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Question 8

A 34-year-old man injures his right shoulder playing hockey. On testing, he is unable to maintain abduction against downward pressure when his arms are held at ~90° abducted. Which muscle is most likely injured?
A. Deltoid
B. Infraspinatus
C. Subscapularis
D. Supraspinatus

Answer: A. Deltoid RCEM
Explanation: The deltoid is the prime abductor after the first ~15° (beyond supraspinatus), so inability to maintain abduction against resistance suggests deltoid dysfunction.

Question 9

A sample MRCEM SBA question: “A 60-year-old plumber attends the ED with painful swelling to his left knee… hot, erythematous… what is the most appropriate management?”
(This is the same as question 1).
Answer: Flucloxacillin Cloudinary

(This question is repeated here to emphasize a classic presentation in emergency settings.)

Question 10

In the MRCEM Primary exam, which lung volume or capacity is the most important “oxygen store” for prolonging safe apnoea time in preoxygenation?
A. Tidal volume
B. Vital capacity
C. Functional residual capacity
D. Expiratory reserve volume
E. Inspiratory reserve volume

Answer: C. Functional residual capacity Medical Exam Prep
Explanation: Functional residual capacity (FRC) is the residual volume after passive expiration, and during preoxygenation it serves as the reservoir for oxygen during the apnea period.

Question 7

A 67-year-old man complains of 2 months of worsening left upper arm and shoulder pain. On examination, he has weakness of shoulder abduction and reduced sensation over the deltoid. Which cervical level is most likely affected?
A. C1
B. C3
C. C5
D. C7
E. C8

Answer: C. C5 RCEM
Explanation: The C5 nerve root contributes to the deltoid muscle (axillary nerve) and sensation over the deltoid region; a lesion here causes impaired abduction and sensory change in the area.

Question 6

A patient has CSF findings of > 60% of serum glucose, normal protein level, and a clear appearance. Which CSF finding makes viral meningitis most likely?
A. Elevated opening pressure
B. > 60% serum glucose
C. Normal protein level
D. Cloudy appearance
E. WBC 0–5 cells/µL

Answer: B. > 60% serum glucose RCEM
Explanation: Viral (aseptic) meningitis often shows normal or near-normal glucose (relative to serum), mild or moderate protein elevation, and lymphocytic pleocytosis; very low WBC, cloudy appearance, or very elevated pressure are less likely.

Question 4

You examine a patient and find there is loss of vision in both eyes on the left side of the vertical midline. Which arterial occlusion is most likely to cause this field defect?
A. Posterior inferior cerebellar artery
B. Posterior cerebral artery
C. Anterior communicating artery
D. Middle cerebral artery
E. Anterior cerebral artery

Answer: B. Posterior cerebral artery RCEM
Explanation: A lesion affecting the right occipital lobe (PCA territory) would commonly cause left homonymous hemianopia (left visual field loss in both eyes).

Question 5

A 28-year-old asthmatic patient on a salbutamol inhaler and theophylline develops headache, dizziness, and tachycardia after being started on an antibiotic. Which antibiotic is most likely responsible?
A. Ciprofloxacin
B. Amoxicillin
C. Trimethoprim
D. Cephalexin
E. Doxycycline

Answer: A. Ciprofloxacin RCEM
Explanation: Ciprofloxacin can inhibit the metabolism of theophylline, leading to increased theophylline levels and associated symptoms (e.g. CNS stimulation, tachycardia).

Question 2

A 17-year-old man presents with a rash after having had a cold sore the previous week. He now has multiple lesions on his hands and torso, but is systemically well. What is the most likely diagnosis?
A. Erythema migrans
B. Erythema multiforme
C. Gianotti-Crosti syndrome
D. Pityriasis rosea
E. Stevens-Johnson syndrome

Answer: B. Erythema multiforme Cloudinary
Explanation: Erythema multiforme is often associated with preceding herpes simplex infection and causes characteristic target lesions, often on extremities and trunk, in a patient who is otherwise relatively well.

Question 3

An 18-month-old child has had fever and an upper respiratory symptoms for three days, then the fever subsided this morning. She now develops a widespread rash but is otherwise well on examination. What is the most likely diagnosis?
A. Erythema infectiosum
B. Kawasaki syndrome
C. Measles
D. Roseola infantum
E. Scarlet fever

Answer: D. Roseola infantum Cloudinary
Explanation: Roseola (exanthem subitum) typically presents with high fever for a few days, which resolves, followed by sudden rash; children often look well when the rash appears.

Question: A 60-year-old plumber presents with a hot, swollen, and erythematous left knee. His temperature is normal, and he has a limited range of motion from 20° to 120°. What is the most appropriate initial treatment?

A. Arthroscopic washout

B. Flucloxacillin

C. Incision and drainage

D. Naproxen

E. Penicillin V

Answer: B. Flucloxacillin Cloudinary

Explanation: In a likely septic arthritis scenario affecting a native joint, empiric antibiotic therapy against Staphylococcus aureus (e.g., flucloxacillin) is appropriate while awaiting culture results.