1 The most
commonly injured carpal bone is:
a) the triquetral bone
2 In deciding
whether to x-ray the foot or ankle after someone has injured this area the
nurse should use which of the following principles to aid them?
a) all injuries of the ankle and
foot should have foot and ankle x-rays
3 Which of the
following statements best describes the attributes of a leader rather than a
manager?
a) has formal authority,
minimises risks and makes rules
4 Which of the
following findings during the assessment of a child with a head injury is of
LEAST clinical significance?
a)
a
single episode of vomiting a short time after the injury
5 Ottawa
a) weight bear i.e. take 4 steps
either now or could not at the time of the injury
6 Axial loading
injury is the term used to describe injuries associated with compression of the
body along its longitudinal plane. These are seen in patients who fall from
height. Which of the following would you NOT expect to find in a patient with
an axial loading injury
a)
acetabular
fractures of the hip
7 Abduction describes the movement of a
joint away from the midline in the transverse plane. What is the term used to
describe the opposite, that is the movement of a joint toward the midline in
the transverse plane:
a)
Pronation
8 Mallet finger is a common minor injury
of the finger and is best described as:
a)
a
rupture of the flexor tendon of the distal phalange of the finger
9 Why are patients with suspected
fractures of the scaphoid bone still
immobilised even in the absence of x-ray evidence of a fracture?
a)
because
of the risk of avascular necrosis of a fracture segment
10 Head injury advice:
a)
should
be given only to those patients that the nurse is concerned about
11 The
following are all early signs of circulatory compromise EXCEPT:
a) hypotension
12 Which of the
following IS NOT an indicator of potentially serious asthma
a) the patient has been
ventilated on 2 previous admissions to the hospital
13 Information
about mechanism of injury provides clues to the nature of possible injuries.
The vast majority of ankle injuries are sustained by what mechanism?
a) inversion injury
14 Glasgow
a)
eye
opening response/verbal response/pupil reaction to light
15 Recognition
of the unwell child is crucial. The following are all signs and symptoms of
respiratory distress in children EXCEPT:
a) nasal flaring
16 Which of the
following IS NOT a contraindication for thrombolysis in myocardial infarction
a) current anticoagulant therapy
17 Pregnant trauma patients should not
be laid supine, particularly in the third trimester of pregnancy, because:
a)
If
the foetal head is engaged it may become dis-engagedOttawa
a) 12-55 year olds
19 Kurt Lewin
identified 3 broad classifications of leadership style that may be applied to
individuals or organisations. These 3 classifications are:
a) Autocratic, Laissez-faire and
Democratic
20 In managing the care of the airway in
a patient that has suffered major trauma the following manoeuvre should be used
to open and maintain the airway:
a)
Jaw
thrust
21 The British
Association for Emergency Medicine’s (BAEM) 2004 guidelines concerning pain
relief in children recommend which one of the following methods for the relief
of severe pain in children?
a) administration of oral
morphine (oramorph)
22 In caring
for the patient who is apparently drunk with a head injury all of the following
statements will be true EXCEPT:
a)
If
the patient is drunk then it is safe to assume their symptoms are because of
this
23 In caring
for bereaved relatives in the emergency care setting all of the following
strategies may enhance the care provided EXCEPT:
a) Providing the opportunity to
view the deceased
a) The size of your palm
25 The
following are all utilised for the assessment of pain in children EXCEPT:
a) The Oucher scale
26 Which of the
following IS NOT a risk factor for ectopic pregnancy
a) smoking
27 The 3 phalanges of the fingers are
described according to their anatomical position: What is the 1st
phalange of the finger i.e. that nearest to the hand called:
a)
The
intermediate phalange
28 Kurt Lewin
classified organisations by the predominant culture within them – Which of the
following sets of attributes best describes a democratic organisation?
29 Which of the
following would make you think that burn/scald injury in a child is ACCIDENTAL
rather than a result of abuse:
a) The scald or burn has a ‘tide
mark’ with well delineated borders
30 Which of the
following is the correct classification of forms of child abuse:
a) neglect, physical abuse,
emotional abuse, sexual abuse
|
Emergency Care Multiple Choice
Questionnaire Answers
|
|
1
|
C
|
Fractures
of the scaphoid bone account for 95% of all fractures of the carpal bones and
this is partly due to it’s long narrow shape.
|
|
2
|
C
|
Examination
of the foot and ankle and the application of the
|
|
3
|
B
|
Leadership
and management are different concepts. Leaders are thought of as being ready
to take risks in order to get results and may be powerful because of personal
charisma rather than the formal authority that comes with a job title
|
|
4
|
A
|
A
high speed injury should raise the suspicion of serious head injury. Amnesia
of greater than 5 minutes and witnessed loss of consciousness of more than 5
minutes are indications for CT scan of the head in the NICE head injury
guidelines. Vomiting after head injury is not a significant finding in
children unless it is delayed or happens more than 3 times
|
|
5
|
A
|
Inability
to weight bear more than 4 steps at consultation or at the time of the injury
is included as an indication for x-ray in the
|
|
6
|
D
|
From
transmission of kinetic energy through the skeleton after landing on the feet
from height fractures of the calcaneum and spine are not unexpected findings.
Pressure on the femoral head may also fracture the acetabulum of the hip.
Sternal fractures would be an unexpected finding when transmission of energy
is along the lower limb and spine of the patient
|
|
7
|
C
|
Pronation
and supination of the forearm is the act of rotating the forearm so that the
palm of the hand is facing down (pronation) and up (supination). Extension is
the opposite of flexing a joint and adduction is the opposite of abduction
when a joint is moved towards the midline of the body
|
|
8
|
B
|
Mallet
finger is a rupture of the extensor tendon in the finger where it inserts at
the base of the distal phalange. Sometimes as a result of this rupture there
may be an avulsion fracture of the distal phalange
|
|
9
|
A
|
Blood
supply to the scaphoid bone is via the distal pole of the bone. Most
fractures are through the waist or middle of the bone. If the proximal part
of the bone then becomes displaced as a result of the fracture it loses
contact with the blood supply through the distal pole and becomes avascular
|
|
10
|
D
|
Head
injury advice should be given to all patients with a head or facial injury.
Feedback about understanding of the advice should be gained by verbally
reinforcing the written advice
|
|
11
|
A
|
Hypotension
is a late marker of circulatory failure as systolic pressure is maintained by
compensatory mechanisms within the body. Earlier markers of compromise
include tachycardia, tachypnoea and prolonged capillary refill time beyond 2
seconds
|
|
12
|
D
|
A
history of intensive care treatment for asthma makes the prospect of brittle
asthma with rapid deterioration more likely. Inability to talk in complete
sentences and an expiratory wheeze audible prior to auscultation with a
stethoscope are also signs of potentially severe disease. A cough perhaps
indicative of a superimposed chest infection is not in itself a sign of
severe asthma
|
|
13
|
A
|
The
majority of ankle injuries are caused by inversion of the ankle away from the
midline of the body. Eversion is toward the midline. Plantar flexion is
flexion of the ankle downwards and axial loading is associated with landing
on the feet after a fall from height
|
|
14
|
C
|
Eye
opening response, verbal response and motor response are the 3 components of
the Glasgow Coma Scoring system
|
|
15
|
C
|
Children
in respiratory distress will adopt an upright (tripod or Fowlers) position to
maximise respiratory intake. Nasal flaring and intercostal muscle recession
are markers of increased respiratory effort. Children who are short of breath
will not preferentially adopt a supine position
|
|
16
|
C
|
Any
recent bleeding or anticoagulation is a contraindication to thrombolysis as
is hypotension rather than hypertension
|
|
17
|
C
|
In
lying supine the uterus may occlude the inferior vena cava and reduce cardiac
filling leading to syncope. In pregnant trauma patients a wedge (
|
|
18
|
A
|
|
|
19
|
A
|
Lewin
identified autocracies typified by a top down approach to leadership,
democracies typified by a collaborative approach and laissez-faire
organisations typified by a ‘hands off’ approach to leadership
|
|
20
|
A
|
Jaw
thrust manoeuvres minimise movement of the cervical spine which is important
to avoid exacerbating or causing injury to the neck in patients who have
suffered trauma. Head tilt and chin lift will involve movement of the
cervical spine.
|
|
21
|
B
|
BAEM
recommends the use of intranasal diamorphine which has more rapid onset than
oral morphine solution (oromorph) and this may then be supplemented of
necessary with intravenous morphine sulphate
|
|
22
|
A
|
The
apparently drunk patient is particularly vulnerable in emergency care
settings: they may be unable to provide critical details about their medical
history, they may be more prone to bleeding if they are chronic alcohol
abusers and staff may make value judgements about them being drunk that
potentially affect the care they are given. The apparently drunk patient
should be closely observed and assumed to have a head injury until proven
otherwise
|
|
23
|
B
|
Apologising
for the fact that the life of a loved one could not be saved may lead
relatives to think that not everything that should have been done to save
life was done. It may give the impression also that something that was done
may have been done incorrectly
|
|
24
|
C
|
The
size of the palm of the patient roughly equates to 1% of body surface area
and this may be used as an estimate of the severity of burns and scalds where
access to more formal tools such as the
|
|
25
|
C
|
The
FLACC scale was developed to assess post operative pain in children by
observing their behaviour and expression whilst Wongs smiley faces and the
Oucher scale were developed to assess acute pain in children by
interpretation of facial expression
|
|
26
|
D
|
Previous
surgery to the pelvis or fallopian tubes and previous episodes of ectopic
pregnancy has an association with an increased risk of ectopic pregnancy.
There is also an association between smoking and incidence of ectopic pregnancy
|
|
27
|
C
|
The
phalange of the finger nearest to the hand - i.e. the one that articulates at
the metacarpophalangeal (MCP) joint (or the knuckle) is called the proximal
phalange. The middle phalange of each finger is termed the intermediate or
middle phalange and the one at the end of the finger is the distal or
terminal phalange
|
|
28
|
A
|
A
democratic organisation is one in which there is a collaborative approach to
management and leadership that involves all levels of staff within the
organisation. Education and training is valued in such organisations and
blame cultures are not associated with their working. Answer b) and c) typify
a laissez-faire organisation where management is very much ‘hands off’ and
there may be little co-ordination of activities. Answer d) typifies an
autocratic organisation with a top down approach to management and leadership
|
|
29
|
D
|
Superficial
burns and scalds with evidence of splash marks demonstrate brief exposure to
the burning or scalding agent and a struggle to escape from it. Where the
history provided does not seem to account for the injury sustained, where the
burn is patterned or shaped as may result from deliberate burning with a
domestic appliance such as an iron then suspicion of abuse should be raised.
Lack of splash marks and a well delineated border to the burn or scald (a
‘tide mark’) is evidence of immersion in scalding fluid and either restraint
of the child in the fluid or the child being too scared to attempt
escape
|
|
30
|
A
|
Emotional
abuse may also be a facet of the 3 other categories of abuse in children that
are physical abuse, sexual abuse and neglect. Financial abuse may be a
feature of elder abuse
|
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