MRCEM INTERMEDIATE SBA

14 th SEPTEMBER 2021

1. you are leading a trauma case of multiple casualties of road traffic accident, you have
a patient who has blunt abdominal trauma and lost cardiac output 45 min ago.
surgical registrar wants to perform resuscitative thoracotomy, while you are against it.
your consultant is busy in intubating a child from the same accident and he is not to
be disturbed, what will you do...?

A. continue resuscitation until your consultant is free

B. over ride the surgical registrar
C. arrange instruments for thoracotomy and ask the surgical registrar if you can assist him
D. discuss with your team 

according to MRCEM success, resuscitative thoracotomy is indicated within 15 min for

penetrative trauma and within 10 min for blunt trauma

2. a paramedic has called you for advise on a baby who is dead in his home in his cot,
what should be done next...?
A. bring the baby to ED
B. call the police/authorities
C. leave the baby with parents and return
D. stay there until baby well being authorities arrive
E. Call the GP to attend

3. Patient SVT stable but nurses struggling to measure bp because heart rate over 200
A.Valsalva maneuver
B.  DC shock
C. Iv adenosine

4. Double fang marks of a venomous snake bite pic ? Patients vitals were okay, and
had a rash around the wound. Venomous snake bite have two fang marks. No there
were no systemic upset, they only showed de pic of de fang mark
A. Antivenom
B. Antihistamines
C. Analgesics
5. There was anothe x ray pic, distal radius fx, diagnosis;
Barton or smith fracture?
volar displacement +
Not involving the articular surface 

6. Another question of massive thromboembolsim .... thrombus found.... no contra

indications mentioned against thrombolysis
A.  unfractioned heparin
B. Alteplase
7.  Acute on chronic  Respiratory acidosis with partial metabolic compensation
Metabolic compensation usually will take time
8. Abdominal aorta more than 3cm
Bowing of interventricular septum
A. In cardiac tempobade
B. pericardial effusion.. 
C. dissection extending to sac
9. Fomepezole for ethanol ? ABG - HAAGMA

10. Slipped upper femoral epiphysis

11. Lunate or perilunate fracure.

12. In 32 year old agitated sweating hyperthermic patient? Drug abuser

A. acute alcohol. 
B. Serotonin syndrome
C. NIMS
13. Wheezy chest in a child who ate fertilizer... atropine?

14. Child with bleeding pv, brought by grand parents - female genital mutilation?

15. HIV and Need for post exposure prophylaxis

A. semen splash
B. Receptive anal intercourse
C. IV drug abuser
D. Sub saharan dwelling more than last 5 years
16.  Child with bleeding pv, brought by grand parents 
A. female genital mutilation
B. Sex abuse
17. frozen meat consumption 5 days back. Diarrhoea started on day2. 
A. Rotavirus 
B. Norovirus 
C. Ecoli O1507
D. Campylobacter jejuni
E. Some salmonella or shigella 

E coli takes 3-5 days

C jejuni takes 2-4 days
The symptom started on 2nd day . C jejuni cannot survive in refregeration
18.  NIV criteria for COPD ....
A.  acidosis 
B.  raised paco2?? 
19. Dendritic ulcer .geniclovir
20.  Peripheral vertigo - horizontal unidirectional nystagmus
21.Several renal collic intolerant to nsaids…
A.  IV morphine
B. Ketorolac is NSAID.C.
C. Iv paracetamol according to nice guidelines

22..      Which of the following is the earliest sign of compartment syndrome? (pallor of
skin/pain on passive stretch/loss of distal pulses/paresthesia of limbs)

23.   Which of the following is the analgesia of choice for a child presented to your unit with
burns over bilateral upper limbs? (intranasal diamorphine/IV morphine/oral diclofenac/rectal
diclofenac/oral paracetamol)

24.      You are in a restaurant and you notice a child who is 18 months old presented with
choking episode. He is gasping and unresponsive. What is your next course of active? (5
rescue breath/ 5 back blow and chest thrust/5 back blow and abdominal trust/ encourage
coughing/ start CPR)

25.     A 38 weeks old mother delivered a baby in your ED. Upon deliver noted the baby is
floppy and blue. What is your next course of action? (start chest compression/ give 5
inflation breath/ call for senior help/ dry the baby/ suction of trachea)

26.      A 12 years old boy presented with abdominal pain and vomiting. Blood gases revealed
severe metabolic acidosis and high blood glucose and ketone. What is your insuline regime?
(IV Insulin 20 unit stat dose/SC insulin 10 unit stat dose/IVI insulin 0.05 unit/kg/hour/ IVI
insulin 0.1 unit/kg/hour)

27.    A 35 years old lady developed sudden onset occipital headache associated with
multiple episodes of vomiting. She is currently on OCP. She just had her hairwash in the
local saloon yesterday. What is the most likely causes? (subarachnoid
hemorrhage/stroke/venous sinus thrombosis/vertebral artery dissection

28. Capnography diagram asking points for Co2 which maching

29.  TIA , till when should he not drive LMV

30. tallux

31. salterharris 3

32.  paracetamol over dose graph

33. target temp for drugs ACLS

34.  tetnus in old man

35. 300 mcg dose 10 year

36. CPR rate 100-120/min

37. carbon monoxide poisioning

38.  svt-- vagual manuware

39. GCS good and then fell down bec raised icp

40.  4 year kid shock 4j/kg answer 50J

41.  fluids given initially ans 1 lit

42. ketamine used intubation in excerbation of asthama. 

Ketamine is the only drug used in RSi For asthma because of its bronchodilator properties. 

Though there is a risk ? of laryngospasm  The incidence of laryngospasm is 0.3%without

paralytic agent. With paralytic agent, it's negligible

43. succynclholine contraindicated hyperkalemia

44. Capnography diagram which keep on oncreasing the co2 diagram. cause

45. Glaucoma

46. The husband bought sick wife to ED and due to busy ED and he took wife back home
without treatment. next day shes dead. amd options were write death cerificate from Gp,
inform police etc

47. pt came with pesiticide all parameters were pointing towards Organophospate poisioning
except the raised heart rate which was 145. So i didnt choose atrope and chose something
else

48. knee joint with bifringent needle along with neutrophils. options given were Gout, and
calcium pyrophosphate49. how will you declare someone dead with cardiorespiratory arrest

options were gag reflex, respiratory examination ettc

50. Nsaids, anaphylaxis reaction. 

51.  fracture of midshaft of humerus. unble to move wrist

52. A burn question of hand and options what is the pain managemnt intranasal dimorphone,
intravenous dimorphine

53. opiate poisioning naloxne given and gcs came down afrer few hours commense the
infusion of naloxe

54..A child having cynotic spells eating food, options were Asd, vsd, pda. (tof) not given in
option

55.  Diaphramatic hernia

56.  Ludwigs angina

57.paedriatic chocking
58 fluid calculations in a child

59. Size of an ett tube in 4 year child. options were 4,4.5,5,5.5 and 5

60. mallampati score 3 pics given

61. A pic given in which right eye was constricted and facing upwards and other left was
dilated and asking which nerve involved right occulomotor, left occulomotor, rt 4th nerve and
rt and left 6 nerve

62.  there was one question where women has had a hairwash and suddenly developed
occipital headache

A. SAH
B. Temporal arteritis

63. 75 year old pt has capacity and doesnt want treatment but the family wants treatment

64.  calculate fluids 4ml per kg first 10kg then 2ml per kg for 5 amswer was 50. like the
question was 15 year old child how much fluid. i did 2*15= 30 which was wrong

65.  DKA and insulin dose answer was 0.1 

66. Dabagitran mechanism ans 2a

67. Dabigratran Antidode Idarizumiba

68.  ecg showing trifasicular block

69. Ecg showing LAD MI

70.  Child swolled magnets x ray given and the magnets crossed stomach and is in bowels

71. parkinsonism leading to acute tonic reaction amswer was procyclidine

72.  beta blocker toxicity  treatment 

A. glucagon

73. wells criteria

74.  Ecg bradycardia , low BP , First treatment

A. transcutebous pacing

75. ecg with svt answer was vagual manuver

76.  Indications to NIV

77.  paracetamol posioning and a graph showing the plasma concentration of paracetmol vs
time and there were options

78. there was a question to differentialte between Kawaski disease and some other and the
answer was cervical lymphadenopayhy greater than 1.5.
79. Child with history of strep pharyngitis develops ankle pain.... what other investigation us
would like to do.... i chose urine rme for psgn

80.  There was an xray of osgood schlatter disease

81. Calus formation osteosarcoma

82. there was a scuba diving question adverse effect with options nystagmus, skin allergy,
vomiting and something whats the answer. i chose nystagmus( i think this is regarfing
decompression sickness)

84. Varicel bleed answer? Both octerotide and terlipressin were there.

85. Lateral foot sensation loss and absent of ankle reflex

A. S1 nerve root
B. Common peroneal nerve injury

86. One was a picture of a throat with inflammation but not apparent abnormalities.... i put
paul bunnel test ....

87) pic of a women with winging scapula. 

answer: long thoracic nerve

88) Child with upper uti followed by testicular swelling with bluish spots over testes 

A. Torsion
B. Mumps orchitis 
C. Epididmoorchitis?
D. Appendage torsion is the answer

89. There was a lady with hypertthyroidism and thyroid swelling having AF since a long
time.... they asked about treatment 

A. .Amiodarone
B. .Flecainide
C. Verapamil
D. .bisoprolol
E. .Cardioversion or something

90.  The senario of hypo magnisemia , hypokalemia and hypocalcemia which to treat first.  
Magnesium

91. a seldinger drain was put and the patient became more hypovolemic after 1 hour.

A. lung contusion
B. ventricular wall rupture

Worsening pneumothorax was another option

-internal mammary artery injury

-development of pneumothorax again

Intercostal artery trauma

92. Contraindication for NIV

A. GCS 8
B. Upper airway obstruction