MRCEM Primary Paper 6

A 26 week gestation baby is born precipitously in your department. The neonatal team give artificial surfactant once the baby is intubated.

What cell type within the lungs normally produces surfactant?

A 50 year old woman presents to the ED with palpitations. Her ECG reveals a prolonged QTc. She has been taking an antibiotic for a skin infection.

Which antibiotic is the most likely to have caused her ECG abnormalities?

You suspect pertussis in a three month old baby.

Which is the most common complication in this age group?

An 86 year old man has severe abdominal pain and is unwell with a high lactate on venous blood gas. Infarction in the ascending colon is suspected on CT scan.

Which artery is most commonly implicated in this presentation?

A 38 year old man has a regular narrow complex tachycardia and you suspect an AV-nodal re-entrant tachycardia. Vagal manoeuvres have not worked and you plan to use intravenous adenosine.

What factor in his history is most likely to be a contraindication to this?

You are teaching a medical student about heart sounds whilst examining a patient. The student thinks the first heart sound is loud.

What is most likely to generate this sound?

An elderly man with complete heart block is being externally paced. As the current is being increased, the muscles of his chest wall begin to twitch.

The action potential which leads to skeletal muscle contraction is initiated by changes in which transmembrane proteins?

A 65 year old woman with a known malignancy on the anterior two thirds of the tongue presents with neck swelling.

What is the most likely group of lymph nodes to be involved first?

A 65 year old man with a long history of smoking and breathing difficulties presents with fever and productive cough. He has had five lower respiratory tract infections in the past six months.

What is the most likely cause of his increased susceptibility to infection?

A 23 year old man presents following significant head trauma. He requires a rapid sequence induction and you plan to use suxamethonium as a paralytic agent.

What is the main mechanism by which suxamethonium achieves muscle relaxation?

An 18 year old man falls onto an outstretched arm while playing rugby. His elbow is painful and deformed. An x-ray confirms posterior dislocation of the elbow joint.

What is most likely to be fractured in this case?

An eight year old boy with haemophilia presents to the ED after a fall. He is complaining of a warm, painful right knee.

The replacement of which clotting factor will most likely aid his recovery?