1.

A 21-year-old footballer presents to A&E

with a stabbing pain above his right knee
joint. He states the pain came on suddenly
while he was sprinting. On examination he
is unable to extend the leg and he walks
with a limp. There is suprapatellar swelling
and an absent knee jerk. What is the likely
diagnosis?
A Fracture of patella
B Injury to posterior cruciate ligament
C Tear of adductor magnus muscle
D Tear of biceps femoris muscle
E Tear of quadriceps tendon
2. During strenuous exercise, what else
occurs besides tachycardia?
A Rise in Paco2
B Increased stroke volume
C Rise in mixed venous blood O2 saturation
D No change to blood pressure
E Increased renal blood flow

1. Postoperative fluid therapy (1)

A 70 kg patient is 1 day following total hip replacement. He has not started eating
and drinking. He is being rehydrated with dextrose/saline (4 per cent dextrose and
0.18 per cent saline). Which one of the following best describes this type of fluid
therapy?
A. It is an inappropriate fluid therapy for a postoperative patient
B. It contains 120 mmol of Na+ ions
C. Potassium supplementation is not required
D. Its osmolality is almost isotonic with plasma (286 mOsm/kg)
E. It has a pH of 7.35
2. Intravenous access in the trauma patient
A 22-year-old man is admitted following a stab injury to the right groin. He is
bleeding profusely from the wound. His blood pressure is 80/40 mmHg and his
pulse is 140 beats/min. He is agitated and mildly confused. His skin is cool and
mottled. In this scenario, which is the best mode of fluid delivery?
A. Left subclavian central line
B. Long saphenous vein cut down
C. Right internal jugular approach central line
D. Left femoral long line
E. Two wide-bore cannulae inserted bilaterally to the antecubital fossae
3. Intravenous fluid management in the trauma patient
For the patient described in Question 2, which one of the following statements
regarding fluid resuscitation is most correct?
A. Hartmanns solution should not be used.
B. The best fluid replacement is cross-matched blood
C. It is mandatory to use colloid over crystalloid
D. Colloids are preferable to expand the intracellular volume
E. Crystalloids should be avoided as they may cause anaphylaxis