ACUTE CARE WRITTEN PAPER (OCTOBER 2016)

*Those havent type your question, can claim your questions here if you think that
question is your question. TQ. bye

Old man, come in with hematoma over the back of head, still able to give history, on
dabigatran for AF. what you do next?
A. Send to resuscitation hall
B. Send to yellow zone
C. Send to green zone
D. Secondary triage and take vital signs
E. ??

Young lady drink half a cup bleaching agent, tell you she was forced to come here. She
told she was normal. What you do next?
A. Send to resuscitation hall
B. Send to yellow zone
C. Send to green zone (psychiatric unit)
D. Secondary triage
E. Discharge her home

10. Which of the following is indication of severe dengue?

A. Presence of gum bleeding
B. Coffee ground vomitus in NG tube
C. Persistent vomiting
D. Rapidly reduced platelet count
E. Positive HESS test

Which of the following has the highest risk of aspiration?

A. A pregnant lady that is electively admitted for Caesarean section under general
anaesthesia
B. An obese lady with history of GERD undergoing …. under LA
C. A young man undergoing anterior cruciate ligament repair under spinal block

Which of the following indicate organ dysfunction?

A. Concentrated urine
B. Agitation
C. Postural Hypotension
D. Delayed capillary refill time
E. Tachypnea

Patient suddenly develop AF after induction. Despite fluid resus, his BP is still
80/40mmHg. What is the most appropriate first line treatment?
A. Electronic cardioversion
 B. Esmolol??
C. Adenosine

Patient have chest pain and lightheadedness. SPO2 98%. BP low. Given fluid?????What
you should do next?
A. Maintain organ perfusion with fluid resuscitation
B. Give oxygen??
C. Give inotropes

?Age/Man, presented with colicky abdominal pain, multiple vomiting, LOA and poor fluid
intake due to vomiting (?duration). PU 2x/day. No bowel motion. SpO2 ?, Tachycardia,
blood pressure within normal limit, dry mucous membrane, CRT 3sec.
A. Intestinal obstruction with less than 5% dehydration
B. Intestinal obstruction with 5-10% dehydration
C. Intestinal perforation with 5-10% dehydration
D. Intestinal obstruction with 15-30% dehydration
E. Intestinal perforation with 40% dehydration

1. Chest injury in adult commonly present with rib fracture associated with
pneumothorax. However, which of the following options is the most common injury in
blunt chest trauma among paeds age group?
A. Pulmonary contusion
B. Mediastinal injury
C. Flail chest
D. Rib fracture
E. Tension pneumothorax

2. All are signs of Cardiac tamponade except :

A. Hypotension
B. Kussmaul's sign
C. Muffled heart sound
D. Bradycardia
E. distended neck vein

3. Disaster is an ecological phenomenon with sufficient magnitude that require an

external assistance. Among the options below, which does not need to be relayed to
medical base by the first responder?
A. The best route to be accessed by the team
B. Hazard present in the incident site
C. Number of casualties
D. Precise location of the incident
E. Type of injuries sustained by the casualties
4.A man was found had loss of consciousness by his neighbour. He was sent to
emergency and he smell taken alcohol
Urea increase, creatinine increase, lactic increase, CK increase
Urine - blood positive and protein positive
What did the diagnosis for the patient?
A. Acute glomerulonephritis
B. Focal segmented glomerulosclerosis
C. Allergic induced glomerulonephritis
D. Rhabdomyolysis
E. Acute cystitis

5. You are waiting for your relative at airport. Suddenly a middle-aged man who is sitting
next to you stumble to the floor and become unconscious. What would you do
immediately based on the basic life support training?
A. Do chest compression
B. Give 2 rescue breath
C. Attach AED
D. Shout for help
E. Check for victim’s response

6. A 24 year-old female who had underwent motor vehicle accident came in complaint of
pleuritic chest pain. Her vital signs: BP 80/40 mmHg, pulse rate 120 beats per minute,
respiratory rate 30 breaths per minute, SpO2 89%. Physical examination reveals she has
decreased in breath sound and hyperresonance in percussion on the right chest. What is
your immediate management?
A. Endotracheal tube
B. Needle Thoracocentesis
C. Chest tube
D. Chest X-ray

7. A 20 year old woman ingested 16 tablets of 500mg paracetamol. What is the definitive
treatment for her?
A. Activated charcoal through NG tube
B. IV N-acetylcystine
C. Refer her for liver transplant
D. Send for hemodialysis

8. A young men presented with vomiting, diarrhea, drenched in sweat and drooling of
saliva. What is the most likely cause?
A. Symathomimetic
B. Cholinergic
C. Anti-cholinergic
D. Opiod
 E. Hallucinogenic

9. A 40 year-old man IVDU, brought in to the ED with altered mental status. On

examination, he was found to have pinpoint pupils. His vital signs are as below:-
Oxygen saturation: 85%
BP: 90/50
Heart rate: 50bpm
Respiratory rate: 6 breaths per minute
GCS: 11/15
What would be the appropriate management of this patient?
A. Activated charcoal via NG tube
B. IV Atropine
C. IV Flumazenil
D. IV Naloxone

11. 60 years old man with Continous Ambulatory Peritoneal Dialysis, developed
abdominal pain, fever, chills and rigors for 2 days. On examination, abdomen is
distended, there is guarding, and rebound tenderness.

A. Peritonitis secondary to Acute pancreatitis

B. Perforation secondary to appendicitis
C. Peritonitis secondary to gastric ulcer
D. Peritonitis secondary to bacterial translocation
E. Catheter-related Peritonitis

12. A 20 year old man with underlying type 1 diabetes mellitus presented with seizure.
Upon admission, his blood glucose level was 1.0 mmol/L. You were unable to insert an
intravenous line for him. What is the next life saving action for this patient?
A. Intramuscular injection of glucagon 1mg STAT
B. Insert a nasogastric tube and infused glucose-enriched fluids
C. Try to get an intravenous line until successful and administer 50% dextrose
D. Rapid sequence intubation
E. Intramuscular injection of 50% dextrose

13. A 35 year old female presented with loss of consciousness for 1 day. She had an
argument yesterday with her husband and had threatened to kill herself.
SpO2: 89%
HR: 50 bpm
BP: 92/50 mmHg
RR: 6 breaths/min
GCS: 11/15
What is your immediate action while waiting for help?
 A. Bag-valve-mask patient
B. Insert nasopharyngeal airway
C. Insert endotracheal tube
D. Give oxygen 15L/min via non-rebreather mask
E. Non-invasive ventilation (BiPAP)

16. 34 year-old woman presented with persistent headache for 2 month and not improve
after taking regular pain killer..she's having the headache since her last labor 2 months
ago which is complicated with massive blood loss.she also feels easily tired, cold even
in hot weather and constipation. She was unable to give breast milk to her son as she
does not have any breast milk.
A. Cerebral vein thrombosis
B. Hypothyroidism
C. Sheehan's syndrome
D. Iron deficiency anemia
E. Post partum depression

17. 5-year-old boy came in with shortness of breath and wheezing. Given nebulised
salbutamol but did not improve his condition. What to do next?
A. Continue nebulised salbutamol and add IV adrenaline
B. Continue nebulised salbutamol and add terbutaline
C. Continue nebulised salbutamol with IV hydrocortisone
D. Continue nebulised salbutamol with IV magnesium sulphate
E. Continue nebulised salbutamol and add ipratropium bromide

18. Came in with fever, chills, rigor. X ray show multilobar consolidation and cavitation.
Organism?
A. Pneumocystis jiroveci
B. Streptococcus pneumoniae
C. Haemophilus influenzae
D. Staphylococcus aureus
E. Mycoplasma pneumonia

19. Presented with chest pain, primary survey normal. What is the finding during
secondary survey?
A. Myocardial contusion
B. Flail chest
C. Pericardial tamponade
D. Tension pneumothorax
E. Massive hemothorax

21. A 21 years old man MVA, LOC, Stridor, Absence of gag reflex, tried jaw thrust but
failed. What to do next?
 A. Head tilt chin lift
B. LMA
C. Nasopharyngeal airway
D. Oropharyngeal airway
E. ETT

22. Retrosternal chest pain and diaphoresis. ECG as follow (ST elevation at V1- V5, III,
AVL, AVF) What is the diagnosis:
A. Left anterior descending artery
B. Left circumflex artery
C. Left marginal artery
D. Right marginal artery

26. A 30 year-old male was diagnosed with a heat stroke. What is the standard clinical
approach to augment the heat loss and reduce the body temperature for above
condition?
A. Exposed the patient for better air flow
B. Place patient on cold surface
C. Place patient in a cold room
D. Splash patient with cold water
E. Submerge patient in cold water

27. You and your friend wer jungle trekking when you encounter a 35-year-old man who
claimed to have been bitten by a snake on his left ankle. He was crying in pain. His left
ankle is bruised and swollen. What is the most appropriate thing to do.
A. Immobilised the leg
B. Torniquet the proximal part
C. Cut a laceration and let toxin flows
D. Suck the toxin out
E. Elevate the leg

28. A 22 year old woman with underlying bronchial asthma was saved from a burning
building. She had a singed eyebrow and her face was flushed and tender. She coughs
out carbonaceous sputum. On examination, her respiratory rate was 30 breaths/min and
her nails are pink. What is the main concern for this patient?
A. Acute exacerbation of bronchial asthma
B. Carbon monoxide poisoning
C. Aspiration pneumonitis
D. Inhalation injury

29. Jellyfish Infested waters. Came up with wheals and erythema. First aid response.
A. Warm water
B. Iodine solution
C. Urine
 D. Normal Saline
E. Vinegar

30. A 55 year old obese woman presented with right hypochondrium pain for the past 2
days, associated with fever and rigor. On examination, she appeared jaundice and toxic.
Her abdominal examination revealed right hypochondrium tenderness. What is the
diagnosis?
A. Acute hepatitis
B. Acute cholangitis
C. Acute cholecystitis
D. Portal vein thrombosis
E. Acute appendicitis

31. ‘Safe surgery saves lives’ is for

A. Reduce post- op length of stay
B. Reduce intra- op time
C. Reduce peri- op morbidity and mortality
D. Increase peri- op cost effectiveness
E. Increase peri- op cost benefit

32. Required to administer 3l/min . O2 saturation is 95%. Which equipment is the most
appropriate.
A. Nasal prong
B. High flow mask
C. Venturi mask
D. Cpap
E. Non rebreather

33. What the significant for adequate hydration during general anaesthesia?
A. Postoperative nausea and vomiting
B. Hypothermia
C. Hypoglycaemia
D. Adequate perfusion to the organs
E. Postoperative delirium

34. Anesthestic include narcotic, anesthetic and muscle paralysis. Guedel classification
is for what?
A. Degree of Sedation
B. Degree of neuromuscular paralysis
C. Amnesia
D. Analgesia
E. Depth of anesthesia

35. Parameter for volatile agent

 - MAC
- Capnogram
- HR
- BP

36. Which of the following is in opioid group?

A. Amitriptyline
B. Diclofenac sodium
C. Paracetamol
D. Pethidine
E. Celecoxib

38. Patient diagnosed with intestinal obstruction needs emergency laparotomy. Pre op
given fluid and electrolytes for resuscitation. What would you order to confirm sufficient
resuscitation?
A. Haematocrit to check erythrocytes: plasma fluid volume
B. Echocardiogram to check for stroke volume
C. Electrocardiogram to check rate and rhythm
D. Serum sodium, potassium and lactate
E. ABG to check PaO2 and PaCO2

39. Presented with SOB before LOC. A/w urticaria, feeble pulse, wheezing. What is the
management?
A. 50mcg of Adrenaline
B. 1 mg of adrenaline
C. Hydrocort

40. Side effect of subarachnoid block (SAB) is hypotension. All these can be done to
prevent hypotension except :
A. Adequate colloid before SAB
B. Position the patient in trendelenburg position
C. Administer IV vasopressor
D. Administer IV inotrope
E. Slow administration of local anaesthesia.

41. Which of the following volatile inhalation agent is the safest and most efficacious
among the pediatric age group.
A. Desflurane
B. Isoflurane
C. Sevoflurane
D. Enflurane
E. Nitrous oxide

44. Route of paracetamol EXCEPT

 A. Intravenous
B. Intramuscular
C. Oral suspension in syrup
D. Suppository
E. Oral tablet

45. Enteral route advantage, EXCEPT

A. Increase gastric emptying
B. Reduces bacterial translocation
C. Prevent villous atrophy
D. Increase gastric secretion
E. Increase intestine peristalsis

46. 84 year old lady planned for surgery developed atrial fibrillation at rate of 140 bpm.
Her blood pressure is 60/40 despite 150 ml of colloid infusion. What is the appropriate
first line treatment?
A. Bolus dose of amiodarone
B. Electrical cardioversion
C. Esmolol infusion
D. Adenosine

48. Laryngeal Mask Airway is not as invasive as compared to Endotracheal intubation.

LMA are used in the following situation except:-
A. Difficult intubation
B. Cardiopulmonary resuscitation
C. mastectomy for women with adenocarcinoma
D. Surgical removal of supraglottic tumour in adult
E. anterior cruciate ligament repair in adult

49. You are asked by the nurse to attend to a post-thoracotomy patient with severe pain.
He is currently on patient-controlled morphine. The following intervention may help to
reduce pain by synergistic effect, EXCEPT
A. Small boluses of IV morphine
B. Oral gabapentin
C. Paravertebral block with LA
D. IV Paracetamol
E. IM NSAIDs

50. 40 years old post nephrectomy, vital sign of bp 90/60 , heart rate 120, urine output 30
ml over 2 hrs. What is the most appropriate fluid?
A. Hartmann solution
B. Fresh frozen plasma
C. Human albumin
D. Starch solution
 E. 0.18 saline +5% dextrose

51. Compromised airway is a life-threatening condition. Which of the following sign

suggest a condition that require emergent intervention?
A. Ability to cough
B. Stridor
C. Hoarseness of voice
D. Swallowing incoordination
E. Tongue oedema

52. What is the best method to assess tissue hypoxia?

A. Capnometer
B. Serum lactate
C. Serum
D. Serum lactate dehydrogenase
E. Hemoglobin

53. You are asked to transfer ventilated patient. What should you be concerning while
transferring?
A. Bp
B. Oxygen saturation
C. Respiratory rate
D. Heart rate
E. Urine output

54. Inhalational induction is routinely performed prior to surgery in paediatric age group.
Which of the following combinations is safest for this age group?
A. O2 + nitrous oxide
B. O2 + nitric oxide
C. O2 + sevoflurane
D. O2 + desflurane
E. O2 + isoflurane

56. 60-year old lady, U/L DM and Hypertension, will undergo knee replacement surgery.
She was on lithium for bipolar disorder. What is the indication for special referral to
anaesthetist?
A. Optimisation and assessment of lithium level
B. Optimisation and assessment of DM and hypertension
C. General health assessment
D. Lung function assessment
E. To avoid medicolegal consequences.
57. 18 year old boy suddenly developed loss of consciousness and pulseless after
administration of antibiotic cloxacillin. Which of the following would be your next step in
managing this patient ?
A. Administer 1 mcg of adrenaline
B. Start Cardiopulmonary resuscitation
C. Administer hydrocortisone

58. You have just ended your night shift and would like to pass over to the morning shift.
A 65 years old female from the ICU had undergone a laparatomy for massive
retroperitoneal mass 4 hours ago. Her vital signs after 1 L of Gelofusine still the same.
The vital signs are as below

GCS : 11/15
HR : 140/min
BP: 90/70 mmHg
SpO2 : 94%
CRT : 3 secs

Which statement best describe your report?

A. A post-op bleeding patient who requires surgical intervention as she is not
responding to the fluid resuscitation
B. A post-op patient that has nosocomial abdominal infection as she is not
responding to the fluid resuscitation
C. A post-op patient having pulmonary embolism
D. A post-op patient having myocardial infarction
E. A post-op patient having anaphylaxis

EMQ
59. Patient SOB, pleuritic chest pain, fever, chills. PE: crackle at basal part. What is
diagnosis? Pneumonia

60. 20 year old young man, right sided chest pain, reduced chest expansion on the right,
hyperresonance. What is the diagnosis? Pneumothorax