 A18 B19 E20 D21 B22 B23 A24 D25 C26 B27 D28 D29 E30 A31 E32 C33 B34 A35 A

36 C37 E

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Sce Acute Med Sample Qs