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FRCEM Primary Examination FRCEM Primary examination: ● Anatomy (60 questions) ● Physiology (60 questions) ● Pharmacology (27 questions) ● Microbiology (18 questions) ● Pathology (9 questions) ● Evidence-Based Medicine (6 questions) # ANATOMY – 60 : *HEAD AND NECK : 1- platysma – stab wound to anterior triangle of neck – which muscle would be injured (choices were sternocleidomastoid, scalenous anterior, trapezius, platysma and one other) 2- head injury with fractured internal acoustic meatus, which TWO nerves would be affected – facial and glossopharyngeal 3- female with mass on anterior 2/3rds of tongue, where is lymph drainage? i chose submental because tip of tongue drains there but rest of anterior tongue drains to submandibular, so I am not sure, both were in the options 4- lower lip numbness, nerve involved? inferior alveolar 5- optic tract lesion, right or left – scenario depicting right homonymous hemianopia 6- headache, increased intracranial pressure symptoms, bitemporal hemianopia ? lesion site – optic Chiasm 7- mass in optic chiasm, symptomatic, hyperglycemia, likely hormone excess? growth hormone 8- orbital blowout fracture, diplopia on upward gaze. which is entrapped? superior oblique, inferior oblique, inferior rectus, superior rectus, medial rectus 9- orbital blowout fracture – inferior orbital fissure fracture, which will be damaged? 10- oculomotor nerve – consensual light reflex scenario where light shined in right eye, reflex present, light moved to left eye but right pupil dilates, lesion? 11- scenario of elderly male involuntary tremors in one hand, gait changes, rigidity in muscles, expression changes, where is the lesion? substantia nigra 12- neck surgery on thyroid, which nerve is damaged? recurrent laryngeal nerve 13- Ant triangle neck injury=platysma0/scm/infrahyoid 14- Muscle divided during thoracotomy=latissimus dorsi/trapezius/s.a 15- Thoracotomy done which nerve injure=thoracodorsal nerve,axillary etc 16- Internal auditory meatus nerve injured=7th+8th 17- Damage to mastoid which nerve injured jaw reflex lost=5thnerve 18- Ear lobule=n.s=greater auricular nerve 19- Orbicluaris occuli=n.s= 20- Jaw pain reffered to ear=ATN 21- Papillary light reflex 22- Optic chiasm –bitemporal hemianopia 23- Optic tract–homonymous hemianopia 24- Scenario of left temoral–right nasal vision loss 25- Expressive dysphasia case=brocas–fronal lobe 26- Supraclavicular fossa dermatome=C 3 27- facial nerve=stylomastoid foramen 28- nerve to periorbital area=zygomatic/infraorbital/buccal 29- mysthania gravis suspected case optic neurtitis findings=due to loss of myelanation 30- Emergency tracheostomy done, wound starts bleeding, which vessel? Jugular vein/ Carotid/brachiocephalic/aortic arc 31- First lower molar infection goes to which lymph node—mandibular lymph nodes 32- Deep wound on parotid, structures damaged? –facial N ,maxillary A 33- Trauma to sella tercica, which bone damaged? … sphenoid 34-Corneal ulcer, pain sensation will travel by which nerve..? ophthalmic of trigeminal 35- Difficulty focusing which muscle involved? .. cilliary 36-Left pupil is dilated when light crosses from right to left eye, which nerve damaged? Oculomotor. 37- Left temporal lobe injury- contralateral homonymous superior quadranopia 38- Ludwig angina is abscess on floor of mouth?? submandibular space 39- 30 yrs old male with dental abscess and sob, the infection has spread to which neck space? --- Parapharangeal space(also called lateral pharangeal) 40- Laceration on forehead midline, u have to give nerve block. Which nerve will u block with anesthesia? supratrochlear 41- Head injury scenario, fracture to base of the skull, numbness over upper lip and maxilla. Which part fractured? foramen rotundum 42- most common aneurysm is anterior communicating artery 43- tragus sensory supply- auriculotemporal nerve 44- Bitemporal hemianipia which artery- posterior cerebral artery 45- 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 46- Ptosis, anhydrosis (horner syndrome) 47- Typical features of PICA? Lateral medullary syndrome Posterior inferior cerebellar artery. (PICA) 48- Patient with diplopia- which cranial nerve damaged--- oculomotor/ trochlear *CHEST AND SPINAL : 1- hilar lymph adenophathy on CXR? bronchopulmonary? paratracheal? tracheobronchial? superior thoracic? pulmonary? 2- dentures stuck in trachea at T4/5 level, what causes the constriction? – arch of aorta 3- patient with spinal cord injury, central cord suspected syndrome suspected, clinical signs to be expected? – proximal musculopathy? upper limb muscles affected worse than lower limb muscles, 4- L.p highest safest level in adults=l3-l4 5- Thoracic outlet syndrome=subclavian arty 6- Pericarditis=phrenic nerve 7- Athelete unique finding=inc sroke volume 8- Ant spinal arty syndrome case 9- Right middle lobe auscultation=T4–T 10- Aortic regurgitation auscultation=right2ic 11- Breast outer quadrent l.n=ant group or pectoral group 12- If asked medial quadrant=parasternal node 13- nipple dermatome=T4 14- A child swallows a coin, it lodges in esophagus... structure compressing esophagus at mid thoracic level... aortic arch 15 external intercostal muscles—elevate the ribs 16- 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/ 17- 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 18- Dermatome at level of nipple… T4 19- aortic diaphragmatic opening---T12 20- A patient has consolidation, and you auscultate which part in RT 5th Intercostal space. ??-middle lobe 21- thoracic inlet syndrome—subclavian 22- Thoracotomy done, bleeding vessel, which one? 23- Lumber puncture , “give” before entering the csf is what structure—dura/arachnoid/ligamentum flavum 24- Patient of Bacterial meningitis, csf is cloudy, what differentiates it from viral meningitis... increased proteins/increased lymphocytes/decreased glucose *UPPER LIMBS : 1- msuculocutaneaous nerve – stab wound to axilla, causing weakness of elbow flexion and supination 2- woman presents with right shoulder weakness, difficulty in raising it above her head and also shoulder contour different – which nerve implicated? accessory (deltoid) 3- froments sign 4- picture of winged scapula, which muscle likely to be affected? – serratus anterior 5- winged chapel scenario in hiker, which nerve is damaged? long thoracic nerve 6- plumber/painter, right elbow lateral condyle tenderness/painful movements of elbow, what movement will be affected? wrist extension 7- slip and fall on outstretched hand, wrist pain, lunate dislocation, also c/o severe pain in hand, what is likely to have been injured? – distal radius, radial artery, ulnar nerve, scapholunate dissociation, radial nerve 14 year old fell from horse, numbness and tingling to medial 2 fingers and ulnar border of hand ? lesion where? 8- fall on outstretched hand, elbow injury, posterior dislocation of bow, what is likely fractured? – capetellum, trochlear part, olecranon, radio head, supracondylar region 9- volar wrist aspect injury, laceration, possible injury to structures above flexor retinaculum, what will be injured? 10- slip and fall landed on back/hip, painful movement of hip adduction but hip flexion is normal, what muscle is injured 11- unable to move below waist, wrist elbow and shoulder movements intact, unable to flex fingers or grip anything, lesion? 12- fracture base of little finger metacarpal, which muscle injured? 13- Thenar injury glass pieces etc=opponens polices/fpl/fpbetc 14- Ant compartment forearm injury=musculocutaneous nerve=c5-c7 15- Ant compartement forearm injury=pronator teres not heret 16- Instrinsic muscle hands injury lower brachial plexius injury=c8-t1 17- medial epicondyle injury=muscle group involve wrist flexors/elbow 18- Shoulder cuff rotators–int rotation loss+=subscapulri 19- cut at volar wrist abd polices/fpb/o.p 20- DIP joint deformity?? Mallet finger 21- 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 22- Fracture of shaft of humerus—radial nerve damaged 23- What passes above the flexor retinaculum and is outside the carpel tunnel. ----Tendon of flexor carpi radialis, 24- Flexor tendon sheath continues with??--- The little finger. 25- Superficial wound on extensor surface of proximal IP joint of middle finger, what will be damaged? Tendons were in option. 26- Trauma to the medial side of arm 5 cm above medial epicondyle. There is a bleeding vessel, which structure is damaged? ulnar collateral 27- Ant shoulder dislocation, ligament damaged? – glenohumeral 28- Patient cannot abduct his arm from 0-15 degrees. Muscle injured? Supraspinatous 29- Accessory nerve damage.—muscle paralyzed?--- trapezius 30- Loss of sensation over thumb—C6 dermatome 31- Patient cannot laterally rotate- muscle involved- infraspinatous 32- Thenar eminence question- flexor polices bravis *LOWER LIMBS : 1- achilles tendon rupture – ciprofloxacin 2- ankle movement loss – ? location of lesion 3- neck of fibula fracture – common perennial nerve injury 4- valgus deformity of knee joint following football injury i think, ?ligament damaged – medial collateral 5- hyperextension of knee joint – horse-riding incident, unable to weight bear swollen painful knee
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