MRCEM Primary Paper 8

A 48 year old man presents with a lump in his right groin which increases in size when he strains and disappears on lying down. You suspect he has a direct inguinal hernia.

This hernia is most likely due to weakness of which structure?

A 20 year old man arrives in the ED from the airport with severe diarrhoea. He has just returned from a place where there was an outbreak of cholera.

What is the most likely cause of the excessive intestinal secretions in this patient?

A 24 year old man attends the ED having been assaulted. You suspect he has fractured his mandible. He complains of numbness of his lower lip.

Which nerve is most likely to have been damaged?

An 18 year old man presents with rigors. He had a splenectomy due to trauma four years ago. You decide to screen for infection.

Which characteristic of the infecting bacterial cell wall puts him most at risk from infection?

A 20 year old man presents after a large overdose of his grandmother’s digoxin.

What is the most appropriate indication for the use of digoxin specific antibody?

You are exploring a wrist laceration and note the flexor retinaculum is intact. However, you are concerned that some of the structures passing on the top of the retinaculum might have been injured.

Which structure is most at risk of damage?

A 25 year old man is stabbed in the abdomen with a kitchen knife. A CT demonstrates a diaphragmatic injury involving the oesophageal hiatus.

Which structure is most likely to be damaged?

At journal club you present a paper on the use of a biomarker to predict the presence of clinically important infection.

When assessing applicability to facilitate safe discharge what is the most useful statistical attribute?

A 34 year old dialysis patient collapses at home. He is due for dialysis today. He has severe hyperkalaemia and you perform a 12 lead ECG.

What ECG feature would you be most likely to see immediately prior to deterioration to cardiac arrest?

You are seeing an 80 year old woman who is hypoglycaemic. You need to administer glucose urgently.

What is the mechanism by which glucose enters the cells of the body?

A 22 year old man is injured during a mixed martial arts competition. He complains of pain and weakness of his shoulder. The photo shows the following abnormality as he leans forwards.

Which muscle is most likely to be involved?

A 25 year old man presents with diabetic ketoacidosis. You start to treat him with short-acting insulin and intravenous fluids as per your local protocol.

Which electrolyte disturbance is he most at risk of developing as a result of your treatment?