FRCEM FRCEM Primary Examination Questions and Answers

An 88 year old woman presents with haematemesis CT scan identifies a posterior ulcer of the superior part of the duodenum At what vertebral level would this be evident on the CT scan?

A patient presents with acute cardiac failure and is prescribed a loop diuretic

In which part of the nephron will the diuretic inhibit the sodium-potassium-chloride cotransporter?

A 55 year old heavy smoker presents with cough, sputum production and dyspnoea A chest x-ray shows hyperinflation with diminished pulmonary vasculature

Which measurement is likely to be increased on lung function testing?

A patient presents following a stabbing to his chest and has a cardiac arrest You perform an anterolateral thoracotomy. Which muscle in addition to pectoralis major are you most likely to incise? • A. Latissimus dorsi

B. Pectoralis minor

C. Serratus anterior

D. Subclavius

E. Teres major

A 78 year old woman presents with a painful shoulder after a fall. On examination she is unable to lift the dorsum of her hand off her mid-lumbar spine (lift-off test).

Which muscle is most likely to have been injured?

A therapeutic trial demonstrates that everyone who received the drug has improved while no one improved with placebo What best describes the expected number needed to treat?

A five year old girl is brought to the ED by her parents She is pyrexial and has coryzal symptoms. Which diagnosis would require notification to a UK Public Health department?

A 63 year old patienl presents with symptoms of hemiplegia and sensory loss of the right side of face and extremities. Which artery is most likely to be involved?

A 52 year old woman (alls from a root sustaining a fracture dislocation at T12/L1 level Which muscle is most likely to be injured*?

A 50 year old man with HIV has not been taking his treatment and presents with severe headache and neck stiffness His current CD4+ count is 180/mmc (normal 500-1400/mmc)

What is the most likely causative agent of his meningitis?

An 83 year old woman presents with acute dyspnoea and is diagnosed with cardiac failure She has a history of dysphagia and CT confirms oesophageal cancer.

Compression of which chamber of the heart is most likely to have caused her cardiac failure? A Both ventricles

A 40 year old woman taking the oral contraceptive pill was prescribed phenytom following a seizure Some months later she becomes pregnant

What is the most likely mechanism by which this treatment has led to tailure of her contraception?

You are discussing physiology of the body compartments and distribution of body water while teaching nurse practitioners.

Which extracellular fluid compartment is most likely to contain the most water?

A 32 year old woman presents with dizziness She has been laking medication tor low back pain Blood tests reveal a haemolytic anaemia.

Which drug is most likely to be responsible?

A patient with severe renal impairment requires regular opioid analgesia for their pain You are concerned about opiate accumulation Which drug in this class is most appropriate in this patient?

A 78 year old has a (all and hits her forehead During (he fall she hyperexlended her neck and now complains of weakness in her arms You suspect she may have central cord syndrome

What is the most likely anatomical cause of this injury during hyperextension?

An 18 year old man presents with persistent vomiting You diagnose type I diabetes mellitus He asks you the implications of his diagnosis for driving a car

What is the most accurate advice according to the DVLA?

A 45 year old woman requires procedural sedation for a dislocated shoulder She has recently eaten a fatty meal Which substance is most likely to be secreted when the food reaches the small intestine ' ' A. Cholecystokmin

B. Gastrin

C. Gastrointestinal peptide

D. Secretin

E. Vasoactive intestinal peptide

A 30 year old woman attends the ED with a worsening headache and tight periorbital pain over the last (ew hours You suspect cavernous sinus thrombosis Her right eye has ptosis, mydriasis and is deviated laterally and downward

Which nerve is most likely to be affected?

A 67 year old woman is being treated for haematemesis Within a few minutes of starting transfusion of packed red cells she reports dizziness, breathlessness, tingling of her lips and develops a maculopapular rash

What type of hypersensitivity reaction is most likely to be occurring?

A 45 year old man with type II diabetes presents after a hypoglycaemic episode He has a history of diabetic eye disease He asks your advice about diabetes and driving.

Which situation is most likely to allow him to continue driving according to the DVLA?

A 65 year old patient presents to the ED with a three hour history of expressive dysphasia. You suspect a stroke and order a CT scan Which area of the brain is the most likely site of the infarct?

A 67 year old man presenls one month post resection for cancer with breathlessness He is found to have iron deficiency anaemia Resection of what part of the gastrointestinal tract is most likely to be responsible for this deficiency ' '

You have achieved haemostasis of a wound A medical student asks you about the subsequent inflammatory response. Which is the predominant cell type in this phase?

You are leaching medical students cardiovascular examination and the link between heart sounds and the cardiac cycle. Which phase best correlates with the start of the first heart sound?

An 85 year old man complains of double vision on looking down. You note his right eye does not move when he looks down and medially.

Impaired (unction of which nerve is most likely responsible?

A clinical pathway uses a predictive tool to guide use of diagnostic tests. Your patient has a high risk score, but a negative test They ask you how likely it is that they have the disease in question.

Which statistic are you most likely to use in your explanation?

A 33 year old man presents with signs of sepsis. A venous blood gas is taken which confirms an elevated haematocnt level What best describes the normal range of haematocnt you expect to find in a healthy male of this age?

A 43 year old Afghan national presents to the ED with a four month history of cough, weight loss and night sweats What test is most consistent with active tuberculosis?

You are treating a patient with an acute exacerbation of COPD and they remain wheezy after two doses of nebulised salbutamol You decide to add nebulised ipratropium to improve bronchodilation

Which receptors are most likely to be targeted by this treatment?

A 50 year old man presents with hypoglycaemia You decide to give him intramuscular glucagon Which organ is most affected by this treatment to increase blood sugar levels?

When taking a history from a 74 year old woman, she tells you she has pernicious anaemia Where are the cells that are attacked in this autoimmune condition most likely to be located?

A 77 year old woman is brought to the ED following a house fire Arterial blood gas confirms she has an increased carboxyhaemoglobin level

What is the most likely effect on the oxygen dissociation curve?

A 26 year old man sustains a stab wound to the anterior aspect of the left side of his neck The wound involves the thoracic inlet Which structure is most likely to be encountered and injured first? A A. Oesophagus

B. Pleura

C. Subclavian artery

D. Subclavian vein

E. Thoracic duct

A 76 year old patient is found on examination to have an absent jaw jerk What cranial nerve nucleus is the1 most likely site of pathology?

You are conducting a study of children presenting with febrile convulsions. As pari of your data collection you record their temperature in degrees Celsius on arrival

Which is the best description of this type of data?

A 28 year old woman with a dislocated left shoulder has altered sensation along the radial aspect of her left forearm and loss of flexion at the elbow and wrist

Injury at which location of the brachial plexus best explains her neurological symptoms?

A 34 year old woman with Graves ' disease presents with fever, palpitations, tremor and anxiety Which hormone is most likely to be causing her symptoms?

A patient presents with muscle spasms caused by hypocalcaemia Which substance is used to adjust (or an abnormality in the calcium level?

A patient is brought in unconscious following a collapse and a subsequent CT shows a pontine haemorrhage Which clinical tindmg best describes what you expect on examination of the eyes?

An 87 year old man is brought to the ED from his nursing home with loose stools and abdominal pain. You suspect Clostridium difficile infection because he had a recent course of antibiotics for pneumonia.

What measure is most likely to reduce the spread of infection to other patients?

A patient is brought into the ED unconscious Calculation from the venous blood gas confirms a low anion gap acidosis What is the most likely cause of this abnormality?

Diabetic ketoacidosis

B. Hypoalbummaemia

C. Methanol

D. Rhabdomyolysis

E. Salicylates

A premature baby is born at 28 weeks ' gestation in your ED. They are at risk of respiratory distress syndrome due to lack of surfactant What best describes the composition of this substance?

A 32 year old football player attends with a painful right knee after a tackle On examination she is unable to dorsiflex her foot Which nerve is most likely injured ' '

A16 year old girl is diagnosed with nephrotic syndrome

What is the most likely mechanism responsible for generalised oedema in this condition?

A 34 year old woman presents with flank pain She has recently been diagnosed with glomerulosclerosis. Which part of the kidney is most likely to be affected in this condition?

A 20 year old woman has an incised wound over the angle of her jaw and you suspect damage to a branch of the facial nerve What action are you most likely to test to confirm your suspicion? A. Mandibular elevation

B. Mandibular retraction

C. Protrude lower lip

D. Pull corner of lips out and down

E. Stick tongue out

A four year old girl presents with a fever Her skin feels warm to touch What is the most likely mechanism of effective thermoregulation?

A 52 year old man presents to the ED with headaches, sweating and a change in his voice. He is complaining of tingling in his hands and is hypertensive

What is the most likely visual defect you will find on neurological examination ' ?

A patient presents with unilateral tongue swelling with no additional signs of allergic reaction She is on multiple cardiac medications Which drug is most likely to have caused these symptoms?

A patient presents with an area of cellulitis with discharge on their foot following a puncture wound A swab shows a large number of gram positive rods on initial culture.

Which organism does this most likely represent?