Emergency Surgery Past Paper PDF

EMERGENCY SURGERY Question : The most commonly fractured ribs: A.8 through 12. B.4 through 8. C.2 through 5. D.3 through 10. Question: The most important, immediate step in the management of an open pneumothorax is: Select one: A.Initiation of 2, large-caliber IVs with crys...

EMERGENCY SURGERY Question : The most commonly fractured ribs: A.8 through 12. B.4 through 8. C.2 through 5. D.3 through 10. Question: The most important, immediate step in the management of an open pneumothorax is: Select one: A.Initiation of 2, large-caliber IVs with crystalloid solution. B.Placement of an occlusive dressing over the wound. C.Placement of a chest tube through the chest wound. D.Operation to close the wound. Question: Which of the following xenobiotics is most likely to cause tinnitus in overdose? Select one: A.Ibuprofen. B.Salicylates C.Gentamicin D.Haloperidol E. Carbamazepine Question: Which effects is NOT associated with muscarinic activation? Select one: A.decrease heart rate. B.constriction of bronchioles. C.pupil dilation. D.increase peristalsis. Question: All of the following are possible causes of mental status changes in the patient with snakebite, EXCEPT Select one: A. A comorbidity. B.Direct effect of venom on the brain. C.Hypoxia related to pulmonary failure. D.Cerebral bleed due to coagulopathy. Question: What is the recommended first intravenous dose of Amiodaron for adult patient with refractory ventricular fibrillation? Select one: A.1 mg/kg. B.150 mg. C.100 mg. D.300 mg. Question: A patient in respiratory failure becomes apneic but continues to have a pulse. The heart rate is dropping rapidly and now shows a sinus bradycardia at a rate 30/min. What intervention has the highest priority? Select one: A.Simple airway maneuvers and assisted ventilation. B.Atropine IV push. C.Application of transcutaneous pacemaker. D.Epinephrine IV infusion. Question: Which of the following statements about digoxin is correct? Select one: A.Digoxin decreases automaticity. B.Digoxin decreases cardiac conduction velocity. C.Digoxin increases cardiac refractoriness. D.Digoxin decreases cardiac excitability. E. Digoxin increases atrioventricular conduction. 1- What skull injury is consistent with the “raccoon sign” ? a) Frontal bone b) Occipital c) Basilar skull d) Temporal 2- Which is the osmotic diuretic that is most commonly given to reduce elevated intracranial pressure? Select one: a. Furosemide b. Amiloride c. Mannitol d. Torsemide (Demadex) 3- An individual is involved in a motor vehicle collision. He is found to have a deviated trachea and now complains of chest pain. His BP is 75/60 mmHg, pulse is 122, and RR is 22. What is the first step? Select one: a. Needle decompression b. Chest x-ray c. Pain medication d. Intubation 4- What is the definitive therapy for compartment syndrome? Select one: a. Hyperbaric oxygen b. Mannitol c. Fasciotomy d. Elevation of limb 5- A patient has asymmetric chest movement and unilateral decreased breath sounds. Which is the most likely diagnosis? Select one: a. Pulmonary fibrosis b. Pulmonary hypertension c. Pericardial tamponade d. Pneumothorax 6- Which is a not sign of tension pneumothorax? Select one: a. Audible breath sounds b. Tracheal deviation c. Decreased compliance d. Decreased breath sounds 7- Paradoxical chest movement is associated with which condition? Select one: a. Cardiac tamponade b. Pulmonary hypertension c. Flail chest d. Pneumothorax 8- Which of the following does not contribute to a low score on the Glasgow coma scale? Select one: a. Use of narcotics b. Paralysis c. Low glucose level d. Smoking. 9- What is the most effective method to confirm a diagnosis of bronchial injury after blunt trauma? Select one: a. Fluoroscopy b. Bronchoscopy c. CT Scan d. Chest X-ray 10- In an epidural hematoma, the blood collected is usually? Select one: a. Venous b. Arterial c. Capillary d. Mix type 11- 25 year old man is brought in after a motorcycle crash in which he was not wearing a helmet. He has injuries to his face, head, and leg. His pulse is 124 at the femoral artery. He is nonverbal and combative. He has gross deformities of the mandible, right hip, and femur, and scalp lacerations. What should be done first? Select one: a. Check for bilateral breaths sounds. b. Start an IV. c. Check the oropharynx for foreign bodies. d. Check distal pulses in the affected leg. 12- A female escapes from a fire in her building and she suffers 35 percent burns to her body. What finding is most specific for inhalation injury? Select one: a. Carbonaceous sputum b. Cough c. Swollen face and mouth d. Cyanosis 13- Which is the least likely presentation of retroperitoneal bleeding? Select one: a. Pain b. Ecchymosis c. Nausea and vomiting d. Hematuria. 14- A patient involved in a road accident is brought to the emergency department in an unconscious state. On arrival, her vitals show a temperature of 35.4, a respiration rate of 24 breaths per minute, a heart rate of 140 beats per minute, and a blood pressure of 80/40 mm Hg. She is cold, shivering, and perspiring profusely. She has bilateral reactive pupils but she does not respond to pain. On physical examination, she has no obvious sign of external bleeding. Which of the following cannot be the cause of hypotension in this patient? a. Hemothorax b. Pelvic fracture c. Intracranial hemorrhage. d. Femur fracture 15- 34-year-old with severe head trauma and elevated intracranial pressures is intubated. Which of the following should be the target for mechanical ventilation? Select one: a. Set PaCO2 between 45-50. b. Set PaCO2 < 30. c. Set PaCO2 between 35-40. d. Set PaCO2 between 30-35. 16- All of the following statements are true except? Select one: a. Hypertension may be a long term complication of renal injury. b. Intravenous urography or contrast enhanced computed tomography (CECT) scan should be performed urgently in suspected renal injury. c. Hematuria following trivial injury of the kidney indicates a previously pathological kidney. d. In closed renal injury, surgical exploration is necessary in the majority. 17- Immediately life-threatening injuries are all of them except? Select one: a.Spleen injury B.Flail chest C.Tension pneumothorax D.Cardiac tamponade 18- What does mean Beck's triad? Select one: a. norm tension, endophtalm, and muffled heart sounds. b. acrocianosis, endophtalm, and muffled heart sounds. c. hypertension, distended neck veins and muffled heart sounds. d. hypotension, distended neck veins and muffled heart sounds. e. hypertension, endophtalm, clear heart sounds. 19- Focused Assessment with Sonography in Thoracic Trauma. Following areas examined: 1. pelvis, 2. perihepatic, 3. perisplenic, 4. pericardial. Select one: a. all are correct b. correct are 1.3 c. correct are 2.4 d. correct are 1,2,3 e. correct is only 4 20- All the following statements are true except? Select one: a. A negative DPL is often more helpful. b. Diagnostic peritoneal lavage (DPL) as an investigation has largely been superseded by FAST. c. All patients with liver trauma are treated surgically. d. Diagnostic laparoscopy has a screening role in the stable patient. 21- Disadvantages of CT arteriography (CTA) are all of them except. Select one: a. inability to intervene; b. rapid evaluation; c. poor arterial opacification d. increased need for larger IV contrast load. 22- Complications of genital injuries can be: Select one: a. erectile dysfunction. b. All of them; c. urethral scarring d. infection. 23- Which of the following statements are false? Select one: A. A penetrating chest injury always requires a thoracotomy. b. 80 per cent of chest injuries can be managed non-operatively. c. In the unstable patient, chest X-ray is the first investigation of choice. d. A chest drain can be both diagnostic and therapeutic. 24- All the following statements are true except? Select one: a. All patients with multiple injuries must have a contrast enhanced computerized scan (CECT) of the abdomen for accurate evaluation. b. Diagnostic laparoscopy has a screening role in the stable patient. c. In the stable patient with intra-abdominal injury, CECT is the gold standard of investigation. d. Video-assisted thoracoscopy (VATS) is an accurate method of evaluating diaphragmatic injury. 25- Which of the following statements regarding focused abdominal sonography in trauma (FAST) are false? Select one: a. It is operator-dependent. b. It is a useful tool to diagnose hollow viscus injury. c. It is accurate when there is >100 mL of free blood in a cavity. d. The technique focuses on pericardial, splenic, hepatic and pelvic areas. 26- Signs of cardiac tamponade 1. Beck's triad 2. pulsus paradoxus 3. Kussmaul's sign 4. Murphy sign Select one: a. correct is only 4 b. correct are 1.3 c. all are correct d. correct are 1,2,3. e. correct are 2.4 27- Breast cancer is found most frequently in the: Select one: a. lower outer quadrant; b. lower inner quadrant; c. upper outer quadrant; d. upper inner quadrant; 28- Blunt chest trauma is predominantly due to : 1.road traffic accidents. 2. weapon. 3. falls from height. 4. bullets Select one: a. correct are 2.4 b. correct are 1,2,3 c. correct is only 4 d. all are correct e. correct are 1.3. 29- The 'lethal six' includes : 1- Airway obstruction, Tension pneumothorax Massive haemothorax. 2. Pneumonia, Plevritis, Pericarditis. 3. Open pneumothorax, Cardiac tamponade; Flail chest. 4. Bronchitis, Alveolitis; Tracheitis. Select one: A. Correct are 1.3 b. all are correct c. correct are 1,2,3 d. correct are 2.4 e. correct is only 4 30- Simple pneumothorax primary treatment primarily involves Select one: a. pulmonectomy. b. thoracotomy. c. chest drainage. d. pleurectomy. e. lobectomy. 31- In trauma patients saline-based fluids increase all of the except? Select one: a. coagulopathy b. acidosis; c. the incidence of secondary abdominal compartment syndrome. d. Alkalosis; 32- All the following statements are true except? Select one: a. The vast majority of chest injuries can be managed closed. b. Liver failure is the commonest cause of death in trauma. c. Early preventable deaths due to trauma are often the result of lack of delay in airway control. d. 40 percent of deaths from trauma are due to torso injury. 33- Amazia means: Select one: a. Both of them; b. Accessory breasts; c. None of them; d. Congenital absence of the breast; 34- Immediately life-threatening injuries are all of them except? Select one: a. Airway obstruction b. Liver injury. c. Massive hemothorax d. Open pneumothorax 35- All the following statements are true except? Select one: a. A chest drain can be both diagnostic and therapeutic. b. A penetrating chest injury always requires sternotomy. c. In a chest injury, auscultation from the front only can be misleading. d. Early preventable deaths due to trauma are often the result of lack of delay in airway control. 36- In a patient with a stab wound, what is the first sign of hemorrhagic shock? Select one: a. Dilated pupils b. Tachycardia c. Mental confusion d. Pain 37- Which of the following is an early feature of raised intracranial pressure? Select one: a. Dilated pupil on affected side. b. Altered Glasgow coma scale (GCS). c. Coma. d. Seizures. 38- What is the next best step in a patient with spleen trauma who is hemodynamically stable? Select one: a. Bed rest. b. Angiogram with embolization. c. CT guided drainage. d. Surgery. 39- Which is not a symptom of basilar skull fracture? Select one: a. Otorrhea b. Ecchymoses c. Rhinorrhea d. Vision loss 40- Which of the following is not characteristic of early hemorrhagic shock? Select one: a. Cold skin b. Bradycardia c. Confusion d. Slow capillary refill 41- Breast investigations include all of them except: Select one: a. Endoscopy b. MRI c. Ultsasound d. Mammography 42- All of the following are a potentially life-threatening injuries except? Aortic injuries Select one: a.Tracheobronchial injuries b. Myocardial contusion c. Injury of the stomach d. Aortic injuries. 43- A 23-year-old male patient has been brought in with a stab injury to his central abdomen. Although in sever pain around the injured site. he is stable haemodynamically. At this stage an intraperitoneal injury needs to be excluded. FAST is normal. what screening procedure might you consider Select one: A.Video assisted thoracoscopy (VATS). B. Diagnostic laparotomy. C. Diagnostic laparoscopy (DL d. FAST. 44- Which of the following are not potentially life-threatening injuries? Select one: a. Hollow viscus injury b. Oesophageal injuries c. Rupture of the diaphragm d. Pulmonary contusion 45- all of the following is true except? A.Multiorgan failure is the commonest cause of death in trauma. B.Good history and understanding of the mechanism of injury will help predict the type of injury. C.40 per cent of deaths from trauma are due to torso injury. D.Junctional zones help in the overall management  Emergency medicine 1- If you suspect that an unresponsive victim has head or neck trauma, what is the preferred method of opening the airway? A) Jaw Thrust B) Head tilt-neck lift C) Head tilt-chin lift D) Avoid opening the airway. 2- Which one of the following signs is associated with class II hemorrhagic shock (estimated blood loss of 750-1500 mL)? A) Respiratory rate above 35 breaths per minute B) Normal systolic blood pressure C) Decreased diastolic blood pressure D) Heart rate above 140 beats per minute 3- Which of the following is used for opioid overdose? A) Clonidine B) Naloxone C) Lorazepam D) Disulfiram 4- Which of the following is contraindicated for insertion of nasopharyngeal airway? A) Pleural effusion B) Pneumothorax C) Perforated stomach D) Base skull fracture. 5- After head trauma, a CT scan is warranted in an individual with: A) Seizures B) Vomiting C) All of the above D) Decreased level of consciousness 6- Subdural hematoma is due to: A) Subarachnoid hemorrhage B) Crushing of bone C) Tearing of veins D) Injury to the temporal artery 7- What type of shock develops after a spinal cord injury? A) Neurogenic B) Hemorrhagic C) Cardiogenic D) Obstructive 8- What is a common reason of airway obstruction in an unconscious patient? A) Tongue B) Blood C) Foregin body D) Vomited mass 9- Which is the drug of choice to reverse benzodiazepine overdose? A) Protamine B) Naloxone C) Flumazenil D) Methadone 10- Which of the following conditions is appropriate for use of an oropharyngeal airway? A) Conscious with a gag reflex B) Unconscious with no gag reflex C) Conscious with no gag reflex D) Unconscious with a gag reflex 11- Performing head tilt chin lift manoeuvre is done in an attempt to: A) Prevent the patient from chocking B) Open the airway C) Check for neck dislocation D) Assess severity of jaw injury 12- A patient receiving intravenous morphine should be closely monitored for which one of the following? A) Mental status B) Heart rate C) Respiratory status D) Constipation 13- After intubation of 23-year old male with facial trauma, the best way to assess endotracheal tube placement in the trachea is: A) Arterial blood gas B) Capnography C) Percussion D) Auscultation 14- Neurogenic shock has all of the following classic characteristics except: A) Bradycardia B) Vasodilation C) Narrow pulse pressure D) Hypotension 15- Which medication will be selected for procedural sedation of patient who needs burn dressing change? A) Propofol B) Ketamine C) Diazepam D) Midazolam 16- In the scenario of increased pressure (ICP), an early sign of worsening is: A) Apnea B) Decreased level of consciousness C) Hypertension D) Bradycardia 17- A patient has a kidney contusion after motor vehicle accident. His vitals are stable. What is the next step in management? A) Intravenous Pyelogram B) Observation C) CT scan D) Blood transfusion 18- How much time is necessary for direct pressure to stop external bleeding? A) 20 minutes B) 5 minutes C) 10 minutes D) 1 minute 19- What is the percentage of blood loss in a patient with Class II hemorrhage? A) 10% B) 25% C) 55% D) 35% 20- Morphine affects all organ system except: A) GI tract B) Urinary C) Musculoskeletal D) CNS 21- Overdose of which medication can cause bradycardia and hypotension? A) Naloxone B) Flumazenil C) Morphine Sulfate D)Naltrexone 22- What are the CT/MRI criteria for hydrocephalus? A) Cerebellar atrophy B) The size of both temporal horns > 2mm C) Sylvlan and interhemispheric fissures and cerebral sulcus are not visible D) Ratio of FH/ID > 0.5 E) All of the above F) 2;3;4 G) 1;2;3 23- If the above mentioned patient - opens eyes in response to pain, makes incomprehensible sounds and on pain stimuli flexes upper limbs and extends lower limbs - what point he will score on Glasgow coma scale? A) 9 points B) 8 points C) 7 points D) 6 points 24- For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: A) Respiratory acidosis B) Pulmonary edema C) Metabolic acidosis D) Cerebral vasoconstriction with diminished perfusion. 25- 40-year-old male is brought to the emergency department after fall from a height of just over 3 meters, His airway is clear, respiratory rate is 28, and systolic blood pressure is 140 mm Hg. There is equal air entry on both sides of chest with comparable percussion sounds bilaterally, He complains of pain on palpation of the chest. Which intervention is most likely needed? A) Tube thoracostomy B) Pain management C) Pericardiocentesis D) Needle decompression of the chest. 26- Cervical collar should be applied in situations except: A) Fall from height B) Shallow water diving C)Internal bleeding from single gunshot wound D)Pedestrian struck by motor vehicle 27- The greatest threat to life from injury to a solid abdominal organ is: A) Peritonitis B) Ascites C) Multiple organ failure D) Hemorrhage 28- 80-year-old female presents after being stuck by a scooter. Her respiratory rate is 20, heart rate is 86, and blood pressure is 100/70 mm Hg. Her Glasgow Coma Scale score is 12, and she is bleeding from a scalp laceration, Which one of the following treatment steps is the priority? A) Obtaining detailed information about medication and previous history B) Administering 1 L of crystalloid C) Obtaining CT scan of the head D) Controlling bleeding from the scalp. 29- The most common type of shock in trauma patients is: A) Septic B) Neurogenic C) Hypovolemic D) Cardiogenic 30- A patient is involved in a head on collision with another car. He was an unrestrained passenger and is brought to the hospital with a GCS of 6. Quick survey does not reveal any frank bleeding but the patient remains hypotensive. Which of the following does not account for his low blood pressure? A) Femur fracture B) Subdural Hematoma C) Retroperitoneal bleeding D) Liver laceration 31- 22-year-old woman falls while skiing. She presents on a spine board with cervical collar, oxygen mask at 5 L, and two antecubital IVs. Her Glasgow Coma scale score is 12, pupils are equal, blood pressure is 135/76 mm Hg, heart rate is 105, and respiratory rate is 19. Chest x-ray is normal, This patient’s management priorities are: A) Definitive airway, CT of the head, and intracranial pressure monitor B) CT of the head, ECG, cerebral perfusion pressure monitoring and hypertonic saline C) IV mannitol, definitive airway, CT of the head and neurosurgery consult D) CT of the head and repeat Glasgow Coma Scale. 32- Which of the following is not a part of the clinical triad of cardiac tamponade? A) Bradycardia B) Muffled heart sounds C) Jugular venous distension D) Hypotension 33- A 20-year-old male is brought to hospital approximately 30 minutes after being stabbed in the chest. There is a 3-centimetre wound just medial to the left nipple. His blood pressure is 70/33 mm Hg, and heart rate is 140. Neck and arm veins are distended. Breath sounds are normal. Heart sounds are diminished. IV access has been established and warm crystalloid is infusing. The next most important aspect of immediate management is: A) Left tube thoracostomy B) FAST exam C) CT scan of the chest D) Begin infusion of packed RBCs 34- A patient presents to the emergency room after a motor vehicle accident with hypotension, tachycardia and abdominal distension. Select the most likely diagnosis: A) Neurogenic shock B) Spleen injury C) Pneumothorax D) Closed head injury 35- A patient is brought into the emergency department with a large open knife wound to the right mid thigh. His blood pressure is 85/40 and his pulse is 110. Blood appears to be spurting from the wound. The next step is to: A) Explore wound in ER B) Clamp bleeding artery C) Apply direct pressure with sterile gauze D) Apply pneumatic anti shock garment over involved leg 36- Evaluation of the retroperitoneum in a hemodynamically stable patient is most accurately accomplished by: A) FAST exam B) CT scan C) Diagnostic peritoneal lavage (DPL) D) Physical exam 37- Hyperventilation can lead to all of following except: A) Increased in intrathoracic pressure B) Metabolic acidosis C) Hypocarbia D) Respiratory alkalosis 38- What skull injury is consistent with battle sign? A) Basilar skull fracture B) Parietal fracture C) Occipital fracture D) Frontal bone fracture 39- Referencing the Parkland formula, what percent of the calculated IV volume should be administered in the first 8 hours following the injury? A) 10% B) 50% C) 25% D) 33% 40- Kehr sign is due to: A) Appendicitis B) Lung trauma C) Intestinal injury D) Splenic trauma 41- What is indication for tourniquet application? A) Large bleeding from the wound on the chest B) Severe arterial bleeding from partial amputation of the leg C) Mild bleeding from the wound on the forearm D) Moderate bleeding from the wound on the neck 42- Periorbital ecchymosis is suggestive of: A) Tooth fracture B) Basilar skull fracture C) Blindness D) Migraines 43- 17-year-old female was found unresponsive on the ground after falling from a second-floor balcony. The patient is pale, cool and clammy. Which of the following is the most appropriate initial action? A) Start two large-bore IVs B) Ensure a patient airway C) Obtain baseline vital signs D) Assess pupils 44- 7-year-old boy is brought to the emergency department by his parents several minutes after he fell through a window. He is bleeding profusely from a 6-cm wound of his medial right thigh. Immediate management of the wound should consist of: A) Packing the wound with gauze B) Direct pressure on the femoral artery at the groin C) Application of a fourniquet D)Direct pressure on the wound 45- Which of the following is the priority when managing a patient with traumatic brain injury? A) Treating wounds B) Assessing the level of brain damage C) Maintaining airway and blood flow D) Preventing infection 46- A construction worker falls from a scaffoid and is transferred to the emergency department. His heart rate is 124 and blood pressure is 85/60 mm Hg. He complains of lower abdominal pain. After assessing the airway and chest, immobilizing the c-spine, and initiating fluid resuscitation, the next step is to perform: A) Cervical spine x-ray B) FAST exam C) Detailed neurological exam D) Urethral catheterization 47- 30-year-old male is stabbed in the right chest. On arrival in the emergency department, he is very short of breath.His heart rate 120, and blood pressure is 80/50 mm Hg. His neck veins are flat. On auscultation of the chest, there is diminished air entry on the right side, and on percussion there is dullness posteriorly. These findings are most consistent with: A) Hemothorax B) Pericardial tamponade C) Hypovolemia from liver injury D) Tension pneumothorax 48- A patient presents to the emergency department with profuse bleeding from a gunshot wound to the anterior neck. What is the most appropriate first step in management of this patient? A) Rapidly explore the the wound to obtain control of the injured vessel B) Establish a stable airway C) Obtain a brief history of the injury, including the cailber of weapon used in the assault D) Obtain a lateral radiograph of the neck to evaluate the cervical spine 49- What is the common cause of distributive shock following trauma? A) Significant blood loss B) Spinal cord injury C) Tension pneumothorax D) Blunt cardiac injury 50- A tension pneumothorax is differentiated from a simple pneumothorax by which sign? A) Tympanic percussion note B) Shortness of breath C) Hemodynamic compromise/hypotension D) Decreased lung sounds 51- How many millilitres of CSF is produced in adults per day? A) 150 ml/24h B) 250 ml/24h C) 350 ml/24h D) 450 ml/24h 52- What are the possible complications for ETV? A) Hypothalamic injury B) Cerebellar injury C) Occlusion of foramen of magendie D) Transient 3rd and 6th nerve palsies E) 1;4 53- Which one of the following findings in an adult is most likely to require immediate management during the primary survey? A) Glasgow Coma Scale score of 11 B) Deformity of the right thigh C) Respiratory rate of 40 breaths per minute D) Distended abdomen 54- How much blood can be lost in a single femur fracture? A) About 125 ml B) About 500 ml C) About 1000 ml D) About 750 ml 55- A 24-year-old male pedestrian, struck by an automobile,is admitted to the emergency department 1 hour after injury. His blood pressure is 80/60 mm Hg, heart rate is 140 beats per minute, and respiratory rate is 36 breaths per minute. He is lethargic. Oxygen is delivered via face mask, and two large-caliber IVs are initiated. Arterial blood gases are obtained.His PaO2 is 118 mm Hg, PaCO2 is 30 mm Hg and pH is 7.21. The treatment of his acid-base disorder is best accomplished by: A) Administration of sodium bicarbonate B) Restoration of normal perfusion C) Initiation of low-dose dopamine D) Hyperventilation 56- A patient is seen in the ER after having being stabbed in the abdomen just above the umbilicus. He is cold, pale and clammy. The abdomen is tender and his BP is 80/50 and a pulse of 122. The next step in his management is? A) Explore knife wound B) Venous access C) Assess airways D) Diagnostic peritoneal lavage 57- What are symptoms of progressive hydrocephalus in young children? A) Abnormalities in head circumference B) “Setting sun sign” C) Fontanelle full and bulging D) Enlargement and engorgement of scalp veins E) All of the above 58- The approximate location of sylvian fissure AKA lateral fissure is calculated by following methods? A) Line above the pina, crossing ½ of calvaria B) Line connecting lateral canthus and inion C) The point where “posterior” ear line crosses circumference of the skull D) Line connecting lateral canthus and ¾ of posterior convexity of calvaria 59- Some people are very allergic to insect bites and stings. This condition is called. A) Cardiac arrest B) Toxic shock syndrome C) Septic shock D) Anaphylactic shock 60- Which of the following types of traumatic brain injury is most likely associated with hemorrhage from the middle meningeal artery? A) Subdural hematoma B) Subarachnoid hemorrhage C) Epidural hematoma D) Intracerebral hematoma 61- For the management of arterial bleeding from the extremity, where should the tourniquet be placed A) Tourniquet is not needed for bleeding management B) 5-7 cm proximal to the bleeding site C) 5-7 cm distal to the bleeding site D) On the site of the bleeding 62- Ion balance is very important in maintaining a normal cardiac rhythm. Which of the following statements is TRUE? A) Calcium is transported into the cell via a Ca2+ A phase B) Blockade of Ca2+ channels has a positive inotropic effect C) Intubation of Na+ channels increases conduction velocity D) Blockade of K+ channels decreases the duration of the action potential E) Blockade of the Na+/K+ A phase increases contractility 63- A 65 year old female is brought to the emergency department after a motor vehicle accident, She was hit head on while travelling on a highway, She is in severe pain and holding her chest, There is a large confusion over the anterior chest, muffled heart sounds, pulsus paradoxus and jugular venous distension, Blood pressure is 85/56 mm Hg, Select initial management A) Pericardiocentesis B) Electrocardiogram C) CT of the chest D) Chest radiograph 64- An early sign of digoxin toxicity is: A) Hypertension B) Bradycardia C) Atrial fibrillation D) Wide QRS complex E) Wide QT interval 65- Which rhythm requires synchronized cardioversion? 1. Unstable supraventricular tachycardia 2. Normal Synus rhythm on the monitor but no pulse 3. Sinus tachycardia 4. Atrial fibrillation. 66- Which of the following mushrooms is commonly thought for its hallucinogenic potential? A) gytonea esculenta B) Clocybe jhjnkjmlkk C) Cortinarius orellanus D) Psilocybe cubensis E) Chlorophyllum molybdites 67- Idiosyncrasy is: A) An immunologically mediated reaction B) An altered psychological state produced by repeated drug use C) A genetically determined abnormal reaction to drugs D) A characteristic toxic effect of therapeutic doses 68- What is the recommended second dose of Adrenaline for adult patients in refractory but stable narrow-complex tachycardia? A) 3 mg B) 12 mg C) 5 mg D) 6 mg 69- Which of the following neurotransmitters undergoes synaptic enzymatic degradation as the main mechanism by which its actions are terminated? A) Dopamine B) Acetylcholine C) Serotonin D) Norepinephrine E) Glutamate 70- A patient is brought to the emergency room by ambulance, She was involved in a motor vehicle accident, Close observation shows that her chest expands with expiration and contracts with inspiration, The most likely diagnosis is: A) Flail chest B) Ruptured esophagus C) Ruptured thoracic aorta D) Pneumothorax 71- What is the most common clinical manifestation of the intermediate syndrome? A) Proximal limp and cranial nerve weakness. B) Bronchorrhea C) Mydriasis D) Vomiting and diarrhea E) Ventricular 72- What is the most appropriate medication for procedural sedation of patient with lower airway obstruction presented with expiratory wheezing ? A) Propofol. B) Ketamine. C) Midazolam. D) Diazepam. 73- Shock is best defined as? A)Any Injury leading to decreased level of consciousness. B)Widespread inadequate perfusion of the tissues. C)Systolic blood pressure less than 90 mmHg. D)Loss of 30% or greater of blood volume. 74- Which medication is often used to induce coma in patients with elevated intracranial pressure? 1. Diazepam. 2. Fentanyl. 3. Phenytoin. 4. Thiopental. 75- Which of the following is a sign of ROSC ? 1. Diastolic intra-arterial pressure < 20 mmHg. 2. End Co2 > 40 mmHg. 3. Core temperature > 32°C. 4. Urine output 1. 76- in case of poisoning with Amanita phalloides gastric lavage is recommended ? 1. Not the time passed after the intake. 2. Within first two hours. 3. Within 12-24 hours. 4. Within 3-6 hours. 5. Within 6-12 hours. 77- protein binding of a drug helps in ? 1. Prolonging half-life. 2. Distribution. 3. Limiting metabolism. 4. All of the above. 78- an example of drug from class Acetylcholine antagonist ( muscarinic antagonist) is ? 1. Paraoxon. 2. Carbachol. 3. Donepezil. 4. Atropine. 79- Which is the most appropriate treatment for severe coagulopathy without bleeding following rattlesnake Envenomation? 1. Cryoprecipitate. 2. Antivenom. 3. Fresh-frozen plasma. 4. Vitamin K. 5. Plasmapheresis. 80- Which of the following are common symptoms of pit viper bite? 1. Nausea & Vomiting. 2. Hallucinations. 3. Sweating. 4. Pain. 81- While on a medical mission in Syria, you are exposed to the nerve gas Sarin. Effective treatment typically involves the i.m. administration of ? 1. atropine + pralidoxime 2. atropine +bethanechol. 3. pilocarpine +pralidoxime 4. tubocurarine+ganglionic blocker. 5. varenicline+tubocurarie. 82- A 35-year-old female falls down a flight of stairs. She has extensive bruising of her face and head. Her heart rate is 120, blood pressure is 90/70 mm Hg, and respiratory rate is 25. The patient's condition is most readily explained by ? 1. Neurogenic shock from cervical spine injury. 2. Associated head injury. 3. Hypovolemia from abdominal or pelvic injury. 4. Alcohol intoxication. 83- A 40 year old obese patient with a Glaagow Coma Scale score of 8 requires a CT scan. Before transfer to the scanner, you should ? 1. insert an NG tube. 2. Give more sedative drugs. 3. Establish definitive airway. 4. Request a lateral cervical spine film. 84- You have completed your first 2 minute CPR. On the rythm check you see an organized, nonshockable rhythm on monitor. What is the most appropriate next action? 1. Administer Epinephrine at 1 mg IV/IO. 2. Administer normal saline at 20 ml/kg. 3. Obtain blood pressure and oxygen saturation. 4. Palpate a carotid artery to check the presence of pus. 85- Cardiac glycosides ? 1. make the resting membrane potential more negative. 2. can have sympathomimetic and parasympathomimetic effects. 3. Decrease Ventricular contractility. 4. Increase the activity of the Na+/K+ -ATpase. 86- Which is not a common feature of flail chest ? Select one : 1. Atelectasis. 2. Chest pain. 3. Single rib facture. 4. Shortness of breath. 87- Which of the following is the best next step in a hypotensive patient with a stab wound to the upper abdomen Select one : 1. FAST. 2. Chest and abdominal X-ray. 3. Laparotomy. 4. CT of abdomen and pelvis of the upper abdomen. 88- The most common cause of hypotension following injury in an unconscious patient is : Select one : 1. Intracranial hemorrhage 2. Hypoxia 3. Spinal cord injury 4. Blood loss. 89- Difficult airways will be considered in all patients except : Select one : 1. Small mandible. 2. Mallampati class III and IV 3. Neck injury. 4. Mallampati class I and II 90- a patient with respiratory failure becomes apneic but continues to have a pulse, the heart rate is dropping rapidly and now she has a sinus bradycardia at rate 30 in a minute. What intervention has the highest priority? 1. Atropine intravenously. 2. Epinephrine intravenously. 3. Application of transcutaneous pacemaker. 4. Simply airway manyles and assess the ventilation. 91- adult patient develops cardiac arrest high cogen CPR started, ECG reveals ventricular fibrillation. What is appropriate next intervention ? 1. Synchronised cardioversion. 2. Defibrillation. 3. amiodarone. TOXICOLOGY University questions 1- Morbidity can be significant depending on ? A. Venom depositione (intravascular vs intramuscular/ subcutaneous). B.All of the above. C.Patient comorbidities. D.Snake species. E. Bite location ( face/ neck vs extremities). F. Envenomation severity. 2- which of the following is true of N-acetylcysteine? A. It is a glutathione substance but does not lead to increased glutathione supply. B.If administered within 6-8 hours of an acute acetaminophen ingestiont can usually prevent Hepatic failure.  C.Interferes with the acetaminophen assay. D.It decreases the capacity for sulfason of acetaminophen. E. It is a glutathione substance and prevents the formation of Nacetyl-p-bennzoqinonine. 3- What is the best procedure for treating a known poisonous snake bite? A.Keep the victims calm , keep the bite location lower than the heart, get medical help immediately. B.Treat the victim for shock and continue the planned activity. C.Capture the snake Place it in an ice chest and take the snake and victim to a hospital. D.Place a constricting bandage 4 inches above the head of the snake to slow the spread of venom. 4- Which of the following statements regarding local signs and symptoms of pit viper envenomation is TRUE? A.The early spread of venom is by venous flow. B.Swelling and tenderness of regional lymph nodes is rare. C.Deeper bites are more likely to result in rapid clinical deterioration. D.Bites rarely penetrate subcutaneous tissue. 5- Which clinical manifestation of organic phosphorus agent poisoning is of greatest life-threatening concern after acute exposure? A.Respiratory insufficiency. B.Prolonged QTc interval. C.Bradydysrhythmias. D.Increased Gi motility. E. Bronchorrhea 6- Entering to into the organism CO induces lesions of all the following biochemical structures except: A.Haemoglobin. B.Sulphydric group. C.Cytochrome-C. D.Myoglobin 7- Toxic chemicals are most likely to be biotransformed in which of the following organs? A.Pancreas. B.Lung. C.Central nervous system. D.Heart. E. Liver 8- Who is the most likely to give incorrect information while taking a history of poisoned patient? A.Patient. B.Pharmacist. C.Employer. D.Emergency Medical Technician. E. Family members. 9- Which of the following is correct with regard to carbon monoxide? A.Its binding to hemoglobin is irreversible. B.It has no effect on the unbinding of oxygen at tissue sites. C.It shifts the oxyhemoglobin dissociation curve to the right. D.Its poisoning usually results from intentional exposures. E. It binds to the tissue cytochromes disrupting cellular respiration. 10- What’s the most common clinical finding in organic phosphorus poisoning that is not effectively treated with atropine? A.Muscle weakness. B.Miosis. C.Bronchoconstriction.  D.Bronchorrhea. E. Diarrhea. 11- What is the most common etiology of heart failure? A.Ischemic. B.Drug-induced. C.Viral cardiomyopathy. D.Hypertension. E. Idiopathic, unknown cause. 12- Which of the following is a chemical aspyxiant? A.acrolein. B.carbon dioxide. C.carbon monoxide. D.isocyanates. E. chlorine. 13- The pharmacokinetic process or property that distinguishes the elimination of ethanol and high doses of phenytoin and aspirin from the elimination of most other drugs is called Select one: A.Excretion. B.Distribution. C.Zero-order elimination. D.First-order elimination  E. First-pass effect 14- Carbon monoxide (CO) exerts its toxic effects via its interaction with which of the following? Select one A.DNA polymerase. B.hemoglobin. C.kinesin D.microtubules E. actin. 15- Drug metabolism in humans usually results in a product that is Select one: A.More likely to be reabsorbed by kidney tubules. B.More likely to distribute intracellularly. C.Less lipid soluble than the original drug. D.More lipid soluble than the original drug. E. Less water soluble than the original drug. 16- A farm worker was accidentally in the field during the aerial spraying with parathion. He was brought to the emergency department. Which of the following will be used in the treatment of this patient? Select one: A.Hemodialysis. B.Atropine and pralidoxime. C.Measures to reduce pulmonary edema. D.Antiseizure drugs. E. Hyperbaric oxygen. 17- Which of the following is not one of the four fundamental pathways of drug movement and modification in the body? Select one: A.elimination. B.absorption. C.metabolism. D.dissolution. E. Distribution. 18- The study of the effect of DRUGS on the function of living systems Select one: A.Define Toxicology. B.Define Pharmacology. C.Define Toxicokinetics  D.Define Teratogenesis. 19- Hemodialysis would be most helpful for a medication overdose with which of the following properties? Select one: A.Large volume of distribution Low protein avidity. B.Small volume of distribution. Low protein avidity. C.Small volume of distribution. High protein avidity. D.Large volume of distribution High protein avidity. 20- What is the primary goal in taking a history in a poisoned patient? Select one: A.determining susceptibility to drug overdose. B.determining drug allergies. C.determining likelihood of an attempted suicide. D.determining the ingested substance. E. determining the motive behind the poisoning. 21- Which of the following is true about carbon monoxide? Select one:  A.carbon monoxide is visible in high concentrations. B.carbon monoxide is irritating. C.carbon monoxide is denser than air. D.carbon monoxide causes toxicity by binding to methemoglobin. E. carbon monoxide is odorless. 22- Which ONE of the following is NOT a potential complication in the treatment of metabolic acidosis with sodium bicarbonate? Select one: A.Dehydration. B.Overshoot alkalosis. C. Cerebrospinal fluid (CSF) acidosis. D.Hypercapnia and respiratory failure. 23- Elimination of drugs from the body is dependent on which of the following? Select one: A.Sufficient blood flow to the liver and kidneys. B.Only a and b. C.Filtration or secretion in the kidney. D.a, b, and c. E. Biotransformation in the liver. 24- A cyanotic patient is brought to the emergency department from a house fire Which of the following are likely to be cause of cyanosis? Select one: A.hypoxia from pulmonary injury caused by smoke inhalation. B.Hypoxia from upper airway edema caused by thermal injury. C.Hypoxia caused by bronchospasm. D.All of the above. E. methemoglobinemia resulting from inhaled smoke toxins. 25- An employee of a company engaged in clearing vegetation from county roadsides accidentally ingested a small quantity of an herbicidal solution that contained paraquat. Within2 h, he was admitted to the emergency department of a nearby hospital Which of the following best describes his probable signs and symptoms in the emergency department? Select one: A.Diarrhea, vomiting, sweating, and profound skeletal muscle weakness.  B.Hypotension, tachycardia, and respiratory impairment. C.Gastrointestinal irritation with hematemesis and bloody stools. D.Dyspnea, pulmonary dysfunction, and elevated body temperature. E. Dizziness, nausea, agitation, and hyperreflexia. 26- What physiological process(es) does pharmacodynamics characterize? Select one: A.Distribution. B.Metabolism. C.Dose-response. D.Absorbtion. E. Toxicity. 27- Carbon monoxide poisoning many occur from which of the following exposures? Select one: A.Propane. B.methylene chloride (paint remover). C.trichloroethylene. D.all of the above E. trichloroethane. 28- Which one of the following statements regarding toxicology is true? Select one: A.Modern toxicology is concerned with the study of the adverse effects of chemicals forms of life. B.Modern toxicology has its roots in the knowledge of plantandanimal poisons, which predates recorded history and has been use to promote peace. C.Modern toxicology is concerned with the study ofchemicals in mammalians species. D.Modern toxicology studies embrace principles from such disciplines as biochemistry, botany,chemistry, physiology, and physics. E. Modern toxicology studies the mechanisms by which inorganicchemicals produce advantageous as well as deleterious effects. 29- All of the following complications of forced diuresis are except Select one: A.Organism hyperhydratation. B.Pulmonary congestion. C.Hypokalemia.  D.Acute renal failure. E. Brain congestion. 30- Which of the following is correct with regard to methemoglobin? Select one: A.It is hemoglobin with the iron in the 3+ valence state. B.It shifts theoxyhemoglobindisscociation curve to the right. C.It is less commonly found in infants. D.It normally constitutes approximately 8% of total hemoglobin. E. It is primarily reduced (in vivo) by ascorbic acid. 31- What agent reverses the neuromuscular junction acetylcholinesterase inhibition caused by organic phosphorus Select one: A.Lorazepam. B.Pralidoxime. C.Diazepam D.Glycopyrrolate E. Atropine. 32- Which of the following is the most important to monitor when using atropine to treat a patient with cholinergic poisoning? Select one: A.Respiratory rate. B.Blood preassure. C.Temperature D.Pulse. E. Mental status 33- Toxins of Amanita Phaloidea most of all influence: Select one: A.Liver. B.CNS. C.GIT. D.All listed Dr. Otar questions 1- In case of acute poisoning with opioids the following triad is manifested Select one: a. Miosis, lethargy, respiratory depression. b. Miosis, dry skin, lethargy. c. Mydriasis, dry skin, respiratory depression. d. Mydriasis lethargy, respiratory depression. 2- Mild salicylate poisoning manifests as: Select one: A.Shok, Seizures. B.Tachypnea, Hypepyrexia. C.Tinnitus, Nausea/Vomiting. D.Diaphoresis, Ataxia. 3- breakdown products of Ethanol are: Select one: A.Glycolaldehyde, Glycolic Acid, Glyoxylic Acid, Oxalic Acid. B.Acetaldehyde, Acetic Acid, acetyl COA. C.Formaldehyde, Formic Acid 4- Which symptom does not occur in intoxication with calcium channel blockers? Select one: A.Hypotension. B.atrioventricular block. C.Bradycardia. D.Hypertension. 5- Which characterises the first stage of acute acetaminophen poisoning? Sect one:  A.Clinical improvement and recovery or deterioration to multiorgan failure and death. B.Recurrence of anorexia, nausea and vomiting, encephalopathy. C.Anorexia, nausea, vomiting, malaise. D.Improvement in anorexia, nausea and vomiting, abdominal pain, hepatic tenderness. 6- In acute poisoning, hemodialysis is indicated, except for one Select one: A.Life-threatening poisoning by lithium B.Hemodynamic instability. C.Life-threatening poisoning by Salicylates. D.Metformin-induced lactic acidosis. 7- Moderate salicylate poisoning manifests as: Select one: A.Acute Lung Injury. B.Shok, Seizures. C.Diaphoresis, Ataxia. D.Tinnitus, Nausea/Vomiting. 8- What is the correct treatment for acute salicylate poisoning? Select one: A.insulin 1U per kg/hour. B.Urinary alkalinization.  C.acetylcysteine PO, Loading dose 140 mg/kg Maintenance dose 70 mg/kg every 4 hours for 17 doses. D.Calcium chloride 1000 mg IV. 9- With Protocol for Urinary Alkalinization in Adults all are correct except one Select one: A.infuse 100 mEq of sodium bicarbonate mixed with 1 L of D5W at 250 ML/h. B.Administer a 1 to 2 mEq/kg IV sodium bicarbonate bolus. C.Don't correct existing hypokalemia D.Monitor serum potassium and bicarbonate every 2-4 hours to detect hypokalemia or excessive serum alkalinization. 10- Semi-synthetic opioids are: Select one: A.Codeine, Morphine. B.Fentanyl, Methadone C.Buprenorphine Hydrocodone. 11- Synthetic opioids are Select one: A.Codeine, Morphine. B.Fentanyl, Methadone. C.Buprenorphine, Hydrocodone. 12- How Do you treat a Patient with Ethylene Glycol or Methanol Toxicity? Select one: A.Fomepizole, ethanol, hemodialysis. B.Atropine, pralidoxime, methylene blue. C.Neostigmine, penicillamine, hemodialysis. D.Flumazenil, dimercaprol, hemodialysis. 13- Which one does not belong to the complications of urinary alkalinization? Select one: A.Hyperkalemia. B.Hypervolemia. C.Metabolic alkalosis. D.Hypokalemia. 14- Treatment of acute opioid poisoning is: Select one: A.Insulin 1 IU/kg per hour. B.Dimercaprol 5 mg im. C.Flumazenil 0.2 mg IV. D.Naloxone 0.4-2 mg IV. 15- Natural opioids are: Select one: A.Buprenorphine, Hydrocodone.  B.Codeine, Morphine. C.Fentanyl, Methadone. 16- Which characterises the third stage of acute acetaminophen poisoning? Select one: A.Anorexia, nausea, vomiting, malaise. B.Improvement in anorexia, nausea and vomiting abdominal pain, hepatic tenderness. C.Recurrence of anorexia, nausea, vomiting, Encephalopathy Anuria jaundice. D.Clinical improvement and recovery or deterioration deterioration to multiorgan failure and death. 17- Which symptom does not occur in intoxication with Beta blockers? Select one: A.Hypertension B.Atrioventricular block. C.Bradycardia. D.Hypotension. 18- What is the incorrect treatment for acute poisoning with- Beta blockers Select one: A.Crystalloids and vasopressors. B.Insulin 1 kg per hour with glucose. C.Glucagon 3-10-10 iv.  D.Methylene blue. 19- Which of the following is not correct when using activated charcoal Select one: A.The dose is 1g/kg. B.Ingestion within the previous hour of a toxic substance known to be absorbed by activated charcoal. C.it is safe to use in an unconscious patient. D.Activated charcoal does not effectively absorb metals, corrosives, and alcohol. 20- The correct treatment protocol for acute acetaminophen poisoning Select one: A.Acetylcysteine iv, Loading dose 75 mg/kg in 200 ml 5% dextrose in water infused over 60 min. Maintenance dose 25 mg 250m 5% dextrose in water infused over 4h(75 mg/ kg per hour) followed by 100 mg/kg 1000ml 5% dextrose in water infused over 16h , (6.25mg/kg per houre). B.Acetylcysteine iv Loading dose 150 mg/kg in 200 ml 5% dextrose in water infused over 60 min, maintaining dose 50 mg/kg in 250 ml 5% dextrose in water infused over 4h (12.5mg/kg per hour) followed by 100 mg/kg in 1000 ml 5% dextrose in water infused over 16 h, (6.25mg/kg per houre).  C.Acetylcysteine iv, single dose 150 mg/kg in 200 ml 5% dextrose in water infused over 60 min. D.Acetylcysteine iv, single dose 75 mg/kg in 200 ml 5% dextrose in water infused over 60 min. 21- The correct treatment protocol for acute acetaminophen poisoning: Select one: A.Acetylcysteine PO, Loading dose 140 mg/kg, Maintenance dose 70 mg/kg every 4 h for 17 doses. B.Acetylcysteine PO, Loading dose 70 mg/kg, Maintenance dose 35 mg/kg every 4 h for 17 doses. C.Acetylcysteine PO 140 mg/kg single dose. D.Acetylcysteine 70 mg/kg single dose. 22- Which symptom is not manifested during anticholinergic syndrome? Select one: A.Miosis. B.Altered mental status. C.Hyperthermia. D.Dry flushed skin. 23- in case of acute poisoning with salicylates, the following disorders of acid-base balance are classically manifested Select one:  A.Early respiratory alkalosis, followed by an elevated anion gap metabolic acidosis and possibly late respiratory acidosis. B.Early respiratory alkalosis, followed by an elevated anion gap metabolic acidosis and possibly late respiratory alkalosis. C.Early respiratory alkalosis followed by an metabolic alkalosis and possibly late respiratory acidosis. D.Early metabolic alkalosis, followed by an elevated anion gap metabolic acidosis and possibly late respiratory acidosis. 24- Which of the following does not apply Indications for Hemodialysis in Patients with Salicylate Poisoning? Select one: A.if standard therapy (eg, supportive measures, bicarbonate) fails. B.Salicylate concentration > 100 mg/dL (>7.2 mmol/L). C.Salicylate concentration >90 mg/dl. (6.5mmol/L) in the presence of normal Kidney function. D.Altered mental status New hypoxemia requiring supplemental oxygen. 25- What is the incorrect treatment for acute poisoning with calcium channel blockers? Select one: A.Digoxin Fab.  B.b. Crystalloids and vasopressors. C.Calcium chloride 1000 mg IV over 5 minutes D.Insulin 1 IU/kg per hour with glucose. 26- Which alcohol does not cause Wide Anion Gap metabolic acidosis? Select one: a. Ethylene Glycol. b. Ethanol c. Methanol 27- breakdown products of Methanol are: Select one: A.Acetaldehyde, Acetic Acid, Acetyl COA. B.Formaldehyde, Formic Acid. C.Glycolaldehyde, Glycolic Acid, Glyoxylic Acid, Oxalic Acid.