MRCEM Primary Recalls, October 2024
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19 : FRC scenario
1 : IVC at T8
20 : FEV / FVC ratio increased
2 : thoracic duct with aorta
2
3 : Cavernous sinus 3rd 21 : ADH from post pituitry
S
The cavernous sinus contains a number of important structures (CN III (occulomotor), CN IV (trochlear), CN V1
(ophthalmic branch of trigeminal), CN V2 (maxillary branch of trigeminal), CN VI (abducens) and the Internal carotid.
R
CNIII pierces the dura near the edge of the tentorium cerebelli and passes through the lateral part of the cavernous
sinus with the IV and VI nerves to enter the orbit
4 : Frontal lobe , expressive dysphasia 22 : position of pituitry in sphenoid sinus : superior
O
1
T
5 : gag reflex , IX nerve 23 : thiazide diuretic at DCT 9
C
The sensory limb is mediated predominantly by CN IX The thiazide receptor is a sodium-chloride transporter that pulls NaCl from the lumen in the distal convoluted tubule. Thiazide
(glossopharyngeal nerve) the motor response by CN X (Vagus diuretics inhibit this receptor, causing the body to release NaCl and water into the lumen, thereby increasing the amount of urine
produced.
O
24 : Avoid with gout : thiazide
D
6 : abducent Nerve scenario
25 : hypokalemia U wave
I
H
7 : optic tract ; homonymous hemianopia
10
S
3 paralyis : C. jejuni
26 : ascebding
Guillain-Barré syndrome (GBS) is a rare condition that causes nerve damage. Symptoms
8 : direct hernia ; E
include muscle weakness, tingling, and sometimes paralysis. Campylobacter jejuni infection
is one of the most common causes of GBS
D
transversalis fascia 27 : shift toward left , type 2 failure
LA
9 : central cord syndrome 4 28 : j receptors
Upper limb weakness is > lower limb weakness (due to motor fibres for upper limb travelling more centrally in cord)
G
Sensory loss variable with proprioception, vibration and deep touch sensation often less affected than pain and
temperature sensation as bulk of dorsal column based in periphery of cord
10 : lower limb involved ; Ant cerebral artery 29 : dud ulcer : gastrin 11
N
Acid production in the stomach occurs from parietal cells, predominantly in the body with few in the cardia. Secretion is
increased by gastrin, acetylcholine and histamine.
A
5 injury
11 : pure motor stroke : internal capsule 30 : B12 def : ileum 12
B
A thrombosis or haemorrhage occurring in the internal capsule results in a contralateral
The ileum is the major site of absorption of vitamin B12
hemiparesis or hemiplegia. This is the most common site of intracerebral haemorrhage
13
R
12 : Foramen of Munro 31 : brush border : small intestine
The surface of the small intestine villi is covered with a layer of epithelial cells which, in turn, have many
FO
small projections
called microvilli that project towards the lumen of the intestine (forming the brush border).
13 : Frank starling law : more preload : more force 32 : parietal cells , acid release 14
7
Gastrin acts to: *Stimulate acid secretion from parietal cells (both directly and indirectly by stimulating
of contraction release of histamine from ECL cells)
M
*Stimulate pepsinogen secretion from chief cells *Increase gastric motility *Stimulate growth of gastric
mucosa
Starling's Law states that the heart will eject a greater stroke volume if it is filled to a greater volume at the end of diastole
33 : V/ Q shunt
E
14 : frank starling law : more ionotrope more shift
C
towards left upward 6 34 : 2nd heart sound delay , inspiration 15
R
Increasing inotropy (increasing contractility) moves the curve upward and to the left whilst negative Physiologic Split S2
inotropy (decreased contractility) moves the curve downwards to the right This happens during inspiration when increased venous return to the right side of the heart delays the closure of the pulmonic valve (major effect), and
decreased return to the left side of the heart hastens the closure of the aortic valve (minor effect)
:M
15 : staph aur contain igA Protein for complement 35 : MAP diastolic + 1/3 PP
activation
FB
36 : pencillin causing C difficile infection
16 : staph is an opportunistic pathogen
37 : tetanus causes loss of inhibitory action 16
17 : ketamine NMDA receptor 8 Tetanus neurotoxin (TeNT) binds to the presynaptic membrane of the neuromuscular junction, is internalized and transported
retroaxonally to the spinal cord. The spastic paralysis induced by the toxin is due to the blockade of neurotransmitter release from
spinal inhibitory interneurons
In contrast to most other anaesthetic agents, ketamine is a NMDA (N-methyl-D-aspartate) receptor antagonist. It is a
non-competitive antagonist of the calcium-ion channel in the NMDA receptor. It further inhibits the NMDA-receptor
by binding to its phencyclidine binding site. Ketamine also acts at other receptors as an opioid receptor agonist
(analgesic effects), as an muscarinic anticholinergic receptor antagonist (antimuscarinic effects) and by blocking fast
38 : handwashing in C diffice 18
while alcohol-based hand sanitizers are effective against many pathogens, they are not effective against C. difficile spores.
sodium channels (local anaesthetic effect).
18 : temporal lobe fracture : unable to close eye : Handwashing with soap and water is the preferred method for hand hygiene when dealing with C. difficile
facial nerve 39 : measles 4 days
17
Children with measles must not attend primary school and children’s service centres from symptom onset until at least 4 days after the onset of rash.
