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 etc, injury to? – anterior cruciate
6- swollen tender knee joint, known recurrent joint problems elderly female, what blood test will be raised? – rheumatoid factor
7- football injury young male – snapping noise when hip joint moved, avulsion of anterior superior iliac spine ? muscle involved – sartorius
8- anterior aspect of thigh numbness – lateral cutaneous nerve of thigh
9- fifth metatarsal base fractured – muscle?
10- fibular neck fracture, which muscles is injured?
11- stabbed through adductor canal, injury to what structure? saphenous nerve, femoral nerve, obturator nerve
12- Tigh nerve supply ant-lat=femoral nerve
13- foot drop sensation loss=lateral compartment of leg
14- dash board injury rta=pcl injur
15- foot drop=commen peroneal nerve inju
16- ankle reflex=S1S
17- Pain in leg, Patient is unable to flex his foot and big toe. Compartment syndrome. flexor halusis longus
18- Ankle jerk… L5S1
19- Patient has fractured anterior superior iliac spine during a trauma. Which muscle is affected?
Sartorius
20- Sensory supply to the lateral of sole of foot-- Sural n
*ABDOMIN & PELVIC :
1- stab 5 cm above iliac crest left lateral abdomen – deepest structure before peritoneum? – transversus abdominis
2- megacolon found in 7 day old infant, passed meconium at 3 days of both and no bowel movements since then, which system affected? – myenteric plexus
3- ectopic pregnancy scenario, site of likely pregnancy? – ampulla of fallopian tube direct inguinal hernia, defect?
4- middle aged male, struck in anterior abdomen with steel girder, fast scan shows intra-abdominal fluid, which organ would be injured? – spleen injury (other options were kidney, pancreas, colon, aorta, none likely to be injured than spleen)
5- 48, male, perforation, pneumoperitoneum on CT, likely organ to be perforated? – duodenum, sigmoid colon, transverse colon, ascending colon, oesophagus
6- elderly patient, abdominal pain, high lactate, very unwell, scenario of ischemic bowel. CT shows ascending colon affected, what blood supply?- right colic artery
7- FAST scan in patient RTA, hypovolemic shock, where will fluid likely be seen when supine? – paracolic gutter? para-aortic gutter? between liver and diaphragm, between liver and right kidney, between spleen and left kidney
8- patient is stabbed in abdomen, diaphragmatic injury at region where oesophagus enters the diaphragm, what other structure would be injured? vagus, azygos, thoracic duct, aorta, vena cava
9- Oesophagus pierce at which diaphragm level=T10
10- Contents of rectus sheath=pyramidalis
11- Abdominal injury scenario ,contents of rectus sheath=again pyramidalis
12- Waddling gait=sup gluteal nerve
13- Retero peritoneal hematoma=duodenum(sad pucker)
14- Hernia medial to epigastric vessels=direct inguinal hernia
15- Duodenalinjury,d1isat=L1
16- Gluteal inj given–foot drop=scietic/commen peroneal nerve
17- Hip prosthesis displacement ligament involve =transverse/illio lumbe
18- scitic nerve damage=extension of hip+flexion of knee
19- SMA blood supply=jejunium
20- toxic megacolon–dx hierschprung diseases=myentric or auerbacs plexus
21-artry damage in rectus sheath=inf epigastric vessel-arty 22- abdoiminal trauma–herniation of intestine into chest through=t7 t9level/ domesod diaphragm/centraltendo
23- Descending colon blood supply? Inferior mesenteric
24- Umbilicus T10
# PHYSIOLOGY – 60 :
1-loud s1? cause – opening of pulmonary valve, closing of aortic valve, vibration, opening of mitral valve, closure of tricuspid valve
2- cause of prolonged PR interval
3- cause of prolonged QT interval – clindamycin? (scenario of patient recently using antibiotic for skin infection, ECG shows QT prolongation
4- hyperkalemia, ECG changes just before cardiac arrest? Tall, peaked T waves and wide Qrs, Af
5- ECG shown, which vessel involved based on ECG changes?
6- Angiography of chest pain patient, occlusion of left circumflex branch, which cardiac area affected
7- something about starling’s law
8- pre oxygenation for intubation, which lung volume needs to be replaced with o2?
9- MAP calculation formula
10- duodenal/gastric ulcer – likely cause? Gastrin
11- DKA treatment commenced, what will be low as a consequence – potassium
12- dka scenario, what causes drowsiness – sodium
13- osmolality, major contributor? – sodium
14- in patient with addison’s disease, scenario and lab results given what specifically is deficient? –
Mineralocorticoid
14- scenario of tachycardia at 135/min, weight loss, diarrhoea, in a patient with grave’s disease, what will be lab finding supportive of it? increased T3 hyponatremia, hyperkalemia – hypo adrenalism
15- scenario of ADH secretion, location? posterior pituitary
16- blood volume? 5 litres
17- recurrent pneumonias in chronic smoker, what is the factor causing him to have recurrent pneumonias? – decreased mucociliary clearance
18- contact dermatitis scenario? – type 3 hypersensitivity reaction? 19- anaphylaxis, which immunoglobulin? – IgM
20- trancutaneous pacing, skeletal muscle contractions of anterior chest wall ? cause – voltage gated sodium channels opening
21- SLE ab=ANA
22- Siadh features=hyponatremia
23- Drug causing siadh=flouxetine
24- Anaphylaxis reaction ab=IgE
25- Surfactant function=reduce the surface tension
26- Surfactant formed by=pneumocytes type2
27- Ecg changes in hyperkeleimic pt before the cardiac arrest=tall t/broad qrs
28- Adenosine ci=asthma
29- Furosemide Moa=thick ascending loop
30- Furosemide moa=na/k/2cl
31- Thiazide moa=dct
32- Carotid sinus massage=at which level=thyroid cartilage , cricoid etc
30. Frank straling law in inotropes use=move up &left curve
31. Right sided oxygen dissociation curve=acidosis low ph
32. Most effective method of controlling duodenal ph=brunners gland- bicarb
33. Factor regulate appetite-satiety=gherlin from epsilon cell?
34. Massive ascites cld pt–pleural effusion-spirometry=
35. Copdon spiromtery=
36. Heroin use given naloxone–abg=incpco2respdepression
37. Bagging to remove nitrogen=resp vol finding tlc/frc/fevi/fvc/RV
38- Aldosterone deficiency=Addison=hypona+hyperk
39- Conns syndrome scenario=hypernatremia
40- Case of IBS nsaids use=b12absorptiondec=b12de
41- cushing diseases=scenario=dms test done=no effec
42- Femoral fracture blood loss dec bp then maintained bp =barro receptors
43- CBF=physiologic dec icp due to=initial inc pco2=hyperventilation
44- sBP7opost transfusion bp maintained=tprdec?
45- massive Pulmonary embolism =echo finding=left artrium pressure dec? 46- chemoreceptor location=carotid body/carotid sinus
47- pancreas-exocrine-protien digestion=trypsin
48- only endocrine pancreatic secretion is=glucagon by alpha cell
49- liver alt enzymes high=inc activity of cytosol
50. Cause of steatorrhea – lipase deficiency.
51. henry law
52. cannula 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. Carboxy hb 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
*OTHER :
1-hemorrhage, life threatening, what will be the effect on kidneys? – decrease urine production
2- scenario of heart failure, furosemide given, site of action? – loop of henle
3- someone in type 2 resp failure, how will body realise it needs to increase breathing rate? –
Chemoreceptors
4- alcoholic, male, ascites, cause? – portal hypertension 5- ascitis in female, lung function tests, which would be increased? FEV1/FVC
6- acute infection with hepatitis B – raised ALT
7- terminal ilium resection, absorption of which will be affected – vitamin c, zinc, proteins, carbohydrates, vitamin d
8- gout scenario – negatively bifringent crystals on aspirate
9- glucagon secreted from- alpha cells
10- young patient with DKA – which pancreatic islet cell dysfunction? BETA
11- glucagon site of action for gluconeogenesis and glycogenolysis? liver
12- factors that increase gastric emptying – cholecystokinin, histamine, secretin, duodenal distension,astral distension
13- scenario of scalp laceration, what will cause clotting – conversion of prothrombin to thrombin, conversion of fibrinogen to fibrin, activation of external clotting cascade
14- pulmonary surfactant function – increase surface tension
15- pulmonary surfactant produced by? – pneumocytes
16- Sickle cell-anemia due to–rbc sequestration
17- 110.ipratropium bromideinhaler=receptors=muscarinic
18- poisoing case of antichilergic toxidrome=ach receptors blockage
19- heart block case some ecg finding=slow av conductio
20- hypertonic saline moa=intracellular-intravascular/intravascular-I.C
21- low anion gap=hypoalbunemia
22- anion gap only anions=cl+hco3
23- mucocilarry escalator function cells=ciliated columnar epithelium
24- hypokalaemia= vit d def
25- pth def scenario(dec capthdecincph
26- ppI moa=h/ k atpase pump
27- rx of dka=important Electrolyte replacement=potassium re
28- child with gastric loss ,vomiting ,metabolic alkalosis electrolyte disturbance=due to loss of hc
29- moa or NE in septic shock=v.c
30- glucagon by which cell=alpha cell of endocrine portion
31- acromegaly case scenario
32- mitochondria function=cellular respiration & atp formation # Pharmacology – 27 :
1-scenario of pancytopenia ? causative drug? – choices included celecoxib and mefenamic acid – i chose celecoxib
2- lip/peri-oral swelling not improving with adrenaline, which drug implicated mainly as cause? – ramipril (don’t remember specifically – one of the ‘prils’)
3- anaphylaxis, adrenaline dose? 1:1000
4- scenario of heart failure, furosemide given, site of action? – loop of henle
5- newborn with eye discharge, mummyen under treatment for chlamydia, what is newborn at risk of? pneumonia, encephalitis, corneal ulcer, meningitis, and one other option – i chose corneal ulcer
6- digoxin toxocity, when to give digiband? – prolonged seizures, severe bradyarhythmia
7- precipitant of gout in a patient’s drug regimen? – hydrocholothiazide
8-gout treatment, scenario given elderly, heart failure, diabetes, acute gout treatment? – colchicine, allopurinol, diclofenac, etc etc
9- rationale for steroid use in asthma- reduce bronchial inflammation(duh?)
10- adenosine contraindication (scenario of SVT) – recent severe exacerbation of asthma
11- scenario or warafrinized patient with head injury? reversal with? – FFP
12- digoxin toxicity, worsens – hypokalemia
13- succinylcholine mechanism of action – depolarizing neuromuscular blockage
14- propofol, mechanism of action – GABA receptors
15- cause of warfarin to be potentiated – clarithromycin?
16- cause of pregnancy despite oral contraceptive pills – carbamezepine
17- lithium toxicity – ataxic gait
18- proton pump inhibitor acts on- parietal cell
19- Adrenaline dose in cardiac shock acto acls=1:10k
20- Crush injury ,drug ci=suxamethonium
21- Doxycycline use in pregnancy=s.e tooth discolouration in baby
22- Crp released stimulated by=IL-6
23- Drug that inc the action of aminophylene in copd/asthma=FQ:cipro
24- Non sedating antihistamine=fenoxifinadine
25- Pt with eps necks tiffness=antiemtic use=Metachloropromide 26- Safest beta blocker in afib with asthmatic pt=atenolol ,carvi .prpranalol (cardioselective?
27- Gouty pt with heart failure=exacerbation of gout=colcichin
28- Nsaid which have less gis,e=ibuprofen/indomethacin/dicl
29- Lorezepam se=resp depression
30- scenario of pt on lmwh with heamtemesis=rx protamine sulphate
31- adenosine effect on heart moa=+chrontrpic/ chrontropic /+dromotropic /inc cornoray blood perfusion
32- diltiazem s.e=
33- ccb amlodipine se=pedal edema
34- rash after taking med in tonsilittis=amoxicillin–pmpdueto(EBV)
35- scenario of dx of pheochrocytoma–alpha blockad
36- 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?
37- Tetanus prone wound, wound puncture.
38- 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
39- 20 wks Pregnant lady with Chicken pox exposure—varicella immunoglobulins/varicella vaccine/ check antibody status / no action required
40- Live vaccine? BCG
41- 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
42- A patient presented is jaundiced and is diagnosed to be a case of hemolytic anaemia, cause? asprin/mefaminic acid/diclo/
43- 20 wks pregnant with herpes, u plan to give acyclovir, MOA of acyclovir?
44- S/e of katemine…hyperventilation/tachycardia/hypotention
45- Child with diarrhea, oral rehydration solution given, what will correct dehydration? Sodium chloride/sodium citrate/sachrosodium/glucose
46- 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. 47- likely cause of hypokalemia in patient on polypharmacy : Salbutamol or Bendroflumethazide/ furosemide
48- What type of immunity is it wen u give immunoglobulin. innate
49- Naloxone works on which receptors…… delta/gamma/mu receptors
50- Antibiotic causing cholestatic jaundice? flucloxacillin/ co amoxiclav / cephalosporin
51- Ibuprofen causes hematemisis in a patient, mechanism involved? ----mucosal irritation/decrease in prostaglindins/hcl production/bicarbonate production etc
52- Tendon rupture caused by ---quinalones
53- Patient with gram negative infection. What antibiotic with u give? Cefalosporins/ co-amoxicalv/ trimathoprim
54- Hay fever treatment- anti muscrininic
55- Bicarbonate in which solution?---- Hartman solution
56- Patient develops MI after taking Nsaids which of the following nsaid it is? diclofenac because it is more common associated with thromboembolic events
57- Antipsychotics acts on which receptor. Dopamine
58- Cholestatic jaundice--co-triamoxiclave
59- For urinary retension, drug given act on which receptor, anti mascarinic, dopamine, anticholinestrase, acetylecholine.
60- Cyto450 inducer and inhibitor question
61- Precipitation of gout in a patients drug regimen
62- Terrerist attack used nerve gas, Pt. Was given atropine, What remains after given atropine,
/Bronchoconstriction/Increased salivation & lacrimation/Skeletal muscle relaxation/Bradycardia/tachycardia
63- Dose of Cipro IV in patient with renal problem?? – 200mgBID/ 400mg OD/ 200mg OD etc
64- Erythromycin oral and chloramphenicol drops for neonatal ophthalmoplagia?
65- MOA of colchicine?? Inhibition of microtubules polymerization # MICRO – 18 :
1-scenario of impetigo in child, what factor causes its spread? fecal- oral, droplet, intact skin, broken skin – i chose broken skin.
2- swollen painful knee joint youngish male (35 or so?) no other history, what would you find on gram stain? gram positive pairs of cocci in clusters, or gram positive cocci in chains, or gram negative rods or gram positive rods or gram negative intracellular organisms arranged like kidney beans (correct answer – gonococcal arthritis)
3- picture of a weird target lesion like rash on hand of young male, said to have been acute in onset over last two days started on limbs now involving trunk etc ? cause – options were HIV, Herpes simplex, staph aureus (my answer because I thought it was scalded skin syndrome and nothing else really fit)
4- 3 month old, diagnosed pertussis, most horrible complication? – apneic spells
5- alcoholic male, cough, bloody sputum, fevers, consolidation on xray, microorganism? – klebsiella
6- cholera scenario, profuse watery diarrhoea, mechanism of action? – chloride ions leakage?
7- scenario of steattorhea – defect in exocrine pancreas
8- 35 yo woman with fatigue, icteric sclera, unconjugated bilirubin – hepatitis
9- shingles rash scenario, seen in ED, what would you do to confirm before beginning treatment? – history and clinical judgement
10- scenario of herpes zoster ophthalmicus, which nerve involved? – trigeminal
11- soiled open wound with open fracture of tibia fibula, treatment options? no tetanus treatment, tetanus immunoglobulin only, tetanus immunoglobulin and vaccine now, tetanus immunoglobulin and vaccine now and 1 month later, tetanus vaccine only
12- 8 month old child, fully updated with jabs for age. what has he still not received yet? men a, men b, hiB, rotavirus, mumps
13- patient has been bitten by someone who is hep b positive, she herself has never received vaccination for it, management plan? immunoglobulin now, immunoglobulin plus vaccine course over three months, immunoglobulin plus vaccine course over 6 months
14- child with proven meningitis being intubated in ED, who needs prophylaxis (post-exposure) clinician intubating, nursing staff in ED, children at party with child, classmates and teachers in school boy with hemophilia scenario, deficiency? – factor 8
15- patient fully uptodate with tetanus injections according to UK protocol, presents to ED with very dirty
16- scenario of TB, how to diagnose? – options were CT chest, sputum culture, monteux test,
17- tapeworm infection, how to diagnose? IgE levels raised, eggs in stools
18- diarrheal illness, ascending paralysis scenario, organism implicated? – campylobacter jejuni
19- Rubella most dangerous=1st trimester(organogens is period)
20- Tetnus igG most indicative factor=park injury soil 21- Wound in leggas forming organism=clostridium perfringes
22- Weakness flaccid paralysis scenario=botulinism
23- Herpes simplex encephalitis scenario=ctfinding=temporallob
24- Young pt with meningitis signs with rash=N.meningit
25- Cholera=inc chloride secretion channels activity
26- Intestinal flora disturbance=clostridium difficil
27- Pneumonia old age in nursing care home=organism=
28- Sickle cell–osteomylitis=salmonella
29- Salmonella=feaco-oralroute
30 - Case of Mumps +dec plt bleeding renal failure=hsp/immune throboctopnia
31- Febrilechildhavefeverrashon9-10monthvaccinatedall.following Sysmptoms due to which?=mmr vaccine rubella suspectd
32- Post speenectomy=mcorganism pnemococcal/h.influenza
33- Ecoli infection=fimbria attachment/hostdefense/flagerymovement
34- S.erysipelas=s.pyogenes
35- Heart defect now Infective endocarditis=strepviridians alpha heamolytic
36- tapeworm infestation=rx=niclosamide or praziquantal
37- herpes zoster ganglion=lat geniculate
38- tb case from india=dx sputum afb smear
39- rash after taking med in tonsilittis=amoxicillin–pmp due to(EBV)
40- Mumps isolation period=5days(4-4)
41-rash after taking med in tonsilittis=amoxicillin–pmpdueto(EBV)
42- wooping cough=nasopharngeal swab
43-Leptospira gain access through…. Intact skin/droplets/feco-oral rout
44- Man with diarrhea and vomiting then have eye symptoms and urethral discharge, organism involved?
45- Hep B infection, which one investigation u will order,
46- How does giardiasis attach… oral hooks/sucker disc/
47- Scenario of pneumonia, right middle lobe consolidation, which is the organism…
48- Scenario of Traveler pneumonia
49- Influenza mode of attachment on host... 50- Legionella causes… hyponatremia
51- Pseudomonas inf. Acquired in hospital… heater fans/
52- Chlorhexidine hand wash effective against--- gram positive/gram negative/
53- Coxscacki virus correct answer.
54- Diarrheal illness, ascending paralysis scenario, organism involved? compylobacter jejuni
55- Encapsulated bacteria—ecoli
56- Reactive arthritis which organism- shigella/ compylobactor/ salmonella
# Pathology – 9 :
1-small wound on ankle, swollen acutely inflamed next day – what is the most abundant cell type present? neutrophils
2- patient with von willibrand disease scenario – what is the dysfunction? – platelet aggregation
3- female hx of innate immunity=recurrent uti infection=causes urineflow dribbling due to structural by birth defect… 4- heamostatsis injury most abudand cell atend=fibroblast/platelet plug/N/L
5- chronic gastritis on biopsy predominant cell
=lymphocytes/macrophages/multi nucleated giant cell/neutrophils
6- Supra condyler fracture in a boy, what kind of bone healing will be present after treatment.
Callus/bone/
7- Swelling of ankles... reason/pathophysiology in ccf patient
8- Immunoglobulin mediated immunity is?? innate/natural/
9- Cellulitis patient, process involved??--- capillary wall leakage/fibrin formation
10- c3 c4 marker for post streptocoocus glomerulonephritis