MRCEM SBA RECALL April 2023

1- ECG : SVT , Pt. Unstable crt>2 = Adenosine? Is there shock op??????

2- ECG( picture) trosde de point = Mg 2 Gm
3- ECG ( picture): Mobtiz 2
4- Tachyarrythmia in child ( HR= 230 ) = SVT
5- AF with murmer ( 4 days ) = metobrolol IV
6- Hypertensive emergency , best drug = labetalol
7- Plant with poisoning = foxglove ? Hemlock? Willow?
8- PE . wills score = > or equal 4
9- Suxamethonium side effect = bradycardia
10- Suxamethonium with ketamin after 30 min no spontinous resp what is the reason=
cholinesterase deficiency
11- Pt. warfarin on with epistaxis , INR 6 = vit. K? Stop today dose of warfarin? PCC ?
12- Intoxication pt. Seniro of HAGAMA = fomepizole

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13- Immediate complication of fracture ( x-ray ) of compound penetrating fibula fracture = skin

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tear? infection ? hemorrhage? Compartment $ ?

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14- Finger ( thumb ) injury = tenosynovitis ? tenden sheet infection

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15- Breast skin organisim = staph. Areus
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child arrested with rigor mortis and mother refuse to stop cpr and er consultant will take 20
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min to come = send mother to relative room and stop cpr ? stop infront of her ? continue till
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consultant come ? ask paediatric registrar to confirm your decision to stop cpr
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17- Complication of massive blood transfusion = hypocalcemia

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18- BB refractory bradycardia despite atropine= glucagon iv

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19- Avulsed tooth pt in er = saline and reimplant in socket? Put in milk ? refer to maxillofacial
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20- Painless bleeding young age = harmorrhoid

21- X-ray knee ap ( picture ) = tibial platue fracture
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22- X-ray ankle and proximal fibula ( picture) = Maisonneuve

23- X-ray pelivic child 12 year = trethwan sign (sufe ) ? pereth ?
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24- Ankle dislocation what to do = procedural sedation then reduction? NITRIOUS OXIDE AND
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REDUCTION
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25- Complication of disltal fibula # = posterior tibial Artery injury? Common peronel nerve
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26- FEMAL wash hair in saloon with Occipital headache = venography ? CT ANGIO
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27- Eye ( picture ) = orbital cellulitis? PREORIBITAL CELLULITIS

28- Eye ( picture ) dendritic ulcer = topical ganciclovir ? iv acyclovir
29- Nose ( picture ) = septal ( contusion )haematoma ? nasal polyp ? perforation ?
30- Knee dislocation (picture) = posterior dislocation ? ant dislocation?
31- Xr elbow ( picture) Olecranon fracture = orthopedic oncall ? no fracture ? slap and refer?
32- Foot x- ray ( picture) = normal ? lis France # ? os calci #
33- Pedia 18 month choking collapse but there is pulse and shallow breath = 5 breath first ? 5
back brust and 5 chest brust
34- Pedia with fever crt > 3 and sign of instabilitywhat is the high risk sign = graunting? Crt>3 ?
35- Lyme disease ( picture of rash ) dr suspected = AB then then elisa ? ab no need inv ? invt first
ther ab?
36- Iv abuse , headache , convulsion( picture of uncal herniation) what is the cause = meningitis
? abscess ? encephalitis ? Empyema
37- Pedia seizure after buccal midazolam = phenobarbital ? levaceritam?
38- Subungal hematoma nail( picture ) = incision and drainage ? Terphination?
39- Chest x-ray no medical history ( xr milliry tb ? xr pcp ? ) what inv to be done = HIV? Tb teat ?
Sputum culture?
40- Blow in head , eye gaze and upward = inferior rectus avulsion?
41- 23 years Burn severe pain what to give initially = morphin iv ? nasal diamorph
42- ROSIER score arm weakness and leg weakness and lateral gaze cannot see in left side = 3? 2?
43- Pelvic dislocation( open book ) with bleeding = pelvic pander?
44- Hypothermia what protocol for adrenaline = adrenalin after 30 degree
45- Xr knee ( femur and tibia) white round lesion= ewings ? Fibrous cortical lesion ? Osteo
sarcoma
46- Pneumothorax more than 3( young male smoker = sildenger drain ? aspiration
47- Scenario of abdomen old age with cramps pain and bleeding per rectum = ischaemic colitis
48- Scenario of abdomen = intussesception
49- loss of weight , good appetite , tachycardia = hyperthyroidism
50- hyponatremia ( Na= 119 ) what treatment = Na 3%

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51- hyponatremia , hyperkalemia ( Addison) = hydrocortisone 100 mg

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52- Upper back (picture) (medial wing scapula) which ms= serratus ant ? Trapezius?
53- upper GIT bleeding best drug reduse mortility = tellibressin ? Ppi ?

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54- Xr abdomen ( picture ) pt with abdominal pain what the cause = constipation ? Bowel
obstruction
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55- female with skin flap at shin 10 cm = suture ? stristarp?
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56- Women sleep with man what increase possilbilty for pcp = anal sex with subsahran Africa?
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Sperm splach to eye

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57- Femal with blood in underwear came from somilia = Fgm ? Vaginal tear?
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58- Swelling neck ( Ludwig angina) vitally stable =AB ? CT ? intubation ?

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59- Hyper thermia ,NoClonus , agitation , normal pupil = neuroleptic syndrome? Seritonin syn?
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60- Scenario Pt. confused best initial inv = glucose bedtest? Ct?
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61- Hyperrglycemia , ketonemia = DKA

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62- Hyperglycemia without ketonemia ( hyperosmolar ) best initial = IV fluids ? Insulin?

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63- 5 years on ACEI drug with swelling tangue on ACI what to give = ffp?
64- Anaphylaxis after 2 aadrenaline Im not resolved what next= antihistamine ? adrenaline
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infusion ?
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65- Indication of NIC = pco2 > 8 ?? sat.> 92% ??

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66- Antiemetics drugs in end of life palliative care = cyclizine ? metoclopramide ? Hyocine?
67- Scenario pt. confusion SAH WITH GCS <8 WHAT BEST INITIAL = intubaion & ventilation ?
Nimodipine? Manitol?
68- Fever , coryza acute viral infection in child what causative Organism = rsv ? Parainfluenza?
Influenza?
69- swelling tonsil with pus( picture of glandular fever) diagnosis or orgnism= strpt. A ?? virus ?
Ebv?
70- Not notifiable disease = EBV ? Influenza?
71- Throat infection ( picture ) diagnosis = peritonsillar abscess ( quinsy)?
72- Upper3/5 lower normal no sensory loss xr doesn’t show any fructure = central cord
syndrome ?
73- BRUE referral what the risk factor for the child 31 week = LOC ?? , prematurity ??
74- Brown sequard $what finding on contralateral = loss of pain and temp ?
75- Pt on Dibagatrin with bleeding what to give = idurazimab? Ffp?
 76- Young male smoker with pneumothorax 3cm vitally stable what to do = aspiration?
Slidenberg tube?
77- Pt with flank pain radiate to the back us show AAA 3.5cm but measured from outer to outer
and asymptomatic = think other diagnosis? Refer to surgery ? Refer to gp ? Ct kub in the
morning?
78- Scenario of penetrating wound in abdomen pt unstable what to do. = fast scan ?? Ct? Send
to surgery?
79- Picture of echo PS SHORT AXIS = Pericardiac tamponade ??
80- Optic neuritis (picture) , LL weakness = MS ??
81- 28 Y PT WITH HISH RISK PROUNE Wound full secheduald ttt vaccination in childhood = anti
tetanus & IVIG ?? Tt alone ? No need?
82- Drooling with fever in child xr neck ( picture) = epiglottitis ?? Perpharyngeal abcess?
83- Ms investigation for respiratory ms affection = FVC ?? PEFR?
84- Woman bed sores with blocked catheter her son is carer = inform safeguard? Change
catheter and discharge ? Inform social to send home care?

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85- Renal colic ppainbest pain killer of choice = paracetamol iv ?/ , rectal NSAID ??

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86- Pt with major trauma. Rsi with recronium and ketamine failed intubation after 20 min of rsi
what to do = cricothrodectomy ?? revere ms paralysis ??

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87- Female menorrhagia , headache what is the cause = Anemia ??

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88- Pt with Hypoglycemia improved and refuse to continue ttt capcity assed and he had capacity
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what next = allow to discharge ? for him to stay?
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89- Organ donation # in 80 y old male with myloma in remission 8 y and renal cancer operated 2
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year ago = age ?? , myloma ?? Renal cancer ?

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90- Pleural effusion and Picture of us for venacave distended what to give = frusimide ?
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Vasopressor?
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91- Chemical Powder on hand symptoms of organoph poision what initial = ?? Remove clothes ?
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Wash with water ?

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92- ABG for copd pt = acute on top of RF type 2

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93- Ankle jerk reflex , sciatica what is diagnosis = S1 compression ? Disc herniation l4-l5
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94- Alcohol overdose , agitation = thiamin ? sedation ?? Chlorpromazine oral

95- Troponin +ve in pt with chest pain radiate to back and bp diff= acute coronary syndrome ?
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AORTIC DISECTION?
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96- Priapism is sickle cell given anaglsic no improvement what next = aspiration of blood? Iv
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fluid?
97- ECG history of recurrent collapse what finding= WPW ( delta wave ) ? St proplem?
98- Eye ( picture ) = corneal foreign body? Penetrating wound?
99- House fire = Co poisoning ? Cyanide toxicity? Methhemoglobinemia
100- Placenta with tender uterus = placenta abruptia? Rupture uterus?
101- PARA PLEGIC Pregnant 8 WEEK with HTN , vision proplem = pre eclapsai? SAH? Venous
thrombosis?
102- Distal redial fracture un displaced( x-ray ) = ??? slap and refer to # Clinic? Orthopedic oncall?
103- Rash(picture) use otc antihistamine not improved what diagnosis = scabies ?? Contact
dermatitis?
104- Scenario of 4 mo baby crying after feed with blood in napi and in between normal and now
stable = diverticulosis? Intussiption? Cow milk allergy?
105- X-ray hand( picture) = dislocation of base of 5 th finger? Fracture 5th finger ? Normal xr?
106- X-ray hand( picture ) = scapholunate dislocation ( Terry Thomas sign)? Scaphoid Fracture?
107- X-ray knee and tibia (picture) distorted border = osteosarcoma ? Ewings tumor ? Fibrous
lesion ?
108- PM Female with vaginal bleeding Incontinence , painful defecation, lower abd. Pain = cancer
bladder? Ovarian cancer?
109- Fertilizer ( organophosphorus ) what initial to give = atropine
110- Criteria of life threatening asthma = spo2 91% ? Can’t complete sentence?
111- Scenario of Naso gastric tube ( picture ) kinked one = remove and reinsert ? Start feeding?
112- Blood transfusion with oozing blood from sit of canula and pain = haemolytic reaction? Non
immune reaction?
113- Scenario of thoracocentesis to be done after 40 min = discus with team? Overlay order ?
114- Mother addict and has son whit his father and home what to do = Check record for nai ?
Inform safeguard? Inform child school social? Inform husband?
115- Picture of leg with brusis after urti aweek ago = hsp? Eczema?
116- Pt. his father consultant surgery wand to do CT brain = firm refuse ? Do it?
117- Chest x-ray in pt with fever and tonsil infection what is the reason= septic emboli?

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Bronchpneumonia?

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118- Chest xr in pt with upper rt lobe whitness . trachea shifted to rt side intubated spo2 90%
what is the cause = wrong intubation ? Hemothorax ? Upper lobe prolapse

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119- Pt. ectric , abdominal pain , fever = acute cholangitis? Cholecystitis?

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120- Pt with left sensioneural hearing loss what to find in clinical examination= bc > ac – renne ?
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Webber to affected side ? Weak whisper test In affected side?
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121- Picture of CT Brain (SAH) GCS 8 WHAT BEST INITIAL= intubaion and ventilation? Nimodipine
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122- Old man with delirium on furosemide and other medication what is the cause = drug side
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effect ? dementia ?
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123- Pt. agitation , ….which drug = SSRIs ? TCA??

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124- Pleural fluid in pt with fever and hypotensive despite iv fluid and icu team is busy what to do
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= vasopressor after central line ? Wait for icu?

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125- Husband of pt with lewy body er was busy go without ttt . next day died and want death
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certifcate = give the certificate ? Ask to take from gp? Call the croner and authority?
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126- Religious in report protected by which act = data protection act ? Human rights?
127- CVP confirmation in unstable pt in icu = flushing ? Erect xr ? Transduser waveform
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128- Cause of haemothorax or tamponade on pt with long term anticoaglant therapy no trauma =
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anticoagulant ? Infection ?
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129- Posterior shoulder dislocation what is clinical finding= arm addected ? Arm external rotated ?
Can’t touch the other shoulder ? Later deltoid sensation loss ?
130- Necrotising facitis ( picture ) = surgery for debridement ?? Ab ?
131- Old male with end of life and has pneumonia refuse admission and want to die in peace has
capcity relative want to be admitted= discharge with palliative ttt , force admission?
132- Pain in elevation of test with blue dot sign = testicular tortion ? torsion of hydate morgagni ?
epidimyitis?
133- Pt (addict or Intoxication) with stab wound and police want the details what to do = give
name age and wound details? Refuse ? Tell the pt that you obliged to give ?
134- Muscle weakness after exercise what is the cause = Myathenia ? Ms ? Compressive
myopathy?
135- Other seniro for htn pt with cerebral bleeding what is the correct = aim for b.p 140/ ?? Rapid
reduce b.p ? Iv Labetalol is the drug to start
136- Agitated young adult what is the diagnosis = acute behavioral personality disorder?
137- Pt with psychosis and agitated what to do initially = force restrain in the floor for 20 min?
Sedate ?
138- Pt after tooth extraction come with dental pain site is clean and no sign of infection what to
do = irrigate with saline ?? Ab? Chlorhexamedine?
139- Lp # in 28y pt with confusion
140- Xr tibia and fibula ( picture) in pt with cellulitis not improved despite ab systemically well=
osteomyelitis? Necrotising facitis? Ab resistant?
141- 11 years old jehova witness child need live saving blood transfusion and parent refuse what
to do = transfuse ? Don’t? Call the trust
142- Seniro of l.l ischaemia with abcent pulse what to do = send vascular surgery?
143- Chest tube long time infected what to do = bl culture from 2 different site??
144- History of 4 month child with nai what is the risk facto = immobile
145- Pt with urinary symptoms and painful defecation and fever = prostatic abscess?
146- Pace maker no electric capture ecg what next = increase current?
147- Gp sent mail to you about one pt and pt want acopy of that mail what to do = refuse it is

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confidential? Give to him? Ask him to go to his gp? Send to hospital to ask

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148- Female pt with chest trauma multiple left side rib fracture vitally stable no pain after
morphine what to do= chest drain? Discharge and analgesia? Admit for pain control? Do ct?

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149- Pt with end off life on multiple medicine which one to continue= furosemide? Digixon? Anti
parkinson? Anti coagulant?
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150- Pt with fever sever back pain and obstructed uropathy what to do = urology oncall?
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151- What is not in heart score = stroke ? Ihd in his father at 70 y? Obesity?
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152- Pt was pe unstable = thrombolyiss? Ct?

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153- Pt with intermittent pain > 3 month and under tongue swelling = silalioadenitis ?
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Siliolithethsis
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154- Cough syncope what about driving= can drive no need to inform? Inform and 3 month stop?
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Inform and 6 week stop

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155- Lady with alkai burn in abdomen 3 days what to do = iv fluid ? Refer?
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156- What is complication after lung contusion = ARDS?

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157- Massive blood transfusion pprotocol take 2 o -ve blood unit hg 9 inr 1.3 fibrinogen 2 and
platlates 95 what to give next= transxemic acid? Continue o blood ? Ffp ?
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158- Female on carbamzipine need contraception = advice for iud? Give tablet ?
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159- Open pneumothorax management = occlusive cover ?

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160- Medication cause toxic epidermal necrosis on carbamzepine long time recently got urti on
medication what is the cause = carbamzepine ? Ab forget the name ?
161- Child with pic of allergic rash after panadol what is the cause=? Drug induced allergy?
162- What favor for anaphlyctoid reaction = 1st exposure to allergen?
163- Medication cause glucoma = tca ? Ssri?
164- Old lady with weakness happen many time within last 2 week refuse to come before and
today ct show stroke refuse thrombolyiss what to do = to be assessed by psychiatry and
mental health team ? Take consent from husband? Don’t give ?
165- Cardiac arrest asthma what to consider = b/l pneumothorax?
166- Child with battery ingestion after 2 day sign of instability and xr show the battery= surgery
admission for removal
167- Pt with trachal tube deterioration what to do = remove inner tube?
168- Pt with laryngeal tube what to do = oxygenate?
169- photophobia, neck stiffness , neurological manifestation csf viral = hsp encephalitis
170- Pt with Intoxication of recaritional substance = popers ( methahemglobinemia)? hydroxy
burate ?
171- Ll weakness asending manner after ge = guaian bari $?
172- Hyperkalemia no ecg change what is management = ??
173- Old pt admitted for Alcohol Intoxication came with his grandson 15 y with alcohol smell what
to do = inform safeguard guard? Inform father at home?
174- Pt with head trauma and which one is not indication to do immediate ct = retrograde
amnesia 30min
175- Sickle cell pt infection by which Organism cause deterioration = parvovirus b19
176- How to ass anathesia respone = deep seediation purposely painful response?
177- Finger dislocation what to use for anathesia = digital nerve block??
178- Pt with bronchiolitis and fever give adrenaline and steroid not improved = bacteraial
trachitis?

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