Self-Assessment MCQ Questions Vol.1 No.2
Authors:   Acute Medicine, Royal Bournemouth Hospital, Taylor Martin , Edmunds B ,   Glaucoma Unit, Moorfields Eye Hospital, 162 City Road, London, Evans Alison ,   Diabetes and Endocrinology, Cheltenham General Hospital, Francis P J ,   Professorial Eye Units, Moorfields Eye Hospital, 162 City Road, London, Borland Colin ,   Hinchingbrooke Hospital, Fletcher Simon J ,   Anaesthesia and Intensive Care, Norfolk & Norwich University NHS Foundation Trust, Jones Graeme R ,   Medical Microbiology, Public Health Laboratory, Southampton University Hospitals Trust, Southampton, Frew AJ , Krishna Thirumala ,   Department of Immunology, Southampton General Hospital, Williams AP 
Published: June 2021

(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