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Self-Assessment MCQ Questions Vol.1 No.2

(A Evans & M Taylor)

· Diabetic Ketoacidosis
1. Only occurs in patients with a history of Insulin-treated Diabetes
2. Can be precipitated by Acute Pancreatitis
3. The diagnosis is excluded by a blood glucose less than 14 mmol/l
4. Has a higher mortality than Hyper-Osmolar Non-Ketotic coma
5. Patients with newly diagnosed Diabetes Mellitus rarely present with Diabetic Ketoacidosis

· The Sliding Scale Insulin Regimen
6. 50 units of isophane insulin should be mixed in 50 mls of N/Saline and commenced at 6 units/hour
7. If there is a delay in commencing the intravenous sliding scale 10 units of soluble insulin should be given sub-cutaneously
8. Blood glucose falls of greater than 5 mmol/hour should be avoided
9. When the blood glucose falls to less than 5 mmol/l then the insulin infusion should be stopped
10. If the blood glucose remains above 20mmol/l additional bolus injections of insulin should be administered

· Cerebral oedema in DKA
11. Is more common in children than adults
12. Typically occurs 4-12 hours after the start of treatment
13. If suspected clinically a CT scan should be performed prior to treatment with mannitol
14. Should be treated with mannitol 0.5g/kg
15. Intubation and hyperventilation may be required

(AP Williams, T Krishna & AJ Frew)

· The following statements are true of Anaphylaxis
16. Anaphylaxis results from generation of specific IgG antibody directed against an allergen
17. Biphasic reactions affect fewer than 5% of patients
18. Intravenous adrenaline is the treatment of choice
19. Bronchodilators such as salbutamol may be useful
20. Intravenous hydrocortisone will provide rapid relief from symptoms

(G R Jones)

· Regarding the antibiotic treatment of cellulitis
21. Aspiration of the lesion yields a pathogen in over 80% of cases
22. Cellulitis resulting from a bite injury may be due to an unusual pathogen
23. Oral agents may be as effective as vancomycin in treating MRSA cellulitis
24. 80% of patients are suitable for outpatient intravenous antibiotic therapy
25. Combination of gentamicin with penicillin enhances streptococcal killing

(S Fletcher)

· Indicators of life threatening asthma requiring immediate ICU admission are
26. PEFR < 200 l/min
27. Cyanosis despite high inspired FiO2
28. Generalized audible inspiratory and expiratory wheeze
29. Hypertension and tachycardia
30. Altered level of consciousness or confusion

· CPAP and Non Invasive Ventilation
31. Has no place in the management of the asthmatic patient
32. May reduce the inspiratory work of breathing
33. May reduce air trapping
34. CPAP > 10 cm/H2O is most beneficial
35. Can be usefully combined with a heliumoxygen mix

· Mechanical ventilation of asthmatic patients is
36. A straightforward therapeutic manoeuvre
37. Intubation is associated with severe acute complications
38. Requires a careful balancing act between high inspiratory flow and prolonged expiratory time
39. May not aim for normocapnoea
40. Is well tolerated

(C Borland)

· Pulmonary embolism
41. Is associated with a mortality of less than 5%
42. Is the most frequent cause of maternal death
43. Nowadays is rarely an unsuspected post mortem finding
44. Is found in a minority of patients undergoing perfusion lung scanning
45. Is usually due to genetic factors

· For pulmonary embolism in women
46. The pill is a major risk factor
47. Warfarin may be safely given in pregnancy provided control is optimum
48. Warfarin may be safely given during breast feeding
49. Thrombolysis is indicated for massive post partum pulmonary embolism
50. Spiral CT is the imaging method of choice in pregnancy

· In treatment of pulmonary embolism
51. Low molecular weight heparin is no more effective than unfractionated heparin
52. Warfarin can be started at diagnosis
53. Thrombolysis has not been shown to reduce mortality in hypotensive patients
54. Alteplase is preferred to streptokinase or urokinase
55. Inferior vena caval filters double the risk of deep vein thrombosis

(P J Francis & B Edmunds)

· Regarding direct ophthalmoscopy
56. The macula is located temporal to the optic disc
57. Blurring of the temporal margin of the optic disc can be a normal finding
58. To examine the red reflex, the patient is instructed to fixate over the examiner’s shoulder
59. Myopic examiners should set the dial on the ophthalmoscope on a minus lens (unless wearing their glasses)
60. Viewing the fundus of a myopic patient is challenging because the image is magnified

· Regarding papilloedema
61. Visual loss occurs early in the disease
62. Unilateral swelling of the ONH excludes the diagnosis
63. Spontaneous venous pulsation will be absent
64. The presence of spontaneous venous pulsation excludes the diagnosis
65. The optic nerve head (ONH) swells because axoplasmic flow is interrupted

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