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RCEM FRCEM Primary Examination Sample Questions:

1. You are treating a patient with left ventricular failure and decide to revise some cardiovascular physiology to help you understand the likely response to treatment Which statement best describes Starling's law in relation to cardiac output?

A) Increased force of contraction due to an increase in preload
B) Increased filling pressure leading to an increase in heart rate ID.
C) Increased afterload due to an increase in cardiac output
D) Increased heart rate due to an increase in sympathetic stimulation
E) Increased contractility leading to an increase in stroke volume

2. A 34 year old man presents to the ED with chest and left shoulder pain A diagnosis of pericarditis is made Involvement of which nerve best explains hts symptoms?

A) Recurrent laryngeal
B) Left vagus
C) Phrenic
D) Right vagus
E) Cervical ganglia of sympathetic trunk

3. A patient presents with septic shock A venous blood gas shows a metabolic acidosis Following treatment with crystalloid infusion and antibiotics their HR and BP are normal A repeat venous gas shows a persistent metabolic acidosis with a normal anion gap Which mechanism best explains the results of the repeat blood gas?

A) Lactic acidosis due to tissue hypoperfusion
B) Metabolic acidosis due to occult aspirin overdose
C) Hyperchloraemic acidosis due to excessive infusion of normal saline
D) Capillary leak due to sepsis causing continued hypovolamia
E) Acute kidney injury due to reduced renal blood flow

4. A three week old baby is brought in by her concerned parents She is vomiting substantially after feeds and is failing to gain weight. Investigation reveals an alkalosis and a low serum potassium.
The alkalosis is most likely to be due to which mechanism?

A) Exchange of H* at the gastric protein pump
B) Loss of hydrochloric acid
C) Hypoventilation causing reduced pC02
D) Increased loss of magnesium
E) Increased production of bicarbonate

5. You are discussing the different muscles within the medial thigh and movements at the hip joint with a medical student. Which muscle within this compartment is most likely to be involved in hip extension?

A) Gracilis
B) Pectineus
C) Adductor brevis
D) Adductor magnus
E) Adductor longus

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