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RCEM FRCEM Primary Examination Sample Questions:

1. A 40 year old woman wilh a new diagnosis of type II diabetes has significant hyperglycaemia What is the most likely cause of her elevated blood glucose?

A) Reduced insulin production by pancreatic beta cells
B) Excessive glucocorticoid production
C) Production of abnormal insulin
D) Reduced glucagon secretion
E) Increased cellular resistance to insulin

2. 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) Hypoventilation causing reduced pC02
C) Increased production of bicarbonate
D) Increased loss of magnesium
E) Loss of hydrochloric acid

3. An 80 year old man presents to the ED with clinical features suggestive of ischaemic bowel Which artery is most commonly occluded in this condition?

A) Inferior mesenteric
B) Superior mesenteric
C) Gastroduodenal
D) Coeliac
E) Left colic

4. A 40 year old woman taking the oral contraceptive pill was prescribed phenytom following a seizure Some months later she becomes pregnant What is the most likely mechanism by which this treatment has led to tailure of her contraception?

A) Inhibition of oestrogen receptors
B) Interference with protein binding of the contraceptive pill
C) Increased renal clearance of the contraceptive pill
D) Alteration of intestinal flora
E) Liver enzyme induction

5. A 48 year old man presents with a flare up of gout You recommend treatment with a non-steroidal anti-inflammatory drug (NSAID) He is concerned because his wife suffered a peptic ulcer associated with NSAID use Which medication would be your first choice NSAID to minimise his risk of gastrointestinal side effects?

A) Indomethacin
B) Diclofenac
C) Naproxen
D) Ibuprofen
E) Piroxicam

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