MCEM Pathophysiology MCQ

MCEM Pathophysiology MCQ

1. Pancreatitis (a) Because the pancreas is located in the retroperitoneal space with a capsule, inflammation cannot spread easily.

True False

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.

True False

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 True FalseFat necrosis may cause hypocalcemia.(d) The incidence of acute pancreatitis is about 100 per 100,000 population. True FalseThe 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%.

True False

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. True False

(b) Jaw infection. True False

(c) Gastroenteritis. True False

(d) Hysteria. True False

(e) Drug reaction. True FalseThe 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. True FalseIn alcohol withdrawal syndrome autonomic hyperactivity peaks after 24-48 hours.(b) Mydriasis is not a feature. True False(c) Seizures usually occur between 2 and 3 days after stopping drinking. True FalseSeizures usually 6-48 hours after stopping drinking.(d) Delerium tremens has a mortality rate even when treated of 20%. True FalseThe treated mortality rate of delerium tremens is 5-15%. The untreated mortality rate of delerium tremens is 35%.(e) 15% of people in ethanol withdrawal go on to develop delirium tremens. True False5% 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. True False

(b) The chest X Ray would show cardiothoracic ratio less than 1:2. True FalseA cardiothoracic ratio less than 1:2 is normal.(c) ) Clinically cardiomegaly is suggested if the apex beat is more than 10cm from the midline. True False Clinically cardiomegaly is suggested if the apex beat is more than 10cm from the midline.(d) Is a characteristic finding in pericardial effusion. True FalseCardiac enlargement on CXR is a characteristic finding in pericardial effusion.


(e) May be a finding in cases of cardiomyopathy. True FalseCardiac 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. True FalseThe 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. True FalseThe 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 True FalseAt 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. True FalseThe 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).

True False

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. True FalseConn's syndrome is characterised by overproduction of aldosterone leading to sodium retention and potassium excretion. (b) Amiloride. True FalseAmiloride is a recognised cause of hyperkalaemia.(c) Suxamethonium. True FalseSuxamethonium is a recognised cause of hyperkalaemia.(d) Loop Diuretics. True FalseDiuretics are associated with hypokalaemia via secondary hyperaldosteronism.

7. Thrombolysis:(a) Streptokinase has more fibrin specificity than tissue plasminogen activator. True FalseStreptokinase 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. True FalseTenecteplase 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. True FalseHypotension is a common side effect of streptokinase therapy and occurs in about 10-15%. The infusion should be slowed. (d) Streptokinase activates plasminogen. True FalseStreptokinase activates plasminogen(e) Streptokinase is a polypeptide made from gamma-hemolytic Streptococcus cultures. True FalseStreptokinase 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 120-180ml/min.

True False

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 200-250ml/min.

True False

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 250-300ml/min.

True False

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.

True False


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.

True False

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. True False

(b) Vitamin C deficiency. True False (c) ) Vitamin k deficiency. True False

(d) ) Zinc deficiency. True FalseMild 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 infections, bullous pustular dermatitis, diarrhea, and alopecia. (e) Copper deficiency. True FalseOther 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. True FalsePatients 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. True FalsePatients 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. True False

(d) Salivation. True False

(e) Urinary retention. False True 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. True FalseCOPD is an example of obstructive lung disease. (b) The FEV1 is decreased. True FalseIn restrictive lung disease the FEV1 is decreased. (c) The FVC is normal or increased. True FalseIn restrictive lung disease the FVC is reduced.(d) The total lung capacity (TLC) is increased. True FalseIn restrictive lung disease the TLC is reduced. (e) The TLC in decreased. True FalseThe 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. True FalseThis may be partly due to dilution of the fracture haematoma by synovial fluid.(b) Fractures of osteoporotic bone. True False

(c) Fractures of the elderly. True False

(d) Compound fractures. True FalseCompound fractures often lead to delayed fracture healing.(e) Excessive mobility at the fracture site. True FalseExcessive mobility at the fracture site often lead to delayed fracture healing.

13. Causes of respiratory acidosis: (a) Obesity. True FalseObesity may cause respiratory acidosis. (b) Thoracic wall deformities. True FalseThoracic wall deformities may cause respiratory acidosis. (c) Neuromuscular disorders. True FalseNeuromuscular disorders may cause respiratory acidosis.(d) COPD. True FalseCOPD may cause respiratory acidosis. (e) Acute asthma. True FalseAcute 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. True FalseHyper-resonance of percussion note is a clinical sign of pneumothorax. (b) Decreased chest excursion. True FalseDecreased chest excursion is a clinical sign of pneumothorax.(c) Decreased breath sounds. True FalseDecreased breath sounds is a clinical sign of pneumothorax. (d) Auscultatory clicks. True False

(e) Hypotension. True FalseHypotension 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. True FalseIn many cases the chest X Ray appears normal.(b) Raised hemidiaphragm. True FalseA raised hemidiaphragm may be found in PE.(c) Abnormally decreased lucency due to increased vessels distal to the embolus. True FalseMay occasionally see abnormally increased lucency due to reduced vessels distal to the embolus. (d) 'Rat tail' appearance of pulmonary vessels on unaffected side. True False'Rat tail' appearance of pulmonary vessels on affected side. This is because of an abrupt cut off of pulmonary vessels. (e) Pleural effusion. True FalseOther 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.

True False

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 True False


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.

True False

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 True FalseTypically 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 True FalseThere 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.

True False

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. True FalseThe earliest symptom of acute mountain sickness is light-headedness and mild breathlessness. (c) Symptoms usually present at about 12 hours after arrival at altitude. True FalseSymptoms 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. True FalseMild 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. True FalseHypoxaemia 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.

True False

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. True FalseInfant 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. True FalseOxygenated 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

True False

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 True FalseTypically a R/IR ratio of 0.5 equates to approximately 100% SpO2

19. In exopthalmos due to graves disease: (a) May be unilateral. True FalseMay be both unilateral or bilateral.(b) Exopthalmos is present in the majority of patients with graves disease. True FalseAbout 85% of patients with thyrotoxicosis have exopthalmos.(c) Lid retraction is a characteristic finding. True FalseLid retraction in which the sclera are visible above the iris is a characteristic finding in exopthalmos.(d) May be present in euthyroid patients. True FalseThe patient may be euthyroid, hypothyroid or hyperthyroid.(e) Over 90% of patients steadily improve without treatment. False True FalseOften persists despite therapy.

20. Peritonsillar abscess: (a) Aspiration treats 85% of people effectively. True FalseAspiration treats 85% of people effectively. (b) Aspiration treats 100% of people. True False


(c) Puncture of the carotid artery is a known complication. True FalsePuncture of the carotid artery is a known complication.(d) Puncture of the vertebral artery is a known complication. True False

(e) Carotid artery is behind and medial to peritonsillar abscess. True FalseCarotid 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. True FalseUsually managed as an inpatient with IV gentamicin and ampicillin or a quinolone. (b) Chronic prostatitis requires anti-biotics for at least 10 days. True FalseUsually 1 month treatment with a quinolone. (c) Co-amoxyclav is the first choice antibiotic for chronic prostatitis. True FalseUsually a quinolone for 1 month. (d) Acute prostatitis is more common in younger men while chronic prostatitis is more common in older men.

True False

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.

True False

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 True FalseIn 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 True FalseHypoalbuminaemia 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.

True False

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. True FalseThe 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. True FalseThere 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. True FalseThere 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. True FalseIf 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.

True False

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. True FalseAnterior 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. True FalseHereditary Haemorrhagic Telangiectasia ( HHT ) is a rare cause of anterior epistaxis.(c) Direct pressure is usually all that is required for paediatric epistaxis. True FalseDirect pressure is usually all that is required for paediatric epistaxis. (d) Anterior epistaxis is usually bilateral. True FalseAnterior epistaxis is usually unilateral.(e) The sensation of blood in the back of the throat is more frequently associated with posterior epistaxis.

True False

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. True FalseCerebral blood flow is approximately 50ml/100g/min.Cerebral blood flow is approximately 12% of cardiac output(CO). (b) Is subject to autoregulation. True FalseCerebral blood flow is subject to autoregulation. (c) Decreases with hyperkalaemia. True FalseHyperkalaemia results in dilatation of cerebral blood vessels. (d) Is increased by 4% for each 0.1 kPa rise in PCO2. True FalseCerebral blood flow is increased by 4% for each 0.1 kPa rise in PCO2. (e) May be measured clinically by transcranial doppler measurement. True FalseCerebral blood flow may be measured clinically by transcranial doppler measurement.

26. Pulmonary Embolus(PE): a) Normal ABG excludes PE. True FalseFeatures on an ABG to suggest PE include low PCO2 (secondary to hyperventilation) and low PO2.(b) Low PaCO2 is a frequent finding. True FalseThis occurs because a patient with a PE is tachynoeic and 'blowing off' their CO2. (c) Mild metabolic acidosis is frequent. True FalseBecause 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. True FalseThis is clasical but uncommon. (e) Sinus tachycardia is frequently present on the ECG. True FalseSinus tachycardia is frequently present on the ECG.

27. Hand infection:(a) Staphylococcus and Streptococcus are the most common pathogens. True FalseStaphylococcus and Streptococcus are the most common pathogens. (b) Eikenella corrodens may infect human bite wounds. True FalseEikenella corrodens may infect human bite wounds. (c) Pasturella multocida may infect animal bite wounds. True FalsePasturella multocida may infect animal bite wounds(d) Abcesses sometimes require surgical drainage. True FalseAbscesses almost always require surgical drainage. (e) Staphylococcus aureus may be the pathogen in IV drug users. True FalseStaphylococcus 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. True FalseTroponin T may stay elevated for 10-14 days. (b) CK is elevated in stable angina. True FalseCK is normal in stable angina. (c) With stable angina there will be regional wall motion abnormality on an ECHO scan. True FalseWith 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. True FalseWith 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. True False60% 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. True False

(b) PR segment is isoelectric. True False

(c) ST segment elevation >5mm. True False

(d) Mild reciprocal changes in VI and AVR only. True False

(e) ST segments diffuse over most leads. True False

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. True FalseType 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. True FalseMost 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 True FalseIt 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. True FalseThe 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.

True False

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. True FalseGangrene is most commonly because of the failure of blood supply to the tissues. (b) Can result from trauma. True FalseGangrene can result from trauma. (c) Infection is the cause in gangrenous appendicitis. True FalseInfection is the cause in gangrenous appendicitis. (d) Dry gangrene spreads rapidly. True False

(e) There is almost always infection in wet gangrene. True FalseThere 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. True FalseExercise ECG is more likely to give a false positive result in women. (b) Regular exercise will reduce the risk. True FalseModerate excercise of about 30min on most days of the week is needed. (c) Smoking is the leading preventable cause. True FalseRisk disappears 3 to 5 years after stopping smoking. (d) Isolated systolic elevation is not a risk factor. True FalseTreating systolic blood pressure of greater than 160 reduces the risk by 25%. (e) The oral contraceptive pill is a major risk factor. True FalseNo evidence that it increases the risk of coronary artery disease.

33. Serum urea level is increased by: (a) Infection True FalseInfection increases catabolism and this increases production of urea. (b) Tetracyclines True FalseTetracyclines increase production of urea. (c) Old Age True FalseOld Age is a form of reduced catabolism and this decreases urea production. (d) Dehydration True FalseIn dehydration there is a decreased renal blood flow(e) Hypotension True FalseIn hypotension there is a decreased renal blood flow.

34. Swallowed Foreign Body: (a) About 10% of swallowed objects require intervention. True FalseAbout 10% of swallowed objects require intervention.(b) Most paediatric obstructions occur in the proximal oesophagus. True FalseMost paediatric obstructions occur in the proximal oesophagus.(c) The majority of adults presenting with foreign bodies are also caught in the proximal oesophagus. True FalseThe 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. True FalseThe 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 True FalseObjects are likely to have the most difficulty traversing the pylorus

35. Transudate ascites:(a) Have <30g protein/litre fluid. True FalseTransudate ascites have <30g protein/litre fluid. (b) Are caused by cirrhosis. True FalseTransudate 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. True False

(d) Are caused by hypoalbuminaemia. True False

(e) Are caused by pancreatitis. True False

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. True FalseThe 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. True FalseThe hand position of function for splinting includes the MCP joint being at 50 to 90 degrees flexion.(c) The hand position of function for splinting includes PIP joints in 10 to 15 degrees of extension. True FalseThe 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.

True False

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 True False

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

Documents

Transcript of MCEM Pathophysiology MCQ