RCEM

LEARNING
FRCEM Primary Paper 1
prepared by
Hani Hammouda
00966562372833

FRCEM Primary group in

1. Question
1 point
A 20 year old man presents to ED with a stab wound to his axilla. He has weak elbow flexion and forearm
supination.
Damage to which nerve is most likely to be the cause of these findings?

o Axillary

o Median
o Ulnar

o Musculocutaneous

o Radial

2. Question
1 point
A six year old girl presents to the ED with impetigo around her mouth and nose.
What is the most likely method of spread?

o Invasion of breached skin

o Haematogenous spread

o Via faecal oral route

o Invasion of intact skin

o Droplet spread

3. Question
1 point
A 69 year old woman presents with a spontaneous rupture of her Achilles tendon.
Which of her current medications is most likely to be related to her symptoms?

o Ramipril

o Atenolol

o Ciprofloxacin

o Levothyroxine

o Metformin

4. Question
1 point
A 25 year old man presents following a road traffic collision with signs of haemorrhagic shock.
Which mechanism best describes the changes that take place in his urinary system in response to his blood
loss?

o Increase in renal blood flow

o Decrease in urinary output

o Renal vasodilation

o Decrease in circulating aldosterone

o Increase in glomerular filtration

5. Question
1 point
 A 25-year-old man attends ED after injury to his knee while skiing. He has a valgus deformity of knee.
Which ligament is most likely to be damaged?

o Anterior cruciate

o Lateral collateral

o Medial collateral

o Patellar

o Posterior cruciate

6. Question
1 point
A 70 year old man presents with “tingling” spots that have erupted over his nose overnight. You make a diagnosis
of Hutchinson’s sign, identifying the affected nerve as the nasociliary nerve, and counsel the patient about the
development of ophthalmic herpes zoster.
From which cranial nerve does this nerve originate?
o Optic

o Olfactory

o Trochlear

o Oculomotor

o Trigeminal

7. Question
1 point
A 70-year-old man presents with an episode of gout. He tells you that he is prescribed medication for hypertension.
Which class of antihypertensive drug is most likely to have precipitated this presentation?

o Thiazide diuretic

o Calcium antagonist

o Beta blocker

o Alpha 1 blocker

o ACE inhibitor

8. Question
1 point
A 48-year-old man has recurrent admissions to hospital for severe upper abdominal pain. His stools are pale, loose
and tend to float in the toilet rather than flush away. An abdominal x -ray shows calcification in the epigastric
region.
What mechanism is most likely to be responsible for his diarrhoea?

o Reduced bile production

o Failure of duodenal cholecystokinin

o Increased small bowel motility

o Bacterial overgrowth

o Loss of pancreatic exocrine function

9. Question
1 point
A 24-year-old construction worker is struck in the abdomen by a steel girder suspended from a crane. A FAST scan
(focussed assessment sonography in trauma) shows abdominal free fluid.
Damage to which structure is most likely to give rise to this finding?

o Aorta

o Pancreas

o Spleen

o Vena cava
o Ureter

10. Question
1 point
A 40 year old man with a history of intravenous drug use presents with vomiting, fever and painful joints. You note
he is jaundiced and has a rash.
Which finding would be most indicative of a diagnosis of acute Hepatitis B infection?

o Elevated alanine transferase

o Elevated alkaline phosphatase

o Reduced lymphocytes

o Reduced platelets

o Reduced serum albumin

11. Question
1 point
A father brings his febrile eight week old child to the ED. He tells you that the child’s vaccinations are fully up to
date.
Which of the following vaccines has the child not yet received?

o Rotavirus

o Meningococcal C

o Mumps

o Meningococcal A

o Haemophilus influenza B

12. Question
1 point
A seven day old baby boy is brought to the ED with constipation. His mother tells you that he first passed
meconium at three days and has not passed stool since. An abdominal x -ray demonstrates megacolon.
A lack of ganglion cells in which structure most like ly causes this condition?

o Hypogastric plexus

o Coeliac plexus

o Inferior mesenteric plexus

o Superior mesenteric plexus

o Myenteric plexus
13. Question
1 point
A 72 year old man is brought to the ED with difficulty swallowing. A chest x -ray shows a denture lodged at the
T4/T5 level.
What anatomical structure has led to the foreign body becoming lodged in this position?

o Cricopharyngeus muscle
o Cricoid cartilage

o Aortic arch

o Hyoid bone

o Lower oesophageal sphincter

14. Question
1 point
A 20 year old man has been intubated after a significant head injury. While making a referral to the neurosurgeon
they ask you for his mean arterial pressure.
How would you best calculate this?

o Diastolic pressure + 1/3 pulse pressure

o Systolic pressure – 1/2 diastolic pressure

o Diastolic pressure + 1/2 pulse pressure

o Diastolic pressure + 1/2 systolic pressure

o Systolic pressure – 1/3 pulse pressure

15. Question
1 point
A 14 year old girl fell off a horse and is now complaining of numbness in ring and little fingers and the ulnar border
of the hands.
Which nerve root is most likely injured?

o C5

o C6

o C7

o C8

o T1

16. Question
1 point
A journal article describes a diagnostic test for sepsis. A Receiver Operator Characteristic (ROC) curve is shown for
a cut-off value of more than 10 mmol/L. The area under the curve is 0.5.
What are the most appropriate descriptors of the x and y axis?
o Pre-test probability against post-test probability

o True negative rate against false negative rate

o Positive predictive value against negative predictive value

o Sensitivity against specificity

o True positive rate against false positive rate

17. Question
1 point
A 30 year old man presents with symmetrical ascending muscle weakness. He had a diarrhoeal illness a few weeks
previously.
What is the most likely pathogen?

o Borrelia burgdorferi

o Mycoplasma pneumoniae

o Campylobacter jejuni

o Cytomegalovirus

o Epstein-Barr virus

18. Question
1 point
A 42-year-old man presents with an acutely inflamed ankle after noticing a small wound on it yesterday.
What is the most likely dominant cell type in the inflammatory response in this patient?

o Neutrophils

o Fibroblasts
o Lymphocytes

o Macrophages

o Plasma cells

19. Question
1 point
A 45-year-old man presents with a deep vein thrombosis despite a long history of stable anticoagulation on
warfarin. His international normalised ratio is 1 (target range 2 -3). He has had some recent medication changes.
Which of the following is most likely to be responsible for his sub - therapeutic INR?

o Amiodarone

o Fluoxetine

o Ciprofloxacin

o Clarithromycin

o Rifampicin

20. Question
1 point
A 52-year-old man presents with a stab wound to his scalp. The wound appears superficial but it is bleeding
profusely.
What pathway is most important for primary haemostasis of this wound?

o Activation of Protein C

o Conversion of prothrombin to thrombin

o Activation of Protein S

o Activation of von Willebrand factor

o Conversion of fibrinogen to fibrin .

21. Question
1 point
A 50-year-old woman presents with a hoarse voice two weeks after neck surgery for an enlarged thyroid gland.
Which structure is most likely to have been injured during her surgery?

o Recurrent laryngeal nerve

o Thyrohyoid muscle

o Cricothyroid muscle

o Superior laryngeal nerve

o Vagus nerve