MRCEM Primary Paper 1

A 20 year old man presents to ED with a stab wound to his axilla. He has weak elbow flexion and forearm supination.
Damage to which nerve is most likely to be the cause of these findings?

A six year old girl presents to the ED with impetigo around her mouth and nose.
What is the most likely method of spread?

A 69 year old woman presents with a spontaneous rupture of her Achilles tendon.
Which of her current medications is most likely to be related to her symptoms?

A 25 year old man presents following a road traffic collision with signs of haemorrhagic shock.

Which mechanism best describes the changes that take place in his urinary system in response to his blood loss?

A 25 year old man attends ED after injury to his knee while skiing. He has a valgus deformity of knee.

Which ligament is most likely to be damaged?

A 70 year old man presents with “tingling” spots that have erupted over his nose overnight. You make a diagnosis of Hutchinson’s sign, identifying the affected nerve as the nasociliary nerve, and counsel the patient about the development of ophthalmic herpes zoster.
From which cranial nerve does this nerve originate?

A 70 year old man presents with an episode of gout. He tells you that he is prescribed medication for hypertension.
Which class of antihypertensive drug is most likely to have precipitated this presentation?

A 48 year old man has recurrent admissions to hospital for severe upper abdominal pain. His stools are pale, loose and tend to float in the toilet rather than flush away. An abdominal x-ray shows calcification in the epigastric region.
What mechanism is most likely to be responsible for his diarrhoea?

A 24 year old construction worker is struck in the abdomen by a steel girder suspended from a crane. A FAST scan (focussed assessment sonography in trauma) shows abdominal free fluid.
Damage to which structure is most likely to give rise to this finding?

A father brings his febrile eight week old child to the ED. He tells you that the child’s vaccinations are fully up to date.
Which of the following vaccines has the child not yet received?

A seven day old baby boy is brought to the ED with constipation. His mother tells you that he first passed meconium at three days and has not passed stool since. An abdominal x-ray demonstrates megacolon.

A lack of ganglion cells in which structure most likely causes this condition?

A 72 year old man is brought to the ED with difficulty swallowing. A chest x-ray shows a denture lodged at the T4/T5 level.

What anatomical structure has led to the foreign body becoming lodged in this position?