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A 65 year old man has a persistent high temperature, profuse diarrhoea and abdominal pain two weeks after finishing antibiotics following an elective hip replacement. There are reddened ulcers and yellowish plaques on his colonic mucosa at sigmoidoscopy. Which is the single most likely diagnosis?

Select one: 
A. Clostridium perfringens enterocolitis 
B. Crohn’s disease 
C. pseudomembranous colitis 
D. ulcerative colitis 
E. viral gastroenteritis

C. Pseudomembranous colitis - Severe inflammatory changes in the mucosa and antibiotic use suggest pseudoembranous colitis due to clostridium difficile infection.


A 93 year old man has a series of falls. He has been progressively forgetful and has had episodic hallucinations over the past year. Which is the single most likely diagnosis?

Select one: 
A. Alzheimer’s disease Incorrect 
B. diffuse Lewy body disease 
C. multi-infarct dementia 
D. multisystem atrophy 
E. Parkinson’s disease

B. Diffuse Lewy body dementia - This is a classical description of Diffuse Lewy Body disease – drop attacks and neuropsychiatric symptoms occur early in the disease.


A 79 year old woman has urinary frequency, urgency and urgency incontinence. Which single investigation is most appropriate to arrange next?

Select one: 
A. dipstick urinalysis 
B. frequency volume chart (bladder diary) 
C. multi-channel cystometry 
D. renal tract ultrasound 
E. video urodynamics

A. Dipstick urinalysis - A dipstick urinalysis is the next simplest examination to perform; all others either will add nothing to the diagnosis or are unnecessarily invasive.


A 87 year old man has a longstanding, non healing ulcer on the side of his nose. It has an opalescent sheen and multiple telangectases running over the surface. The centre is depressed and necrotic. Which is the single most likely diagnosis?

Select one: 
A. basal cell carcinoma 
B. keratoacanthoma 
C. melanoma 
D. solar keratosis 
E. squamous cell carcinoma

The basal cell carcinoma typically has the features as described and may also have a depressed centre.
- non healing ulcer (often on side of nose)
- opalescent sheen
- multiple telangectases
- centre depressed / necrotic


An 80 year old woman inpatient with schizophrenia has a temperature of 38.6oC and increasing rigidity. Which is the single most likely cause of her symptoms?

Select one: 
A. haloperidol and amitriptyline 
B. haloperidol and diazepam 
C. haloperidol and flupenthixol 
D. haloperidol and sertraline 
E. haloperidol and zopiclone

C. Haloperidol and flupenthixol - The diagnosis here is neuroleptic malignant syndrome which can be precipitated by either high doses of a single anti-psychotic medication, but more commonly by the use of combinations of anti-psychotic medication (haloperidol and flupenthixol)


A 50 year old man with epigastric burning pain has an OGD which shows gastro-oesophageal reflux. Which single oral medication is the most effective for his condition?

Select one: 
A. bismuth 
B. gaviscon 
C. magnesium trisilicate 
D. omeprazole 
E. ranitidine

D. Omeprazole - A PPI is more effective than the H2 antagonist.


A 47 year old man had a history of chronic alcohol misuse. Which single enzyme would most likely be found to be raised in his serum?

Select one: 
A. alcohol dehydrogenase 
B. alkaline phosphatise 
C. amylase. 
D. gamma glutamyl transferase 
E. pancreatic lipase

D. GGT - Gamma GT is commonly raised in patients who consume large amounts of alcohol.


A 75 year old man who smokes 20 cigarettes a day has had a worsening productive cough, high temperature, fatigue and shortness of breath for four days. His oxygen saturations is 91% on room air and he has focal coarse crepitations at the left base. Which single organism is the most likely cause of his symptoms?

Select one: 
A. Haemophilus influenza 
B. Legionella pneumonia 
C. Mycoplasma pneumonia 
D. Staphylococcus aureus 
E. Streptococcus pneumonia

E. Streptococcus pneumonia - the commonest cause of community acquired pneumonia is streptococcus pneumonia


A 67 year old woman has had shortness of breath and a productive cough for two days. Her temperature is of 38˚C, pulse rate 100bpm, respiratory rate 26, oxygen saturations 93%, and BP 110/50 mmHg. Her abbreviated mental test score is 6/10. Blood tests show:

Haemoglobin 13.0g/dL
White cell count 15 x 109/L
Urea 9 mmol/L
Creatinine 105µmol/L

Which is the single most appropriate action to take?

Select one:
A. admit to hospital and consider ITU referral
B. admit to hospital for immediate NIV
C. admit to hospital to the medical assessment unit
D. discharge home on oral antibiotics
E. discharge home with home iv antibiotic service


A. Admit to hospital and consider ITU referral - She is hypoxic with altered mental status and evidence of sepsis, she could deteriorate rapidly so is in urgent need of high dependency care.


A 49 year old woman is waiting for a liver transplant. Which single condition is the most likely indication in this woman?

Select one: 
A. alcoholic liver disease 
B. chronic active hepatitis 
C. Hepatitis A liver disease 
D. Hepatitis E liver disease 
E. hepatocellular carcinoma

A. Alcoholic liver disease - hepatitis c, alcoholic liver disease and primary biliary cirrhosis are the commonest indications for liver transplantation in the uk


A 23 year old university student wakes up in the middle of the night with vomiting, malaise and a high temperature. He is admitted to hospital for observation. Within two hours, he has a stiff neck and convulses. Which is the single most likely diagnosis?

Select one: 
A. Haemophilus influenzae type B meningitis 
B. Listeria meningitis 
C. Meningococcal meningitis 
D. Pneumococcal meningitis 
E. Tuberculous meningitis

C. Meningococcal meningitis - meningism in a young patient should alert you to the possibility of meningococcal infection and prompt immediate antibiotic treatment before LP