Royal College of Emergency Medicine

63-year-old man presents to the Emergency Department with a 3-day history of central abdominal pain and vomiting. He underwent a total colectomy for ulcerative colitis 4 years ago, otherwise he has no significant past medical history. An abdominal X-ray can be seen above. What is the diagnosis?
• a. Sigmoid volvulus
• b. Small bowel obstruction
•cLarge bowel obstruction
• d. Constipation
e. Hollow viscus perforation

An 81 year old man presents to the Emergency Department with a 3 hour history of a change to the vision in his left eye. He describes visual loss affecting one quadrant. Fundoscopy reveals the following:
What is the diagnosis?
O a. Branch retinal vein occlusion
O b. Vitreous haemorrhage
O c.Central retinal artery occlusion
• d. Central retinal vein occlusion
e. Wet macular degeneration

A 68-year-old man presents with sudden painless loss of vision in his left eye. On fundoscopy there is diffuse retinal pallor with a central cherry red spot at the macula.
What is the diagnosis?
O a. Optic neuritis
O b. Branch retinal vein occlusion
O c. Wet macular degeneration
O d. Central retinal artery

MRCEM Primary Anatomy MCQ
The posterior one-third of the tongue is attached to the:

A Maxilla and hyoid

B Mandible and hyoid

C Palatine bones only

D Styloid process

E Thyroid cartilage

4-day-old baby was brought to the emergency
department by worried parents. The baby was
delivered in the same hospital 4 days back by a c
section. Vaccinations are up to date. The parents
complain that the baby is in distress after every
feed. They deny any colour change during the
episode. A chest X-ray is taken and it is shown
below.
What is the likely diagnosis?

A-Diaphragmatic hernia
B-Congenital heart disease.
C-Perforation hollow viscous organ
D-Pneumonia
E-Pneumothorax

A 5-year-old boy is brought to the emergency
department by his mum. He slipped and fell down
on his elbow while he was playingsat his school. A
swelling is noted around the elbow joint. His vital
parameters are within normal limits. An X-ray of
the elbow joint is shown below.
What is the likely diagnosis?

A-Supracondylar fracture
B-Fracture head of radius
C-Radioulnar dislocation
D-Olecranon fracture
E-Radial head fracture

Stay Safe from Pneumonia ( Vaccines You Shouldn’t Miss )

Pneumococcal Vaccines
There are two main types:

A. Pneumococcal Conjugate Vaccines (PCV)
B. Pneumococcal Polysaccharide Vaccine (PPSV)

A. Pneumococcal Conjugate Vaccines (PCV)
• PCV13 (Prevnar 13)
• PCV15 (Vaxneuvance)
• PCV20 (Prevnar 20)

B. Pneumococcal Polysaccharide Vaccine (PPSV)
• PPSV23 (Pneumovax 23)

Pneumococcal Vaccine Indications

1. All infants and children: Routine PCV series (PCV13/15/20).

2. Adults ≥65 years: Prefer PCV20; alternatively PCV15 + PPSV23.

3. Adults 19–64 with risk factors (chronic heart, lung, liver, kidney disease, diabetes, immunocompromised, asplenia, cochlear implants, CSF leaks): PCV20 or PCV15 + PPSV23.

4. High-risk/immunocompromised adults: Shorter intervals between PCV and PPSV23 may be needed.

5. PPSV23 alone: Only if conjugate vaccine not given; may require repeat after 5 years in high-risk adults.

Dosage

Adults
• PCV20: single dose (no further PCV needed)
• PCV15: single dose, followed by PPSV23 after ≥8 weeks (immunocompromised) or ≥1 year (immunocompetent)

Pneumococcal Polysaccharide Vaccine (PPSV23)

Adults ≥65 years or high-risk adults 19–64 years
• Single dose
• Repeat dose: Only in high-risk adults (immunocompromised, asplenia, chronic renal failure) after 5 years