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Arab Board Emergency Medicine Clinical Exam study materials
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Arab Board Emergency Medicine Clinical Exam practice questions

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Question 1Resuscitation, Shock and Critical Care

An adult with sepsis-induced hypotension and a lactate of 5 mmol/L has no history of heart failure or dialysis. What volume of balanced crystalloid should be given as the initial bolus?

  1. 10 mL/kg
  2. 50 mL/kg
  3. 20 mL/kg
  4. 30 mL/kg Correct answer.

Explanation

Current sepsis guidance advises an initial bolus of at least 30 mL/kg of balanced crystalloid within the first three hours when sepsis is accompanied by hypotension or a lactate of 4 mmol/L or more. The bolus is only a starting point, and further fluid is guided by repeated assessment of perfusion, lung auscultation and haemodynamic response. Smaller volumes leave the patient under-resuscitated, while larger routine boluses increase the risk of pulmonary oedema.

Question 2Resuscitation, Shock and Critical Care

An adult develops stridor and hypotension minutes after a bee sting. Which is the first and most important treatment?

  1. Intravenous chlorphenamine 10 mg
  2. Nebulised salbutamol 5 mg
  3. Intramuscular adrenaline 0.5 mg of 1:1000 Correct answer.
  4. Intravenous hydrocortisone 200 mg

Explanation

Intramuscular adrenaline into the anterolateral thigh is the first-line treatment for anaphylaxis with airway or circulatory compromise. The adult dose is 0.5 mg of the 1:1000 concentration, repeated after five minutes if there is no improvement. Antihistamines, steroids and nebulised bronchodilators are adjuncts and must never delay adrenaline.

Question 3Resuscitation, Shock and Critical Care

An unconscious adult with a capillary glucose of 1.8 mmol/L has no obtainable intravenous access. Which is the most appropriate immediate treatment?

  1. Intravenous 50% dextrose 50 mL
  2. Subcutaneous insulin 10 units
  3. Oral glucose gel 15 g
  4. Intramuscular glucagon 1 mg Correct answer.

Explanation

When intravenous access cannot be obtained promptly in severe hypoglycaemia, intramuscular or subcutaneous glucagon 1 mg is the recommended alternative because it mobilises hepatic glycogen and raises glucose within about ten minutes. Once access is secured, intravenous dextrose should be given and the glucose rechecked. Glucagon may fail in glycogen-depleted patients such as chronic alcohol users.

Question 4Resuscitation, Shock and Critical Care

A trauma patient has brisk arterial bleeding from a thigh wound and a patent airway. What is the immediate priority?

  1. Give two litres of crystalloid then reassess
  2. Splint the limb and obtain radiographs
  3. Complete the secondary survey first
  4. Apply a tourniquet proximal to the wound Correct answer.

Explanation

Catastrophic external haemorrhage is controlled during the primary survey, before airway, breathing or any diagnostic imaging. A tourniquet placed 5-7 cm proximal to a limb wound, or direct pressure where a tourniquet cannot be used, stops the bleeding at once. Fluid resuscitation and the secondary survey follow only after haemorrhage control.

Question 5Resuscitation, Shock and Critical Care

An intubated trauma patient becomes profoundly hypotensive with absent left-sided breath sounds, distended neck veins and tracheal deviation to the right. What should be done immediately?

  1. Bronchoscopy to exclude a mucous plug
  2. Needle decompression, then tube thoracostomy Correct answer.
  3. Urgent portable chest radiograph before any intervention
  4. Fluid bolus and vasopressor infusion

Explanation

Tension pneumothorax is a clinical diagnosis and decompression must never wait for imaging. Needle decompression is followed immediately by a definitive intercostal drain. Requesting a chest radiograph in this unstable patient delays treatment and may precipitate cardiac arrest.

Question 6Resuscitation, Shock and Critical Care

An adult has been convulsing continuously for eight minutes and has intravenous access. Which drug is first line?

  1. Phenytoin 20 mg/kg intravenously
  2. Propofol 2 mg/kg intravenously
  3. Lorazepam 0.1 mg/kg intravenously Correct answer.
  4. Levetiracetam 60 mg/kg intravenously

Explanation

Convulsive status epilepticus is terminated with an adequate dose of a benzodiazepine, and intravenous lorazepam 0.1 mg/kg is first line, with intramuscular midazolam used when access is lacking. Second-line antiseizure drugs are given only if seizures persist after benzodiazepines. Propofol is a third-line anaesthetic agent that requires definitive airway control.

Question 7Resuscitation, Shock and Critical Care

Which statement best describes shock?

  1. A systolic blood pressure below 90 mmHg
  2. A haemoglobin concentration below 70 g/L
  3. A heart rate above 120 beats per minute
  4. Inadequate tissue oxygen delivery relative to demand Correct answer.

Explanation

Shock is a state of inadequate tissue oxygen delivery relative to metabolic demand and can exist with a normal blood pressure in compensated states. Hypotension is a late and unreliable marker, particularly in young and pregnant patients. Lactate, base deficit, mental status, urine output and skin perfusion reveal the underlying perfusion failure.

Question 8Resuscitation, Shock and Critical Care

A 35-year-old man with a pelvic fracture has a heart rate of 135/min, a systolic pressure of 90 mmHg, a respiratory rate of 32/min and is confused. Which class of haemorrhagic shock does this represent?

  1. Class II
  2. Class I
  3. Class IV
  4. Class III Correct answer.

Explanation

Class III haemorrhage corresponds to a loss of 30-40% of blood volume (about 1500-2000 mL) and is marked by tachycardia, hypotension, tachypnoea and altered mental status. Class I loss is under 15% with normal vital signs, class II is 15-30% with tachycardia but a preserved systolic pressure, and class IV is over 40% with marked hypotension and lethargy.

Question 9Resuscitation, Shock and Critical Care

An adult with septic shock remains hypotensive with a mean arterial pressure of 55 mmHg after 30 mL/kg of crystalloid. Which vasopressor is first line?

  1. Norepinephrine infusion Correct answer.
  2. Phenylephrine infusion
  3. Dopamine infusion
  4. Dobutamine infusion

Explanation

Norepinephrine is the recommended first-line vasopressor in septic shock because it raises mean arterial pressure with fewer tachyarrhythmias than dopamine. The usual initial target is a mean arterial pressure of 65 mmHg, with vasopressin added for refractory cases. Dobutamine is an inotrope used when cardiac output is low despite adequate filling and pressure.

Question 10Resuscitation, Shock and Critical Care

An adult has a potassium of 7.4 mmol/L with a widened QRS complex on the ECG. Which treatment should be given first?

  1. Sodium bicarbonate infusion
  2. Oral sodium polystyrene sulfonate
  3. Intravenous calcium gluconate Correct answer.
  4. Insulin-dextrose infusion

Explanation

Intravenous calcium salts are given first whenever hyperkalaemia produces ECG changes, because they stabilise the myocardium within minutes without lowering the serum potassium. Insulin with dextrose, nebulised salbutamol and bicarbonate then shift potassium into cells, while dialysis or binders remove it from the body. Calcium is repeated if ECG changes persist.

Question 11Resuscitation, Shock and Critical Care

An adult in diabetic ketoacidosis has a serum potassium of 3.1 mmol/L. Which is the most appropriate next step?

  1. Start the insulin infusion at once with potassium in the fluid
  2. Give intravenous potassium and delay the insulin infusion Correct answer.
  3. Give 3% saline to correct the serum sodium
  4. Give sodium bicarbonate to correct the acidosis

Explanation

Insulin drives potassium into cells, so insulin must be withheld until the potassium is above about 3.3 mmol/L and potassium replacement is running. Starting insulin in this setting can precipitate life-threatening hypokalaemia and arrhythmia. Bicarbonate is reserved for severe acidaemia and is not indicated here.

Question 12Resuscitation, Shock and Critical Care

A patient with ARDS has a PaO2/FiO2 ratio of 120 on PEEP 12 cmH2O and a plateau pressure of 34 cmH2O. Which ventilator strategy is correct?

  1. 6 mL/kg predicted body weight, plateau below 30 cmH2O Correct answer.
  2. Tidal volume of 12 mL/kg with permissive hypercapnia
  3. FiO2 of 1.0 with no applied PEEP
  4. Increase tidal volume until plateau pressure normalises

Explanation

Lung-protective ventilation with tidal volumes of about 6 mL/kg predicted body weight and a plateau pressure of 30 cmH2O or less reduces mortality in ARDS. Permissive hypercapnia is accepted, and PEEP is titrated against oxygenation and compliance. Larger tidal volumes cause volutrauma and worsen outcome.

Question 13Resuscitation, Shock and Critical Care

A patient with a stab wound to the chest has hypotension, distended neck veins and muffled heart sounds, and ultrasound shows a pericardial effusion with right ventricular collapse. Which management is most appropriate?

  1. Immediate left chest tube insertion
  2. Nitroglycerine infusion to unload the ventricles
  3. Loading dose of intravenous amiodarone
  4. Fluid bolus and emergency pericardiocentesis Correct answer.

Explanation

Tamponade causes obstructive shock, so preload is maintained with an intravenous fluid bolus while definitive drainage is arranged. Emergency pericardiocentesis, ideally ultrasound-guided, relieves the constraint on ventricular filling. Vasodilators such as nitrates can precipitate cardiovascular collapse.

Question 14Resuscitation, Shock and Critical Care

A trauma patient with ongoing haemorrhage is being resuscitated with a major haemorrhage protocol. Which transfusion strategy is best supported?

  1. Crystalloid until four units of red cells have been given
  2. Red cells alone until laboratory coagulopathy appears
  3. Withhold plasma until the INR exceeds 2.0
  4. 1:1:1 plasma, platelets and red cells Correct answer.

Explanation

Major haemorrhage protocols give red cells, plasma and platelets in a balanced ratio close to 1:1:1, which reduces dilutional coagulopathy and improves survival compared with red cells alone. Cryoprecipitate and calcium are added according to fibrinogen and ionised calcium results. Crystalloid is minimised because it aggravates coagulopathy, hypothermia and acidosis.

Question 15Resuscitation, Shock and Critical Care

A patient with a C6 spinal cord injury has a blood pressure of 78/50 mmHg, a heart rate of 48/min and warm dry skin. Which is the most appropriate initial management?

  1. Phenylephrine infusion alone
  2. Transfusion of two units of packed cells
  3. Norepinephrine infusion as the only measure
  4. Fluids, vasopressor and atropine if bradycardic Correct answer.

Explanation

Neurogenic shock results from loss of sympathetic outflow, producing hypotension with bradycardia and warm dry skin rather than the tachycardia of other shock states. Initial treatment is cautious crystalloid followed by a vasopressor, usually norepinephrine, with atropine or pacing for symptomatic bradycardia. Mean arterial pressure is often targeted at 85-90 mmHg to support cord perfusion.

Question 16Resuscitation, Shock and Critical Care

An adult on long-term prednisolone presents with hypotension unresponsive to fluids and vasopressors, together with hyponatraemia and hypoglycaemia. Which drug should be given empirically?

  1. Fludrocortisone 0.1 mg orally
  2. Levothyroxine 100 mcg intravenously
  3. Hydrocortisone 100 mg intravenously Correct answer.
  4. Octreotide 100 mcg subcutaneously

Explanation

Adrenal crisis should be treated empirically with intravenous hydrocortisone 100 mg as soon as it is suspected, before confirmatory results are available. Hydrocortisone provides both glucocorticoid and mineralocorticoid activity. Fluid, glucose and the precipitating illness are treated in parallel.

Question 17Resuscitation, Shock and Critical Care

A ventilated patient in shock has already received three litres of fluid. Which bedside manoeuvre best predicts fluid responsiveness?

  1. Central venous pressure measurement
  2. Repeat lactate after one hour
  3. Passive leg raise with output monitoring Correct answer.
  4. Chest radiograph to look for oedema

Explanation

A passive leg raise transiently increases venous return, and a rise in cardiac output of more than about 10% indicates that the patient is likely fluid responsive. The manoeuvre is fully reversible and does not commit the patient to a fluid bolus. Static measures such as central venous pressure do not reliably predict the response to fluid.

Question 18Resuscitation, Shock and Critical Care

An adult with a penetrating abdominal injury and no head injury has a systolic pressure of 80 mmHg with bleeding that is temporarily controlled. Which pressure target is most appropriate while awaiting theatre?

  1. Mean arterial pressure 90 mmHg
  2. Systolic 120 mmHg
  3. Systolic 140 mmHg
  4. Systolic around 90 mmHg Correct answer.

Explanation

In uncontrolled haemorrhage without traumatic brain injury, a systolic pressure of about 80-90 mmHg is targeted until surgical or endovascular control, which limits clot disruption and dilutional coagulopathy. Permissive hypotension is contraindicated in traumatic brain injury, where cerebral perfusion pressure must be maintained. The strategy ends once haemorrhage is controlled.

Question 19Resuscitation, Shock and Critical Care

Twenty minutes after intubation, a sedated patient desaturates to 78% with rising airway pressures. What is the most appropriate first step?

  1. Request an urgent chest radiograph
  2. Give a 500 mL fluid bolus
  3. Increase PEEP and inspired oxygen only
  4. Bag with 100% oxygen, check the tube Correct answer.

Explanation

Sudden desaturation after intubation is approached with a DOPE search: displacement, obstruction, pneumothorax and equipment failure. The tube should be disconnected and the patient ventilated with 100% oxygen by bag while position and patency are checked. Imaging and other investigations are arranged only after this immediate assessment.

Question 20Resuscitation, Shock and Critical Care

A woman at 34 weeks' gestation has a witnessed cardiac arrest in the emergency department. When should perimortem caesarean delivery be undertaken?

  1. Only after 20 minutes of full resuscitation
  2. After 4 minutes without return of circulation Correct answer.
  3. Only once spontaneous circulation returns
  4. Only after fetal heart sounds disappear

Explanation

Perimortem caesarean delivery is performed when there is no return of spontaneous circulation after about four minutes of good-quality resuscitation in a woman whose uterus is at or above the umbilicus. It relieves aortocaval compression and improves maternal haemodynamics, with fetal survival a secondary aim. It is done at the site of the arrest without moving the patient or waiting for fetal assessment.

Question 21Resuscitation, Shock and Critical Care

A patient with confirmed massive pulmonary embolism has a systolic pressure of 75 mmHg and right ventricular strain on echocardiography, with no bleeding contraindication. Which treatment is preferred?

  1. Unfractionated heparin alone
  2. Systemic thrombolysis with alteplase Correct answer.
  3. Oral rivaroxaban
  4. Inferior vena cava filter insertion

Explanation

Haemodynamic instability with right ventricular dysfunction defines high-risk pulmonary embolism, and systemic thrombolysis is the treatment of choice when there is no contraindication. Heparin alone is inadequate in shock, while catheter or surgical embolectomy is reserved for failed thrombolysis or absolute contraindications. Anticoagulation is continued after lysis.

Question 22Resuscitation, Shock and Critical Care

An adult with refractory hypotension and bradycardia after a metoprolol overdose has not responded to fluids, atropine or glucagon. Which therapy is most appropriate next?

  1. High-dose insulin with glucose Correct answer.
  2. Naloxone infusion
  3. Sodium bicarbonate bolus
  4. N-acetylcysteine infusion

Explanation

High-dose insulin with glucose is used for refractory beta-blocker or calcium channel blocker poisoning because it improves myocardial carbohydrate use and contractility. Glucagon, calcium salts, atropine and pacing are used earlier in the sequence. Extracorporeal support is considered when these measures fail.

Question 23Resuscitation, Shock and Critical Care

An adult with septic shock on norepinephrine 0.5 mcg/kg/min remains hypotensive with a mean arterial pressure of 58 mmHg. Which addition is best supported?

  1. Sodium nitroprusside infusion
  2. Vasopressin plus intravenous hydrocortisone Correct answer.
  3. Dopamine at 20 mcg/kg/min
  4. Dobutamine for a high cardiac output

Explanation

For septic shock that remains hypotensive despite adequate norepinephrine, adding vasopressin and intravenous hydrocortisone is recommended. Vasopressin acts on V1 receptors and may reduce catecholamine requirements, while hydrocortisone addresses relative adrenal insufficiency. Dobutamine is added only when there is evidence of low cardiac output.

Question 24Resuscitation, Shock and Critical Care

A patient with acute myocardial infarction has a cardiac index of 1.5 L/min/m2 and a wedge pressure of 26 mmHg despite maximal inotropes and vasopressors. Which intervention is most appropriate?

  1. Continuous renal replacement therapy alone
  2. Insertion of an intra-aortic balloon pump alone
  3. Initiation of veno-venous ECMO
  4. Referral for veno-arterial ECMO Correct answer.

Explanation

Veno-arterial ECMO provides circulatory support for refractory cardiogenic shock when optimal drug therapy and revascularisation are insufficient. It maintains end-organ perfusion while the ventricle recovers or a decision about longer-term support is made, though it carries bleeding and vascular risks. Intra-aortic balloon counterpulsation offers only modest augmentation, and veno-venous ECMO supports oxygenation alone.

Question 25Trauma, Burns and Wound Management

Using the rule of nines in an adult, what percentage of total body surface area is represented by the anterior trunk?

  1. 27%
  2. 13.5%
  3. 9%
  4. 18% Correct answer.

Explanation

In the adult rule of nines the anterior trunk accounts for 18% of total body surface area, and the posterior trunk accounts for another 18%. Each entire upper limb is 9%, each entire lower limb is 18%, and the head is 9%. The perineum is counted as 1%.

Question 26Trauma, Burns and Wound Management

A 70 kg adult with a 35% total body surface area burn is resuscitated using the Parkland formula (4 mL/kg/%TBSA). What volume should be given in the first 8 hours from the time of injury?

  1. 9800 mL
  2. 7350 mL
  3. 2450 mL
  4. 4900 mL Correct answer.

Explanation

The Parkland formula gives 4 mL × 70 kg × 35% = 9800 mL over the first 24 hours. Half of this total, 4900 mL, is given in the first 8 hours and the remainder over the following 16 hours. The clock starts at the time of injury, not at the time of arrival.

Question 27Trauma, Burns and Wound Management

A 30-year-old man has a deep, contaminated laceration from a rusty metal fence. His last tetanus toxoid booster was 7 years ago. What is the most appropriate tetanus management?

  1. Give a tetanus toxoid booster plus tetanus immunoglobulin
  2. Give a tetanus toxoid booster only Correct answer.
  3. Give tetanus immunoglobulin only
  4. Give no tetanus prophylaxis

Explanation

For a contaminated wound, a toxoid booster is indicated when more than 5 years have elapsed since the last dose. Immunoglobulin is reserved for patients who are unimmunised, have an incomplete course, or whose history is unknown. This patient has a complete course with a booster 7 years ago, so toxoid alone is sufficient.

Question 28Trauma, Burns and Wound Management

A trauma patient arrives with blood spurting from a femoral wound and is pale and confused. According to current trauma resuscitation priorities, what is the immediate first step?

  1. Apply direct pressure to control the external haemorrhage Correct answer.
  2. Insert two large-bore intravenous lines
  3. Secure the airway with endotracheal intubation
  4. Perform a complete secondary survey

Explanation

Exsanguinating external haemorrhage is controlled before airway assessment in the current primary survey sequence. Direct pressure, packing or a tourniquet is applied immediately while the airway is being assessed in parallel by the team. Uncontrolled bleeding will kill the patient faster than any other early problem.

Question 29Trauma, Burns and Wound Management

Which finding is the earliest and most reliable clinical sign of acute compartment syndrome of the leg?

  1. Paralysis of the distal limb is the earliest and most reliable sign
  2. Pallor of the overlying skin is the earliest and most reliable sign
  3. Pain on passive stretch of the muscles in the compartment Correct answer.
  4. Absence of the distal pulse is the earliest and most reliable sign

Explanation

Pain out of proportion to the injury, particularly pain provoked by passive stretch of the muscles within the compartment, is the earliest and most dependable sign. Pulselessness, pallor and paralysis are late features and their absence does not exclude the diagnosis. Distal pulses are typically preserved because compartment pressures rarely exceed arterial pressure.

Question 30Trauma, Burns and Wound Management

Which finding best distinguishes a superficial partial-thickness burn from a full-thickness burn?

  1. Presence of a leathery eschar
  2. Blanching with pressure and preserved pain sensation Correct answer.
  3. Cherry-red, dry skin with thrombosed vessels
  4. Absence of blister formation

Explanation

Superficial partial-thickness burns are moist, blistering and intensely painful, and they blanch with pressure because the dermal capillary bed is intact. Full-thickness burns are leathery, dry and insensate because the nerve endings have been destroyed. This difference in sensation and blanching is the key bedside discriminator.

Question 31Trauma, Burns and Wound Management

Which solution is preferred for irrigating a contaminated open wound in the emergency department?

  1. Povidone-iodine scrub solution
  2. Hydrogen peroxide
  3. Normal saline Correct answer.
  4. Chlorhexidine gluconate

Explanation

Normal saline is isotonic, does not damage tissue, and is the standard irrigant for contaminated wounds, ideally delivered at low pressure with copious volume. Antiseptic solutions are cytotoxic to fibroblasts and keratinocytes and impair wound healing when used inside the wound. They are suitable for intact skin preparation but not for wound irrigation.

Question 32Trauma, Burns and Wound Management

A 25-year-old sustains blunt chest trauma and becomes hypotensive with absent breath sounds on the right, distended neck veins and tracheal deviation to the left. What is the immediate management?

  1. Immediate needle decompression followed by tube thoracostomy Correct answer.
  2. Chest radiograph followed by tube thoracostomy
  3. Pericardiocentesis
  4. Intubation with positive-pressure ventilation alone

Explanation

Tension pneumothorax is a clinical diagnosis and requires immediate needle decompression without waiting for imaging. This is followed by definitive tube thoracostomy. Positive-pressure ventilation before decompression can worsen the tension and precipitate cardiovascular collapse.

Question 33Trauma, Burns and Wound Management

In a haemodynamically unstable patient with blunt abdominal trauma, what is the primary purpose of the FAST examination?

  1. To grade the severity of solid organ lacerations
  2. To exclude hollow viscus perforation
  3. To identify a retroperitoneal haematoma
  4. To detect free intraperitoneal and pericardial fluid Correct answer.

Explanation

FAST is a rapid bedside ultrasound screen for free fluid in the pericardium, perihepatic, perisplenic and pelvic spaces. In an unstable patient, positive findings prompt laparotomy without further imaging. It does not characterise organ injury, exclude hollow viscus injury or reliably visualise the retroperitoneum.

Question 34Trauma, Burns and Wound Management

A trauma patient in haemorrhagic shock is receiving a massive transfusion. Which strategy best reflects current damage-control resuscitation?

  1. Large-volume crystalloid resuscitation until blood arrives
  2. Packed red cells alone until coagulation tests become abnormal
  3. Balanced transfusion of red cells, plasma and platelets with minimal crystalloid Correct answer.
  4. Aggressive diuresis to prevent pulmonary oedema

Explanation

Damage-control resuscitation uses a balanced ratio of red cells, plasma and platelets, approximating 1:1:1, with restrictive crystalloid to avoid dilutional coagulopathy, hypothermia and worsening acidosis. Blood products are given empirically rather than waiting for laboratory evidence of coagulopathy. Permissive hypotension is used until haemorrhage is controlled.

Question 35Trauma, Burns and Wound Management

A patient has a circumferential full-thickness burn of the forearm with progressive numbness, an absent radial pulse and a tense limb. What is the most appropriate next step?

  1. Elevate the limb and reassess in one hour
  2. Doppler ultrasound of the radial artery
  3. Urgent escharotomy of the circumferential burn Correct answer.
  4. Fasciotomy of all forearm compartments

Explanation

A circumferential full-thickness burn acts as an unyielding band that raises tissue pressure and compromises perfusion, so urgent escharotomy is required. Escharotomy divides the eschar along the limb to restore perfusion. Fasciotomy is reserved for cases in which compartment pressures remain elevated after escharotomy or where deep muscle injury is present.

Question 36Trauma, Burns and Wound Management

A patient rescued from a house fire has singed nasal hairs, soot in the oropharynx and a hoarse voice. What is the most appropriate airway management?

  1. Observe with continuous pulse oximetry
  2. Await arterial blood gas results before deciding
  3. Nebulised salbutamol and reassess in one hour
  4. Early endotracheal intubation Correct answer.

Explanation

Stridor, hoarseness, soot in the oropharynx and singed nasal hairs indicate inhalational injury with developing upper airway oedema. Oedema progresses rapidly and can make later intubation impossible, so the airway should be secured early. Pulse oximetry and blood gases may remain normal until obstruction is advanced.

Question 37Trauma, Burns and Wound Management

A patient rescued from a smoke-filled room has headache and confusion, and the carboxyhaemoglobin level is 25%. Which treatment is most appropriate?

  1. Observation without supplemental oxygen
  2. Intravenous naloxone
  3. 15 L/min oxygen by nasal cannula
  4. 100% oxygen by non-rebreather mask Correct answer.

Explanation

High-flow 100% oxygen accelerates the dissociation of carboxyhaemoglobin and is the first-line treatment for carbon monoxide poisoning. Nasal cannula oxygen cannot deliver a high enough inspired fraction to be effective. Hyperbaric oxygen is considered for severe poisoning, syncope, neurological signs, acidosis or pregnancy.

Question 38Trauma, Burns and Wound Management

A laboratory worker sustains a splash burn from hydrofluoric acid. After copious irrigation, which specific treatment should be applied?

  1. Sodium bicarbonate solution
  2. Silver sulfadiazine cream
  3. Dilute acetic acid soaks
  4. Calcium gluconate gel Correct answer.

Explanation

Hydrofluoric acid penetrates deeply and binds tissue calcium and magnesium, causing severe pain, hypocalcaemia and arrhythmias. Calcium gluconate gel applied topically binds the fluoride ion, and intravenous calcium is given for systemic toxicity. Cardiac monitoring is required because of the risk of life-threatening hypocalcaemia.

Question 39Trauma, Burns and Wound Management

A patient presents with a fresh dog bite to the hand. Which antibiotic prophylaxis is recommended?

  1. Vancomycin alone
  2. Ciprofloxacin alone
  3. Amoxicillin-clavulanate Correct answer.
  4. No antibiotic prophylaxis is required

Explanation

Dog and cat bites are typically polymicrobial, and Pasteurella multocida is the key organism; amoxicillin-clavulanate provides reliable cover. Prophylaxis is particularly indicated for hand bites, deep puncture wounds, immunosuppressed patients and bites requiring surgical repair. Tetanus status and rabies risk must also be assessed.

Question 40Trauma, Burns and Wound Management

In a patient with an open fracture, within what time should intravenous antibiotics be given?

  1. Within twenty-four hours
  2. Within twelve hours
  3. Within six hours Correct answer.
  4. Within one hour

Explanation

Intravenous antibiotics should be administered as soon as possible after the injury, ideally within one hour, and this is widely stated as within 6 hours at the latest; earlier administration is associated with lower infection rates. A first-generation cephalosporin is used for most fractures, with additional cover for grossly contaminated or farm injuries. Tetanus status is checked at the same time.

Question 41Trauma, Burns and Wound Management

A woman at 32 weeks of gestation is hypotensive after a road traffic collision. After haemorrhage control has begun, which positioning improves venous return?

  1. Trendelenburg position
  2. Supine with both legs elevated
  3. Left lateral tilt with manual uterine displacement Correct answer.
  4. Prone position

Explanation

After about 20 weeks of gestation the gravid uterus compresses the inferior vena cava when the patient lies supine. Tilting the patient to the left or manually displacing the uterus restores venous return and improves cardiac output. This is done while resuscitation and haemorrhage control continue.

Question 42Trauma, Burns and Wound Management

A hypotensive patient has a suspected open-book pelvic fracture after blunt trauma. What is the most appropriate early intervention?

  1. Apply a pelvic binder at the level of the iliac crests
  2. Obtain a pelvic radiograph before any intervention
  3. Apply a pelvic binder at the level of the greater trochanters Correct answer.
  4. Apply bilateral skin traction to the lower limbs

Explanation

A pelvic binder placed at the level of the greater trochanters closes the pelvic ring and reduces pelvic volume and bleeding. Placing it higher, over the iliac crests, fails to compress the symphysis. Binder application should not be delayed for imaging in an unstable patient.

Question 43Trauma, Burns and Wound Management

A 25-year-old has a clean 4 cm laceration on the forearm repaired with sutures. When should the sutures be removed?

  1. 10 to 14 days Correct answer.
  2. 3 to 5 days
  3. 21 days
  4. 7 to 10 days

Explanation

Sutures on the trunk and extremities are generally removed at 10 to 14 days because these areas heal more slowly and are subject to greater tension. Facial sutures are removed earlier, at about 3 to 5 days, and scalp sutures at about 7 to 10 days. Leaving sutures too long increases scarring and tract marks.

Question 44Trauma, Burns and Wound Management

An 80 kg adult with a 40% total body surface area burn is receiving Parkland resuscitation. Two hours after injury the hourly urine output is 20 mL. What is the appropriate target urine output?

  1. 2 mL/kg/h, which is 160 mL/h
  2. 1 mL/kg/h, which is 80 mL/h
  3. 0.1 mL/kg/h, which is 8 mL/h
  4. 0.5 mL/kg/h, which is 40 mL/h Correct answer.

Explanation

In adults, burn resuscitation is titrated to a urine output of about 0.5 mL/kg/h, which is 40 mL/h for this patient. Children are generally targeted at 1 mL/kg/h because of their higher metabolic rate. The current output is inadequate, so the infusion rate should be increased and reassessed hourly.

Question 45Trauma, Burns and Wound Management

A patient rescued from an enclosed-space fire has soot in the airway, altered consciousness and a lactic acidosis that persists after carbon monoxide is treated. Cyanide toxicity is suspected. Which antidote is indicated?

  1. N-acetylcysteine
  2. Methylene blue
  3. Naloxone
  4. Hydroxocobalamin Correct answer.

Explanation

Hydroxocobalamin binds cyanide to form cyanocobalamin, which is excreted renally, and it is the preferred antidote in smoke inhalation because it does not cause hypotension. Cyanide poisoning should be suspected with persistent lactic acidosis, altered mentation and soot exposure after carbon monoxide has been addressed. The other antidotes listed do not bind cyanide.

Question 46Trauma, Burns and Wound Management

A trauma patient in the intensive care unit has an intra-abdominal pressure of 22 mmHg with new oliguria and rising airway pressures. What is the most appropriate management?

  1. Decompressive laparotomy Correct answer.
  2. Increasing positive end-expiratory pressure
  3. Intravenous furosemide
  4. Fluid loading to improve renal perfusion

Explanation

An intra-abdominal pressure above 20 mmHg with new organ dysfunction defines abdominal compartment syndrome, and the definitive treatment is decompressive laparotomy. Medical measures such as neuromuscular blockade, drainage of intraluminal contents and paracentesis may be used while preparing for surgery. Fluid loading and diuretics do not relieve the underlying pressure.

Question 47Trauma, Burns and Wound Management

A patient with midface trauma has a mobile maxilla while the nasal bridge and zygomas remain stable, and the hard palate moves as a unit with the maxilla. Which fracture is present?

  1. Le Fort III fracture
  2. Zygomaticomaxillary complex fracture
  3. Le Fort II fracture
  4. Le Fort I fracture Correct answer.

Explanation

A Le Fort I fracture is a low transverse fracture through the maxilla above the tooth roots, so the hard palate and alveolar ridge move while the nasal bridge and zygomas stay fixed. Le Fort II is pyramidal and involves the nasal bridge, and Le Fort III is a craniofacial dysjunction that moves the zygomas. A zygomaticomaxillary fracture produces malar depression and diplopia rather than a mobile palate.

Question 48Trauma, Burns and Wound Management

A patient has rapidly spreading leg pain, fever, skin necrosis and crepitus, and necrotizing fasciitis is suspected. What is the most important intervention?

  1. Immediate surgical debridement with broad-spectrum antibiotics Correct answer.
  2. Intravenous antibiotics alone
  3. Magnetic resonance imaging before any intervention
  4. Hyperbaric oxygen as the primary treatment

Explanation

Necrotizing fasciitis is a surgical emergency, and the single most important intervention is immediate radical debridement of all necrotic tissue together with broad-spectrum antibiotics. Antibiotics alone cannot penetrate the devitalised, thrombosed tissue. Imaging must not delay surgery when the clinical picture is convincing.

Question 49Cardiovascular Emergencies

Which ECG finding defines an ST-elevation myocardial infarction in the setting of ischemic chest pain?

  1. A pathologic Q wave in one lead
  2. ST depression in a single lead
  3. New ST elevation in two contiguous leads Correct answer.
  4. T-wave inversion in two leads

Explanation

STEMI is defined by new ST elevation at the J point in two anatomically contiguous leads, with thresholds that vary by lead, age, and sex. Reciprocal ST depression can support the diagnosis but is not required. Isolated T-wave inversion or Q waves do not by themselves establish an acute STEMI.

Question 50Cardiovascular Emergencies

A 64-year-old woman has ischemic chest pain, dynamic ST depression, and a rising troponin. She is hemodynamically stable. Which early antiplatelet strategy is indicated unless contraindicated?

  1. Dual antiplatelet therapy Correct answer.
  2. Prophylactic lidocaine infusion
  3. Warfarin monotherapy
  4. Fibrinolytic therapy before angiography

Explanation

NSTE-ACS is managed with dual antiplatelet therapy plus anticoagulation and early risk stratification for an invasive strategy. Fibrinolysis is indicated for STEMI, not for NSTE-ACS. Warfarin and prophylactic lidocaine have no routine role in this setting.