care of patient with minor illness MCQ

1.      Principles that guide the documentation of the consultation process in patient records include all of the following EXCEPT:

A) Be written clearly in permanent blue ink

B) Be signed, dated and timed

C) Be written sequentially or consecutively

D) Be factual and not include offensive or subjective statements

2.     The British Thoracic Society’s definition of a mild exacerbation of asthma is:

A) Adults and children >5years with peak flow >75% of anticipated maximum

B) Adults and children >5years with peak flow >60% of anticipated maximum

C) Adults and children >2 years with peak flow >75% of anticipated maximum

D) Adults and children without an audible wheeze

3.     The area where the thorax borders the abdomen is called:

A) The costal margin

B) The upper quadrant

C) The lower quadrant

4.     Which of the following IS NOT a sign or symptom of respiratory distress:

A) An expiratory grunt in children

B) Adoption of a supine position by the patient

C) Breathing through pursed lips

D) Nail bed cyanosis

5.     Which of the following findings would you NOT EXPECT in a patient with a chest infection:

A) Right lower lobe consolidation

B) Widespread crackles

C) Normal percussion findings

6.     Children are more prone to respiratory distress as a result of airway inflammation or infection because

A) They become more anxious than adults thus increasing the demand for oxygen

B) They do not have the ability to become tachypnoeic in response to respiratory insufficiency

C) They have funnel shaped airways with a narrow portion that is prone to occlusion and narrowing in disease

D) They contract diseases which are more likely to cause respiratory distress

7.     Patients with costochondritis will have pain on palpation of:

A) the junction of the ribs with the sternum

B) the junction of the ribs with the spine

C) the clavicle

D) the costal margin

8.     Which of the following signs and symptoms would lead you to suspect that a patient had otitis media:

A) Bulging, bright red or retracted tympanic membrane and fever

B) Inflammation of the external ear and crust formation on the auditory canal

C) Blocked feeling in the ear and reported reverberation of patients own voice

D) Sensor neural hearing loss and complaints of tinnitus

9.      Bacterial conjunctivitis is highly infectious and associated with the characteristic symptoms of:

A) Muco-purulent discharge and sticky eye after sleep or in the morning

B) Muco-purulent discharge and reduced visual acuity

C) Sub-conjunctival haemorrhage and reduced visual acuity

D) Severe photophobia and sticky eye after sleep or in the morning

10. Children are more prone to middle ear infections because:

A) Their Eustachian tube lies at a more acute angle to the middle ear than adults

B) Their Eustachian tube lies at a less acute angle to the middle ear than adults

C) They have less well developed tympanic membranes

D) They have less well developed Malleus, Incus and Stapes bones  

11.  In a 26 year old patient with a temperature of 39.2̊, and pain on swallowing you discover, when examining his throat, that he has deviation of the uvula. What is the most likely diagnosis:

A) Gingivitis

B) Peri-tonsillar abscess

C) Globus hystericus

D) Oral carcinoma

12. All of the following are sight threatening illnesses EXCEPT:

A) Acute glaucoma

B) Scleritis

C) Retinal detachment

D) Iritis

13. Which of the following is more suggestive of croup than epiglottitis:

A) Sudden onset of symptoms

B) Gradual onset of symptoms

C) Drooling

D) High temperature

14. A patient you are caring for has renal colic. All of the following would prompt you to refer the patient for admission EXCEPT:

A) Their pain had resolved in 45 minutes after NSAID analgesia

B) They have a temperature of 38.7°

C) They have only one functioning kidney

D) They have anuria

15. You will need to exclude all of the following before diagnosing renal colic EXCEPT:

A) Urinary Tract Infection

B) Pyelonephritis

C) Gastroenteritis

D) Aortic aneurysm

16. John, a 42 year old man, presents with a painful 1^st metatarsal. What findings would be suggestive of gout:

A) Bruising

B) Increased capillary refill time in the associated nail bed

C) Red inflamed joint

D) Reduced sensation

17. Herpes zoster infection is characterised by pain that may precede a skin rash by up to 5 days and a previous history of varicella (chicken pox) infection. Which of the following is also specifically diagnostic of herpes zoster infection:

A) Linear distribution of vesicles

B) Dermatomal distribution of vesicles

C) Hyperpyrexia

D) Pruritis

18. The following are all dermatological indicators of liver disease EXCEPT:

A) spider naevi

B) macular rash

C) palmar erythema

19. A patient presents with a painful elbow. What feature would indicate to you that the patient has olecranon bursitis:

A)    Full painless range of movement in the elbow

B)    Warm fluctuant swelling

C)    Crepitus

D)    Pain radiating to the shoulder

20. Carpal tunnel syndrome is caused by compression of which nerve:

A) Median nerve

B) Radial nerve

C) Ulnar nerve

D) Axillary nerve

21. Impetigo infection is characterised by:

A) Being highly contagious and having honey coloured peri-oral lesions

B) Being highly contagious and having petechial type lesions

C) Being highly contagious and having dermatomal distribution

22. Which form of skin cancer accounting for 1% of skin cancers but 60% of deaths caused by skin cancer is associated with this degree of mortality because it metastasises early

A) Basal cell carcinoma

B) Squamous cell carcinoma

C) Malignant melanoma  

23. Which of the following would give you cause for concern in a 2 year old child you are assessing?

A) Respiratory rate of 30

B) Pulse rate of 125

C) Blood pressure of 90/50

D) Cold limbs and a withdrawn mood

24. The four ‘geriatric giants’ is the name given to presentations that complicate assessment in the older patient. What are these four ‘geriatric giants’:

A) Confusion, incontinence, immobility and pressure sores

B) Confusion, immobility, incontinence and falls

C) Confusion, falls, shortness of breath and anxiety

25. Certain types of prescribed medication may contribute to the incidence of falls in the elderly: these may include all of the following EXCEPT:

A)    Diuretics

B)    Anti-hypertensives

C)    Hypnotic or sedative medication

D)    Non-steriodal anti-inflammatory drugs

26. Prescription and administration of emergency contraception is a feature of the work of many minor illness practitioners. Before you administer the medication to a 14 year old you will want to ensure, where possible, that all of the following conditions are true EXCEPT:

A)    That sex was consensual

B)    That the 14 year old has not been abused by an adult

C)    That parents are made aware of attendance even if she does not wish this

D)    That she obtains some sexual health education subsequent to the visit

27. Which one of the following IS NOT an indication for a chest x-ray:

A) Haemoptysis

B) Hypoxia

C) ?pneumothorax

D) Costochondritis

28. In abdominal obstruction what characteristic sign is found on the abdominal x-ray:

A) Air-fluid levels

B) Megacolon

C) Renal hypertrophy

D) Air under the diaphragm

29. In uncomplicated urinary tract infection in the adult female trimethoprim should be supplied for:

A) 7 days

B) 10 days

C) 3 days

30. Plantar fasciitis is typically seen in the overweight and those who undertake uncharacteristic levels of exercise. A diagnostic aid in plantar fasciitis is the fact that it is characterised by pain that is:

A) Worse in the evening

B) Worse on elevating the leg

C) Worse in the morning on first weight bearing

D) Worse on flexing the knee

Minor Illness MCQ Answers

1	A	Documentation should be in black ink to facilitate photocopying of records when necessary
2	A	The British Thoracic Society’s asthma guidelines refer to adults and children over 5 years old, where obtaining a peak flow recording is possible, and to children below 5 years of age where obtaining a peak flow recording is unlikely. In adults and children over 5 years of age the Society defines mild exacerbation of asthma as being associated with a peak flow recording of 75% or more of the expected maximum for the patient dependent upon age and gender
3	A	The costal margin is where the thorax borders the abdomen below the last rib - it is where a liver edge may be felt on the right side and sub-costal recession may be seen in patients, especially children, with increased respiratory effort
4	B	Adults breathe through pursed lips and children forcibly close the glottis producing an expiratory grunt in an effort to maintain positive end pressure during expiration. Nail bed cyanosis may be seen in hypoxic patients. Patients who are in respiratory distress will generally adopt an upright position bending slightly forwards (Fowler’s or tripod position) to maximise air intake during inspiration. They will not be comfortable lying supine.
5	A	Consolidation with fluid is associated with pneumonia and is not a feature of chest infection. Widespread crackles and normal findings on percussion of the chest are associated with chest infection
6	C	The trachea of a young child narrows like a funnel towards the larynx. The trachea of adults is a uniform lumen for its entire length. This narrow part of the trachea in the child occludes more readily during inflammatory and infective changes in the upper respiratory tract
7	A	Costochondritis is an inflammation of the ligaments of the sternal margins where the ribs attach to it. Its cause is largely unknown though it may occur after illness or injury. It is seen mainly in adolescents and young adults
8	A	Otitis media, an infection of the middle ear, will produce a red inflamed tympanic membrane which may bulge. The patient, usually a child, will have a fever. If the condition is chronic there may be a purulent discharge. A healthy tympanic membrane is flat and silver/grey in colour
9	A	Mild photophobia may be a feature of conjunctivitis but it should not be more severe than this. Reduced visual acuity is not expected in conjunctivitis
10	B	The Eustachian tube of a child lies at a less acute angle between the middle ear and the upper respiratory tract than is the case in the adult. This makes transmission of infection between the upper respiratory tract and the middle ear, and vice-versa, much easier
11	B	High fever, dysphagia and deviation of the uvula away from the abscess are some of the features of peritonsillar abscess or quinsy
12	B	Scleritis, or inflammation of the white of the eye, is not generally sight threatening whereas the raised intra-orbital pressures associated with glaucoma, the shearing of the retina away from the back of the eye in retinal detachment and the inflammation of the ciliary muscles and the iris in iritis are all potentially sight threatening processes
13	B	Croup is characterised by gradual onset and children or their parents may give a history of a viral like illness for a few days prior to development of other symptoms. Unless severe it is not generally associated with high fever and drooling or inability to swallow
14	A	Clinical Knowledge Summary guidelines for assessment and management of renal colic state that if pain can be controlled within an hour then discharge with appropriate aftercare may be considered. Anuria or having only one functioning kidney will prompt referral and associated fever may be indicative of systemic illness secondary to infective processes in the renal or urinary tract
15	C	Stagnation of urine behind large renal calculi may predispose to urinary tract infection and pyelonephritis. In older males especially with a sudden onset of severe pain in the back an aortic aneurysm will need to be excluded.
16	C	70% of patients with gout have the first episode in the 1st metatarsophalangeal joint of the big toe which becomes painful, red and inflamed
17	B	Herpes zoster infection always unilaterally follows the path of a dermatome. Thus it is seen on one side of the body or the other and when on the face a visible demarcation line may be seen along the midline of the face
18	B	Spider naevi and palmar erythema are indicative of liver disease. A macular rash is a flat rash where there is a change in colour of the skin, usually pink or red, and may be seen in measles or generalised allergic type rashes
19	B	Patients with olecranon bursitis may have movement limited by swelling and pain and should not have crepitus or radiation of pain to the shoulder joint
20	A	The median nerve passes through the carpal tunnel at quite a superficial level and is compressed during carpal tunnel syndrome. The median nerve provides sensory innervation to the thumb, index and middle fingers and in most people the lateral aspect of the ring finger also
21	A	Honey or brown coloured crusting lesions usually around the mouth and nose in children typify impetigo infection. It is highly contagious. Petechial lesions are caused by bleeding into skin from damaged blood vessels and dermatomal distribution of lesions is characteristic of herpes zoster infections
22	C	Basal cell carcinomas and squamous cell carcinomas do not in general metastasise as early as malignant melanomas
23	D	The haemodynamic observations are within normal limits for a 2 year old. Cold peripheries may indicate peripheral shutdown and vascular damage secondary to sepsis and withdrawn or altered mood may be attributable to raised intracranial pressure
24	B	These so called ‘Geriatric Giants’ may complicate assessment of the older patient and may be a cause or effect of illness in this patient group
25	D	Non-steroidal anti-inflammatory drugs are associated with an increased incidence of gastrointestinal bleeding in older patients but do not account for any higher incidence of falls
26	C	Providing the 14 year old is deemed Fraser competent then she is entitled to the same level of confidentiality as an adult attending for care. If she does not wish her parents to be informed then disclosure to them without adequate justification will constitute a breach of this confidentiality
27	D	There is no indication to x-ray a patient with inflammation of the ligaments at the sternal margins
28	A	Obstruction will lead to a backlog of entrapped air and fluid which will show up as fluid or air levels with a flat upper edge on the abdominal x-ray
29	C	3 days is now the recommended course of treatment in adult females and the 2007 NICE guidelines for the management of UTI in children now also advocate this in uncomplicated infections in children older than 3 years
30	C	Pain in plantar fasciitis is always worse when first weight bearing after sleep and this is particularly useful in diagnosing the condition

Emergency nursing care MCQ

1 The most commonly injured carpal bone is:

a)      the triquetral bone

b)      the pisiform bone

c)      the scaphoid bone

d)      the hamate 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

b)      the foot never needs to be x-rayed with the ankle

c)      examination of the foot and ankle will provide the information needed to decide whether just the foot, just the ankle, or the foot and ankle need x-raying 

d)      if the ankle does not need x-raying then neither does the foot

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

b)      has personal charisma, takes risks and breaks rules

c)      enjoys control, avoids conflict and blames others

d)      enjoys stability and planning in detail

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

b)      amnesia concerning the event

c)      a history of loss of consciousness for several minutes after the injury

d)      history of a high speed injury

5 Ottawa ankle & foot rules help to decide whether to x-ray an ankle or foot. They state that the ankle should be x-rayed if there is tenderness at the lateral or medial malleolus, or in the 6cm posterior to these points, and also if the patient cannot:

a)      weight bear i.e. take 4 steps either now or could not at the time of the injury

b)      dorsiflex the ankle

c)      plantar flex the ankle

d)      stand on tiptoe

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

b)      spinal fractures

c)      calcaneal fractures

d)      sternal fractures

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

b)      Supination

c)      Adduction

d)      Extension

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

b)      a rupture of the extensor tendon of the distal phalange of the finger

c)      a fracture of the proximal 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

b)      because scaphoid bones fracture more readily than other carpal bones

c)      because patients may have post injury arthritis if the fracture is missed

d)      because there may be damage to the radial nerve in missed fractures

10 Head injury advice:

a)      should be given only to those patients that the nurse is concerned about

b)      should be given in written form

c)      should be given only for children with head injury

d)      should be given verbally and in written form

11 The following are all early signs of circulatory compromise EXCEPT:

a)      hypotension

b)      tachypnoea

c)      tachycardia

d)      prolonged capillary refill time

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

b)      the patient is not able to talk in complete sentences

c)      the patient has an audible wheeze

d)      the patient has a cough

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

b)      plantar flexion injury

c)      eversion injury

d)      axial loading injury

14 Glasgow Coma score (GCS) is made up of 3 component parts and these are:

a)      eye opening response/verbal response/pupil reaction to light

b)      eye opening response/motor response/pupil reaction to light

c)      eye opening response/motor response/verbal response

d)      eye opening response/limb power/verbal response

15 Recognition of the unwell child is crucial. The following are all signs and symptoms of respiratory distress in children EXCEPT:

a)      nasal flaring

b)      intercostal and sternal recession

c)      lying supine

d)      adopting an upright position

16 Which of the following IS NOT a contraindication for thrombolysis in myocardial infarction

a)      current anticoagulant therapy

b)      miscarriage 3 days ago

c)      Diastolic pressure of 105

d)      actively bleeding peptic ulcer 3 months ago

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-engaged

b)      It may precipitate premature labour

c)      The uterus will occlude the inferior vena cava and reduce cardiac filling

d)      It may inhibit the work of the anaesthetist 

18 Which age group is the Ottawa ankle and foot rules applied to?

a)      12-55 year olds

b)      55 year olds and older

c)      under 16’s

d)      all age groups

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

b)      Autocratic, Democratic and Liberal

c)      Autocratic, Laissez-faire and Prescriptive

d)      Autocratic, Democratic and Conservative

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

b)      Head tilt and chin lift

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)

b)      administration of intra-nasal diamorphine +/- intravenous morphine sulphate

c)      administration of oral morphine +/- non-steroidal anti-inflammatory medication

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

b)      The symptoms of patients who are drunk with a head injury should be attributed to the head injury until this can be proven otherwise

c)      Alcoholics present additional problems when apparently drunk with a head injury as they may also have a clotting disorder which makes bleeding more likely

d)      Those apparently drunk with a head injury need regular neurological observations

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

b)      Apologising for the fact that life could not be saved

c)      Ensuring privacy

d)      Providing written information for relatives to take away

24 Tools exist to estimate burn surface area. However an adequate reckoner of burn surface area in adults or children is to compare the burnt area to:

a)      The size of your palm

b)      The size of your sole

c)      The size of the patient’s palm

d)      The size of your nose

25 The following are all utilised for the assessment of pain in children EXCEPT:

a)      The Oucher scale

b)      Wongs smiley faces

c)      The flincher scale

d)      The FLACC scale

26 Which of the following IS NOT a risk factor for ectopic pregnancy

a)      smoking

b)      tubal or pelvic surgery

c)      previous ectopic pregnancy

d)      alcohol abuse

27 The 3 phalanges of the fingers are described according to their anatomical position: What is the 1^st phalange of the finger i.e. that nearest to the hand called:

a)      The intermediate phalange

b)      The central phalange

c)      The proximal phalange

28 Kurt Lewin classified organisations by the predominant culture within them – Which of the following sets of attributes best describes a democratic organisation?

a)       

fair blame culture

networked approach

creativity and risk taking is nurtured

role development

long term plans/proactive

teams are dynamic

targets are met and new ones devised

education is valued and linked to IPR

b)       

your manager thinks they know you

you think you know your manager

high staff turnover, sickness is poorly managed and monitored

complaints may be high

sink or swim culture

c)       

no blame culture

unclear approach

creativity may be valued but is not nurtured

targets are sometimes met

loose teams

role uncertainty

education is valued but not planned

d)       

blame culture

top-down approach

protocol driven

education is not valued

creativity and risk taking are not valued

targets may be met but need to be constantly reinforced

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

b)      The pattern of the scald or burn does not fit with the history given

c)      The burn is patterned or shaped

d)      The burn is superficial with evidence of splash marks

30 Which of the following is the correct classification of forms of child abuse:

a)      neglect, physical abuse, emotional abuse, sexual abuse

b)      neglect, physical abuse, financial abuse, sexual abuse

c)      neglect, manipulation, 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 Ottawa ankle and foot rules will allow the nurse to request appropriate x-rays of the ankle, foot, ankle and foot or neither of these
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 Ottawa ankle and foot rules
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 (Cardiff wedge) should be placed under the right side of the abdomen to avoid this
18	A	Ottawa ankle rules do not apply to patients older than 55 as they may have osteoporotic bone more likely to fracture. Children’s ligaments are relatively strong compared to adults and avulsion fractures are more likely and they are not included in the rules which apply to 12-55 year olds
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 Lund and Browder chart is limited
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