1. 90yearselderlywithinfluenzabreakoutinoldagehome.

Hehasproductive
coughforoneday.Histemperatureis39degreesCelsius,bloodpressure
90/50mmHg,heartrate119regular,oxygensaturation85%on4L/minoxygen
withrespiratoryrateof25/minute.Heisconfused.Whatistrueoftheinfection
controlmeasuresrequired:
Selectone:
a.Singlepatientnegativepressureroom
b.N95maskforpatient
c.Droplet+standard+contactprecaution
d.Airborne+standard+contactprecaution
e.Isolation

Thisistherightansjustcheckeditwithselfassessment

2)HypoKwithK<3.4,withrecentAF,VF,nowadmittedforcoronaryangiogram,whatwillbe
yourmanagement?
a. IVKCLinfusion20mmolin100mlwaterover1hr
b. IVKCLinfusion20mmolin100mLwaterover15min
c. 600mgKCLtablet(preferred)
d. Potassiumsyrup(alsoright!)

e.

3)An80yearsoldpatientwithhistoryofischemicheartdiseaseday1postbelowknee
amputationwasfoundtohaveabloodpressuredropto80/40mmHg(MAP53mmHg).The
surgicalwoundisoozing.Thehemoglobinhasdroppedfrom10to8g/dL.theECGshows
newTwaveinversionoveranteriorleads.Whatistheprimarytargetofinitialresuscitationin
thisscenario:
Selectone:
a.elevatepulsepressure
b.elevatehemoglobinlevel
c.elevatediastolicbloodpressure
d.elevatemeanarterialpressure
e.elevatesystolicpressure

4)GCS:Patientrightsidelocalizespainbutleftsidenomotorresponse.Speech
inappropriate.Eyesopentopain.WhatistheGCS?Ans:9

5)A56yearoldmalewithknownhypertensionanddiabetespresentswithexertionalchestpain
andshortnessofbreathfor30minutes.Theheartrateis100/minute,BP170/90mmHg,
respiratoryrate22/min,SaO292%on100%O2mask,JVP9cm,bilateralcrackles,anuric.
ThesearetheECGandCXR.Thecardiologisthasbeenconsulted.Whatisthemost
appropriateimmediatenextstepofmanagement?


a.givefluid500mlFR
b.givenitrates ?????
c.giveivmorphine
d.giveamiodarone
e.givenoradrenaline

6.Priorityofseeingpatient
a. youngmanacuteepiglotitis,stridor,nowquietbreathingreportedtobesleepingby
nurse(accordingtoGomersallheissleepingnotLOC)
b. anoldmanpneumonia,afterresuscitation,stilllconfused,BP100/60,HR130,
PaCO24.0,pH7,26
c. Apatientwithasthmaattack,deteriorating,,RR26,SaO292%,HR100(apart
fromRR,otherparametersdonotmeetthecriteriaofsevereasthma)
d. Patientstable,CTbraindone,noSOL,suspectedmeningitis,alreadyonAntibiotic,
nowneedyouforLP
BCDA

7.YouadmitapatientwithableedingtendencyanddiscoverthathisPTissignificantly
raised.APTTisnormal.Possiblecausesforthisinclude(selectoneormoreanswers)
Selectoneormore:
a.VitaminKdeficiencey(althoughGomersallesaysthisisacutallyWRONGmessage
fromtheredbook)
b.Therapeuticdoseofheparin
c.Antiphospholipidantibody
d.Disseminatedintravascularcoagulation
e.Therapeuticdoseofwarfarin

8.PatientpresentswithSOB.Systolicmurmuratapexradiatingtoaxilla.Whatisthecause
ofherSOB?
a. APOduetoMR
b. APOduetoMS
c. APOduetoischemicheartdisease

9.SBAR
A56yearoldladywasadmittedwithsevereaorticstenosiscomplicatedwithAPO..Shehad
fever,clubbing,ejectionsystolicmurmurattheaorticareaandleftsternalborderradiatingto
thecarotids.Shebecamemoredyspnoeic.Shehadasymmetricallysizedlowerlimbsbutno
tenderness.Shehasnotpassedurineforlast12hrs.
WhichofthefollowingisyourstatementinSituation?
a. initiallcarotidstenosis,nowdeveloppulmonoryedema,improveed,now
deteriorateverylong
b. Severeshock
c. Shehasanuria
d. PtPE>SOB
e. probableIE

10.A54yearoldmanisadmittedwithamyocardialinfarctiontothecoronarycare
unit.HehasahistoryofhypertensionandheartfailuretreatedwithdiureticsandACE
inhibitors.Hehashadasystoliccardiacarrest.Youhavejustshockedhimonce.
Nursesareprovidingeffectivebagmaskventilationandchestcompressions.You
prioritiesduringthenextfourcyclesofCPRare(selectoneormoreanswer):
Selectoneormore:
a..Checkcoretemperature
b.Ensurepatentairway,giveoxygen,fluidresuscitation
c.Fluidchallengeof50mlofcolloid
d.IV1mgepinephrine
e.Checkpulse
f.Givethrombolysis
g.Giveaspirin
h.Checkpupils
i.Arrangepercutaneouscoronaryintervention
f.Measurebloodpressure
g.Attach/checkECGelectrodes
h.TakebloodforABG,glucose,Na,K
i.Auscultateandpercussthechest
l.12leadECG
j.IVaccess

11.Patientincoma,Headinjury,BP70/40,GCS3/15,Reye5mm,Leye3mmnormal,
Whatisyourmanagement?

a. OxygenandMannitol
b. OxygenandHypertonicSaline(becasepatientisinshock)
c. Oxygen
d. Oxygen+
e. OxygenandNormalsaline

12.ConfusedpatientNa120mmol,urineosmolality320,serumosmolality245,urinesodium
78.Whatisyourmanagement?(choosemorethan1)
a. 3%saline2ml/kg
b. FluidrestrictionsothatNashouldrisenotmorethan5mmol
c. Salineq6H
d. TFT
e. Shortsynacthentest

13.Youarecalledtoassessthepatientonanaeroplane,thepatientispulselessandalso
havegaspingeffort.
a. CalltheflightattendantforAED
b. Startchestcompressions
c. GiveRescueBreaths
d. Startbagvalveresuscitation
e. Donothingasthepatientisstillgaspingforbreath&putpatientinrecoveryposition

14.Thecorrecttechniqueofchestcompressionsis(chooseallcorrectanswers):
Selectoneormore:
a.Thechestcompressionrateshouldbe100/min
b.Compression:ventilationratioshouldbe30:2untilthepatientisintubated
c.Thedepthofcompressionshouldbemorethan6cm
d.Thehandshouldjustbetotheleftofthesternum
e.Startmouthtomouthimmediately

Isthisimmediatelylifethreateninghypotension?
d.Temporarilystopventilation,andresumeataslowerrateandvolumeiftheBP
improves
(duetooverdistentionoflung&increasedintrathoracicpressurecausingprofound
hemodynamicinstabilityuse300500ml&1016breaths/mininstead)
c.Intravenoustissueplasminogenactivator
d.Urgentpercutaneouscoronaryintervention

15.tachycardia
a.Oraldiclofenac
b.IVmorphinetitration
c.Oralparacetamol
d.Oraltramadol

16.Patientwithlong\historyofhypertension.LOCfor1hour,RR15,Sp)297%reactive
2mmpupilbothside,absentdollseyeandcornealreflex,bilateralplanterupgoing,GCS6,
(E2V2M2),depresseddeeptendonreflex.Whatshouldyoudo?Selectoneormore
a. intubatethepatient
b. CTbrain
c. hyperventilate
d. mannitol
e. recoveryposition

17.ECGshown,MAT(MultifocalTachycardia),patientBP90/40
Whatisyourmanagement?
DCcardioversion
IVdiltiazem+fluid
IVverapamil+fluid
IVdiltiazem+IVverapamil
IVfluidreplacement(TREATtheunderlyingcause&givesupportivecareisMOST
important)

18..InwhichofthefollowingsurgerieswillALLpatientsneedantibioticprophylaxis
Genitourinary
Gastrointestinal
Neurosurgery
Cardiac
Respiratory
Orthopedics

19.A54yearoldpatientiscomplainingofwoundpainfollowingatotalgastrectomy(orother
GIsurgery?forgotten).Themostappropriateanalgesiais:
Selectone:
A.Intramuscularmorphine
B.Dextropropoxyphene
C.Ibuprofen
D.Tramadol
E.Intravenousmorphine

20.Steriletechnique.Selectoneormore:
a. bloodculture
b. urinarycatheterinsertion
c. Lumbarpuncture
d. Centralvenouscatheterplacement
e. phlebotomy

21.AMLpatientD10chemotherapy,withfever,VitalssuggestiveofSepticshock,MAP=58
withSaO2=86%on4LO2?whatshouldbethenextstepofmanagement?
antiboticsandreassessthepatientsymptomsandvitals
fluidbolusandreassessthepatientsymptomsandvitals
oxygenandreassessthepatientsymptosmandvitals

22.Shoppinglady,pasthxofHTandDMsuddenSOBmetabolicacidosis+respacidosis
a. Pulmonaryembolism
b. acuteHF
c. Pleuraleffusion
d. pneumothoraxi
e. COPD

23.ProgressiveSOBoverpastfewdays.SaO2onroomair86%,increasesto93%after
giving24%oxygen.Whatisthelikelydiagnosis?
a. COPD
b. Pneumonia
c. PE
d. Pneumothorax
e. asthma

24.Youhavenoticedthatapatientonthewardisbreathingfast(respiratoryrate26/minute).
Youplacethepatientona40%oxygenmaskandhesayshefeelsbetter.Youobservehislips
andtongue,althoughpreviouslyblue,nowappearmorepink,butyouarestillconcernedand
performanarterialbloodgas.
pH7.32
PaO 6.7kPa(50mmHg)
2

PaCO 2 11.2kPa(84mmHg)
BasedonyourinterpretationoftheABG,whichofthefollowingismostlikelythecauseforthe
patient'shypoxia?
Selectone:
a.Lobarpneumonia
b.Chronicobstructivepulmonarydisease(COPD)andpneumonia
c.Pulmonaryembolus
d.Acuteexacerbationofchronicobstructivepulmonarydisease(COPD)withoutpneumonia
Incorrect.
e.Acutesevereasthmawithoutpneumoniaorcollapse
(COPD=>CO2retentionwithoutmuchacidosis)
(presenceofAagradient=>pneumonia)

25.Hudsonmask6L/min.WhatistheexpectedPaO2?
a. 30kPa

26.ICUadmissiondistributivejustice
a. admitapatientwhopotentiallybenefitmost
b. admitthosewhocanpayforthecost
c. lottery,firstcomefirstserve
d. donotadmitCOPDbecausehesmokes,hecauseshisownillness
e. admitsurgerypatientsbecauseitwilllookbackiftheycannotgetabed

27.12yearsago,patientwithhistoryofhypertensionandclippedaneurysm,shenowhasa
centralcrushingchestpainfor2hours,ECGshowsSTEMI.
a. IVamiodarone
b. UrgentPCI
c. Tenectaplase
d. TPA
e. Enoxaparin

28.Patientshock80/50,afterresuscitationstraightlegraisetestBP130/70to145/85(Pulse
pressurenotraised),P104,stillanuric.whichisthemostappropriatevasopressor?
a. dobutamine
b. epinephrine
c. norepinephrine
d. dopamine

29.Liverabscess.K5.3.HewasgivenantibioticandBPnormal??
a. Urgentdrainageofliverabscess.
b. 20mgfrusemideIV
c. 10Uinsulinin50mlD50
d.

30.
Apatientpresentswithconfusion.Onexaminationheistakingdeepbreathsatabout
25/minandisclinicallydehydrated.HisinitialbloodresultsshowpH7.1,PaCO22.4kPa
(18mmHg),PaO211.1kPa(83mmHg)onroomair,bloodglucose45mmol/l,sodium145
mmol/l,potassium5.4mmol/l.Yourinitialmanagementshouldinclude(selectoneor
more):
5unitinsulininfusion
1Lsalineover1hr
1LsalineNor+20mmolKClover1h
10%calciumgluconatein10mL
10Uinsulinbolus

AcuteMedMCQ(FromWLeung)

9.postop4hoursforlaparotomyseverepain,mildrenalimpairment
IMpethidine
oralparacetemol
IVmorphine
IVfentanyl
IVdiclofenacacid

11.Liverabscesswitholiguria,JVP5cm,Passivelegraisenochange,presentedafter4hours.
500mlfluid
IVfrusemide
renalreplacement
Drainage
Norepinephrine

12.A65yearsoldgentlemanwithhistoryofCOPDisnowhospitalizedbecauseofcommunityacquired
pneumonia.HisBPisnow80/40withheartrate150/minandJVP3cmandhisSpO2is94%whileusing2L/min
O2nasalcannula.HisECGisasfollows:(MultifocalAtrialTachycardia??)
Selectone:
a.ivdigoxinandfluidreplacement
b.DCcardioversion
c.ivdigoxinandivdiltiazem
d.ivdiltiazemandfluidreplacement
e.Increaseoxygenandfluidreplacement

19.ElectivePCI,Na138,K3.4whattodo?
SyrupK2g
substancereleaseK600mg
20mmolKin100mlover15mins
20mmolKin100mlover1hr
20mmolKin500mlover6hrs

21.Donetriplemanouever,nochestrise,whatwouldyoudo?
A.jawthrust
B.oropharyngealairway
C.checkmaskseal
D.Twopersonventilation
E.Intubation

24.PatienttakenNSAIDanaphylacticshock(withlipswellingbutwithgoodsaturation),BP50/30,Mx?
A.IV0.1mgepinephrine
B.IM0.3mgepinephrine
C.Antihistamine
D.Fluid

E.considerintubation

25.PatientonchemoforAML,developfever,cough.SaO286%on?LO2,hypotensive

A.NE
B.NS
C.increaseFiO2