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1. Man comes into A&E with a deep (penetrating superficial fascia) police dog bite in thigh.

The wound is irrigated and debrided under local. What ABx do you prescribe?

a. Flucloxacillin po

b. Co-amoxiclav

c. Doxycycline po

d. Doesn’t require antibiotics

b. Co-amoxiclav


Woman presents with 2/7 Hx dysuria, haematuria, now severe flank pain, fever, rigors. What

is most likely organism on urine culture?

a. Serratia marcescens

b. Pseudomonas aeruginosa

c. E coli

d. Proteus mirabilis

e. Enterococcus faecalis

c. e coli


Gentleman attends with 1 day Hx vomiting, non-bloody voluminous diarrhoea, previously fit

and well, no other significant symptoms/signs, no foreign travel Hx, eaten takeaway food 3h

before onset symptoms. What is most likely causative organism?

a. Campylobacter jejuni

b. Staphylococcus aureus

c. Salmonella sp

d. Shigella sp

e. E coli

b. staph aureus


53 yo F presents with headache, fever, photophobia. O/E nuchal rigidity. Lumbar puncture

demonstrates gram +ve cocci. Which organism?

a. N meningitidis

b. Listeria monocytogenes

c. E coli

d. Strep pneumoniae

e. Strep agalactiae

d. Strep pneumoniae


Middle-aged M w/ HTN, increased serum Cr and urea, proteinuria and haematuria, bilateral

palpable costovertebral angle masses, dad died of SAH. Most likely diagnosis?

a. Horseshoe kidney


c. Nephrotic syndrome

d. Rapidly progressive glomerulonephritis

e. Conn’s syndrome



33yo plumber presents with acute-onset SoB, cough, haemoptysis. Urinalysis shows

haematuria and proteinuria, anti-GBM Ab +ve. Dx?

a. Goodpasture syndrome

b. PE

c. TB

d. Mesothelioma

e. Diabetic nephropathy

a. Goodpasture syndrome


Middle-aged M presents with ulcer L hallux. Sharp borders, deep, minimal granulation tissue

in base. Sensation preserved around edges of ulcer. Does not recall any trauma Hx. ABPI 0.68

L leg, 0.92 R. Major factor in pathogenesis of ulcer?

a. Venous insufficiency

b. Peripheral neuropathy

c. Arterial insufficiency

d. Infection

c. Arterial insufficiency


50-60something M has two fasting glucose measurements 7.2 and 7.9mmol/l, given diet and

lifestyle advice. Returns to GP couple of months later, fasting BM 10.2mmol/L. BMI 31kg/m 2 ,

renal function normal, liver function normal, glucose ++ on urinalysis, otherwise normal. Most appropriate starting medication?

a. Gliclazide

b. Glibenclamide

c. Metformin

d. Exenatide

e. Mannitol

c. Metformin


49yo Caucasian M with HTN, doesn’t respond to lifestyle modification. Renal function OK.

What drug should GP start him on?

a. Alpha-blocker

b. ACE inhibitor

c. Beta-blocker

d. CCB

e. Thiazide diuretic

b. ACE inhibitor


30-something F with 2/12 Hx diarrhoea with blood and mucus, some LLQ discomfort. No

weight loss, some other relevant stuff *mild-moderate UC Hx* What appropriate 1 st -line


a. Betamethasone?? See if it responds to steroids

b. Methotrexate

c. Azathioprine

d. Aspirin

e. Mesalazine

e. Mesalazine


20-something M with diagnosed asthma presents with increasing chest tightness and waking

up at night coughing. On SABA, no other medication, otherwise fit and well. Symptomatic

episodes well managed with 2x SABA puffs. After lifestyle/education advice and assessment of inhaler technique, appropriate mgmt.?

a. Long-acting beta 2 agonist

b. PO corticosteroid

c. PO theophylline

d. Inhaled corticosteroid

e. Anti-muscarinic

d. Inhaled corticosteroid


30-something F with diagnosed asthma presents with… *worsening of asthma symptoms

over wks*. Already on SABA and ICS, using them appropriately. Appropriate mgmt.?

a. Increased ICS dose

b. Add po corticosteroid

c. Add po theophylline

d. Add cromone

e. Add inhaled LABA

e. Add inhaled LABA


30-something F with known asthma presents at A&E with severe breathlessness, barely able

to speak. O/E dynamic hyperinflation, severe wheeze throughout both lungs, accessory

breathing,… Sats ?lowish, RR ?28/min, HR ?110/min. Appropriate 1 st -line mgmt.?

a. 4L O 2 nasal cannulae

b. 15L O 2 reservoir mask

c. 24% O 2 venturi mask

d. Perform ABG

e. Intubate immediately

c. 24% O 2 venturi mask


Middle-aged M w/ 40-yr smoking Hx, worked in office all life, presents w/ progressive severe breathlessness over time course of ? months, ? yrs. 20ml white sputum produced daily. Wheeze

throughout both lungs. Spirometry given – something around FEV 1 < 50% predicted, FVC ~

60% predicted, FEV 1 /FVC v low. Most likely Dx?

a. Bronchiectasis

b. TB


d. Pulmonary fibrosis

e. Pneumonia



M presents at A&E after being involved in RTA. GCS 15/15 on arrival, within 1h deteriorated to

9/15. Some other detail inc fixed dilated R pupil. What most likely Dx?

a. Subdural haematoma

b. Extradural haematoma

c. Sub arach

d. Carotid artery dissection

e. Intracranial haemorrhage

b. Extradural haematoma


Older F presents w/fever, malaise, transient episode R-sided weakness. Long-standing

rheumatic mitral valve disease. O/E temperature 38 o C, pansystolic murmur loudest at apex,

think there may’ve been some clubbing going on. First-line investigation?

a. Cerebral angiogram

b. Blood cultures

c. Chest Xray

d. Carotid dopplers

e. something else

b. Blood cultures


Older M presents with 1 hour of having a …barn-door L-sided CVA. Bruit over L carotid

artery. First investigation?

a. Carotid Doppler

b. Carotid angiography

c. CT brain

d. Lumbar puncture

e. Summat else

c. CT brain


19yo F attends w/ father c/o lower abdo pain. She is unable to speak any English, he is. She
doesn’t make eye contact at any point. Do you:

a. Take Hx w/ father as interpreter

b. Ask father to leave, take Hx w/interpreter

c. Take Hx w/interpreter, allow father to hang around

d. Skip Hx and proceed to examination with chaperone and no Dad

e. Take Hx from father

b. Ask father to leave, take Hx w/interpreter


Chap signs a valid DNAR, deteriorates, daughter demands resuscitation. Which ethical principle does she violate?

a. Autonomy

b. Beneficence

c. Non-maleficence

d. Justice

e. Compassion

a. Autonomy


Chap makes some nonspecific arrangements about end-of- life mgmt., deteriorates, managing

team consult family in making care-related decisions. ACCORDING TO MENTAL CAPACITY

ACT, why should family be consulted?

a. Next of kin have decision-making authority when pt lacks capacity and wishes

unknown in advance

b. Helps family deal w/ situation to be involved in mgmt.

c. Family may be able to make managing team better aware of patient’s values and preferences when they have capacity

d. So that team incorporates family’s wishes in making care-related decisions

e. Summat else

d. So that team incorporates family’s wishes in making care-related decisions


Someone gets a biopsy of a growth in their colon. Which of these benign lesions has the highest risk of malignant transition?

a. Villous adenoma

b. Tubular adenoma

c. Tubulovillous adenoma

d. Hyperplastic polyp

e. Some other kind of polyp

a. Villous adenoma


Here are some ABG results showing low CO2, middling to high O2, Low Bicarb and low ph.

Interpret them: (to make it even easier there was a story about a 20 year old kussmauling)

a. Uncompensated metabolic acidosis

b. Respiratory alkalosis

c. Normal

d. Respiratory acidosis with metabolic compensation

e. Metabolic acidosis with respiratory compensation

e. Metabolic acidosis with respiratory compensation


Chap has an MI while he’s on ramipril for HTN. Looks like he’s suffering AKI. What compensatory mechanism for maintaining GFR is the ramipril messing up?

a. Afferent arteriolar dilation

b. Efferent arteriolar constriction

c. Positive inotropism

b. Efferent arteriolar constriction


A 40 year old lady is having an ovarian tumour removed. She previously had a PE during

her first pregnancy. During the surgery she had all the usual DVT prophylaxis (compression stockings, calf balloons, etc.), and is now on the ward recovering. She is currently wearing compression stockings. What is the most appropriate medical DVT prophylaxis?

a. Unfractionated heparin


c. Aspirin

d. Clopidogrel

e. Warfarin



Someone’s put on amoxicillin. How does amoxicillin work as an antibiotic?

a. Inhibits peptidoglycan cross-linking in cell wall formation

b. Inhibits sterol synthesis in cell wall formation

c. Inhibits protein synthesis

d. Inhibits RNA transcription

a. Inhibits peptidoglycan cross-linking in cell wall formation


A 40 year old lady presents with weight gain, hirsuitism, acne and other PCOS symptoms.

She is referred to an endocrinologist. What is the most appropriate 1st line investigation?

a. Serum LH and FSH

b. Serum testosterone

c. USS of her ovaries

d. Thyroid function tests

e. Dexamethasone suppression

c. USS of her ovaries


A 42 year old lady comes in vomitting blood and has oesophageal varices banded by
endoscopist. She has various stigmata of chronic liver disease and bloods which agree. First
line ix (?to confirm cirrhosis), not counting bloods?

a. US abdo

b. Liver biopsy

c. CT abdo

d. Chest X ray

e. Can’t remember

c. CT abdo


MSK - a lady has fairly obvious RA. What changes would you expect to see on x-ray of her hand?

a. subchondral cysts

b. osteophytes

c. periarticular erosions

d. subchondral sclerosis

c. periarticular erosions


Chap has acute gout in the knee and 1st MTP. What is the acute management of gout?

a, Oral diclofenac-

b. Oral opiates

c. Oral allopurinol

d. IV fluids

e. Oral ABx

a, Oral diclofenac-


First Ix in suspected septic arthritis. Afebrile.

a. Blood cultures

b. Aspirate the knee and send for MC&S

c. X ray of the knee

d. Ultrasound of the knee

e. MRI (or something)

b. Aspirate the knee and send for MC&S