Practice Papers for MCEM Part A by Jaydeep Chitnis

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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?

Saginata b) T. 7 kPa b) Is seen in early stages of severe asthma c) Can be caused by ventilation/perfusion mismatch d) Is treated by increasing the FiO2 9 In a child with a fever a) Ideally, both paracetamol and ibuprofen should be given together to reduce the temperature as they act synergistically b) For suspected meningococcal septicaemia, cefotaxime is the preferred antibiotic c) It is important to get blood cultures as soon as possible d) For a suspected urinary tract infection, the urine should be obtained using urine bags 10 Investigations for suspected TB include a) Biopsies of solid lesions and lymph nodes b) Gastric washings subjected to staining and culture c) Chest X-ray d) Sputum culture in Ziehl–Nielsen medium 54 Practice Paper 6 CHAPTER 6 11 Osteomyelitis a) Is never caused by fungi, viruses and other parasites b) Is an infection of the cortex of a bone c) Is common in children due to haemophilus d) May originate from a small lesion such as a boil on the skin 12 At the shoulder joint a) The deltoid muscle initiates abduction b) The subacromial bursa does not communicate with the articular cavity c) The teres minor and teres major muscles form a part of the rotator cuff d) Anterior dislocations may lead to a radial nerve palsy 13 The autonomic nervous system a) Differs from the cerebrospinal nervous system by having the course of its efferent nerves interrupted by a synapse in a peripheral ganglion b) Has its sympathetic motor cells in the anterior grey columns of all the thoracic and upper two lumbar segments c) Has its cranial parasympathetic outflow along cranial nerves III, VIII, IX and X d) All sympathetic postganglionic terminals release adrenaline and noradrenaline 14 About chronic granulocytic leukaemia a) The platelet count can be normal to high b) Philadelphia chromosome is present in the neoplastic cells c) Blast crisis is more common in chronic lymphocytic leukaemia d) Splenomegaly is common 15 Causes of polycythaemia include a) Non-neoplastic kidney disease b) Chronic pulmonary disease c) High altitude d) Benign familial polycythaemia 16 Regarding immunodeficiencies a) In DiGeorge’s syndrome, B cells and immunoglobulin levels are usually normal b) Wiskott–Aldrich syndrome is characterised by thrombocytopenia, eczema and recurrent infections 55 CHAPTER 6 Practice Paper 6 c) X-linked agammaglobulinaemia starts presenting at 8–9 months of age d) CD8+ helper T-cell depletion is central to the pathogenesis of AIDS 17 Cortisol a) Increases the quantity of protein in most tissues in the body b) Has its main function to increase resistance of the body to any physical stress c) Depresses utilisation of glucose by tissues d) Stabilises lysosomal membranes 18 With somaesthetic sensation there are several specialised tactile receptors a) The pacinian corpuscle is quite superficial in tissues and responds to rapid tissue deformation b) The meissner corpuscle is found in the toes and enables us to discriminate very precise texture and fine details of objects touched c) Krause’s corpuscles are located in the sexual organs and are responsible for some sexual sensations d) Ruffini’s end-organ detects stretch of tissues and joints allowing determination of the degree of angulation of the joint 19 Refractory shock a) Can occur only with haemorrhagic shock b) Causes damage to the gastrointestinal mucosa allowing bacteria to enter the circulation c) Is a state when there is no longer any response to vasopressors despite correcting the blood volume d) Is contributed to by negative feedback mechanisms of the CNS 20 Regarding infections with Salmonella a) S.

Typhimurium causes acute gastroenteritis b) Humans are the only known reservoirs of S.