MCQ

Question 1

Bleeding can result from disseminated intravascular coagulopathy due to:
A : consumption of coagulation factors and increased fibrinolysis
B : consumption of thrombocytes
C : inflammatory mediated haemolysis
D : excessive production of thrombin

Answer 1

A

Question 2

Pressure-induced injury (pressure sores) are primarily due to:

A : prolonged pressure applied to the skin
B : inflammation induced excessive capillary permeability
C : friction caused when moving patients
D : moisture against the skin through sweating or incontinence

Answer 2

A

Question 3

Erythema, oedema and unusually severe pain are signs of:
A : diabetic ulcers
B : furuncle
C : pressure sores
D : necrotising fasciitis

Answer 3

D

Question 4

Characteristics of a full thickness burn include:

A : blisters on the epidermal layer
B : dry, intact and reddened skin
C : dry, leathery skin with muscle and bone involvement
D : white to red skin with intense pain

Answer 4

C

Question 5

The severity of electrical burns is difficult to assess because:
A : electricity causes widespread superficial skin burns
B : the burns are not generally visible in the first hour after injury
C : electricity does not tend to cause thermal injuries
D : external injury is a poor determinate of the extent of internal damage

Answer 5

D

Question 6

Radiation sickness has which characteristic clinical signs?

A : muscle fasciculation’s and cramps
B : bleeding from mucosa, nausea and vomiting
C : cardiac arrhythmia and dyspnoea
D : hyperthermia and coma

Answer 6

B

Question 7

Inhalation injuries affecting the bronchial tree and alveoli are most likely to result from:

A : poisoning from cyanide
B : thermal injury to the mucosa
C : inhalation of carbon monoxide
D : aspiration of acids, alkali or hydrocarbons

Answer 7

A OR C

Question 8

In the initial phase of a major burn, hypovolaemic shock is complicated by:

A : inflammatory response causing distributive shock
B : hypokalaemia
C : haemodilution due to red blood cell loss
D : sodium mediated diuresis

Answer 8

A

Question 9

Severe circumferential burns have a high risk of causing:

A : bone infections due to damaged periosteum
B : flaccid paralysis due to nerve damage
C : deep vein thrombosis due to haemostasis
D : compartment syndrome due to the pressure in underlying tissues

Answer 9

D

Question 10

A serious consequence of thrombocytopenia is:

A : renal failure
B : infection
C : bleeding
D : hepatitis

Answer 10

C

Question 11

Polycythaemia increases the risk of:

A : malignancies
B : thrombo-emboli
C : vascular injury
D : haemorrhage

Answer 11

B

Question 12

Which of the following is a true medical emergency arising from pathophysiology of the blood?

A : polycythaemia
B : chronic leukaemia
C : neutropenic sepsis
D : macrocytic anaemia

Answer 12

C

Question 13

Acquired immunodeficiency syndrome (AIDS) is defined as the presence of a human immunodeficiency virus infection and:

A : opportunistic illnesses
B : symptoms of fever and fatigue
C : high white cell count
D : systemic inflammatory reactions

Answer 13

A

Question 14

Metastases describes:

A : a tumour which has spread from its original site
B : a benign growth
C : an irregular boundary that does not infiltrate neighbouring tissue
D : a rapidly growing tumour in a single site

Answer 14

A

Question 15

When caring for a patient who is receiving chemotherapy, it may be necessary to use reverse barrier infection control to:

A : protect the patient exacerbation of a pre-existing infection
B : protect yourself from infection
C : protect the patient from infection
D : protect the next patient in the ambulance from infection

Answer 15

C

Question 16

A chronic lymphocytic leukaemia patient is at risk of:

A : anaemia
B : immunodeficiency
C : thrombocytopenia
D : neutropenia

Answer 16

B

Question 17

A patient with anaemia may present with which symptom?

A : low oxygen saturations
B : dyspnoea
C : frequent bruising
D : oedema

Answer 17

B

Question 18

Which of the following hormones is secreted by the anterior lobe of the pituitary gland?

vasopressin
oxytocin
anti-diuretic hormone
thyroid stimulating hormone

Answer 18

thyroid stimulating hormone

Question 19

The brain is highly sensitive to a low blood glucose level because:
neurons have high levels of insulin resistance
hypoglycaemic induced alkalosis causes neuronal dysfunction
neurons cannot utilise anaerobic metabolism
neurons have limited capacity to store glycogen.

Answer 19

neurons have limited capacity to store glycogen.

Question 20

After treating a patient with hypoglycaemia, they recover fully and elect to stay at home. You should ensure:

the patient eats some complex carbohydrates and has a responsible person with them
the patient will give themselves an extra unit of insulin after their next meal
the patient has a supply of glucagon to administer later that day
the patient must go to hospital because you have a duty of care

Answer 20

Complex carbohydrates and a responsible person

Question 21

You attend a 20-year old male with Type 1 Diabetes who has been on a football trip. He has been drinking heavily, has forgotten to take his insulin and now feels unwell. What signs and symptoms would he most likely be presenting with?

A : hypoglycaemia, diaphoresis and bradycardia
B : pale, diaphoretic skin, bradycardia and urinary retention.
C : hyperglycaemia, hot dry skin and polyuria
D : hyperglycaemia, urinary retention and bradypnea

Answer 21

C

Question 22

You are called to an 82-year old female who has dyspnoea, a productive cough, a temperature of 38.6 degrees, and generalised aches and lethargy. On examination, you find her BGL is 16.2mmol/L. Her medical history reports no diabetes. Her BGL could be accounted for by:

A : oxidative stress due to an infection
B : pancreatitis stimulating excessive glucagon release
C : catecholamine and glucocorticoid hormone mediated glycogenolysis.
D : inflammation induced insulin resistance

Answer 22

D

Question 23

In a patient with poorly managed Type 2 Diabetes, the glomerulus is at risk of chronic degradation causing renal impairment. This is because the cells of the glomerulus:
A : are resistant to insulin due to an impaired GLUT 4 receptor response
B : are highly sensitive to acidosis
C : are insulin independent and cannot regulate glucose influx
D : become glucose depleted impairing function

Answer 23

C

Question 24

Acidosis in a diabetic person is a result of:
A : acute renal impairment resulting in poor pH buffering
B : formation of acids by the catabolism of excessive glucose
C : utilisation of fats for metabolism resulting in the formation of ketones.
D : acetic acid formation due to impaired metabolism

Answer 24

C

Question 25

When treating a patient in the pre-hospital setting with severe hyperglycaemia you should: A : consider IV fluids and complete a 12-lead ECG B : give immediate IV glucose C : infuse at least one litre of normal saline rapidly and administer IM glucagon| D : encourage the patient to self-administer a second dose of their insulin.

Answer 25

A

Question 26

Which of the following statements regarding a person with diabetes is false: A : a type 2 diabetic patient may need supplementary insulin. B : metformin is a useful drug for stimulating insulin sensitivity C : sulfonylurea medication cannot induce hypoglycaemial D : a person with gastroenteritis should consider reducing their insulin doses

Answer 26

C

Question 27

Pheochromocytoma is a tumour on the adrenal gland. The best management of a patient pre-hospital with this condition is: A : administer a fluid bolus, IV dextrose and give aspirin to prevent a stroke B : keep patient warm, restrict fluid intake and administer GTN for Angina. C : administer atropine and IV fluids to treat bradycardial D : reduce stressful stimuli, 12-lead ECG and check BGL

Answer 27

D

Question 28

Goitre and ophthalmopathy are signs of which disorder? Addison's disease acromegaly. Grave's disease. myxoedema comal

Answer 28

Grave's disease.

Question 29

A thyroid crisis (storm) is a life-threatening manifestation of hyperthyroidism. Which of the following clinical features would you expect? A : bradycardia, hyperthermia and hypertension B : tachycardia, hyperthermia and hypotension C : tachycardia, hyperthermia and hypertension D : bradycardia, hypothermia and hypotension.

Answer 29

C

Question 30

Which of the following are clinical signs of Cushing's syndrome? A : excessive bone growth and heart failure B : osteoporosis and cold intolerance C : hypertension and hyperglycaemia D : severe dehydration and hypernatraemial

Answer 30

C

Question 31

Addison's disease is caused by which hormonal abnormality? hypersecretion of aldosterone hyposecretion of catecholamines hyposecretion of cortisol hypersecretion of thyroid stimulating hormone

Answer 31

hyposecretion of cortisol

Question 32

A patient with myxoedema coma should be managed by: A : cooling the patient and keeping stimulation to a minimum. B : rapidly infusing IV fluids and IV dextrose C : keeping the patient warm and ensuring adequate hydration. D : restricting fluid intake and administering GTN for pulmonary oedema

Answer 32

C - Myxedema coma is a severe form of hypothyroidism and requires careful management to maintain body temperature and hydration. Warming the patient is important because they are often hypothermic, and ensuring adequate hydration helps to support overall physiological function. Other supportive measures include thyroid hormone replacement therapy.

Question 33

Infarction of the pituitary gland may cause cardiovascular collapse due to: A : excessive adrenal response B : excessive antidiuretic hormone and parathyroid secretion. C : loss of both antidiuretic and adrenal responses D : loss of both aldosterone and oxytocin secretion

Answer 33

C

Question 34

Prednisolone is sometimes prescribed for inflammatory disorders. If a patient suddenly stops taking prednisolone, they may suffer symptoms similar to: Grave's disease Cushing's syndrome hypothyroidism Addison's disease

Answer 34

Addison's disease

Question 35

Hyperaldosteronism is a disorder which may be caused by adrenal cancer. It can cause cardiac arrhythmias due to: sodium loss metabolic acidosis potassium loss tetany

Answer 35

potassium loss - excessive aldosterone leads to increased reabsorption of sodium and increased excretion of potassium in the kidneys. This can result in hypokalemia (low potassium levels), which is a known cause of cardiac arrhythmias. The other options (sodium loss, metabolic acidosis, and tetany) are not directly related to the arrhythmias associated with hyperaldosteronism.

Question 36

Conditions related to increase parathyroid hormone

Answer 36

4 parathyroid glands 2 on either side of the thyroid gland The parathyroid gland releases parathyroid hormone increases calcium levels to increase bone reabsorption by osteoclasts, increases renal reabsorption and increases intestinal absorption via the stimulation of vitamin D3 synthesis. Parathyroid gland releases calcitonin to decrease plasma calcium levels. This reduced bone resorption and reduces renal reabsorption. Hypercalcaemia : too much calcium due to increase release of parathyroid hormone Clinical presentation : - Bones : abnormal bone resorption hence the bones remodel – very painful - Stones : kidney stones due to increased calcium ions clump together and begin to form crystals - Groans : abdominal pain - GI symptoms, nausea and vomiting, constipation, indigestion - Psychiatric moans : disrupt nervous system, NT release and neuronal signalling (↑ lethargy, fatigue, memory loss, psychosis, depression) Hypocalcaemia : not enough calcium due to increase levels of calcitonin – lack of vitamin D3 Clinical presentation : - Muscle aches - Thyroid spasms

Question 37

Hormones secreted in response to reduce blood volume and their actions

Answer 37

ADH : antidiuretic (against, urine production) hormone is released in response to reduced blood volume ADH is a vasopressin When there is decrease blood volume it means there is increased plasma osmolarity hence increased concentration of solutes - Reduced blood volume = Increased plasma osmolarity = ↑ concentration of solutes ADH is released from the posterior pituitary gland in response to a stimuli of decreased blood pressure, decreased atrial stretch or an increase osmolarity (detected by the osmoreceptors). ADH is synthesised in the hypothalamus but secreted by the posterior pituitary gland into the blood stream. The 2 different process to increase BP by ADH 1. Baroreceptors in the aortic arch : triggers aquaporins to open their channels and allow water to cross the membrane and enter the bloodstream causing an increase in blood pressure 2. Baroreceptors in the kidneys : cause the RAAS system angiotensin 2 to increase ADH secretion • increasing the water reabsorption from the kidneys back into the bloodstream • vasoconstriction of the peripheries hence increasing peripheral vascular resistance