CAPÍTULO I. MARCO TEÓRICO
1.3 Bases teóricas
1.3.7 Chanchamayo, Junín
D. Empyema is often loculated and seen as a pleural-based collection
4. Regarding life-threatening massive haemoptysis in an elderly patient, which ONE of the following statements is TRUE?
A. Selective intubation of the bleeding lung may be attempted
B. If the bleeding side can be identified, the patient should be positioned with that side down
C. Exsanguination is the usual cause of death D. 90% of bleeding originates from systemic circulation
5. Regarding a patient presenting to the ED with haemoptysis, which ONE of the following statements is TRUE?
A. CXR is usually normal in most patients with lung malignancy
B. PE is a common cause of severe haemoptysis C. Early bronchoscopy,within the first 48 hours, is more valuable in identifying the bleeding site than late bronchoscopy
D. When it is associated with right upper lobe collapse on CXR, it is usually due to pneumonia 6. Regarding the diagnosis and management of pertussis which ONE of the following is TRUE?
A. Positive serology (IgM) is the gold standard for diagnosis
B. Maternal antibodies produce robust protection for infants in the first 6 months of life
C. Treatment with macrolide antibiotic shortens the clinical course but does not alter the transmission rate
D. The illness is highly communicable early in the illness with attack rates of 75–100% from symptomatic individuals to susceptible contacts 7. Regarding assessment of severity of a patient with community-acquired pneumonia (CAP) in the ED, which ONE of the following statements is TRUE?
A. Assessment based on a single validated severity scoring system is often adequate
B. The SMART-COP score identifies patients who require ventilatory and haemodynamic support Waruna de Alwis and Sean Lawrence
QUESTIONS
QUEsTions 19
C. Pneumonia severity index (PSI) mainly predicts clinical deterioration in patients with CAP
D. Determining the severity of CAP is useful in distinguishing typical from atypical aetiology
8. Regarding use of blood culture and sensitivity in a patient with CAP, which ONE of the following
9. Regarding the aetiological diagnosis of CAP, which ONE of the following statements is FALSE? assay where Streptococcus pneumoniae is suspected
D. Throat swab polymerase chain reaction (PCR) is useful to identify a virus aetiology
10. Regarding pneumonia caused by Staphylococcus aureus, all of the following statements are correct 11. Regarding pneumonia caused by methicillin-resistant S. aureus (MRSA), all of the following statements are correct EXCEPT:
A. It is more likely to be present as severe CAP in children and young adults
B. It should be suspected when it is associated with a history of furunculosis or folliculitis
C. It is caused by community-associated S. aureus strains in many parts of Australia D. S. aureus is the most common causative pathogen a previous Pseudomonas aeruginosa infection if present
20 CHAPTER 3 REsPiRAToRy EmERgEnCiEs
16. It is often difficult to identify a pneumothorax on a supine CXR in a ventilated patient. All of the following signs on the CXR suggest the presence of
pneumothorax EXCEPT:
A. Deep sulcus sign at costophrenic angle B. A sharp outline of the pericardial fat (pericardial fat pad sign)
C. Oligaemic lung field
D. Lucency over liver and upper abdomen not explained by an abdominal structure
17. Regarding the diagnosis of a spontaneous pneumothorax in a patient with severe chronic obstructive pulmonary disease (COPD), which ONE of the following statements is TRUE?
A. Expiratory films are more sensitive than inspiratory films
B. A bulla can be differentiated from a
pneumothorax on CXR because the bulla has a concave inner margin but pneumothorax does not C. CXR is equally sensitive as CT for detecting a pneumothorax
D. Differentiation between a large bulla and a pneumothorax is not important because both can be drained using the same principles
18. All of the following statements are correct regarding detection of a pneumothorax in a supine patient using bedside ultrasound in the ED EXCEPT:
A. The ‘lung point’ sign when present is highly specific for a pneumothorax
B. The lung sliding cannot be seen with a linear or curvilinear probe when there is a pneumothorax C. The comet tail artefacts are due to
pneumothorax
D. A horizontal linear pattern both superficial and deep to the pleural line on M-mode indicates a pneumothorax
19. Regarding management of a patient presenting with a first episode of primary spontaneous
pneumothorax, which ONE of the following statements is TRUE?
A. 100% oxygen treatment prevents reexpansion pulmonary oedema
B. Supplemental oxygen increases the pressure gradient for nitrogen from pleural space (pneumothorax) to alveoli
C. Chest tube drainage is more effective than aspiration
D. Aspiration has been shown to be equally successful across all age groups
20. Regarding the selection of an appropriately sized intercostal catheter or tube when treating a spontaneous pneumothorax, which ONE of the statements is TRUE?
A. Size should be based on the anticipated amount of air leak from the lung because a smaller sized tube could cause a tension pneumothorax B. Smaller tubes should be selected to prevent scarring at the insertion site
C. Inserting a larger tube is not indicated in the management of a spontaneous pneumothorax D. The catheter or tube diameter is indicated in French sizes where 1 French equals 1 mm 21. Regarding reexpansion pulmonary oedema following treatment of a spontaneous pneumothorax, all of the following statements are true EXCEPT:
A. It usually occurs with needle aspiration
B. There is a high risk in a patient who presents late with a larger pneumothorax
C. Treatment includes aggressive fluid resuscitation D. Intubation and ventilation may be needed for severe hypoxaemia
22. Which ONE of the following factors is LEAST likely to predict the risk for a fatal or near-fatal episode of asthma?
A. A life-threatening admission within the previous 12 months
B. Arterial desaturation
C. Normal PaCO2 on ABG analysis D. Current use of corticosteroids
23. Regarding bronchodilator therapy in severe asthma, which ONE of the following statements is TRUE?
A. Intravenous adrenaline infusion is preferable to nebulised salbutamol in life-threatening asthma B. Intravenous salbutamol causes significant reduction of airway oedema
C. The only indication for intravenous salbutamol therapy in adults is a critically unwell asthma patient who cannot effectively have inhaled therapy
QUEsTions 21
D. Up to 50% of the salbutamol dose placed in the chamber is delivered to the bronchioles during nebulisation therapy
24. Regarding the use of magnesium sulphate in severe asthma, which ONE of the following statements is TRUE?
A. The greatest response to intravenous magnesium sulphate is seen in patients with the most severe bronchospasm compared with less severe bronchospasm
B. It reduces the rate of hospital admission in severe asthma
C. Nebulised therapy is as effective as intravenous magnesium sulphate
D. It is not recommended for use in children 25. Regarding intubation of a patient with severe asthma, which ONE of the following is the MOST appropriate option?
A. Intubation of a patient with a normal level of consciousness and severe hypercapnoea and fatigue
B. Intravenous fluid bolus prior to intubation and careful adjustment of the induction dosage
C. Use of ketamine 1–2 mg/kg alone without use of a paralytic agent
D. Brisk bagging using bag–valve–mask ventilation prior to induction and soon after intubation to maintain oxygen saturation
26. Regarding invasive ventilation of a patient with severe life-threatening asthma, all of the following statements are correct EXCEPT:
A. A tidal volume of 5–6 mL/kg is recommended B. The ventilator graph should show expiration to be complete before the next breath is delivered C. Hypercarbia is generally not detrimental except in patients with myocardial dysfunction
D. Pressure control ventilation is considered ideal 27. Regarding the management of acute asthma in adults, which ONE of the following is TRUE?
A. High-inspiratory flow rates are recommended in patients requiring mechanical ventilation
B. Measurement of plateau pressures is not helpful in ventilated asthmatics because dynamic
hyperinflation makes the reading unreliable
C. Non-invasive ventilation (NIV) should currently be avoided because available evidence suggests it is associated with poorer outcomes
D. Parenteral (IV) salbutamol has no benefit over continuous nebulised salbutamol
28. A young adult male was intubated in the ED for a near-fatal asthma episode. A few minutes after connecting to the ventilator, significant oxygen desaturation was observed on the monitor. If the ventilator, ventilator circuit, oxygen delivery and tube placement are found to be functioning well and correct, which ONE of the following statements is TRUE regarding the patient’s hypoxaemia?
A. CXR alone cannot exclude a pneumothorax when it’s due to barotrauma
B. Dynamic hyperinflation is not usually contributory C. Suction may cause further bronchospasm and worsen hypoxaemia
D. Mucus plugging is often the cause 29. Regarding the treatment of acute asthma in children, which ONE of the following is TRUE?
A. Evidence suggests that intravenous salbutamol is the parenteral bronchodilator of choice for life-threatening asthma due to its minimal side effect profile
B. Salbutamol administered via nebuliser has a higher incidence of side effects than when administered via a metered dose inhaler (MDI) and spacer
C. Aminophylline has no role in the management of acute severe asthma
D. NIV is not indicated in children with severe asthma because it does not alter outcomes 30. Regarding the management of acute severe exacerbation of COPD, all of the following statements are correct EXCEPT:
A. Spirometry should be obtained in all patients on presentation
B. ABGs are not routinely required
C. A hypoxic patient should be treated with nasal prong oxygen at 0.5–2.0 L/min or a Venturi mask at 24% or 28%
D. 5 mg of nebulised S-salbutamol is equivalent to 10 puffs of 100 mcg salbutamol delivered with an MDI and a spacer
22 CHAPTER 3 REsPiRAToRy EmERgEnCiEs
B. A very low B-type natriuretic peptide (BNP) <
100 pg/mL is useful in excluding coexistent
QUEsTions 23
D. When pretest probability is lower than the testing threshold, the potential harm to the patient may be more than the benefit of a diagnostic test
39. Regarding management of a haemodynamically stable patient with acute PE, which ONE of the following statements is TRUE?
A. Unfractionated heparin should be given for a patient with creatinine clearance of 40 mL/min B. Unfractionated heparin should be used in pregnancy in place of low molecular weight heparin C. Warfarin should be commenced preferably on the first day of treatment and should be continued for at least 3 months
D. Low molecular weight heparin is the appropriate treatment in morbid obesity
40. Regarding DVT affecting the upper extremity, which ONE of the following statements is TRUE?
A. Patients are more likely to have cancer than patients with a DVT of the legs
B. It is not associated with PE
C. In suspected patients with low pretest probability, a D-dimer test is as reliable as in DVT of the legs for screening
D. Up to 20% of the cases are due to secondary causes such as central venous lines, pacemaker or defibrillator leads and malignancy
24 CHAPTER 4 NEuRologiCAl ANd NEuRosuRgiCAl EmERgENCiEs
1. Which ONE of the following features is LEAST likely to be helpful in making a clinical diagnosis of migraine?
A. A gradual onset hemiparaesthesia preceding or accompanied by headache that lasts <60 minutes B. Onset of lethargy and yawning a few hours before the onset of headache
C. Bilateral headache
D. External ocular muscle palsy associated with headache
2. Which ONE of the following statements is TRUE regarding a patient aged over 50 years who presents to the emergency department (ED) with a severe headache?
A. The occipitonuchal location of the headache has a high positive predictive value (PPV) for a critical secondary cause
B. Ischaemic optic neuritis can be a complication in this patient
C. Headache onset associated with exertion is not a predictor of subarachnoid haemorrhage
D. Secondary causes of headaches are more common in this age group than primary causes 3. Regarding secondary causes of headache, all of the following statements are true EXCEPT:
A. Pregnancy and the postpartum period increases the risk for cerebral venous thrombosis
B. Abnormal findings on neurological examination are present in the majority of patients with brain tumours
C. Diastolic hypertension is a recognised cause of severe headache
D. 10–25% of ischaemic stroke in the young and middle-aged population is secondary to
spontaneous cervical arterial dissection
4. Regarding temporal arteritis, all of the following statements are correct EXCEPT:
A. It is almost exclusive to the over-50 age group B. The classic headache is an essential diagnostic criterion
C. Jaw claudication may be a prominent feature D. Scalp necrosis may be found on examination