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1

A 43-year-old man presents with a painless lump in his groin that appeared 2 weeks ago. He claims that the lump protrudes on defecation and he also reports becoming constipated recently. On examination, the lump is reduced, and a finger is placed over the midpoint of the inguinal ligament. When the patient is asked to cough, the lump reappears. What is the most likely diagnosis?
A Direct inguinal hernia
B Indirect inguinal hernia
C Femoral hernia
D Obturator hernia
E Spigelian hernia

A

2

Which of the following murmurs is associated with severe aortic regurgitation?
A Austin-Flint
B Graham-Steell
C Gibson
D Carey-Coombs
E Barlow

A

3

A 67-year-old man is brought into A&E having been involved in a road traffic accident. On examination, he opens his eyes to pain, makes a few grunting noises and withdraws his legs from painful stimuli. What is his GCS?
A2
B4
C6
D8
E 10

D

4

A 2-year-old boy is brought to the GP after his father noticed some swelling around his eyes. On examination, there is periorbital and pedal oedema. A urine dipstick is positive for proteins and negative for blood. What is the most likely diagnosis?
A IgA nephropathy
B Membranous glomerulonephritis
C Rapidly progressive glomerulonephritis
D Minimal change glomerulonephritis
E Henoch-Schӧnlein purpura

D

5

A 54-year-old man is brought into A&E with a suspected acute coronary syndrome. An ECG is performed, which reveals ST elevation in leads I, aVL, V5 and V6. Which coronary artery has been occluded?
A Left main stem
B Left anterior descending coronary artery
C Left circumflex coronary artery
D Right coronary artery
E Posterior descending artery

C

6

A 46-year-old housewife visits her GP complaining of pain in the joints of her hands that has gradually got worse over 3 months. It has started affecting her ability to complete daily tasks such as cooking for her children. Both of her hands are affected equally and the pain and stiffness is worst in the morning but gets better when she starts using her hands. On closer inspection, her hands do not appear to be deformed although her metacarpophalangeal joints and proximal interphalangeal joints appear slightly swollen, warm and tender.
What is the most likely diagnosis?
A Reactive arthritis
B Osteoarthritis
C Rheumatoid arthritis
D Psoriatic arthritis
E Septic arthritis

C

7

A 56-year-old man with a history of alcoholism complains of intermittent epigastric pain that radiates through to his back. When questioned, he admits to losing about 3 kg in weight over the past 6 months and says that his stools have become pale and difficult to flush away. Which investigation would you request to aid the diagnosis?
A Serum amylase
B Blood cultures
C Faecal elastase
D CA 19-9
E OGD

C

8

A 25-year-old female has suffered from shortness of breath over the past 2 months. She gets particularly breathless when she exerts herself, and has had to stop going on her morning jog. She has not experienced a cough, fever or chest pain. She has no past medical history of note, however, her periods have become quite heavy over the past 3 or 4 months. What is the most likely diagnosis?
A Hyperthyroidism
B Anaemia
C Pneumonia
D COPD
E Asthma

B

9

A 46-year-old man, with a history of type 1 diabetes, visits the GP for an HbA1c reading. He has recently been feeling more tired than usual and has noticed that the skin on his hands has become darker over the past few months. On examination, hepatomegaly and a tanned complexion (despite not having been on any recent holidays) are noted. Haemochromatosis is suspected and iron studies are requested. Which set of results would be consistent with haemochromatosis?
A High serum iron, high ferritin, high transferrin, low transferrin saturation, low TIBC
B High serum iron, low ferritin, low transferrin, high transferrin saturation, low TIBC
C High serum iron, high ferritin, high transferrin, high transferrin saturation, low TIBC
D High serum iron, high ferritin, low transferrin, high transferrin saturation, high TIBC
E High serum iron, high ferritin, low transferrin, high transferrin saturation, low TIBC

E

10

10. A 72-year-old woman has recently suffered a fracture of her right distal radius after falling on an outstretched hand. She is at high risk of osteoporosis because she is post-menopausal and has undergone several decades of steroid treatment for her asthma. A DEXA scan is performed. Which result would be diagnostic of
osteoporosis?
A T score of -1.5 or worse
B T-score of -2 or worse
C T-score of -2.5 of worse
D T-score of -3 or worse
E T-score of -3.5 or worse

C

11

A 52-year-old man was watching TV yesterday when he suddenly become very aware of his heart beating rapidly. This lasted around 45 mins and then subsided spontaneously. It has happened several times over the past 2 months. An ECG reveals no abnormalities. However, due to the strong suspicion of atrial fibrillation, the patient is placed on a 24-hr tape, which confirms the diagnosis. Which scoring system should be used to determine the benefit of long-term anticoagulation in this patient?
A QRISK2 score
B ABCD2 Score
C GRACE score
D CHA2DS2-VASc score
E CURB-65 score

D

12

Which of the following is not a feature of background diabetic retinopathy?
A Hard exudates
B Soft exudates
C Microaneurysms
D Blot haemorrhages
E Leakage of lipids from blood vessels

B

13

A 53-year-old man, who has recently recovered from a diarrhoeal illness, comes to A&E with a 1-week history of gradually worsening weakness in his legs. A neurological examination reveals reduced tone, reduced reflexes and impaired sensation in both lower limbs. He adds that the weakness began in his feet and has gradually progressed up his legs. Guillain-Barré syndrome is suspected. Which of the following parameters should be closely monitored in this patient?
A Body temperature
B Serum osmolality
C Serum potassium
D Forced vital capacity
E Urine output

D

14

A 14-year-old school boy was diagnosed with asthma 6 months ago. He was
given a salbutamol inhaler to use PRN, however, he continued to have regular
episodes of breathlessness. He was started on a regular inhaled corticosteroid
(beclomethasone) 3 months ago. Although the frequency of his attacks has reduced
with the medication, he is still experiencing bouts of breathlessness about 4 times
per week. What would be the next most appropriate step in his management?
A Increase the dose of salbutamol
B Add an inhaled corticosteroid
C Add an oral corticosteroid
D Add a long-acting beta agonist
E Montelukast therapy

B

15

Which of the following is the most common cause of chronic kidney disease?
A Hypertension
B Diabetes mellitus
C Glomerulonephritis
D Pyelonephritis
E Polycystic kidney disease

B

16

A 46-year-old woman has been suffering from frequent headaches over the past 4 months, along with some blurring of vision. She also mentions that she has developed a fiercely itchy rash on several occasions, usually occurring soon after she has had a bath. What is the most likely diagnosis?
A Anaemia
B Acute lymphoblastic leukaemia
C Chronic myeloid leukaemia
D Polycythaemia vera
E Myelofibrosis

D

17

A 27-year-old female comes to A&E complaining of severe right iliac fossa pain. She has vomited three times whilst waiting to be seen. On examination, there is rebound and percussion tenderness in the right iliac fossa and the pain gets worse
when the doctor extends the patient’s hip. What is the name of the sign being elicited?
A Murphy’s sign
B Cope sign
C Rovsing’s sign
D Psoas sign
E Aarons sign

D

18

A 74-year-old man presents with a skin lesion on his left cheek, which has gradually grown over 4 months. On closer examination, the lesion has raised, everted edges with an ulcerated centre revealing a keratotic core. What is the most likely diagnosis?
A Basal cell carcinoma
B Squamous cell carcinoma
C Melanoma
D Keratoacanthoma
E Actinic keratosis

B

19

A 53-year-old man presents to A&E with severe pain in his right flank that radiates to his right groin. Ureteric colic is suspected and a CT-KUB is requested. The CT-KUB confirms the diagnosis but it also shows an abdominal aortic aneurysm with a diameter of 4.7 cm. When questioned, the patient denies any back pain (other than the pain caused by ureteric colic) or symptoms of vascular disease. What is the most appropriate management option for this patient?
A Reassure and discharge
B Surveillance with an ultrasound scan every 1 year
C Surveillance with an ultrasound scan every 6 months
D Surveillance with an ultrasound scan every 3 months
E Surgical repair of the aneurysm

D

20

A 38-year-old man is complaining of excessive thirst and frequent urination over the past month. He describes the thirst as being ‘insatiable’, and claims to drink about 8-12 litres of water every day. He undergoes a water deprivation test, which revealed the following results:
Urine osmolality
2 hr : 212 mOsm/kg 4 hr: 227 mOsm/kg
6 hr : 221 mOsm/kg 8 hr: 242 mOsm/kg
Following administration of 2 mg IM desmopressin (DDAVP) : 278 mOsm/kg (normal
> 600 mOsm/kg).
What is the most likely diagnosis?

A Diabetes mellitus type 1
B Central diabetes insipidus
C Nephrogenic diabetes insipidus
D Psychogenic polydipsia
E Hyperparathyroidism

C

21

A 37-year-old man visits the GP because his partner has recently noticed some dark patches on his back. On examination, there are multiple painless red papules on his back, some of which have merged to form purple plaques. He was diagnosed with HIV 8 years ago. What is the most likely diagnosis?
A Discoid lupus
B Guttate psoriasis
C Kaposi’s sarcoma
D Shingles
E Chronic mucocutaneous candidiasis

C

22

A 16-year-old school girl has been suffering from depression for 6 months. Last night (12 hours ago) she decided to end her life and ingested 40 paracetamol tablets. She has since decided that she has made a mistake and does not want to end her life. She appears reasonably well when she presents to A&E, only complaining of some mild nausea. What is the most appropriate treatment option?
A N-acetylcysteine
B Naloxone
C Flumezanil
D Atropine
E Sodium bicarbonate

A

23

A 7-year-old girl has had severe, bloody diarrhoea with cramping abdominal pain for the past 3 days. She has also been emptying her bladder less and less frequently. Blood tests, including a blood film, are performed which revealed a low
Hb, low platelets and the presence of schistocytes. U&Es are also performed: Creatinine : 182 micromol/L (baseline = 92 micromol/L)
Urea : 9.2 mmol/L (2.5-6.7)
A stool culture identifies E. coli O157. What is the most likely diagnosis?

A Microangiopathic haemolytic anaemia
B Haemolytic uraemic syndrome
C Thrombotic thrombocytopaenic purpura
D Disseminated intravascular coagulation
E Gastroenteritis

B

24

A 37-year-old plumber presents to his GP with a week-long history of headache, diarrhoea and fever. In the last 2 days, he has also developed a dry cough and his wife has commented that he has appeared to be quite confused recently. What is the most appropriate investigation?

A CT head scan
B Urinary antigens
C Stool culture
D LFTs
E U&Es

B

25

Which system is used to stage prostate cancer?
A Breslow thickness
B Gleason staging
C GRACE score
D W ells score
E Dukes’ staging

B

26

A 28-year-old girl presents with a 5-day history of urinary frequency, dysuria and mild suprapubic pain. Urine dipstick is positive for nitrites and leucocytes. A urinary tract infection is suspected and an MSU is taken and sent to the lab. Whilst awaiting culture and sensitivities, which empirical treatment option is best for this patient?

A Trimethoprim
B Benzylpenicillin
C Vancomycin
D Metronidazole
E Levofloxacin

A

27

A 68-year-old male visits his GP complaining of constipation, rectal bleeding and itchiness around his anus. He often feels ‘a lump’ hanging out after defecating which he has to push back in himself. On examination, anal tone is weak and a protruding mass is felt which has palpable muscular rings. What is the most likely diagnosis?

A Grade 3 haemorrhoids
B Grade 4 haemorrhoids
C Perianal abscess
D Type 1 rectal prolapse
E Type 2 rectal prolapse

E

28

A 54-year-old man is complaining of sharp, central chest pain that has arisen over the last 24 hours. On inspection, the patient is sitting forward on the examination couch. On auscultation, a scratching sound is heard – loudest over the lower left sternal edge, when the patient is leaning forward. He also has a low-grade fever. He has a past medical history of a ST-elevation MI which was diagnosed, and treated with PCI, 6 weeks ago. What is the most likely diagnosis?
A Viral pericarditis
B Constrictive pericarditis
C Cardiac tamponade
D Dressler syndrome
E Tietze syndrome

D

29

A 66-year old man has been experiencing pain in his right calf for the last 6 months. Initially, the pain would come about whenever he went for a walk, and it would be relieved by rest. However, over the last few weeks he has experienced pain during rest. The pain is particularly bad at night, and he gets some relief from dangling his leg over the end of the bed. Recently, he has noticed a small, elliptical ulcer appear in between his toes on his right foot. He has a past medical history of ischaemic heart disease, and underwent a CABG 8 years ago. What is the most likely diagnosis?
A Intermittent claudication
B Critical limb ischaemia
C Acute limb ischaemia
D Leriche syndrome
E Chronic deep vein thrombosis

B

30

A 3-year-old boy is brought, by his father, to see his GP because he has had a fever for the past 4 days and has cried in pain every time he has tried to eat. On examination, the patient’s gums look red and swollen and there are small vesicles and ulcerations along the gumline. The GP suspects gingivostomatitis. What is the most likely cause?
A Varicella
B Primary HSV1 infection
C Reactivation of HSV1
D HSV2 infection
E Infectious mononucleosis

B