Practice Papers for MCEM Part A by Jaydeep Chitnis

By Jaydeep Chitnis

If you’re participating A of the MCEM then glance no extra – we have now the assets that will help you pass!Practice Papers for MCEM half A good points perform questions according to unique exam papers to be present in half A of the varsity of Emergency Medicine Membership exam, together with eight perform paper MCQs written by means of lecturers and up to date individuals within the exam.The perform papers (and their solutions) featured listed here are in accordance with the curriculum for the exam as released through the varsity of Emergency medication, and canopy all of the center matters which are demonstrated, making perform Papers for MCEM half A perfect to check your realizing, establish vulnerable components, consolidate wisdom, and hone your examination talents.

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A) Increased entry of blood into the circulating blood b) Decreased secretion of glucagon c) Decreased secretion of noradrenalin d) Increased secretion of vasopressin 20 The diaphragm a) Is innervated primarily by the phrenic nerve from the C1 to C3 spinal cord levels b) The aorta passes posterior to the median arcuate ligament at the level of T12 vertebra c) The inferior vena cava passes through a large opening at the level of T10 vertebra d) Muscular components originate from the medial and lateral arcuate ligaments 21 The Carpal tunnel a) Is formed by the flexor retinaculum and the distal ends of radius and ulna b) The flexor pollicis longus tendon and the median nerve pass through the carpal tunnel 46 Practice Paper 5 CHAPTER 5 c) The ulnar nerve passes anterior to the flexor retinaculum d) The median nerve is posterior to the tendons in the carpal tunnel 22 The validity of therapy studies is affected by a) Randomisation b) Duration of follow-up c) Intention to treat d) Blinding 23 Henoch–Schonlein syndrome a) Females are affected more frequently than males b) Purpura may be absent c) Biopsy from involved kidney and skin shows IgG deposition d) Is a self-limiting illness with no recurrence 24 In hyperthyroidism a) If prolonged, it can cause a degenerative process to occur particularly of the myocardium b) Exophthalmos occurs and resolves with treatment c) Atrial fibrillation occurs but readily responds to cardioversion d) Is most commonly caused by a thyroid adenoma 25 Causes of ulceration of throat include a) Agranulocytic angina b) Vincent’s angina c) Infectious mononucleosis d) Diphtheria 26 The atlas vertebra a) Has the first cervical spinal nerve posterior to the atlanto-occipital joint b) Has the vertebral artery lying on its anterior arch c) Has the alar ligament attached to it d) Moves with the occipital bone on rotation of the head 27 Avulsion fractures of the pelvis occur a) As a result of chronic stress in young athletes b) At the anterior superior iliac spine c) As a result of direct trauma d) At the ischial tuberosity due to adductor brevis contracting severely 47 CHAPTER 5 Practice Paper 5 28 The following is true in needlestick injuries a) The risk of blood-borne virus transmission will reduce with exposure of the needle to sunlight b) Testing of the needle for the presence of blood-borne viruses is highly recommended c) Approximate risk of transmission of HIV from a known infected source and fresh blood on the needle is 3 per 1000 d) Informed consent is mandatory before testing source patient for HIV 29 Regarding tapeworm infections a) Cerebral cysticercosis is caused by T.

4 g/L 28 The following can present with abdominal pain a) Herpes zoster b) Myocardial infarction c) Pleurisy d) Superior mesenteric artery embolism 29 According to the immunisation schedule a) Measles, mumps and rubella vaccine should be given around 13 months of age b) The first dose of pneumococcal conjugate vaccine should be given at 2 months of age c) Hepatitis B vaccine to be given at birth to babies whose mothers are at high risk of having hepatitis B d) BCG vaccination at birth to all babies who are likely to come in contact with cases of TB 30 Syphilis a) Has an incubation period of 4–8 weeks b) Presents with a chancre on the genitalia or anus and causes regional tender and enlarged lymph nodes c) In the secondary stage may present with any of the following: a maculopapular rash; condylomata lata; widespread lymphadenopathy and skin granulomas d) Is caused by treponema pallidum and treated with penicillin 31 The rectum a) Is related posteriorly to the third, fourth and fifth sacral nerves b) Has a venous drainage into the superior mesenteric vein c) Begins in front of the second sacral vertebra d) Is covered anteriorly by peritoneum along its entire length 28 Practice Paper 3 CHAPTER 3 32 The left phrenic nerve a) Descends through the thorax in the left pleural cavity b) Receives sensory branches from the diaphragmatic peritoneum c) Passes through the caval opening of the diaphragm d) Arises from the dorsal rami of the third, fourth and fifth cervical nerves 33 Causes of eosinophilia include a) Malaria b) Hodgkin’s disease c) Scabies d) Loeffler’s syndrome 34 In haemolytic disease of the newborn a) The majority of cases are due to Rh incompatibility b) Haemolytic disease of the newborn due to ABO incompatibility commonly occurs with the first pregnancy c) The maternal IgM antibodies cross the placenta and react with foetal red cells d) Can occur due to anti-Kell and anti-S antibodies 35 According to the Salter–Harris classification of epiphyseal injuries a) Type 1 is crushing of part or all of the epiphysis b) Type 2 is the commonest injury c) Type 3 is a separation of part of the epiphyses d) Type 4 is one in which the whole epiphysis is separated from the shaft 36 Cyclic AMP performs the following intracellular function a) Activates enzymes b) Alters the permeability of cell membranes c) Activates protein synthesis d) Alters the degree of smooth muscle contraction 37 Regarding reflexes a) A muscle jerk can be elicited in any skeletal muscle by suddenly striking its tendon or the muscle itself b) The extensor thrust reflex helps support the body against gravity c) The crossed extensor reflex occurs when an extensor reflex occurs in one limb, impulses pass to the opposite side of the cord 29 CHAPTER 3 Practice Paper 3 and stimulate interneurons controlling the extensor muscles of the opposite limb d) Tendon reflexes can be inhibited by the brain 38 The response to acute severe haemorrhage includes a) The release of thromboxane A1, activating platelets and controlling bleeding vessels b) Increased release of ADH from the anterior pituitary c) The increase in renin secretion from the juxtaglomerular cells in the kidneys d) An increase in base line vagal tone 39 Tetanus prone wounds are a) Those less than 6 hours old b) Puncture wound on the buttock c) Those with devitalised tissue d) Sustained in farms 40 The narrowest part of the male urethra is at a) The internal urethral orifice b) The navicular fossa c) The site of the colliculus seminalis d) The level of the perineal membrane 41 The cerebral hemispheres a) Consists of four lobes b) The frontal lobe has all cortical areas in front of the central sulcus of Rolando c) The parietal lobe is mainly concerned with somatic sensation d) Paraplegia may result from very midline lesions, like sagittal sinus thrombosis 42 The femoral artery a) Is a continuation of the common iliac artery b) Is located at the midpoint of the inguinal ligament c) Gives off the profunda femoris branch which provides collateral circulation by anastomosing with the popliteal artery d) Is often injured with fractures of the femoral shaft 43 Referred pain a) Occurs when a visceral sensation is transmitted through a visceral pathway via sensory autonomic fibres to an area remote from the organ 30 Practice Paper 3 CHAPTER 3 b) From the heart is typically felt in the left shoulder and left arm because of its embryonic development in this area c) Is visceral pain and one of the most important stimulus for this is ischaemia d) Can be manifested as headache 44 Synovium a) Lines joints, tendon sheaths and bursae b) Secretes a viscous fluid rich in hyaluronan c) Is not permeable to water d) Has a net of small blood vessels beneath its surface cell layer 45 The following drugs can reduce glomerular filtration rate (GFR) a) Ranitidine b) Lisinopril c) Iodine-containing contrast media d) Naproxen 46 Suxamethonium a) Is a non-depolarising neuromuscular blocking agent b) Is broken down by plasma cholinesterase, an enzyme which is genetically controlled c) Can cause complete skeletal muscle paralysis in 45 seconds d) Causes a rise in potassium and intraocular pressures 47 Cardiac output is measured in man by a) An electromagnetic flow meter placed over the ascending aorta b) Using a Doppler and an echocardiogram c) Injection of a dye and measuring its dilution over a period of time d) Multiplying the oxygen consumption by the A–V difference of oxygen across the lungs 48 Causes of syncope include a) Complete heart block with ventricular asystole b) Pressure on the carotid sinus c) Autonomic insufficiency d) Increased stroke volume 49 The skin a) Regulates the body temperature b) Functions as an excretory organ 31 CHAPTER 3 Practice Paper 3 c) Is the most extensive and varied form of the sense organs d) Produces vitamin D 50 About statistical tests a) Pearson’s coefficient of linear correlation is a non-parametric test b) Chi-squared test is used to compare proportions or percentages between groups c) Parametric tests usually assume that the data are normally distributed d) Non-parametric tests are usually based on ranks 32 Practice Paper 4 1 HIV/AIDS a) Progression to AIDS is defined by the development of two of the AIDS-defining illnesses b) Only about 15% of AIDS patients develop Pneumocystis carinii pneumonia c) Opportunistic infections are the most frequent complications of HIV infection d) Diagnosis is based on detecting anti-HIV antibodies in the serum 2 Regarding acquired immunisation a) BCG is a killed whole bacterial vaccine b) The protective immunity conferred by the MMR vaccine lasts lifelong c) Subunit vaccines are used for passive immunisation d) Polio vaccine is made in both live and killed forms of the virus 3 Drugs that may interact with local anaesthetic agents are a) Ketamine b) Antiemetics c) Calcium-channel blockers d) Antihypertensive 4 Digoxin a) Is a cardiac glycoside and inhibits sodium–potassium ATPase b) Causes a reduction in intracellular calcium c) Stimulates the vagus nerve and sensitises the baroreceptors d) Takes up to 6 hours to achieve its peak effect if given orally but only 1 hour if given intravenously 5 In late diastole a) The pressure in the ventricles are low b) The mitral valve is shut 33 CHAPTER 4 Practice Paper 4 c) The aortic valve is closed d) Blood stops filling the atria 6 Which of the following statements are true?

4% sodium bicarbonate contains 1000 mmol/L of sodium c) Primary hyperaldosteronism causes hyponatraemia d) Urine osmolality is always very high in hypernatraemic patients 10 Regarding oxygen transport a) 5% of oxygen in the blood is carried in the dissolved state b) Fever reduces the affinity of haemoglobin to oxygen 44 Practice Paper 5 CHAPTER 5 c) Increase in 2,3 DPG shifts the oxyhaemoglobin dissociation curve to the right d) Metabolic alkalosis reduces the affinity of haemoglobin to oxygen 11 Chlamydial infection a) Causes an increased risk of cervical cancer in women b) May present as right upper quadrant pain in men due to perihepatitis and called Fitz-Hugh and Curtis syndrome c) Is confirmed by cell culture and has a high sensitivity and rarely has false-negative results d) Should be treated with azithromycin or doxycycline 12 Regarding the scalp a) The auriculotemporal nerve supplies the scalp posterior to the ear b) The aponeurotic layer includes the occipitofrontalis muscle c) The superficial temporal artery supplying the scalp is a branch of the external carotid artery d) Bleeding from scalp lacerations is usually self-limiting 13 The posterior mediastinum a) Is continuous through the superior mediastinum with the neck b) Is traversed by the deep cardiac plexus of nerves c) Can be involved in neck infections spreading between the pretracheal and prevertebral fasciae d) Extends posteriorly down to T10 vertebra level 14 Cerebrospinal fluid a) Has more protein compared with plasma b) Raised intracranial pressure is a contraindication for performing a lumbar puncture c) Normal glucose level is Ͼ60% of blood level d) Shows predominantly lymphocytes in viral meningitis 15 Biomechanics a) Is concerned with the internal and external forces acting on the body b) When abnormal can lead to chronic injuries c) Should be considered in patellofemoral syndrome d) Also, deals with work energy and power 45 CHAPTER 5 Practice Paper 5 16 Ketamine a) Is a phencyclidine derivative and binds to GABA receptors b) Provides substantial analgesia and can be administered intramuscularly c) Increases arterial pressure by 25% but reduces intracranial pressure d) Can cause nightmares especially in children 17 Anticholinergic inhaled agents a) Work by inhibiting the bronchoconstriction caused by stimulation of the vagus nerve b) Reduce secretion of mucus c) Ipratropium bromide is a derivative of atropine d) Inhibit the rise in intracellular cyclic AMP 18 The cardiac output is determined by a) Blood volume b) Blood flow to cardiac muscle c) Stroke volume d) Heart rate 19 Which of the following occur in haemorrhagic shock?

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