FRCEM (primary) – recall questions

So these are the recall questions from my attempt at this exam – June 2017 (happy to report that I passed the exam – if you are interested in my experience with the exam, do read about it here Good luck!)

  • achilles tendon rupture – ciprofloxacin
  • msuculocutaneaous nerve – stab wound to axilla, causing weakness of elbow flexion and supination
  • platysma – stab wound to anterior triangle of neck – which muscle would be injured (choices were sternocleidomastoid, scalenous anterior, trapezius, platysma and one other)
  • head injury with fractured internal acoustic meatus, which TWO nerves would be affected – facial and glossopharyngeal
  • female with mass on anterior 2/3rds of tongue, where is lymph drainage? i chose submental because tip of tongue drains there but rest of anterior tongue drains to submandibular, so I am not sure, both were in the options
  • ankle movement loss – ? location of lesion
  • lower lip numbness, nerve involved? inferior alveolar
  • scenario of impetigo in child, what factor causes its spread? fecal- oral, droplet, intact skin, broken skin – i chose broken skin.
  • swollen painful knee joint youngish male (35 or so?) no other history, what would you find on gram stain? gram positive pairs of cocci in clusters, or gram positive cocci in chains, or gram negative rods or gram positive rods or gram negative intracellular organisms arranged like kidney beans (correct answer – gonococcal arthritis)
  • small wound on ankle, swollen acutely inflamed next day – what is the most abundant cell type present? neutrophils
  • neck of fibula fracture – common perennial nerve injury
  • valgus deformity of knee joint following football injury i think, ?ligament damaged – medial collateral
  • hyperextension of knee joint – horse-riding incident, unable to weight bear swollen painful knee etc, injury to? – anterior cruciate
  • scenario of pancytopenia ? causative drug? – choices included celecoxib and mefenamic acid – i chose celecoxib
  • lip/peri-oral swelling not improving with adrenaline, which drug implicated mainly as cause? – ramipril (don’t remember specifically – one of the ‘prils’)
  • anaphylaxis, adrenaline dose? 1:1000
  • optic tract lesion, right or left – scenario depicting right homonymous hemianopia
  • headache, increased intracranial pressure symptoms, bitemporal hemianopia ? lesion site – optic chiasm
  • mass in optic chiasm, symptomatic, hyperglycemia, likely hormone excess? growth hormone
  • hemorrhage, life threatening, what will be the effect on kidneys? – decrease urine production
  • scenario of heart failure, furosemide given, site of action? – loop of henle
  • someone in type 2 resp failure, how will body realise it needs to increase breathing rate? – chemoreceptors
  • picture of a weird target lesion like rash on hand of young male, said to have been acute in onset over last two days started on limbs now involving trunk etc ? cause – options were HIV, Herpes simplex, staph aureus (my answer because I thought it was scalded skin syndrome and nothing else really fit)
  • newborn with eye discharge, mum under treatment for chlamydia, what is newborn at risk of? pneumonia, encephalitis, corneal ulcer, meningitis, and one other option – i chose corneal ulcer
  • 3 month old, diagnosed pertussis, most horrible complication? – apneic spells
  • alcoholic male, cough, bloody sputum, fevers, consolidation on xray, microorganism? – klebsiella
  • alcoholic, male, ascites, cause? – portal hypertension
  • ascitis in female, lung function tests, which would be increased? FEV1/FVC
  • stab 5 cm above iliac crest left lateral abdomen – deepest structure before peritoneum? – transversus abdominis
  • loud s1? cause – opening of pulmonary valve, closing of aortic valve, vibration, opening of mitral valve, closure of tricuspid valve
  • cholera scenario, profuse watery diarrhoea, mechanism of action? – chloride ions leakage?
  • scenario of steattorhea – defect in exocrine pancreas
  • 35 yo woman with fatigue, icteric sclera, unconjugated bilirubin – hepatitis
  • acute infection with hepatitis B – raised ALT
  • terminal ilium resection, absorption of which will be affected – vitamin c, zinc, proteins, carbohydrates, vitamin d
  • cause of prolonged PR interval
  • cause of prolonged QT interval – clindamycin? (scenario of patient recently using antibiotic for skin infection, ECG shows QT prolongation
  • digoxin toxocity, when to give digiband? – prolonged seizures, severe bradyarhythmia
  • hyperkalemia, ECG changes just before cardiac arrest?
  • ECG shown, which vessel involved based on ECG changes?
  • Angiography of chest pain patient, occlusion of left circumflex branch, which cardiac area affected
  • megacolon found in 7 day old infant, passed meconium at 3 days of both and no bowel movements since then, which system affected? – myenteric plexus
  • gout scenario – negatively bifringent crystals on aspirate
  • glucagon secreted from- alpha cells
  • young patient with DKA – which pancreatic islet cell dysfunction? BETA
  • glucagon site of action for gluconeogenesis and glycogenolysis?   liver
  • factors that increase gastric emptying – cholecystokinin, histamine, secretin, duodenal distension, astral distension
  • shingles rash scenario, seen in ED, what would you do to confirm before beginning treatment? – history and clinical judgement
  • scenario of herpes zoster ophthalmicus, which nerve involved? – trigeminal
  • orbital blowout fracture, diplopia on upward gaze. which is entrapped? superior oblique, inferior oblique, inferior rectus, superior rectus, medial rectus
  • orbital blowout fracture – inferior orbital fissure fracture, which will be damaged?
  • something about starling’s law
  • oculomotor nerve – consensual light reflex scenario where light shined in right eye, reflex present, light moved to left eye but right pupil dilates, lesion?
  • precipitant of gout in a patient’s drug regimen? – hydrocholothiazide
  • gout treatment, scenario given elderly, heart failure, diabetes, acute gout treatment? – colchicine, allopurinol, diclofenac, etc etc
  • rationale for steroid use in asthma- reduce bronchial inflammation(duh?)
  • adenosine contraindication (scenario of SVT) – recent severe exacerbation of asthma
  • scenario or warafrinized patient with head injury? reversal with? – FFP
  • patient with von willibrand disease scenario – what is the dysfunction? – platelet aggregation
  • patient fully uptodate with tetanus injections according to UK protocol, presents to ED with very dirty soiled open wound with open fracture of tibia fibula, treatment options? no tetanus treatment, tetanus immunoglobulin only, tetanus immunoglobulin and vaccine now, tetanus immunoglobulin and vaccine now and 1 month later, tetanus vaccine only
  • 8 month old child, fully updated with jabs for age. what has he still not received yet? men a, men b, hiB, rotavirus, mumps
  • patient has been bitten by someone who is hep b positive, she herself has never received vaccination for it, management plan? immunoglobulin now, immunoglobulin plus vaccine course over three months, immunoglobulin plus vaccine course over 6 months
  • child with proven meningitis being intubated in ED, who needs prophylaxis (post-exposure) clinician intubating, nursing staff in ED, children at party with child, classmates and teachers in school
  • boy with hemophilia scenario, deficiency? – factor 8
  • digoxin toxicity, worsens – hypokalemia
  • succinylcholine mechanism of action – depolarizing neuromuscular blockage
  • propofol, mechanism of action – GABA receptors
  • cause of warfarin to be potentiated – clarithromycin?
  • cause of pregnancy despite oral contraceptive pills – carbamezepine
  • ectopic pregnancy scenario, site of likely pregnancy? – ampulla of fallopian tube
  • direct inguinal hernia, defect? –
  • middle aged male, struck in anterior abdomen with steel girder, fast scan shows intra-abdominal fluid, which organ would be injured? – spleen injury (other options were kidney, pancreas, colon, aorta, none likely to be injured than spleen)
  • woman presents with right shoulder weakness, difficulty in raising it above her head and also shoulder contour different – which nerve implicated? accessory (deltoid)
  • scenario of elderly male involuntary tremors in one hand, gait changes, rigidity in muscles, expression changes, where is the lesion? substantia nigra
  • lithium toxicity – ataxic gait
  • scenario of TB, how to diagnose? – options were CT chest, sputum culture, monteux test,
  • tapeworm infection, how to diagnose? IgE levels raised, eggs in stools
  • diarrheal illness, ascending paralysis scenario, organism implicated? – campylobacter jejuni
  • pre oxygenation for intubation, which lung volume needs to be replaced with o2?
  • proton pump inhibitor acts on- parietal cell
  • MAP calculation formula
  • duodenal/gastric ulcer – likely cause? Gastrin
  • 48, male, perforation, pneumoperitoneum on CT, likely organ to be perforated? – duodenum, sigmoid colon, transverse colon, ascending colon, oesophagus
  • elderly patient, abdominal pain, high lactate, very unwell, scenario of ischemic bowel. CT shows ascending colon affected, what blood supply?-  right colic artery
  • DKA treatment commenced, what will be low as a consequence – potassium
  • dka scenario, what causes drowsiness – sodium
  • in patient with addison’s disease, scenario and lab results given what specifically is deficient? – mineralocorticoid
  • osmolality, major contributor? – sodium
  • froments sign
  • scenario of tachycardia at 135/min, weight loss, diarrhoea, in a patient with grave’s disease, what will be lab finding supportive of it? increased T3
  • hyponatremia, hyperkalemia – hypoadrenalism
  • scenario of ADH secretion, location? posterior pituitary
  • FAST scan in patient RTA, hypovolemic shock, where will fluid likely be seen when supine? – paracolic gutter? para-aortic gutter? between liver and diaphragm, between liver and right kidney, between spleen and left kidney
  • blood volume? 5 litres
  • scenario of scalp laceration, what will cause clotting – conversion of prothrombin to thrombin, conversion of fibrinogen to fibrin, activation of external clotting cascade
  • pulmonary surfactant function – increase surface tension
  • pulmonary surfactant produced by? – pneumocytes
  • picture of winged scapula, which muscle likely to be affected? – serratus anterior
  • winged chapel scenario in hiker, which nerve is damaged? long thoracic nerve
  • recurrent pneumonias in chronic smoker, what is the factor causing him to have recurrent pneumonias? – decreased mucociliary clearance
  • hilar lymphadenophathy on CXR? bronchopulmonary? paratracheal? tracheobronchial? superior thoracic? pulmonary?
  • dentures stuck in trachea at T4/5 level, what causes the constriction? – arch of aorta
  • plumber/painter, right elbow lateral condyle tenderness/painful movements of elbow, what movement will be affected? wrist extension
  • swollen tender knee joint, known recurrent joint problems elderly female, what blood test will be raised? – rheumatoid factor
  • contact dermatitis scenario? – type 3 hypersensitivity reaction?
  • anaphylaxis, which immunoglobulin? – IgM
  • trancutaneous pacing, skeletal muscle contractions of anterior chest wall ? cause – voltage gated sodium channels opening
  • slip and fall on outstretched hand, wrist pain, lunate dislocation, also c/o severe pain in hand, what is likely to have been injured? – distal radius, radial artery, ulnar nerve, scapholunate dissociation, radial nerve
  • fall on outstretched hand, elbow injury, posterior dislocation of bow, what is likely fractured? – capetellum, trochlear part, olecranon, radio head, supracondylar region
  • volar wrist aspect injury, laceration, possible injury to structures above flexor retinaculum, what will be injured?
  • slip and fall landed on back/hip, painful movement of hip adduction but hip flexion is normal, what muscle is injured
  • 14 year old fell from horse, numbness and tingling to medial 2 fingers and ulnar border of hand ? lesion where?
  • patient with spinal cord injury, central cord suspected syndrome suspected, clinical signs to be expected? – proximal musculopathy? upper limb muscles affected worse than lower limb muscles,
  • unable to move below waist, wrist elbow  and  shoulder movements intact, unable to flex fingers or grip anything, lesion?
  • football injury young male – snapping noise when hip joint moved, avulsion of anterior superior iliac spine ? muscle involved – sartorius
  • fracture base of little finger metacarpal, which muscle injured?
  • anterior aspect of thigh numbness – lateral cutaneous nerve of thigh
  • fifth metatarsal base fractured – muscle?
  • fibular neck fracture, which muscles is injured?
  • stabbed through adductor canal, injury to what structure? saphenous nerve, femoral nerve, obturator nerve
  • patient is stabbed in abdomen, diaphragmatic injury at region where oesophagus enters the diaphragm, what other structure would be injured? vagus, azygos, thoracic duct, aorta, vena cava
  • neck surgery on thyroid, which nerve is damaged? recurrent laryngeal nerve
  • there was a graph shown – this question I most likely got wrong – and I don’t even remember the stem – they asked us to label what we thought was on the x- and y- axes! I had no clue!
  • some scenario of a patient requiring a test for a disease – and then they went on to ask, in order for the patient to be discharged safely, what factor of the test was most significant in deciding whether or not it was safe for him to go home : sensitivity, specificity, negative predictive value, positive predictive value, or odds
  • patient with stroke symptoms,weakness, sensory loss and poor coordination – which vessel likely to be blocked? anterior cerebral, middle cerebral, posterior cerebellar,anterior communicating posterior communicating
  • facial nerve exits through which foramen
  • trochlear nerve exits through which foramen
  • insulin causes glucose to be transported into the cells, mechanism? active transport, passive transport, facilitated diffusion, osmosis, cotransport
  • mechanism of ketoacidosis in young girl with DM type 1
  • drug causing extrapyramidal side effects
  • child has taken grandmother’s medications, based on symptoms what medication has he taken?
  • effects of which drug causes patient to be dry, warm, psychotic
  • post splenectomy which organisms will cause problems – encapsulated bacteria (do not remember was probably strep pneuma or meningococcus)
  • patient with peptic ulcer – whats the mechanism? decreased prostaglandins, increased arachidonic acid metabolites,
  • patient with pulmonary embolism, which lung volume/space will be affected
  • discussion of an x-ray 1-2 weeks post fracture with fracture line surrounded by hazy area ? cause bone formation, calcium deposition, refractor, failed hearing, malunion
  • patient recently back from swimming, ear canal painful discharge etc what caused it? swelling of wax in ear canal
  • innate immunity
  • ascending paralysis with diarrhoeal illness, organism? campylobacter jejuni

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