MRCEM Primary Paper 3

Following a blow to the face a 42 year old woman sustains an orbital blow out fracture. She has diplopia on upward gaze.

Entrapment of which muscle is most likely to be the cause of her diplopia?

A 38 year old man attends the ED feverish with an acutely painful, swollen, hot knee. You suspect septic arthritis.

If an organism is seen on Gram stain of the joint aspirate which characteristics are most likely?

A 71 year old man with a history of heart failure and type 2 diabetes mellitus presents with an acutely painful, swollen first metatarsophalangeal joint. A clinical diagnosis of gout is made.

Which treatment would be most appropriate for the acute management of this patient?

A 35 year old woman presents with fatigue and yellow sclera. Blood tests reveal a high bilirubin which is found to be unconjugated bilirubin.

What pathology is the most likely cause for her jaundice?

A 50 year old woman attends after recent incision and drainage of an abscess in the posterior triangle of her neck. She has noticed her shoulder has drooped and she can no longer raise her right hand above her head.

Which nerve is most likely to have been damaged?

A 52 year old man is seen in the ED with a hot painful swollen knee. A joint aspirate is sent for analysis.

Which of these findings makes a diagnosis of gout most likely?

A 45 year old man attends with confusion and agitation. He is a known diabetic and he is hypoglycaemic on arrival. You decide to give him intramuscular glucagon.

Which type of cell in the pancreatic islets normally secrete glucagon to regulate blood glucose level?

A 56 year old man who works as a painter and decorator attends after three weeks of worsening burning pain in his right elbow. The pain is worse on heavy lifting or gripping objects. There is tenderness over the lateral (external) epicondyle.

Involvement of which muscle group is most likely to be responsible for his pain?

A 72 year old woman presents to the ED with a 24 hour history of blistering rash on the left side of her forehead. You suspect varicella zoster virus infection (shingles).

What is the most appropriate way to make the diagnosis prior to starting treatment?

A 22 year old woman presents with a widespread urticarial rash after taking penicillin. You suspect an allergic reaction.

Which immunoglobulin is most likely to be responsible for this reaction?

A woman sustained a human bite from someone known to have hepatitis B two hours ago. She has not had any previous hepatitis B vaccinations.

Regarding prophylaxis against hepatitis B, what is the most appropriate schedule to follow?

A patient with nausea and vomiting is found to have hypoglycaemia and hyponatraemia.

What is the most likely endocrine disorder?