Imperial questions I got wrong

Question 1

A patient on trimethoprim for UTI develops a widespread rash. Next step?
A) Continue and give antihistamine
B) Stop and refer dermatology
C) Stop and report Yellow Card
D) Corticosteroids
E) Monitor

Answer 1

C) Stop and report Yellow Card
A widespread rash can signal a serious ADR; drug should be stopped and reported.

Question 2

A 19-year-old woman presents with heavy periods and fatigue. FBC: microcytic,
hypochromic anaemia. Treatment?
A) Folic acid
B) Ferrous sulfate
C) Vitamin B12
D) Blood transfusion
E) Erythropoietin

Answer 2

B) Ferrous sulfate
Microcytic, hypochromic anaemia with heavy periods suggests iron deficiency — treat with
oral iron

Question 3

A woman started on fluoxetine 20 mg for depression now reports restlessness and tremor.
What’s the likely cause?
A) Parkinsonism
B) Akathisia
C) Anxiety
D) Hypoglycaemia
E) Serotonin syndrome

Answer 3

B) Akathisia
Restlessness and inner agitation = akathisia — an extrapyramidal side effect.

Question 4

38. A man presents with haematemesis. He has liver cirrhosis. What is the most likely cause?
    A) Gastric ulcer
    B) Duodenal ulcer
    C) Mallory-Weiss tear
    D) Oesophageal varices
    E) Gastritis

Answer 4

D) Oesophageal varices
In a cirrhotic patient with haematemesis — suspect bleeding varices.

Question 5

A patient is prescribed erythromycin and develops palpitations. ECG shows prolonged
QT. What’s the mechanism?
A) Increased AV nodal conduction
B) Inhibition of potassium channels
C) Increased sodium influx
D) Enhanced vagal tone
E) Calcium channel blockade
B) Inhibition of potassium Chanels

Answer 5

B) Inhibition of potassium channels
Macrolides like erythromycin can prolong the QT interval by blocking cardiac potassium
efflux.
44. A wo

Question 6

A 60-year-old man is prescribed co-codamol 30/500 tablets for chronic back pain. He also
takes sertraline 100 mg daily. What is the main safety concern?
A. Risk of liver failure
B. Risk of serotonin syndrome
C. Risk of constipation
D. Risk of dependency
E. Risk of hypotension

Answer 6

Risk of dependency
Co-codamol (codeine) is an opioid — dependency risk is significant with chronic use. No
major serotonergic interaction with sertraline.

Question 7

Which of the following drugs should be withheld 48 hours before contrast imaging in a
patient with reduced renal function?
A. Metformin
B. Amlodipine
C. Insulin glargine
D. Ramipril
E. Gliclazide

Answer 7

Metformin should be withheld before contrast imaging due to risk of contrast-induced
nephropathy and lactic acidosis.

Question 8

Which of the following vaccines is contraindicated in pregnancy?
A. Pertussis (whooping cough)
B. Influenza (inactivated)
C. MMR
D. COVID-19 (mRNA)
E. Tetanus

Answer 8

MMR- live vaccine so is CI in pregnancy

Question 9

A 77-year-old woman with heart failure with reduced ejection fraction (HFrEF). She is
already on ramipril and bisoprolol at maximum tolerated doses but remains symptomatic with
breathlessness and fatigue.
A. ACE inhibitor (e.g. ramipril)
B. Angiotensin II receptor blocker (ARB) (e.g. losartan)
C. Beta-blocker (e.g. bisoprolol)
D. Calcium channel blocker (e.g. amlodipine)
E. Thiazide-like diuretic (e.g. indapamide)
F. Mineralocorticoid receptor antagonist (e.g. spironolactone)
G. Sacubitril/valsartan
H. Loop diuretic (e.g. furosemide)

Question 10

A 64-year-old man with type 2 diabetes has an eGFR of 28 mL/min/1.73 m². He is
currently on metformin, which is to be discontinued.
A. Levothyroxine
B. Carbimazole
C. Metformin
D. Gliclazide
E. Empagliflozin
F. Liraglutide
G. Sitagliptin
H. Insulin glargine

Answer 10

Sulfonylurea suitable in CKD (eGFR <30), monitor hypoglycaemia.