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