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RCEM FRCEM Primary Examination Sample Questions:

1. A three week old baby is brought in by her concerned parents She is vomiting substantially after feeds and is failing to gain weight. Investigation reveals an alkalosis and a low serum potassium.
The alkalosis is most likely to be due to which mechanism?

A) Hypoventilation causing reduced pC02
B) Exchange of H* at the gastric protein pump
C) Increased loss of magnesium
D) Increased production of bicarbonate
E) Loss of hydrochloric acid

2. A 46 year old woman arrives after being hit by a car She has sustained a head injury You suspect she may have increased intracranial pressure due to a traumatic brain injury.
Which is the earliest clinical finding you are likely to see?

A) Dilated ipsilateral pupil
B) Papilledema
C) Cushmg's triad
D) Bilateral fixed dilated pupils
E) Impaired corneal reflex

3. A patient with major trauma requires a central line. They have right sided neck and chest burns You decide to insert a left subclavian central line.
Which complication is more likely to occur during this procedure on the left in comparison to the right?

A) Pneumothorax
B) Injury to the phrenic nerve
C) Injury to the recurrent laryngeal nerve
D) Perforation of the oesophagus.
E) Injury to the thoracic duct ID.

4. A 56 year old woman with severe ascites attends the ED with breathlessness Chest auscultation is normal What findings would you expect on spirometry?

A) Increased vital capacity
B) Increased total lung capacity
C) Increased FEV,/FVC ratio
D) Increased FVC
E) Increased inspiratory capacity

5. A 43 year old Afghan national presents to the ED with a four month history of cough, weight loss and night sweats What test is most consistent with active tuberculosis?

A) Sputum sample showing ziehl-nielsen stain negative bactena
B) Chest x-ray showing lobar consolidation
C) Chest x-ray showing a cavitating lesion
D) Positive mantoux test
E) Absence of a bacille calmette-guenn scar

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