FRCEM PRIMARY RECALL – June 2018

Compiled by Dr. Maha Asif

Head n neck

1. Emergency tracheostomy done, wound starts bleeding, which vessel? Jugular vein/
Carotid/brachiocephalic/aortic arc
2. First lower molar infection goes to which lymph node—mandibular lymph nodes
3. Deep wound on parotid, structures damaged? –facial N ,maxillary A
4. Trauma to sella tercica, which bone damaged? … sphenoid
5. Corneal ulcer, pain sensation will travel by which nerve..? ophthalmic of trigeminal
6. Difficulty focusing which muscle involved? .. cilliary
7. Left pupil is dilated when light crosses from right to left eye, which nerve damaged? Oculomotor.
8. Left temporal lobe injury- contralateral homonymous superior quadranopia
9. Ludwig angina is abscess on floor of mouth?? submandibular space
10. 30 yrs old male with dental abscess and sob, the infection has spread to which neck space? ---
Parapharangeal space(also called lateral pharangeal)
11. Laceration on forehead midline, u have to give nerve block. Which nerve will u block with
anesthesia? supratrochlear
12. Head injury scenario, fracture to base of the skull, numbness over upper lip and maxilla. Which
part fractured? foramen rotundum
13. most common aneurysm is anterior communicating artery
14. tragus sensory supply- auriculotemporal nerve
15. Bitemporal hemianipia which artery- posterior cerebral artery

Thorax

16. A child swallows a coin, it lodges in esophagus... structure compressing esophagus at mid
thoracic level... aortic arch
17. external intercostal muscles—elevate the ribs
18. A child appears in emergency department with hematemesis after swallowing a battery, ct shows
it is stuck at T10, which vessel has been damaged and is bleeding? Subclavian/
19. needle piercing what chamber of the heart if gone too far while aspirating for tamponade/ Nerve
that can be damaged when u incise pericardium- phrenic nerve

20. Dermatome at level of nipple… T4

21. aortic diaphragmatic opening---T12
22. A patient has consolidation, and you auscultate which part in RT 5th Intercostal space. ??---
middle lobe
 23. thoracic inlet syndrome—subclavian
24. Thoracotomy done, bleeding vessel, which one?

Upper Limb

25. DIP joint deformity?? Mallet finger

26. A man fell on open arm, he cannot flex his wrist, Loss of elbow flexion with loss of lat foreman
sensation. Which cord involved... lateral cord
27. Fracture of shaft of humerus—radial nerve damaged
28. What passes above the flexor retinaculum and is outside the carpel tunnel. ----Tendon of flexor
carpi radialis,
29. Flexor tendon sheath continues with??--- The little finger.
30. Superficial wound on extensor surface of proximal IP joint of middle finger, what will be
damaged? Tendons were in option.
31. Trauma to the medial side of arm 5 cm above medial epicondyle. There is a bleeding vessel,
which structure is damaged? ulnar collateral
32. Ant shoulder dislocation, ligament damaged? – glenohumeral
33. Patient cannot abduct his arm from 0-15 degrees. Muscle injured? Supraspinatous
34. Accessory nerve damage.—muscle paralyzed?--- trapezius
35. Loss of sensation over thumb—C6 dermatome
36. Patient cannot laterally rotate- muscle involved- infraspinatous
37. Thenar eminence question- flexor polices bravis

Abdomen-

38. Descending colon blood supply? Inferior mesenteric

39. Umbilicus T10

Lower limb

40. Pain in leg, Patient is unable to flex his foot and big toe. Compartment syndrome. flexor halusis
longus
41. Ankle jerk… L5S1
42. Patient has fractured anterior superior iliac spine during a trauma. Which muscle is affected?
Sartorius
43. Sensory supply to the lateral of sole of foot-- Sural n

CNS

44. 50 year old male hypertensive has a sudden loss of consciousness with quadraplagia, he is
moving eye balls. CT is done, suggestive of bleed in which of the following …thalamus/
pons/basal ganglia
45. Lumber puncture , “give” before entering the csf is what structure—dura/arachnoid/ligamentum
flavum
46. Patient of Bacterial meningitis, csf is cloudy, what differentiates it from viral meningitis...
increased proteins/increased lymphocytes/decreased glucose
 47. Ptosis, anhydrosis (horner syndrome)
48. Typical features of PICA? Lateral medullary syndrome Posterior inferior cerebellar artery. (PICA)

CRANIAL NERVES

49. Patient with diplopia- which cranial nerve damaged--- oculomotor/ trochlear

PHYSIO

50. Cause of steatorhea – lipase deficiency.

51. henry law
52. canuala used for resus, if radius is doubled, flow will be increased ?--- 16 times
53. Hypersensitivity reaction 1/2/3/4?
54. dead space in a healthy individual- 150
55. residual volume in a healthy individual ?—7ml/kg
56. C1 esterase deficiency ffp
57. Fetal hemoglobin shifts oxygen saturation curve to left becuase? Affinity for oxygen increases
58. Carboxyhb shifts oxygen saturation curve to ….left
59. Haselbach equation requires values of which of the two to be calculated? hco3+co2
60. A-a mismatch... asthma/copd/
61. Pregnant lady which lung volume will decrease? TV
62. sob, Normal A-a ratio.----- copd/asthma/myasthenia gravis/
63. 45 y o male treated for pneumonia, got drowsier after treatment with hyponatremia and
increased urinary sodium, cause? SIADH
64. 13 yr old girl with menhorragia, epistaxis which test will identify the disease. aptt
65. Type-1 pneumocytes in lung have what function?---- secrete surfactant/act as macrophages/gas
exchange/reduce surface tention
66. Enzyme in pancreatic juice? trypsinogin
67. What increases gastric emptying…
68. Chemo receptors that sense co2 changes and effect respiration accordingly are located in? aortic
arch/ carotic body/ j receptors
69. Parietal cells produce? Intrinsic factor
70. Chief cells produce? pepsinogen
71. Type 1 diabetes scenario
72. Glucose filtered in which part of nephron? PCT
73. Acid reflux pathophysiology?
74. Rennin deficiency- hyperkalemia
75. J receptors
76. Graves disease scenario, palpatations due to ?--- T3 /T4/albumin
77. Thyrotoxicosis scenario, medication to be given- B-blockers
78. Scenario of oesophageal varices, asking about other possible location for portosystemic shunt...
umbilicus/ rectum
79. Pacing will activate which area --SA node
80. prolonged QT corresponds to which cardiac phase— phase 3
 81. Scenario: Wernickys Encaphlopathy, Patient consumes too much alcohol, presented with
vomiting? thiamine deficiency
82. Pulmonary embolism-3 questions
83. Action of parathyroid on DCT-
84. Somatostatin secreted from delta cells
85. Angiography of chest pain patient, occlusion of left circumflential branch, which cardiac area
affected?
86. Ecg shown, v2,v3,v4, which vessel involved based on ecg changes—LEFT anterior descending
87. Ecg changes in hypokalemia –pr increased/
88. Qrs corresponds to which jvp cycle- isovolumetric contraction.
89. Systolic pressure in right ventricle- 15-30mmHg
90. Lead reversal- AVR-AVL
91. Macrocytic anemia- vit b12 deficiancy
92. B12 def--- ilium resection
93. Intentional tremor in Parkinsonism??Essential tremors?? Nigrostriate tract??
94. Scuba diving related question

PHARMA

95. A cardiac patient with acute onset of joint pain, he is a known case of gout and is also on gout.
Which painkiller will you suggest… colchicine, nsaids avoided in cardiac patient?
96. Tetanus prone wound, wound puncture.
97. Tetanus vaccine? Patient fully up-to date with tetanus VC. According to UK protocol, presented
in ED with soiled open wound with fracture of tibia fibula, vaccination options?? No tetanus
required/ tetanus immunoglobulin only/ tetanus img + vaccine etc
98. 20 wks Pregnant lady with Chicken pox exposure—varicella immunoglobulins/varicella vaccine/
check antibody status / no action required
99. Live vaccine? BCG
100. a boy presented after 2 days of dog bite incident & was in high rabies area, anti rabies
regimen?… 5 doses of vaccine in 1 month/vaccine + immunoglobulin
101. A patient presented is jaundiced and is diagnosed to be a case of hemolytic anaemia, cause?
asprin/mefaminic acid/diclo/
102. 20 wks pregnant with herpes, u plan to give acyclovir, MOA of acyclovir?
103. S/e of katemine…hyperventilation/tachycardia/hypotention
104. Child with diarrhea, oral rehydration solution given, what will correct dehydration? Sodium
chloride/sodium citrate/sachrosodium/glucose
105. Case of hyponatrimea, hypertonic saline given to correct this state. How will this effect
intracellular compartment? Efflux of intracellular water/ influx of extracellular water/ no effect
on cell water.
106.likely cause of hypokalemia in patient on polypharmacy : Salbutamol or Bendroflumethazide/
furosemide
107. What type of immunity is it wen u give immunoglobulin. innate
108. Naloxone works on which receptors…… delta/gamma/mu receptors
109. Antibiotic causing cholestatic jaundice? flucloxacillin/ co amoxiclav / cephalosporin
 110. Ibuprofen causes hematemisis in a patient, mechanism involved? ----mucosal irritation/decrease
in prostaglindins/hcl production/bicarbonate production etc
111. Tendon rupture caused by ---quinalones
112. Patient with gram negative infection. What antibiotic with u give? Cefalosporins/ co-amoxicalv/
trimathoprim
113. Hay fever treatment- anti muscrininic
114. Bicarbonate in which solution?---- Hartman solution
115. Patient develops MI after taking Nsaids which of the following nsaid it is? diclofenac because it is
more common associated with thromboembolic events
116. Antipsychotics acts on which receptor. Dopamine
117. Cholestatic jaundice--co-triamoxiclave
118. For urinary retension, drug given act on which receptor, anti mascarinic, dopamine,
anticholinestrase, acetylecholine.
119. Cyto450 inducer and inhibitor question
120. Precipitation of gout in a patients drug regimen
121. Terrerist attack used nerve gas, Pt. Was given atropine, What remains after given atropine,
/Bronchoconstriction/Increased salivation & lacrimation/Skeletal muscle
relaxation/Bradycardia/tachycardia
122. Dose of Cipro IV in patient with renal problem?? – 200mgBID/ 400mg OD/ 200mg OD etc
123. Erythromycin oral and chloramphenicol drops for neonatal ophthalmoplagia?
124. MOA of colchicine?? Inhibition of microtubules polymerization

MICRO

125. Leptospira gain access through…. Intact skin/droplets/feco-oral rout

126. Man with diarrhea and vomiting then have eye symptoms and urethral discharge, organism
involved?
127. Hep B infection, which one investigation u will order,
128. How does giardiasis attach… oral hooks/sucker disc/
129. Scenario of pneumonia, right middle lobe consolidation, which is the organism…
130. Scenario of Traveler pneumonia
131. Influenza mode of attachment on host...
132. Legionella causes… hyponatremia
133. Pseudomonas inf. Acquired in hospital… heater fans/
134. Chlorhexidine hand wash effective against--- gram positive/gram negative/
135. Coxscacki virus correct answer.
136. Diarrheal illness, ascending paralysis scenario, organism involved? compylobacter jejuni
137. Encapsulated bacteria—ecoli
138. Reactive arthritis which organism- shigella/ compylobactor/ salmonella

PATHOLOGY

139. Supracondyler fracture in a boy, what kind of bone healing will be present after treatment.
Callus/bone/
140. Swelling of ankles... reason/pathophysiology in ccf patient
141. Immunoglobulin mediated immunity is?? innate/natural/
142. Cellulitis patient, process involved??--- capillary wall leakage/fibrin formation
 143.c3 c4 marker for post streptocoocus glomerulonephritis

EBM

144. You are doing a study based on the outcomes of many previous studies on that topic...What is
this type of study called?
145. You tell a patient he is suffering from xxxx and put him on yyyy. And tell him is a part of a study
and ask him to come for follow up...What is the bias expected in this form of study
146. ..
147. …
148. …