MRCEM Primary Paper 5

A 16 year old boy attends the ED with a bleeding scalp wound. He has von Willebrand disease.

Which aspect of haemostasis is most likely to be affected by this condition?

An 85 year old man presents with a two month history of feeling as if he is ‘slowing down’. He complains of stiffness and intermittent shaking of his left arm. He has low volume slow speech and reduced speed of fine finger movements on the left side.

What part of the nervous system is most likely to be affected?

A 19 year old man presents with an open tibial fracture contaminated with soil. His immunisations are up to date.

With regard to tetanus prophylaxis what is the most appropriate management?

A 52 year old man presents with significant bradycardia. He is on digoxin for atrial fibrillation.

Adverse effects from digoxin are more likely in patients with which electrolyte abnormality?

A 50 year old woman attends with vomiting and diarrhoea. She is a diabetic and her blood sugar level is low. You decide to give her glucagon.

Glucagon controls blood sugar by activating glycogenolysis and gluconeogenesis in which part of the body?

A 45 year old man injured his right wrist during a fall. X-rays demonstrate a lunate dislocation. He is complaining of severe wrist pain and numbness in his hand.

Damage to what structure is most likely to be causing these symptoms?

A 14 year old boy injured himself playing football. He had sudden onset of right hip and thigh pain when he kicked the ball. A pelvic x-ray shows an avulsion fracture of the right anterior superior iliac spine.

The forceful contraction of which muscle most likely caused his injury?

A 30 year old man presents following an injury to their hand two weeks ago. An x-ray shows opacification around the fracture site.

What is this most likely to represent?

A 52 year old man arrives at the ED with a reduced level of consciousness. His calculated plasma osmolality is high.

Which molecule is likely to be exerting the greatest influence on his plasma osmolality?

A 34 year old woman presents with a two month history of nausea, weight loss and diarrhoea. She returned from working in Nigeria five months ago. You suspect tapeworm infestation.

What diagnostic method is most likely to confirm acute infestation?

A 48 year old woman who is prescribed long-term lithium treatment is referred by her GP with suspected lithium toxicity.

Which clinical feature would help support this diagnosis?

A 19 year old man attends the ED after sustaining a head injury. He has a facial nerve palsy and a CT shows a fracture of the temporal bone.

His facial nerve has most likely been injured at which foramen of the skull base?