MCQ 2 Flashcards
(99 cards)
1
Q
- A five year old has had a tonsillectomy. Three hours later, the ward nurse calls you and states
that the patient is restless, his pulse rate is 160 beats per minute and the blood pressure is
85/45mmHg. Which of the following would be the most appropriate action to take?
A
Suction the patient’s throat to clear blood
2
Q
- A 25 year old man fell on his outstretched right hand. The injury most likely to occur is:
A
Scaphoid fracture
3
Q
- Non-union is seen frequently in the following fractures except:
A
Distal ulna
4
Q
- The goal attack in a netball match sustained a twisting injury to her left knee however was
able to continue playing until the end of the game. She noted swelling of the knee joint six
hours afterwards. Examination revealed an effusion. The most likely diagnosis is:
A
A torn meniscus
5
Q
- The following injuries are paired with their associated complications except:
A
Anterior dislocation of the shoulder and brachial artery injury - axillary nerve injury is
common; artery at risk of injury is the profunda brachii
6
Q
- In the third trimester of pregnancy, a 27 year old primigravid woman presented with oedema
of the fingers of both hands along with numbness in the radial three and a half digits. The
treatment of choice would be:
A
Splints
7
Q
- A sixteen year old girl slashed her wrist resulting in damage to the ulnar nerve. Which of the
following would she not be able to do?
A
Abduct the digits
8
Q
- A fourteen year old active footballer presents to you with pain on kneeling and whenever he
kicks or climbs stairs. Examination revealed prominent swellings at the anterior proximal
tibiae. Radiographs showed no abnormality. Which condition most closely fits the clinical
picture?
A
Patellar tendonitis - tendinopathy of the patellar tendon associated with activity-related
anterior knee pain, X-rays are usually normal
9
Q
- A seventy five year old man has noted that increasingly he is getting pain and numbness in
his lower limbs on walking and also on standing in line to collect his pension. His pain is
relieved by sitting down. His physical examination is entirely normal apart from mild back
discomfort. His condition is best attributed to:
A
Spinal stenosis
10
Q
- A twenty two year old rugby player fell on his left shoulder and was unable to move the arm,
primarily as a result of pain. He is seen supporting the elbow using the opposite hand and has
swelling of the shoulder joint. Which of the following is most likely?
A
Dislocation of the glenohumeral joint
11
Q
- A twenty two year old rugby player fell on his left shoulder and was unable to move the arm,
primarily as a result of pain. He is seen supporting the elbow using the opposite hand and has
swelling of the shoulder joint. Which combined radiographic views would give you most
information in treating this young man?
A
Anterior-posterior and axillary views
12
Q
- A twenty two year old rugby player fell on his left shoulder and was unable to move the arm,
primarily as a result of pain. He is seen supporting the elbow using the opposite hand and has
swelling of the shoulder joint. Assuming a diagnosis of anterior shoulder dislocation, what would
be the most common cause of recurrent dislocation of the joint?
A
Detachment of the glenoid labrum
13
Q
- A 45 year old man slips and falls onto his right shoulder. Plain radiographs show an anterior
shoulder dislocation. Which of the following neurovascular structures is most likely to be
injured?
A
Axillary nerve
14
Q
- A 45 year old man slips and falls onto his right shoulder. Plain radiographs show an anterior
shoulder dislocation. In order to reduce this dislocation, which of the following is the
recommended technique or procedure?
A
Kocher
15
Q
- A five year old boy fell off his bicycle and presents with pain and swelling of the right ankle.
X-ray shows a fracture line through the metaphysis and epiphysis of the ankle joint. Which
Salter-Harris classification best describes the appearance?
A
Type 4
16
Q
- A previously active 74 year old grandmother is brought to the emergency room by her family.
She had fallen at home that morning and, since then, had been unable to stand on her right leg.
You suspect a fracture of the neck of the right femur. Which of the following attitudes of the
affected limb would most strongly support this diagnosis?
A
Abduction and external rotation
17
Q
- A previously active 74 year old grandmother is brought to the emergency room by her family.
She had fallen at home that morning and, since then, had been unable to stand on her right leg.
You suspect a fracture of the neck of the right femur. Which of the following fracture types is
most likely to result in avascular necrosis of the femoral head as a complication?
A
Displaced subcapital
18
Q
- A previously active 74 year old grandmother is brought to the emergency room by her
family. She had fallen at home that morning and, since then, had been unable to stand on her right
leg. You suspect a fracture of the neck of the right femur. Which of the following
fracture-treatment option combinations is correct?
A
Subcapital - Dynamic hip screws
19
Q
- A previously active 74 year old grandmother is brought to the emergency room by her family.
She had fallen at home that morning and, since then, had been unable to stand on her right leg.
You suspect a fracture of the neck of the right femur. Which one of the following is not a
common complication of this condition?
A
Post-traumatic osteoarthritis
20
Q
- A previously active 74 year old grandmother is brought to the emergency room by her family.
She had fallen at home that morning and, since then, had been unable to stand on her right leg.
You suspect a fracture of the neck of the right femur. Which one of the following percent ranges
most accurately represents the survival rate for this condition at 1 year following injury?
A
60-80%
21
Q
- A 78 year old hypertensive and diabetic male stepped onto his porch, lost his balance and fell.
He was brought to the Emergency Department walking however he complained of pain in the
right groin. Examination revealed normal attitude of the lower limbs however he had some
discomfort on movement of the right hip joint. Radiographs of the pelvis were reported as normal.
The most appropriate line of management would be:
A
Discharge home with an outpatient appointment
22
Q
- A 25 year old male is seen in the emergency room of your hospital with a closed, undisplaced
fracture of the left tibia sustained in a motor vehicle accident. No other injuries are apparent. A
plaster back-slab is applied and the patient is allowed home with analgesics and a routine
appointment for clinic follow-up. However, he is brought back to the emergency room by his
family the following morning because he is found to be acting strangely and appeared confused.
On examination, he is found to be conscious but confused and marked tachypnoeic. Pulse is
100/min and blood pressure is normal. Which one of the following investigations should be
performed immediately?
A
Arterial blood gas analysis
23
Q
- A 25 year old male is seen in the emergency room of your hospital with a closed, undisplaced
fracture of the left tibia sustained in a motor vehicle accident. No other injuries are apparent. A
plaster back-slab is applied and the patient is allowed home with analgesics and a routine
appointment for clinic follow-up. However, he is brought back to the emergency room by his
family the following morning because he is found to be acting strangely and appeared confused.
On examination, he is found to be conscious but confused and marked tachypnoeic. Pulse is
100/min and blood pressure is normal. Which one of the following blood gas analysis would be
most supportive of a diagnosis of respiratory failure in this patient?
A
pH 7.0
paCO2(mmHg) 80
PaO2(mmHg) 30
HCO3(mmol/L) 25
24
Q
- A 25 year old male is seen in the emergency room of your hospital with a closed, undisplaced
fracture of the left tibia sustained in a motor vehicle accident. No other injuries are apparent. A
plaster back-slab is applied and the patient is allowed home with analgesics and a routine
appointment for clinic follow-up. However, he is brought back to the emergency room by his
family the following morning because he is found to be acting strangely and appeared confused.
On examination, he is found to be conscious but confused and marked tachypnoeic. Pulse is
100/min and blood pressure is normal. Which of the following skin conditions is classically
associated with this condition?
A
Petechial haemorrhages on the upper torso
25
137. The most likely injury in a 20 year old adult who falls on an outstretched arm is:
Scaphoid fracture
26
138. A 65 year old man with a recent diagnosis of myocardial infarction develops sudden
excruciating pain of the right lower limb. On physical examination, the right femoral pulse is not
felt. The blood pressure is 160/90mmHg and the pulse rate is 100/min. The most likely diagnosis
is?
Acute arterial embolus
27
139. A sixty five year old man is diagnosed with a carcinoma of the sigmoid colon. In regard to
large bowel cancer, all the following statements are correct except:
Tubular adenomas are more likely to become cancers than villous adenomas
28
140. A 25 year old woman with a strong family history of breast carcinomas presents with a 2cm
discrete mobile mass in the upper outer quadrant of the breast. The most likely diagnosis is:
Fibroadenoma
29
A 60 year old female on her way to work fell and sustained a displaced fracture of the
neck of the femur. What would be the most appropriate method of treatment?
Total hip
replacement
30
An 85 year old lady fell in her garden and sustained an intertrochanteric fracture of the
right femur. What would be the most appropriate treatment option?
Dynamic hip screw
31
What would be the chosen fixation method for a nine year old boy who fell out of a tree
and sustained a displaced, angulated fracture of the distal left radius and ulna?
Plaster of paris cast;
32
142. An unhelmeted 25 year old motorcyclist is involved in a road traffic accident. Physical
examination in Accident and Emergency reveals quadriplegia, drowsiness and bilateral tibial
fractures. Which of the following is most likely?
Bradycardia, hypotension and warm dry skin
33
143. An unbelted 25 year old man is involved in a road traffic accident. He presents with neck
pain. Which of the following parameters will guide your decision to do a cervical spine X-ray?
Neck pain
34
144. A 17 year old boy sustains a laceration to the face while involved in a fight. When seen one
hour after the incident, he was noted to be alert with stable vital signs. His only significant finding
was a 4cm jagged laceration to the left cheek with mild contamination. He recalls being
immunized as a child but has no recollection of booster injections. Which of the following
would be the most appropriate treatment to minimize the risk of tetanus?
0.5cc Tetanus toxoid intramuscularly
35
145. A 56 year old man is thrown violently against the steering wheel of his truck during a motor
vehicle crash. On arrival in the emergency department, he is diaphoretic and complaining of chest
pain. His blood pressure is 60/40mmHg and his respiratory rate is 40 breaths per minute. Which
of the following would best differentiate cardiac tamponade from tension pneumothorax as the
cause of his hypotension?
Breath sounds
36
146. A 56 year old man is thrown violently against the steering wheel of his truck during a motor
vehicle crash. On arrival in the emergency department, he is diaphoretic and complaining of chest
pain. His blood pressure is 60/40mmHg and his respiratory rate is 40 breaths per minute. After he
has been resuscitated he reports pain in his left hip and says that his knee struck the dashboard.
What is the most likely abnormality?
A posterior hip dislocation
37
147. A 56 year old man is thrown violently against the steering wheel of his truck during a motor
vehicle crash. On arrival in the emergency department, he is diaphoretic and complaining of chest
pain. His blood pressure is 60/40mmHg and his respiratory rate is 40 breaths per minute. After he
has been resuscitated he reports pain in his left hip and says that his knee struck the dashboard.
Apart from radiographs of his hip, what is the trauma series of radiographs that you should order?
C-spine, chest, pelvis
38
148. A 48 year old female is seen in your clinic with a three centimetre painless lump in the upper
aspect of her left breast which she had noted on bathing seven days previously. On examination,
the lump was noted to be firm and mobile with ill-defined edges and uninvolved overlying skin.
The most appropriate initial step in her management would be:
Mammography
39
149. A 21 year old medical student was involved in a motor vehicle accident one hour ago. He
presented with severe pains in the left leg. On examination his left leg was grossly swollen but no
deformity was noted. He had a palpable dorsalis pedis pulse. Which of the following is correct?
Measurements of compartmental pressures should be done
40
150. A patient who has survived a high speed automobile crash:
May have an aortic injury which can be occult
41
151. A 65 year old man trips at home and falls, striking his chin on a table. He is transferred to the
Teaching Hospital one week later where he is diagnosed to have an upper motor neuron
syndrome. Which of the following is most likely?
Spasticity, hyperreflexia and weakness
42
152. A 41 year old man falls down the stairs at a party. One week later, he develops low back pain
and leg symptoms and is diagnosed with a nerve root lesion. Which of the following best
describes his expected findings?
Lasague’s positive, weakness and extensor plantars
43
153. The following are features of plaster of Paris except:
Chemically it is hemi-hydrated calcium carbonate
44
154. The following are features of a torn anterior cruciate ligament except:
A negative Lachman’s test
45
155. An eleven month old child is brought to you by parents who are concerned about the bowing
of the legs. The most likely cause of this is:
Blount’s disease
46
156. A 20 year old man fell on the outstretched right hand and sustained an injury to the wrist.
Examination revealed tenderness in the snuff box and the radiographs showed no fractures. The
most appropriate next step would be?
A back slab and repeat X-rays in two weeks time
47
157. The appropriate period of initial immobilization for the treatment of this scaphoid fracture
should be:
8 weeks
48
158. After one year, the patient continued to have pain in the wrist. The most likely finding on
repeat radiographs would be:
Sclerosis of the distal pole the scaphoid
49
159. A 22 year old football player sustained an inversion injury to the right ankle. The most likely
ligament to be damaged is?
Anterior talofibular ligament
50
161. Appropriate prophylactic antibiotic for total hip replacement surgery would be:
Cefuroxime
51
162. The following can cause delayed/non-union of fracture except:
Pathological fracture
52
163. Organisms causing osteomyelitis in sickle cell anaemia
Salmonella
53
164. Osteosclerotic secondaries can arise from all except:
Renal carcinoma
54
165. Sunray appearance is seen in:
Osteogenic sarcoma
55
166. The average blood loss in a fracture shaft of femur is:
1 200 ml
56
167. A 20 year old female volleyball player has had 4 anterior dislocations within the past year.
You would recommend:
Shoulder surgery to correct laxity of the anterior capsule
57
168. Fat embolism: which statement is false?
Intravenous heparin is the mainstay of treatment
58
169. Compartment syndrome:
In head injured patients, compartment pressure monitoring is useful for establishing the
diagnosis
59
170. Pelvic fractures: which statement is true?
Can be associated with injury to the urethra
60
171. Fingertip injuries: which statement is true?
Conservative treatment is associated with a good outcome particularly in children
61
172. A closed Monteggia fracture should be treated with:
Long arm cast for 6 weeks
62
173. Colles fractures: all statements are true except:
Malunion is rare in conservative treatment
63
174. Paediatric supracondylar humeral fractures:
The brachial artery may be injured by the distal fragment
64
175. Humeral shaft fractures:
A broad arm sling is commonly employed in conservative treatment
65
177. An acute knee haemarthrosis following a non contact injury in a footballer:
Clinical examination accurately identifies the injury in >90% of cases irrespective of the
clinician’s experience
66
178. Femoral shaft fractures:
Open intramedullary nailing is the treatment of choice
67
179. Femoral neck fractures in the elderly:
A hemiarthroplasty is commonly accepted treatment for displaced intracapsular fractures
68
180. In patients with osteoarthritis:
The first carpometacarpal joint is frequently involved in middle aged women
69
181. Open fractures:
Skeletal stabilisation is an essential set in reducing the infection rate
70
182. Scaphoid fractures:
A Herbert screw can be used to stabilise these fractures
71
183. Osteoporosis:
Hip fractures in the elderly early a 30-35% 1 year mortality rate
72
184. Which is the commonest organism involved in acute otitis media?
H influenzae
73
185. Which of the following is not a well known presenting feature of nasopharyngeal carcinoma?
Facial nerve palsy
74
186. The commonest benign tumour of the parotid is:
Pleomorphic adenoma
75
187. Blast injury can cause damage in:
Lung
76
188. Felon is:
Terminal pulp space infection
77
189. First line treatment in multiple facial bone fractures is:
Airway maintenance
78
190. Regarding local anaesthetics:
Main toxic effects are seen on CVS and CNS systems
79
192. In the classification of nerve injuries a complete division of a nerve is known as:
Neurotemesis
80
194. A twenty five year old man was knocked off his motorbike and is found to have an inability
to supinate his extended right forearm. The most likely fracture to result in this would be:
Neck of the radius - the biceps brachii muscles are responsible for forearm supination;
they insert onto the radial tuberosity which is located dorsomedially on the radial neck
81
195. The radiographs of the hip joint of a sixty year old hypertensive female on diuretics showed
the following features: periarticular osteopenia, joint space narrowing and multiple cysts within
the femoral head. The most likely diagnosis is:
Rheumatoid arthritis
82
196. The following are injuries with their associated complications except:
Colles’ fracture and reflex sympathetic dystrophy
83
197. A five year old child with sickle cell disease presents with a fever, pain and swelling of the
distal right femur for three days. Blood cultures grew a gram positive organism. The most
appropriate choice of antibiotic would be:
Chloramphenicol
84
198. A twenty three year old female stuck her thumb with a pin from her infant’s diaper at the
interphalangeal joint. The thumb and hand in particular became swollen and painful. The most
likely diagnosis is:
Radial bursa infection
85
199. A twenty three year old female stuck her thumb with a pin from her infant’s diaper at the
interphalangeal joint. The thumb and hand in particular became swollen and painful. The
appropriate treatment would be:
Intravenous antibiotics
86
200. Likely causes of delayed union of fractures of the shaft of the femur:
Infection
87
201. Arthodesis of the knee joint:
Is the salvage for a failed total knee replacement
88
202. The whiplash syndrome:
Sometimes presents with blurred vision and dysphagia
88
203. The carpal tunnel syndrome:
Is associated with rheumatoid arthritis
89
204. Osteochondromas:
Have a 5% chance of malignant transformation - 5%-10% malignant transformation to
chondrosarcoma in patients with MHE
90
205. Chondrosarcomas:
Classically there is calcification within the lesions
91
206. Slipped upper femoral epiphysis:
May be associated with hypothyroidism
92
207. Acute haematogenous osteomyelitis:
Produces periosteal reaction by day five - changes may not be obvious until 5 to 7 days
from the onset in children and 10 to 14 days in adults.
93
208. Spinal shock:
Recovers faster with the use of steroids
94
209. Supracondylar fractures of the humerus:
Characteristically results from a fall on the elbow
95
210. The following are true of hallux valgus except:
Is seen commonly osteoarthritis - commonly seen in RA
96
211. Section of the common peroneal nerve results in all the following except:
Loss of inversion and dorsiflexion
97
212. A fourteen year old ballet dancer presents with pain in the anterior knee with difficulty
negotiating stairs. She has pain with prolonged sitting and squatting. She has no obvious
abnormalities on inspection. The most likely diagnosis:
Patellar tendinitis
98
213. A forty five year old male presents with an overnight history of pain and swelling of the right
great toe. The toe is warm and throbbing. His white cell count is found to be elevated and ESR is
increased. Uric acid is normal. The most likely clinical diagnosis is:
Septic arthritis
