MRCEM Primary Paper 4

An 80 year old man trips hitting his head on the pavement. He has neurological findings and you suspect he may have central cord syndrome.

What neurological findings are you most likely to observe?

A 41 year old man presents with loss of balance and right sided weakness. He also has dysarthria, a left sided facial droop and his eyes are deviating to the left. There is right sided sensory loss.

Which artery is most likely to be occluded?

A 24 year old woman attends complaining of lower abdominal pain. She has a positive pregnancy test despite taking the contraceptive pill. She has epilepsy and has recently had her medication changed.

Which antiepileptic is most likely to have had an effect on her oral contraceptive?

A woman gives birth to a preterm baby in the ED. The Neonatal Team attend and administer surfactant.

Which statement best describes the action of surfactant on the lung?

A 40 year old woman attends the ED with a head injury. Her CT brain scan shows a fracture through the internal auditory meatus.

Which cranial nerves are most at risk of injury?

A young man presents to the ED with a stab wound to the left side of the abdomen approximately 5cm above the iliac crest.

What is the deepest muscle that the knife penetrated before puncturing the peritoneum?

A 10 day old boy has a one day history of red eyes with purulent discharge. He had a normal delivery at term. His mother started a course of treatment for chlamydia two days ago.

What potential complication is this baby at increased risk of ?

A 25 year old woman presents with clinical features of anaphylaxis. You consider administering intramuscular adrenaline.

Which strength of adrenaline is most appropriate in this situation?

A 45 year old man with a history of longstanding excessive alcohol intake presents with ascites.

What pathological process has most likely led to formation of ascites in this patient?

A 70 year old man presents with visual impairment. When testing the pupillary reaction to light, the right pupil dilates when the light source moves from the right pupil to the left.

Which nerve is likely to be abnormal?

A 30 year old woman attends the ED with an exacerbation of asthma. She has been prescribed prednisolone for five days.

What best describes the mechanism of action of oral steroids?

A 23 year old man attends the ED with abdominal pain. He has a history of Crohn’s disease and has had a previous resection of his terminal ileum.

Which of the following is most likely to be deficient due to the absence of the terminal ileum?