1
Q
NOT TRUE for lactate
a. Its trend can be used to guide your treatment in case of shock
b. Endogenous adrenalin can cause its elevation
c. A high lactate is always a sign of a disease
d. The brain and the heart can use it a “fuel”
A
a. Its trend can be used to guide your treatment in case of shock
2
Q
It is not a classical form of shock:
a. Obstructive
b. Toxic
c. Hypovolemic
d. Distribute
A
b. Toxic
3
Q
- How can you calculate the MAP?
a. MAP=(2xDBP + SBP)/2
b. MAP=(2xDBP + SBP)/3
c. MAP=(3xDBP + SBP)/2
d. MAP=(3xDBP + 2xSBP)/3
A
b. MAP=(2xDBP + SBP)/3
4
Q
Which toxidrome is this: tachycardia, hypertension, mydriasis, warm, dry skin, elevated temperature a. Cholionerg b. Anticholinerg c. Sedative-hypnotic d. Opioid
A
b. Anticholinerg
5
Q
- Which one of these can be used to assess the severity of ischemic stroke:
a. GCS
b. Four score
c. NIHSS
d. Hunt-hess
A
c. NIHSS
6
Q
- The children are not small adults, because:
- The efficiency of the breathing is decreased due to the shape of infant chest and the positions of ribs
- Tachycardia is the first sign of hypoxia
- The arrhythmia usually is benign in children
- CO basically depends on the afterload and preload volume
A
- The efficiency of the breathing is decreased due to the shape of infant chest and the positions of ribs
- The arrhythmia usually is benign in children
7
Q
Rewarming technique in case of severe hypothermia
- Warm bath
- Hemodialysis
- Plasmapheresis
- ECMO
A
- Hemodialysis
4. ECMO
8
Q
Monitors of tissue perfusion:
- Lactate level and its trend
- Venous PCO2
- Mentation and its change
- Arterial CO2 saturation
A
- Lactate level and its trend
- Venous PCO2
- Mentation and its change
9
Q
It is true for ischemic stroke
- Perfusion CT brain is necessary in most of the cases
- After 4.5 hours no specific therapy is indicated
- Thrombolysis only be indicated by neurologist
- The time window for thrombolysis is 4.5 hours
A
- The time window for thrombolysis is 4.5 hours
10
Q
- It is true for an intraosseous access:
- A good alternative for peripheral iv lines
- It can be kept in place up to 60 hours (up to 24 hr)
- The aspirated bone marrow can be used for certain lab tests
- There is no absolute contraindication of IO cannulation (fracture of the tibia)
A
- A good alternative for peripheral iv lines3. The 3.aspirated bone marrow can be used for certain lab tests
11
Q
- What is true for acute pain?
- Usually it does not require analgesics
- Sudden onset
- Usually there is no tissue damage behind it
- The onset was within 6 weeks
A
- Sudden onset
4. The onset was within 6 weeks
12
Q
- The forms of delirium
- Hypertonic - Hypertonic
- Hypoactive - Hyperactive
- Hormonal - Neural
- Mixed
A
- Hypoactive - Hyperactive
4. Mixed
13
Q
- The cardiac output depends on:
- The venous return
- The autonomic nerve system
- The heart rate, the contractility and on the end dysastolic volumen.
- The heart rate and stroke volume
A
- The venous return
- The autonomic nerve system
- The heart rate, the contractility and on the end dysastolic volumen.
- The heart rate and stroke volume
14
Q
What are true for Normal Saline?
- Its sodium concentration is 154 mmol/l
- Isosmolar
- Its chlorine concentration is higher than the serum’s
- It does not cause acidosis
A
- Its sodium concentration is 154 mmol/l3. Its chlorine
3. Its chlorine concentration is higher than the serum’s
15
Q
- What are true for Isolyte?
- Its sodium concentration is 137 mmol/l
- Isosmolar
- Its chlorine concentration is higher than the serum’s
- Contains lactate (?)
A
- Isosmolar
4. Contains lactate ?
16
Q
- Could be the part of semi specific tox, treatment
- Oxygen
- Thiamin
- Naloxon
- Flumazenil
A
- Oxygen
- Thiamin
- Naloxon
17
Q
- Life-threatening thoracic injuries
- TPTX
- Tamponade
- Flail chest
- Serial rib fractures
A
- TPTX
- Tamponade
- Flail chest
18
Q
- The treatment of CO poisoning comprises of:
- Immediate evacuation
- High flow oxygen
- Hyperbaric oxygen chamber
- Supportive therapy
A
- Immediate evacuation
- High flow oxygen
- Hyperbaric oxygen chamber
- Supportive therapy
19
Q
- It is a “red flag” in case of fever:
- Hypotension
- Petechia
- Altered mental status
- Immunosuppression
A
- Hypotension
- Petechia
- Altered mental status
- Immunosuppression
20
Q
Can mimic a stroke
- Hypoglycemia
- Hypercalcemia
- Hyponatremia
- Hypomagnesemia
A
- Hypoglycemia
3. Hyponatremia
21
Q
- In case of Pulmonary Embolism it can help the workup:
- PERC
- YEARS
- PESI (?)
- Well’s (?)
A
- PERC
2. YEARS
22
Q
- It is recommended to use colloids in case of a non-hemorrhagic shock. - True / False
A
False
23
Q
- In septic shock noradrenaline is the first choice of vasoactive drug. - True / False
A
True
24
Q
- Administering too much Oxygen can worsen the outcome of a critically ill patient. - True
/ False
A
True
25
34. Usually there is a single sign or symptom which directly suggest sepsis. - True / False
false
26
One should always try to individualise the care of the patient - True / False
True
27
The use of an EWS (or NEWS or MEWS) decreases intrahospital mortality. - True / False
True
28
In case of a suspected PE D-dimer level always has to be measured. - True / False
False
29
In case of a suspected STEMI the indication of PCI is an elevated troponine level. - True /
False
false
30
Central venous cannulation in a patient with shock is not the first choice of obtaining an
iv access- True / False
false
31
If the O2 saturation is above 95% measured by a pulsoxymeter can be sure that the
oxygenation of the tissue is adequate - True / False
false
32
```
Which neurological symptom(s) indicate(s) an emergency? (Select one or more:)
ᣚ chronic headache
ᣚ slurred speach
ᣚ seizures
ᣚ acute focal neurological sign
ᣚ inability to walk
```
ᣚ slurred speach
ᣚ seizures
ᣚ acute focal neurological sign
ᣚ inability to walk
33
Organic Brain Syndrome (Select one or more:)
ᣚ can be caused by traumatic brain injury (ICH, trauma)
ᣚ is a dysfunction of the cortex alone
ᣚ is a general designation to such altered mental states where the pathopysiology is medical and not psychitatric
ᣚ is a late indicator of neurological deficiency
ᣚ one of the most important features in OBS is cognitive dysfunction
ᣚ can be caused by traumatic brain injury (ICH, trauma)
ᣚ is a general designation to such altered mental states where the pathopysiology is medical and not psychitatric
ᣚ one of the most important features in OBS is cognitive dysfunction
34
```
Basic terminology in toxicology: (Select one or more:)
ᣚ volume of distribution
ᣚ clearance
ᣚ area above the curve
ᣚ capillary permeability
ᣚ half life
```
ᣚ volume of distribution
ᣚ clearance
ᣚ half life
35
Complicated febrile seizure is: (Select one or more:)
ᣚ prolonged (>15 mins)
ᣚ unilateral
ᣚ always repeated within a short period of time
ᣚ associated with focal neurological signs
ᣚ provoked by mild fever
ᣚ prolonged (>15 mins)
ᣚ unilateral
ᣚ always repeated within a short period of time
ᣚ associated with focal neurological signs
ᣚ provoked by mild fever
36
Frostbite treatment in the ED comprises of: (Select one:)
○ rapid rewarming in warm bath until capillary circulation is restored
○ early surgical intervention prior to rewarming
○ rewarming with parenteral warm infusions to the affected extremity
○ slow rewarming to minimize damage by ice crystals
○ rapid rewarming in warm bath for 15 minutes
○ rapid rewarming in warm bath until capillary circulation is restored
37
Emergency neurological signs are:
a. Delirium
b. Acute cranial nerve involvement
c. Lumboischialgia
d. Seizures
e. Extreme headache
f. Dizziness
a. Delirium
d. Seizures
e. Extreme headache
38
OBS (organic brain syndrome) can be provoked by
a. Hypoxia
b. Hypertensive encephalopathy
c. Depression
d. Brain injury
e. Vitamin C deficiency
f. Stroke
a. Hypoxia
b. Hypertensive encephalopathy
d. Brain injury
f. stroke
39
Physiological effects of severe hypothermia
a. Respiratory alkalosis
b. Hypotension
c. Tachycardia
d. Pulmonary oedema
e. Cold diuresis
f. Areflexia
b,d,f
40
Vasoactive treatment is a double edged sword because (1)
a. Despite an increase in the BP peripheral perfusion can deteriorate due to vasoconstriction
b. Vasoactive treatment always causes tachycardia
c. Increasing the BP will increase the filtration pressure
d. Increasing the BP will decrease cerebral perfusion pressure /??? The amount
of pressure
a.
41
Airways characteristics in infants and children:
a. The narrowest part in upper airways is the vocal cord
b. Increased work of breathing due to elastic chest wall
c. Susceptibility to laryngo-bronchospasms due to underdeveloped cartilage
muscles
d. Mucous membranes are extremely vulnerable
e. Diaphragm being the main respiratory muscle
c,e
42
A CAUSE (Cardiac Arrest Ultra-Sound Exam) is capable of demonstrating during arrest
a. LV function
b. Hypovolemia
c. Valve disease
d. PE
e. tamponade/pneumothorax
b,d,e
43
It is true for PoCT (1)
a. Is a decision supporting process
b. Can be performed only by a licensed physician
c. Is only done in a diagnostic unit
d. Is an effective screening method
e. Is only a lab test
a
44
To choose the right LMA size: (1)
a. The patient ideal bodyweight should be used
b. The patient actual bodyweight is the basic
c. The patient little finger is used to measure the correct size
d. You should measure the distance between the mouth and the tragus
A
45
```
Which of the following oxygen supplementation system(s) warrant permanent FiO2
level for the patient (1)
a. Fixed performance systems
b. Low compliance systems
c. Variable performance systems
d. Adaptive performance systems
```
a
46
```
10. In which situation(s) can tissue hypoxia develop in spite of normal reading by the
pulseoximeter?
a. Chlorine intoxication
b. Severe anemia
c. CO2 intoxication
d. CO intoxication
```
b,d
47
11. Steps of ED visit:
a. ABCDE patient examination, stabilization
b. Primary triage
c. Definitive care, disposition
d. Symptom and risk-oriented diagnostics
a,b,d
48
12. Which is NOT a reversible cause of the 4T? (1)
a. Tamponade
b. Toxins
c. Tension pneumothorax
d. Thrombosis (ACS, PE)
e. Torsade de point
e
49
13. Highly time dependent pathologies in patients with chest pain:
a. Pericarditis
b. Pleurodynia
c. Tension pneumothorax
d. Pulmonary embolism
e. Esophageal rupture
f. Aortic dissection
c,d,e,f
50
14. Stroke care pathway is, EXCEPT
a. Clarifying etiology
b. Delay of adequate therapy due to lack of staff
c. Recognition of reversible pathologies
d. Late management of complications
e. Recognition and confirmation of stroke
b,d
51
Criteria for alerting the trauma team are
a. SpO2 < 90%
b. Systolic BP <90mmHG or pulse >130/min
c. Respiratory rate < 10 or > 30/min
d. Injured in a mass casualty
e. GCS < 13 or seizures*
a,c,d
52
Red flag might be:
a. Any new headache after the age of 50
b. A sudden, striking headache experienced for the first time
c. A headache that is usual for years but cannot be alleviated with simple
painkillers
d. Any headache associated with seizures and neurologic deficit
a,b,d
53
17. The most frequent acute neurological problem in the ED (1)
a. Ischemic stroke
b. Vertebral palsy
c. Traumatic brain injury
d. Bacterial meningitis
e. Intracerebral bleeding
a
54
18. Strategic points in the treatment of sepsis
a. hemoculture
b. Volume resuscitation
c. Antibiotics within one hour
d. Lactate measurement
e. CT scan
f. Mechanical ventilation in all cases
a,b,c,d
55
19. Emergent neurological disorders are:
a. A single epileptic fit in a known epileptic
b. disorientation
c. Sinus thrombosis
d. meningitis
e. SAH
c,d,e
56
20. Metabolic causes of OBS aught be
a. Hypernatremia
b. Renal insufficiency
c. Hyperkalemia
d. Hyponatremia
e. Wernicke’s encephalopathy
a,d,e
57
Indication of extracorporeal warning techniques (1)
a. Core temperature is 34C
b. Core temperature is not improving with less invasive techniques
c. Severe organic heart disease
d. Severe occlusive arterial disease
e. Old age
b
58
22. Parts of at scene activity are, EXCEPT (1)
a. Medical therapy
b. Rescue
c. Transport
d. Long term observation
e. Targeted patient examination
d
59
LD 95 is the dose of a toxic agent that is (1)
a. That is survivable in 95%
b. That is responsible for 95% of the side effects
c. Lethal in 95% of cases
d. That is used as frequently as 95% in medicine
e. That is associated with typical symptom in 95% of the cases
c
60
24. Causes of functional seizures, EXCEPT (1)
a. Drug side effect
b. Dehydration
c. epilepsy
d. Febrile seizures
e. Hypoglycemia
c
61
25. Physiological parameters changing with the child’s age
a. Decreased circulatory reserve
b. Increased oxygen carrying capacity
c. Relative diameter of airways
d. Total body water
e. Degree of myelinization
C,D,E
62
ST elevation in aVR
a. Is non-significant if higher than the one in V1
b. Is physiological
c. Might reveal LAD occlusion if associated with elevated J-point and prominent T-waves in V1-4
d. Might reveal LMACA occlusion if associated with ST-depression in I, II,
v4-6
e. C and D are ST elevation equivalent changes that must be observed in lieu
with clinical picture and biomarkers
C,D
63
27. It is NOT true in adrenalin administration
a. General dosage sequence: every 3 cycles (6-8 min)
b. Can be administered only IV
c. Given in 1 single dose
d. Should not be administered endotracheally
e. Initial dosage is the same in shockable and non-shockable rhythms
f. It is not used off-label in resuscitation
A,B,D
64
28. It is not the role of ambulance dispatcher: (1)
a. To give advice to the caller
b. Evaluation of the call
c. Coordination
d. Acute care on the scene
e. Determine the priority of the call and level of emergency medical unit required to that situation
D
65
29. Which statement is true?
a. The goal of emergency care is stabilizing the patient’s condition after early recognition and early risk assessment with appropriate allocation
b. Patient stabilization can be carried out only in the ICU after early disposition
c. The goal of emergency care is the quickest possible, through examination
d. Treating a critically ill patient, there is a general goal: the restoration and stabilization of the patient’s oxygenation and perfusion
A,D
66
30. Emergency care is characterized by:
a. Improving the outcome by decreasing the extent of secondary injury
b. Prevention of primary injury
c. Continuously available care
d. Same level of care at any time
C,D
67
31. Parts of RUSH (rapid ultrasound in shock)
a. Echocardiography - detailed visualization of the valves
b. Great vessels TUBES
c. Thoracic cavity + IVC + FAST - TANK
d. Focused echocardiography - PUMP
e. Abdominal cavity - free fluid
B,C,E
68
32. It is true for ISS (Injury Severity Score)
a. Can be applied in the resus room to assess injury severity
b. Patient’s condition is critical if above >=35
c. Considers only life threatening injuries
d. Based on the description of the extent of tissue injury
e. Based on AIS
A,D,E
69
Emergencies according to the Hungarian Triage System
a. Phantom pain
b. Mild lower abdominal pain
c. Left back pain with no trauma or musculoskeletal origin
d. Intolerable headache
e. New onset visceral epigastric pain in a patient older than 50
f. Non-traumatic chest pain
D,E,F
70
34. Secondary headaches source:
a. Headache in stroke
b. Arteritis temporalis
c. Migraine with aura
d. Tension headache
e. Hypertensive headache
A,B,E
71
35. Malignant neuroleptic syndrome can be provoked by
a. MAO inhibitors
b. neuroleptics
c. Tricyclic antidepressants
d. Benzodiazepines
e. Atropine
f. Antiemetics
A,B,C,F
72
36. Signalling error or mistake is used for:
a. System development
b. Correction, improving patient safety
c. Guarantee of safety of the core provider
d. Learning, development, and strengthening trust
A,B,D
73
TIA patients must be admitted if (1)
a. If the patient is on OAC (oral anticoagulant)
b. Requested by relatives
c. If symptoms are worsening
d. If the patient had an initial high blood pressure but it was controlled within ashort period of time
e. If the NIHSS is 3
C
74
Which of the list DOES NOT SIGNIFY high risk? (1)
a. Pulmonary embolism, ACS
b. Boerhaave syndrome
c. Tension pneumothorax
d. Aortic dissection
e. Intercostal neuralgia
E
75
39. The Point of Care method in the differential diagnosis of shock with unknown origin
a. Biomarker analysis
b. Lactate measurement
c. Hemodynamic monitoring
d. Ultrasound (RUSSH)
e. CT scan
D
76
Initial treatment regime in bacterial meningitis
a. EGDT
b. Mannitol
c. Furosemide
d. Ceftriaxone + vancomycin + ampicillin IV
e. Ceftriaxone IV
f. Dexamethasone 10mg
F,E
77
Frostbite treatment in the ED comprises: (1)
a. Slow rewarming to minimize damage by ice crystals
b. Rewarming with parenteral warm infusions
c. Rapid rewarming in warm bath for 15 minutes until capillary circulation is
restored
d. Early surgical intervention prior to rewarming
e. Rapid rewarming in warm bath for 15 minutes
C
78
43. Croup score is comprised of
a. Respiratory rate
b. Nasal breathing
c. stridor
d. cyanosis
e. SpO2
f. Cough
C,D,
79
44. Drowning is characterized by
a. Aspiration of an average amount of 3-4 ml/kg water
b. More significant ion derangements in sweet water
c. Ion disturbances when inhaling salt water of 5ml/kg
d. Better survival in salt water
e. Changing blood volume induced by aspiration of 25 ml/kg of water
E
80
True for TIA (1)
a. Most of the TIAs are not visible on CT
b. TIA is like a stroke, producing similar symptoms, but usually lasting only a
few minutes and causing no permanent damage
c. Usually its of antithrombotic origin
d. Often called a maxi stroke - may be a warning
B
81
46. In severe trauma circulatory arrest can origin form
a. Hypoxia
b. Tension PTX
c. Limb fractures
d. Heavy blood loss
e. Airway obstruction
A,B,D,E
82
47. Giving antibiotics in a severely septic patient comprises:
a. Administration of wide spectrum antibiotics supposedly penetrating into
the desired compartment
b. Administration of targeted antibiotics only
c. The decision about initiation of antibiotics made on the ward accepting the
patient
d. Microbiological sampling before administration of antibiotics
e. A start within 4 hours within the onset of symptoms
a. Administration of wide spectrum antibiotics supposedly penetrating into the desired compartment
d. Microbiological sampling before administration of antibiotics
83
48. Emergency patient examination is characterized by (1)
a. Invasive hemodynamic procedures
b. Full examination
c. ABCDE aspect
d. Detailed patient history with family history
C
84
49. Sepsis criteria, SIRS + 1 or more from the list below
a. Documented infection
b. Leukocytosis
c. Alkalosis
d. Increased serum lactate
e. Left shift in CBC
A
85
50. Which statement is not true? (1)
a. Pathophysiological processes accompanying secondary damage may in....
Surface
b. It is good practice to use crystalloids in fluid replacement in critical illness
c. It is prudential to use macromolecular solutions in critical illness
d. Damage of the endothelial surface may contribute to the appearance of ...
C
86
Meningitis can be complicated by (?)
a. Myocardial damage
b. Alkalosis
c. Hypoxia
d. Aspiration
e. Hypercapnia
A,C,D
87
52. Warning signs and symptoms
a. Cyanosis, dyspnea
b. Severe pain, high temperature
c. PPI 1-3, low grade fever, cough
d. Profuse bleeding, irregular, rapid, compressible pulse
A,B,D
88
a. Pain can be alleviated only after surgical examination
b. If justified by the condition of the patient, use of opiates is recommended
c. Only simple painkillers can be administered
d. It is a medical mistake not to give analgesics before the diagnosis
e. It is a medical mistake to give analgesics before the diagnosis
B,D
89
Criteria for alerting the trauma team depends on
a. The mechanism of injury
b. Physiological parameters
c. Allergies
d. Special injuries
e. Accompanying diseases
A,B,D
90
55. Physiological effects of mild hypothermia (1)
a. Cold diuresis
b. Heart conduction abnormalities (moderate)
c. Pulmonary edema (severe)
d. Bradycardia (mild)
e. Decreased minute volume
A
91
56. Causes of lactate acidosis, EXCEPT (1)
a. Decreased lactate metabolism
b. Parenteral colloid infusion
c. Increased oxygen utilization
d. Inadequate tissue utilization
e. Decreased oxygen consumption
B
92
57. Initial steps in children with foreign body in the esophagus
a. Oral rehydration
b. Preparation for crush induction
c. Supine position
d. Sedation
e. Securing a vein
B
93
58. Regarding TIA
a. A transient ischemic attack can serve as an indicator of compliance with prevention
b. Most of the TIAs are visible on CT
c. TIA is like a stroke, producing similar symptoms, but usually lasting only a few minutes and causing no permanent damage
d. Often called a mini stroke may be a warning
e. >90% of TIA patients will suffer a stroke within 10 days
f. Usually its of thrombotic origin
B,C,D,F
94
59. During triage for recognition of shock can be helpful
a. Basic perfusion signs (CRT), skin signs
b. Lactate level
c. Diuresis
d. Level of consciousness
e. Basic hemodynamic measurements (eg. NIBP)
A,D,E
95
60. Stroke Volume is independent from (1)
a. Afterload
b. Ventricular pressure and volume
c. Contractility
d. Filling volume
e. Directly from HR
E
96
61. Allocation is characterized by
a. Ensures the optimal operation of the system in multiple patient entries
b. Allocation ids for EMS only
c. Microallocation: allocating care based on patient
d. Allocation is required only in patients with critical conditions
e. Based on triage
A,C,E
97
62. Cellular oxygen delivery depends on (multiple answers)
a. Minute volume
b. Blood viscosity
c. Hemoglobin content
d. Oxygen saturation
e. Arterial oxygen content
C,D
98
63. Secondary survey in polytrauma (major trauma) patients, EXCEPT (1)
a. Damage control surgery should come prior to secondary survey
b. It happens after treating life threatening injuries
c. Taking detailed medical history belongs in here
d. Can be omitted in patients whom have been previously assessed by a traumatologist
e. It is a head to toe examination
D
99
64. Definition of polytrauma
a. Leads to dysfunction or failure of remote, primarily not injured, organs and
vital systems
b. Syndrome caused by multiple injuries
c. It causes systematical responses
d. The resulting injuries ISS score is over or equal to 17
ALL
100
Symptoms of pseudocroup are, EXCEPT (1)
a. Jugular, inter-subcostal, substernal retraction
b. Barking cough, especially on agitation
c. Prolonged inspiratory time above the jugulum
d. Symmetrically prolonged breathing above both lung fields
e. Breathing difficulty
D
101
66. In ehtylenglycol poisoning it should be avoided (1)
a. Thiamine
b. Blocking alcohol-dehydrogenase
c. Hemodialysis
d. Decontamination by induced emesis
e. Pyridoxin
D
102
67. It is true for any pain observed in the ED
a. Use of morphine might be justified in the early stages of pain management
b. Morphine is not contraindicated in patients presenting with acute abdomen
c. 20% of the patients reporting in the ED have some degree of pain
d. Pain management must be started at the earliest possible time, practically at
the level of triage
e. The majority of patients does not receive adequate pain management
f. Intensity of pain does not affect triage category
A,B,E
103
OBS can be provoked by
a. Alcohol
b. Sepsis
c. Vitamin C deficiency
d. Hepatic failure
e. Schizoaffective disorders
f. Alzheimer’s disease
A,B,D,F
104
To diagnose bacterial meningitis, we need (1 or more)
a. Carotis Duplex scan
b. Skull angio-MR
c. Lumbar puncture (LP) with CSF analysis
d. Hemoculture, labs
e. Head CT
C
105
70. Basic drug on resuscitation is (1)
a. Noradrenalin
b. adrenalin
c. Amiodaron
d. Bicarbonate
e. Atropine
B
106
71. The criteria for calling the trauma team are the following
a. Respiratory difficulty
b. Injury of 2 or 3 regions of the body
c. Penetrating injury of the head, neck, or upper limbs
d. Fracture of one long bone
C
107
Wernicke encephalopathy can be treated with (1)
a. Diazepam 5mg/day
b. ECT
c. thiamin
d. Propofol and barbiturates
e. Clonidine as first drug of choice
C
108
73. It is NOT true for FAST
a. Can be performed only by a radiologist
b. If the examination is negative no further imaging is necessary
c. FAST is an imaging technique using ionizing radiation
d. Must not be performed in unstable patients
e. It is only used to confirm thoracic and abdominal bleeding
A,B,C,D
109
74. Metabolic derangements in the background of OBS might be
a. Hypokalemia
b. Porphyria
c. hypoglycemia
d. hyperglycemia
e. Hypocapnia
f. Hypoxia
A,B,C
110
75. Outcome of stroke is determined by
a. Revascularization
b. age
c. Extent of carotid stenosis
d. Severity of stroke
e. Quality of vertebral circulation
A,B,D,E
111
76. Venous return will be improved from
a. Intrathoracal and intraabdominal pressure (?)
b. Contractility
c. Circulating volume
d. muscle-pump
e. HR - on a direct way
A,C.D
112
Patient disposal from the emergency unit is EXCEPT (1)
a. Definitive care and discharge to home
b. Rapid stabilization, diagnostics and admission
c. Stabilization and observation
d. Long term treatment: (days) in the emergency
e. Death
D
113
78. Childhood injuries are characterized by
a. Chance of associated injuries is less in injuries without a bone fracture due
to the elasticity of the tissues
b. Safety seats do not decrease the severity of injuries
c. If there is no visible injury, infants can be left at the scene
d. Hitting by a car is the most frequent cause of trauma in 0-3 years population
e. The energy/mass quotient is higher resulting in more severe injuries
A
114
What should be done if you suspect pulmonary embolism – choose the incorrect
answer: (1)
a. CT angiography without delay in patients with high risk or probability
b. Immediate CT angiography in haemodynamically unstable patients
c. Immediate D-dimer and echocardiography is the diagnostic choice in
patients with high risk
d. D-dimer analysis might exclude PE in low risk and haemodynamically stable
patients
C
115
“Hunting response”: (1)
a. Genetically missing in Northern territories
b. Functions extremely well in those living under tropical conditions
c. Predisposes to cellular ice crystal formation
d. Can be detected if the temperature of the limb is below 10oC
e. Restores capillary circulation temporarily for 5-10 minutes
E
116
Ileus in newborn and infants are mainly caused by: (1)
a. Tumors, abdominal ischemia, atresia
b. Hypervolemia, trauma, lactose-intolerance
c. Volvulus, invagination, incarcerated inguinal hernia
C
117
Croup score is composed of , except: (1)
a. Respiratory rate
b. Stridor
c. Air entry
d. Chest wall retractions
e. Cyanosis
f. Cyanosis
g. Level of consciousness
A
118
83. Which statement is true? (1)
a. The shorter the cannula the better the flow
b. The higher the infusion stand the better the absorption is
c. The higher level the patient’s bed the better the flow
d. The longer the cannula the better the flow
A
119
84. Malignant neuroleptic syndrome can not be provoked by: (1)
a. Antiemetics
b. MAO inhibitors
c. Trycyclic antidepressants
d. Neuroleptics
e. None of these
f. All of these
E
120
is true for the unstable trauma patient, except: (1)
a. They mostly require transfusion
b. Circulation can’t be stabilized by fluid resuscitation only
c. Only 1000 ml crystalloid is required to stabilize circulation
d. An urgent operation is required for haemorrhage control
e. Basic diagnostics (FAST, chest and hip X-rays) are compulsory
C
121
```
Which phase of the spontaneous breathing cycle is the most important regarding
oxygen therapy (1)
a. Post inspiratory pause
b. Post expiratory pause
c. Expiration
d. Inspiration
```
B
122
STE in aVR (1)
a. Is non-significant if it is higher than the one in V1
b. Might reveal LAD occlusion if associated with elevated J-point and
prominent T-waves in leads V1-4
c. Is always physiologic
B
123
First choice for vasoactive therapy in patients with septic shock (1)
a. Dobutamine
b. Isoprenaline
c. Dopamine
d. Noradrenaline
e. Adrenaline
D
124
Deleterious effects of pain, except: (1)
a. Neuroendocrine activation
b. Immunodepression
c. Limited chest movement – hypoventilation
d. Sympathetic activation
e. Shortened gastric emptying
E
125
Which one is not a “red flag” of headache? (1)
a. Headache with altered mentation
b. Headache in cancer or HIV patient
c. Headache with accompanying neurological deficit
d. Headache associated with seizures
D
126
```
Life saving procedures that can be performed in a trauma bay or an emergency
room, except: (1)
a. Applying a pelvic binder
b. Tracheostomy
c. Pericardial puncture
d. Chest drain insertion
e. Osteosynthesis of distal bones
```
E
127
Acute stroke care at the ED includes, except: (1)
a. The reconginition of reversible causes
b. The late management of complications
c. The recognition and confirmation of stroke
d. The clarification of the etiology
B
128
Etiology of OBS incudes:
a. Cocain, headache, hyperglycemia
b. Alcohol-withdrawal, hyperprotaemia, hypocalcemia
c. Hypoprotaemia, VIP-ome, toxins
d. Trauma, hypo- or hyperthermia, toxins
D
129
Factor(s) determining the severity, long term effects and mortality of an injury is/are
EXCEPT (1)
a. Accompanying diseases
b. Physiological response to the injury
c. Anxiety level of a person causing the injury
d. Extent of tissue damage
e. Age, the general state of the injured
C
130
The triad of emergency medicine is: (1)
a. Multipoint entry, patient selection, assessment
b. Integrativity, allocation, time-dependency
c. Specialization, definitive care, all in one
d. Specialization, allocation, time-dependency
B
131
Advantages of PoCT are, EXCEPT: (1)
a. Detailed examination
b. Immediate analysis
c. Rapid diagnosis
d. Possibility of effective recognition
e. Portability
A
132
Which of the followings is used for assessing the severity of stroke? (1)
a. EEG
b. Carotid duplex scan
c. NIHSS
d. Examination of reflexes
e. GCS
f. None of these
g. GDP
h. All of these
C
133
98. Warming techniques in severe hypothermia is: (1)
a. Immersion in warm bath; warming blankets
b. VENUS treatment; warm sweaters
c. Isolated warming of extremities, MARS treatment
d. ECMO therapy; hemodialysis
e. Plasmapheresis; plasma exchange
D
134
99. In severe trauma circulatory arrest can be originated from: (1)
a. None of these
b. Tension PTX
c. Airway obstruction
d. Hypoxia
e. All of these
f. Heavy blood loss
E
135
Parameters that change with the child’s age, EXCEPT: (1)
a. Degree of myelinisation (increases)
b. Total body water (increases)
c. None of these
d. Circulatory reserve (decreases)
e. Relative diameter of airways (increases)
f. All of these
C
136
Not a “red flag”: (1)
a. Known and treated hypertension
b. Syncope
c. Altered mental status; progressive palsy
d. Transient loss of consciousness
A
137
What can you use to asses airway obstruction: (1)
a. Auscultation over the large airways and the assessment of the breathing work
b. Auscultation over all lung fields and the use of a video laryngoscope
c. Pulsoxymeter and an arterial blood gas
d. You have to put down your finger through your patients mouth and larynx
e. Measurement of peak expiratory flow and auscultation of all lung fields
A
138
```
Which one of the following need to be managed prehospitally at a high urgency
level? (1)
a. None of these
b. Major trauma
c. Sudden severe shortness of breath
d. Suspected acute stroke
e. Suspected ACS
f. All of these
```
all of these
139
The definition of severe sepsis is: a proven or suspected sepsis + which of the
following? (1)
a. Leukocytosis and/or high PCT
b. Increased serum lactate and/or hypotension
c. Left shift in WBC count and/or fever
d. Documented infection and/or hypothermia
B
140
The first step of oxygen therapy is: (1)
a. Endotracheal intubation in all cases
b. Is to choose an oxygen supplementary system based on the weight of the
patient
c. Set the oxygen flow
d. Rule out any airway obstruction; if needed secure airway first
D
141
Characteristics of delirium are, EXCEPT: (1)
a. Disorders of consciousness, orientation, alertness
b. Cognitive disorders
c. A change in normal circadian activity
d. Focal neurologic deficit
D
142
Serotoninergic syndrome is characterized by, EXCEPT: (1)
a. Hyperthermia, diaphoresis
b. Mental disorder: confusion, agitation, coma
c. Bradycardia, miosis
d. Hyperreflexia, myoclonus, ataxia
B
143
Which statement is true? (1)
a. The goal of emergency care is to treat every patient as soon as they arrive to
the ED
b. Patient stabilization can be carried out only in the ICU – so in critically ill
patients early disposition is the main goal.
c. The goal of emergency care is the quickest, through examination
d. Treating a critically ill patient, there is a general goal: the restoration and
stabilization of the patient’s oxygenation and perfusion
D
144
Which conditions DO NOT predispose to hypothermia?(1)
a. Alzheimer’s disease
b. Diabetes mellitus
c. Parkinson’s disease
d. Severe injury
e. Hypothyrosis
f. Hyperthyrosis
F
145
True for the use of LMA (1)
a. In an emergency setting, after placement the patient shouldn’t be ventilated
b. It protects the airways from aspiration
c. The patient should be deeply unconscious to tolerate it
d. It always should be the first choice
e. None of these
f. All of these
C
146
Anticholinergic syndrome can be triggered by EXCEPT (1)
a. Barbiturate
b. Phenothiazine
c. Baclofen
d. Atropine
e. Antihistamines
A
147
Which statement is true for stroke? (1)
a. Hypoperfusion is due to vasodilation
b. Energy disturbance at cellular level happens late (hours to days after the
event)
c. None of these
d. Oxidative stress is an important issue
e. All of these
f. It is very rarely associated with smoking
D
148
Symptoms of foreign body aspiration, EXCEPT: (1)
a. Dry irritative cough, hiccups
b. A sudden onset of choking in a previously healthy child during play, eating or
after a fall
c. Dyspnea, respiratory arrest
d. Increased salivation
e. Unusual crying
D
149
Opiate overdose is NOT associated with (1)
a. Tachycardia and mydriasis
b. Respiratory arrest as cause of death
c. Use of naloxone as antidote
d. The need for securing the airways
A
150
Airways and breathing characteristics in infants and children: (1)
a. Thoracic organs are less vulnerable due to more elastic chest wall
b. Susceptibility to laryngo-bronchospasms
c. Supine position improves breathing mechanism
d. Mucous retention is hard to develop
e. Chest anatomy improves the effectivity of breathing
B
151
Can NOT cause OBS: (1)
a. Amphetamine OD
b. Aspirin OD
c. ACEI intoxication
d. Ethylene-glycol or alcohol or methanol OD
e. TCA OD
C
152
Hypoglycemia in the NBs and infants is characterized by EXCEPT: (1)
a. Seizures with loud crying
b. Warm, dry, hyperaemic skin
c. Short wave tremor
d. Apnea, cyanosis
e. Irritability
B
153
Is it true for the pain observed in emergency units: (1)
a. Pan intensity does not affect triage category
b. Analgesics are CI in the first hour after admission
c. Most patients with pain do not require analgesics
d. Administration or morphine is allowed only for intolerable pain in cancer
patients
e. 70% of ED visits are due to some kind of pain
E
154
It is true for IO cannulation: (1)
a. You can only administer crystalloid solutions via the IO cannula
b. It should be the next choice in a critically ill patient if IV cannulation failed
c. The IO cannula can be used for 48-72 hours
d. The correct needle position should be confirmed with X-ray prior use
e. Antibiotic prophylaxis is always necessary
B
155
Warning signs and symptoms (red flags) are, EXCEPT: (1)
a. Severe pain; high temperature
b. Cyanosis, dyspnoe
c. Profuse bleeding; irregular, rapid, compressible pulse
d. PPI 1-3/10, low grade fever, cough
D
156
It is not a criteria to alert the trauma team: (1)
a. Special injuries
b. Accompanying diseases
c. Vital parameters
d. The mechanism or injury
B
157
Characteristics of OBS are, EXCEPT: (1)
a. Cranial nerve palsy
b. Emotional episodes
c. Cognitive disorders
d. Acute or chronic change in mentation
e. Disorientation
A
158
Not a “red flag”: (1)
a. Any headache associated with seizures and neurological deficit
b. A chronic headache (experienced for years) but now cannot be alleviated
with the usual painkillers
c. All of these
d. None of these
e. Any new headache after the age of 50
f. A sudden, striking headache experienced for the first time
B
159
Reperfusion therapy for myocardial salvage in ACS: (1)
a. Is usually not time dependent
b. Only need to be done if the EF is less than 20%
c. Has its maximum effect after the first 12 hours
d. Is effective only in the first 2-3 hours
D
160
Meningitis cannot be complicated by: (1)
a. Alkalosis
b. Hypoxia
c. Myocardial damage
d. Aspiraton
A
161
The correct steps treating an intoxicated patient: (1)
a. Decontamination; elimination; specific therapy (antidote); aspecific therapy
b. aspecific therapy; elimination; Decontamination; specific therapy (antidote)
c. elimination; aspecific therapy; specific therapy (antidote); Decontamination;
d. aspecific therapy; specific therapy (antidote); Decontamination; elimination
e. aspecific therapy; Decontamination; elimination; specific therapy
(antidote) ;
E
162
Symptom(s) of bacterial meningitis in infants (1)
a. Protruding fontanels
b. AMS (e.g inability to comfort)
c. All of these
d. None of these
e. Fever, vomiting, headache
C
163
Cardiovascular characteristics in infants and children EXCEPT: (1)
a. Circulating blood volume is 70-80 ml/kg
b. In infants HR is high, SV is low
c. The most frequent dysrhythmias are bradycardia and asystole
d. Less cardiac output by kgs of body weight
e. CO depends on HR
C
164
Advantages of PoCT: (1)
a. Used for verification of a lab finding
b. Always mean detailed examination
c. Can perform real time analysis
d. Does not shorten the time required for diagnosis, only increases safety
e. Cannot be used for follow up
C
165
```
In a spontaneously breathing patient which spaces help to elevate the FiO2 level
during oxygen therapy?
a. Oesophagus
b. Alveoli
c. Bronhi
d. Trachea
e. Nasal, oral & pharyngeal spaces
```
B
166
It is not an emergency, EXCEPT: (1)
a. Vestibular neuronitis
b. Basilar artery migraine
c. Occlusion of the basilar artery
d. BPPV
e. Meniere’s syndrome
C
167
Treatment of croup EXCEPT (1)
a. O2 by mask
b. Inhalation with racemic adrenaline
c. Steroid (inhalation, suppository, IV)
d. Warm humidified air inhalation
e. Monitoring
D
168
What is important in case of long term oxygen therapy? (1)
a. Prophylactic antibiotic treatment
b. The flow should be at or below 1 L/min
c. Immobilization
d. Only nasal cannula can be used
e. Humidification
f. None of these
g. All of these
E
169
It is true for adrenalin administration:
a. Can be administered only IV
b. Given in 1 single does
c. Should not be administered endotracheally
d. It is used off-label in resuscitation
e. Initial dosage is the same in shockable and non-shockable rhythms
f. General dosage sequence: every 3 cycles (6-8 min)
B,E
170
Which statement is NOT true? (1)
a. Damage to the endothelial surface may contribute to the translocation of
larger molecules into the interstitial space
b. It is good practice to use crystalloids for fluid resuscitation
c. There is a lot of evidence for the safe use of macromolecular solutions in
critical illness
d. Pathophysiological processes arise from secondary damage may damage the
integrity of the endothelial surface
C
171
Physiological effects of intermediate hypothermia: (1)
a. Decreased minute volume
b. Tachycardia
c. Cold diureses
d. Respiratory alkalosis
e. Pulmonary edema
A
172
Which of the following is / are variable performance oxygen supplementation
system(s):
a. Non rebreathing oxygen mask with reservoir
b. CPAP systems
c. Venturi mask
d. Non rebreathing oxygen mask
e. Nasal cannula
A,D,E
173
Which statement is NOT true? (1)
a. Stroke volume is the volume of blood ejected with one contraction of the left
ventricle
b. Stroke volume = cardiac output x heart rate
c. Stroke volume depends on the contractility
d. Stroke volume depends on the total peripheral resistance
e. Stroke volume depends on the end diastolic volume
B
174
It is true (1 or more)
a. After IV fluid therapy the SV change will be high if intitally there was volume
overload
b. The SV can be increased by improving contractility
c. After IV fluid therapy the SV will not change if the preload was inadequate
d. After IV fluid therapy the SV will rise if the preload was inadequate (?)
B,D
175
```
Initial pharmacological therapy in Meningococcus meningitis composed by: (1 or
more)
a. Vancomycin
b. Gentamycin
c. Dexamethasone
d. Ampicillin
e. Meropenem
f. Ceftriaxone
```
C,F
176
It is true for STEMI (1 or more)
a. ST depression in V1-3 is pathological
b. There is usually reciprocal ST depression in the electrically opposite leads
c. Only ST elevation are of diagnostic value in chest leads
d. ST elevation in aVR might be pathological
e. You can’t diagnose STEMI in the presence of LBBB
f. Any ST elevation with RBBB is of no diagnostic significance
A,B,D
177
In amphetamine overdose it is contraindicated to (1)
a. Administer beta blockers
b. Give benzodiazepines
c. Perform supportive therapy
d. Perform a gastric lavage within 60 minutes
A
178
The components of Westley’s croup score are (1 or more)
a. Chest wall retractions
b. Stridor
c. Air entry
d. Level of consciousness
e. Cyanosis
f. Fever
g. Respiratory rate
h. SpO2
A,B,C,D,E
179
```
Sign(s) and symptom(s) of esophageal foreign body (in childhood) can be: (1 or
more)
a. Abdominal pain
b. Cough
c. Altered mentation
d. Sudden salivation
e. Dysphagia
```
B,C,D,E
180
Which of the following device(s) can maintain a fix FiO2? (1)
a. Venturi mask
b. Non rebreathing oxygen mask
c. Nasal cannula
d. Non rebreathing oxygen mask with reservoir
A
181
Source(s) of communication error (1 or more)
a. Receiver does not understand the info
b. Receiver does not follow recommendation / order
c. Relevant info is not told
d. Receiver does not hear the info
C,D
182
Characteristics of time dependency (1 or more)
a. Early death
b. Early detection
c. Early diagnostics
d. Early disposition
e. Early stabilization (?)
B,C
183
This is true for oxygen cascade EXCEPT (1)
a. The cascade is affected by humidification pressure
b. The cascade is affected by shunt fraction
c. Mitochondrial oxygen requirements is above 50 mmHg
d. The cascade is affected by diffusion
e. It describes the decrease of oxygen tension from room air to subcellular level
C
184
What are the important factors in assessment of pain? (1 or more)
a. Radiation
b. Duration
c. Accompanying diseases
d. Quality
e. Regular mediation
f. Proving and alleviating factors
A,B,D,F
185
Elements of the “lethal triad” (1 or more)
a. Acidosis
b. Hypovolemia
c. Coagulopathy
d. Hypothermia
e. Alkalosis
f. Hyperthermia
A,C,D
186
It is true for ACS (1 or more)
a. ECG always shows ST elevation in the appropriate leads
b. Troponin positivity is not diagnostic criterion
c. Only organic disease can be the underlying cause
d. It is an imbalance between supply and demand of myocardial O2
e. One subtype of ACS is unstable angina
f. It is presented as an acute chest pain syndrome in 25-30%
D,E
187
Care in CO poisoning comprises (1 or more)
a. High flow oxygen
b. Immediate rescue
c. ECMO therapy
d. Supportive therapy
e. Hyperventilation
f. Hyperbaric oxygen chamber
A,B,D,F
188
Potential complication(s) of gastric lavage (1 or more)
a. Esophageal rupture
b. Posterior fossa trauma
c. Laryngospasm
d. Aspiration
e. Vagus-reflex bradycardia
f. Water intoxication
A,C,D,E,F
189
Troponin levels can be elevated apart from STEMI in (1 or more)
a. Hypoxia
b. Myocarditis
c. Pulmonary embolism
d. AAA rupture
e. Pancreatitis
f. Global ischemia
B,C
190
Troponin levels can be elevate in EXCEPT (1 or more)
a. Level ventricular hypertrophy
b. Renal insufficiency
c. Pulmonary embolism
d. SIRS
e. Hepatic failure
f. AAA rupture
A,F
EMG
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