FRCEM Practice Exam Questions and Answers

A patient is brought into the ED unconscious Calculation from the venous blood gas confirms a low anion gap acidosis What is the most likely cause of this abnormality?

Diabetic ketoacidosis

B.  

C.  

D.  

E.  

An 88 year old woman presents with haematemesis CT scan identifies a posterior ulcer of the superior part of the duodenum At what vertebral level would this be evident on the CT scan?

A 55 year old woman is found to have clinical and biochemical features of cholestatic jaundice. You think her jaundice might be caused by one of her medications.

Which medication is the most likely cause of her jaundice?

An 85 year old man complains of double vision on looking down. You note his right eye does not move when he looks down and medially.

Impaired (unction of which nerve is most likely responsible?

A ten day old baby is brought in with purulent conjunctivitis. The gram stain of the purulent exudate did not show any organisms. Which bacteria is the most likely cause?

A 24 year old man sustains an injury to his right eye The x-rays confirm an orbital floor fracture He complains of double vision on upward gaze

Entrapment of which muscle is most likely responsible for his symptom?

A 75 year old man is concerned about having frequent chest infections He is a heavy smoker and you explain to him that this can affect the normal mechanism of mucociliary clearance of microorganisms and pollutants

What type of cell is primarily responsible for this method of pathogen clearance?

You are caring for a 68 year old patient with known heart failure and significant tachypnoea Stimulation of which receptor type is most likely to cause this increase in respiratory rate?

A patient is brought in unconscious following a collapse and a subsequent CT shows a pontine haemorrhage Which clinical tindmg best describes what you expect on examination of the eyes?

A 60 year old woman presents lo the ED feeling generally unwell She is found to be uraemic She has missed several of her renal dialysis sessions.

Urea will most likely move through the dialysis membranes by which mechanism?

A five year old girl is brought to the ED by her parents She is pyrexial and has coryzal symptoms. Which diagnosis would require notification to a UK Public Health department?

You are treating a patient with an acute exacerbation of COPD and they remain wheezy after two doses of nebulised salbutamol You decide to add nebulised ipratropium to improve bronchodilation

Which receptors are most likely to be targeted by this treatment?

A newborn infant is brought to your ED He was born at 39 weeks gestation with low birthweight, a purpuric rash, hepatosplenomegaly and bilateral cataracts You suspect the signs are secondary to an infection acquired while khe baby was still in utero

Which organism is most likely to cause this clinical presentation?

A 50 year old man presenls with a history of a productive cough and fever Chest x-ray shows right middle lobe consolidation Which is the most likely causative organism?

A patient presents with muscle spasms caused by hypocalcaemia Which substance is used to adjust (or an abnormality in the calcium level?

A patient with major trauma requires a central line. They have right sided neck and chest burns You decide to insert a left subclavian central line.

Which complication is more likely to occur during this procedure on the left in comparison to the right?

A 32 year old woman presents with dizziness She has been laking medication tor low back pain Blood tests reveal a haemolytic anaemia.

Which drug is most likely to be responsible?

A patient is in respiratory distress and you suspect left ventricular failure Which respiratory volume is most likely to be increased?

A 78 year old woman presents with a painful shoulder after a fall. On examination she is unable to lift the dorsum of her hand off her mid-lumbar spine (lift-off test).

Which muscle is most likely to have been injured?

A 21 year old woman attends with an earring becoming lodged in the lobule of her ear You decide to perform a nerve block to allow removal of the earring

Which nerve are you most likely to need to block?

A 22 year old woman sustained an incised wound to the sole of her foot from standing on glass. Examination of the wound under local anaesthetic identifies the wound depth is limited to the first plantar layer.

Which structure is most likely to be injured?

A 70 year old woman presents to the ED with symptoms and signs suggestive of sepsis Her BP is 80/40 You think her low BP is because of a drop in the systemic vascular resistance

Which type of blood vessels are most likely implicated in causing her hypotension?

A 45 year old man with type II diabetes presents after a hypoglycaemic episode He has a history of diabetic eye disease He asks your advice about diabetes and driving.

Which situation is most likely to allow him to continue driving according to the DVLA?

A 57 year old man has had a myocardial infarction His coronary angiogram has shown a 50% decrease in the radius of the right coronary artery.

Which parameter is most likely to increase by a factor of 16 as a result?

You review a paper where patients were recruited through a response to an invitation from a heart foundation charity.

What term best describes this sample?

A 60 year old woman presents following blunt trauma to her abdomen A CT scan demonstrates herniation of small intestine into the chest

At what site is the diaphragmatic injury most likely to have occurred1?

A 28 year old woman has an expanding skin rash: lethargy and body ache You suspect Lyme disease Which microorganism is most likely to be the cause?