FRCEM Primary Paper 5

A traveller returns from India with cough, fever, breathlessness and haemoptysis.

What investigation would be most helpful in excluding acute tuberculosis?

A 30 year old man has cut his arm whilst using a saw. The ambulance crew estimate one litre of blood loss at the scene.

What is the approximate normal adult value for total blood volume?

A 35 year old man has a dislocation reduced under sedation using propofol.

Which neurotransmitter receptor is propofol most likely to act on?

A 48 year old man presents with a lump in his right groin which increases in size when he strains and disappears on lying down. You suspect he has a direct inguinal hernia.

This hernia is most likely due to weakness of which structure?

A 20 year old man arrives in the ED from the airport with severe diarrhoea. He has just returned from a place where there was an outbreak of cholera.

What is the most likely cause of the excessive intestinal secretions in this patient?

A 24 year old man attends the ED having been assaulted. You suspect he has fractured his mandible. He complains of numbness of his lower lip.

Which nerve is most likely to have been damaged?

An 18 year old man presents with rigors. He had a splenectomy due to trauma four years ago. You decide to screen for infection.

Which characteristic of the infecting bacterial cell wall puts him most at risk from infection?

A 20 year old man presents after a large overdose of his grandmother’s digoxin.

What is the most appropriate indication for the use of digoxin specific antibody?

You are exploring a wrist laceration and note the flexor retinaculum is intact. However, you are concerned that some of the structures passing on the top of the retinaculum might have been injured.

Which structure is most at risk of damage?

A 25 year old man is stabbed in the abdomen with a kitchen knife. A CT demonstrates a diaphragmatic injury involving the oesophageal hiatus.

Which structure is most likely to be damaged?

At journal club you present a paper on the use of a biomarker to predict the presence of clinically important infection.

When assessing applicability to facilitate safe discharge what is the most useful statistical attribute?

A 34 year old dialysis patient collapses at home. He is due for dialysis today. He has severe hyperkalaemia and you perform a 12 lead ECG.

What ECG feature would you be most likely to see immediately prior to deterioration to cardiac arrest?

You are seeing an 80 year old woman who is hypoglycaemic. You need to administer glucose urgently.

What is the mechanism by which glucose enters the cells of the body?

A 22 year old man is injured during a mixed martial arts competition. He complains of pain and weakness of his shoulder. The photo shows the following abnormality as he leans forwards.

Which muscle is most likely to be involved?

A 25 year old man presents with diabetic ketoacidosis. You start to treat him with short-acting insulin and intravenous fluids as per your local protocol.

Which electrolyte disturbance is he most at risk of developing as a result of your treatment?

An alcoholic man presents with a productive cough, blood-stained sputum and signs of upper lobe pneumonia with cavitation on chest x-ray.

What is the most likely pathogen?

A 52 year old man is unwell with crushing central chest pain. An ECG shows significant ST segment changes. Angiography shows occlusion of the circumflex branch of the left coronary artery.

This condition most commonly results in ischaemia of which area of the heart?

A patient requires intubation due to respiratory failure. Your consultant wants to ensure you correctly preoxygenate the patient to replace nitrogen with oxygen, allowing a safer apnoea time during intubation.

Which lung volume measurement best describes the volume of nitrogen that you are displacing?

A 11 year old boy presents with a rash to the skin under his new watch strap.

Which type of hypersensitivity reaction is this most likely to reflect?

A 75 year old man who takes warfarin and digoxin for atrial fibrillation has sustained a head injury. A CT brain scan shows a subdural haematoma.

What treatment is the best option to reverse his anticoagulation?