SBAs Flashcards by Harriet Guthrie

A man breaks his leg and it is plastered for 6 weeks. When the plaster is removed, the leg is much thinner than the other leg. What has happened?
a) Atrophy
b) Hyperplasia
c) Hypertrophy
d) Metaplasia
D) Dysplasia

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Acute inflammation actively involves
A) Constriction of arterioles
B) Capillary endothelial cell enlargement
C) Influx of macrophages 
D) Influx of mast cells
E) Influx of neutrophils

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Most common type of cell present in appendicitis?
A. Neutrophils 
B. Basophils
C. Eosinophils
D. Macrophages
E. Lymphocytes

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Which 2 cell types are involved in the response to acute inflammation?

a) Neutrophils and basophils
b) Eosinophils and basophils
c) Neutrophils and monocytes
d) Neutrophils and lymphocytes
e) Lymphocytes and monocytes

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Which of these is NOT an outcome of acute inflammation?

a) Pus formation
b) Destruction
c) Organisation
d) Resolution
e) Progression to chronic inflammation

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Hypertrophy is best described as:

a) Increased size of organ/tissue due to increased number of cells
b) Increased size of organ/tissue due to decreased number of cells
c) Increased cell growth and decreased differentiation
d) Increased size of organ/tissue due to increased size of cells
e) Replacement of one differentiated tissue by another

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In which pathological process would you expect:

Organelles to be damaged
Cell lysis
Inflammation
Altered chromatin

a) Metaplasia
b) Apoptosis
c) Dysplasia
d) Hypertrophy
e) Necrosis

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What is a malignant neoplasm of smooth muscle called?

a) Adenocarcinoma
b) Leiomyoma
c) Rhabdomyoma
d) Leiomyosarcoma
e) Adenoma

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What is a malignant neoplasm of glandular origin called?

a) Adenocarcinoma
b) Leiomyoma
c) Rhabdomyoma
d) Leiomyosarcoma
e) Adenoma

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You suspect a patient has Sarcoidosis, which blood marker do you investigate?
A) D-Dimer
B) Phosphate
C) Serum ACE
D) FBC
E) c-ANCA

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What is the name of a benign neoplasm of secretory epithelium? 
A) Myeloma
B) Adenoma
C) Leioma
D) Adenocarcinoma
E) Sarcoma

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What is the name of a malignant neoplasm of connective tissue? 
A) Myeloma
B) Adenoma
C) Leioma
D) Adenocarcinoma
E) Sarcoma

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Which of the following does not typically spread to bone?
A) Breast
B) Lung
C) Thyroid
D) Adrenal
E) Prostate

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Which of the following is NOT a stage of metastasis?
A) Intravasion
B) Adherance to endothelium
C) Evasion of host defence
D) Angiogenesis
E) Invasion of host cells

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What best describes extravasation
A) Erosion of tissue boundaries by enzymes
B) Colonisation of a new site
C) Development of its own blood supply
D) Gaining access to metastatic routes
E) Excretion of enzymes

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Which of the following is not typically a drug target
A) Ducts
B) Receptors
C) Enzymes
D) Transporters
E) Ion channels

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Which of the following is true
A) Agonists show affinity only
B) Antagonists show affinity and efficacy
C) Agonists show efficacy only
D) Agonists show affinity and efficacy
E) Antagonists show efficacy only

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Which condition is a contraindication of beta-blockers?
A) Kidney failure
B) Asthma
C) Liver cirrhosis
D) Headaches
E) Hypertension

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In a typical 70Kg man, which of the following is correct for the amount of water in his  extracellular compartment?
A) 28L
B) 11L
C) 14L
D) 3L
E) 42L

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Which of the following is not a stage of pharmacokinetics?
A) Ingestion
B) Absorption
C) Distribution
D) Metabolism
E) Excretion

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What are foam cells?
A) Endothelial cells
B) Macrophages that have taken up LDLs
C) Neutrophils that have accumulated lipid
D) Macrophages that have taken up HDLs
E) Smooth muscle cells

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Which of the following does NOT trigger apoptosis in a cell
A) Bcl-2
B) Bax
C) Fas ligands
D) Caspases
E) p53

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Which of the following is not a type of necrosis? 
A) Coagulative necrosis
B) Liquefactive necrosis
C) Gangrene
D) Caseous necrosis
E) Epithelious necrosis

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Which of the following is linked to Burkitt's lymphoma?
A) Smoking
B) EBV
C) HPV
D) UV radiation
E) Aflatoxins

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``` Which of the following is linked to hepatocellular carcinoma? A) Smoking B) EBV C) HPV D) UV radiation E) Aflatoxins ```

``` Which of the following is a characteristic of malignant tumours? A) Does not invade the basement membrane B) Exophytic C) Low mitotic activity D) Necrosis and ulceration common E) Circumscribed ```

``` What is used for cervical cancer staging? A) The FIGO system B) The Enneking system C) Duke's classification D) Ann Arbor Staging E) Binet System ```

``` What is used for leukaemia staging? A) The FIGO system B) The Enneking system C) Duke's classification D) Ann Arbor Staging E) Binet System ```

``` Which of the following would indicate breast cancer? A) High PSA B) High calcitonin C) CA 15.3 D) CA 19.9 E) Alpha-Fetoprotein ```

``` Which of the following would indicate germ cell tumours? A) High PSA B) High calcitonin C) beta-hCG D) CA 19.9 E) Alpha-Fetoprotein ```

``` Which of the following does not have a screening programme? A) Breast cancer B) Cervical cancer C) Bowel cancer D) Prostate cancer E) Abdominal aortic aneurysm ```

Which tumour has the shortest median survival a. Basal cell carcinoma of the skin b. Malignant melanoma of the skin c. Breast cancer d. Anaplastic carcinoma of the thyroid

Which one of the following is not a feature of malignant tumours? a. Vascular invasion b. Metastasis c. Increased cell division d. Growth related to overall body growth

Which of the following is not known to be a carcinogen in humans? a. Hepatitis C virus b. Ionising radiation c. Aromatic amines d. Aspergillus niger fungus

Which of the following tumours never metastasises? a. Malignant melanoma b. Small cell carcinoma of the lung c. Basal carcinoma of the skin d. Breast cancer

Which of the following is length-bias? A) Volunteers for screening are more at risk of good-prognosis tumours B) Diagnosis of lesions that, although histologically malignant, are clinically relatively harmless C) Preferential detection of slow growing tumours with intrinsically better prognosis D) Earlier detection does not affect the inevitable fatal outcome, but prolongs the apparent survival time

``` Where in the mitochondria is the site of glycolysis? A) Cytosol B) Matrix C) Cristae D) Inner membrane E) Outer membrane ```

What is the function of the perioxisomes? A) Synthesis and processing of proteins B) Synthesis of lipids C) Structural support D) Contains acid hydrolases for digestion and recycling E) Fatty acid and ethanol oxidation

What is paracrine communication? A) Chemical released form cell into ECF and acts upon itself B) Local cellular communication; travels short distances. Travels in the ECF C) Secretion into blood not via a duct. Long distance communication D) The whole cell is lost with the secretion E) No part of the cell is lost with the secretion

What is autocrine communication? A) Chemical released form cell into ECF and acts upon itself B) Local cellular communication; travels short distances. Travels in the ECF C) Secretion into blood not via a duct. Long distance communication D) The whole cell is lost with the secretion E) No part of the cell is lost with the secretion

``` Which of the following can cause hyponatraemia? A) Renal failure B) mineralocorticoid excess C) Diabetes insipidus D) Excess IV fluid E) ACE inhibitors ```

``` Which of the following can cause hyperkalaemia? A) Renal failure B) mineralocorticoid excess C) Diabetes insipidus D) Excess IV fluid E) Hypomagnesemia ```

``` What is a consequence of Hypercalcaemia? A) Metastatic calcification B) Tetany C) Risk of MI D) Weakness E) Cardiac dysrhythmia ```

``` What is a consequence of hypokalaemia? A) Metastatic calcification B) Tetany C) Risk of MI D) Metastases E) Cardiac dysrhythmia ```

``` What does Glucose+Fructose form? A) Lactose B) Maltose C) Galactose D) Glycogen E) Sucrose ```

Which of the following is NOT true? A) Topoisomerase relieves the supercoils, unwinding the double helix B) Single strand binding protein keeps the two DNA strands held together during synthesis- preventing annealing C) DNA polymerase reads 3’ to 5’, and prints 5’ to 3’ D) A primer is a short stand of DNA that acts as a starting point for DNA synthesis E) DNA helicase breaks hydrogen bonds between the two strands, exposing nucleotides

``` In which phase of mitosis does crossing over occur? A) Prophase B) Prometaphase C) Metaphase D) Anaphase E) Telophase ```

``` Which of the following would decrease BMR? A) High BMI B) Hyperthyroidism C) Pregnancy D) Higher age E) Infection ```

What is NOT true about the RAAS? A) Angiotensin 1 is converted to Angiotensin 2. B) Renin is secreted by the kidney. C) Aldosterone causes the kidney to reabsorb NaCl. D) Angiotensinogen is secreted by the liver. E) Angiotensin Convulsing Enzyme is secreted by the kidney.

``` What is the energy value of lipids? A) 4kcal/g B) 7kcal/g C) 9kcal/g D) 7mmHg E) 9mmHg ```

Which of the following is true regarding ketogenesis/ ketone bodies? A) Ketones are strong alkalis. B) Ketones are weak acids. C) Increased ketone bodies can lead to diabetic ketoacidosis. D) NADH is an example of a ketone. E) Increased ketone bodies enhance oxygen binding to haemoglobin.

``` Which of the following is not a typical antigen presenting cell? A) T cells B) Macrophages C) Dendritic cells D) B cells ```

``` What cell type is measured in HIV monitoring? A) CD4+ B) CD8 C) TREG cells D) CD17 E) B cells ```

``` Which of the following is not a polymorphonuclear leukocyte? A) Neutrophil B) Macrophage C) Basophil D) Eosinophil ```

``` Which of the following is not a stage of phagocytosis? A) Binding of insult B) Engulfment C) Phagosome formation D) Presentation of MHC I E) Secretion of waste products ```

Which of the following is not a component of innate immune system a) Skin b) Antimicrobial peptides c) Antibodies d) Mucosa

Antigen presenting cells process and present antigens for recognition by A) Neutrophils B) Red blood cells C )Eosinophils D) T cells

Which of the following are features of the adaptive immune response A) Does not require prior contact with the pathogen B) It works with B and T lymphocytes C) Lacks specificity D) Distinguishes "self" from "non-self" E) Enhanced by complement

``` Which of the following is not part of the Elimination phase of complement activation? A) Opsonisation B) Production of interferons C) Target cell lysis D) Chemoattraction of leukocytes E) Phagocytosis ```

``` Influenza vaccine is targeted towards 'at risk' groups in the UK. Which of the following aren't classified as 'at risk'? A) Asthmatics B) Diabetics C) The obese of any age D) 6 months of age ```

Which of the following is not a classical PAMPs? A) Flagellin, a protein found in bacterial flagella B) Lipopolysaccharide (LPS) from the outer membrane of gram-negative bacteria C) Peptidoglycan, found in bacterial cell walls D) Lipoarabinomannan of mycobacteria E) Interleukin 12

``` Which of the following is not a component of the innate immune system? A) Complement system B) Toll-like receptors C) Macrophages D) T helper cells E) C-reactive protein ```

``` Which of the following is a type 3 hypersensitivity reaction- A) Tuberculosis B) Goodpasture’s Disease C) Systemic Lupus Erythematosus D) Contact Dermatitis E) Anaphylaxis ```

``` Which of the following antibodies is implicated in asthma? A) IgG B) IgA C) IgM D) IgE E) IgD ```

``` Which of the following antibodies is implicated in the secondary response to infection? A) IgG B) IgA C) IgM D) IgE E) IgD ```

``` Which type of cytokine causes B cells to produce IgE? A) IL-1 B) IL-3 C) IL-4 D) IL-5 E) IL-13 ```

``` What type of T cell plays an important role in type 1 hypersensitivity reactions? A) Th-1 B) Th-2 C) Th-17 D) TC E) Treg ```

``` The immune system is made up of both innate and adaptive aspects and involves a variety of cells. Which is the most abundant white blood cell in humans? A) Basophils B) CRP C) Neutrophils D) Mast Cells E) Lymphocytes ```

``` A mother brings her 3-year-old child to the GP saying he has a fever and is generally unwell. The GP suspects the they have a viral infections such as respiratory syncytial virus. What cell would you expect to be raised in this patient? A) Mast Cell B) Microglia C) Neutrophils D) Macrophages E) Lymphocytes ```

``` A 34-year-old male comes into the GP complaining of haemoptysis. He notes that he wakes up at night due to waking up in a pool of sweat and mentions he recently returned from a holiday in Pakistan. The GP suspects tuberculosis. Which of the following cytokines is primarily responsible for activating macrophages? A) IL-2 B) IL-4 C) TNFα D) IL-1β E) IFN-γ ```

``` A 5-year-old girl is brought to the GP after repeated episodes of allergic rhinitis and eczema. Which cytokine is involved in atopy and, amongst other things, causes class switching of immunoglobulins to IgE? A) IL-4 B) IL-17 C) IL-5 D) IL-1β E) IFN-γ ```

``` A 35-year-old woman presents to her GP complaining of unintentional weight loss, palpitations, and oligomenorrhoea. She is subsequently diagnosed with Graves disease by a specialist. Given their involvement in autoimmunity, where does T cell maturation occur? A) Spleen B) Bone Marrow C) Bursa of Fabricius D) Thymus E) Liver ```

``` It’s your first day on placement and you take a history from an elderly gentleman who is currently running a high-grade fever. You later find out he is currently suffering from a Pseudomonas aeruginosa infection. Which pattern recognition receptor is most likely to detect this infection? A) TLR2 B) TLR6 C) TLR4 D) NOD-2 E) RIG1 ```

``` It’s your second day on placement and you take a history from an elderly gentleman who is currently running a high-grade fever. You later find out he is currently suffering from a Streptococcus pneumoniae infection. Which pattern recognition receptor is most likely to detect this infection? A) TLR2 B) TLR6 C) TLR4 D) NOD-2 E) RIG1 ```

``` An intravenous drug user presents to A&E complaining of fever, a hot painful red lump, and general malaise. The F1 who clerked them suspects an MRSA infection. Which white blood cell is most likely to be raised in this patient? A) Neutrophil B) Mast Cell C) Basophil D) Lymphocyte E) Dendritic cell ```

``` An infant presents to hospital with a fever, shortness of breath and a cough producing yellow sputum. She has had many previous admissions due to similar infections and has been diagnosed with a deficiency in mannose binding lectin (MBL). Which substance is failing to trigger a complement cascade reaction in this patient? A) IgE B) IgM C) C3 Convertase D) Pathogen surface carbohydrates. E) Membrane attack complex ```

``` A 13-year-old boy has been brought to the GP by his dad after having a sore throat and a cough for the last week. After an examination, the GP concludes that he likely has a viral infection that will resolve without other treatment. Which immune cells are responsible for directly combating this type of infection through apoptosis? A) Basophils B) Plasma Cells C) T helper cells D) Neutrophils E) Cytotoxic T-cells ```

``` A 10-year-old boy presents with an itchy rash on his elbows. The rash is red and there are excoriation marks. He has a past history of hay fever and has generally dry skin. The GP diagnoses him with eczema and he is prescribed hydrocortisone. Which antibody is responsible for mediating type 1 hypersensitivity? A) IgG B) IgA C) IgM D) IgE E) IgD ```

``` A mother is concerned about infection of her newborn child. She asks her GP about best to protect their child from infections. Which is the most abundant antibody in colostrum? A) IgG B) IgA C) IgM D) IgE E) IgD ```

``` A 38-year-old male attends the human immunodeficiency virus (HIV) clinic for routine blood tests for monitoring of his condition. The number of which of the following cells is used to measure the progression of disease in HIV positive patients? A) Neutrophils B) B Cells C) NK cells D) CD4 T cells E) CD8 T cells ```

``` A 34-year-old man is referred to the gastroenterologist due to persistent epigastric pain and nausea. He returned travelling from south-east Asia ten weeks ago. Blood tests reveal iron deficiency anaemia, and faecal microscopy reveals the presence of hookworm eggs. Which immune cell is responsible for the defense against helminths? A) Basophils B) Eosinophils C) Neutrophils D) Macrophages E) Dendritic Cells ```

``` A 14-year-old boy complains of a 3-day history of fatigue, aches and pains, and fever. Upon examination his temperature is 38ºC and his tonsils are inflamed. He is suspected to have a bacterial infection which will be fought by his adaptive immune system. Which of the following cell-surface proteins are found on cytotoxic T-cells? A) CD4 B) CRP C) MHC I D) CD 8 E) MHC II ```

``` A 65-year-old man is admitted to hospital following a fall. He subsequently developed hospital-acquired pneumonia. Given the most likely causative microorganism, which molecule is responsible for presenting its antigenic material to immune cells? A) CD4 B) MHC III C) MHC I D) TCR E) MHC II ```

``` A father brings their 6-year-old boy to the GP complaining of an incredibly lengthy chest infection and recurrent gastritis. He is referred to an immunologist. His bloods extremely low levels of IgA and IgG. He is diagnosed with common variable immunodeficiency (CVID). Which adaptive cell type is essential in aiding class switching of B cells? A) Natural Killer T cells. B) Th17 cells C) Th2 cells D) Th1 cells E) Dendritic Cells ```

``` A 24-year-old lady collapses after being stung by a wasp. You run to her aid and find marked facial oedema and a loud wheeze. You suspect anaphylaxis. Which type of immunoglobulin (Ig) is associated with this kind of reaction? A) IgG B) IgA C) IgM D_ IgE E) IgD ```

``` Which of the following develops from a common lymphoid progenitor? A) Natural killer cell B) Erythrocyte C) Thrombocyte D) Eosinophil E) Mast cell ```

``` Which of the following is a primary lymphoid organ? A) Lymph nodes B) Bone marrow C) Spleen D) Transient germinal centres ```

Which of the following is not a function of the spleen? A) Mechanical filtration of RBC B) Active immune response C) Production of RBCs up to 5 months gestation D) Aids in the production of thrombocytes e) Storage of RBCs, lymphocytes and other elements

``` Which of the following is a characteristic of innate immunity? A) Highly specific B) Fast (hours to days) C) Highly regulated D) Has amplification E) Lasts a long time ```

``` What is the name of an inactivated X chromosome in women? A) Heinz body B) Bite cell C) Barr Body D) Popcorn Cells E) Fragment cells ```

``` What is the main source of histamine? A) Mast cells B) Basophils C) Eosinophils D) B cells E) Neutrophils ```

``` Which of the following cells do not present MHC-I? A) Neutrophils B) Antigen presenting cells C) Erythrocytes D) Thrombocytes E) Macrophages ```

``` Which of the following does not typically present MHC-II? A) T cells B) Macrophages C) Dendritic cells D) B cells ```

``` Which of the following is not required for a T cell response to occur? A) Binding of primary receptors B) Binding of co-stimulatory molecules C) A robust release of cytokines D) Multiple APC binding ```

``` What cell type is antagonistic to Treg cells? A) Th17 B) Th1 C) Th2 D) Cd4+ E) Th20 ```

``` What region of an antibody binds to epitopes of an antigen? A) Fab Region B) Fc Region C) Light chain D) Constant region E) Hinge region ```

``` Which type of antibody is most abundant in the blood? A) IgA B) IgM C) IgG D) IgE E) IgD ```

``` Which type of antibody is bound to mast cells and basophils by the Fc-epsilon-receptor? A) IgA B) IgM C) IgG D) IgE E) IgD ```

``` Which type of antibody is the least abundant in the blood? A) IgA B) IgM C) IgG D) IgE E) IgD ```

``` What promotes IgA class switching? A) IL-5 B) IL-4 C) IL-10 D) IL-12 E) TNF-alpha ```

``` What promotes IgE class switching? A) IL-5 B) IL-4 C) IL-10 D) IL-12 E) TNF-alpha ```

``` Which type of hypersensitivity is Th1 mediated? A) 1 B) 2 C) 3 D) 4 ```

``` What is the first line treatment for anaphylaxis? A) Adrenaline B) Clorphenamine C) Hydrocortisone D) Prednisolone E) Beta-blocker ```

``` Which of the following is true of passive immunity? A) Produced by the host immune system B) Durable effective protection C) Immunological memory D) Boosted effect on subsequent dose E) No negative phase ```

``` Which of the following cytokines is anti-inflammatory? A) IL-1 B) IL-2 C) IL-4 D) IL-12 E) TNF-Alpha ```

``` Which of the following cytokines is produced by Th1 cells? A) IL-1 B) Interferon-gamma C) IL-4 D) IL-10 E) TNF-alpha ```

``` Which of the following cytokines is not involved in inducing fever? A) IL-1 B) IL-6 C) IL-10 D) TNF-alpha ```

``` Which cell surface marker is associated with activated B cells? A) CD4 B) CD25 C) CD20 D) CD14 E) CD56 ```

``` Which of the following is not used as part of the gram staining process? A) Crystal violet B) Iron sulphide C) Iodine D) Alcohol E) Safranin ```

``` A man presents with diarrhoea. You take a stool sample for culture. The bacteria grown appears pink on gram staining and is a rod. It goes pink on MacConkey Agar. What is it likely to be? A) E. Coli B) Salmonella C) Shigella D) Vibro. Cholerae E) H. Pylori ```

``` A man presents with diarrhoea. You take a stool sample for culture. The bacteria grown appears pink on gram staining and is a rod. It is negative on the oxidase test. What is it likely to be? A) E. Coli B) Salmonella C) C. Jejuni D) Vibro Cholerae E) H. Pylori ```

``` A woman presents with a skin infection. You take a skin swab, and the bacteria grown is a class A beta haemolytic bacteria. What is it likely to be? A) Staph. Aureus B) Strep Pyogenes C) Strep Agalactiae D) Staph Epidermis E) Strep oralis ```

``` A woman presents with a throat infection. You take a swab, and the bacteria grown is a class A beta haemolytic bacteria. What is it likely to be? A) Staph. Aureus B) Strep Pyogenes C) Strep Agalactiae D) Staph Epidermis E) Strep oralis ```

``` A woman presents with a chest infection. A blood culture is taken, and the bacteria grown appears as a purple cocci on gram staining. It is grown on a CBA plate and appears dark green. It is optochin sensitive. What is it likely to be? A) Staph. Aureus B) Strep Pyogenes C) Strep Pneumoniae D) Staph Epidermis E) Strep oralis ```

``` A woman presents with a severe chest infection. A blood culture is taken, and the bacteria grown appears red on ziehl-Neelson stain. What is it likely to be? A) Staph. Aureus B) Strep Pyogenes C) Strep Pneumoniae D) Mycobacterium Tuberculosis E) Strep oralis ```

``` A woman presents with a skin infection. You take a swab, and the bacteria appears as a coagulase positive cocci that sits in clusters. What is it likely to be? A) Staph. Aureus B) Strep Pyogenes C) Strep Pneumoniae D) Staph. Epidermis E) Strep oralis ```

``` A woman presents with a skin infection. You take a swab, and the bacteria appears as a coagulase positive cocci that sits in clusters. How would you treat her? A) Oral Flucloxacillin B) Oral Benzylpenicillin C) Oral Amoxicillin D) Trimethoprim E) Oral cephalosporins ```

``` A woman presents with a skin infection. You take a swab, and the bacteria appears as a coagulase positive cocci that sits in clusters. On sensitivity testing, it appears to be methicillin resistant. How would you treat her? A) Oral Flucloxacillin B) Oral Vancomycin C) Oral Amoxicillin D) Trimethoprim E) Oral cephalosporins ```

``` A man presents with diarrhoea. You take a stool sample for culture. The bacteria grown appears pink on gram staining and is a rod. It goes pink on MacConkey Agar. How would you treat him? A) Oral flucloxacillin B) Oral Vancomycin C) Trimethoprim D) Oral Co-amoxiclav E) Oral Metronidazole ```

``` A woman presents with thin grey vaginal discharge and a burning pain. You think the bacteria must be Gardnerella vaginalis. How would you treat her? A) Oral flucloxacillin B) Oral Vancomycin C) Trimethoprim D) Oral Co-amoxiclav E) Oral Metronidazole ```

``` You see a man on the ward who has been diagnosed with peritonitis. On gram staining, his bacteria was found to be a gram negative anaerobic bacilli. What would you treat him with? A) Oral flucloxacillin B) Oral Vancomycin C) Trimethoprim D) Oral Co-amoxiclav E) Oral Metronidazole ```

``` You see a man on the ward who has been diagnosed with peritonitis. You are unable to culture, so what would you treat him with? A) 6 weeks IV Flucloxacillin B) Benzylpenicillin and clindamycin C) Oral Metronidazole D) Oral Co-amoxiclav E) IV Cefuroxime and metronidazole ```

``` Which of the following types of antibiotics, does not work by inhibiting cell wall synthesis? A) Glycopeptides B) Penicillins C) Macrolides D) Cephalosporins E) Carbapenems ```

``` A patient comes in presenting with minor hospital acquired pneumonia, thought to be due to E. Coli. His PMX includes recurrent chest infections, and a hypersensitivity reaction to amoxicillin. He is a smoker. What would you prescribe? A) Clarithromycin B) Co-Amoxiclav C) Gentamicin D) Flucloxacillin E) Benzylpenicillin ```

``` Which of the following antibiotics does not work by inhibiting protein synthesis? A) Erythromycin B) Doxycycline C) Gentamicin D) Flucloxacillin E) Chloramphenicol ```

``` Which of the following antibiotics does not work by inhibiting nucleic acid synthesis? A) Trimethoprim B) Doxycycline C) Rifampicin D) Metronidazole E) Ciprofloxacin ```

``` Which of these tests differentiates the types of streptococci? A) Haemolysis B) Catalase C) Coagulase D) Oxidase ```

Which of the following describes shigella? A) Gram positive bacilli, non-lactose fermenting B) Gram negative bacilli, lactose fermenting C) Gram negative cocci, positive oxidase test D) Non-lactose fermenting, negative oxidase test

``` Which of these is the most appropriate way of detecting viruses? A) Light microscopy B) Culturing C) PCR D) API strip ```

``` Chains of purple cocci are seen on a gram film. They don't grow near the optochin disc These are probably.. A) Streptococcus pneumoniae B) Staphylococcus epidermidis C) Viridans Streptococci D) S. pyogenes E) Neisseria meningitidis ```

``` A pink colony is picked off a MacConkey plate and is found to contain pink staining bacilli with Gram's staining. Which organism is most likely? A) Shigella sonnei B) Listeria monocytogenes C) Neisseria meningitidis D) Eschericia coli E) Streptococcus pyogenes ```

``` Which of the following is Haemophilus influenzae NOT an important cause of? A) meningitis in pre-school children B) Otitis media C) Pharyngitis D) Gastroenteritis E) Exacerbations of COPD ```

Which of these is NOT a means by which viruses cause disease? A) direct destruction of host cells B) cell proliferation and cell immortalisation C) inducing immune system mediated damage D) Endotoxin production E) modification of host cell structure or function

The HIV envelope contains A) RNA + capsid + DNA polymerase B) DNA + capsid + RNA reverse transcriptase C) DNA + p24 + RNA polymerase D) RNA + capsid + RNA reverse transcriptase E) RNA + gp120 + RNA polymerase

What is the definition of potency? A) How well the ligand activates the receptor B) Binding affinity of the drug for the receptor C) Fraction of the drug that reaches systemic circulation unaltered D) Binds to a receptor and activates it E) Binds to a receptor and blocks its activation

What is the definition of efficacy? A) How well the ligand activates the receptor B) Binding affinity of the drug for the receptor C) Fraction of the drug that reaches systemic circulation unaltered D) Binds to a receptor and activates it E) Binds to a receptor and blocks its activation

``` A patient presents with suspected paracetamol over dose. Which of the following would you not expect to find? A) Metabolic acidosis B) Hypoglycaemia C) Raised PTT D) Raised creatinine E) Decreased ALT ```

Which of the following is not an action of alpha-1 adrenoceptor activation? A) Vasoconstriction B) Increased closure of internal sphincter of bladder C) Mydriasis D) Increased peripheral resistance E) Tachycardia

``` Which of the following is not an action of beta-2 adrenoceptor activation? A) Vasodilation B) Bronchodilation C) Increased glucagon release D) Relaxed uterine smooth muscle E) Increased release of renin ```

``` Which of the following is a beta-2 agonist? A) Tamsulosin B) Adrenaline C) LABA D) Cocaine E) Dopamine ```

``` Which of the following is an alpha-1 antagonist? A) Tamsulosin B) Adrenaline C) LABA D) Cocaine E) Dopamine ```

``` Which of the following is a COX-2 selective NSAID? A) Celecoxib B) Diclofenac C) Ibuprofen D) Naproxen E) Aspirin ```

``` A patient presents with hypertension and oedema caused by ischaemic heart disease. What would you prescribe? A) Ramipril B) Furosemide C) Candesartan D) Propranolol E) Atenolol ```

``` A drug given through IV route is assumed to have a bioavailability of.. A) 50% B) 75% C) 100% D) 10% ```

``` Which of the following processes do beta lactam antibiotics intefere with... A) Bacterial protein synthesis B) Bacterial cell wall synthesis C) Bacterial nucleic acid synthesis D) Viral protein synthesis ```

``` Which of the following is an irreversible enzyme inhibitor... A) Enalapril B) Aspirin C) Ibuprofen D) Salbutamol ```

``` Acromegaly is the overproduction of which pituitary hormone? A) Prolactin B) Growth hormone releasing hormone C) Growth hormone D) LH E) ACTH ```

``` Which of the following is not a cause of primary adrenal insufficiency? A) Addison's disease B) Steroids C) Surgical removal D) TB E) ACTH resistance ```

``` What cells produce catecholamines? A) Chromaffin cells B) C cells C) P cells D) Follicular cells E) Parafollicular cells ```

A 48-year-old man has a 4-month history of increasing fatigue and anorexia. He has lost 5.5 kg and noticed increased skin pigmentation. He has been otherwise healthy. His mother has Hashimoto's thyroiditis and one of his sisters has type 1 diabetes. His blood pressure is 110/85 mmHg (supine) and 92/60 mmHg (sitting). His face shows signs of wasting and his skin has diffuse hyperpigmentation, which is more pronounced in the oral mucosa, palmar creases, and knuckles What condition does this man likely have? A) Conn’s syndrome B) Type 1 diabetes C) Addison’s disease D) Cushings syndrome E) Hypothyroidism

A 12-year-old girl is brought to the emergency department by her parents due to 12 hours of rapidly worsening nausea, vomiting, abdominal pain, and lethargy. Over the last week she has felt excessively thirsty and has been urinating a lot. Physical examination reveals a lean, dehydrated girl with deep rapid respirations, tachycardia, and no response to verbal commands. What is the most likely condition she is suffering from? A) Hyperosmolar-hyperglycaemic state B) Diabetic Ketoacidosis C) Adrenal crisis D) Anaphylactic shock E) Hypoglycaemia

A 34-year-old woman presents with complaints of weight gain and irregular menses for the last several years. She has gained 20 kg over the past 3 years and feels that most of the weight gain is in her abdomen and face. She notes bruising without significant trauma, difficulty rising from a chair, and proximal muscle wasting. She was diagnosed with type 2 diabetes and hypertension 1 year ago. What is the most likely condition she is suffering from? A) Addison’s disease B) Cushing syndrome C) Pheochromocytoma D) Polycystic Ovary Syndrome

``` A 30-year-old female presented to you last week in an ill-fitting T-shirt and shorts, looking wide-eyed and fidgety. She said she is always hungry. What is her most likely diagnosis? A: Generalised Anxiety Disorder B: Pituitary tumour C: Hyperthyroidism D: Carcinoid Syndrome E: Hypothyroidism ```

``` Which of these is NOT a symptom of hypercalcaemia? A: Fractures B: Long QT C: Constipation D: Kidney stones E: Depression ```

``` A 45-year-old man presents to you complaining of joint pain and struggling to see out the corner of his eyes. He also says he is frequently urinating, even at night. What is the first line investigation for his possible disease? A: HBA1C B: Growth hormone levels C: CT head D: ILGF-1 Levels ```

``` A 28-year-old woman presents with frequent headaches and a white discharge from her nipple. Upon further questioning she hasn't had her period for 5 months. Her urine is negative for hCG. What is her most likely diagnosis? A: Pregnancy B: Malnutrition C: Prolactinoma D: Breast infection ```

``` What is the TFT profile of hypothyroidism caused by apoplexy (bleed in the pituitary)? A: high TSH, low T3/4 B: low TSH, high T3/4 C: Low TSH, Low T3/4 D: High TSH, high T3/4 ```

``` What test can differentiate between Nephrogenic and neurogenic DI? A: Fluid restriction test B: glucose tolerance test C: ADH suppression test D: U and Es ```

``` A 66-year-old man with lung cancer has been rushed to hospital. He is unresponsive, with his wife saying he was confused and weak before having a seizure. She says that he hadn’t been to the toilet for some time. His U and Es showed low sodium and normal potassium. CT showed dilated ventricles and no lesions. What is his most likely possible diagnosis? A: Brain tumour B: SIADH C: hypothyroidism D: Addison’s disease ```

``` A 89-year-old person comes in with convulsions, a long QT and Paraesthesia. What else would you expect from this hypocalcaemic individual? A: Euphoria B: Tetany C: Renal stones D: Wt. gain ```

``` A 55-year-old woman comes in, saying she is feeling a bit down and cold all the time, which she puts down to losing the warmth of joy in her heart. She says the extra weight she has put on in recent months has not insulated her. She is struggling to pass stools. She has a history of Atopy and type 1 diabetes. Which is a likely diagnosis? A: depression B: hypothyroidism C: hypercalcaemia D: Addison’s disease ```

``` Which of the following antibodies is not typically present in type 1 diabetes? A) Anti-GAD B) Pancreatic islet autoantibodies C) Islet antigen-2 antibodies D) Anti-TPO ```

``` A 26 year old woman presents with suspected hypothyroidism. She has recently found out that she is pregnant. Which of the following is not a possible complication that could arise due to her hypothyroidism? A) Low birth weight B) Neonatal goitre C) Post-partum haemorrhage D) Eclampsia ```

``` Which of the following medications could be given to lower cortisol? A) Ketoconazole B) Carbimazole C) Levothyroxine D) Metformin E) Demeclocycline ```

``` Which of the following medications could be given to lower ADH? A) Ketoconazole B) Carbimazole C) Levothyroxine D) Metformin E) Demeclocycline ```

``` Which of the following is not a feature of diabetic ketoacidosis? A) Kaussmaul breathing B) Polyuria C) Dehydration D) Hypertension E) Tachycardia ```

``` A 16 year old patient presents with a failure to start puberty. You perform some blood tests, and she shows a decreased GnRH. What condition does she have? A) Kallmann's syndrome B) Carcinoid syndrome C) PCOS D) Endometriosis E) Klinefelter's syndrome ```

``` What hormone is secreted in carcinoid tumours? A) Aldosterone B) Serotonin C) Cortisol D) Thyroxine E) Prolactin ```

``` Which of the following does not cause diabetes? A) Acromegaly B) Cushing's C) Pheochromocytoma D) Glucocorticoid use E) SIADH ```

``` Which of the following substances increases appetite? A) PPY B) Lectin C) CCK D) GLP-1 E) Ghrelin ```

A patient presents with a fracture. He also reports having small testes and has a notably short stature. On examination, he has some breast growth, and on questioning, he reveals he has quite a low sex drive, and him and his partner have being trying to get pregnant for a few years without success. What test would you order? A) Pituitary function tests B) A blood test for the presence of an extra X chromosome C) Pituitary MRI scan D) Serum prolactin E) Serum PSA

``` A patient is 180 cm and weighs 70kg. What is their BMI category? A) Underweight B) Normal weight C) Overweight D) Obese E) Morbidly obese ```

``` A patient is 186 cm and weighs 92kg. What is their BMI category? A) Underweight B) Normal weight C) Overweight D) Obese E) Morbidly obese ```

``` Which of the following is not typically a place that pituitary tumour metastasise to? A) Prostate B) Breast C) Lung D) Stomach E) Kidney ```

``` Which of the following antibodies is not typically raised in Graves' disease? A) TSHR-ab B) TPO antibodies C) Thyroglobulin antibodies D) Anti-GAD ```

``` Which of the following is not under control of the pituitary? A) Thyroid B) Adrenal cortex C) Adrenal medulla D) Testis E) Ovary ```

Which of the following statements is false? A) The pituitary gland lies in the sella turcica B) The weight of the pituitary gland is around 0.5g C) ACTH is secreted from the pituitary during stress D) The pituitary regulates calcium metabolism E) The anterior and posterior pituitary are distinct on an MRI scan

``` In men all the following are mainly produced in the adrenal cortex except? A. DHEAS B. Testosterone C. Aldosterone D. 17-OH progesterone E. Androstenedione ```

Which of the following regarding AVP is false? A. AVP levels have a linear relationship with serum osmolality B. It is produced in the pituitary gland C. It stimulates reabsorption of water in the collecting duct of the nephron D. In hypotension baroreceptors predominantly activate ADH production and secretion E. Further AVP production is no longer effective once urine osmolality has reached a plateau

``` Where is growth hormone’s main site of action to stimulate IGF1 release? A. Bone B. Liver C. Adrenal cortex D. Muscle E. Pancreas ```

``` The following are typical features of excess growth hormone secretion except? A. Polyuria B. Joint pains C. Sweating D. Hypotension E. Headaches ```

``` The following hormones all have a circadian rhythm except? A. Cortisol B. Testosterone C. DHEA D. 17OH progesterone E. Thyroxine (T4) ```

``` Typical features of cortisol deficiency include the following except? A. Hypotension B. Muscle aches C. Weight loss D. Hyperglycaemia E. Lethargy ```

``` A 38 year old lady presented with weight gain, menorrhagia and constipation. She is most likely to be suffering from? A. Cushing’s syndrome B. Addison’s disease C. Primary hypothyroidism D. Graves disease E. Acromegaly ```

Which test would you likely want to perform in a patient with proximal muscle weakness, purple striae and thin skin? A. Synacthen test B. Overnight dexamethasone suppression test C. Insulin tolerance test D. Glucagon test E. Skin allergy tests

``` A 24 year old girl presented with hirsutism, oligomenorrhoea and acne. What test would you likely carry out from the ones below? A. Ultra sound adrenals B. Ultra sound ovaries C. MRI ovaries D. CT scan adrenals E. Prolactin ```

``` A 54 year old gentleman presented with hyponatraemia. All the following conditions need excluding before confirming SIADH except? A. Hypothyroidism B. Hypervolaemia C. Euvolaemia D. Adrenal insufficiency E. Diuretic use ```

A 66 year old gentleman had a serum sodium of 124 mmol/l, serum osmolality 265 mmol/l and a urine sodium of 52 mmol/l. What would you like to perform first? A. Chest X-ray B. CT brain C. Skin turgor and jugular venous pressure test D. Thyroid function tests E. Synacthen test

``` The following are most likely causes of SIADH except? A. Multiple sclerosis B. Lung abscess C. Subdural haemorrhage D. Lymphoma E. Cerebrovascular accident ```

``` A 28 year old presented with a microprolactinoma. What is the most unlikely symptom? A. Galactorrhoea B. Oligomenorrhoea C. Decreased sexual appetite D. Headaches E. Visual field defects ```

``` The main adipose signal to the brain is A. CCK B. Neuropeptide y C. Leptin D. Agouti-related peptide E. Adiponectin ```

A 65 year old lady is diagnosed with SIADH. Her sodium is 123mmol/l. What is your first line of management? A. If she is symptomatic I will treat with fluid restriction B. If she is asymptomatic I will treat with hypertonic saline C. If she is asymptomatic I will treat with fluid restriction D. If she is asymptomatic I will repeat the sodium level the next day E. If she is asymptomatic I will give normal saline

A patient with Addison’s disease presents with a chest infection. What do you do? A. Omit his steroids to avoid immunosuppression B. Stop his steroids as they have precipitated a chest infection C. Double his steroid dose whilst unwell D. Keep him on his usual steroid dose E. Not of the above

``` The following tests are typical of secondary hypogonadism A. Low LH; High testosterone B. Low LH; Low testosterone C. High prolactin; high testosterone D. Low FSH; Low prolactin E. None of the above ```

``` Typical features of hypogonadism in a male include the following except: A. Decreased sweating B. Joint and muscular aches C. Decreased sexual appetite D. Decreased hair growth E. Asymptomatic ```

A patient has a noon testosterone level below the normal range. What will you do? A. Treat with testosterone gel B. Repeat the test at 0900h and check for symptoms C. Repeat the test at noon to keep things equal D. Refer to endocrinology E. Ignore it

``` The first line treatment for a patient with a symptomatic prolactinoma is usually: A. Radiotherapy B. Transphenoidal surgery C. Dopamine agonists D. Transfrontal surgery E. Somatostatin analogues ```

``` Typical visual field defect of a patient with a large pituitary mass is A. Unilateral quadrantanopia B. Bitemporal hemianopia C. Complete unilateral visual field loss D. Complete bilateral visual field loss E. None of the above ```

Satiety is A. The physiological feeling of no hunger B. Inhibited by activation of POMC neurons C. The physiological feeling of hunger D. Induced by ghrelin release E. Enhanced by Agoutirelated peptide

``` The centres of appetite regulation in the brain are mainly found in the: A. Pituitary B. Cerebellum C. Hypothalamus D. Basal ganglia E. Brain cortex ```

``` What type of enzyme converts T4 to T3 peripherally A) Deiodinases B) Triiodinases C) TPO D) Iodine Dehydrogenase ```

``` Which one of these would most likely be found in graves disease A) TSH high, T3 and T4 low B) TSH high, T3 and T4 high C) TSH low, T3 and T4 high D) TSH low, T3 and T4 low E) TSH, T3 and T4 normal ```

``` Which one of these is not a symptom of hyperthyroidism A) Diarrhoea B) Weight loss C) Palpitations D) Cold intolerance E) Irritability ```

``` Which condition is characterised by a diffusely reduced uptake on a radioiodine scan of the thyroid A) Grave's B) Toxic adenoma C) De Quervain's thyroiditis D) Iodine deficiency ```

A patient presents with feeling very down. He thinks that this low mood could be related to the changes he has noticed to his body, including weight gain around his tummy, acne, and dark purple stretch marks. What investigation would you order? A) Overnight dexamotheasone suppression test B) Plasma aldosterone: renin ratio C) HbA1c D) Plasma GH levels E) Thyroid function testing

``` You are looking through a patients results that have just been sent to you. They show that the patient had an overnight dexomethasone suppression test, and had no suppression. What medication would you prescribe? A) Ketoconazole B) Spironlactone C) Demeclocycline D) Lanreotide E) Metformin ```

``` A 30 year old man presents with hypertension. He had been started on an ACE-Inhibitor a few weeks ago but his blood pressure has not improved, and he has noticed some weakness and cramps. What is a likely diagnosis? A) Atherosclerosis B) Cushing's syndrome C) Conn's syndrome D) Phaeochromocytoma ```

A 30 year old man presents with hypertension. He had been started on an ACE-Inhibitor a few weeks ago but his blood pressure has not improved, and he has noticed some weakness and cramps. What investigations would you order? A) Plasma aldosterone:Renin ratio and serum K+ B) Serum Na+ and urine Na+ C) Overnight dexamethasone suppression test D) Thyroid function testing E) CT angiogram

``` An alcoholic man has recently started a detox regime. However, he has noticed a significant loss of appetite, weakness, confusion, and aching pains. He attends the GP practice after he had a fit in his home. You order some tests, and everything is normal except for a low sodium. How would you treat? A) Laproscopic adrenalectomy B) Radioactive iodine C) Loop diuretic D) Immediate ABC E) Restrict fluids and demeclocycline ```

A 56-year-old man presents with a headache, decreased libido, excessive sweating and snoring. On examination, he has macroglossia and slight visual disturbances. What investigation would you order? A) Plasma aldosterone:Renin ratio and serum K+ B) Serum Na+ and urine Na+ C) Overnight dexamethasone suppression test D) Thyroid function testing E) Glucose tolerance testing

``` Which of the following is not a typical complication of diabetes? A) Staph skin infections B) Retinopathy C) Erectile dysfunction D) Addison's disease E) Candida infection ```

A man presents to A&E with decreased consciousness, and severe dehydration. He has hyperglycaemia and glycosuria on dipstick. He has a past medical history of T2DM, and angina. How would you treat? A) Low flow insulin and heparin B) Oral sugar and long acting starch C) Watch and wait D) IV hydrocortisone and replace steroids E) Oral carbimazole and oral propanolol

``` Which of the following does not cause hypoglycaemia? A) Pituitary insufficiency B) Liver failure C) Addison's disease D) Hyperthyroidism E) Exogenous drugs ```

A woman presents with low mood and a new tanned pigmentation of the skin. She also has amenorrhoea and constipation. What test would you order? A) Plasma aldosterone:Renin ratio and serum K+ B) Short ACTH stimulation test C) Overnight dexamethasone suppression test D) Thyroid function testing E) Glucose tolerance testing

``` Which of the following is the most common cause of Addison's disease worldwide? A) Autoimmune adrenalitis B) TB C) Adrenal metastases D) Long term steroid use E) Opportunistic infections ```

``` A patient presents with lid lag, palmar erythema, diarrhoea and heat intolerance. What would you give first for rapid control of symptoms? A) Propanolol B) Carbimazole C) Propylthiouracil D) Radioactive iodine E) Potassium iodide ```

``` You are looking through a patients results that have just been sent to you. It shows raised TSH receptor stimulating antibodies. What do you diagnose? A) Carcinoid Syndrome B) Grave's disease C) Hashimoto's thyroiditis D) Toxic multinodular goire E) de Quervain's thyroiditis ```

``` You are looking through a patients results that have just been sent to you. Their ECG shows tall tented T waves, small P waves and a wide QRS. What do they have? A) Hyperkalaemia B) Hypernatraemia C) Hypercalcaemia D) Hypokalaemia E) Hypocalcaemia ```

``` Which of the following does not cause hypokalaemia? A) Thiazide diuretics B) Increased aldosterone C) AKI D) Diarrhoea E) Salbutamol ```

``` You are looking through a patients results that have just been sent to you. They have a low PTH, with normal skeletal appearance. What do they have? A) Hypoparathyrodism B) Pseudohypoparathyrodisim C) Pseudopseudohypoparathyroidism D) Pituitary tumour E) None of the above ```

``` What is the most common cause of hypocalcaemia? A) Vitamin D deficiency B) diGeorge syndrome C) Bisphosphonates D) CKD E) Calcitonin ```

``` A patient is being prescribed oral desmopressin. What condition do they likely have? A) Nephrogenic diabetes insipidus B) SIADH C) Cranial diabetes insipidus D) Diabetes mellitus type 1 E) Diabetes mellitus type 2 ```

``` What is the most common type of thyroid carcinoma? A) Papillary B) Follicular C) Anaplastic D) Lymphoma E) Medullary cell ```

A 58 year old man has been admitted to the general medical ward with abdominal pain and fluctuating consciousness. On examination he has shifting dullness and yellowing of sclera. A social history has been taken and he has been started on a reducing regime of diazepam. Blood tests have been undertaken, which show: Hb 92 g/l (normal 135-180), MCV 130fl (80-102fl), platelet count 145 (140-450). What is the most likely cause for this patient’s anemia? A) Autoimmune pernicious anaemia B) Malabsorption causing folate deficiency C) Iron deficiency anaemia D) Anaemia of chronic disease E) Chronic excess alcohol

``` A 4 year old boy came to clinic to have bloods taken for a check-up following a recent stay in hospital with a chest infection. However, following venipuncture, his mother has noticed that he bled for quite some time. On examination you also notice multiple petechiae on his legs, without any history of significant trauma. Mum remembers that her brother had the same problem when he was young. Blood tests show PT 12 seconds (normal 11-14), APTT 55 seconds (normal 29-39) & fibrinogen 2.2g/l (normal 1.9-4.3). Von Willebrand factor is normal. Factor VIII assay is reduced, whilst factor IX is normal. What is the most likely cause of the above presentation? A) Non Accidental Injury B) Ehlers-Danlos syndrome C) Von Willebrand Disease D)Hemophilia A E) Hemophilia B ```

A 68 year old man has presented with progressive shortness of breath, fatigue and worsening pain in his left leg and back. He has lost 2 stone of weight in the past year. On his last appointment it was noted that his renal function was deranged. Routine bloods show Hb 104g/l (normal 135-180), MCV 93fl (normal 80-102fl), WCC 2.8 (normal 3.4-11.0). Which of the following investigations would be most useful initially in finding the source of his symptoms? A) Abdominal ultrasound B) Lumbar spine X ray C) Blood film D) Urine electrophoresis (Bence Jones protein) E) DEXA Scan

``` A 7 year old girl has presented with petechiae on her knees and shins as well as frequent nosebleeds. She had a viral infection 2 weeks ago from which she apparently recovered. She appears clinically well in herself, with no temperature. She has no joint pain. PT, APTT, vW factor, factor VIII and factor IX are all normal. Her platelets are 100 (140-450). What is the most likely cause of these findings? A) Meningococcal septicaemia B) Henoch-Schonlein purpura C) Idiopathic thrombocytopenic purpura D) Von Willebrand’s disease E) Non-accidental injury ```

A 19-year-old female presents to the GP with a one-week history of fever, numbness, and difficulty speaking. She has never experienced anything like this before, and takes no medication. On examination, splenomegaly is noted as well as several purpura on her extremities. Bloods reveals normocytic anemia, decreased platelets, and elevated creatinine. What is the most likely diagnosis? A) Disseminated intravascular coagulation B) Drug-induced thrombocytopenia C) Haemolytic uraemic syndrome D) Immune thrombocytopenic purpura E) Thrombotic thrombocytopenia purpura

``` A four-year-old boy presents to the GP surgery with his mother. He has been feeling unwell for the past 3 weeks, with fevers, headaches and tiredness. His mother is concerned that he has been getting worse over time instead of better. He looks very pale and has many bruises and petechiae on his arms and legs, which have appeared spontaneously over the past week. Abdominal examination reveals an enlarged liver and spleen. An urgent full blood count shows: haemoglobin 68g/L (normal 120-180), platelets 25 (normal 150-450), white cell count 83 (normal 3.4-11.0). What is the most likely diagnosis in this child? A) Acute lymphoblastic leukaemia B) Aplastic anaemia C) Epstein-Barr virus D) Idiopathic thrombocytopenic purpura E) Lymphoma ```

``` A 6-month-old baby boy born to Pakistani parents presents with failure to thrive. He is found to have pallor and hepatosplenomegaly. His FBC shows Hb 78 g/l (99–141), MCV 65 fl (71–84) and MCH 18 pg (24–34). His blood film shows hypochromia, microcytosis and some nucleated red blood cells. Serum ferritin is 25 μg/l (14–200). What is the most likely diagnosis A) β thalassaemia B) Congenital dyserythropoietic anaemia C) Congenital sideroblastic anaemia D) Iron deficiency anaemia E) Lymphoma ```

``` A 63-year-old man with rheumatoid arthritis has come in complaining about tiredness and fatigue. His blood tests show an Hb of 98 g/l (low) and an MCV of 78 fl ( 80-100). His serum iron and TIBC are low and his serum ferritin is 115 μg/l (15–200). The most likely diagnosis is: A) Iron deficiency Anemia B) Acquired sideroblastic anemia C) Anemia of chronic disease D) Aplastic Anemia E) β thalassemia trait ```

A 59-year-old woman presents with fatigue. Her FBC shows WBC 4.8 × 109 /l(normal), Hb 93 g/l (low), MCV 115 fl(80-100). Her blood film shows macrocytes and hypersegmented neutrophils. She has a past history of Hashimoto thyroiditis. What is the most appropriate test to confirm the diagnosis you suspect? A) Beta cell antibodies B) Intrinsic factor antibodies and Parietal cell antibodies C) Adrenal antibodies D) Plasma homocysteine E) Serum iron levels

A 1-year-old boy presents with sudden-onset fever and vomiting. Findings include irritability, tachycardia, pallor, cold extremities, diffuse skin rash with abdominal petechiae, signs of meningeal irritation and is hypotensive. He is bleeding from the IV sites. Blood tests show leukocytosis, markedly decreased platelet count, increased prothrombin time (PT) and partial thromboplastin time (APTT), decreased fibrinogen, elevated fibrin degradation products, elevated urea, and metabolic acidosis. What is the most likely diagnosis? A) Hemolytic Uremic Syndrome B) Thrombotic Thrombocytopenic Purpura C) Disseminated Intravascular Coagulation D) ITP E) Von Willebrand Disease

A 20-year-old female student is referred by her GP to your specialist clinic because she has felt unwell for the past two weeks. She has had a sore throat and felt very fatigued. On examination she seems pale, her throat is inflamed, and she has swollen cervical lymph nodes. You examine her abdomen and find a palpable spleen just below the left costal margin. Her blood tests show low hemoglobin, elevated LDH and bilirubin and a positive Direct Coombs Test for complement on the surface of cells. What is the most likely diagnosis A) Autoimmune Hemolytic Anemia B) Hemolytic uremic syndrome C) Disseminated intravascular coagulation D) Malaria E) Paroxysmal nocturnal hemoglobinuria

A 16-year-old boy presents to his GP complaining of nosebleeds and bleeding after brushing his teeth. He is unsure of how long this has been occurring but decided to seek advice after having to continually excuse himself from lessons. On examination you notice he has some skin bruises. A blood test shows a prolonged bleeding time and activated partial thromboplastin time (APTT), while platelet count and prothrombin times are all normal. The most likely diagnosis is: A) Von Willebrand disease B) Liver disease C) Disseminated intravascular coagulation D) Congenital afibrinogenaemia E) Glanzmann’s thrombasthenia

A 33-year-old man travels to South Africa to take part in a safari. On arriving, the patient takes his antimalarial tablets. A few days into his course he becomes ill complaining of shortness of breath, pallor and bloody urine. Blood tests reveal anemia and reduced hematocrit, while a blood smear shows the presence of Heinz bodies. The most likely diagnosis is: A) Hereditary elliptocytosis B) Glucose-6-phosphate dehydrogenase deficiency C) Hereditary spherocytosis D) Autoimmune hemolytic anemia E) Microangiopathic hemolytic anemia

A 65-year-old man presents to you reporting he has become increasingly worried about his lack of energy in the last 2 weeks. He mentions he has been increasingly tired, sleeping for long periods and has suffered from fevers unresponsive to paracetamol. He became increasingly worried when he noticed bleeding originating from his gums. A blood film shows rod like inclusion bodies in granular blast cells. The most likely diagnosis is: A) Acute lymphoblastic leukemia B) DiGeorge syndrome C) Disseminated intravascular coagulation D) Acute myeloid leukemia E) Afibrinogenemia

``` A 47-year-old woman presents complaining of dark stools and painful fingers on both hands. She appears plethoric and complains of severe itching, often when she takes a hot shower. A large liver and spleen is palpable. You measure red cell mass which is raised but EPO levels were decreased. Which of the following is likely to be the diagnosis? A) Anemia of chronic disease B) AML C) Polycythemia Rubra Vera D) ALL E) Pyruvate-Kinase deficiency ```

``` A 55 year old man presents with fatigue. He has had several episodes of haematemesis in the past 48 hours. He has a history of alcoholic cirrhosis and is being treated for ascites and encephalopathy. OE he has a HR of 85bpm and BP 84/62. What is the most likely cause of his fatigue? A) Excess alcohol intake B) Azathioprine use C) Acute blood loss D) Lead poisoning E) Haemolysis ```

``` A 45 year old woman presents with symptoms of fatigue, depression and weight gain. OE she has a heart rate of 58bpm, dry skin and bilateral eyelid oedema. FBC reveals a macrocytic anemia. What is the likely cause of the anemia? A) Iron deficiency B) B12 deficiency C) Alcohol D) Hypothyroidism E) Lead poisoning ```

``` A 62 year old male presents to his GP for his annual review. He denies any weight loss, fevers or fatigue. Bloods are taken and show an elevated WBC, predominantly lymphocytes. On blood smear, ruptured white blood cells are seen. What is the most likely diagnosis? A) CLL B) AML C) Hodgkin’s lymphoma D) ALL E) Myeloma ```

``` Which of the following drugs works by inhibiting CD20? A) Doxorubicin B) Bleomycin C) Vincristine D) Rituximab E) Cyclophosphamide ```

``` "An accumulation of mature B cells that have escaped apoptosis and undergone cell cycle arrest" A) CLL B) CML C) ALL D) AML ```

``` "Blood count would show low/normal Hb, very high WCC with high lymphocytes, smudge cells in vitro" A) CLL B) CML C) ALL D) AML ```

``` "Uncontrolled clonal proliferation of myeloid cells due to Philladelphia chromosome" A) CLL B) CML C) ALL D) AML ```

``` "Blood count would show low Hb, very high WCC with high neutrophils, basophils and eosinophils." A) CLL B) CML C) ALL D) AML ```

``` "Treated using Imatinib (a tyrosine kinase inhibitor) or stem cell transplant" A) CLL B) CML C) ALL D) AML ```

``` "A cancer of childhood" A) CLL B) CML C) ALL D) AML ```

``` "Malignancy of immature lymphoid cells= Usually B cell precursors if in children" A) CLL B) CML C) ALL D) AML ```

``` "Neoplastic proliferation of blast cells derived from marrow myeloid" A) CLL B) CML C) ALL D) AML ```

``` A 39 year old man presents with a three month history of lethargy, fatigue and night sweats. On examination you note enlarged, painless cervical lymph nodes and splenomegaly. Blood tests show Hb 103 g/l (normal 135-180g/l), WCC 12.0 (normal 3.4-11), ESR 70 (<12). Histologically multinucleated giant cells (Reed-Sternberg cells) are noted. What is the most likely cause of this patient’s symptoms? A) Burkitt’s Lymphoma B) Hodgkin’s Lymphoma C) Chronic Myeloid Leukemia D) Non-Hodgkin’s Lymphoma E) Tuberculosis ```

``` Which of the following blood types is the most common A) A+ B) B+ C) AB+ D) O+ E) None of the above ```

``` Angular stomatitis, lemon-yellow skin, ataxia and delusions are hallmarks of which type of anaemia? A) Pernicious anaemia B) Iron deficiency anaemia C) Anaemia of chronic disease D) Blood loss anaemia E) Sickle cell anaemia ```

``` You are a junior doctor on your haematology rotation. You have just seen a 50 year old woman who presented with anaemia, gum hypertrophy and bone pain. You do a full blood count which shows thrombocytopaenia and neutropoenia. A bone marrow biopsy shows Auer rods. What would you treat this woman for? A) ALL B) AML C) CLL D) CML E) None of the above ```

You are an F2 on a tropic medicine rotation. You are seeing a patient who has recently been on holiday to Asia and is now complaining of nausea, loss of appetite, abdominal pain and some weight loss. Her symptoms started 6 weeks after returning to the UK. You perform some tests and diagnose tapeworm. Which of the following would you expect to see? A) Neutrophilia B) Neutropenia C) Eosinophilia D) Lymphocytosis E) Lymphocytopenia

You are looking through a patients results that have just been sent to you. They show microcytic red blood cells, a low serum iron, and high transferrin receptors. What do you diagnose? A) Autoimmune pernicious anaemia B) Malabsorption causing folate deficiency C) Iron deficiency anaemia D) Anaemia of chronic disease E) Chronic excess alcohol

A 24 year old woman presents with brittle hair and nails, headaches, and ulceration at the courner of the mouth. What is it most likely to be? A) Autoimmune pernicious anaemia B) Malabsorption causing folate deficiency C) Iron deficiency anaemia D) Anaemia of chronic disease E) Chronic excess alcohol

``` Which of the following is not a cause of normocytic anaemia A) Acute blood loss B) Anaemia of chronic disease C) Pregnancy D) Liver failure E) Hypothyroidism ```

What is the most common cause of anaemia world wide? A) Autoimmune pernicious anaemia B) Malabsorption causing folate deficiency C) Iron deficiency anaemia D) Anaemia of chronic disease E) Chronic excess alcohol

``` A patient presents with anaemia. They have yellowing of the skin, and have a past medical history of Addison's disease. How would you treat? A) Ferrous sulphate B) Erythropoietin C) IM Hydroxocobalamin D) IV iron E) Oral B12 ```

``` A 64 year old man presents with a pain in his leg. It is swollen, red and there are enlarged veins. He has recently travelled back from USA. What would be your first line investigation? A) Plasma D dimer B) X Ray C) Aspiration D) Blood culture E) FBC ```

``` A 64 year old man presents with a pain in his leg. It is swollen, red and there are enlarged veins. He has recently travelled back from USA. How would you treat? A) Oral Imatinib B) Allopurinol C) Prednisolone D) Bed rest E) Enoxaparin and warfarin ```

``` A patient presents with painless 'rubbery' cervical lymphadenopathy, but no other symptoms. On CT, they appear to have tumour spread to multiple lymph nodes; the axillary lymph nodes, the cervical lymph nodes and the inguinal lymph nodes. What Ann Harbor stage are they at? A) IA B) IB C) IIA D) IIIA E) IIIB ```

``` A patient presents with painless 'rubbery' cervical lymphadenopathy, but no other symptoms. On CT, they appear to have tumour spread to multiple lymph nodes; the axillary lymph nodes, the cervical lymph nodes and the inguinal lymph nodes. What chemotherapy regime would you use? A) ABVD B) RCHOP C) VAD D) ECF E) CMV ```

A 72 year old patient presents with hypercalcaemia, thirst, fatigue and back pain. What tests would you order? A) CT of chest B) Bone marrow aspirate C) Serum and urine electrophoresis for bence jones protein and B-12 microglobulin D) Genetic screen for JAK2 mutation E) Coagulation screen

``` A 72 year old patient presents with hypercalcaemia, thirst, fatigue and back pain. What chemotherapy regime would you use? A) ABVD B) RCHOP C) VAD D) ECF E) CMV ```

``` Which type of immunoglobulin is most commonly used in myeloma? A) IgA B) IgG C) IgM D) IgD E) IgE ```

``` A patient is positive for JAK2 mutation. What condition is this associated with? A) Multiple Myeloma B) Burkitt's lymphoma C) Thalassemia D) Polycythaemia vera E) G6PD Deficiency ```

``` A 68 year old patient presents with headaches and tiredness. On questioning, she also reveals that she often gets burning sensations in her fingers, and feels very itchy after having a hot bath. When you examine her, she has hepatosplenomegaly and hypertension. How would you treat? A) Radioactive phosphorus B) Venesection C) Warfarin D) Stem cell transplant E) Fresh frozen plasma ```

``` What would spherocytes and a negative direct Coombs' test be indicative of? A) Drugs e.g. NSAIDs B) Autoimmune haemolytic anaemia C) Hereditary spherocytosis D) Thrombotic thrombyctopenia E) DIC ```

``` What is haemolytic anaemia associated with? A) Bite cells B) Blister cells C) Heinz Bodies D) Popcorn cells E) Fragmented red blood cells ```

``` A patient presents with a rash and fever. They appear confused. On blood tests, they show fragmented red blood cells, and a raised lactate dehydrogenase. What is it likely to be? A) ITP B) TTP C) SLE D) DIC E) Thalassemia ```

How would you treat thrombotic thrombocytopenic purpura? A) Plasma exchange B) Splenectomy C) IV immunoglobulins D) Folic acid and BMT if severe E) Replace platelets, plasma and fibrinogen

How would you treat immune thrombocytopenic purpura? A) Plasma exchange B) Corticosteroids C) Chemotherapy D) Folic acid and BMT if severe E) Replace platelets, plasma and fibrinogen

A patient presents with fatigue and headaches. She also reports pain in the hands and feet, and this appears worse on cold days. How would you treat her? A) Plasma exchange B) Corticosteroids C) Chemotherapy D) Folic acid and BMT if severe E) Replace platelets, plasma and fibrinogen

``` A woman has just had an emergency C section. Afterwards, the midwife notices that she seems pale, confused and is bleeding from her IV sites and nose. What is it likely to be? A) ITP B) TTP C) SLE D) DIC E) Thalassemia ```

``` How would you treat warfarin overdose? A) Protamine sulfate B) Phytomenadione C) N-acetylcysteine D) Activated charcoal E) Fomepizole ```

``` John, a 56 year-old male, is recovering chemotherapy treatment for his Acute Myeloid Leukaemia. You perform a blood test which reveals hyperkalaemia, hyperuricemia, hyperphosphatemia, hypocalcaemia. What condition has john developed? A) Anaemia of chronic disease B) Mucositis C) Hand-foot syndrome D) Tumour lysis syndrome E) Multiple myeloma ```

``` Which of the following is not a common side effect of ferrous sulphate? A) Nausea B) Black stools C) GI Upset D) Abdominal discomfort E) Headaches ```

Camilla is a 25 year old lady who has just returned home from visiting Ghana. She presents with very generic flu-like symptoms (fever, headache, cough) and is concerned that something is wrong. Whilst taking her history, you learn that she suffered from many mosquito bites during her trip. What investigation would you organise to confirm your diagnosis? A) FBC B) Thick and thin blood smears C) Coagulation factors D) X Ray E) BLood culture

``` You are an F1 who sees a 5 year-old patient. His mother tells you that he has recently had a lot of nosebleeds and feels tired all the time. What is it likely to be? A) ITP B) TTP C) SLE D) DIC E) Thalassemia ```

``` Which of the following is not typically present on pulmonary embolism X ray? A) Westermark sign B) Palla's sign C) Kernig's sign D) Hampton's hump E) Melting sign ```

A patient with recently diagnosed heart failure comes to your GP practice for a check-up and medication review. He tells you that he has felt a little weaker and more tired than usual recently. His current medications include: Furosemide, Ramipril, Bisoprolol His blood results show: Sodium: 142 (135-145) Potassium: 2.4 (3.5-5.5) Which of the following drugs is the most likely cause of the electrolyte abnormality? a) Furosemide b) Ramipril c) Bisoprolol d) None of the above

A patient with recently diagnosed heart failure comes to your GP practice for a check-up and medication review. He tells you that he has felt a little weaker and more tired than usual recently. His current medications include: Furosemide, Ramipril, Bisoprolol His blood results show: Sodium: 142 (135-145) Potassium: 2.4 (3.5-5.5) Which of the following diuretics is most appropriate? A) Furosemide B) Bendroflumethiazide C) Spirolactone D) Verapamil

A patient presents to A and E following an episode where they lost consciousness. They were alone so are unsure how long they were out for. On questioning, you find out that the episode was preceded by palpitations, dizziness and shortness of breath, and that they have a family history of 'heartbeat problems’. You perform an ECG, which shows a sawtooth pattern. What is the most likely diagnosis? A) Atrial fibrillation B) Atrial flutter C) Mobitz II heart block D) Tachycardia

You are a junior doctor and see a 26 year old woman who came to A&E complaining of chest pain. She has a past medical history of type 1 diabetes, and has a family history of rheumatoid arthritis. You decide to perform an ECG, and whilst you're placing the leads you notice a widespread rash on the patient's cheeks, neck and chest, which she says gets worse after she's been in the sun. The ECG shows widespread saddle-shaped ST elevation. What is the likely cause of her chest pain? A) STEMI B) Infective Endocarditis C) Prinzmetal Angina D) Pericarditis

You are a junior doctor and see a 26 year old woman who came to A&E complaining of chest pain. She has a past medical history of type 1 diabetes, and has a family history of rheumatoid arthritis. You decide to perform an ECG, and whilst you're placing the leads you notice a widespread rash on the patient's cheeks, neck and chest, which she says gets worse after she's been in the sun. The ECG shows widespread saddle-shaped ST elevation. What is the most likely underlying cause? A) Type 1 Diabetes Mellitus B) Rheumatoid arthritis C) Systemic Lupus Erythematosus D) Mycobacterium Tuberculosis

22 year old presents to the GP saying sometimes he experiences 'his heart racing' and he gets really dizzy. He sometimes gets chest pain during these episodes. His dad and grandad both died in their twenties/thirties, but he doesn't remember what from, and he is scared that he has the same condition. Which of the following differential diagnoses is the most common cause of sudden cardiac death in young people? A) Restrictive cardiomyopathy B) Dilated cardiomyopathy C) Hypertrophic cardiomyopathy D) Pericarditis

You are the on-call doctor for the cardiology ward, and the dental hospital sends you an urgent referral for a patient who they are treating for gum disease, who has signs of sepsis. The patient is a known intravenous drug user. What diagnosis springs to mind without even seeing the patient? A) Pericarditis B) Infective endocarditis C) NSTEMI D) Rheumatic fever

You are the on-call doctor for the cardiology ward, and the dental hospital sends you an urgent referral for a patient who they are treating for gum disease, who has signs of sepsis. The patient is a known intravenous drug user. Which of the following signs would help towards your diagnosis A) Splinter haemorrhages B) Roth spots C) Neither D) Both

``` You take blood cultures for a patient with infective endocarditis, which show MRSA growth. What antibiotics do you use? A) Rifampicin B) Vancomycin + Rifampicin C) Erythromycin + Vancomycin E) Amoxicillin ```

``` Mrs S is a 56-year-old woman who comes to GP complaining of increased fatigue and palpitations. On examination, you hear a pansystolic murmur at the apex that radiates into the axilla. Which pathology causes this murmur? A) Mitral stenosis B) Aortic stenosis C) Mitral regurgitation D) Aortic regurgitation ```

Mrs S is a 56-year-old woman who comes to GP complaining of increased fatigue and palpitations. On examination, you hear a pansystolic murmur at the apex that radiates into the axilla. When you ask about previous episodes of palpitations, Mrs S tells you that when she was around 12 and still lived in India, she did experience palpitations, fever and a rash on her torso which she thinks happened around 3 weeks after she had a sore throat. What was the likely cause of her childhood illness? A) Infective endocarditis B) Rheumatic fever C) Scarlet fever D) Hypertension

``` Which of the following is a Lancefield Group A, Beta-Haemolytic streptococcus. A) Streptococcus pyogenes. B) Streptococcus pneumoniae C) Streptococcus bovis D) Streptococcus aureus ```

``` What is the Wells score used for? A) Assessment of risk for DVT or PE B) Risk of developing cardiovascular disease in the next 10 years C) Risk of stroke after TIA D) Risk of mortality in ICU E) Severity of pneumonia ```

``` What is the QRISK score used for? A) Assessment of risk for DVT or PE B) Risk of developing cardiovascular disease in the next 10 years C) Risk of stroke after TIA D) Risk of mortality in ICU E) Severity of pneumonia ```

``` What is the ABCD2 score used for? A) Assessment of risk for DVT or PE B) Risk of developing cardiovascular disease in the next 10 years C) Risk of stroke after TIA D) Risk of mortality in ICU E) Severity of pneumonia ```

``` What is the apache score used for? A) Assessment of risk for DVT or PE B) Risk of developing cardiovascular disease in the next 10 years C) Risk of stroke after TIA D) Risk of mortality in ICU E) Severity of pneumonia ```

``` What is the CURB65 score used for? A) Assessment of risk for DVT or PE B) Risk of developing cardiovascular disease in the next 10 years C) Risk of stroke after TIA D) Risk of mortality in ICU E) Severity of pneumonia ```

``` Which of the following is not a true stage of the fontaine classification? A) Asymptomatic B) Intermittent claudication C) Rest pain D) Oxygen debt E) Necrosis ```

``` What would be the first-line treatment for a 49-year-old Caribbean male with a BP of 148/96? A) Ramipril B) Amlidopine C) Candesartan D) Hydrochlorothiazide E) Furosemide ```

``` What would be the first-line treatment for a 46-year-old white male with a BP of 148/96? A) Ramipril B) Amlidopine C) Candesartan D) Hydrochlorothiazide E) Furosemide ```

``` What would be the first-line treatment for a 46-year-old white male with a BP of 148/96. He has severe asthma. A) Ramipril B) Amlidopine C) Candesartan D) Hydrochlorothiazide E) Furosemide ```

``` Which of the following arteries does not typically get atherosclerosis? A) Ascending aorta B) Cerebral C) Common iliac D) Coronary E) Carotid ```

``` A 69-year-old man presents to you with shortness of breath, tiredness and swelling in his ankles. Which of the following blood test abnormalities would you expect to see? A) Low haemoglobin and reticulocytes B) Bence jones protein band C) Increased BNP D) Raised plasma D dimer E) CRP and ESR raised ```

``` What is the commonest cause of heart failure? A) Ischaemic heart disease B) Cardiomyopathy C) Valvular heart disease D) Hypertension E) Cor pulmonale ```

``` What is the most common congenital heart defect? A) Tetralogy of Fallot B) Ventricular septal defect C) Patent ductus arteriosus D) Atrial septal defect E) None of the above ```

Which of the following is not one of the components of tetralogy of fallot? A) A large, maligned ventricular septal defect B) An overriding aorta C) RV outflow obstruction D) Stenosis of aortic valves E) RV hypertrophy

``` A 3 day old baby is brought into A&E as baby's mother is concerned that baby's tummy has a blue tinge. She also appears distressed and doesn't want to eat. You order an X ray, and it shows a boot shaped heart. What is it likely to be? A) Tetralogy of Fallot B) Ventricular septal defect C) Patent ductus arteriosus D) Atrial septal defect E) None of the above ```

``` A patient presents with a tight pain in the chest that radiates to the jaw. This pain lasted around 15 minutes, and when the patient sat back down the pain dissipated. However when walking into the GP surgery today, the pain returned. What investigation would you order? A) CXR B) Echocardiogram C) FBC and BNP D) CT coronary angiography E) Abdominal MRI ```

``` A 65 year old man has just had his abdominal aortic aneurysm screen, and the ultrasound doctor noted an aneurysm that is roughly 5cm diameter. How would you treat? A) Endovascular stent B) Urgent antihypertensives C) Watch and wait D) GTN Spray E) Coronary revascularisation ```

``` How are abdominal aortic aneurysms screened for? A) Ultrasound B) MRI C) CT D) Abdominal X ray E) Echocardiogram ```

``` A 58 year old man presents with a sudden onset of severe central chest pain. He appears shocked and after some initial tests, you note that alongside the main problem, he has AKI and hypertension. His ECG all appears normal. What investigation would you order? A) Echocardiogram B) CT chest and abdomen C) Abdominal ultrasound D) CT coronary angiography E) ECG ```

``` A 58 year old man presents with a sudden onset of severe central chest pain. He appears shocked and after some initial tests, you note that alongside the main problem, he has AKI and hypertension. His ECG all appears normal. What is it likely to be? A) Aortic aneurysm B) Aortic dissection C) Angina D) Acute pericarditis E) Infective endocarditis ```

``` Which of the following is not part of the steps of immediate management of ACS? A) Morphine/ other analgesic B) Statins C) Nitrate D) Aspirin 300mg stat E) Clopidogrel ```

``` A patient presents with central chest pain that radiates. Their ECG shows ST elevation. What would your treatment of choice be? A) Fondaparinux B) Clopidogrel C) PCI D) Nitrate E) None of the above ```

``` A patient presents with central chest pain that radiates. Their ECG shows ST depression but normal troponins. What is it likely to be? A) STEMI B) NSTEMI C) Unstable angina D) Stable angina E) Aortic dissection ```

``` Which of the following is not typically given for ACS prevention? A) ACE-I B) Clopidogrel C) Atorvastatin D) Aspirin E) Nitrate ```

``` Which of the following is not a common complication of ACS? A) Sudden death B) Rupture of myocardium C) Oedema D) Increased risk of aortic dissection E) Arrhythmias ```

``` A 67 year old man presents with chest pains and palpitations. You perform an ECG and it shows an irregular and rapid QRS complex with absent P waves. What is it likely to be? A) Atrial flutter B) Atrial fibrillation C) Ventricular tachycardia D) Long QT E) Sinus Tachycardia ```

Which of the following is most likely to be seen in atrial flutter? A) Irregular and rapid QRS complex with absent P waves B) Regular sawtooth-like F waves C) Rapid ventricular rhythm D) Prolonged QT interval E) Saddle shaped ST elevation

Which of the following is most likely to be seen in atrial fibrillation? A) Irregular and rapid QRS complex with absent P waves B) Regular sawtooth-like F waves C) Rapid ventricular rhythm D) Prolonged QT interval E) Saddle shaped ST elevation

Which of the following is most likely to be seen in acute pericarditis ? A) Irregular and rapid QRS complex with absent P waves B) Regular sawtooth-like F waves C) Rapid ventricular rhythm D) Prolonged QT interval E) Saddle shaped ST elevation

A patient presents with regular sawtooth like flutter waves on ECG. How would you treat? A) Electrical cardioversion with enoxaparin beforehand B) Calcium channel blocker C) IV Isoprenaline D) Carotid massage E) IV antibiotics

``` A patient presents with absent femoral pulses and cold white legs. They report that during exercise they pain in the leg. He smokes and has a PMH of hypertension and type 2 diabetes. How would you diagnose? A) ECG and Echo B) Echocardiogram C) Ankle-brachial pressure index and USS D) CXR E) CT coronary angiography ```

``` Which of the following is not a symptom of acute lower limb ischaemia? A) Pallor B) Perishing cold C) Pulselessness D) Paraplegia E) Pins and needles ```

``` What is the commonest cause of infective endocarditis? A) P. Aeruginosa B) Staph Aureus C) Strep Viridans D) Enterovirus E) Autoimmune ```

``` What is the commonest cause of pericarditis? A) P. Aeruginosa B) Staph Aureus C) Strep Viridans D) Enterovirus E) Autoimmune ```

``` A 27 year old man reports to A&E with a severe fever, headache, confusion and chest pains. You perform a transoesophageal echo and notice an embolism at the pulmonary valves. What is the most likely cause of his infective endocarditis? A) IV drug use B) Dental surgery/ treatment C) Skin infection D) Cardiac surgery E) Bicuspid valves ```

``` A 27 year old man reports to A&E with a severe fever, headache, confusion and chest pains. You perform a transoesophageal echo and notice an embolism at the pulmonary valves. You perform some tests and notice that it is a coagulase positive, gram positive cocci. How would you treat? A) IV benzylpenicillin B) IV amoxicillin C) IV Cefuroxime and metronidazole D) Erythromycin + Vancomycin E) IV vancomycin and Rifampicin ```

``` A 27 year old man reports to A&E with a severe fever, headache, confusion and chest pains. You perform a transoesophageal echo and notice an embolism at the pulmonary valves. Which of the following is not a likely sign? A) Splinter haemorrhages on nail beds B) Osler nodes C) Janeway lesions D) Kerley B lines E) Roth spots ```

``` A woman presents with a severe chest pain that is worse when she breathes in, and feels better when she leans forwards. She also has a fever and is breathless. She has a PMH of Sjorgrens syndrome. How would you diagnose? A) ECG B) Transoesophageal Echocardiogram C) Ankle-brachial pressure index and USS D) Blood culture E) CT coronary angiography ```

``` A woman presents with a severe chest pain that is worse when she breathes in, and feels better when she leans forwards. She also has a fever and is breathless. She has a PMH of Sjorgrens syndrome. How would you treat? A) IV benzylpenicillin B) Aspirin C) IV Cefuroxime and metronidazole D) Colchicine for 3 weeks E) IV vancomycin and Rifampicin ```

``` How do you diagnose bundle branch block? A) ECG B) Transoesophageal Echocardiogram C) Ankle-brachial pressure index and USS D) Blood culture E) CT coronary angiography ```

``` What is anaphylactic shock a type of? A) Hypovolaemic shock B) Cardiogenic shock C) Distributive shock D) Anaemic shock E) Cytotoxic shock ```

``` How can you quickly check for shock? A) ECG B) Transoesophageal Echocardiogram C) Ankle-brachial pressure index and USS D) Capillary refill time E) CT coronary angiography ```

Wat is the most common cause of cardiac death in young people? A) Arrhythmogenic right ventricular cardiomyopathy B) Restrictive cardiomyopathy C) Dilated cardiomyopathy D) Hypertrophic cardiomyopathy E) None of the above

Which of the following would be the ECG finding of Wolff-Parkinson-White syndrome? A) Irregular and rapid QRS complex with absent P waves B) Regular sawtooth-like F waves C) Wide QRS complex that begins with a slurred Delta wave D) Prolonged QT interval E) Saddle shaped ST elevation

``` A patient presents with breathlessness, chest pain and oedema of the ankles. On examination, the apex beat is displaced inferiorly and laterally, and you can hear systolic ejection murmer. She has a Corrigan's pulse. What is it likely to be? A) Aortic regurgitation B) Aortic stenosis C) Mitral regurgitation D) Mitral stenosis E) None of the above ```

``` A patient presents with breathlessness and angina. On examination, you can hear an systolic ejection murmer that has crescendo-descendo character. What is it likely to be? A) Aortic regurgitation B) Aortic stenosis C) Mitral regurgitation D) Mitral stenosis E) None of the above ```

``` Which of the following does not typically cause aortic stenosis? A) Calcium build up B) Congenital BAV C) Rheumatic heart disease D) Anaemia E) Past radiotherapy ```

``` Which valve defect is the most common? A) Aortic regurgitation B) Aortic stenosis C) Mitral regurgitation D) Mitral stenosis E) None of the above ```

``` A patient presents with malar flush and atrial fibrilation. On examination, she has a mid-diastolic, low pitched rumbling murmer. What is it most likely to be? A) Aortic regurgitation B) Aortic stenosis C) Mitral regurgitation D) Mitral stenosis E) None of the above ```

``` A patient presents for a regular check up, but on examination you notice she has a pan systolic, high pitched whistling murmur. She has a PMH of Marfans syndrome. What is it most likely to be? A) Aortic regurgitation B) Aortic stenosis C) Mitral regurgitation D) Mitral stenosis E) None of the above ```

``` What medication would you prescribe for a patient with heart failure A) Statins B) Digoxin C) Calcium channel blocker D) Enoxaparin E) Warfarin ```

Which of the following is false regarding colorectal cancer.. A) Bowel cancer screening is offered to people aged 60+ B) The majority of cancers occur in the proximal colon C) FAP and HNPCC are two inherited causes of colon cancer D) Proximal cancers usually have a worse prognosis E) Patients with PSC and UC have an increased risk of developing colon cancer

A 50 year old man presents with dysphagia. Which one of the following suggests a benign nature of the disease A) Weight loss B) Dysphagia to solids initially then both solids and liquids C) Dysphagia to solids and liquids from the start D) Anaemia E) Recent onset of symptoms

``` A 19 year old girl presents with abdominal pain and loose stool. Which of the following would suggest IBS A) Anaemia B) Nocturnal diarrhoea C) Weight loss D) Blood in stool E) Abdominal pain related to daefacation ```

Which statement is true regarding H pyolri A) It is a gram positive bacteria B) HP prevalence is similar in developing and developed countries C) 15% of patients with duodenal ulcer are infected with H pylori D) PPIs should be stopped a week before a H pylori stool antigen test E) It is associated with an increased risk of gastric cancer

Which of the following features best distinguishes ulcerative colitis from Crohn's disease A) Ileal involvement B) Continuous colonic involvement on endoscopy C) Non caseating granuloma D) Transmural inflammation E) Perianal disease

``` A 68 year old lady presents with abdominal pain and distention. She last opened her bowel 5 days ago. She has a poor appetite and has lost weight recently. She drinks and smokes regularly. She previously had abdominal hysterectomy and diverticulosis. On examination there is tympanic percussion throughout. There is a small left groin lump with a cough impulse. Which of the following is not the likely cause A) Colon cancer B) Adhesions C) Ascites D) Diverticulitis E) Strangulated hernia ```

``` A 16 year old girl is admitted with vomitting and abdominal pain. She reports taking 20 paracetamol tablets after her boyfriend split up with her. Which one of the following would you not expect to see A) Metabolic acidosis B) Prolonged prothrombin time C) A raised creatinine D) Hyperglycaemia E) ALT 1000 ```

``` Which of the following has continuous lesions... A) IBS B) UC C) Crohn's D) Coeliac's ```

``` Which of the following can be managed with TCAs... A) IBS B) UC C) Crohn's D) Coeliac's ```

``` Which of the following has transmural lesions... A) IBS B) UC C) Crohn's D) Coeliac's ```

``` Which of the following has no nocturnal diarrhoea... A) IBS B) UC C) Crohn's D) Coeliac's ```

``` Which of the following shows villous Atrophy... A) IBS B) UC C) Crohn's D) Coeliac's ```

``` Which of the following is more likely to have mucoid Diarrhoea... A) IBS B) UC C) Crohn's D) Coeliac's ```

``` Which of the following has dermatitis herpetiformis... A) IBS B) UC C) Crohn's D) Coeliac's ```

``` Which of the following is a pANCA positive IBD... A) IBS B) UC C) Crohn's D) Coeliac's ```

``` Which of the following has smoking as a protective factor... A) IBS B) UC C) Crohn's D) Coeliac's ```

``` Which of the following is tTG and EMA positive... A) IBS B) UC C) Crohn's D) Coeliac's ```

``` Which of the following has 3 distinct subtypes... A) IBS B) UC C) Crohn's D) Coeliac's ```

``` Which of the following would use methotrexate to maintain remission... A) IBS B) UC C) Crohn's D) Coeliac's ```

``` A 13 year old child presents in a&e with severe pain and vomitting. The pain has migrated over the last few hours around their umbillicus to a sharp pain in her RLQ. She has guarding and tenderness in this area. Which of the following is the least common cause of acute appendicitis A) Trauma B) Metastases C) Worms D) Bezoars E) Lymphoid hyperplasia ```

``` Which of the following is the most common cause of diarrhoea in adults... A) Norovirus B) C. Jejuni C) Rotavirus D) E. Coli E) Salmonella ```

``` What is the first line test for coeliac disease A) FBC B) HLA DQ2 genotyping C) Serology D) Duodenal Biopsy E) Colonoscopy ```

``` Glenis is a 78 year old lady with a 3 hour history of severe and worsening abdominal pain. On examination, she is very uncomfortable but there are few findings. She has a PMH of HTN and AF. What is the most likely diagnosis? A) Pancreatitis B) Gastroenteritis C) Peritonitis D) Volvulus E) Mesenteric Ischaemia ```

``` Where does diverticular disease normally occur? A) Ascending colon B) Transverse colon C) Rectum D) Sigmoid colon E) Descending colon ```

``` What is used for colon cancer staging? A) The FIGO system B) The Enneking system C) Duke's classification D) Ann Arbor Staging E) Binet System ```

``` Which types of hepatitis are foecal-oral spread? A) A only B) B, C, D C) A and E D) E only E) B only ```

``` A patient had a chest infection and was prescribed ciprofloxacin. However, after afew days she developed severe diarrhoea. What should the antibiotic be changed to? A) Oral Clindamycin B) Oral Vancomycin C) Trimethoprim D) Oral Co-amoxiclav E) Oral Metronidazole ```

``` Simon, a 57-year-old banker, comes in to the surgery complaining of pain immediately below the ribs. After a taking a history, he tells you the pain is typically worse at night and when he’s hungry but has found that a glass of milk seems to help. He had a MI 3 years ago and takes aspirin daily. What is this history suggestive of? A) Diverticulitis B) Appendicitis C) Duodenal ulcer D) Peritonitis E) Gastritis ```

A doctor is performing an abdominal examination of a patient with suspected bowel obstruction. When they percuss an area of the bowel they hear tympanic sounds. What does this indicate is the contents of the bowel in this area? A) Stool B) Liquid C) Air/Gas D) None of the above

``` Patients with Crohn’s disease are often put on long term steroids. Which of the following is not a common side effect? A) Weight gain B) Hypotension C) Osteoporosis D) Hyperglycaemia E) Oedema ```

``` Which of the following is not a part of reynold's pentad? A) RUQ pain B) Hypertension C) Jaundice D) Fever E) Tachycardia ```

``` Which of the following is not correct? A) G cells= Gastric acid B) Parietal cells= Intrinsic factor C) Chief cells= Pepsinogen D) D cells= Somatostatin E) Enterochromaffin-like cells= Histamine ```

``` A 74 year old man presents with a change in bowel habit and anaemia. On colonoscopy it is seen that he has a large tumour in his large bowel which travels into the lumen, and on CT he has metastases in the liver. What Duke's stage is his cancer? A) Dukes A B) Dukes B1 C) Dukes B2 D) Dukes C1 E) Dukes D ```

``` A 74 year old man presents with a change in bowel habit and anaemia. On colonoscopy it is seen that he has a tumour that invades the wall but doesn't appear to go through the wall. On CT he has no metastases. What Duke's stage is his cancer? A) Dukes A B) Dukes B1 C) Dukes B2 D) Dukes C1 E) Dukes D ```

``` What is used for coeliac's disease villous atrophy staging? A) The FIGO system B) The Enneking system C) Duke's classification D) Marsh Stages E) Binet System ```

``` What is the midgut supplied by? A) Coeliac trunk B) Greater splanchnic C) Superior mesenteric D) Inferior mesenteric E) Least splanchnic ```

``` Which of the following is not crossed in the transpyloric plane of Addison? A) Gallbladder B) Calots triangle C) Pancreas D) Duodenal-jejunal flexure E) Kidneys ```

``` Which of the following is not a fat soluble vitamin? A) A B) B C) D D) E E) K ```

``` Which of the following is associated with coeliac's disease A) HLA DQ2 B) HLA B27 C) NOD2 D) HLA DR3 E) None of the above ```

``` A patient presents with a sudden onset of left sided abdominal pain, and has been passing bright red bloody stools. She appears pale and confused, and she has a rapid and weak pulse. What is it most likely to be? A) Acute appendicitis B) Mesenteric ischaemia C) Colonic polyps D) Obstruction E) Cholangitis ```

``` A patient presents with a sudden onset of left sided abdominal pain, and has been passing bright red bloody stools. She appears pale and confused, and she has a rapid and weak pulse. Why would you not do a colonoscopy and biopsy immediately? A) Perforation risk B) Risk of strictures C) Risk of abscess formation D) Risk of septic peritonitis E) Risk of gangrene ```

``` A patient presents with umbilical pain that migrates to the right side after afew hours. She is vomitting and on examination, her abdomen is tender. How would you diagnose? A) Ultrasound scan B) Barium swallow C) Colonoscopy with biopsy D) CT abdomen E) X ray abdomen ```

``` A patient presents with umbilical pain that migrates to the right side after afew hours. She is vomitting and on examination, her abdomen is tender. You schedule her for surgery, but in the meantime, what antibiotic would you prescribe? A) 6 weeks IV Flucloxacillin B) Benzylpenicillin and clindamycin C) Oral Metronidazole D) Oral Co-amoxiclav E) IV Cefuroxime and metronidazole ```

``` What is the most common cause of acute appendicitis? A) Malignancy B) Faecolith C) Lymphoid hyperplasia D) Filarial worms E) Foreign object ```

``` A 42 year old man presents to the GP with a pain in his chest. He has also noticed reoccuring hiccups, and bloating. Which of the following does not typically trigger his condition? A) Being overweight B) Pregnancy C) Smoking D) Aspirin E) Anxiety and stress ```

``` Which of the following is a proton pump inhibitor that would be given for GORD? A) Omeprazole B) Ranitidine C) Ramipril D) Lansoprazole E) Simvastatin ```

``` A 45 year old man presents to the GP with recurrent burning epigastric pain. It is worse in the evenings, and he has noticed that it seems worse when he is hungry. What would be your first line investigation? A) Gastroscopy B) Stool antigen testing C) Gastric histology D) Biopsy urease test E) CT abdomen ```

A 45 year old man presents to the GP with recurrent burning epigastric pain. It is worse in the evenings, and he has noticed that it seems worse when he is hungry. You perform a stool antigen test and it shows positive for H pylori. What would be an appropriate treatment regime? A) Omeprazole, Metronidazole, Amoxicillin B) Ranitidine, Clarithromycin, Amoxicillin C) Omeprazole, Lansoprazole, Metronidazole D) Clarithromycin, metronidazole, amoxicillin E) Metronidazole, Ranitidine, Lansoprazole

``` A 33 year old woman presents to her GP with abdominal pain and bloating. On questioning, she also reports that she is frequently getting diarrhoea, and her period seems more painful than it did prior. This has been happening for 7 months. How would you treat her diarrhoea? A) Mavicol B) Lactulose C) Tricyclic antidepressant D) Antispasmodics E) Loperamide ```

``` A 61 year old patient presents to A&E with an acute, severe abdominal pain. She has no other symptoms. How would you diagnose? A) Gastroscopy B) Stool antigen testing C) Colonoscopy with biopsy D) Barium swallow E) CT angiography ```

``` A 61 year old patient presents to A&E with an acute, severe abdominal pain. She has no other symptoms. What would you suspect? A) Pancreatitis B) Gastroenteritis C) Peritonitis D) Volvulus E) Mesenteric Ischaemia ```

``` A patient presents with weight loss and vomitting. On a blood test he has anaemia, and you request a gastroscopy and biopsy. The results show a gastric adenoma at the pylorus. What chemotherapy regime would you use? A) ABVD B) RCHOP C) VAD D) ECF E) CMV ```

``` A 78 year old man presents with bloody stool, night sweats and weight loss. You perform a few tests, and find he also has anaemia. What test should you order? A) X ray B) Colonoscopy and biopsy C) CT abdomen D) Stool antigen test E) Barium swallow ```

``` Which of the following is not a cardinal sign of obstruction? A) Vomitting B) Abdominal distension C) Colicky abdominal pain D) Absolute constipation E) Pallor ```

``` A patient presents with constant abdominal pain and distension. After afew hours he develops vomitting. He reports he hasn't opened his bowels in several days. What is the most likely cause of his condition? A) Colon Malignancy B) Volvus C) Adhesions D) Hernia E) Crohn's disease ```

``` A patient presents with colicky abdominal pain that develops into a constant pain. He is vomitting, and on examination he has increased bowel sounds. He reports he hasn't opened his bowels in several days. What is the most likely cause of his condition? A) Colon Malignancy B) Volvus C) Adhesions D) Hernia E) Crohn's disease ```

A patient presents with constant abdominal pain and distension. After afew hours he develops vomitting. He reports he hasn't opened his bowels in several days. What would be your first line investigation? A) CT B) X Ray C) MRI D) Immediate treatment without investigation E) Colonoscopy

A patient presents with constant abdominal pain and distension. After afew hours he develops vomitting. He reports he hasn't opened his bowels in several days. What would be your gold standard investigation? A) CT B) X Ray C) MRI D) Immediate treatment without investigation E) Colonoscopy

``` A patient presents with constant abdominal pain and distension. After afew hours he develops vomitting. He reports he hasn't opened his bowels in several days. What would be your gold standard treatment? A) "Drip and suck" technique B) Antispasmodics for the pain C) IV metronidazole D) Appendicectomy E) Supportive treatment ```

``` Which of the following does not cause malabsorption? A) Pancreatitis B) Anorexia nervosa C) Coeliac disease D) Giardia lamblia E) Disaccharidase deficiency ```

``` A patient presents with bloody diarrhoea and abdominal pain. She also has mouth ulcers and says she feels "tired all the time". On bloods she is faecal calprotectin positive, and pANCA negative. What would be the gold standard investigation? A) Abdominal X ray B) Abdominal CT C) Barium swallow D) Serology E) Colonoscopy with biopsy ```

``` You are reviewing a patients results that have been sent to you. It shows anaemia, raised ESR and CRP, abnormal liver biochemistry, faecal calprotectin positive, and pANCA negative. What is it most likely to be? A) Ulcerative colitis B) Crohn's disease C) Coeliac's disease D) IBS E) Peritonitis ```

``` You are reviewing a patients results that have been sent to you. It shows anaemia, raised ESR and CRP, abnormal liver biochemistry, faecal calprotectin positive, and pANCA positive. What is it most likely to be? A) Ulcerative colitis B) Crohn's disease C) Coeliac's disease D) IBS E) Peritonitis ```

``` A patient presents with bloody diarrhoea and abdominal pain. She also has mouth ulcers and says she feels "tired all the time". On bloods she is faecal calprotectin positive, and pANCA negative. What would you prescribe to induce remission? A) 5-Aminosalicylic acid B) Azathioprine C) Cefuroxime D) Lidnocaine E) Prednisolone ```

``` A patient presents with bloody diarrhoea and abdominal pain. She also has mouth ulcers and says she feels "tired all the time". On bloods she is faecal calprotectin positive, and pANCA negative. What would you prescribe to maintain remission? A) 5-Aminosalicylic acid B) Azathioprine C) Cefuroxime D) Lidnocaine E) Prednisolone ```

``` You are reviewing a patient's results that have just been sent to you. It reports a CT showing cobblestone bowel in the descending colon and terminal ilium. What is it most likely to be? A) Ulcerative colitis B) Crohn's disease C) Coeliac's disease D) IBS E) Peritonitis ```

``` A patient presents with bloody diarrhoea and abdominal pain. She also has mouth ulcers and says she feels "tired all the time". On bloods she is faecal calprotectin positive, and pANCA positive. What would be the gold standard investigation? A) Abdominal X ray B) Abdominal CT C) Barium swallow D) Serology E) Colonoscopy with biopsy ```

``` A patient presents with bloody diarrhoea and abdominal pain. She also has mouth ulcers and says she feels "tired all the time". On bloods she is faecal calprotectin positive, and pANCA positive. What would you prescribe? A) 5-Aminosalicylic acid B) Azathioprine C) Cefuroxime D) Lidnocaine E) Prednisolone ```

``` You are reviewing a patient's results that have just been sent to you. It reports a CT showing reddened and inflamed colon, extending from the rectum for about 5 inches. What is it most likely to be? A) Ulcerative colitis B) Crohn's disease C) Coeliac's disease D) IBS E) Peritonitis ```

``` You are reviewing a patient's results that have just been sent to you. It reports a CT showing villous atrophy and crypt hyperplasia. What is it most likely to be? A) Ulcerative colitis B) Crohn's disease C) Coeliac's disease D) IBS E) Peritonitis ```

``` A patient presents with diarrhoea and vomitting that has been happening on and off for the past 4 months. This has started waking her up in the night which has caused her to be increasingly worried. She has a PMH of hypothyroidism. What would be your first line investigation? A) Serology B) Distal duodenal biopsy C) FBC D) Erect CXR E) CT abdomen ```

``` A patient presents with diarrhoea and vomitting that has been happening on and off for the past 4 months. This has started waking her up in the night which has caused her to be increasingly worried. She has a PMH of hypothyroidism. What would be your gold standard investigation? A) Serology B) Distal duodenal biopsy C) FBC D) Erect CXR E) CT abdomen ```

``` A 46 year old man presents with abdominal pain. He reports that it only seems to improve when he lies down and puts his hands on his tummy. You perform some blood tests, and it shows a raised WCC and CRP. How would you treat? A) 6 weeks IV Flucloxacillin B) Benzylpenicillin and clindamycin C) Oral Metronidazole D) Oral Co-amoxiclav E) IV Cefuroxime and metronidazole ```

``` A 46 year old man presents with abdominal pain. He reports that it only seems to improve when he lies down and puts his hands on his tummy. You perform some blood tests, and it shows a raised WCC and CRP. You insert an ascitic tap, and it shows the growth of a gram negative bacilli that is a lactose fermenter. What is it most likely to be? A) E. Coli B) Salmonella C) Shigella D) Vibro. Cholerae E) H. Pylori ```

``` A 24 year old man presents to A&E with haematemesis. He appears confused, and his blood alcohol levels are relatively high. What is it most likely to be? A) Variceal bleeding B) Mallory-Weiss Tear C) Peptic ulcer D) Oesophageal tumour E) Mesenteric ischaemia ```

``` A 67 year old man presents with fever and constipation. On examination, he has tachycardia, and has tenderness and guarding on the left side of the abdomen. You perform some blood tests, and it shows a raised WCC, and CRP. How would you treat? A) 6 weeks IV Flucloxacillin B) Benzylpenicillin and clindamycin C) Oral Metronidazole D) Oral Co-amoxiclav E) IV Cefuroxime and metronidazole ```

``` A patient presents with a bulging lump at the top of the thigh. It is not painful and it does press back down. It points towards the groin. What is it most likely to be? A) Direct inguinal hernia B) Indirect inguinal hernia C) Femoral hernia D) Incisional hernia E) Hiatus hernia ```

``` A patient presents with a bulging lump in the stomach. It is not painful and it does press back down. She had an appendicectomy 3 months ago. What is it most likely to be? A) Direct inguinal hernia B) Indirect inguinal hernia C) Femoral hernia D) Incisional hernia E) Hiatus hernia ```

``` A patient presents with a distended abdomen and pain. You examine and can show shifting dullness. How would you diagnose? A) Aspiration of ascitic tap B) Stool antigen testing C) Colonoscopy with biopsy D) Barium swallow E) CT angiography ```

``` Which of the following is not a component of bile? A) CCK B) Bilirubin C) Cholesterol D) Bicarbonate E) Lecithin ```

``` Which of the following liver diseases affects the pancreas and heart? A) Haemochromatosis B) Hep B C) Alpha-1-antitrypsin D) Wilson’s disease ```

``` What is the characteristic FBC finding in alcoholic liver disease A) High platelets B) Macrocytic anaemia C) Microcytic anaemia D) Low WCC ```

``` How to monitor for HCC in patients with cirrhosis A) LFTs B) FBC C) MRI liver D) AFP + USS ```

``` Which of the following has a complication of cholangiocarcinoma A) Autoimmune hepatitis B) Hep B C) PSC D) PBC ```

``` Which of the following clotting factors is not produced by the liver? A) 2 B) 5 C) 7 D) 9 E) 10 ```

``` What is the maximum recommended weekly alcohol intake? A) 10 Units B) 12 Units C) 14 Units D) 16 Units E) 18 Unites ```

``` How is hepatic encephalopathy treated? A) Mavicol B) Lactulose C) Tricyclic antidepressant D) Antispasmodics E) Loperamide ```

``` An Egyptian business man presents to clinic on routine screen. He feels well and has not left the UK for the last 5 years. His partner has recently tested positive for acute hepatits B, but he has no jaundice and feels well. On ultrasound, he has a bright echogenic liver texture but with no focal abnormalitiy. What is it likely to be? A) Hepatitis A B) Acute Hepatitis B C) Chronic Hepatitis B D) Acute Hepatitis D E) Chronic Hepatitis E ```

``` A 21 year old women travelled to Malaysia and was well throughout the holiday. She was unwell for 3 weeks on return with headache, lethargy, aches, poor apetite and fevers. This was self limitting, but she then noticed yellowing of the skin. What is it likely to be? A) Hepatitis A B) Acute Hepatitis B C) Chronic Hepatitis B D) Acute Hepatitis D E) Chronic Hepatitis E ```

``` A 46 year old woman presents with lethargy, poor appetite, yellow skin and dark orange urine. On examination she has tender hepatomegaly and mild pitting oedema. She has not left the UK in over a year, and has a Egyptian new partner recently. What is it likely to be? A) Hepatitis A B) Acute Hepatitis B C) Chronic Hepatitis B D) Acute Hepatitis D E) Chronic Hepatitis E ```

``` A 27-year-old man presents underweight with tender liver. He is not jaundiced, but reports that he has used IV heroine and crack cocaine frequently. On ultrasound, he has a cirrhotic liver. What is it likely to be? A) Hepatitis A B) Acute Hepatitis B C) Chronic Hepatitis B D) Acute Hepatitis D E) Chronic Hepatitis c ```

``` How would you treat a patient with Wernicke-Korsakoff encephalopathy? A) Mavicol B) Lactulose C) IV Thiamine D) Fomepizole E) Loperamide ```

``` A patient presents with history of drinking with dark sticky faeces and blood in her vomit. Which drug would you use to treat her? A) Spironolactone B) Ciprofloxacin C) Propranolol D) Amlodipine E) None of the above ```

``` Which type of hepatitis is acute only? A) Hepatitis A B) Hepatitis A and E C) Hepatitis B D) Hepatitis B, C and D E) Hepatitis E ```

``` What condition would a patient with Charcot's triad likely have? A) Pancreatitis B) Cholangitis C) Appendicitis D) Peritonitis E) Gallstones ```

``` What is the most common cause of portal hypertension worldwide? A) Portal vein thrombosis B) Cirrhosis C) Schistosomiasis D) Right heart failure E) Sarcoidosis ```

``` What is the most common cause of portal hypertension in the UK? A) Portal vein thrombosis B) Cirrhosis C) Schistosomiasis D) Right heart failure E) Sarcoidosis ```

``` A patient presents with fatigue and joint pain. Afew months later, he presents with bronze skin pigmentation, hepatomegaly and diabetes mellitus. What is it likely to be? A) Hepatocellular carcinoma B) Addison's disease C) Gross iron overload D) Alcoholic liver disease E) Portal hypertension ```

``` A patient presents with fatigue and joint pain. He returns afew months later with a slate-gray skin pigmentation and arrhythmia. What would be a first line investigation? A) Serum iron and ferritin B) MRI C) Liver biopsy D) Transabdominal ultrasound E) Abdominal CT ```

``` A patient presents with fatigue and joint pain. He returns afew months later with a slate-gray skin pigmentation and arrhythmia. How would you treat? A) Surgery B) Lifelong venesection C) Iron supplementation D) Liver transplant E) Avoid food high in copper ```

``` What is the most common place for pancreatic adenocarcinoma to occur? A) Pancreatic head B) Pancreatic tail C) Pancreatic body D) Uncinate process E) Pancreatic neck ```

``` What would be raised in hepatocellular carcinoma? A) Alpha fetoprotein B) Beta-hCG C) PSA D) CA15.3 E) CEA ```

``` What would be raised in breast cancer? A) Alpha fetoprotein B) Beta-hCG C) PSA D) CA15.3 E) CEA ```

``` What would be raised in colon cancer? A) Alpha fetoprotein B) Beta-hCG C) PSA D) CA15.3 E) CEA ```

``` What would be raised in testicular carcinoma? A) SCC Antigen B) Beta-hCG C) PSA D) CA15.3 E) CEA ```

``` A patient presents with a sudden onset severe abdominal pain that is increasing. It radiates over the right shoulder. The pain began at around 9pm and lasted until 4am. All lab tests appear normal. What would be your first line investigation? A) MRC B) Genetic testing C) Biopsy D) Enhance CT E) Ultrasound scan ```

``` A patient presents with a sudden onset severe RUQ pain that is increasing. It radiates over the right shoulder. Blood tests show a raised WCC, Increased CRP, Increased serum bilirubin and increased alk phos. What is it likely to be? A) Biliary Colic B) Cholecystitis C) Pancreatic adenocarcinoma D) Hepatocellular carcinoma E) Wilson's disease ```

``` A patient presents with a sudden onset severe RUQ pain that is increasing. It radiates over the right shoulder. Blood tests show a raised WCC, Increased CRP, Increased serum bilirubin and increased alk phos. What would be your first line investigations? A) MRC B) Genetic testing C) Biopsy D) Enhance CT E) Ultrasound scan ```

``` A patient presents with a green-brown pigment around the eye, and hepatitis. What element do they likely have too much of? A) Copper B) Iron C) Phosphorus D) Sodium E) Calcium ```

``` A patient presents with a green-brown pigment around the eye, and hepatitis. How would you treat? A) Thiamine B) Fomepizole C) Penicillamine D) Lactulose e) Ferrous sulphate ```

``` Which of the following is not a cause of pancreatitis? A) Alcohol B) Gallstones C) ERCP D) Iron overload E) Steroids ```

``` A patient presents with severe epigastric pain that radiates to the back. She appears severely dehydrated and has hypotension with tachycardia. Her temperature is raised, and she has left flank bruising. What is it likely to be? A) Ascending cholangitis B) Obstruction C) Acute pancreatitis D) Acute appendicitis E) Mesenteric ischaemia ```

``` A patient presents with severe epigastric pain that radiates to the back. She appears severely dehydrated and has hypotension with tachycardia. Her temperature is raised, and she has left flank bruising. Which lab test would you expect to see? A) Raised WCC B) Raised serum amylase C) Raised ESR D) Viral markers E) Alpha-fetoprotein ```

``` A 48 year old man presents with haematemesis and abdominal pain. He has a PMH of cirrhosis and is taking diazepam and ramipril. What is it likely to be? A) Variceal bleeding B) Mallory-Weiss Tear C) Peptic ulcer D) Oesophageal tumour E) Mesenteric ischaemia ```

``` A 48 year old man presents with haematemesis and abdominal pain. He has a PMH of cirrhosis and is taking diazepam and ramipril. What would be the first line investigation? A) Ultrasound scan B) Barium swallow C) Endoscopy D) CT abdomen E) X ray abdomen ```

``` What blood test result would show heavy drinking? A) Raised alk phos B) Increased MCV C) Decreased MCV D) Leucocytosis E) Elevated serum bilirubin ```

``` How do you treat delerium tremens? A) Thiamine B) Fomepizole C) Penicillamine D) Lactulose E) Diazepam ```

``` A patient presents with liver failure. Which of the following would you not expect to find? A) Low ammonia B) Hyperglycaemia C) Raised PTT D) Raised creatinine E) Decreased ALT ```

``` A patient presents with finger clubbing, palmar erythema, spider naevi and xanthelasma. On examination, you find ascites and a low albumin. What would be the gold standard diagnosis? A) Serum iron and ferritin B) MRI C) Liver biopsy D) Transabdominal ultrasound E) Abdominal CT ```

``` Which of the following is not included in the child-pugh classification for cirrhosis? A) Long prothrombin time B) Serum albumin C) Total serum bilirubin D) Hepatomegaly E) Acites ```

``` What is used to inhibit osteoclasts from bone resorption? A) RANK B) RANKL C) OPG D) GLUT-2 E) Calcitonin ```

``` What is a disease in which there is excessive and unorganised deposition and resorption of the bone? A) Osteoporosis b) Osteomalacia C) Osteopenia D) Osteogenesis imperfecta E) Paget’s disease ```

``` In what disease is there brittle bones due to inefficient collagen? A) Osteoporosis b) Osteomalacia C) Osteopenia D) Osteogenesis imperfecta E) Paget’s disease ```

``` In what disease is there Poorly mineralised matrix due to vitamin D or calcium deficiency? A) Osteoporosis b) Osteomalacia C) Osteopenia D) Osteogenesis imperfecta E) Paget’s disease ```

Which of the following clinical features is typical of osteoarthritis A) 60 mins of early morning stiffness B) Painful, swelling across metacarpophalangeal joints and proximal interphalangeal joints C) Pain in 1st carpo-metacarpal joints D) Mobile, subcut nodules at points of pressure E) Alternating buttock pain

``` Which of the following is an extra-articular manifestation of rheumatoid arthritis A) Sub cut nodules B) Episcleritis C) Peripheral sensory neuropathy D) Pericardial effusion E) All of the above ```

``` Which of the following is a classical feature of RA on X-ray A) Periarticular sclerosis B) Sub-Chondral cysts C) Osteophytes D) Peri-articular erosions E) New bone formation ```

Which of the following could reduce the risk of gout A) A diet with a high red meat content B) A diet rich in dairy C) Drinking >5 cans of non-diet fizzy drinks per day D) A diet rich in sugary foodstuff E) Switching from drinking beer to lager

``` Which of the following is not an autoimmune connective tissue disease A) SLE B) Ehler Danlos syndrome C) Primary Sjorgren's syndrome D) Systemic sclerosis E) Dermatomyositis ```

``` A 23 year old woman presents with mouth ulcers, fever, painful white fingers and pleuritic chest pain. She is ANA +ve, high ESR and low WCC. Which of the following would not be expected to be associated A) Deforming arthritis B) Photosensitive rash C) Seizures D) Pulmonary embolism E) Thrombocytosis ```

``` Which of the following is used in the treatment of SLE A) Anti TNF B) Anti-malarials C) Ustekinuab (IL12/13 blocker) D) Sulfasalzine E) Allopurinol ```

``` Which of the following is not a risk factor for osteoporosis? A) Steroid use B) Alcohol C) Low BMI D) High testosterone E) Malabsorption ```

``` You are reviewing a patient's notes that have been sent to you. They show a T score of -2.6. What does this patient have? A) Osteoporosis B) Osteopenia C) Osteomalacia D) Osteoarthritis E) Osteomyelitis ```

``` What is the gold standard investigation for osteoporosis? A) X Ray B) Serum calcium C) Clinical history D) FRAX score E) Dexa scan ```

``` You are reviewing a patient's notes that have been sent to you. They show a T score of -2.6. What would you prescribe as a first line treatment? A) Oestrogen B) Aldendronate C) Calcium D) Testosterone E) Allopurinol ```

``` A 72 year old man presents with muscle weakness and aching bones that are worse when he walks. He has a PMH of hypertension, and he says that since the start of the COVID-19 pandemic he has left the house as little as possible. What does this patient likely have? A) Osteoporosis B) Osteomyelitis C) Osteomalacia D) Osteoarthritis E) Fibromyalgia ```

``` You are reviewing a patient's results that have just been sent to you. They show a low calcium and phosphate, a raised alk phos, raised PTH and a low 25-hydroxy vitamin D. What would be a gold standard investigation to confirm your suspicions? A) DEXA scan B) Bone biopsy C) X ray D) Antibody testing E) MRI ```

``` You are reviewing a patient's results that have just been sent to you. They show a low calcium and phosphate, a raised alk phos, raised PTH and a low 25-hydroxy vitamin D. The patient is a 72 year old man, who has bone pain and states he leaves the house very little due to the pandemic. What would you prescribe? A) IM Calcitriol B) Alfacidol C) Oral calcium and vitamin D D) Oral allopurinol E) Oral aldrendonate ```

``` A 65 year old woman presents with joint pain in her knee that is worsened with exercise. The joint is slightly warm, and on questioning, she reveals that it is stiff in the mornings but is better within around 15 minutes. What do you suspect? A) Osteoporosis B) Osteomyelitis C) Osteomalacia D) Osteoarthritis E) Fibromyalgia ```

``` You are revieiwng a patients results that have just been sent to you. It reveals an X ray showing loss of joint space, osteophytes and subarticular sclerosis. What do you suspect? A) Osteoporosis B) Osteomyelitis C) Osteomalacia D) Osteoarthritis E) Fibromyalgia ```

``` You are revieiwng a patients results that have just been sent to you. It reveals an X ray showing loss of joint space, osteophytes and subarticular sclerosis. What would you prescribe? A) Paracetamol B) NSAIDs C) Calcium and vitamin D D) Aldrendonate E) Prednisolone ```

``` A 46 year old woman presents with pain in both hands and fingers. She says that in the mornings they "take a long time to get going" and on examination, the joints are warm, swollen and tender. What is the gold standard treatment? A) Rituximab B) Aldrendonate C) NSAID/ paracetamol D) Sulfasalazine and methotrexate E) TNF alpha inhibitor ```

``` You are reviewing a patients results that have just been sent to you. It shows the patient has a low Hb, raised ESR, and is positive for rheumatoid factor and anti-CCP. What is it likely to be? A) Osteoporosis B) SLE C) Rheumatoid arthritis D) Osteoarthritis E) Fibromyalgia ```

``` A 26 year old woman presents to A&E due to a severe shortness of breath and pain in the chest. On examination, she also has rash over her cheeks, and mouth ulcers. Her ESR is raised, and she is anaemic. What is it likely to be? A) Osteoporosis B) SLE C) Rheumatoid arthritis D) Osteoarthritis E) Fibromyalgia ```

``` You are reviewing a patients results that have just been sent to you. It shows the patient has a raised ESR, low WCC and is ANA and anti-dsDNA positive. What is it likely to be? A) Osteoporosis B) SLE C) Rheumatoid arthritis D) Osteoarthritis E) Fibromyalgia ```

``` Which of the following is not typically prescribed for a patient with SLE? A) Paracetamol B) Antimalarial drugs C) Oral methotrexate D) Prednisolone E) Rituximab ```

``` Which of the following is not a classic tumour to metastasise to the bone? A) Breast B) Liver C) Prostate D) Kidney E) Thyroid ```

``` A 62 year old man presents with a hot, swollen toe that is very painful. What would be gold standard diagnosis? A) Serum uric acid B) Joint fluid aspiration C) FBC D) X ray E) DEXA scan ```

``` A 82 year old woman presents with an acutely hot, swollen knee that is very painful. What would be gold standard diagnosis? A) Serum uric acid B) Joint fluid aspiration C) FBC D) X ray E) DEXA scan ```

``` You are reviewing a patient's notes that have just been sent to you. It shows negatively bifringent needle shaped crystals on a joint fluid aspiration. What is it likely to be? A) Gout B) Pseudogout C) Septic arthritis D) Rheumatoid arthritis E) Reactive arthritis ```

``` You are reviewing a patient's notes that have just been sent to you. It shows positively bifringent rhomboid shaped crystals on a joint fluid aspiration. What is it likely to be? A) Gout B) Pseudogout C) Septic arthritis D) Rheumatoid arthritis E) Reactive arthritis ```

A patient is on a prescription of allopurinol. What is it likely to be for? A) Treatment of an acute attack of gout B) Treatment of an acute attack of pseudogout C) Prevention of gout D) Prevention of pseudogout E) None of the above

``` A 96 year old man presents with deafness and joint pain. On examination, he also has a bowed tibia. What is it likely to be? A) Pagets disease B) SLE C) Rheumatoid arthritis D) Osteoarthritis E) Fibromyalgia ```

``` A 69 year old women presents with chronic pain in her legs and morning stiffness. She says the pain is worse in the cold. She also says she feels tired constantly. She has a PMH of IBS and RA. What does she likely have? A) Pagets disease B) SLE C) Rheumatoid arthritis D) Osteoarthritis E) Fibromyalgia ```

``` A 8 year old child presents with pain in his thigh. His mum says it has lasted a couple of days, and he is also feverish and is off his food. He has a raised WCC and CRP. A culture shows growth of an organism. What is most likely? A) Staph. Aureus B) Strep Pyogenes C) Strep Agalactiae D) Staph Epidermis E) Strep oralis ```

``` A 82 year old man presents to A&E with a very painful knee that is hot and swollen. What would be the first line investigation? A) X Ray B) Bone biopsy C) DEXA scan D) Joint aspiration E) MRI ```

``` You are reviewing a patient's results that have just been sent to you. They report a joint fluid aspiration that was thick and yellow, and grew staph aureus. How would you treat? A) Washout + 2 weeks IV Flucloxacillin B) Washout + 2 weeks Benzylpenicillin and clindamycin C) Oral Metronidazole D) Washout + 6 weeks Oral Co-amoxiclav E) IV Cefuroxime and metronidazole ```

``` A 63 year old man presents with pain in his back and hips. He says he is stiff in the mornings, but if he goes for a walk this eases. What is it likely to be? A) Ankylosing spondylitis B) Osteoarthritis C) Osteosarcoma D) Rheumatoid arthritis E) Reactive arthritis ```

``` You are reviewing a patient's results that have just been sent to you. It reports an X ray showing erosion and sclerosis and calcification around the sacrum and iliac joints. What is it likely to be? A) Ankylosing spondylitis B) Osteoarthritis C) Osteosarcoma D) Rheumatoid arthritis E) Reactive arthritis ```

``` A patient presents with pain, swelling and stiffness in the right hand and lower back. On examination, the joints are slightly warm, and you notice the skin between his fingers looks sore. What is it likely to be? A) Ankylosing spondylitis B) Osteoarthritis C) Psoriatic Arthritis D) Rheumatoid arthritis E) Reactive arthritis ```

``` You are reviewing a patient's results that have just been sent to you. It reports "pencil in a cup" deformity on X ray. What is it likely to be? A) Ankylosing spondylitis B) Osteoarthritis C) Psoriatic Arthritis D) Rheumatoid arthritis E) Reactive arthritis ```

``` A patient presents with diarrhoea and vomitting. You treat him, but he returns afew weeks later reporting pain in his right knee. What is it likely to be? A) Ankylosing spondylitis B) Osteoarthritis C) Psoriatic Arthritis D) Rheumatoid arthritis E) Reactive arthritis ```

``` Which of the following is not associated with HLA-B27? A) Ank spon B) Psoriatic arthritis C) Acute anterior uveitis D) Polymyositis E) Reactive arthritis ```

``` A patient tests positive in the Schirmer's test. What do they likely have? A) Sjorgren's syndrome B) Polymyalgia Rheumatica C) Systemic sclerosis D) Dermatomyositis E) SLE ```

``` Which of the following is used to test for anti-phospholipid syndrome? A) Anticardiolipin test B) Lupus anticoagulant test C) Anti-B2-Glycoprotein I test D) All of the above E) None of the above ```

``` A patient presents with recurrent miscarriage. After performing some tests, you diagnose anti-phospholipid syndrome. What would you prescribe? A) Clorphenamine B) Aspirin and warfarin C) Prednisolone D) Dexamethosone E) Adrenaline ```

``` A patient is ANA+ve and anti-MSA +ve. What does she likely have? A) Ank spon B) Psoriatic arthritis C) Acute anterior uveitis D) Polymyositis E) Reactive arthritis ```

``` A patient has pain at the buttock and down the back of their thigh to the ankle. He has lost his ankle jerk reflex. Where is his spine lesion likely to have occured? A) Cervical spine B) Thoracic spine C) Sacrum D) Lumbar spine ```

``` A 68 year old woman presents with sudden onset of severe pain and stiffness in the shoulders, neck, hips and lower back. These symptoms are worse in the morning, and she also has fever and weight loss. She has a raised ESR, CRP and alk phos. What is it likely to be? A) Ankylosing spondylitis B) Osteoarthritis C) Osteosarcoma D) Rheumatoid arthritis E) Polymyalgia Rheumatica ```

A 51 year old man presents with fever, myalgia and numbness/ tingling in the hands. He has a raised WCC and ESR, and is ANCA negative. What is it likely to be? A) Polymyalgia Rheumatica B) Polyarteritis Nodosa C) Kawasaki disease D) Eosinophilic granulomatosis with polyangiitis E) Henoch-Schonlein Purpura

A 4 year old patient presents with a fever and strawberry tongue, with a rash on his palms. He has a raised ESR. What is it likely to be? A) Polymyalgia Rheumatica B) Polyarteritis Nodosa C) Kawasaki disease D) Eosinophilic granulomatosis with polyangiitis E) Henoch-Schonlein Purpura

A patient presents with severe asthma and rashes. He has high eosinophils on FBC, and is p-ANCA +ve. What is it likely to be? A) Polymyalgia Rheumatica B) Polyarteritis Nodosa C) Kawasaki disease D) Eosinophilic granulomatosis with polyangiitis E) Henoch-Schonlein Purpura

A patient presents with symmetrical rash on the legs and joint pain. He has hypertension and haematuria. What is it likely to be? A) Polymyalgia Rheumatica B) Polyarteritis Nodosa C) Kawasaki disease D) Eosinophilic granulomatosis with polyangiitis E) Henoch-Schonlein Purpura

``` Which of the following is not a function of the kidneys? A) Water removal B) Vitamin D activation C) Erythropoietin production D) Creatinine production E) Acid-base balance ```

``` What is the average GFR? A) 1 ml/min B) 125 ml/min C) 150 ml/min D) 1000 ml/min E) 2000 ml/min ```

``` Which of the following makes a substance less likely to be filtered? A) Increased blood pressure B) Smaller substance C) Attachment to a protein D) High surface a rea E) Positively charged substance ```

``` Which tubule section of the nephron has cuboidal epithelium with microvilli for bulk reabsorption? A) Proximal convoluted tubule B) Descending limb of loop of henle C) Ascending limb of loop of henle D) Distal convoluted tubule E) Collecting duct ```

Which of the following is false? A) The loop of henle is only found on juxtamedullary (15%) of nephrons- 85% do not extend into medulla B) The ascending limb is impermeable to water, and functions for Na, K and Cl reabsorption C) The macula densa is detected on the distal convoluted tubule, and signals for renin release if there are low Na level D) The principle cells of the collecting to control acid-base levels by adjusting levels of H+ and HCO3- E) Aldosterone and ADH act upon the cells of the distal convoluted tubule and collecting duct for fine tuning of the urine

``` Which of the following can cause metabolic acidosis? A) Hypoventilation B) Diarrhoea C) Respiratory failure D) Vomitting E) High aldosterone ```

``` What receptor does ADH bind to? A) V2R B) P2C C) GLUT 2 D) GLUT 4 E) S4K ```

Which of the following is not an effect of angiotensin II? A) Tubular reabsorption of Na+ and Cl-, and excretion of K+ B) Increased thirst response C) Vasoconstriction of blood vessels D) Aldosterone release from zona glomerulosa E) Increased parasympathetic activity

Which of the following is true? A) Aldosterone causes excretion of Na+ B) ANP is released when there is a lack of cardiac distention signalling BP is too low C) ANP acts by blocking sodium channels in the collecting duct D) ANP increases aldosterone release via renin secretion E) ANP causes vasoconstriction of the afferent arteriole, decreasing GFR

``` What is the active form of vitamin D? A) 7-decholesterol B) Calcitriol C) 25 OH Vitamin D D) 25, 25 (OH)2 Vitamin D E) Calcitrioic acid ```

``` What is the name of the muscle of the bladder used for micturition? A) Puborectalis B) Pubococcygeus C) Detrusor D) Sartorius E) Soleus ```

``` What part of the urogenital sinus forms the urethra? A) The upper part B) The pelvic part C) The phallic part D) The caudal part ```

``` What is the developing system of the definite kidney? A) Prosenephros B) Mesonephros C) Metanephros D) Rhombencephalon E) Prosencephalon ```

``` Which of the following could cause post-renal acute kidney injury? A) Heart failure B) Sepsis C) ACE inhibitors D) Glomerulonephritis E) Enlarged prostate ```

``` Which of the following is NOT region of the male urethra? A) Pre-prostatic B) Prostatic C) Membranous D) Pelvic E) Spongy ```

What is the role of hCG during pregnancy? A) Regulates levels of progesterone, prepares the uterus for the baby, prepares the breasts for lactation, induces synthesis for oxytocin receptors B) Prevents miscarriage- builds up endometrium for support of placenta, inhibits uterine contractility C) Stimulates oestrogen/progesterone production by ovary D) Role in initiation of labour E) Triggers “caring” response, responsible for uterine contractions during pregnancy and labour

What is the role of prostaglandins during pregnancy? A) Limits uterine activity, softens cervix, and involved in cervical ripening for delivery B) Prevents miscarriage- builds up endometrium for support of placenta, inhibits uterine contractility C) Increases milk production D) Role in initiation of labour E) Triggers “caring” response, responsible for uterine contractions during pregnancy and labour

Which of the following does not happen during pregnancy? A) Increased cardiac output B) Increased systemic blood pressure C) Darkened areola of breasts D) Increased acid reflux and gastroparesis E) Increased blood volume

What happens during the latent phase of labour? A) Small amount of cervical dilation B) Organised uterine contractions and dilation C) Foetal expulsion D) Placental expulsion E) Rupture of amniotic sac

Which of the following is false? A) During pregnancy, the uterus is sealed at the outlet by firm, inflexible collagen fibres- this is maintained by progesterone B) In the last few weeks of pregnancy, the cervix becomes soft and flexible C) Cervical ripening occurs due to enzymatically mediated breakdown of collagen fibres D) Synthesis of enzymes is mediated by progesterone, hGC, and oxytocin E) Labour is initated by PGFa

``` What is the outermost serous layer of the uterus? A) Endometrium B) Perimetrium C) Myometrium D) Endomysium E) Epimysium ```

``` Which of the following hormones is NOT produced by the placenta during pregnancy? A) hCS B) Progesterone C) Prolactin D) Oestrogen E) Relaxin ```

``` What is the first follicle in the cycle known as? A) Secondary follicle B) Small primary follicle C) Primordial follicle D) Pre-ovulatory follicle E) Corpus luteum ```

What triggers shedding of the stratum functionalis during the menstrual cycle? A) An increase in hGRH B) A drop in LH levels after the LH surge C) An increase in FSH levels D) An increase in oestrogen levels E) A drop in progesterone levels

``` Of an average 28 cycle, on which day is the highest LH levels seen? A) Day 10-11 B) Day 12-13 C) Day 14 D) Day 15-16 E) Day 18-20 ```

``` What stage comes after the cleavage stage of embryo development? A) Syngamy B) Compaction C) Cavitation D) Expansion E) Hatching ```

``` What is the first stage of embryo implantation? A) Apposition B) Attachment C) Trophoblast differentiation D) Invasion E) Maternal recognition ```

``` Which of the following does not derived from the Mullerian duct? A) Fallopian tubes B) Uterus C) Cervix D) Upper 1/3 of vagina E) Clitoris ```

Which of the following statements is false? A) Sertoli cells in the testis secrete Mullerian inhibitory factor, which causes degeneration of the paramesonephric duct B) 5- alpha reductase converts testosterone to dihydryotestosterone androgen which triggers development of the external male genitalia C) If an individual is SRY positive their wolffian duct regresses and Mullerian duct develops D) The genitalia is differentiated by 10 weeks E) Leydig cells of the testes secrete testosterone, which causes the wolffian duct to become the seminal vesicle, vas deferens and epididymis

``` During which phase of meiosis does crossing over occur? A) Prophase I B) Metaphase I C) Anaphase I D) Prophase II E) Metaphase II ```

``` During which phase of meiosis do oogonia arrest at until puberty? A) Prophase I B) Metaphase I C) Anaphase I D) Prophase II E) Metaphase II ```

Which of the following statements is true? A) Pale (Ap) cells are stem cells that stay outside of the blood-testes barrier and produce more daughter cells until death B) Type A cells differentiate into primary spermatocytes C) Spermatids differentiate into spermatozoa via spermatogenesis D) Primary spermatocytes can pass through the blood testes barrier through tight junctions of Sertoli cells E) Androgen binding protein (released by Leydig cells) bind to testosterone within the seminiferous tubule, which in turn stimulates sperm production

``` What does sperm travel into after the rete testis? A) Epididymis B) Vas deferens C) Efferent ducts D) Ejaculatory duct E) Seminiferous tubules ```

``` A 9 year-old child presents to your GP clinic with his mother. His mother tells you that she has noticed the child has a lot more swelling in his face and his urine seems frothy. The child also seems to be a little bit lethargic compared to normal. You do a urine dipstick on the child’s urine discovering significant (+++) proteinuria but no haematuria. What is the most likely cause of these symptoms? A) SLE B) Rickets C) Minimal Change Disease D) Post-streptococcal glomerulonephritis E) Goodpasture’s syndrome ```

``` A 6 year-old child presents to A&E with their father. His father is quite anxious as he noticed blood in his child’s urine earlier in the morning. When asking about a more detailed history, you discover that the child had a really sore throat and cold 2 weeks earlier. What is the most likely cause of these symptoms? A) Granulomatosis with polyangitis B) IgA nephropathy C) Henoch-Schonlein purpura D) Post-streptococcal glomerulonephritis E) NSAIDs ```

``` A 42 year-old man presents to A&E. He complains of coughing up blood as well as noticing a darkness to his urine. You perform a urine dipstick on his urine which shows some blood. What is the most likely cause of these symptoms? A) Granulomatosis with polyangitis B) IgA nephropathy C) Henoch-Schonlein purpura D) Goodpasture’s syndrome E) SLE ```

``` A 52 year old woman presents to you in A&E complaining of severe flank pain that is radiating towards her groin. The pain is constant but has peaks where it is much more severe. She tells you she has not passed urine for 2 days. What is the most appropriate investigation and management for this patient? A) Ultrasound KUB + codeine B) Ultrasound KUB + ibuprofen C) X-ray KUB + paracetamol D) X-ray KUB + morphine E) CT-KUB + Diclofenac ```

``` A 28 year old pregnant woman presents to you in GP complaining of very frequent urination and it is quite painful. She has brought you a urine sample which appears quite cloudy. You suspect a UTI. What is the most appropriate choice of antibiotic for this patient? A) Nitrofurantoin B) Trimethoprim C) Ceftriaxone D) Amoxicillin E) Cefalexin ```

``` A 45 year old man presents with a left scrotal mass. He had a vasectomy 2 years ago. The mass is painless and unilateral. On examination it is soft and smooth, and his left testis cannot be palpated. Light can be shone through the mass. What is the most likely diagnosis? a) Left orchitis b) Left primary hydrocele c) Left secondary hydrocele d) Left varicocele e) Left spermatocele ```

A 45 year old man presents with a left scrotal mass. He had a vasectomy 2 years ago. The mass is painless and unilateral. On examination it is soft and smooth, and his left testis cannot be palpated. Light can be shone through the mass. What would be the first line investigation to confirm this diagnosis? a) USG b) CT scan c) Venography d) MRI e) Mid-stream urine sample

A 72 year old man comes to see his GP, he has recently experienced urethral discharge and has been needing to urinate often with urgency and pain, and has blood in his urine. The GP notices his left testis very hot and tender, and is swollen. Light cannot be shone through it. What is the most likely causative organism? a) Streptococcus pyogenes b) Neisseria gonorrhoea c) Chlamydia trachomatis d) Klebsiella spp. e) Escherichia Coli

Which of these is correct? a) A left hydrocele can be a sign of left kidney cancer b) A right hydrocele can be a sign of right kidney cancer c) A left varicocele can be a sign of left kidney cancer d) A right varicocele can be a sign of right kidney cancer

A 17 year old male is brought to A&E with left testicular pain that started in the last hour. He is embarrassed and says he wants to leave and go home, however he admits the pain is so bad that walking is very uncomfortable. Upon examination you discover his left testis is very tender and warm. It is also larger than normal, and is not lying in its normal position in the scrotum. Within what time window does surgery need to happen? a) 2 hours b) 6 hours c) 9 hours d) 12 hours e) 24 hours

A 66 year old man has had problems with urinary frequency and needing to urinate at night for 2 months. He finds that when he urinates it takes him a while to be able to start, and he often experiences dribbling after finishing. After a transrectal prostate biopsy he is diagnosed with benign prostatic hyperplasia. Which of these would be the first line treatment for BPH? a) Oxybutynin b) Finasteride c) Tamsulosin d) Transurethral resection of prostate (TURP) e) Goserelin

What type of urinary incontinence can diabetic neuropathy lead to? a) Urge incontinence b) Overflow incontinence c) Stress incontinence d) None of the above

What type of urinary incontinence can a spastic spinal cord injury lead to? a) Urge incontinence b) Overflow incontinence c) Stress incontinence d) None of the above

What biochemical changes can be observed in acute kidney injury? A) Hyperkalaemia, hyponatremia, hypercalcaemia B) Hyperkalaemia, hyponatremia, hypocalcaemia C) Hyperkalaemia, hypernatremia, hypercalcaemia D) Hypokalaemia, hypernatremia, hypercalcaemia E) Hypokalaemia, hyponatremia, hypocalcaemia

A 68 year-old patient has got an estimated glomerular filtration rate of of 50ml min/1.73m2 . What stage of chronic kidney disease does he have? A) Stage 1 B) Stage 2 C) Stage 3a D) Stage 3b E) Stage 4

``` What is the most common cause of chronic kidney disease in the UK? A) Renal artery stenosis B) Long use of NSAIDs C) Benign prostatic hyperplasia D) Diabetes E) Renal vein thrombosis ```

``` Which of the following is not a storage symptom? A) Urgency B) Hesitancy C) Frequency D) Overflow incontinence E) Nocturia ```

``` Which of the following would not be a reason for a raised PSA? A) Prostate cancer B) BPH C) BMI over 25 D) Taller men E) UTI ```

A 19 year old female presents with suprapubic pain and visible haematuria. What would be your first line investigation? A) Blood culture B) Sending a midstream urine sample for culture and sensitivity C) Midstream urine dipstick for leucocytes, blood and nitrates D) Clinical diagnosis E) Abdominal examination

A 19 year old female presents with suprapubic pain and visible haematuria. What would be your gold standard investigation? A) Blood culture B) Sending a midstream urine sample for culture and sensitivity C) Midstream urine dipstick for leucocytes, blood and nitrates D) Clinical diagnosis E) Abdominal examination

``` A 19 year old female presents with suprapubic pain and visible haematuria. What would you prescribe? A) Nitrofurantoin for 3 days B) Nitrofurantoin for 7 days C) Amoxicillin for 5 days D) Co-amoxiclav for 3 days E) Co-amoxiclav for 7 days ```

``` A 19 year old male presents with suprapubic pain and visible haematuria. What would you prescribe? A) Nitrofurantoin for 3 days B) Nitrofurantoin for 7 days C) Amoxicillin for 5 days D) Co-amoxiclav for 3 days E) Co-amoxiclav for 7 days ```

A 19 year old female presents with suprapubic pain and visible haematuria. You send a urine sample for culture/ What is the most likely organism to grow? A) A non-lactose fermenting, gram -ve bacilli B) A lactose fermenting, gram -ve bacilli C) A catalase positive, gram +Ve cocci D) An anaerobic, gram -ve bacilli E) A catalase negative, beta haemolytic cocci

``` You are reviewing a patient's results that have just been sent to you. They show a urine culture which grew E. Coli. Which of the following is not a classic symptom that the patient may have had? A) Dysuria B) Frequency C) Urgency D) Hesitancy E) Haematuria ```

``` A 25 year old man presents with suspected epididymo-orchitis. Which of the following is the most likely causative agent in this patient? A) Mumps B) E. Coli C) Trauma D) Staph spp. E) Chlamydia Trachomatis ```

``` A 39 year old man presents with suspected epididymo-orchitis. Which of the following is the most likely causative agent in this patient? A) Mumps B) E. Coli C) Trauma D) Staph spp. E) Chlamydia Trachomatis ```

``` A 26 year old man presents with dysuria and discharge. He has a fever, and on examination of his testicles, there is tenderness and a palpable swelling. What is the most likely diagnosis? A) Cystitis B) Benign prostatic hyperplasia C) Testicular torsion D) Varicocele E) Epididymo-Orchitis ```

``` A 26 year old man presents with dysuria and discharge. He has a fever, and on examination of his testicles, there is tenderness and a palpable swelling. What would be the gold standard investigation? A) Nucleic acid amplification test B) Blood culture C) Full blood count D) Abdominal examination E) Digital rectal examination ```

``` What is the most common STI in 16-25 year olds? A) Gonorrhoea B) Chlamydia C) Syphilis D) Herpes E) HIV ```

``` A 42 year old man presents with fever and malaise. He also reports some LUT symptoms, including pain on ejaculation, dysuria and straining when voiding. His urine dipstick is positive for leucocytes and nitrates. What would be an appropriate investigation? A) DRE B) FBC C) Surgical exploration D) Prostate biopsy E) PSA test ```

You are performing a digital rectal exam. What would be a typical finding in a patient with prostatitis? A) A hard prostate that is hot to touch B) A hard and irregular prostate (Craggy) C) A enlarged but smooth prostate D) Normal prostate E) A diminished prostate

You are performing a digital rectal exam. What would be a typical finding in a patient with prostate carcinoma? A) A hard prostate that is hot to touch B) A hard and irregular prostate (Craggy) C) A enlarged but smooth prostate D) Normal prostate E) A diminished prostate

You are performing a digital rectal exam. What would be a typical finding in a patient with BPH? A) A hard prostate that is hot to touch B) A hard and irregular prostate (Craggy) C) A enlarged but smooth prostate D) Normal prostate E) A diminished prostate

``` A 42 year old man presents with a 5 day history of fever and malaise. He also reports some LUT symptoms, including pain on ejaculation, dysuria and straining when voiding. His urine dipstick is positive for leucocytes and nitrates. His DRE showed a hard, hot prostate. What would be an appropriate prescription? A) Trimethoprim B) Oral Acliclovir C) Oral Co-Amoxiclav D) IV Metronidazole E) IV Ciprofloxacin ```

``` A 17 year old boy presents with abdominal pain and nausea. He is struggling to walk without pain, and after afew prompts, he reports that this is because there's alot of pain and swelling in his left testicle. It feels hot and tender to touch. What would be an appropriate first line investigation? A) Doppler ultrasound of the testes B) Urinalysis to rule out infection C) Surgical exploration D) Digital rectal exam E) Abdominal exam ```

``` A 17 year old boy presents with abdominal pain and nausea. You question him regarding a possible testicular torsion, but he can't say where the pain is coming from. What would be an appropriate first line investigation? A) Doppler ultrasound of the testes B) Urinalysis to rule out infection C) Surgical exploration D) Digital rectal exam E) Abdominal exam ```

``` A 69 year old man presents with nocturia, poor stream and hesitancy. He has no signs of infection. What would be an appropriate first line investigation? A) Trans-rectal ultrasound and biopsy B) Urine biomarkers test C) Endorectal coil MRI D) Digital rectal examination and PSA E) Low urine flow rate test ```

``` You are reviewing a patient's results that have just been sent to you. They show a raised PSA, and a craggy prostate on examination. What is likely? A) BPH B) Prostate cancer C) Prostatitis D) Testicular cancer E) Testicular torsion ```

``` You are reviewing a patient's results that have just been sent to you. They show a raised PSA, and a smooth, enlarged prostate on examination. What is likely? A) BPH B) Prostate cancer C) Prostatitis D) Testicular cancer E) Testicular torsion ```

You are reviewing a patient's results that have just been sent to you. They show a raised PSA, and a craggy prostate on examination. What would be a gold standard investigation to confirm your suspicions? A) Trans-rectal ultrasound and biopsy B) Urine biomarkers test C) Endorectal coil MRI D) Serum electrolytes and renal ultrasound E) Low urine flow rate test

What is the Gleason score used for? A) Assessment of risk for DVT or PE B) Risk of developing cardiovascular disease in the next 10 years C) Prostate cancer diagnosis and staging D) Risk of mortality in ICU E) Severity of pneumonia

``` A 79 year old patient is diagnosed with stage 1 prostate adenocarcinoma. It has not got any metastatic spread. What would be the appropriate treatment plan? A) Radical prostatectomy B) Radiotherapy C) Hormone therapy D) Bradytherapy E) Active surveillance ```

``` A 72 year old man presents with nocturia, poor stream and overflow incontinence. On DRE he ha an enlarged, smooth prostate. What would be an appropriate treatment? A) Nitrofurantoin B) Naproxen C) Tamsulosin D) Sildenafil E) Oxybutynin ```

``` A 72 year old man presents with a 3 month history of being unable to maintain an erection. What would be an appropriate treatment? A) Nitrofurantoin B) Naproxen C) Tamsulosin D) Sildenafil E) Oxybutynin ```

``` A 42 year old man presents with a painless lump in his testicle. He is very worried as his father had testicular cancer. What is the most common testicular cancer in adults? A) Teratomas B) Leydig cell tumours C) Sertoli cell tumours D) Sarcomas E) Seminomas ```

``` A 42 year old man presents with a painless lump in his testicle. He is very worried as his father had testicular cancer. You suspect a seminoma. What blood marker may be raised? A) Alpha-fetoprotein B) Beta-hCG C) PSA D) CA15.3 E) CEA ```

``` A 42 year old man presents with a painless lump in his testicle. He is very worried as his father had testicular cancer. What would be a gold standard diagnosis? A) Ultrasound of testicles B) Serum tumour markers C) CXR and CT D) Biopsy and histology E) Digital rectal exam ```

``` What is the most common cancer in men aged 15-44? A) Lung B) Prostate C) Testicular D) Skin E) Colon ```

``` A 75 year old man presents with painless haematuria but no other symptoms currently, although he has had 3 UTIs in the last 6 months. What would be a gold standard investigation? A) Ultrasound abdomen B) Renal biopsy C) Mid-stream urine culture D) Cystoscopy with biopsy E) Urinary tumour markers ```

``` A 75 year old man presents with painless haematuria but no other symptoms currently, although he has had 3 UTIs in the last 6 months. He shows positive urinary tumour markers, and on bladder biopsy, he showed non-muscle invasive bladder cancer. What would be an appropriate chemotherapy regime? A) ABVD B) RCHOP C) VAD D) ECF E) CMV ```

``` A 19 year old woman presents with dysuria, menstrual irregularity and discharge. What would be an appropriate investigation? A) Self collected vaginal swab for NAAT B) First void urine for NAAT C) Urine culture D) Ultrasound of ovaries E) Blood culture ```

``` A 19 year old man presents with dysuria and discharge. What would be an appropriate investigation? A) Self collected swab for NAAT B) First void urine for NAAT C) Urine culture D) Ultrasound of testes E) Blood culture ```

``` A 19 year old, male patient has been found to have chlamydial infection. What would be an appropriate treatment? A) Oral doxycycline for 7 days B) Erythromycin for 7 days C) IM ceftriaxone D) Oral Ciprofloxacin E) Oral metronidazole ```

``` A 19 year old, male patient has been found to have chlamydial infection. What would be an appropriate treatment? A) Oral doxycycline for 3 days B) Erythromycin for 7 days C) IM ceftriaxone D) Azithromycin stat E) Oral metronidazole ```

``` A 27 year old, pregnant patient has been found to have chlamydial infection. What would be an appropriate treatment? A) Oral doxycycline for 3 days B) Erythromycin for 7 days C) IM ceftriaxone D) Azithromycin stat E) Oral metronidazole ```

``` A 19 year old, pregnant patient has been found to have chlamydial infection. What would be an appropriate treatment? A) Oral doxycycline for 7 days B) Erythromycin for 14 days C) IM ceftriaxone D) Oral Ciprofloxacin E) Oral metronidazole ```

``` A 19 year old, pregnant patient has been found to have gonococcal infection. What would be an appropriate treatment? A) Oral doxycycline for 7 days B) Erythromycin for 14 days C) IM ceftriaxone with azithromycin stat D) Oral Ciprofloxacin E) Oral metronidazole ```

``` A 19 year old, male patient has been found to have gonococcal infection. What would be an appropriate treatment? A) Oral doxycycline for 7 days B) Erythromycin for 14 days C) IM ceftriaxone with azithromycin stat D) Oral Ciprofloxacin E) Oral metronidazole ```

``` Which of the following is not a common complication of chlamydial infection in women? A) Neonatal transmission B) Fitz-Hugh-Curtis syndrome C) Pelvic inflammatory disease D) Infertility E) Renal infection ```

``` A 19 year old male presents with a dull ache in his scrotum. On examination, you see distended scrotal blood vessels that feel like a "bag of worms". What is it likely to be? A) Varicocele B) Hydrocele C) Epididymal cyst D) Testicular torsion E) Testicualar cancer ```

``` A 2 month old boy presents with scrotal enlargement that isn't tender. The swelling is smooth and cystic. What is it likely to be ? A) Varicocele B) Hydrocele C) Epididymal cyst D) Testicular torsion E) Testicualar cancer ```

``` A 42 year old man presents with lumps in his scrotum. They have recently become painful and he is worried that they could be something sinister. What is it likely to be? A) Varicocele B) Hydrocele C) Epididymal cysts D) Testicular torsion E) Testicualr cancer ```

``` A 19 year old male presents with a dull ache in his scrotum. On examination, you see distended scrotal blood vessels that feel like a "bag of worms". What would be an appropriate investigation? A) Surgical exploration B) DRE C) Colour doppler ultrasound D) First void urine for NAAT E) PSA test ```

``` A 42 year old man presents with lumps in his scrotum. They have recently become painful and he is worried that they could be something sinister. What would be an appropriate investigation? A) Surgical exploration B) DRE C) Colour doppler ultrasound D) First void urine for NAAT E) PSA test ```

``` A female patient presents with pain in the left abdomen, and shoulder. She has been having brown, watery discharge and is very worried as 2 weeks ago she had a positive pregnancy test. What would be an appropriate investigation? A) Surgical exploration B) Cultures C) Transvaginal ultrasound D) First void urine for NAAT E) Self collected vaginal swab ```

``` A female patient is in your clinic because 2 weeks ago she had a positive pregnancy test. You have been measuring her hCG as you are concerned, and have seen that levels are low, and have only very slightly raised in the last 48 hours. What are you concerned about? A) Spontaneous abortion B) Ectopic pregnancy C) Failure of implantation D) Chlamydia infection E) PID ```

``` A patient presents with loin pain, haematuria, excessive water and salt loss, hypertension and kidney enlargement. His mother had ADPKD. What would be an appropriate investigation? A) Genetic testing for PKD1 B) MRI of kidneys C) GFR testing D) Ultrasound scan of kidneys E) Blood testing for eletrolytes ```

``` Which of the following is not a cause of pre-renal AKI? A) Vomitting B) Sepsis C) Hypotension D) Tubular injury E) Cardiac failure ```

``` A patient had just had an appedicectomy. After the surgery, she is nauseous and dehydrated. She appears confused, and hasn't passed any urine in around 6 hours. What would be an appropriate investigation? A) Genetic testing for PKD1 B) MRI of kidneys C) GFR testing for creatinine D) Ultrasound scan of kidneys E) Blood testing for electrolytes ```

``` What percentage of adults admitted to hospital develop AKI? A) 5 B) 10 C) 15 D) 20 E) 25 ```

``` A patient presents with swollen ankles, nausea, anaemia, hypertension and bone pain. What would be an appropriate investigation? A) GFR and ACR B) Renal biopsy C) Renal ultrasound D) HepB, HIV and HepC testing E) Abdominal X ray ```

``` Which of the following is not a part of the nephrotic syndrome classic triad? A) Proteinuria B) Hypoalbuminaemia C) Oedema D) Hypertension E) None of the above ```

``` A 4 year old girl presents to A&E with frothy urine and marked oedema. On dipstick, she has proteinuria, and on blood tests she has hypoalbuminaemia. What is the most likely cause of her illness? A) Focal segmental glomerulosclerosis B) Minimal change disease C) Diabetes mellitus D) Amyloid E) RA ```

``` A 67 year old woman presents to A&E with frothy urine and marked oedema. On dipstick, she has proteinuria, and on blood tests she has hypoalbuminaemia. What is the most likely cause of her illness? A) Focal segmental glomerulosclerosis B) Minimal change disease C) Diabetes mellitus D) Amyloid E) RA ```

``` A 67 year old woman presents to A&E with frothy urine and marked oedema. On dipstick, she has proteinuria, and on blood tests she has hypoalbuminaemia. What would be an appropriate investigation? A) Ultrasound abdomen B) Renal biopsy C) Mid-stream urine culture D) Cystoscopy with biopsy E) Urinary tumour markers ```

A 3 year old boy presents with frothy urine, fatigue and facial oedema. You perform a dipstick and it shows proteinuria. You suspect minimal change disease. What would be a gold standard diagnosis? A) Ultrasound abdomen B) Renal biopsy under electron microscopy C) Mid-stream urine culture D) Cystoscopy with biopsy E) Urinary tumour markers

``` A patient presents with loin pain, fever and pyuria. What would be a gold standard diagnosis? A) Renal biopsy B) Ultrasound of kidneys C) Cystoscopy with biopsy D) Urine dipstick E) Midstream urine microscopy ```

``` A patient presents with loin pain, fever and pyuria. Their midstream urine microscopy shows a gram negative lactose fermenting bacilli. How would you treat? A) Oral flucloxacillin B) Oral Vancomycin C) Trimethoprim D) Oral Co-amoxiclav E) Oral Metronidazole ```

``` A patient presents with sudden, severe pain in the loin that travels to the groin. What would be an appropriate first line investigation? A) Midstream urine culture B) Kidney biopsy C) Kidney-ureter-bladder X ray D) Non contrast CT E) Blood testing ```

``` A patient presents with sudden, severe pain in the loin that travels to the groin. What would be an appropriate gold standard investigation? A) Midstream urine culture B) Kidney biopsy C) Kidney-ureter-bladder X ray D) Non contrast CT E) Blood testing ```

``` A patient presents with sudden, severe pain in the loin that travels to the groin. It shows a stone that is about 3mm in diameter. What would be an appropriate treatment? A) Diclofenac for pain only B) Diclofenac and tamsulosin C) Antibiotics D) Extracorporeal shockwave lithotripsy E) Paracetamol ```

``` A patient presents with sudden, severe pain in the loin that travels to the groin. It shows a stone that is about 7mm in diameter. What would be an appropriate treatment? A) Diclofenac for pain only B) Diclofenac and tamsulosin C) Antibiotics D) Extracorporeal shockwave lithotripsy E) Paracetamol ```

``` Which cells are the “resident immune cells of the CNS”? A) Olgiodendrocytes B) Schwann cells C) Microglia D) Astrocytes E) Glia ```

Which of the following is NOT a part of the blood brain barrier? A) Astrocyte end feet B) Fenestrated capillaries C) Endothelial tight junctions D) Pericytes E) Specific transporters for glucose, water, essential ions etc.

What is temporal summation? A) Lots of axons firing simultaneously B) A new action potential cannot occur C) When the membrane becomes more negatively polarised than its resting potential D) A new action potential can only occur if the depolarisation is more significant than the previous one E) One axon firing multiple times

``` Which of the following is a fast neurotransmitter? A) GABA B) Dopamine C) Noradrenaline D) Serotonin ```

``` Which component of the eye controls the shape of the lens? A) Sclera B) Cornea C) Choroid D) Ciliary body E) Retina ```

``` What is a defective outer/middle ear known as? A) Sensorineural hearing loss B) Tympanic hearing loss C) Vestibular hearing loss D) Transmissural hearing loss E) Conductive hearing loss ```

``` Which of the following is not an element of the human stress response? A) Environmental B) Biochemical C) Emotional D) Cognitive E) Physiological ```

``` Which extrapyramidal tract is responsible for head/eye movements in response to visual stimuli? A) Corticobulbar B) Tectospinal C) Rubrospinal D) Vestibulospinal E) Reticulospinal ```

``` Which extrapyramidal tract originates in the red nucleus? A) Corticobulbar B) Tectospinal C) Rubrospinal D) Vestibulospinal E) Reticulospinal ```

``` Which extrapyramidal tract originates in the superior colliculus? A) Corticobulbar B) Tectospinal C) Rubrospinal D) Vestibulospinal E) Reticulospinal ```

``` Which extrapyramidal tract is responsible for posture and balance? A) Corticobulbar B) Tectospinal C) Rubrospinal D) Vestibulospinal E) Reticulospinal ```

``` Which of the following is a characteristic feature of a LMN lesion? A) Hyperreflexia B) Absent fasciculation C) Atrophy D) Hypertonia E) Paralysis of group of muscles ```

``` What component of the brain produces dopamine? A) Amygdala B) Globus pallidus C) Subthalamic nucleus D) Hypothalamus E) Substantia Nigra ```

``` Through which foramen does V1 exit the skull? A) Foramen Ovale B) Superior orbital fissure C) Foramen spinosum D) Foramen magnum E) Foremen rotundum ```

``` What sensation does the anterior spinothalamic tract carry? A) Pain and temperature B) Deep/ chronic pain C) Fine touch D) Vibration E) Crude touch and pressure ```

``` What sensation does the DCML pathway carry? A) Pain and temperature B) Deep/ chronic pain C) Fine touch and vibration E) Crude touch and pressure ```

``` What sensation does the lateral spinothalamic tract carry? A) Pain and temperature B) Deep/ chronic pain C) Fine touch and vibration E) Crude touch and pressure ```

``` What sensation does the spinoreticular tract carry? A) Pain and temperature B) Deep/ chronic pain C) Fine touch and vibration E) Crude touch and pressure ```

``` A 35 year old woman comes to her GP complaining of pain that comes and goes, but worsens in the shower. What is it likely to be? A) Myasthenia gravis B) Motor neuron disease C) Multiple sclerosis D) Parkinson’s disease E) ALS ```

``` A patient presents with a severe headache around one temple. She says they normally last about half an hour and happens every other day roughly. Her eye tends to get watery whilst its happening. What is it likely to be? A) Cluster headache B) Tension headache C) Migraine D) Trigeminal neuralgia E) Drug overuse headache ```

``` A patient presents with headache that is a moderate intensity. She doesn't get any nausea or vomitting, and it doesn't get aggrevated by physical acyivity. She says she can still go to work with these headaches, but she is worried it could be something more sinister as she has attacks that last up to 2 days at a time. What is it most likely to be? A) Cluster headache B) Tension headache C) Migraine D) Trigeminal neuralgia E) Drug overuse headache ```

``` A patient presents with a severe headache that seems to get worse when she exercises. These last around 8 hours at a time, and mainly affects the right side. She says she often feels ill due to the pain and feels better if she sits in a dark cold room. What is it likely to be? A) Cluster headache B) Tension headache C) Migraine D) Trigeminal neuralgia E) Drug overuse headache ```

``` A patient presents with a extreme pain in her left cheek. She says these attacks only last about 10 seconds at a time but happen quite often. She reports them feeling like an electric shock. What is it likely to be? A) Cluster headache B) Tension headache C) Migraine D) Trigeminal neuralgia E) Drug overuse headache ```

``` A 24 year old man presents with a gradual onset headache and mild photophobia. On examination he is drowsy and has a fever with neck stiffness. What is it likely to be? A) Giant cell arteritis B) Encephalitis C) Meningitis D) Subarachnoid haemorrhage E) Tension headache ```

``` A 30 year old man presents with a sudden onset of generalised headache that started yesterday whilst he was at the gym doing weights. He also reports nausea and vomitting. His examination is all normal. What is it likely to be? A) Giant cell arteritis B) Encephalitis C) Meningitis D) Subarachnoid haemorrhage E) Tension headach ```

``` A 30 year old woman presents with 2 months of headache that is generalised and worse on lying down. She also has visual obscurations. On examination she has a high BMI and papilloedema. What is it likely to be? A) Giant cell arteritis B) Idiopathic intracranial hypertension C) Meningitis D) Subarachnoid haemorrhage E) Tension headache ```

``` A 59 year old woman presents with a severe headache. On blood tests she has has ESR raised and she is feverish. She also reports getting cramping of the jaw when she eats. What is it likely to be? A) Giant cell arteritis B) Idiopathic intracranial hypertension C) Meningitis D) Subarachnoid haemorrhage E) Tension headache ```

``` A 27 year old woman presents with reduced central vision and pain in one eye. She says that a few weeks ago, she has tingling down her arm and weakness for a couple of days, but this got better so she didn't seek treatment for it. What is it most likely to be? A) Multiple sclerosis B) Myasthenia gravis C) Parkinson's disease D) Motor neurone disease E) TIA ```

``` A 27 year old woman presents with reduced central vision and pain in one eye. She says that a few weeks ago, she has tingling down her arm and weakness for a couple of days, but this got better so she didn't seek treatment for it. How would you investigate? A) Anti-AChR in serum B) CT angiography C) MRI scan of brain D) CT head E) Response to levodopa ```

``` A 27 year old woman presents with reduced central vision and pain in one eye. She says that a few weeks ago, she has tingling down her arm and weakness for a couple of days, but this got better so she didn't seek treatment for it. What would be an appropriate treatment? A) Interferon beta B) Sumatriptan C) Aspirin D) Pyridostigmine E) Amitryptiline ```

``` A 17 year old patient presents with a headache, fever and neck stiffness. What is the most likely causative agent? A) Strep Pneumoniae B) Haemophilius influenza C) Listeria monocytogenes D) N. Meningitdes E) E. Coli ```

``` A 17 year old patient presents with a headache, fever and neck stiffness. What would be an appropriate investigation? A) MRI of head B) Electroencephalography C) Throat swabs D) NSAIDs E) Lumbar puncture ```

``` You are reviewing a patient's results that have just been sent to you. The patient has meningitis. They show polymorphs in the CSF, with raised proteins and low glucose. What is the most likely causative agent? A) Strep Pneumoniae B) Enteroviruses C) TB D) N. Meningitdes E) E. Coli ```

``` You are reviewing a patient's results that have just been sent to you. The patient has meningitis. They show lymphocytes in the CSF, with slightly raised proteins and normal glucose. What is the most likely causative agent? A) Strep Pneumoniae B) Enteroviruses C) TB D) N. Meningitdes E) E. Coli ```

``` You are reviewing a patient's results that have just been sent to you. The patient has meningitis. They show lymphocytes in the CSF, with raised proteins and low glucose. What is the most likely causative agent? A) Strep Pneumoniae B) Enteroviruses C) TB D) N. Meningitdes E) E. Coli ```

``` A 17 year old patient presents with a headache, fever and neck stiffness. Their lumbar puncture reveals growth of a gram negative diplococci. How would you treat? A) IV Cefotaxime/ IV Ceftriaxone B) Erythromycin for 14 days C) IM ceftriaxone with azithromycin stat D) IV Ciprofloxacin E) IV metronidazole ```

``` A 77 year old patient presents with a headache, fever and neck stiffness. How would you treat? A) IV Cefotaxime B) Erythromycin for 14 days C) IM ceftriaxone with azithromycin stat D) IV Cefotaxime and Amoxicillin E) IV metronidazole ```

``` A 88 year old man presents with a fever and headache. He appears confused and drowsy, and whilst he is waiting to be seen, he becomes upset but he isn't making sense as to why he is upset. What is the most likely diagnosis? A) Giant cell arteritis B) Encephalitis C) Meningitis D) Subarachnoid haemorrhage E) Tension headache ```

``` A 88 year old man presents with a fever and headache. He appears confused and drowsy, and whilst he is waiting to be seen, he becomes upset but he isn't making sense as to why he is upset. What is the most likely causative agent? A) Strep Pneumoniae B) Enteroviruses C) TB D) N. Meningitdes E) Herpes Simplex ```

``` A 88 year old man presents with a fever and headache. He appears confused and drowsy, and whilst he is waiting to be seen, he becomes upset but he isn't making sense as to why he is upset. What would be an appropriate investigation? A) Blood cultures B) Skull X ray C) Throat swabs D) CT Head E) Lumbar puncture with PCR ```

``` A 77 year old man presents with pain and a rash running along one of his ribs. He says that he has a headache and feels very tired. On examination, he is feverish, and the rash shows red papules. What is the most likely causative agent? A) Strep Pneumoniae B) Enteroviruses C) Herpes Zoster D) N. Meningitdes E) Herpes Simplex ```

``` A 77 year old man presents with pain and a rash running along one of his ribs. He says that he has a headache and feels very tired. On examination, he is feverish, and the rash shows red papules. How would you treat? A) Oral flucloxacillin B) Oral Aciclovir C) Trimethoprim D) Oral Co-amoxiclav E) Oral Metronidazole ```

``` A patient presents with severe headaches and tenderness of the scalp and temple. She says that she gets cramping in her jaw when she eats. What would be the gold standard diagnosis? A) Temporal artery biopsy B) Skull X ray C) Electroencephalogram D) CT Head E) Lumbar puncture with PCR ```

``` A patient presents with severe headaches and tenderness of the scalp and temple She says that she gets cramping in her jaw when she eats. This morning, she woke up with painless vision loss in the same side as her temple pain. How would you treat? A) Adrenaline B) Clorphenamine C) Hydrocortisone D) Prednisolone E) Beta-blocker ```

``` What is the commonest type of headache? A) Temporal arteritis B) Cluster headache C) Tension headache D) Migraine E) Trigeminal neuralgia ```

``` A patient presents with severe pain around one eye and temple. The pain usually lasts for around an hour at a time, and it causes her to vomit from the pain. What would be an appropriate treatment? A) Interferon beta B) Sumatriptan C) Aspirin D) Pyridostigmine E) Amitryptiline ```

``` Which of the following does not typically trigger migraines? A) Chocolate B) Excessive sleep C) Oral contraceptives D) Smoking E) Alcohol ```

``` A 54 year old woman presents with sever facial pain on the left side. She says the pain is "like an electric shock", and only stays for a few seconds. Which of the following would be an appropriate treatment? A) Paracetamol B) Sumatriptan C) Carbamazepine D) Pyridostigmine E) Amitriptyline ```

``` A patient presents after a head injury. He walked into A&E after his girlfriend thought he should get it checked as he did lose consciousness for a few seconds. However, whilst he is waiting to be seen, he starts to get drowsy and confused. What is it likely to be? A) Extradural haemorrhage B) Subdural haemorrhage C) Subarachnoid haemorrhage D) Spinal cord Injury E) Slipped disc ```

``` You are reviewing a patient's CT scan. It shows a hyperdense haematoma that is lense shaped and adjacent to the skull. What is it likely to be? A) Extradural haemorrhage B) Subdural haemorrhage C) Subarachnoid haemorrhage D) Spinal cord Injury E) Slipped disc ```

``` You are reviewing a patient's CT scan. It shows a hyperdense haematoma that is crescent shaped over 1 hemisphere. It is diffuse spreading. What is it likely to be? A) Extradural haemorrhage B) Subdural haemorrhage C) Subarachnoid haemorrhage D) Spinal cord Injury E) Slipped disc ```

``` You are reviewing a patient's CT scan. It shows a star shaped lesion. What is it likely to be? A) Extradural haemorrhage B) Subdural haemorrhage C) Subarachnoid haemorrhage D) Spinal cord Injury E) Slipped disc ```

``` A patient presents with confusion and drowsiness. His wife says that he did fall off a ladder around a week ago, but he seemed fine after that. He is being aggressive, which his wife says is completely out of character. What is it likely to be? A) Extradural haemorrhage B) Subdural haemorrhage C) Subarachnoid haemorrhage D) Spinal cord Injury E) Slipped disc ```

``` A patient presents after a sudden onset severe headache. He says that he was in his garden at the time that the pain started and it caused him to vomit. He is drowsy and has a raised blood pressure. What is it likely to be? A) Extradural haemorrhage B) Subdural haemorrhage C) Subarachnoid haemorrhage D) Spinal cord Injury E) Slipped disc ```

``` A patient presents after a sudden onset, severe headache. Their CSF is bloody, but a few hours later it is yellow. What is it likely to be? A) Meningitis B) Encephalitis C) Extradural haemorrhage D) Subarachnoid haemorrhage E) Haemorrhagic stroke ```

``` A patient presents with sciatica from the lower back and down the right leg. They say they are struggling to not wet themselves, and their legs feel weak. What is it likely to be? A) Myasthenia gravis B) Motor neuron disease C) Multiple sclerosis D) Cauda Equina syndrome E) ALS ```

``` A 81 year old woman presents with sudden loss of vision in one eye, and hemisensory loss. Her husband called an ambulance but before the ambulance arrived, she was better. What would be an appropriate treatment? A) Thrombolysis B) Aspirin C) Ibuprofen D) Naproxen E) Heparin ```

``` A 71 year old man presents with a severe headache and nausea. He also has hemisensory loss, and facial weakness. What would be an appropriate infestigation? A) Temporal artery biopsy B) Skull X ray C) Electroencephalogram D) CT Head E) Lumbar puncture with PCR ```

``` A 84 year old man presents with hemiplegia, hemisensory loss, facial weakness and hemianopia. He has a pmh of hypertension and diabetes, and he smokes. What would be an appropriate infestigation? A) Temporal artery biopsy B) Skull X ray C) Electroencephalogram D) CT Head E) Lumbar puncture with PCR ```

``` A 84 year old man presents with hemiplegia, hemisensory loss, facial weakness and hemianopia. He has a pmh of hypertension and diabetes, and he smokes. What would be an appropriate treatment? A) Thrombolysis B) Aspirin C) Ibuprofen D) Naproxen E) Heparin ```

``` A 44 year old woman presents with aching pain in her right arm. She says she gets tingling in her thumb, index finger, middle finger and half of the ring finger. The only thing that helps is if she dangles her hand of the side of the bed. What is it likely to be? A) CN X palsy B) Carpal tunnel syndrome C) Motor neurone syndrome D) Osteoarthritis E) Raynaud's phenomenon ```

``` A 44 year old woman presents with aching pain in her right arm. She says she gets tingling in her thumb, index finger, middle finger and half of the ring finger. The only thing that helps is if she dangles her hand of the side of the bed. How would you investigate? A) AutoAntibody testing B) Electromyography C) Electroencephalogram D) CT Head E) Lumbar puncture with PCR ```

``` Which of the following does not classically metastasise to the CNS? A) Non-small cell lung B) Small cell lung C) Breast D) Melanoma E) Bone ```

``` A 59 year old man has a CT of his brain which shows a mass. What would be the best treatment plan? A) Radiotherapy B) Surgical removal C) Corticosteroids D) Palliative care E) Dexomethasone ```

``` A patient presents with headache and motor problems. He also has weight loss and he says he feels tired all the time. You look into his eyes and see a papilloedema. What would you suspect? A) Myasthenia gravis B) Motor neuron disease C) Tumour D) Cauda Equina syndrome E) ALS ```

``` Which primary brain tumour is the most common? A) Astrocytoma B) Meningioma C) Ependyoma D) Oligodendroma E) Neurofibromas ```

``` A 37 year old woman presents with weakness in her arms. She says that they get tired very easily. She also has recently noticed some double vision. What is it likely to be? A) Myasthenia gravis B) Motor neuron disease C) Multiple sclerosis D) Parkinson’s disease E) ALS ```

``` A 37 year old woman presents with weakness in her arms. She says that they get tired very easily. She also has recently noticed some double vision. How would you investigate? A) Anti-AChR in serum B) CT angiography C) MRI scan of brain D) CT head E) Response to levodopa ```

``` A 37 year old woman presents with weakness in her arms. She says that they get tired very easily. She also has recently noticed some double vision. How would you investigate? A) CT Head B) CT angiography C) MRI scan of brain D) Electromyography E) Response to levodopa ```

``` A 37 year old woman presents with weakness in her arms. She says that they get tired very easily. She also has recently noticed some double vision. What would be an appropriate treatment? A) Interferon beta B) Sumatriptan C) Aspirin D) Pyridostigmine E) Amitryptiline ```

``` A 48 year old man presents with personality changes and involuntary, irregular, unpredictable muscle movements. His dad died at 56 but he isn't sure what he died from. What is it likely to be? A) Myasthenia gravis B) Huntington's disease C) Multiple sclerosis D) Parkinson’s disease E) ALS ```

``` A patient presents with symmetrical ascending muscle weakness and lost reflexes. She says that around 2 weeks ago she had a respiratory infection and she is upset that it seems like she constantly unwell. What is it likely to be? A) Myasthenia gravis B) Huntington's disease C) Multiple sclerosis D) Parkinson’s disease E) Guillain-Barre Syndrome ```

``` A 60 year old man presents with difficulty walking. His left side doesn't seem to respond as well to his movements, and he has recently started dropping things. He finds that his body seems to be "working slowly" and he finds this very frustrating. What is it likely to be? A) Myasthenia gravis B) Huntington's disease C) Multiple sclerosis D) Parkinson’s disease E) Guillain-Barre Syndrome ```

``` A 60 year old man presents with difficulty walking. His left side doesn't seem to respond as well to his movements, and he has recently started dropping things. He finds that his body seems to be "working slowly" and he finds this very frustrating. How would you investigate? A) Anti-AChR in serum B) CT angiography C) MRI scan of brain D) CT head E) Response to levodopa ```

``` A 60 year old man presents with difficulty walking. His left side doesn't seem to respond as well to his movements, and he has recently started dropping things. He finds that his body seems to be "working slowly" and he finds this very frustrating. What would be the gold standard treatment? A) IV Interferon beta B) Sumatriptan and aspirin C) Levodopa and co-careldopa D) Pyridostigmine E) IV Amitryptiline ```

``` A 49 year old man presents with reduced dexterity and stiffness of both of his arms. He also has noticed that he is having to focus to make sure he doesn't stumble when walking as his legs don't seem to work how he would like them to. His sensation and all movements from the neck up are normal. What is it likely to be? A) Motor neurone disease B) Huntington's disease C) Multiple sclerosis D) Parkinson’s disease E) Guillain-Barre Syndrome ```

``` A 49 year old A 49 year old man presents with reduced dexterity and stiffness in both of his arms. He also has noticed that he is having to focus to make sure he doesn't stumble when walking. His sensation and all movements from the neck up are normal. How could you treat? A) Riluzole B) Sumatriptan C) Aspirin D) Pyridostigmine E) Amitryptiline ```

``` A patient presents with spinal pain and leg weakness/ sensory loss. On examination, they have contralateral spasticity and hyperreflexia. They have a pmh of lung cancer. What is the most likely cause? A) Extradural haemorrhage B) Subdural haemorrhage C) Subarachnoid haemorrhage D) Spinal cord compression E) Slipped disc ```

``` What is the commonest cause of spinal cord compression? A) Neoplasm B) Nucleus pulposus C) Disc prolapse D) Infection E) Haematoma ```

``` What is the gold standard diagnosis for spinal cord compression? A) Biopsy B) Lumbar puncture C) CXR D) MRI E) EEG ```

``` A patient presents after 2 episodes of seizures. They shook back and forth rhythmically for about a minute. They then were confused and drowsy for about an hour after. How would you treat? A) IV Interferon beta B) Sumatriptan and aspirin C) Levodopa and co-careldopa D) Sodium valproate E) IV Amitryptiline ```

``` What is the commonest type of dementia? A) Alzeimer's disease B) Vascular dementia C) Lewy-body dementia D) Fronto-temporal dementia E) Mixed dementia ```

``` A patient presents with insidious onset of memory loss over a few years. They also seem to have some language difficulties and seem irritable and confused. What would be an appropriate treatment? A) Interferon beta B) Sumatriptan and aspirin C) Levodopa D) Sodium valproate E) Donezepil ```

A 59-year-old male presents in A&E with a crushing chest pain that radiates to the jaw or shoulder for the past 30 minutes. He also feels short of breath and nauseous. O2 is 96% and you carry out an ECG and note that there is ST elevation in leads V3, V4. What part of the heart is likely to be affected by this MI? a) Superior b) Anterior c) Inferior d) Left lateral e) Right lateral

An ECG is taken on someone suspected of suffering a myocardial infarction. They show abnormalities in leads II, III, and aVF. Which coronary artery is most likely to be implicated? a) Septal branches only of the LAD b) Left anterior descending c) Left coronary artery d) Right coronary artery e) Circumflex artery

A 59-year-old male presents in A&E with a crushing chest pain that radiates to the jaw or shoulder for the past 30 minutes. He also feels short of breath and nauseous. O2 is 96% and you carry out an ECG and note that there is ST elevation in leads V3, V4. Which would not be involved in your acute management of this STEMI? a) Aspirin b) Morphine c) Nitrates d) Oxygen e) All of the above options would be indicated

A 59-year-old male has recently suffered a myocardial infarction. The junior doctor looking over the medications in his discharge summary and notices a mistake. Which of the following would not be involved in the management of a previous MI if there was no contraindications? a) Aspirin b) Verapamil c) Atorvastatin d) Propranolol e) Ramipril

Which of the following is not a chest x-ray finding in chronic heart failure? a) Pleural effusions b) Kerley B lines c) Cardiomegaly d) Alveolar oedema e) Dilation prominent in lower lobe vessels

Which of the following may show ST-segment elevation on an ECG? a) Unstable angina b) Pritzmetal angina c) Cardiomyopathy d) Stable angina e) NSTEMI

A 70-year-old female presents to her GP with a history of progressive shortness of breath with exertion over a period of 4 months with no associated chest pain. She has a past medical history of type 1 diabetes mellitus which is well controlled and currently takes amlodipine 10mg once daily for hypertension. On further questioning, the patient has also mentioned that she is often breathless whilst lying in her bed at night. On physical examination there is mild hepatomegaly and pitting oedema. Which of the following blood investigation is most appropriate at this stage? a) Urea and electrolytes b) HbA1c c) B-type natriuretic peptide d) Blood Cultures e) Atrial natriuretic peptide

A 25-year-old male attended to A&E due to sudden onset of palpitations in his chest. He described this as his heart was skipping a beat. On examination it was found that the patient had a SVT. Which of the following would be the most appropriate in the acute management of this patient to return to normal sinus rhythm? a) Valsalvar manoeuvre b) Amiodarone c) Atropine d) DC cardioversion e) Adrenaline

A 70-year-old man has a routine check-up at his local GP. He is found to have a new diagnosis of atrial fibrillation after an ECG. Which of these is a tool that assesses starting anticoagulation in patients with stroke risk due to atrial fibrillation? a) ABCD2 b) HAS-BLED c) CHA2DS2-VASc d) QRISK3 e) Well’s Criteria

A 76-year-old woman present to her GP with shortness of breath on exertion. She felt it has been gradually worsening over the past 6-months. She denies any chest pain but says that she wakes up in the middle of the night gasping for breath. Her legs are oedematous on examination. Which of these investigations is first line for her diagnosis? a) CT Chest b) B-Natriuretic peptide c) Ankle brachial pressure index (ABPI) d) Echocardiogram e) ECG

``` A 54-year-old woman presents with shortness of breath on exertion, fatigue, and palpitations. On examination, her jugular venous pressure is elevated, and a pan-systolic, high-pitched “whistling” murmur is heard. The murmur radiates to the left axilla. What is the likely cause of the murmur? a) Mitral regurgitation b) Mitral stenosis c) Aortic stenosis d) Aortic regurgitation e) Hypertrophic cardiomyopathy ```

A 63-year-old black man presents for a check-up at his GP. He has no significant past medical history but admits to a poor diet. His blood pressure is 153/95 mmHg and the GP wants to start medical management. Which of the following medications is most appropriate? a) Amlodipine b) Ramipril c) Bisoprolol d) Candesartan e) Indapamid

What is the most appropriate diagnostic investigation for aortic stenosis? a) Chest X-ray b) ECG c) Echocardiogram d) Auscultation e) Exercise tolerance test

A 82-year-old woman came to clinic to receive her COVID-19 vaccine. Shortly after its administration she felt short of breath and a rash started developing all over her body. She collapsed a minute later. What is the first medication which should be administered? a) Salbutamol b) High flow oxygen c) Adrenaline d) IV fluids e) Chlorpheniramine

``` A 45-year-old male recently had a coronary artery bypass graft (CABG) after suffering an myocardial infarction 2 weeks ago. He now has a sharp pain in his chest which is radiating to his left shoulder and is worse when he takes a deep breath in. He says the pain is lessened when he is sat forward compared to when he is lying flat. On examination, his vital signs are normal and there are no murmurs on auscultation. His troponin blood test comes back normal. What is the most likely diagnosis? a) Pericarditis b) Interstitial lung disease c) Endocarditis d) Myocardial infarction e) Aortic dissection ```

``` A 75-year-old man presents to his GP with recurrent, intermittent, sudden-onset chest pain and shortness of breath. He reports that he often tires easily climbing the stairs in his house. It has now worsened, and he experiences the pain more often even at rest. Past medical history is significant for hypertension and type II diabetes. An ECG demonstrates mild ST-segment depressions in V1-V2. Cardiac troponins are not elevated. What is the most likely diagnosis? a) NSTEMI b) STEMI c) Prinzmetal angina d) Stable angina e) Unstable angina ```

Which of the following is not a cause of microcytic anaemia? a) Iron deficiency b) Beta thalassaemia c) Sideroblastic anaemia d) Folate deficiency e) Anaemia of chronic disease

Which of the following is the correct mechanism of absorption of vitamin B12? a) B12 binds to CCK produced by enterochromaffin cells b) B12 binds to intrinsic factor produced by the parietal cells of the stomach c) B12 binds to intrinsic factor produced by the terminal ileum d) B12 binds to pepsinogens produced by the chief cells of the stomach e) B12 diffuses freely into the epithelial cells of the terminal ileum

What is the management for hereditary spherocytosis? a) Ferrous sulphate b) Life-long blood transfusions c) Fresh frozen plasma d) Splenectomy e) Bone marrow transplant

Which of the following describes the appearance of a blood film of a patient with beta thalassaemia major? a) Large and small irregular hypochromic RBCs b) Sickled erythrocytes c) Oval macrocytes (large RBCs) with hypersegmented neutrophil polymorphs with six or more lobes in the nucleus d) Blast cells present e) Plasmodium falciparum present

``` A 72-year-old man presents to A&E complaining of general malaise, back pain and not passing urine in a few days. Blood tests were performed with the results below: • Hb 64g/dL (130-180) • WCC 6.8 x 109 (4 x 109 – 11 x 109 ) • Platelets 300 x 109 (150 x 109 – 450 x 109 ) • Creatinine 400umol/L (60 – 110) • Sodium 138mmol/L (135 -145) • Calcium 3.5mmol/L (2.1-2.6) Which of the following conditions is most likely to be the cause of his symptoms? a) Chronic Lymphocytic Leukaemia b) Acute Myeloid Leukaemia c) Multiple Myeloma d) Hodgkin’s Lymphoma e) Non-Hodgkin’s Lymphoma ```

Which of these findings would you expect to confirm a diagnosis of multiple myeloma in a patient? a) Leukaemic blast cells b) Rouleaux formation c) Auer rods d) Reed-Sternberg cells e) Raised myeloid cells

The most severe form of the disease malaria with the highest rate of mortality in humans is caused by which species of mosquito? a) Plasmodium vivax b) Plasmodium ovale c) Plasmodium malariae d) Plasmodium knowlesi e) Plasmodium falciparum

A 38-year-old lady presents to her GP complaining of feeling very ‘warm and cold’ for the past few days. She recently got back from visiting family in Africa and since then she has had some vomiting and diarrhoea, abdominal pain and has just been feeling unwell. Which diagnosis is most likely in this lady? a) Uncomplicated malaria b) Tuberculosis c) Complicated malaria d) Food poisoning e) Cholera

You see a 52-year-old female who went to her GP as she noticed her lymph nodes were enlarged. She has also had a fever recently and is worried she has an infection. You run some blood tests and see a raised ESR and lactose dehydrogenase. You refer her to oncology who do a lymph node biopsy and imaging. The images show non-Hodgkin lymphoma in both her upper and lower body. There are no signs of non lymph node involvement. What would the staging for this woman’s lymphoma be? a) Stage II A b) Stage II B c) Stage III A d) Stage III B e) Stage IV B

You are a CT2 training in oncology. You see a 3-year-old child who has been unwell recently, is breathless and keeps getting headaches. Her GP has referred to her to your department for further investigations. Without any further investigations, what is your immediate concern? a) Acute Myeloid Leukaemia b) Acute Lymphoblastic Leukaemia c) Chronic Myeloid Leukaemia d) Chronic Lymphoblastic Leukaemia e) Multiple Myeloma

You have been seeing a 57-year-old male regularly in your clinic. He has lost a significant amount of weight in the last 6 months, has gout, abdominal pain and is anaemic. Your most recent investigations show raised myeloid cells and a high white cell count. You also see increased cellularity on a bone marrow biopsy. You diagnose chronic myeloid leukaemia. Which of the following would you give this man? a) Ibrutinib b) Rituximab c) Imatinib d) Morphine e) Dexamethasone

Which of the following statement is false regarding thalassaemia? a) Alpha thalassaemia is incompatible with life b) Not all beta thalassaemia patients are dependent on blood transfusions c) Alpha thalassaemia is diagnosed with haemoglobin electrophoresis d) Beta thalassaemia is diagnosed with a blood film e) Alpha thalassaemia results in alpha chain gene depletion

Which of the conditions below will lead to elevated bilirubin levels? a) Immune thrombocytopenic purpura b) Thrombotic thrombocytopenic purpura c) Haemophilia A d) Haemophilia B e) Von Willebrand disease

Which of the following is a cause for secondary polycythaemia vera? a) Dehydration b) Acute blood loss c) High altitude d) JAK2 kinase mutation e) Leukaemia

Which of the following conditions are not a myeloproliferative disorder? a) Myelofibrosis b) Polycythaemia vera c) Essential thrombocytopenia d) Lymphoma e) Hypereosinophilic syndrome

Which of the following is not part of Virchow’s Triad? a) Stasis of blood flow b) Hypercoagulability c) Endothelial injury d) Diameter of the blood vessel

Which species of mosquito causes the most cases of malaria? a) Plasmodium vivax b) Plasmodium ovale c) Plasmodium malariae d) Plasmodium knowlesi e) Plasmodium falciparum

You diagnose a patient with chronic lymphocytic leukaemia. Which of the following would you give this man? a) Ibrutinib b) Prednisolone c) Imatinib d) Morphine e) Dexamethasone

You diagnose a patient with multiple myeloma. Which of the following would you give this man? a) Ibrutinib b) Prednisolone c) Imatinib d) Morphine e) Dexamethasone

Which of these is a tool that assesses major bleeding risk? a) ABCD2 b) HAS-BLED c) CHA2DS2-VASc d) QRISK3 e) Well’s Criteria

A 27-year-old woman presents to her GP complaining of feeling more tired than usual in the past few months and has noticed she’s lost about 5 kg over that time without trying, saying she’s not really had that much of an appetite. She also says she’s been getting “dizzy-spells” where she feels light-headed on standing up – but has never fainted from them. On examination, you notice some darkened skin in the creases of her palms, when asked about this she says she’s also noticed a scar on her knuckle has started to turn much darker. What is the most appropriate investigation to confirm your suspected diagnosis? a) A Cortisol measurement b) Abdominal ultrasound scan c) SynACTHen test d) Low-dose dexamethasone test e) Urinary free cortisol measurement

A 54 year-old patient presents with increased confusion. His family reports that over the past month he has become more irritable, and has complained about headaches and muscle cramps. He has recently been diagnosed with Small cell lung cancer. You suspect SIADH. What finding would you expect to see in SIADH? a) Hypernatremia b) Hyponatraemia c) Hypercalcaemia d) Hypocalcaemia e) Hypomagnesium

Billy, a 62 year-old man, is admitted to A&E with a mild exacerbation of asthma. He suffers from hypertension which is controlled with medication. On the way to hospital, paramedics gave him 5mg salbutamol and 500 µg ipratropium nebulisers. Since admission to A&E he has been given regular salbutamol 5mg nebulisers. He was then transferred to AMU where he received his antihypertension medication and given regular nebulisers. Before being discharged, you check his blood results and notice that his serum potassium is low at 2.3 mmol/L (normal range: 2.6- 5.2 mmol/L). Which drug is most likely to have caused his hypokalaemia? a) Ipratropium b) Amlodipine c) Ramipril d) Salbutamol e) Paracetamol

Lucy presents with symptoms of polyuria, polydipsia and dehydration. You suspect Diabetes insipidus. What test would you perform to differentiate between cranial or nephrogenic? a) Oral glucose tolerance test b) Dexamethasone suppression test c) CT scan d) Water deprivation test e) Random plasma glucose

A 50yr old female presents to clinic with a 6-month history changes to her appearance. Her facial features have become coarse, her voice has deepened, and her joints ache more than usual. What is the first line investigation for the most likely diagnosis? a) OGTT (oral glucose tolerance test) b) Serum IGF-1 c) Pituitary MRI d) Serum GH e) Serum GHRH

Joe, a 32-year-old male, presents to clinic after reporting that his third type of antihypertensive is not working, and his blood pressure is still through the roof. He also reports a constant headache, muscle cramps and fatigue that he is worried might be due to COVID-19. You take a thorough history and find a positive family history of early-onset hypertension. His father had passed away from a stroke at age 50. On examination, his BP is 142/110. His COVID-19 swab comes back negative. What is the first line investigation of the most likely diagnosis? a) Adrenal vein sampling b) Serum aldosterone c) Abdominal HRCT d) Aldosterone renin ratio e) Short synACTHen test

Karen, a 45 year old woman presents with hirsutism and central obesity and she is starting to develop purple striae on her abdomen. She is upset because she had a holiday planned and feels she can no longer wear her bikini. She has a past medical history of severe asthma which is medically controlled with the blue and brown inhaler. ACTH levels are low and there is no cortisol suppression following high dose dexamethasone suppression test. How would you initially manage this condition? a) Metyrapone b) Ketokonazole c) Bilateral adrenalectomy d) Transsphenoidal pituitary resection e) Medication review – stop the ICS

Joanne, a 76 year old woman presents with polyuria and polydipsia. Her bloods show normal blood glucose, high calcium, low phosphate, normal PTH and normal ADH. What is the most likely diagnosis? a) Primary hyperparathyroidism b) Multiple myeloma c) Diabetes mellitus d) Secondary hyperparathyroidism e) Diabetes insipidus

``` A 35-year-old male presents with frequent and recurring episodes of dizziness when standing. On further questioning he explains that he also has frequent headaches and has noticed he is sweating a lot and experiences episodes of palpitations. On examination it was found that he has postural hypotension. He states that he has no past medical history of significance and there is also no significant family history. A urine dipstick was taken, and the patient was also referred for a CT scan. The urine sample showed high levels of plasma catecholamines and metanephrines. What is the most likely diagnosis? a) Adrenal Insufficiency b) Conns syndrome c) Hyperaldosteronism d) Wilm’s tumour e) Pheochromocytoma ```

Which of the following produces and secretes corticosteroids such as cortisol? a) Anterior pituitary gland b) Zona glomerulosa c) Zona reticularis d) Zona fasciculata e) Adrenal medulla

A 30-year-old female presented to her GP after her optician had advised her to visit her GP. She had recently visited her optician as vision was becoming worse. The optician noticed redness and watering of her eyes and noticed that her eyes appeared to be ‘bulging out’ as described by her husband. The patient also stated that she is feeling increasingly tired and often feels that her heart is racing out of her chest. The GP ran some routine bloods including thyroid function tests which found raised T3. TSH receptor antibodies were also detected. Which of the following would not be a typical sign of Grave’s disease? a) Tremor b) Palpitations c) Weight gain d) Pretibial myxoedema e) Ophthalmopathy

A 25-year-old man is brought to A&E by ambulance complaining of abdominal pain and had been vomiting through the last few hours. Since yesterday he stated that he feels very thirsty and is going to the bathroom more frequently. On the way to the hospital, the patient had deteriorated and was losing consciousness. When the patient arrived at A&E, the doctors used an ABCDE approach to examine the patient. The following were found. A - airway was patent. B - respiratory rate was 40 breaths per minutes and noticed that his breath smelt of pears. There was also generalised abdominal tenderness without voluntary guarding. Which of the following is the most appropriate in the first line management of this patient? a) IV fluid resuscitation b) Antibiotics c) Insulin therapy d) Sepsis screen e) Glucose

Which of the following is not associated with hypothyroidism? a) Weight gain b) Increased sweating c) Cold intolerance d) Constipation e) Menorrhagia

Which of the following is the first line medicinal treatment for diabetes mellitus type II? a) Lifestyle modification b) Metformin c) Glimepiride d) Gliclazide e) Insulin

Which of the following is considered the gold standard diagnosis for phaeochromocytoma? a) Elevated plasma free Metanephrine b) 24hr Urinary Metanephrine c) MRI d) CT e) X Ray

A 19-year-old woman has a previous history of type I diabetes. She has come back to the doctor as some new symptoms have developed. She describes looking more tanned than usual despite no sun exposure, anorexia, she craves salty foods (blood tests show low Na+), and is less able to control her blood sugar as she has more regular low readings. What is causing her new symptoms? a) Administering too much insulin to herself b) Primary adrenal failure (Addison’s disease) c) Diabetic ketoacidosis d) Cushing’s syndrome e) Conn’s syndrome

A 34-year-old PhD student has returned from his year abroad in India. During his stay he visited various religious institutes, stayed with locals, and ate local food. During his year he was infected with malaria twice, diarrhoea and a UTI. When arriving back her described chronic diarrhoea which increased after the intake of milk. There was also abdominal pain. His blood results showed decreased haemoglobin and increased mean corpuscular volume (MCV). He had multiple stool examinations that all came up negative. He is also HIV negative. His blood IgA Ttg was also negative. Given his result which of the following would be a suitable investigation in diagnosing this patient? a) Small intestine aspirate culture b) Colonoscopy c) Small intestine biopsy d) Lactose breath test e) Serum B12 levels

A 42-year-old man presents with a 2-month history of epigastric pain and weight loss. He mentions antacids giving him relief, but the pain has gotten worse. He went to the GP after realising he lost 5kg. He denies vomiting or loose stools. He has no significant history of GI pain and no family history of GI conditions. An endoscopy and biopsy are performed showing active inflammation. Given this information which of the following is the most likely diagnosis? a) Duodenal ulcer b) Invasive carcinoma c) Gastrointestinal stromal tumour d) Ulcerative colitis e) Helicobacter pylori gastritis

A 54-year-old man underwent endoscopy for suspected gastritis. The endoscopy reached the oesophagealgastric junction and entered the stomach. Which of the regions of the stomach is closest to this junction? a) Body b) Fundus c) Cardia d) Pyloric antrum e) Pyloric canal

A 62-year-old woman has noticed small amounts of fresh red blood in her stools. There has also been a small amount of mucous in the stool. She denies pain during defecation. She says her anus has felt itchy and sore over the last week. Previous to this she was quite constipated for months. There is no weight loss and her BMI is currently 35. She has a history of COPD and hypercholesterolaemia. She is also recently recovering from a low respiratory tract infection, having almost finished a 7-day course of amoxicillin. What is the most likely cause of the rectal bleeding? a) Haemorrhoids b) Diverticulitis c) Anal fissure d) C diff Collitis e) Colon cancer

A 72-year-old man has presented to A&E with quite intense abdominal pain and bleeding from the rectum. He says he has not opened his bowels in 6 days and when you go to see him on the ward, he says he has been vomiting today and his abdomen is distended. Given this information what is the most likely diagnosis? a) Small bowel obstruction b) Gastritis c) Adhesions d) Large bowel obstruction e) Crohn’s disease

A 45-year-old female present to the GP with the following symptoms. Which symptom would cause you to order urgent investigations? a) Abdominal pain relieved by defecation b) Change in bowel habit c) Rectal bleeding d) Abdominal distention e) Passage of mucous

A 60-year-old man is referred for an upper GI endoscopy by his GP due to longstanding GORD which has failed to improve on antacids and PPIs. A biopsy is taken, and histological changes indicate Barrett’s oesophagus. Which of the following is the most appropriate description of Barrett's oesophagus? a) Metaplasia of the columnar epithelium of the lower third of the oesophagus to squamous epithelium b) Metaplasia of the squamous epithelium of the lower third of the oesophagus to columnar epithelium c) Metaplasia of the squamous epithelium of the middle third of the oesophagus to columnar epithelium d) Metaplasia of the columnar epithelium of the upper third of the oesophagus to squamous epithelium e) Metaplasia of the squamous epithelium of the upper third of the oesophagus to columnar epithelium

``` A 40-year old man, who has a diagnosis of ulcerative colitis, complains of recent-onset itching and fatigue. On examination, his serum alkaline phosphatase level was found to be high. Barium radiography of the biliary tract showed a 'beaded' appearance. What is the likely diagnosis? a) Primary biliary cholangitis b) Primary sclerosing cholangitis c) Haemochromatosis d) Ascending cholangitis e) Mirrizi’s syndrome ```

A 55-year-old female is diagnosed with osteomyelitis and prescribed two antibiotics for 6 weeks. A few days after starting the course of antibiotics she complains of abdominal pain and diarrhoea. Stool samples are taken and are found to be positive for Clostridium difficile toxins. She is diagnosed with pseudomembranous colitis and treated with metronidazole. Which antibiotic is most likely to have caused the C.difficile toxins? a) Doxycycline b) Metronidazole c) Vancomycin d) Clindamycin e) Trimethoprim

Pamela, a 65-year-old female, presents to her GP with diarrhoea and bloating. On questioning, she also states that she has lost weight recently and is feeling fatigued most of the time. She has no blood in her stool. The GP arranges for coeliac antibody tests to be done. The antibody blood test comes back suggesting coeliac disease. What is the next investigation that should be done? a) Endoscopy with ileal biopsy b) Colonoscopy with biopsy c) Endoscopy with duodenal biopsy d) Trial of gluten-free diet e) Endoscopy with jejunal biopsy

``` Ollie, a 60-year-old male, is sent a bowel cancer screening home-test kit. What is the name of this screening test? a) Heel prick test b) Serum alpha-fetoprotein test c) Faecal calprotectin test d) Faecal immunochemical test e) Smear test ```

John, a 45-year-old male, presents to A&E with haematemesis following excessive vomiting after an alcohol binge. An endoscopy was carried out which confirmed the diagnosis of a Mallory-Weiss tear. Where in the GI tract do Mallory-Weiss tears occur? a) Gastro-duodenal junction b) Gastro-oesophageal junction c) Ileo-caecal junction d) Pyloric sphincter e) Upper oesophageal sphincter

Jane, a 57-year-old female, presents to her GP with recurrent, burning, epigastric pain. The pain is worse when she is hungry and relieved by eating and antacids. She states that the pain is also accompanied by nausea. Jane is a businesswoman who admits that she never finds time to relax. She is also a smoker and drinks 2 glasses of wine most evenings. The GP suspects a duodenal ulcer and arranges further tests. Which of the following is not a cause of peptic ulcers? a) Omeprazole b) NSAIDs c) Helicobacter pyloric infection d) Haemodynamic shock e) Stress

A 57 year old man presents with constipation, severe sharp left lower quadrant pain, fever and nausea. On examination he has abdominal tenderness and guarding on the left side and is tachycardic. A diagnosis of acute diverticulitis is made. What is the gold standard investigation for diagnosing acute diverticulitis? a) CRP b) Colonoscopy c) Abdominal x-ray d) Contrast CT colonography e) Barium enema

Which of these is not a red flag symptom of oesophageal cancer? a) Weight loss b) Cervical lymphadenopathy c) Sudden onset dysphagia of solids and liquids d) Anorexia e) Vomiting

Which of these is not a sign of chronic liver disease? a) Malar flush b) Palmar erythema c) Clubbing d) Dupuytren’s contracture e) Spider naevi

Which of these is the commonest cause of oesophageal varices in the UK? a) Right heart failure b) Splenic vein thrombosis c) Schistosomiasis d) Hepatic vein occlusion e) Liver cirrhosis

Which of these surface markings coincides with the position of the appendix? a) Umbilicus b) Transpyloric plane of Addison c) Midaxillary line d) McBurney’s point e) Subcostal plane

``` Which of the following is not a red flag symptom for GI cancer? A) Unexplained weight loss B) Anaemia C) Blood in the faeces D) Waking up in the night with diarrhoea E) Anorexia ```

``` What disease is primary sclerosising chlangitis associated with? A) Crohn's disease B) Ulcerative colitis C) IBS D) Coeliac's disease E) Ascending cholangitis ```

``` Which of the following antibiotics causes red man syndrome? A) Oral Flucloxacillin B) Oral Vancomycin C) Oral Amoxicillin D) Trimethoprim E) Oral cephalosporins ```

``` A 58-year-old man presents to A&E with severe epigastric pain radiating to his back. He has been vomiting for the past hour and is sat forward. He tells you that he binge drank last night and has a history of gallstones. What is the first line investigation? a) CRP b) Chest x-ray c) Abdominal ultrasound d) Serum amylase e) Faecal elastase ```

``` A 29-year-old man presents to GP as they have noticed their skin becoming increasingly itchy. On examination you discover that the whites of their eyes are yellow, and they have ‘track marks’ up their arms. What is the most likely diagnosis? a) Hepatitis A b) Hepatitis B c) Hepatitis C d) Gallstones e) Pancreatic adenocarcinoma ```

``` A 45-year-old woman presents to GP having noticed itchiness, gradual yellowing of her skin and of the whites of her eyes, malaise, anorexia and nausea. Investigative bloods are ordered, and they show raised serum bilirubin, raised AST, raised ALT, raised ALP, raised IgG, and a positive ASMA. What is the first line treatment? a) Prednisolone b) Azathioprine c) Prednisolone and azathioprine d) Ciclosporin e) Liver transplant ```

A patient with chronic ascites presents to hospital with fever, nausea and vomiting, abdominal pain and confusion. Paracentesis is carried out and shows increased neutrophils. Some of the fluid is sent off to be cultured and is found to be a gram-positive bacterium that is a coagulase positive. Which bacteria is most likely to be the cause? a) Streptococcus pyogenes b) Klebsiella pneumoniae c) Escherichia coli d) Staphylococcus aureus e) Streptococcus viridans

A 25-year-old man presents in your GP clinic complaining of feeling tired, and itchy all of the time. Upon looking at him he appears yellowish, so you perform some liver function tests which show normal unconjugated bilirubin, increased conjugated bilirubin and but you cannot read the urobilinogen as it has been missed off. Blood tests reveal that he is negative for AMA and positive for pANCA. What is the pathophysiology of the most likely condition? a) Inherited abnormality of immunoregulation leads to a T lymphocyte mediated attack on bile duct epithelial cells b) Fibrosis destroying the intrahepatic and extrahepatic ducts c) Pre-hepatic obstruction of portal vein d) Intra-hepatic obstruction of portal vein architecture e) Venous blockage outside of the liver

What condition is associated with primary sclerosing cholangitis? a) Cholangiocarcinoma b) Rheumatoid arthritis c) Hepatocellular carcinoma d) Pancreatitis e) Sjogren’s syndrome

``` A 45-year-old man presents to A&E drunk and with a broken hip. On questioning, it is revealed that he consumes around 60 units of alcohol per week. He does not have access to alcohol for his long-term stay in hospital. What is the first line medication? a) Furosemide b) Chlordiazepoxide c) Thiamine d) Vitamin K e) Vitamin B12 ```

What is the most common cause of liver cirrhosis? a) Hepatitis C b) Non-alcoholic fatty liver disease c) Wilson’s disease d) Chronic alcohol abuse e) Ascending cholangitis

Which of these is a complication of ascites? a) Bacterial peritonitis b) Cirrhosis c) Wernicke’s encephalopathy d) Pyelonephritis e) Fatty liver

Which of these is not a risk factor for developing a hernia? a) Lifting heavy weights b) Previous abdominal surgery c) Steroid use d) Chronic cough e) Straining whilst defecating

``` A 35-year-old woman presents to A&E with a temperature and feeling unwell. On examination the doctor notices that she is febrile, slightly jaundice and has a tender abdomen underneath the ribs on the right side. She has a history of gallstones and was scheduled for a cholecystectomy in 2 weeks. She has been taking paracetamol and ibuprofen to deal with the pain. What is the most likely diagnosis? a) Gilbert’s syndrome b) Ascending cholangitis c) Drug-Induced hepatitis d) Cholecystitis e) Peptic ulcer ```

A 22-year-old woman has a chronic productive cough, dyspnoea which is worse on exertion. She has no other symptoms. She denies ever smoking. There is no blood in her sputum and no history of weight loss or night sweats. Her records show that as a child she had a documented history of hepatomegaly, but this was never followed up. Which of the following is false about her diagnosis? a) She has a genetic misfolding in the SERPINA1 gene b) Her chest x-ray would show emphysema and a flattened diaphragm consistent with COPD c) Elastin is broken down in the alveolar structure d) She is at increased risk of developing hepatitis e) She should be referred to the asthma clinic

What causes median arcuate ligament syndrome (MALS)? a) Compression of the coeliac artery b) Compression of the inferior mesenteric artery c) Compression of the superior mesenteric artery d) Occlusion of the superior mesenteric artery e) Occlusion of the coeliac artery

``` A 50-year-old woman presents to her GP for recurrent right upper quadrant pain. She reports 20-minute episodes of pain after meals, especially with fatty food. She has not had any fevers or chills, and her episodes always resolve. Her past medical history includes hyperlipidaemia, morbid obesity, and polycystic ovarian syndrome, for which she takes oral contraceptives. What is the most likely diagnosis? a) Primary biliary cholangitis b) Peptic ulcer disease c) Gallstones d) Pyelonephritis e) Pancreatitis ```

A 23-year-old man presents to his GP with lower back pain and stiffness. He says that he is particularly stiff in the morning, but it gradually improves throughout the day with activity. The GP decides to examine him. Which of the following tests would help the GP make a diagnosis? a) Buerger’s test b) Romberg’s test c) Shober’s test d) Trenselenburg’s test e) Unterberg’s test

You are concerned about a patients balance. Which of the following tests could you use? a) Buerger’s test b) Romberg’s test c) Shober’s test d) Trenselenburg’s test e) Unterberg’s test

A patient comes in complaining of stiffness in the hip and weakness. What test could you use to investigate the hip? a) Buerger’s test b) Romberg’s test c) Shober’s test d) Trenselenburg’s test e) Unterberg’s test

A patient with sickle cell anaemia presents to A&E with dull pain in their leg and fever. They are diagnosed with osteomyelitis. What bacteria is most likely to be grown on their blood culture? a) Escherichia coli b) Pseudomonas aeruginosa c) Salmonella d) Staphylococcus epidermidis e) Staphylococcus aureus

A 17-year-old patient presents to their GP with dull bone pain, which has started waking them up at night. The X-ray report mentions an ‘onion skin’ appearance. Which type of primary bone cancer would this be indicative of? a) Osteosarcoma b) Ewing’s sarcoma c) Chondrosarcoma d) Rhabdomyosarcoma e) None of the above

A 40-year-old lady presents to her GP with fatigue, arthralgia, and hair loss. She also has a ‘butterfly’ shaped rash across her nose and cheekbones which gets worse in the sun. The GP orders a number of blood tests and subsequently diagnoses the patient with systemic lupus erythematosus. What would the inflammatory markers, C-reactive protein (CPR) and Erythrocyte sedimentation rate (ESR), most likely have shown? a) Raised CRP and raised ESR b) Raised CRP and normal ESR c) Normal CRP and raised ESR d) Normal CRP and normal ESR e) None of the above

A 50-year-old obese man presents to A&E with a sudden onset of pain in his big toe. When the doctor inspects the toe, he sees it is red and swollen. The doctor decides to carry out joint fluid aspiration and microscopy. What are the most likely findings of this investigation? a) Rhomboid shaped crystals that are positively bifringent under plane polarised light b) Normal joint fluid that shows no crystals c) Long needle shaped crystals that are negatively bifringent under plane polarised light d) Long needle shaped crystals that are positively bifringent under plane polarised light e) Rhomboid shaped crystals that are negatively bifringent under plane polarised light

Which of these is not seen in an X-ray of a joint affected by rheumatoid arthritis? a) Loss of joint space b) Soft tissue swelling c) Erosion d) Osteopenia e) Osteophytes

Which of these is not a risk factor for developing osteoporosis? a) Obesity b) Early menopause c) Hyperthyroidism d) Steroid use e) Renal failure

Which of the following is not seen in osteoarthritis? a) Heberden’s nodes b) Bouchard’s nodes c) Degenerative disease processes d) Morning stiffness lasting less than 30 minutes e) Symmetrical joint involvement

A 60-year-old Scottish male presents to his GP with left sided hearing loss over the past year. He has also been having severe pelvic pain for the past few weeks. His father died from heart failure at the age of 50. Which of the following would be evident in his blood results? a) Raised ALP b) Raised Ca c) Raised phosphate d) Low ALP e) Raised parathyroid hormone related protein (PTHrP)

Which of the following vasculidities is most associated with the cANCA (cytoplasmic antineutrophilic cytoplasmic antibody)? a) Microscopic polyangitis b) Eosinophilic granulomatosis with polyangitis (churg strauss syndrome) c) Polyarteritis nodosa d) Granulomatosis with polyangitis (Wegener’s granulomatosis) e) Giant cell arteritis

A 26-year-old woman presents to clinic with haematuria, severe fatigue and intermittent joint pain in her hands and feet. She is worried as she has recurrent mouth ulcers, and her hair is starting to fall out. On examination she has mild erythema over her cheeks and around her neck. Her mother has rheumatoid arthritis. Which of the following are most sensitive for her most likely condition? a) Anti-ds DNA b) Lupus anticoagulant c) Anti-Smith d) ANA e) Rheumatoid factor

``` . A 27-year-old presents to the OP gynaecology clinic due to recurrent miscarriages. She has had a PMH of DVTs and one pulmonary embolism. Her blood results show: • APTT: 45 (27-35) • PT: 13 (11-14) • Platelets: 90 (150-400) What is the most likely diagnosis? a) Von Willebrand disease b) Haemophilia A c) Antithrombin III deficiency d) Anti-phospholipid syndrome e) SLE ```

A 45-year-old women attends your clinic complaining of “pain all over” her body that has been happening for the past year. She also furthers details that she commonly suffers for headaches and poor concentration. Which of the following is this patient also likely to present with? a) Sleep Disturbance b) Carpal Tunnel Syndrome c) Dysphagia d) Raynaud’s e) Fever

Which if the following is not a presentation of cauda equina syndrome? a) Progressive b) Bilateral Sciatica c) Perianal or perineal sensory loss d) Strong Anal Tone on PR e) New urinary or faecal retentions and/or incontinence

Which of the following is not a cause of Osteomalacia? a) Vitamin D Deficiency b) Renal Failure c) Inherited d) Liver Disease e) Alcoholism

Which of the following is the first line treatment for neuropathic pain? a) Amitriptyline b) Ondansetron c) Aspirin d) Lamotrigine e) Diazepam

``` A patient presents with stiffness in his left leg. His wife says that he walks more slowly, and seems to drag his left leg. There is subseqeuent gradual tremor in the left hand, with problems doing up buttons and writing smaller. What is it likely to be? A) Motor neuron disease B) Myasthenia gravis C) Parkinson's disease D) Huntington's disease E) Guillain-Barre Syndrome ```

``` A patient presents with right sided weakness, dysarthria, loss of vision and difficulty speaking. What do they likely have? A) ACA stroke B) MCA stroke C) PCA stroke D) Posterior circulation stroke E) None of the above ```

A 27-year-old male presents to the GP with a lump in his testicle. When taking the history, you note his wife is struggling to get pregnant. On examination you note the lump is not painful, but he mentions a dragging sensation. Which tumour marker is most likely to be raised in suspected testicular cancer? a) Prostate specific antigen (PSA) b) Alpha feto-protein (AFP) c) Carcinoembryonic antigen (CEA) d) Cancer antigen 125 (Ca125) e) Fibrin

A 65-year-old women presents to her GP with blood in her urine which is painless. The GP suspects transitional cell carcinoma, and she is referred to the urologists on a 2 week wait list. What is the gold standard investigation to confirm this diagnosis? a) Urine microscopy b) FBC c) CT d) Urinary biomarkers e) Cystoscopy

An 88-year-old man presents to the GP with weight loss, tiredness and difficulties passing urine however he has a feeling of incomplete emptying. The GP notes that he has a raised PSA. What is the staging system used for this cancer? a) Gleason scoring b) TNM c) FIGO d) Child-Pugh e) Dukes

A 35-year-old man presents to A and E with a sudden onset headache that he grades a 10/10. When you look at his family history you note he has autosomal dominant polycystic kidney disease. What is this man likely to be suffering from? a) Sub Dural haemorrhage b) Sub arachnoid haemorrhage c) Extra Dural haemorrhage d) Migraine e) Giant cell arteritis

A 25-year-old male arrives in A&E with severe burns to both legs and torso. The FY1 doctor knows to start IV fluids to replace the water losses in the damaged skin. Before this has happened, the kidneys have already reacted to the hypovolaemia. Which hormone has been released by the kidney is this response? a) Aldosterone b) Angiotensin I c) Angiotensin II d) Renin e) Erythropoietin

A 45-year-old man was seen by his GP when he started coughing and found small amounts of blood in his sputum. On taking a history it was found that the patient had not been urinating very much in a day. The GP decides to get a chest x-ray, take some bloods and do a urine dip. The results are: • CXR – interstitial pneumonia with patchy alveolar infiltrates – suggestive of bleeding sites. • Urine dipstick – positive for blood and protein, negative to nitrates. • Bloods – cANCA negative, pANCA positive, haemoglobin low, anti-Glomerular basement membrane Antibodies positive, urea high, eosinophils normal What is the most likely diagnosis? a) Microscopic polyangiitis b) Granulomatosis with polyangiitis c) Goodpasture’s syndrome d) Post-streptococcal glomerulonephritis e) Eosinophilic granulomatosis with polyangiitis

A 60-year-old female has recently had some routine bloods taken in her annual check-up which shows high cholesterol. She has been repeatedly ill over the last 3 months. On examination her GP finds some pitting oedema and suspects some form of nephrotic syndrome. Which of these results would not be found on further investigation? a) High levels of anticoagulants b) Haematuria c) Low plasma albumin d) Proteinuria e) High serum triglycerides

A 40-year-old male has poorly controlled diabetes. As part of his annual check-up the diabetes specialist orders a urinalysis. This showed an eGFR of 43 mL/min/1.73m2. What stage of chronic kidney disease is can he be classified into? a) Stage 2 b) Stage 3a c) Stage 3b d) Stage 4 e) Stage 5

A 50-year-old male patient comes to see you presenting with blood in their urine. It has been ongoing for the past few days. His blood pressure is high, temperature of 38.5, and has a normal respiratory rate. His urine output is low as well. You note there is slight swelling in both of his legs. Based on his symptoms, what condition or syndrome does he have? a) Nephrotic Syndrome b) Nephritic Syndrome c) Minimal Change Disease d) Hepatocellular Carcinoma e) Diabetes Insipidus

An 85-year-old lady comes into A&E confused after being found on the floor of her house by her son. Her GCS is 6/15, BP 90/50 mmHg and heart rate of 160bpm. She looks frail and has dry lips and skin. Her son claims that she has not been passing water or opening her bowels for the past 24h. Her serum creatinine has increased 250% from her baseline and her urine production is 0.45 mL/kg/hour over 12 hours. What is the diagnosis and what stage is she at? a) AKI, stage II b) AKI, stage III c) Dehydration, Severe d) Frailty, Score of 7 e) CKD, stage II

A 24-year-old male comes into your GP clinic complaining of chest pain. After a thorough history, you find out that he has been coughing up blood and tends to get SOB. On examination, you note some swelling in the legs. He mentions that there has been blood in his urine recently as well. Urinalysis confirms this. Blood tests reveal presence of an antibody which points to Goodpasture Syndrome. What is this antibody? a) Double Stranded DNA Antibody b) Anti-Nuclear Antibody c) Anti-Neutrophil Cytoplasmic Antibody d) Anti-Glomerular Basement Membrane Antibody e) Anti-Ro and anti-Lo

``` A 22-year-old patient presents to the GP with blood in his urine. He complains of having episodes of nausea & vomiting and feeling extra tired lately. He mentions that he has been taking aspirin and ibuprofen for his chronic headaches. What is the most likely diagnosis? a) Minimal Change Disease b) Acute Tubulointerstitial Disease c) UTI d) Headache Exacerbations e) Diabetes insipidus ```

You are a junior doctor working on the urology ward at the Northern General. You have 5 patients under you care who are all have a diagnosed UTI. Which of the following patients are not classed as a complicated UTI patient? a) 26-year-old female with diabetes b) 45-year-old male with renal stones c) 31-year-old pregnant female d) 35-year-old female with an indwelling catheter e) 55-year-old female

Which of the following is not a symptom of pyelonephritis? a) Loin pain b) Severe headache c) Fever d) Enlarged Prostate e) Pyuria

Which of the following antibiotics is used to treat Chlamydia Trachomatis? a) Azithromycin b) Ceftriaxone c) Metronidazole d) Clotrimazole e) Fluconazole

Which of the following class of drugs is the first line treatment for mild Benign Prostatic Hyperplasia? a) A-blockers b) B-blockers c) 5a-reductase inhibitor d) 3a-reducatase inhibitor e) ACE-Inhibitor

A 24-year-old male presents to the GP with a foot drop. He has a loss of sensation in his lateral leg and foot, ankle eversion is unaffected, but inversion is weak. What is the likely cause of his symptoms? a) Common peroneal nerve palsy b) Cauda equina syndrome c) L5 Radiculopathy d) Deep peroneal nerve damage e) Severed spinal cord at the T3 level

A 40-year-old female presents to the GP with a weakness in his hand. He says he has a very poor grip and often ends up dropping objects that he tries to pick up. When questioned he describes a pain in his elbow and a tingling sensation that radiated from his elbow down to his hand. On examination you notice that his hand is fixed in a claw position. What group of muscles would you expect to have wasted due to the nerve damage? a) Hypothenar b) Thenar c) Lateral lumbricals d) Supinators e) Flexor compartment of the forearm

Jane a 30-year-old lady is referred to migraine clinic with shooting pains across the left side of her face. The shooting pains occur randomly, and only last a few seconds. They occur across her left cheek and jaw, and do not affect her forehead or eye. They occur three or four times per day. What would be the most appropriate first line medication to start to help prevent her symptoms? a) Propranolol b) Verapamil c) Paracetamol d) Carbamazepine e) Prednisolone

A 50-year-old male presents to A+E with haemoptysis and epistaxis. When taking a history, he tells you that he was diagnosed with Granulomatosis with polyangiitis 4 years ago. What may you find on this man on examination? a) Clubbing b) Saddle shaped nose c) Roth spots d) Jaundice e) Bouchard’s nodes

Which of these medications is not a prophylaxis treatment for migraines? a) Propranolol b) Ibuprofen c) Amitriptyline d) Topiramate e) Botulinum toxin type A

Which of the following is not a suitable investigation to order for suspected dementia? a) Mini-mental state assessment b) MRI c) CSF analysis d) CT scan e) Confusion screen

``` You see a patient with confusion and memory loss. They are struggling with language recall and their behaviour has changed recently. Upon further questioning, you learn that their symptoms are behaving in a stepwise like progression, and they are stable for a while, before they deteriorate again. What is your most likely diagnosis? a) Alzheimer’s b) Infection c) Vascular dementia d) Dementia with Lewy bodies e) Fronto-temporal dementia ```

You are asked to review a patient with hyperkinesia. She is 40 years old and was adopted so is unsure of her family history. She has recently been forgetful and has a long history of depression. Lately this has become much worse. You also note that her movements are irregular and involuntary. She appears very restless whilst talking to you. Based on this presentation, what would you be concerned about? a) Psychosis b) Parkinson’s Disease c) Motor Neuron Disease d) Meningitis e) Huntington’s Disease

Which of the following best describes the effect of an ischaemic stroke in the anterior, middle and posterior cerebral arteries? a) ACA: impaired judgment, upper limbs affected, paraesthesia MCA: hemiparesis of lower ipsilateral face, peripheral vision loss, PCA: dysphagia, ataxia, nystagmus. b) ACA: contralateral lower limb weakness MCA: hemiparesis of lower contralateral face, speech impairment, contralateral weakness, PCA: acute vision loss, memory loss c) ACA: confusion, limb weakness, hemiparesis, MCA: impaired judgment, nausea, language dysfunction, PCA: Gait apraxia, bitemporal hemianopia, deafness d) ACA: hemiparesis of lower contralateral face, speech impairment, contralateral weakness, MCA: acute vision loss, confusion, memory loss, PCA: contralateral lower limb weakness, urinary incontinence

What brain pathology results from the rupture of berry-aneurysms? a) Subarachnoid Haemorrhage b) Subdural Hematoma c) Extradural Haematoma d) Uncal herniation e) Meningitis

Which is the correct description of, and appropriate treatments for, Myasthenia Gravis? a) Autoimmune disease mediated by antibodies to muscarinic AChRs on the postsynaptic side of the NMJ, affecting mainly muscles of the proximal limbs. Tx: Azathioprine, paracetamol, hydrocortisone b) Reactive disease initiated by Neisseria meningitidis infection, resulting in the inappropriate production of IgG autoantibodies against nicotinic AChRs on the postsynaptic side of the NMJ. Tx: Pyridostigmine, prednisolone, thymectomy c) Autoimmune disease mediated by antibodies to nicotinic acetylcholine receptor (AChR) on the postsynaptic side of the neuromuscular junction, affecting mainly muscles of the eyes and face (NMJ). Tx: Pyridostigmine, prednisolone, thymectomy d) Acute inflammatory demyelinating polyneuropathy affecting Schwann cells of the PNS. Tx: IVIg, plasma exchange, supportive treatment.

Multiple sclerosis is an autoimmune demyelinating condition affecting the CNS. What cells are targeted? a) Schwann cells b) Oligodendrocytes c) Astrocytes d) Microglia e) Parafollicular cells

``` A 70-year-old man comes into your clinic with history of seizures. His wife attends with him and describes he lost awareness and was confused when he came round. During the period of lost awareness, she describes he was fiddling with the buttons on his jacket and was smacking his lip. What is the most likely diagnosis? a) Frontal lobe simple partial seizure b) Frontal lobe complex partial seizure c) Temporal lobe complex partial seizure d) Temporal lobe simple partial seizure e) Occipital lobe partial seizure ```

``` A 60-year-old man comes in with dysarthria, dysphagia and regurgitation of fluids which can sometimes result in choking. When he talks to you, his speech is quite nasal and hoarse. On examination, his tongue is flaccid, and jaw jerk is absent. His sensation is intact and normal. What is the most likely diagnosis? a) Cervical spine lesion b) Amyotrophic lateral sclerosis c) Multiple sclerosis d) Progressive bulbar palsy e) Bell’s palsy ```

An 80-year-old woman comes in complaining of headaches, drowsiness and regular vomiting. She finds she is having issues with her coordination and her speech is slurred when she talks to you. She has a history of breast cancer. What is the most likely diagnosis and what investigation is contraindicated in this condition? a) Cerebellar tumour, lumbar puncture b) Cerebellar tumour, surgery c) Frontal lobe tumour, lumbar puncture, d) Frontal lobe tumour, surgery e) Parietal lobe tumour, surgery

A 25-year-old man comes into A&E, after a motorcycle accident. He is unable to open his right fist and extend his wrist. Which nerve is most likely to be affected? a) Median nerve b) Ulnar nerve c) Radial nerve d) Axillary nerve e) Femoral nerve

Which of the following is not a risk factor for COPD? a) Smoking b) Asbestos exposure c) Owning birds d) Alpha-1 antitrypsin deficiency e) Occupational exposure

Which gene is mutated in cystic fibrosis? a) Transmembrane conductance regulator gene b) JAK2 c) STRC d) Sonic the Hedgehog gene e) Aquaporin 2

Which drug is used in the treatment of tuberculosis and may cause red tears / sweat / saliva? a) Isoniazid b) Rifampicin c) Ethambutol d) Rocephin e) Pyrazinamide

What is the pattern of inheritance of cystic fibrosis? a) Autosomal dominant b) X-linked recessive c) Autosomal recessive d) X-linked dominant e) None of the above

A 34-year-old man diagnosed with chronic asthma comes to your GP practice. He’s been on salbutamol and a low dose budesonide for the last few months, however recently he’s been getting wheezier and shorter of breath. You decide to measure his peak flow, which turns out to be 80% of his best PEFR. What is the first step in the management of this patient? a) Add montelukast b) Increase the dose of budesonide c) Check adherence and inhaler technique d) Add terbutaline sulfate e) Add formoterol fumarate

What’s the most common type of lung cancer? a) Small cell lung cancer b) Squamous cell cancer c) Large cell lung cancer d) Adenocarcinoma e) Bronchial cancer

In bronchiectasis, what’s the common finding on CT? a) Tree-in-bud sign b) Bronchus sign c) Polo mint sign d) Split pleura sign e) Signet ring sign

Which of these is a restrictive cause of lung disease? a) Tuberculosis b) Asthma c) COPD d) Bronchiectasis e) Bronchiolitis

``` A 63-year-old woman presents to A&E with confusion after a fall. She has a productive cough and is short of breath. Her respiratory rate is 32, temperature 37.8C, heart rate 90 regular, blood pressure 85/65 and sats are 94% on air. Chest x-ray reveals right lower zone consolidation and blood results come back with a urea of 8 mmol/L. What is the patient’s CURB-65 score? a) 5 b) 3 c) 4 d) 8 e) 3.5 ```

A 62-year-old man present to a general practice. He complains of increased shortness of breath over the last year or so and a persistent cough. He smokes 20 cigarettes a day and has done so for the last 40 years. On examination his chest is hyperexpanded bilaterally and you hear wheezing on auscultation. All other examination findings are normal. What is most likely causing these signs and symptoms? a) Asthma b) Cystic fibrosis c) Pneumothorax d) Chronic obstructive pulmonary disease e) Collapsed lung

An 80-year-old ex-miner presents to A&E with confusion and increased respiratory rate. ABG reveals low O2 and high CO2. Given the type of respiratory failure and history, what’s the most likely underlying cause? a) Nephrotic syndrome b) Pulmonary embolism c) COPD exacerbation d) Asthma e) COVID-19

A 75-year-old man was admitted into hospital a week ago. Yesterday, he developed pleuritic chest pain, fever and is coughing up greenish phlegm. His covid-19 swab came back negative. What is the most likely organism causing his symptoms? a) Streptococcus pneumoniae b) Staphylococcus aureus c) Pseudomonas aeruginosa d) Chlamydophila pneumoniae e) Legionella pneumophilia

A patient presents to A&E with worsening shortness of breath that came on that morning while sat at their desk at work. Which type of patients are most likely to develop a spontaneous pneumothorax? a) Male, Aged 20-40, Low BMI b) Female, Aged 60-70, High BMI c) Male, Aged 50-70, High BMI d) Female – Aged 15-25, Low BMI e) Male, aged 80+, Low BMI

A 25-year-old man is diagnosed with a left-sided tension pneumothorax following a motorcycle accident. What is the most appropriate site for a needle thoracostomy to treat this tension pneumothorax? a) 5th intercostal space, midclavicular line, on the same side as the pneumothorax b) 2nd intercostal space, mid-axillary line, on the same side as the pneumothorax c) 2nd intercostal space, midclavicular line, on the same side as the pneumothorax d) 5th intercostal space, midclavicular line, on the opposite side as the pneumothorax e) 2nd intercostal space, sternal edge, on the same side as the pneumothorax

A bubble wrap like texture is palpated under the skin of the neck during examination of a patient with a history of chest trauma, which is diagnosed as subcutaneous emphysema. Which of the following signs would further support a diagnosis of tension pneumothorax? a) Tracheal deviation towards the affected lung, hypotension and hypoxia b) Tracheal deviation towards the affected lung, hypertension and hypoxia c) Tracheal deviation away from the affected lung, hypertension and hypocapnia d) Tracheal deviation away from the affected lung, hypotension and hypoxia e) Tracheal deviation away from the affected lung, normal BP and hypercapnia

What is the Gold-standard imaging technique for diagnosing a PE? a) X-Ray b) CT pulmonary angiography (CTPA) c) Magnetic resonance imaging (MRI) d) D-Dimer Blood test e) Spirometry

``` A 78 patient presents with pyrexia, cough, pleurisy and malaise. On examination, she is feverish, has a raised resp rate, and heart rate and a low blood pressure. She has rusty sputum. What is the most likely causative agent? A) Staph. Aureus B) L. Pneumophilia C) M. Pneumoniae D) Strep. Pneumoniae E) E. Coli ```

``` A 78 patient presents with pyrexia, cough, pleurisy and malaise. On examination, she is feverish, has a raised resp rate, and heart rate and a low blood pressure. She has rusty sputum. What staging system could you use to assess severity? A) APACHE B) ABCD2 C) CURB 65 D) QRISK E) Well’s Criteria ```

``` A 78 patient presents with pyrexia, cough, pleurisy and malaise. On examination, she is feverish, has a raised resp rate, and heart rate and a low blood pressure. She has rusty sputum. What is it likely to be? A) Pneumonia B) TB C) Pulmonary hypertension D) Mesothelioma E) Bronchiectasis ```

``` What would be the best diagnostic method for pneumonia? A) CXR B) Echocardiogram C) FBC and BNP D) CT coronary angiography E) Abdominal MRI ```

``` A patient presents with mild pneumonia. What would be an appropriate prescription A) Oral Flucloxacillin B) Oral Benzylpenicillin C) Oral Amoxicillin D) Trimethoprim E) Oral cephalosporins ```

``` A patient presents with sever pneumonia. What would be an appropriate prescription A) IV Flucloxacillin B) IV Benzylpenicillin C) Oral Amoxicillin D) IV Co-Amoxiclav E) Oral cephalosporins ```

``` A patient presents with a productive cough with occasional haemoptysis for around 3 weeks. She says that her chest hurts and she is breathless. What would be an appropriate first line investigation? A) Bronchoscopy B) Lumbar puncture C) Blood culture and sputum culture D) NAAT E) Sputum analysis and CXR ```

``` A patient presents with a productive cough with occasional haemoptysis for around 3 weeks. She says that her chest hurts and she is breathless. What is it likely to be? A) Pneumonia B) TB C) Pulmonary hypertension D) Mesothelioma E) Bronchiectasis ```

``` What is a side effect of rifampicin? A) Hepatitis and neuropathy B) Red urine and hepatitis C) Hepatitis and gout D) Optic neuritis E) Dark stool ```

``` Which of the following is not a typical TB drug? A) Isoniazid B) Pyrazinamide C) Ethambutol D) Fomepizole E) None of the above ```

``` A 48 year old man presents with exertional dyspnoea and chest pain. On examination, he has ankle oedema, and a loud pulmonary second sound. He also has a right parasternal heave. What is it likely to be? A) Pneumonia B) TB C) Pulmonary hypertension D) Mesothelioma E) Bronchiectasis ```

A 48 year old man presents with exertional dyspnoea and chest pain. On examination, he has ankle oedema, and a loud pulmonary second sound. He also has a right parasternal heave. What would be the appropriate first line investigation? a) Chest X-ray b) ECG c) Echocardiogram d) Auscultation e) Exercise tolerance test

What is the definitive diagnosis of pulmonary hypertension? a) Chest X-ray b) ECG c) Echocardiogram d) Right heart catheterisation e) Exercise tolerance test

``` You are reviewing a patient's results that have just been sent to you. They show a chest x ray with enlarged proximal pulmonary arteries and cardiomegaly. There was also right ventricular dilation and hypertrophy. What is the patient likely to have? A) Pneumonia B) TB C) Pulmonary hypertension D) Mesothelioma E) Bronchiectasis ```

A patient presents with chest pain and breathlessness. They say that they used to work with asbestos when they were young but this was over 40 years ago. What would be an appropriate first line investigation? a) Chest X-ray b) ECG c) Echocardiogram d) Right heart catheterisation e) Exercise tolerance test

A patient presents with chest pain and breathlessness. They say that they used to work with asbestos when they were young but this was over 40 years ago. What would be the gold standard diagnosis? a) Chest X-ray b) Pleural biopsy c) Echocardiogram d) Right heart catheterisation e) CT of chest

``` What is the most common malignant tumour worldwide? A) Prostate cancer B) Breast cancer C) Mesothelioma D) Bronchial carcinoma E) Colorectal cancer ```

``` What is the most important indicator of bronchial carcinoma? A) Cigarette smoking B) Asbestos C) Radon exposure D) Pre existing lung disease E) Coal work ```

``` You are reviewing a patient's results that have just been sent to you. They detail a chest X ray which showed a round shadow in the lung, with a fluffy spiked appearance at its edge and hilar enlargement. What is it likely to be? A) Mesothelioma B) Non-small cell cancer C) Sarcoidosis D) Tuberculosis E) Pneumonia ```

``` You are reviewing a patient's results that have just been sent to you. They detail a chest X ray which showed unilateral pleural effusion with pleural thickening. What is it likely to be? A) Mesothelioma B) Non-small cell cancer C) Sarcoidosis D) Tuberculosis E) Pneumonia ```

``` You are reviewing a patient's results that have just been sent to you. They detail a chest X ray which showed an air bronchogram in the consolidated area. What is it likely to be? A) Mesothelioma B) Non-small cell cancer C) Sarcoidosis D) Tuberculosis E) Pneumonia ```

``` You are reviewing a patient's results that have just been sent to you. They detail a chest X ray which showed patchy nodular shadows with loss of volume and fibrosis. What is it likely to be? A) Mesothelioma B) Non-small cell cancer C) Sarcoidosis D) Tuberculosis E) Pneumonia ```

``` You are reviewing a patient's results that have just been sent to you. They detail a chest X ray which showed enlarged proximal pulmonary arteries and cardiomegaly. What is it likely to be? A) Mesothelioma B) Non-small cell cancer C) Sarcoidosis D) Pulmonary hypertension E) Pneumonia ```

``` You are reviewing a patient's results that have just been sent to you. They detail a chest X ray which showed a collapsed lung, and peripheral to it an area devoid of any lung markings. What is it likely to be? A) Mesothelioma B) Pneumothorax C) Sarcoidosis D) Tuberculosis E) Pneumonia ```

``` You are reviewing a patient's results that have just been sent to you. They detail a chest X ray which showed a honeycomb lung that looked like ground glass. What is it likely to be? A) Pneumothorax B) Idiopathic pulmonary fibrosis C) Sarcoidosis D) Tuberculosis E) Pneumonia ```

``` You are reviewing a patient's results that have just been sent to you. They detail a chest X ray which showed pulmonary infiltration, and bilateral hilar lymphadenopathy. What is it likely to be? A) Pneumothorax B) Pulmonary fibrosis C) Sarcoidosis D) Tuberculosis E) Pneumonia ```

``` You are reviewing a patient's results that have just been sent to you. They detail a chest X ray which showed that only 6 ribs were visible. What is it likely to be? A) Pneumothorax B) Pulmonary fibrosis C) Sarcoidosis D) COPD E) Pneumonia ```

``` What is the commonest type of lung cancer? A) Adenocarcinoma B) Small cell carcinoma C) Mesothelioma D) Carcinoid tumour E) Squamous cell cancer ```

``` What type of lung cancer is most strongly associated with asbestos? A) Adenocarcinoma B) Small cell carcinoma C) Mesothelioma D) Carcinoid tumour E) Squamous cell cancer ```

``` Which type of lung cancer is most strongly associated with cigarettes? A) Adenocarcinoma B) Small cell carcinoma C) Mesothelioma D) Carcinoid tumour E) Squamous cell cancer ```

``` What would be an appropriate first line treatment for an adult with chronic asthma? A) Salmetrol only B) Salbutamol only C) Salbutamol + inhaled corticosteroid D) Salmetrol + inhaled corticosteroid E) Oxygen therapy ```

``` What would be an appropriate second line treatment for an adult with chronic asthma? A) Salmetrol only B) Salbutamol only C) Salbutamol + inhaled corticosteroid D) Salmetrol + inhaled corticosteroid E) Oxygen therapy ```

``` Which of the following would not typically be administered during a severe/ life threatening acute asthma attack? A) Oxygen therapy B) Nebulised 5mg of salbutamol C) Prednisolone D) Ipratropium E) High dose salmetrol ```

Which of the following is not one of the RCP3 questions for asthma? A) Recent nocturnal waking? B) Usual asthma symptoms in a day? C) Interference with activities of daily life? D) Smoking status including recent changes in that status E) None of the above

``` A 27 year old man presents as he and his wife has been unsuccessfully trying to get pregnant for the past 2 years. In a general history, his sexual health review is completely normal, but you notice that he has had 3 chest infections in the last year. He also has a PMH of asthma and you notice he has finger clubbing and wheezing. His father died when the patient was a baby, but he isn't sure why. What is it likely to be? A) Abnormal sperm B) Complications of medication C) Undescended testicles D) Hypogonadism E) Cystic fibrosis ```

You are reviewing a patient's results that have just been sent to you. They show a positive sweat test and low elastase levels in the faecal elastase test. What is it likely to be? a) Asthma b) Cystic fibrosis c) Pneumothorax d) Chronic obstructive pulmonary disease e) Collapsed lung

A patient with cystic fibrosis is having trouble because of a long term cough. Which of the following would you likely prescibe? A) Mucolytic such as dornase alfa B) B2 agonist such as salbutamol C) Potassium sparing diuretic such as Amiloride D) Corticosteroid such as beclomethosone E) Antibiotic such as co-amoxiclav

``` A 29 year old man presents to A&E with sudden onset chest pain and shortness of breath. On examination, his ECG is normal, and you notice that he is underweight and hypoxic, but he is not tachycardic or tachypneic. He says that he smokes. What would be an appropriate investigation? A) CXR B) Echocardiogram C) FBC and BNP D) CT coronary angiography E) Abdominal MRI ```

A 29 year old man presents to A&E with sudden onset chest pain and shortness of breath. On examination, his ECG is normal, and you notice that he is underweight and hypoxic, but he is not tachycardic or tachypneic. He says that he smokes. What is it likely to be? a) Asthma b) Cystic fibrosis c) Primary Pneumothorax d) Chronic obstructive pulmonary disease e) Tension pneumothorax

A 29 year old man presents to A&E with sudden onset chest pain and shortness of breath. On examination, his ECG is normal, and you notice that he is underweight and hypoxic, but he is not tachycardic or tachypneic. He says that he smokes. His X ray shows an area devoid of lung markings, peripheral to the edge of a collapsed lung. How would you treat? A) Surgery B) Oxygen then Chest drain C) Low molecular weight heparin and oxygen D) IV fluids E) High flow oxygen and thrombolysis

A 29 year old man presents to A&E with sudden onset chest pain and shortness of breath. On examination, you notice that he is underweight and hypoxic. He appears to be struggling to breath properly, and is tachypneic and tachycardic. His blood pressure is low, and his trachea appears deviated to the left. His girlfriend says that he smokes. What would be an appropriate investigation? A) CXR B) Echocardiogram C) FBC and BNP D) CT coronary angiography E) No investigation; go straight to treatment

A patient's results show an elevated plasma D-dimer, and the patient themselves slightly breathless. What would you order to confirm your suspicion? a) ABG b) CT pulmonary angiography (CTPA) c) Magnetic resonance imaging (MRI) d) CXR e) Spirometry

A patient is brought into A&E after a car crash. She has broken both her tibias, as well as 2 of the smaller bones in her right ankle, and her left ulna. When you see her, she is severely breathless, but she has no significant PMH. What is it likely to be? a) Nephrotic syndrome b) Pulmonary embolism c) COPD exacerbation d) Asthma e) COVID-19

A patient presents with breathlessness. He has a raised plasma D-dimer, and a small pulmonary embolism is found on CT pulmonary angiography. What would be an appropriate treatment? A) Low molecular weight heparin for 5 days B) Surgical embolectomy and vena cava filter C) Inotropic agents D) Chest drain E) High flow oxygen

``` A 79 year old woman presents with persistent daily expectoration of purulent sputum during frequent coughing episodes. She also has chest pain, and you can hear coarse crackles and a wheeze. You suspect bronchiectasis. What would be the gold standard diagnosis to confirm your suspicions? A) Bronchoscopy B) Lumbar puncture C) Blood culture and sputum culture D) High resolution CT E) Sputum analysis and CXR ```

``` What medication is an anti-fibrotic agent that can be prescribed to slow the rate of FVC decline? A) Pirfenidone B) Interferon beta C) Sumatriptan D) Oral Co-amoxiclav E) Oral Metronidazole ```

``` A patient presents with breathlessness and a non-productive cough. He also has finger clubbing, weight loss, and inspiratory basal crackles. He appears breathless, and is upset that he can't play with his grandchildren anymore because it tires him out too much. His X ray shows a honeycomb lung. What would be the gold standard diagnosis? A) Bronchoscopy B) ABG C) Blood culture and sputum culture D) High resolution CT E) Sputum analysis ```

``` A patient is sent for a routine CXR due to a cough they have been having. It shows a bilateral hilar lymphadenopathy with pulmonary infiltrates. Their blood tests show a raised serum ACE and a raised ESR. What would be a gold standard diagnosis? A) Bronchoscopy B) ABG C) Tissue biopsy D) High resolution CT E) Sputum analysis ```

``` A 32 year old patient presents with a productive cough, wheeze and breathlessness. He also looks mildly jaundiced. What would be an appropriate investigation? A) Serum ACE B) Serum Alpha-1-antitripsin levels C) Phosphate D) FBC E) c-ANCA ```

``` What FEV/FVC ratio indicates airway obstruction? A) Less than 0.9 B) Less than 0.8 C) Less than 0.7 D) Less than 0.6 E) Less than 0.5 ```

``` What do the presence of anti-basement membrane antibodies in the blood indicate? A) Hypersensitivity pneumonitis B) Myasthenia Gravis C) Goodpasture's syndrome D) Sjorgren's syndrome E) Rheumatoid arthritis ```

A 20-year-old man presents to his General Practitioner with right foot drop. He celebrated his favourite team winning a football match yesterday by drinking a large volume of alcohol and then spent the night sleeping on the sofa. He immediately noticed the problem on waking this morning. On examination ankle dorsiflexion and eversion are weak but ankle inversion is normal. The right ankle jerk is normal. Sensation is intact. What is the most likely nerve to have been damaged? (a) Common peroneal nerve palsy (b) L5 radiculopathy (c) Left middle cerebral artery territory infarct (d) Spinal cord compression (e) Tibial nerve palsy

A 79-year-old man has a squamous cell carcinoma of the apex of his right lung. He now has wasting and weakness of the small muscles of the right hand. What is the most likely cause of the wasting of his muscles? (a) Involvement of T1 nerve root (b) Involvement of the median nerve (c) Involvement of the sympathetic chain (d) Involvement of the ulnar nerve (e) Peripheral neuropathy

A 42-year-old man with Acquired Immunodeficiency Syndrome (AIDS) develops abdominal pain, bloody diarrhoea and a low grade pyrexia. Sigmoidoscopy shows a friable ulcerated rectal mucosa. Rectal biopsies show severe active chronic proctitis with ‘owls eye’ intranuclear inclusions in endothelial and epithelial cells. In addition to Human Immunodeficiency Virus, with which pathogen is the patient most likely to be infected? (a) Candida albicans (b) Cryptosporidium parvum (c) Cytomegalovirus (d) Pneumocystis jirovecii (carinii) (e) Toxoplasma gondii

A 17-year-old man with coeliac disease since childhood is non-compliant with his gluten-free diet. He describes passing oily stools that float in the pan and are difficult to flush away. What is the main reason for fat malabsorption in this patient? (a) Distortion of the Ampulla of Vater impeding pancreatic secretion (b) Loss of lipase production by the small intestinal epithelium (c) Mucosal surface area reduction due to villous atrophy (d) Obstruction of small intestinal lymphatics by lymphocytes (e) Reduced intestinal transit time because of autonomic stimulation

A 38-year-old woman presents in the Emergency Department with a one-month history of painful enlargement of her cervical and axillary lymph nodes, lethargy and severe oral ulceration. On examination, she has gross cervical, axillary and inguinal lymphadenopathy associated with splenomegaly. He blood film shows ‘occasional blast cells’. The diagnosis is subsequently confirmed on lymph node biopsy. What is the most likely underlying pathological condition? (a) Acute lymphoblastic leukaemia (b) Acute myeloblastic leukaemia (c) Chronic lymphocytic leukaemia (d) Chronic myeloid leukaemia (e) Hodgkin’s lymphoma

``` A 42 year old women undergoing cardiac ablation complains of feeling light-headed. An ECG is performed which shows a narrow complex bradycardia of 40bpm. P waves are present, although shows no relation to the QRS. Which of the following are shown on this ECG? A) First Degree heart block B) Mobitz Type 1 C) Mobitz Type 2 D) Third Degree Heart Block E) Sick Sinus Syndrome ```

``` Which of the following does not typically slow the AV node? A) Adenosine B) Atropine C) Beta-blockers D) Calcium Channel Blockers E) Digoxin ```

``` A 52 year-old man presents to his GP with increasing breathlessness over the last few months. On further questioning the man has also developed a dry cough. The patient is a smoker, but has recently cut down. Examination reveals clubbing and end-inspiratory crackles on auscultation. What is the most likely diagnosis? A) COPD B) Pulmonary Fibrosis C) Sarcoidosis D) Bronchiectasis E) Carcinoma of the Lung ```

``` A 45 year-old women presents with a 2 month history of worsening jaundice, itching and malaise. On examination, she has multiple localized areas of yellow pigmentation around her eyes. She has a past history of Sjὃgren’s syndrome, but is otherwise well. What is the most likely diagnosis: A) Acute cholecystitis B) Ascending cholangitis C) Biliary Colic D) Primary Biliary Cirrhosis E) Primary Sclerosing Cholangitis ```

``` Which of the following is not a respiratory cause of finger clubbing? A) Lung Abscess B) Bronchiectasis C) Cystic Fibrosis D) Pulmonary Fibrosis E) COPD ```

``` You are reviewing a patient's results that have just been sent to you. They show a beaded appearance of biliary tree on ERCP, and a periductal ‘Onion-skin’ pattern on Biopsy. What is likely? A) Acute cholecystitis B) Ascending cholangitis C) Biliary Colic D) Primary Biliary Cirrhosis E) Primary Sclerosing Cholangitis ```

``` A 32 year old Women presents to the GP with sudden pain behind her right eye associated with blurred vision. Last month she experienced sudden loss of her left arm, but this resolved spontaneously within 48 hours. On examination there was no muscle weakness or sensory loss. Select the most likely cause of Motor weakness? A) Muscular dystrophy B) Motor Neurone Disease C) Multiple Sclerosis D) Myasthenia Gravis E) Mononeuritis multiplex ```

``` Which of the following is used for diagnosing MS? A) McDonalds criteria B) El Escorial criteria C) 3Core criteria D) Lights criteria E) Jones Criteria ```

``` Which of the following is used for diagnosing ALS? A) McDonalds criteria B) El Escorial criteria C) 3Core criteria D) Lights criteria E) Jones Criteria ```

``` Which of the following is used for diagnosing learning difficulty? A) McDonalds criteria B) El Escorial criteria C) 3Core criteria D) Lights criteria E) Jones Criteria ```

``` Which of the following is used for diagnosing rheumatic fever? A) McDonalds criteria B) El Escorial criteria C) 3Core criteria D) Lights criteria E) Jones Criteria ```

``` Which of the following is used for measuring pleural effusions? A) McDonalds criteria B) El Escorial criteria C) 3Core criteria D) Lights criteria E) Jones Criteria ```

``` What is the chad s2 criteria used for? A) Atrial fibrillation stroke risk B) Risk of pulmonary embolism C) Risk of stroke after TIA D) Risk of mortality in ICU E) Severity of pneumonia ```

``` A score of T2 for TCC indicates the tumour has spread..? A) to epithelium B) to lamina propria C) superficial muscle D) deep muscle E) beyond bladder ```

``` Which of the following is not a part of the triad of Reiters syndrome? A) Conjunctivitis b) Urethritis C) Arthritis D) Prostatitis ```

``` Which of the following is used for predicting the severity of pancreatitis? A) McDonalds criteria B) Modified glasgow criteria C) 3Core criteria D) Lights criteria E) Jones Criteria ```

``` Which of the following is used for heart failure? A) Framingham criteria B) Modified glasgow criteria C) 3Core criteria D) Lights criteria E) Jones Criteria ```

``` A 45-year old man is admitted with headache and neck stiffness. A lumbar puncture is performed and reveals the following results: cloudy fluid, lymphocytes 1329/mm3, neutrophils 12/mm3, low glucose, high protein, Gram-negative diplococcus seen. Select the most appropriate diagnosis? A) Cryptococcus neoformans B) Multiple sclerosis C) Mycoplasma tuberculosis D) Neisseria Meningitidis E) Mumps ```

``` A 63-year old man presents to the GP practice following two episodes of passing blood in his urine. These episodes were not associated with pain. He has no other past medical history of note, but is a lifelong smoker. Which of the following is the most likely diagnosis: A) Urinary Tract Infection B) Diverticulitis C) Renal Calculi D) Transitional Cell Carcinoma E) Squamous Cell Carcinoma ```

``` A 15 year old girl presents with difficulty walking on her left leg because of pain. On examination, her left knee is hot, swollen and tender. She has a temperature of 38.6°C. Select the most likely diagnosis? A) Psoriatic Arthritis B) Gout C) Septic Arthritis D) Reiter’s Syndrome E) Osteoarthritis ```

``` A 67-year old man presents with fever, shortness of breath and purulent sputum. He is assessed by A&E staff for the level of support he requires. Which of the following scoring system should be used to assess the severity of the man’s likely diagnosis? A) CHADS2 B) CURB-65 C) Glasgow Coma Scale D) Lights Criteria E) Dukes Criteria ```

``` A 27-year old man presents to the emergency department with a 6-hour history of upper abdominal pain, radiating to the back and associated with vomiting. On examination he has marked epigastric tenderness and you notice a bluish discolouration around his umbilicus. His heart rate 118/min and blood pressure is 108/76mmHg. Which of the following would be most useful in identifying a diagnosis? A) Amylase B) C-reactive Protein C) Urea D) Albumin E) Calcium ```

``` A 54 year-old women presents to the GP complaining of generalised muscle weakness, difficulty swallowing, and blurred vision, all of which are worse at the end of the day. Examination is unremarkable, except ptosis of the right eye. Which of the following would be most useful in establishing the cause of her symptoms? A) Creatine Kinase Level B) Electromyography C) Muscle Biopsy D) Tensilon Test E) Troponin Levels ```

``` A 60 year old woman presents to her GP with shortness of breath, which has gradually worsened over the last 4 days. She feels better when sitting up in bed, but struggles to breath when lying flat. On examination she has cool peripheries and is cyanotic. On auscultation, you hear a pan-systolic murmur in the mitral valve region. She also has bi-basal end-inspiratory crackles over her lungs. Her HR is 54bpm, BP 94/63 mmHg. What is the most diagnostic investigation? A) Chest X-ray B) ECG C) Echocardiogram D) Troponin E) Exercise ECG ```

``` A 64-year-old man presents to A & E with central chest pain that radiates to the left shoulder, nausea and sweating. He has no allergies and takes simvastatin for high cholesterol. You commence them on oxygen and administer morphine for pain relief. Your consultant asks you prescribe an appropriate antiplatelet therapy for the patient, what do you give? A. Aspirin alone B. Aspirin and Ticagrelor C. Clopidogrel alone D. Clopidogrel and Warfarin E. Dalteparin ```

Which statement best describes the pharmacology of spironolactone? A. Inhibition of aldosterone receptor in the distal tubules B. Inhibition of cyclooxygenase enzymes in the proximal tubules C. Inhibition of L-type voltage-gated calcium channels in the nephron D. Inhibition of sodium chloride transporter in the distal convoluted tubule E. Inhibition of sodium/potassium/chloride symporter in the loop of Henle

``` Which of the following is not an associated risk factor for hypertension? A. Caucasian race B. High caffeine consumption C. Sedentary lifestyle D. Smoking E. Type A personality ```

``` A patient is referred to a cardiology clinic after presenting to their GP with shortness of breath after walking for 50 metres and general fatigue. on auscultation there is an audible pan-systolic murmur at the apex. What is the most likely diagnosis? A. Aortic stenosis B. Aortic regurgitation C. Mitral stenosis D. Mitral regurgitation E. Tricuspid regurgitation ```

``` Which of the following ECG changes is most typically seen in a patient with a myocardial infarction? A. Absent P waves B. QT prolongation C. ST depression D. Tall, tented T waves E. Wide QRS complex ```

John is a 53-year-old Caucasian gentleman who attended GP clinic 2 weeks ago for an annual check-up. In the GP practice his BP was recorded as 155/100mmHg and he was subsequently given given an ambulatory blood pressure monitor for 2 weeks. His results show an average blood pressure of 138/91mmHg. What is the most appropriate management for this result? A. Amlodipine B. Bendroflumethiazide C. Lifestyle changes only D. Losartan E. Ramipril

``` An 89-year-old patient with multiple undiagnosed cardiovascular co-morbidities is brought to A&E with slurred speech, left arm weakness and a severely ataxic gait. Which underlying condition is most likely to have contributed to this presentation? A. Atrial fibrillation B. Cor pulmonale C. Infective endocarditis D. Left bundle branch block E. Myocardial infarction ```

``` Jane is a 68-year-old woman who has presented to her GP following a diagnosis of hypertension. She is worried that she is at increased risk of having a heart attack and wants to know how likely this is. Which framework should her GP use to calculate Jane’s risk? A. ABCD2 score B. CHA2DS2-VASc score C. COVID19 score D. QRISK2 score E. Wells score ```

Which of the following best describes the concept of relative risk in the context of a trial examining the efficacy of statins compared to placebo in reducing heart attacks? A. The risk of a heart attack in the statin group was 1.65% compared to 2.67% in the placebo group, therefore statins decrease the risk of heart attack by 1.02%. B. The risk of a heart attack in the statin group was 1.65% compared to 2.67% in the placebo group, therefore statins decrease the risk of heart attack by 61%. C. 98 patients would need to be treated with statins to prevent 1 heart attack. D. 98 patients would need to be treated with placebo to cause 1 heart attack. E. If this study was conducted 100 times, these results would occur in 95 of the 100 times.

Which of the following is the correct order for the electrical conduction of the heart? A. AV node -> atria -> SA node -> bundle of His -> Purkinje fibres -> L and R bundle branches -> ventricles B. SA node -> ventricle -> AV node -> bundle of His -> Purkinje fibres -> L and R bundle branches -> atria C. bundle of His -> Purkinje fibres -> atria -> AV node -> L and R bundle branches -> ventricles→ SA node D. SA node -> atria -> AV node -> bundle of His -> Purkinje fibres -> L and R bundle branches -> ventricles E. SA node -> atria -> AV node -> L and R bundle branches -> Purkinje fibres -> bundle of His -> ventricles

``` 1. Judy, a 34 year-old female, presents to the GP with symptoms of hypertension despite being on a current regimen of antihypertensive medications. The junior doctor orders appropriate blood tests and the results come back which suggest a diagnosis of Conn’s syndrome. She is scheduled to have an operation for an adrenalectomy. What medication is prescribed prior to her operation to stabilise her BP and K+ levels? A. Aspirin B. Furosemide C. Ramipril D. Spironolactone E. Warfarin ```

``` Jeremy presents to your GP for review of his recent blood test results. They show raised Renin and raised Aldosterone levels. What is the most likely diagnosis? A. Addison’s disease B. Catatonic state C. Hypertension D. Secondary hyperaldosteronism E. Pseudo pseudohypoparathyroidism ```

``` Which of following signs would someone with a suspected diagnosis of Cushing’s syndrome most likely present with? A. Abdominal striae B. Hypotension C. Hyperpigmentation D. Vertigo E. Weight loss centrally ```

``` Loss of which of the following feedback system results in an increase of cortisol in the body? A. Hypothalamo-pituitary-adrenal axis B. Hypothalamo-adrenal-pituitary axis C. Hypothalamo-pituitary-thyroid axis D. Hypothalamo-thyroid-pituitary axis E. Hypothalamo-pituitary axis ```

Luke presents with symptoms of polyuria, polydipsia and dehydration. You suspect the diagnosis to be Diabetes Insipidus. What test would you perform to differentiate whether the cause is cranial or nephrogenic? A. Alcohol deprivation test B. Blood glucose C. Dexamethasone suppression test D. ECG E. Water deprivation test with desmopressin

``` James’s HbA1c levels are tested in order to determine whether he has Diabetes Mellitus or not. Which of the following values will prove diagnostic? A. ≥6.5 mmol/mol B. ≥11.1 mmol/mol C. ≥24 mmol/mol D. ≥42 mmol/mol E. ≥48 mmol/mol ```

Which of the following is not a cause of hypercalcaemia? A. Down’s syndrome B. Familial benign hypocalciuric hypercalcaemia C. Malignancy D. Sarcoidosis E. Thyrotoxicosis

``` Which of the following is most likely to be present on an ECG with someone who has been hyperkalaemia? A. Narrow QRS complex B. Small T waves C. Tall T waves D. Tall P waves E. U waves ```

``` Due to his excessive alcohol intake, Martin developed pancreatitis. Recently he started to feel thirsty and complained of having to wake up during the night to go the toilet. What is the most likely cause of his symptoms? A. Addison’s disease B. Conn’s disease C. Excessive alcohol intake D. Gilbert’s syndrome E. Pancreatogenic Diabetes ```

``` Molly has come into GP complaining of diarrhoea, heart palpations and feeling quite flushed. She has also noticed a change in mood but thinks this is due to her being recently fired from her job. What is the most likely explanation for her symptoms? A. Carcinoid syndrome B. Depression C. Hypertension D. Hypothyroidism E. Pituitary tumour ```

Steve, a 23-year-old male, presents to the GP with a 6 week history of diarrhoea. He tells the GP he goes four times a day but often feels as if he has to go more. He says he is very tired, has lost weight and has general abdominal cramping. He experienced a bout of diarrhoea similar to this a year ago lasting for two months, where he also noticed blood in his stool and some mucus. However this time there is none. On examination, Steve looks pale with some swollen red patches at the corners of his mouth. What would you expect to find on colonoscopy and biopsy? A. Continuous mucosal inflammation throughout the large bowel which stops abruptly at the ileocecal junction. B. Mucosal inflammation limited to the rectum, with evidence of superficial ulceration and crypt abscesses. C. Patches of transmural inflammation throughout large bowel and terminal ileum, with evidence of granulomas and deep ulceration. D. Continuous mucosal inflammation with contact bleeding from the rectum to the descending colon at the splenic flexure, with evidence of goblet cell depletion. E. Diffuse inflammation throughout the large bowel, with evidence of granulomas and faecal leukocytes. Crypt architecture is normal.

Jane is a 15-year-old female who has come to the GP with her mother regarding her weight. In the past month she has lost 7 kg unintentionally and has also complained of feeling excessively tired. On further questioning, Jane reveals she has also had diarrhoea three times a day for the past two months. When asked to describe her bowel movements she explains that they looked paler and smellier than usual and were difficult to flush away. Her mother is concerned, as Jane’s periods still have not started and thinks it could be linked. Given your suspected diagnosis, what is the most appropriate initial test ? A. Faecal Calprotectin B. Stool sample for microbiology C. Ferritin D. IgA tissue transglutaminase or IgA endomysial antibody E. Erythrocyte sedimentation rate and C-reactive protein

``` Trevor, a 67-year-old male, has come to the GP regarding some difficulty swallowing for three months. He explains that initially it felt like certain food like toast was getting stuck in his throat, but now softer food like mashed potato was causing him pain during swallowing for the past month. He has been treated for ‘reflux’ in the past, but feels the medication isn’t helping and that his symptoms have become worse and has noticed some persistent coughing. In the past week he has been unable to keep food down after meals and mentioned there was some blood in the vomit. Trevor drinks 3 glasses of whiskey every night and has smoked a pipe for the past 45 years. He admits his diet isn’t brilliant, having frequent takeaways and that he’s always been ‘a bit more on the heavy side’. Despite this, he thinks he might have lost around 9kg in the last month without trying. On examination, there is no gurgling heard during palpation of Trevor’s neck and no halitosis. What is the most likely diagnosis? A. Oesophageal cancer B. Gastric cancer C. Pharyngeal pouch D. Crohn’s disease E. Peptic ulcer ```

``` Sally is a 19-year-old female who has turned up to A&E with acute abdominal pain. Upon questioning, she explains that it started around 6 hours previously and gestures to the umbilical region. Then, in the past 3 hours it has spread to over to her right lower abdomen. She also mentions she started feeling nauseous 5 hours ago and has been sick 3 times in the past 3 hours (there was no blood or bile in her vomit). She also mentions she has not had bowel movements in the past two days, and her urinary frequency remains the same. The only medication she takes is the oral contraceptive pill, and she has no other medical history. Her observations show that she is tachycardic and has a temperature of 38.2ᵒC. On examination of her abdomen, she shows guarding and presents some rebound tenderness. On palpation of her left iliac fossa, she complains of pain in her right iliac fossa. From the following list, which diagnosis is most likely? A. Ectopic pregnancy B. Cholecystitis C. UTI D. Crohn’s disease E. Appendicitis ```

Sharon is a 55-year-old female who has come to the GP regarding variable bowel movements. She explains that over the past 6 months she has suffered periods of both constipation and diarrhoea. She also experiences crampy abdominal pain and often some bloating, which usually comes on after eating but is relieved by defecation. She has never noticed any blood in her stool, and her weight has remained stable in this time. When questioned about her social history, she mentions that she has been very stressed recently due to being fired and trying to find a new job and has not travelled abroad recently. What treatment would be useful for Sharon? A. Following a gluten-free diet B. Increasing exercise and altering fibre and fluid intake C. Prednisolone D. Antibiotics E. Surgery and Chemotherapy

Geoff, a 57-year-old male, has come to the GP regarding pain in his chest. Over the past 6 months he has been experiencing a ‘burning’ pain which rises up from the epigastric region into his chest behind the sternum. He denies any chest tightness or pain in the jaw and left arm. The pain seems to come on after every meal and is worse on lying down. He also notes he has noticed it is becoming painful to swallow which makes it difficult. When questioned about his lifestyle, he explains he smokes 10 cigarettes a day, 4 pints of beer per night, and is aware that his weight is well above average. What is most likely to be seen on endoscopy? A. The distal oesophageal epithelium undergoing metaplasia from squamous to columnar B. The proximal oesophageal epithelium undergoing metaplasia from squamous to columnar C. The distal oesophageal epithelium undergoing metaplasia from columnar to squamous D. The gastro-oesophageal junction sliding upwards into the chest cavity E. A bulge of the stomach rising up into the chest cavity alongside the oesophagus

. Bob, a 30-year-old male, presents to the GP with a burning pain in his epigastric region which gets worse when he is hungry or just after meals. He has become more reluctant to eat and as a result has noticed some weight loss. Bob smokes 5 cigarettes a day and drinks 3 glasses of red wine each night. He is told to reduce his alcohol intake and to stop smoking and is prescribed a PPI, however he comes back after 4 weeks with his symptoms unchanged. You undertake a carbon- 13 urea breath test and the results come back positive. What is the first line treatment? A. Add Gaviscon B. Continue with PPI alone C. Add a H2 Blocker D. H2 Blocker + Amoxicillin + Clarithromycin/Metronidazole E. PPI + Amoxicillin + Clarithromycin/Metronidazole

``` Doris has been suffering from dyspepsia for the past 4 weeks, and after trying lifestyle management her GP decides to try her on a Proton pump inhibitor (PPI). Which cells do PPIs act on? A. G cells B. Parietal cells C. Mucous neck cells D. Chief cells E. ECL cells ```

A 39-year-old male presents to A&E with right sided loin pain. He says it came on quite suddenly and that it comes and goes. When the pain is there, it is the worst pain he has ever felt and complains that he can’t get comfortable and it radiates down to his groin. What is the gold standard investigation to undertake? A. Abdominal ultrasound B. Contrast CT of kidney, ureter and bladder C. Non-contrast CT of kidney, ureter and bladder D. Urine dipstick E. X-Ray of the kidneys, ureter and bladder

``` What is the most common composition of renal stones? A. Ammonium Phosphate B. Calcium Oxalate C. Calcium Phosphate D. Cystine E. Uric acid ```

``` A 45-year-old painter presents to the GP with blood in his urine. He says he has the urge to go to the bathroom more been going to the bathroom more often than normal and there isn’t any pain when he goes. He states he has noticed he has lost some weight over the last few weeks without trying to, but he has been quite happy about that. What is the most likely diagnosis? A. Bladder cancer B. IgA Nephropathy C. Prostate cancer D. Renal cell carcinoma E. Urinary tract infection ```

``` Alan, a 72-year-old male, has recently been diagnosed with Benign Prostatic Hyperplasia. Which of the following symptoms is he least likely to have presented with? A. Haematuria B. Nocturia C. Poor stream D. Post-micturition dribbling E. Urgency incontinence ```

``` A man comes in for a medication review. One of the medications he is on is tamsulosin to treat his BPH. Which of these is a potential side effect which you need to ask about? A. Erectile dysfunction B. Haematuria C. Nausea and vomiting D. Postural hypotension E. Weight loss ```

``` Which of these is not a common bacterial cause of urinary tract infections? A. E. coli B. Proteus mirabilis C. Klebsiella pneumoniae D. Staphylococcus saprophyticus E. Streptococcus pneumoniae ```

. A 12-year- old boy with minimal change disease presents to the nephrology clinic for a review. Which of the following clinical pictures fits correctly for minimal change disease? A. Haematuria, hypoalbuminaemia and peripheral oedema B. Hyperlipidaemia, haematuria and hyperalbuminaemia C. Hypoalbuminaemia, peripheral oedema and proteinuria D. Proteinuria, haematuria and oliguria E. Proteinuria, hyperalbuminaemia and peripheral oedema

``` A patient presents to A&E with left sided loin pain. An abdominal x-ray shows a stone blocking the ureter on the left side. Monitoring of the patient’s urine output shows it has been less than 0.5ml/kg/hr for over 6 hours leading to a diagnosis of AKI. Which of the following U&E components should we be most concerned about? A. Chlorine B. Creatinine C. Potassium D. Sodium E. Urea ```

``` Michael, a 91 year old Asian gentleman, has a diagnosis of Chronic Kidney Disease (CKD). His GFR is recorded as 75. What CKD stage is this? A. Stage 1 B. Stage 2 C. Stage 3a D. Stage 3b E. Stage 4 ```

Furosemide is a diuretic indicated for patients with pulmonary oedema and chronic heart failure. Which of the following correctly describes furosemide’s pharmacology? A. It is a loop diuretic which acts on the ascending limb of the loop of Henle B. It is a loop diuretic which acts on the descending limb of the loop of Henle C. It is a potassium sparing diuretic which acts on the proximal convoluted tubule D. It is a potassium sparing diuretic which acts on the distal convoluted tubule E. It is a thiazide-like diuretic which acts on the distal convoluted tubule

``` A 24-year-old female presents to her GP with a single mass in her lower neck. It first appeared about 2 months ago. She recently moved to a new house and attributed her recent weight loss and night sweats to the stress of this. However, the lump in her neck has started to grow and she is getting worried as it now has a 3 cm diameter. On a recent girls night out, she found that it was very painful after drinking alcohol. What is the most likely diagnosis? A. Hodgkin’s lymphoma B. Multiple myeloma C. Non-Hodgkin’s lymphoma D. Polycythaemia Ruba Vera E. Stomach Cancer ```

``` A 55-year-old male is asked to attend a haematology clinic due to his recent diagnosis of chronic myeloid leukaemia. He has some initial investigations prior to his appointment. What is most likely to be found? A. Auer rods B. Decrease in the number of basophils C. Increase in haemoglobin D. Philadelphia chromosome E. Reed-Steinburg cells ```

``` A 76-year-old female has been diagnosed Non-Hodgkin’s lymphoma. She has nodal involvement on both sides of her diaphragm. What stage is she classified under using the Ann-Arbor Classification? A. 1 B. 2 C. 3 D. 4 E. 4+B ```

``` A 50-year-old woman is investigated for weight loss and anaemia. She has no past medical history of note. On clinical examination, the GP finds splenomegaly and pale conjunctivae. Her blood test results are below: - Haemoglobin: 10.9g/dl (12 – 165) - Platelets: 702*109 /l (150 – 450) - White cell count: 56.6*109 /l (4 – 11) - Blood film: Leucocytosis seen with all stages of granulocyte maturation seen. What is the most likely diagnosis? A. Acute lymphoblastic leukaemia B. Chronic lymphocytic leukaemia C. Chronic myeloid leukaemia D. Myelodysplasia E. Myeloma ```

``` Which of the following is not a risk factor for a deep vein thrombosis? A. Dehydration B. Malignancy C. Nausea D. Obesity E. Varicose Veins ```

``` A 45-year-old man has come into hospital after recently having day surgery on his knee with a swollen calf. After taking a history the FY1 finds out that he has also recently been to America and got back 3 days ago. The most likely diagnosis is a DVT. What is the gold standard investigation? A. CT Scan B. D-dimer C. Doppler ultrasound scan D. Venography E. XR ```

``` A 35-year-old vegan presents to her GP with peripheral neuropathy. In her past medical history, the GP also notes that she has coeliac disease that has been troubling her over the past 2 months. She orders a blood test and finds that she has megaloblastic anaemia. What is the most likely cause? A. Folate deficiency anaemia B. Iron deficient anaemia C. Fanconi anaemia D. Sickle cell disease E. Vitamin B12 deficient anaemia ```

``` A patient recently started ceftriaxone for meningitis which has caused haemolysis, what would you expect to see on assessment of the patient? A. Decreased reticulocyte count B. Decreased serum albumin C. Decreased serum phosphate D. Increased Haemoglobin E. Presence of dark urine ```

``` Which of the following is not a cause of iron deficiency anaemia? A. Chronic kidney disease B. GI bleed C. NSAIDS D. Pregnancy E. Sickle cell disease ```

What is the definition of pharmacodynamics? A. Action of the body on the drug. B. Action of the drug on the body. C. Action of the liver on the drug. D. Action of the renal system on the drug. E. The toxic effects of a medication

What is the definition of pharmacokinetics? A. Action of the body on the drug. B. Action of the drug on the body. C. Action of the liver on the drug. D. Action of the renal system on the drug. E. The toxic effects of a medication

``` . Mrs Smith is a 38-year-old lady recently diagnosed with fibromyalgia. Her GP prescribes amitriptyline, a tricyclic antidepressant, to manage her pain alongside CBT. Which of the following is not a known side effect of amitriptyline? A. Blurred Vision B. Confusion C. Dry Mouth D. Urinary retention E. Yellowing of nails ```

What is the mechanism of action for penicillin antibiotics? A. Inhibits bacterial cell wall synthesis B. Inhibits phosphodiesterase type 5 C. Inhibits protein synthesis by bacteria D. Inhibits the action of COX enzyome E. Interferes with bacterial DNA replication and transcription

``` Mr Jones is a 67-year-old gentleman who has recently been started on warfarin for AF and subsequently must monitor his INR regularly. An excess of which of the following foods would decrease warfarin’s effect? A. Bananas B. Beetroot C. Cranberries D. Grapefruit E. Spinach ```

Rosie is a 19-year-old female. She has been brought into A&E by her housemates as she has a severe headache and fever. The doctor suspects meningitis. Rosie is known to have suffered from angioedema when previously exposed to penicillin. Which of the following drugs does she have a contraindication to receiving? A. Ceftriaxone B. Chloramphenicol C. Co-amoxiclav D. Paracetamol E. Sodium Chloride 0.9% solution for infusion

``` Which of the following medications are licensed for use in the UK to treat heroin addiction? A. Diclofenac B. Methadone C. Metformin D. Oxycodone E. Tramadol ```

Which of the following is not a component of antibiotic stewardship? A. Educating staff about the safe and appropriate prescription of antibiotics. B. Prescribing antibiotics in bacterial infections at appropriate doses. C. Prescribing antibiotics in viral infections at appropriate doses. D. Reassessing treatment when culture results are available. E. Switching from IV to oral options after 48 hours in a septic patient who has stabilised.

``` James, a 38-year-old golfer, is diagnosed with a pheochromocytoma and is scheduled for surgery in several weeks. What is the first drug his endocrinologist should prescribe to him to prepare him for the upcoming surgery? A. Atenolol B. Atorvastatin C. Carbimazole D. Insulin E. Phenoxybenzamine ```

``` Which of the following is a complication of Clostridium Difficile infection? A. Ascending cholangitis B. Diverticulitis C. Ischaemic colitis D. Peptic ulcer E. Pseudomembranous colitis ```

``` Which symptom would not be seen in a patient with severe infective gastroenteritis? A. Bloody diarrhoea B. Coffee-ground vomitus C. Fever D. Headache E. Reduced skin turgor ```

``` Which of the following organisms does not cause atypical pneumonia? A. Chlamydia psittaci B. Coxiella burnetii C. Legionella pneumophila D. Mycobacterium avium complex E. Mycoplasma pneumoniae ```

``` Which medication is not used in the management of pulmonary TB? A. Erythromycin B. Ethambutol C. Isoniazid D. Pyrazinamide E. Rifampicin ```

``` Which antibiotic is not indicated in Staphylococcus Aureus infection? A. Ampicillin B. Cefotaxime C. Clarithromycin D. Flucloxacillin E. Vancomycin ```

``` Which heart valve is most commonly affected in infective endocarditis? A. Aortic B. Coronary C. Mitral D. Tricuspid E. Pulmonary ```

``` Which of the following is a Gram-negative diplococcus? A. Enterococcus spp. B. Escherichia coli C. Mycobacterium tuberculosis D. Neisseria spp. E. Staphylococcus aureus ```

``` Which of the following antibiotics does not inhibit cell wall synthesis? A. Benzylpenicillin B. Cefotaxime C. Erythromycin D. Teicoplanin E. Vancomycin ```

``` Which is the most common cause of bacterial pneumonia? A. Haemophilus influenzae B. Moraxella catarrhalis C. Pseudomonas aeruginosa D. Staphylococcus aureus E. Streptococcus pneumoniae ```

``` . Which of the following results would not score a point when assessing the severity of community-acquired pneumonia? A. 72-year old patient B. New onset confusion C. Respiratory rate: 28/min D. Systolic blood pressure: 87mmHg E. Urea: 11mmol/L ```

``` Which of these deformities is not typically seen in Rheumatoid Arthritis? A. Bouchard B. Boutonniere C. Ulnar Deviation D. Swan Neck Deformity E. Z thumb ```

In a patient with Pseudo-Gout what would be seen under light microscopy? A. Needle shape and negative bi-fringent B. Needle shape and neutral bi-fringent C. Needle shape and positive bi-fringent D. Rhomboid shape and negative bi-fringent E. Rhomboid shape and positive bi-fringent

``` An 86-year-old lady has been diagnosed with osteoporosis. Which of these would be second line treatment for the condition? A. AdCal B. Alendronic acid C. Allopurinol D. Corticosteroids E. Denosumab ```

What is the mechanism of action for bisphosphonates? A. Increases osteoblast activity and bone formation B. Increases osteocyte and osteoblast activity C. Inhibit bone resorption through the inhibition of enzyme (Farnesyl Pyrophosphate synthase) which reduces osteoclast activity D. Inhibits bone resorption through increasing osteoclast activity E. Works as a monoclonal antibody for RANK ligand leading to inhibited osteoclast activity.

``` A 58-year-old male presents with sudden painful inflammation of his big toe. What is the treatment? A. Allopurinol B. Colchicine C. Diclofenac D. Febuxostat E. IV antibiotics ```

``` Which of these diseases is associated with joint stiffness that gets worse during the day? A. Ankylosing Spondylitis B. Gout C. Osteoarthritis D. Psoriatic Arthritis E. Rheumatoid Arthritis ```

A 32-year-old women presents to clinic with a history of stiff hands and wrists which are worse on the morning. On examination her PIPJ joints are warm and swollen. You suspect she has Rheumatoid Arthritis. Which of the following investigations is the best for confirming this diagnosis? A. Anti-citrullinated peptide antibody (anti-CCP) B. C-reactive protein C. MRI D. Rheumatoid Factor Levels E. X-Ray

A 72-year-old lady presents to the GP with worsening pain in her left knee that is stopping her from getting around the house and getting to sleep at night. Which of the following describes what would be seen on an X-Ray of the left knee? A. Bony erosions and joint subluxation B. Increased joint space, osteophytes, subchondral sclerosis and subchondral cysts C. Normal X-Ray D. Reduced joint space, osteopenia and soft tissue swelling E. Reduced joint space, osteophytes, subchondral sclerosis and subchondral cysts

A 19-year-old man presents to A&E with a 1-day history of a red, swollen painful left knee. He is feeling generally unwell and has had a fever since yesterday. What is the most appropriate management of this patient? A. Analgesia and send home B. Aspirate the joint and send blood cultures C. Immobilise joint D. IV antibiotic treatment E. X-Ray left knee

``` A 26-year-old male presents to rheumatology clinic with progressive lower back and hip pain that has been going on for the past 2 months. He mentioned that pain and stiffness is worse in the morning and has also noticed that his left heel is also hurting most days. Recent blood tests show a raised ESR and CRP. What is the most appropriate first line treatment? A. Bed rest B. Bisphosphonates C. Physiotherapy only D. Physiotherapy and NSAIDS E. Steroid injections ```

A young patient is rushed to A&E following a sudden loss of consciousness after a period of vomiting and complaining of a headache. You take a history from his girlfriend who lives with him and says he is usually fit and well and he had been playing cricket earlier that day. You enquire about recent injuries and she explains how he got hit in the head earlier with a cricket ball but seemed fine following the injury. You perform a CT head and see a biconvex hypodense haematoma on the brain. Which injury to a blood vessel has caused this image? A. Blood clot in the circle of Willis B. Blood clot in the middle cerebral artery C. Rupture of a berry aneurysm D. Rupture of the bridging veins E. Rupture of the middle meningeal artery

``` A 41-year-old woman visits her GP complaining of recurrent headaches. She says that the pain is often just on one side of her head and feels as though her head is throbbing. She has tried to take some paracetamol which helps a little bit but not enough and these headaches are starting to interrupt her daily life. She is worried about driving because she has experienced some really strange feelings for a few minutes before the headaches start. She said these are quite hard to explain. What would be the 1st line treatment for this patient? A. Amitriptyline B. Aspirin C. Ibuprofen D. Topiramate E. Withdrawal of current medication ```

``` A 6-year-old girl is brought into her GP for an emergency appointment. Her parents are concerned because she has developed a fever over the last 24 hours and has been complaining of a stiff neck and legs. She has now started complaining of a headache that is made worse by bright lights. The GP suspects meningitis and gives IM benzylpenicillin before requesting a lumbar puncture. Which of these is not a causative organism for Meningitis? A. Listeria monocytogenes B. Neisseria meningitis C. Pseudomonas aeruginosa D. Streptococcus agalactiae E. Streptococcus pneumonia ```

``` A 52-year-old man visits the walk-in centre complaining of pain and pins-and-needles in his left hand. He can’t pinpoint exactly where it is, but he knows it doesn’t feel as bad in the palm of his hand. It is worse in the morning than at night, and it usually feels quite numb when he first wakes up until he starts to move it around more. You lightly tap the area just below the palm in the middle of the wrist with your finger and he gets the same sensation of the pins and needles he has been experiencing. Which nerve is responsible for these symptoms? A. Axillary nerve B. Brachial nerve C. Median nerve D. Radial nerve E. Ulnar nerve ```

``` A 19-year-old girl visits her GP because she has started needing the toilet much more than usual and feeling numb in various parts of her body. She tells you that recently her hands have started shaking and she feels generally very weak. She is experiencing pain from random things including some pain in her eyes, and whenever she goes in the shower everything feels ten times worse. This will occur for about a week, and then she will start to feel better again. What is the likely diagnosis based on the clinical history? A. Creutzfeldt-Jakob disease B. Duchenne Muscular Dystrophy C. Motor Neurone disease D. Multiple Sclerosis E. Myasthenia Gravis ```

``` A 45-year-old man visits you in your GP practice. He has previously been diagnosed with upper motor neuron disease and is coming for a review of his progression. He has become much weaker than when you have previously seen him and is now having trouble swallowing. You decide to insert a PEG tube to ensure he is getting enough nutrition. He finds this very distressing but accepts that it is for the best. Which of these is not a usual symptom of upper motor neurone disease? A. Babinski reflex B. Fasciculations C. Increased muscle tone D. Muscle weakness E. Overactive reflexes ```

``` A 42-year-old was diagnosed with Huntington’s disease 7 years ago. He has come to visit his GP for a medication review because his symptoms are no longer managed by the current dose. He hasn’t suffered with chorea for about a year but has now started experiencing random jerks of his limbs again, and he gets very embarrassed about it in public and would like to know if he can increase his dose of the medication that controls this. What medication is used to control the jerky movements described above? A. Gabapentin B. Haloperidol C. Prednisolone D. Risperidone E. Sertraline ```

``` A 32-year-old woman had been recovering from a chest infection, and then started presenting with tingling and numbness in her fingers and toes. Now, 3 weeks later, the weakness has spread further along her limbs and she is starting feel unsteady on her feet. A lumbar puncture is performed, and a diagnosis of Guillian-Barre syndrome is made. What is the treatment for Guillian-Barre syndrome? A. Low dose aspirin B. Dexamethasone C. IV immunoglobulin D. SC Sumatriptan E. Pyridostigmine ```

``` A patient is complaining of a recurring headache that lasts about an hour each time and presents as a tight pain going around the head like a band. There is no nausea or vomiting, but some sensitivity to light. Which of the following is not a cause of tension headaches? A. Depression B. Lack of sleep C. Missed meals D. Dehydration E. Stress ```

``` A 64-year-old woman goes to A&E because she is really worried about a rash that has developed along the side of her arm. She says it is painful and she also feels quite unwell. A history is taken, and she had recently been in contact with her granddaughter who had chicken pox. Which is the most useful investigation? A. Blood culture B. CT head C. Immunofluorescence D. Lumbar puncture E. Viral PCR ```

A 10-year-old girl presents to her GP with her mother. She has had ongoing shortness of breath for the last year, differing in severity over the course of the year. Which one of the following is not indicative of a diagnosis of asthma? A. A history of other atopic conditions such as eczema B. Bilateral widespread wheeze C. Clubbing of the fingers D. Diurnal variability E. Triggered by exercise and animals

``` Which cause of pneumonia is most typically associated with AIDS? A. Haemophilus influenzae B. Legionella pneumophila C. Pneumocystis jirovecii D. Pseudomonas aeruginosa E. Streptococcus pneumonia ```

A 55-year-old man presents to A&E with sudden onset chest pain and shortness of breath. He woke up today with a swollen, painful right leg. Upon further enquiry, you discover the gentleman has metastatic prostate cancer which is deemed inoperable. He has no previous history of DVT/PE and has not coughed up blood. You calculate his Wells score to be 7. You provide the patient with appropriate analgesia and oxygen and decide to admit. Checking his obs chart, you see the following: - Blood pressure: 127/84 - Heart Rate: 86 - Temperature: 37.4 - Saturation: 96% on 15L non rebreath. - AVPU: The patient is alert but in pain Radiology confirm your likely diagnosis. What is the next appropriate course of action? A. Commence thrombolysis such as streptokinase B. Perform a D-Dimer C. Start a DOAC such as apixaban D. Referral for urgent CTPA E. Start on Warfarin

A 45-year-old man is diagnosed with TB and started on appropriate medication. 2 months into his regime, he starts to experience pins and needles in his legs and muscle weakness. His GP suggests this is likely a side effect of his current TB medication. Which of the following is the likely cause? A. Rifampicin B. Isoniazid C. Pyridoxine D. Ethambutol E. Pyrazinamide

A 21-year-old male presents to A&E after developing sudden shortness of breath and right sided pleuritic chest pain. This came on whilst playing football. You perform an erect chest X ray, confirming your diagnosis. Whilst conferring with your colleagues, a nurse alerts you that the patient has gone into tachycardia. You perform a quick respiratory examination, finding reduced air entry on the right side. You also note tracheal deviation towards the left side of the chest. What is the most appropriate action? A. No treatment required, follow up in 2-4 weeks B. Immediate decompression via large bore canula C. Insert a chest drain into the ‘triangle of safety’ D. Oxygen if required and observation E. Needle aspiration

A consultant on a post take ward round shows you this arterial blood gas taken on admission. What is the correct description of the following arterial blood gas? - pH: 7.30 (7.35-7.45) - pCO2: 8.3 kPa (4.5-6.0) - PaO2: 9.2 kPa (10-14) - HCO3-: 29 mEq/L (22-26) A. Metabolic acidosis with partial respiratory compensation B. Metabolic alkalosis with partial respiratory compensation C. Respiratory acidosis with no compensation D. Respiratory acidosis with partial metabolic compensation E. Respiratory acidosis with full metabolic compensation

What drug group cause bronchodilation by blocking acetylcholine receptors which normally cause contraction of bronchial smooth muscle? A. H1 receptor antagonists B. Inhaled corticosteroids C. Leukotriene receptor antagonists D. Long-acting muscarinic antagonists E. Short acting beta-adrenergic receptor agonists

CURB65 is commonly used as a severity index for patients with pneumonia in hospital. What is the correct breakdown of CURB65? A. Confusion, Underlying Medical Condition, Respiration Rate, Blood (sputum), age 65 B. Confusion, Urea, Raised Temperature, Blood Pressure, age 65 C. Confusion, Urea, Respiration Rate, Blood Pressure, age 65 D. Confusion, Underlying Medical Condition, Respiration Rate, Blood Pressure, age 65 E. Confusion, Urea, Raised Temperature, Blood (in sputum), age 65

``` A 28-year-old woman presents with a dry cough and shortness of breath for the last 8 months. She also has a persistent rash on her shins. A chest X ray shows bilateral hilar lymphadenopathy. A biopsy is done to confirm diagnosis. Which shows non caseating granulomas with epithelioid cells. Which of the following electrolyte disturbance is most indicative of the above diagnosis? A. Hyperkalaemia B. Hypercalcaemia C. Hyponatraemia D. Hypocalcaemia E. Hypokalaemia ```

``` What is the antibody involved in Goodpasture’s Syndrome? A. Antiphospholipid B. Anti-smooth muscle C. Anti-TPO D. Anti-citrullinated cyclic peptide E. Anti-glomerular basement membrane ```

``` You are an infectious disease doctor working in the RHH. You have just confirmed a diagnosis of COVID 19 in a patient and subsequently inform Public Health England due to the fact this is a notifiable disease. Which of the following is NOT a notifiable disease in the UK? A. Enteric fever B. HIV C. Leprosy D. Measles E. Tuberculosis ```

``` A standard bottle of Pinot Grigio contains 750ml and its alcohol by volume (ABV) is 12.5%. Mr smith drinks a quarter of a bottle every evening with his meal. How many units is he consuming each week? (to the nearest unit) A. 12 B. 13 C. 14 D. 15 E. 16 ```

``` A mother attends a GP clinic with her baby for the first injection of the 6-in-1 vaccine. Which of the following is not included in this vaccine? A. Haemophilus influenzae type B (HiB) B. Hepatitis B C. Meningococcal group B D. Polio E. Tetanus ```

``` Which parameter isn’t in the scoring system used to calculate the stroke risk in patients with Atrial Fibrillation? A. Age B. Blood Pressure C. Congestive Heart Failure D. Diabetes E. Family History ```

``` Which of the following pulses is associated with Atrial Fibrillation? A. Absent B. Collapsing C. Irregularly irregular D. Pulsus paradoxus E. Radio-Radial delay ```

``` An ejection crescendo-decrescendo systolic murmur would be suggestive of which valvular pathology? A. Aortic regurgitation B. Aortic stenosis C. Mitral regurgitation D. Mitral stenosis E. Pulmonary stenosis ```

What are the three cardinal signs of heart failure? A. Angina, shortness of breath, oedema B. Cough, ankle oedema, fatigue C. Headache, fatigue, shortness of breath D. Pallor, ankle oedema, headache E. Shortness of breath, fatigue, ankle oedema

A 56-year-old Asian man has come into your GP surgery, he has tried to modify his diet, exercise more and improve other lifestyle factors. He wishes to be put onto a tablet and his ambulatory blood pressure reading was 155/100. What would you advise? A. Amlodipine prescription B. Candesartan prescription C. Further lifestyle measures are recommended D. He should return for a health check once he turns 60 E. Ramipril prescription

Which of the following signs on ECG would be most indicative of a diagnosis of Right Bundle Branch Block? A. R wave in V1, and Slurred S wave in V1 B. R wave in V1 and Slurred S wave in V6 C. R wave in V6 and Slurred S wave in V1 D. R wave in V6 and Slurred S wave in V6 E. Wide QRS and abnormal pattern.

``` Which of the following isn’t a sign of critical ischaemia? A. Pain B. Paralysis C. Paraesthesia D. Perishingly cold E. Pink ```

``` Which of these isn’t a feature of tetralogy of Fallot? A. Atrial septal defect B. Hypertrophy of the right ventricle C. Overriding aorta D. Pulmonary stenosis E. Ventricular septal defect ```

``` Which blood pressure reading taken in clinic would be classed as stage 1 hypertension? A. 125/80 B. 135/85 C. 145/95 D. 165/105 E. 180/110 ```

``` Which of the following is not a sign of infective endocarditis? A. Janeway lesions B. Osler’s nodes C. Roth spots D. Splinter haemorrhages E. Xanthelasma ```

``` A 22-year-old female presents to the GP complaining of generalised abdominal pain and bloating. She says the pain sometimes gets worse after eating food but gets better once she has defecated or passed wind. She also says she has been going to the bathroom more and been having episodes of diarrhoea but there hasn’t been any blood or mucus in it. She hasn’t had any recent travel and doesn’t describe any other symptoms. What is the most likely diagnosis? A. Coeliac Disease B. IBS C. Crohn’s D. Ulcerative Colitis E. Infective gastroenteritis ```

``` A 35-year-old male presents to A&E after vomiting blood. He had been having some abdominal pain, feeling very nauseous and had been retching several times a day before finally vomiting blood this morning. He hasn’t noticed any weight loss, fevers or any other systemic symptoms. He drinks 2/3 pints every evening and has been eating/drinking as normal. He doesn’t take any prescribed or over the counter medication. What is the most likely diagnosis? A. Peptic ulcer rupture B. Oesophageal malignancy C. Gastroesophageal reflux disease D. Achalasia E. Mallory Weiss tear ```

``` A 42-year-old female presents to the gastro clinic complaining of chest pain. She says that it feels like a burning sensation in the middle of her chest that gets worse when is lying or bending down. She also says that she wakes up in the evening feeling breathless. She hasn’t been vomiting any blood, had any difficulty swallowing food and drink or lost any weight. What medication would you give first to try treat this patient? A. Sulfasalazine B. Omeprazole C. Amoxicillin D. Prednisolone E. Ranitidine ```

``` Which of these is a not a cause of peptic ulcers? A. H. Pylori B. Increased stomach acid production C. Recurrent NSAID use D. Autoimmune gastritis E. Mucosal ischaemia ```

``` A 35-year-old male presents to A&E with pain in the middle of his abdomen which comes and goes. He says that he has been vomiting a lot over the last 7 days his abdomen is slightly bloated, and he hasn’t opened his bowels or passed wind in the last 3 days. He finds the pain gets much worse after he vomits, and he feels he has lost his appetite. He had an appendicectomy when he was 8 years old, but he has no other medical history of any other condition. What is the most likely diagnosis? A. IBS B. Large bowel obstruction C. Small bowel obstruction D. Crohn’s E. Coeliac Disease ```

A patient comes into the GP with a case of suspected gastritis due to an H. Pylori infection. Which of these managements should you use first? A. Clarithromycin, lansoprazole and omeprazole B. Penicillin, co-amoxiclav and ranitidine C. Lansoprazole, cimetidine and amoxicillin D. Clarithromycin, amoxicillin and omeprazole E. Amoxicillin, ceftriaxone and lansoprazole

``` Which of these is not a risk factor for GORD? A. Obesity B. Hiatus hernia C. Smoking D. Pregnancy E. Recurrent endoscopies ```

``` A patient comes in with abdominal pain, bloating, constipation. You examine the abdomen and discover a hard mass in the left iliac fossa and carry out a digital rectal examination which shows an empty rectum. What is the first line investigation in this case? A. Abdominal X-ray B. Abdominal CT C. Abdominal ultrasound D. Abdominal MRI E. Full blood count ```

``` Which of these is not a possible complication of untreated GORD? A. Oesophageal ulcers B. Oesophagitis C. Achalasia D. Barret’s oesophagus E. Oesophageal cancer ```

Which of these is correct regarding duodenal ulcers? A. They cause pain when eating and it is relieved several hours after eating B. They cause pain several hours after eating and the pain gets better when eating C. They cause pain when the patient is hungry, and it is relieved by eating D. They cause pain when eating and are relieved by drinking E. They cause pain when the patient drinks and is relieved by eating

Which is not a feature of Ulcerative Colitis? A. Affects from rectum to ileocaecal valve B. Affects males and females equally C. Has skip lesions D. Smoking is protective E. Weaker genetic link than Crohn’s

``` A 40-year-old man presents with smelly, floaty stools and diarrhoea. He has lost 7lb and has a rash on his elbows. He has a family history of Type 1 diabetes. What is the most likely diagnosis? A. Bowel Cancer B. Coeliac Disease C. Crohn’s Disease D. Infective illness E. Ulcerative Colitis ```

``` Which of the following is not a risk factor for Oesophageal Cancer? A. Achalasia B. Alcohol C. Obesity D. Smoking E. Spicy food ```

A 60-year-old male presents with blood and mucus in his stools for the past 3 weeks, he has had on off diarrhoea and constipation during this time. He has lost 2 stone over the 3 weeks. He smokes and reveals his father died of rectal cancer. Which is the most appropriate investigation? A. Blood test: FBC, U+E, Tumour Markers etc B. Colonoscopy C. Double contrast barium enema D. CT Colonoscopy E. MRI

``` Where are majority of colon cancers found? A. Ascending colon B. Caecum C. Descending colon D. Transverse colon E. Distal colon ```

``` Which of the following is the first line treatment for Coeliac disease? A. Dexa Scan B. Dietician Review C. Gluten-free Diet D. Prednisolone E. Vitamin Deficiency Correction ```

``` A 19-year-old presents with abdominal pain in his umbilical region which has now migrated to the right iliac fossa. He is pyrexic and vomiting. Which of the of the following is not a likely differential? A. Diverticulitis B. Ectopic Pregnancy C. Food poisoning D. Perforated ulcer E. UTI ```

``` Which of these is not a cause of diverticulum? A. Alcohol B. Low fibre diet C. Obesity D. NSAIDs E. Smoking ```

``` A 48-year-old female complains of bright red rectal bleeding which can be found upon wiping, she has been constipated recently and admits to straining. She feels tired but has not noticed any weight loss. What would the likely diagnosis be? A. Anal Fistula B. Anal Fissure C. Inflammatory Bowel Disease D. Haemorrhoids E. Rectal Cancer ```

A 38-year-old female presents to you with bouts of diarrhoea with urgency, fatigue, abdominal pain and mouth ulcers. She smokes and complains of A stressful life. What investigation result may you expect to see? A. Anaemia due to Iron and Folate deficiency B. C.Diff positive stool sample C. Duodenal biopsy showing villous atrophy and crypt hyperplasia D. Normal ESR and CRP E. pANCA positive

``` Which of the following would you least expect to cause an acute kidney injury? A. Acute tubular necrosis B. Hypervolaemia C. Nephrotoxins D. Prostate hyperplasia E. Sepsis ```

You are a GP and have just used a patient’s creatinine levels to help calculate their estimated glomerular filtration rate. You manage to work out that it’s 46 ml/min. What stage of CKD would you expect this patient to have? A. Stage 2 B. Stage 3a C. Stage 3b D. Stage 4 E. Stage 5

``` Which of the following is not a significant risk factor for CKD? A. Diabetes B. Family history of CKD C. Old age D. Pregnancy E. Recurrent UTI’s ```

``` Which of the following organisms is the most common cause of pyelonephritis? A. Staphylococcus Saprophyticus B. Enterococcus C. Escherichia coli D. Klebsiella E. Proteus ```

Which of the following is the best investigation to use in the management of pyelonephritis? A. Full blood count B. Midstream urine microscopy, culture and sensitivity C. Nuclei acid amplification test D. Ultrasound E. Urine dipstick

``` Alex, a 45-year-old builder presents to your GP with a 7-month history of recurring perineal pain as well as pain and difficulty when passing urine. He says he needs to go to the toilet many times a day which is starting to affect his work. On further questioning he reluctantly tells you that he has also had some pain when ejaculating. Alex mentions a workplace incident that he thinks might be related, where he fell from height and injured his hip close to a year ago. You decide to carry out a digital rectal exam- you don’t think his prostate is hard or irregular. What is the most likely diagnosis based on the history so far? A. Benign prostatic hyperplasia B. Cystitis C. Prostate cancer D. Prostatitis E. Pyelonephritis ```

``` Lucy is a 30-year-old woman who is 2 months pregnant, as her GP you find that she has a lower urinary tract infection and are considering which antibiotic to prescribe her. Which of the following medications would you definitely avoid prescribing? A. Amoxicillin B. Cephalexin C. Fosfomycin D. Nitrofurantoin E. Trimethoprim ```

``` James is a 25-year-old male who recently tested positive for Chlamydia, he went to get tested after he noticed pain on urinating and discharge from his penis. He is now quite concerned as his eyes have turned red and his ankles and feet have become swollen. Which of the following can be used to describe his symptoms? A. Behcet’s syndrome B. Budd-Chiari syndrome C. Charcot’s triad D. Reiter’s syndrome E. Saint’s triad ```

``` Ray, a 32-year-old gentleman with heterozygous polycystic kidney disease (PKD) presents to the genetic counselling clinic. He informs you that his wife, who does not suffer from PKD, is pregnant and that they are expecting their first child in 3 months time. What is the likelihood that their newborn child will also have PKD? A. 25% B. 50% C. 75% D. 100% E. 0% ```

``` Which of the following is not a complication of polycystic kidney disease? A. Cardiovascular disease B. Kidney stones C. Nephrotic syndrome D. Polycystic liver disease E. Subarachnoid haemorrhage ```

How is Hodgkins lymphoma (HL) clinically different from Non-Hodgkins lymphoma (NHL)? A. Clinical presence of B symptoms in HL and its absence in NHL B. Disease is limited to lymph nodes in HL whilst in NHL disease can spread beyond lymph nodes C. Presence of Reed-Sternberg cells in HL on histological observation and absence of such cells in NHL D. Presence of Auer rods in HL on histological observation and absence of such cells in NHL E. Physical examination reveals lymphadenopathy in HL whilst this is not the case in NHL

``` Which one of the following is not a definite risk factor for DVT? A. Pregnancy B. Recent surgery C. Recent leg fracture D. Progestogen-only pill (POP) E. Recent history of cancer ```

``` A 46-year-old male comes into your GP practice and is found to have fever and fatigue. It becomes apparent when you are taking a history from him that he has recently come back from Africa. You suspect he could have malaria. What organism would you see in his blood film that would confirm that he has malaria? A. Giardia lamblia B. Trypanosoma brucei gambiense C. Plasmodium falciparum D. Toxoplasma gondii E. Anopheles gambiae ```

``` A patient presents to A&E with a fever and confusion. Upon further investigation, you find that she has AKI and her FBC reveals thrombocytopenia and anaemia. You recognise this as Thrombotic Thrombocytopenic Purpura and realise it is a medical emergency and you need to treat her immediately without waiting for diagnostic confirmation. What is the urgent gold standard treatment for someone with TTP? A. Platelets B. Hydroxycarbamide C. Immunosuppressants D. Plasma exchange E. Broad spectrum antibiotics ```

``` You are a junior doctor on the acute medical unit and are doing your clerking. You come across a 60-year-old woman who recently had an accident due to which she suffered a fractured right leg a week ago and she has been relatively bed bound since. She tells you she is concerned her right leg is slightly swollen compared to her left leg and her GP sent her here. On further questioning you find out she is currently on hormone replacement therapy. Which risk score would be most appropriate to determine the next step in managing this patient? A. CHA2DS2VASc B. FRAX score C. HAS-BLED score D. QRISK-3 E. Well’s score ```

``` A 22-year-old male is diagnosed with Hodgkin’s lymphoma. Imaging and bone marrow biopsy reveal that the lymphoma is present in his axillary lymph nodes and in his inguinal lymph nodes. He has also lost significant weight and reports having night sweats. What clinical stage is his Hodgkin’s lymphoma currently, according to the Ann Arbor staging system? A. Stage II A B. Stage III B C. Stage IV A D. Stage IV B E. Stage III A ```

Jennifer, a 49-year-old female, was recently started on chemotherapy in preparation for a bone marrow transplant. Which of the following is the least likely complication of her chemotherapy? A. Cytopenia (anaemia, neutropenia and thrombocytopenia) B. Excessive hair growth C. Infertility D. Nausea and GI disturbances (constipation/diarrhoea) E. Secondary malignancies

You are the FY1 on an orthopaedic ward. A 65-year-old man is on the ward recovering from a recent total hip replacement following a neck of femur fracture. What is an appropriate thromboprophylaxis regimen? A. Alteplase B. Compression stockings and aspirin C. Dalteparin acutely and then maintenance treatment with apixaban D. Dalteparin acutely and then maintenance treatment with aspirin E. Aspirin acutely and then maintenance treatment with apixaban

``` What is the protein target of Rituximab? A. CD4 B. CD8 C. CD20 D. HER2 E. TNF-alpha ```

``` What is the ideal first line treatment for severe/complicated malaria? A. IV Artesunate B. IV quinine + doxycycline C. PO chloroquine D. PO primaquine E. Artemisinin combination therapy ```

``` A 24-year-old male presents to General Practice complaining of a painful elbow. Upon examination the GP suspects a diagnosis of olecranon bursitis. The patient asks the GP about the pathological process that occurs in this condition. The GP explains the process of inflammation. Which of the following is not a clinical feature of acute inflammation? A. Rubor B. Dolor C. Suppuration D. Tumor E. Loss of function ```

``` A 53-year-old male attends A&E complaining of central chest pain. An ECG is ordered which shows ST-elevation in the anterior leads. The patient is sent for PCI and recovery in the coronary care unit. On the ward round, the cardiologist explains that unlike other cells in the body, heart muscle cells are unable to regenerate and so part of his heart muscle is non-functional now. Which of the following cells are not capable of regeneration? A. Pneumocytes B. Hepatocytes C. Osteocytes D. Neurones E. Gut epithelial cells ```

A 74-year-old gentleman attends General Practice complaining of urinary symptoms. The GP performs a PR examination which shows a smooth, enlarged prostate. The GP suspects a diagnosis of benign prostatic hyperplasia. Which of the following definitions best describe hyperplasia? A. Increased size of a tissue due to increase in number of constituent cells B. Increased size of a tissue due to increase in size of constituent cells C. Change in differentiation of a cell from one fully differentiated type to a different fully differentiated type D. Abnormal growth of tissue in a body which persists despite removal of initial stimulus E. Decreased size of a tissue due to programmed cell death

``` A 63-year-old female is undergoing investigations for a suspected malignancy. The radiologist report confirms the presence of a malignant tumour of smooth muscle. What is the name for a malignant tumour of smooth muscle? A. Rhabdomyoma B. Leiomyoma C. Liposarcoma D. Leiomyosarcoma E. Rhabdomyosarcoma ```

``` A 14-year-old female presents to A&E with severe abdominal pain. The pain started as a general tummy ache but the pain has now localised to the right iliac fossa. The doctor suspects a diagnosis of acute appendicitis. What type of cells would you expect predominantly during this disease process? A. B lymphocytes B. Macrophages C. Mast cells D. Neutrophils E. T lymphocytes ```

``` Which of the following pathologies would result in resolution? A. Acute cholecystitis B. Cerebral infarction C. Full nephrectomy D. Myocardial infarction E. Partial lobectomy ```

A 17-year-old female attends General Practice complaining of diarrhoea. After investigations, a diagnosis of Crohn’s disease is made. Crohn’s disease is a condition where granulomatous inflammation occurs. What is the definition of a granuloma? A. An aggregate of neutrophil polymorphs B. An aggregate of lymphocytes C. An aggregate of epithelioid histiocytes D. New connective tissue + microscopic blood vessels forming on wound surface E. A pus-filled cavity

``` A 64-year-old male attends General Practice complaining of exertional chest pain. A diagnosis of angina is made and the patient asks the GP what would cause this. The GP explains its most likely due to the process of atherosclerosis. Which of the following is not a constituent in an atherosclerotic plaque? A. Connective tissue B. Foam cells C. Fragments of RBCs D. Lymphocytes E. Smooth muscle cells ```

``` A 63-year-old male attends General Practice complaining of persistent heart burn. The GP decides to investigate this further due to recurrent issues. An endoscopy reveals Barrett’s oesophagus, a process where metaplasia occurs. What cell type is the end result of the metaplastic change in Barrett’s oesophagus? A. Simple squamous B. Simple columnar C. Stratified squamous D. Stratified columnar E. Simple cuboidal ```

Which of the following would be the most indicative of prostate cancer? A. Hard, craggy prostate on digital rectal examination B. History of urinary frequency and dribbling C. History of weight loss D. Raised PSA E. Raised CRP/ESR

``` Which of the following is not a cause of Liver failure? A. Alcohol overuse B. Atrial Fibrillation C. Budd-Chiari syndrome D. Haemochromatosis E. Wilson’s Disease ```

``` Rachel, a 23-year-old female with a known history of depression and borderline personality disorder presents to the Emergency department with stomach aches and profuse vomiting. On examination she has a reduced GCS. Tox-screen results indicate very high level of Paracetamol in the blood. What is the 1st line pharmaceutical treatment for paracetamol overdose? A. Chlordiazepoxide B. Desferroxamine C. Flumezanil D. Naloxone E. N-acetyl cysteine ```

``` Which of the following would you not expect to see in a patient with liver failure? A. Asterixis B. Dupuytren’s contractures C. Kayser-Fleischer rings D. Leukonychia E. Spider Naevi ```

``` Mr Jones, a 45-year-old man, presents to A&E complaining of central pain in his upper abdomen which has come on in the last few days. He also reports that he experiences interscapular pain. The doctor orders some blood tests which reveal a raised serum amylase is very elevated (around 4 times higher than normal) and decreasing renal function. The doctor sets up an IV infusion of normal saline, gives analgesia and contacts the Surgical SHO for an urgent assessment. What is the likely diagnosis? A. Acute Pancreatitis B. Appendicitis C. Diabetic Ketoacidosis D. Duodenal Ulcer E. Paracetamol overdose ```

``` A patient's investigation results are as follows: - ALP – 170 (30-100) - ALT – 90 (3-40) - AST – 87 (3-30) - GGT – 96 (8-60) - Bilirubin – 70 (3-17) - Prothrombin time (PT) – 24s (10-14s) Very high levels of circulating antimicrobial antibodies (AMA) were also found. What is the likely diagnosis? A. Appendicitis B. Acute Pancreatitis C. Coeliac disease D. Systemic Lupus Erythematous (SLE) E. Primary Biliary Cholangitis (PBC) ```

``` Which of the following is not characteristic of an upper Gi bleed? A. Coffee ground vomit B. Diarrhoea C. Hypotension D. Melaena E. Tachycardia ```

Which of the following is a cause of Pancreatitis? A. Coeliac Disease B. Gastro-oesophageal reflux disorder (GORD) C. Horner’s syndrome D. Mumps E. Obesity

``` Mr Jones, a 57-year-old man, presents to his GP with intermittent pain in the right upper quadrant of his abdomen, made worse when he eats, especially fatty meals. He has a BMI of 35 and on examination has yellowish sclera. Last night he had a fever and rigors. What is the likely diagnosis? A. Acute pancreatitis B. Ascending Cholangitis C. Biliary colic D. Primary Biliary cholangitis E. Vincent’s angina ```

``` Mr Gascoigne, a 52-year-old male, is brought to the emergency department by the police after wandering confused in the street. He is a known alcoholic but from what history you can gather, it seems that he has not had a drink in the last 48 hours. Which of the following would be the most appropriate immediate pharmaceutical treatment for this patient? A. Adrenaline B. Amlodipine C. Chlordiazepoxide D. Methadone E. Morphine ```

``` Wernicke’s Encephalopathy is a complication of alcoholism caused by the deficiency of which vitamin? A. Folate B. Vitamin B1 (Thiamine) C. Vitamin B12 (Cobalamin) D. Vitamin C E. Vitamin K ```

``` Which of the following cancers is least likely metastasise to the bone? A. Breast B. Kidney C. Lung D. Stomach E. Thyroid ```

``` Which of the following side effects is most likely to occur with Alendronic Acid use? A. Cough B. Gout C. Haemolytic anaemia D. Oesophagitis E. Urinary frequency ```

``` Richard, a 76-year-old gentleman, presents to his GP with ongoing left knee pain that has now led to him developing a slight limp. He experiences stiffness in the mornings but says it soon gets better as he makes his breakfast. On examination, his left knee is tender and shows some deformity. Richard mentions he used to be a keen footballer and had a nasty injury to his knee several years ago. The GP requests an X-ray. Given the likely diagnosis, which is least likely to be seen on the X-ray? A. Joint space narrowing B. Osteophyte formation C. Soft tissue swelling D. Subchondral cysts E. Subchondral sclerosis ```

``` Which of the following investigations would be most appropriate in diagnosing Sjogren’s syndrome? A. EMG B. Joint aspirate C. Schirmer’s test D. Spirometry E. Joint X ray ```

``` Which of the following X ray signs is mostly likely to be found a patient with psoriatic arthritis? A. Bamboo spine B. Pencil in cup C. Periarticular erosions D. Osteophytes E. Rhomboid crystals ```

``` A 23-year-old student comes to your GP clinic complaining of back pain. He describes an aching pain that has come on over a few months and now wakes him at night. He denies weight loss, fevers or change in appetite. He has found gentle exercise to be helpful but struggles to keep up with his usual yoga class, finding the stretches difficult. Given the likely diagnosis, what is the most appropriate first line management? A. Chemotherapy B. Ibuprofen C. Infliximab D. Paracetamol E. Watch and wait ```

``` Terry, a 52-year-old gentleman, presents to your GP clinic with knee pain. When he woke up this morning his knee was red and swollen, although Terry cannot think why. He also has a low-grade fever but feels well in himself. Terry is generally fit and well, although he tells you he recently had a small operation to remove a benign tumour from his neck. Which of the following is the most likely diagnosis? A. Gout B. Pseudogout C. Reactive arthritis D. Rheumatoid arthritis E. Septic arthritis ```

``` Steve is a 48-year-old with an acutely painful left big toe. He hops into your clinic with a bare foot, saying even socks are too painful. You diagnose him with acute gout. He’s been taking ibruprofen which seems to be helping with the pain and inflammation but wants to know if there’s anything he can take long term to prevent it from happening again. Which of the following medications is the most appropriate to prescribe to prevent future gout attacks occurring? A. Allopurinol B. Colchicine C. Hydroxychloroquine D. Lansoprazole E. Paracetamol ```

``` Beryl is an 83-year-old lady presenting to A&E with a hip fracture after falling from her chair in her care home. On examination Beryl looks frail and underweight. She suffered a stroke 4 years ago and has been left with right sided weakness and has fallen several times. Last year she broke her wrist. You are concerned about her bone health and order a DEXA scan. The T score comes back as -2.2. Which of the following is the most likely cause underlying Beryl’s fractures? A. Osteoarthritis B. Osteomalacia C. Osteopenia D. Osteoporosis E. Osteosarcoma ```

``` Jack is a 19-year-old who presents to your GP clinic with aching knees for 1 week. On questioning he discloses a myriad of other symptoms: a sore eye, rashes on both feet, burning on urination and mouth ulcers. Jack is distressed by these symptoms; he is usually very healthy with no past medical history (except a visit to the clinic for Chlamydia last month). Jack is keen for a diagnosis – which of the following is most likely? A. Dermatomyositis B. Fibromyalgia C. Reactive arthritis D. Sjogren’s syndrome E. Systemic sclerosis ```

A 79-year-old woman is having lunch in her hospital bed after recovering from a urinary tract infection. As she takes a sip of water from her glass, she drops it. The healthcare assistant in the bay then sees to her. They notice that the woman is slurring her speech and that the right side of her face is drooping. Of the following options, which is the most appropriate as your next course of action? A. CT imaging of head B. Immediately stop all anti-coagulation therapy C. Intravenously administered alteplase D. MRI imaging of head E. Urgent speech and language therapy team referral

``` A 52-year-old man complains of an incident occurring a few hours ago as ‘a black curtain suddenly coming down’ over his right eye. He says that the episode was painless and only lasted a few minutes and that his vision was back to normal after. You check his observations and note the following: RR 14, HR 70, T 36.5oC, SPO2 98% room air, BP 165/95. On listening to his neck, you can hear a bruit. He has no other past medical history other than having type 2 diabetes which is controlled with medication. What is the most likely diagnosis? A. Amaurosis fugax B. Glaucoma C. Optic neuritis D. Papilledema E. Retinal vein thrombosis ```

``` Peter, a 23-year-old investment banker, has come to A&E with bleeding from his mouth. His brother has come with him and says that an hour he watched as Peter suddenly gasped for air, fell to the floor and started making jerking movements for about a minute. He was unresponsive for a few minutes and then completely recovered. Peter says he’s doesn’t think he’s ever had seizure before, although when working late he sometimes notices his head or arm twitching. There is no other significant past medical, family or medication histories. Cardiovascular exam, neurological exam, blood tests and ECG are all normal. What pharmacological treatment should be offered to the patient before their discharge from hospital? A. Clonazepam B. Gabapentin C. Rivastigmine D. No treatment needed E. Sodium valproate ```

Which of the following clinical features is not commonly found in patients with Parkinson’s disease? A. Blank facial expressions except when told to smile B. Extremely small handwriting C. Hands shaking when trying to reach for something D. Rigid limbs and difficulty getting out of bed E. Slow walking

A 48-year-old woman presents with a daily headache and blurred vision that has worsened over the past several months. You are worried that she could have a space-occupying lesion. Which of the following clinical features is least likely to occur in patients with brain tumours? A. Ascending paralysis from the lower limbs B. Coma C. Dysdiadochokinesis D. Nausea and vomiting E. Seizures

Dianne, 62-year-old woman, presents in A&E with extreme right-sided head pain and trouble seeing things with her right-eye. She struggles to dictate her history to you, claiming that she also has jaw pain too. She claims she is normally healthy but in the recent months has become more and more drained, with aches all over her body. She also mentions weak shoulders and hips. When you examine her, her right-side scalp is very painful to the touch. Her blood tests also came back and reveal a markedly raised ESR. What is the most appropriate next step in the management of this lady? A. IM benzylpenicillin B. Oral prednisolone C. Prescribe codeine and advise plenty of bed rest at home D. Routine 2 week referral to ophthalmology E. Urgent CT head

``` Alan, a 48-year-old gentleman, attends A&E complaining of back pain. He works as a delivery driver and says that the pain started after loading a heavy pallet into his truck. On presentation, he is in visible discomfort and is unable to walk. He also says that he has been unable to go to the toilet since the pain started. A neurological examination of his lower limbs reveals intact sensation throughout, except his perineum. Power in both his legs is also reduced throughout. A digital rectal examination reveals poor anal tone. Which of the following diagnoses is the most likely? A. Cauda equina syndrome B. Compression of the spinal cord C. Musculoskeletal injury D. Nerve root compression E. Vertebral fracture ```

Which of the following best describes the mechanism of action of the drugs neostigmine and pyridostigmine that are used to treat myasthenia gravis? A. Blocks active site of acetylcholinesterase, increasing the amount of Ach available to the post-synaptic membrane B. Crosses the blood-brain barrier and is converted into dopamine which acts to reduce the neurological symptoms C. Inhibits the conversion of angiotensin I to angiotensin II D. Inhibits the conversion of arachidonic acid to prostaglandins E. Reduces intracranial pressure by setting up an osmotic gradient between the CSF and subarachnoid space

``` Which of the following is least likely to be a risk factor for developing peripheral neuropathies? A. Diabetes Mellitus B. Immunocompromised status C. Lymphoedema D. Systemic lupus erythematosus E. Thiamine (Vit B1) deficiency ```

``` Adult patients with acute ischaemic stroke should receive alteplase treatment within what time after onset of their symptoms? A. <3.5 hours B. <4.5 hours C. <24 hours D. <48 hours E. <7 days ```

``` What is the commonest cause of an infective exacerbation of COPD? A. Haemophilus Influenzae B. Parainfluenza Viruses C. Rhinovirus D. Staphylococcus Aureus E. Streptococcus Pneumoniae ```

Harry, a 75-year-old ex-miner, is admitted to A&E after struggling with breathlessness and a cough. He is known to have COPD and usually manages this with oxygen at home, he has been a smoker for 25 years and previously worked as a coal miner for 30 years. The HCA documents his observations as follows: - O2 Sats : 87% on air - HR : 100 - RR : 24 - BP : 115/75 - Temp : 37.4 On listening to his chest you hear a bilateral expiratory wheeze. You start him on oxygen and prescribe him salbutamol and ipratropium bromide nebulizers. You insert a cannula and send off bloods to the labs, a CXR is requested. What is the next most immediate step in Harrys Management? A. Arterial blood gas sampling B. Assess Peak Flow C. Start non-invasive ventilation (BIPAP) D. Take a sputum sample for microscopy, culture and sensitivity E. Urine sample for microscopy and sensitivity

Which of the following is a sign of a life-threatening asthma attack? A. Inability to complete sentences in one breath B. SpO2 <92% C. Pulse < 110 D. RR≥25 E. RR<25

``` Jess, a 21-year-old asthmatic has come to see her GP after she noticed that she feels shaky and her heart races after she takes one of her new medications for asthma. Which medication below is most commonly associated with a fine tremor? A. Beclametasone inhaler B. Montelukast oral medication C. Proprionate inhaler D. Prednisolone oral medication E. Salbutamol inhaler ```

Which type of lung cancer is most commonly seen in non-smokers? A. Adenocarcinoma B. Carcinoid tumour C. Large cell and differentiated carcinoma D. Small cell lung cancer E. Squamous cell carcinoma

Which lung cancer is strongly associated with asbestos exposure? A. Adenocarcinoma B. Large cell and differentiated carcinoma C. Mesothelioma D. Squamous carcinoma E. Small cell carcinoma

``` Sarah is a 35-year-old and is 7 months pregnant with her first child. Yesterday whilst cooking breakfast she developed a sharp chest pain on her left side and has felt progressively short of breath since. The pain feels sharp and worsens on taking a deep breath or speaking. She is normally fit and well, takes no regular medications and denies any previous episodes like this in the past. On examination her heart rate is 78 bpm, her respiratory rate is 20, temperature is 37.3 and blood pressure is 125/ 85. On listening to her chest you hear normal heart sounds and good air entry bilaterally. What is the mostly likely pathology behind Sarah’s presentation? A. Angina B. Muscular strain C. Myocardial Infarction D. Pneumothorax E. Pulmonary Embolism ```

``` Which of the following is not a risk factor for a Pulmonary Embolism? A. Antiphospholipid syndrome B. Cancer C. Early mobility post-surgery D. Factor V Leiden mutation E. Synthetic Oestrogen ```

``` Mick, a 75-year-old care home resident, has been brought to A&E after suddenly becoming confused and drowsy. On examination he looks dehydrated. On auscultation of his chest you hear coarse crackles and reduced air entry bilaterally and he is coughing up green sputum. His vital signs are: - HR: 100 - RR: 28 - Temp: 38.2 - Oxygen Sats: 94% on 15L high flow oxygen - BP: 100/65 IV access is gained, and bloods are taken, fluid and antibiotics are administered. A CXR is ordered. His bloods come back showing urea levels of 8mmol/L. You suspect Mick is suffering from a chest infection. What is his CURB65 score? A. 1 B. 2 C. 3 D. 4 E. 5 ```

``` Jeremy, a 49-year-old man, has had a productive cough for 4 months and has noticed his sputum is sometimes tinged with blood. On questioning his GP finds out he is also experiencing significant night sweats, fatigue, a decreased appetite and has lost 4kg in the last 4 months. For the past 6 months Jeremy has been sleeping on the streets after being kicked out by his wife. His only past medical history is depression. He drinks heavily but doesn’t smoke or take recreational drugs. He has not been abroad recently. On examination his chest sounds clear with good bilateral air entry. His vital signs are: - HR 75 - RR 16 - Temp 37.4 - SpO2 98 % on air The GP refers him for a chest x-ray which shows a cavitating lesion in the upper left lobe and hilar lymphadenopathy. A sputum sample is taken which comes back positive for growing acid-fast bacilli. What is the most likely diagnosis? A. Bacterial Pneumonia B. Lung Cancer C. Pulmonary Embolism D. Tuberculosis E. Lung abscess ```

``` Which of the following X-ray findings is most characteristic of osteosarcoma? A) Onion skin pattern B) Bony spur formation C) Punched-out lesions D) Sunburst pattern ```

``` Which one of the following is NOT a cause of microcytic anaemia? A) Alpha Thalassemia B) Beta Thalassemia C) Iron Deficiency D) Sideroblastic Anaemia E) B12 Deficiency ```

A 70-year-old woman presents to the clinic for her annual checkup. Her history is largely unremarkable, other than some increased frequency of bowel movements. She maintains a healthy lifestyle, she is physically active and has a healthy diet. Her physical examination is unremarkable. Her lab results last time were normal. Her latest routine labs show the following: Hb: 100g/L Hct: 0.32 WBC: 9x109/L Platelets: 250x109/L MCV: 74 fL Ferritin: low Coeliac screen: negative Peripheral blood smear shows hypochromic red blood cells. Which one of the following is the next most appropriate step? A) Coagulation studies B) CT abdomen C) Faecal occult blood test (Stool guaiac test) D) Colonoscopy E) Upper GI endoscopy

``` A 6-year-old boy presented to the emergency room with his mother, complaining of severe left knee pain after falling down while playing soccer. On examination, the knee was swollen, warm to touch, and range of motion was limited. Investigations reveal a normal full blood count. Coagulation studies are within the normal range, other than APTT which is increased. His mother mentions that her son had prolonged bleeding after a recent dental extraction. What is the most likely diagnosis? A) Von Willebrand Disease B) Haemophilia B-Factor IX Deficiency C) Haemophilia A-Factor VIII Deficiency D) Protein C Deficiency E) Haemophilia A- Factor IX Deficiency ```

Which of the following would help to differentiate Hodgkin's Lymphoma from Non-Hodgkin's Lymphoma? A) Hypersegmented neutrophils on microscopy B) Reed-Sternberg Cells on microscopy C) BCR-ABL Gene on genetic testing D) Sickle shaped cells on microscopy

``` A 33-year-old woman presents to the emergency department with epistaxis that started 1 hour ago spontaneously. She has no history of trauma. On examination, she has multiple bruises and petechiae all over her body. The patient is otherwise healthy and the rest of the examination is unremarkable. Her FBC was unremarkable, with the exception of her platelet count, which is 9 x109/L. The peripheral blood smear came back normal. What is the most likely diagnosis? A) Haemophilia A B) Leukaemia C) Aplastic Anaemia D) Lymphoma E) Immune Thrombocytopaenic Purpura ```

``` Which of the following is a hallmark feature of chronic myeloid leukaemia? A) Heinz Bodies B) Spherocytes C) Reed-Sternberg cells D) Philadelphia chromosome ```

Mr Jones presents to your clinic with a loss of function in his hands, when you inspect them you notice shiny, tight skin and a loss of fat pads on the fingers. He states to you sadly that he is not a well man and suffers from hypertension, shortness of breath, difficulties swallowing, a dry cough and is a poorly controlled type II diabetic. What is your primary differential diagnosis? A) Lung cancer B) Osteoarthritis C) Diffuse cutaneous systemic sclerosis D) Rheumatoid arthritis E) Limited cutaneous systemic sclerosis

A 42-year-old female presents to her GP complaining of intermittent upper abdominal pain. She is experiencing this pain several times a week and experienced a particularly bad episode last night after dinner. The episodes of pain are variable in length, lasting from minutes to a few hours and tend to occur after eating. During the episodes, she feels very nauseated and has vomited on several occasions. She denies any recent weight loss or change in bowel habit. On examination the patient is obese, but there are no other significant findings. Vital signs, FBC, U&Es, LFTs and CRP are all within normal limits. Which of the following is the most likely diagnosis? a) Biliary colic b) Cholangitis c) Pancreatic cancer d) Pulmonary embolism e) Cholecystitis

A 55-year-old female patient has presented to her GP with pain in her left knee and right hip. She describes 6 weeks of pain, which worsens with activity. She also reports stiffness after resting, with a reduced range of movement. Which of the following is the most likely diagnosis? A) Reactive arthritis B) Ankylosing spondylitis C) Rheumatoid arthritis D) Polymyalgia rheumatica E) Osteoarthritis

A 60-year-old man with hypertension is brought to the emergency department because he fell at home while getting out of bed. An MRI of the brain shows a hyperdense lesion in the posterior limb of the left internal capsule, consistent with acute infarction. Which of the following findings is he most likely to have? a) Contralateral lower facial weakness b) Contralateral limb weakness c) Contralateral homonymous hemianopia d) Ipsilateral ataxia e) Ipsilateral hearing loss

``` Which of the following blood markers classically rises with an upper gastrointestinal bleed? A) Urea B) GGT C) Potassium D) Haemoglobin ```

A 32-year-old lady consults her GP because she is worried that her periods have been very heavy and painful recently. She has a past medical history of type 1 diabetes. She also states that her mood has been low recently and she has put on some weight. Which of the following blood results is most likely to be low? A) T4 B) Total iron binding capacity C) Testosterone D) TSH E) Folate

A 32-year-old lady consults her GP because she is worried that her periods have been very heavy and painful recently. She has a past medical history of type 1 diabetes. You suspect PCOS. Which of the following blood results is most likely to be high? A) T4 B) Total iron binding capacity C) Testosterone D) TSH E) Folate

James Simpson, a 20-year-old male presents to the emergency department with shortness of breath. From speaking to his girlfriend you know that James is asthmatic and that his blue inhaler has not cleared his symptoms. When trying to talk to James it becomes clear he is unable to complete sentences because he is too short of breath. On examination, he is not cyanosed but has a bilateral wheeze throughout the thorax. His peak expiratory flow rate (PEFR) is 35% predicted and his PaCO2 is 4.0. Vital signs are as follows: Pulse: 130 beats per minute Blood Pressure: 140/80 mmHg Respiratory Rate: 26 breaths per minute Pulse Oximetry: 90% Which of the clinical findings so far is most likely to indicate that this is a life-threatening asthma attack? A) Unable to complete sentences B) PEFR of 35% predicted C) Pulse oximetry of 90% D) Respiratory rate of 26 breaths per minute E) PaCO2 of 4.0

``` Which of the following antiemetics is primarily a 5-HT3 antagonist? A) Prochlorperazine B) Cyclizine C) Ondansetron D) Metoclopramide E) Domperidone ```

Adam is a 60-year-old male presenting with a collapse, witnessed by his wife. Which of the following makes the diagnosis of a seizure more likely than syncope? a) Confusion after recovery B) Dehydration prior to fall C) Looking pale prior to fall D) Intense exertion prior to fall E) Mild jerking of upper limbs for 15 seconds during fall

``` When assessing pulse, which of the following is a potential cause of a regularly irregular rhythm? A) Atrial fibrillation B) Second-degree atrioventricular block C) Sinus tachycardia D) Third-degree atrioventricular block E) First-degree atrioventricular block ```

A 19-year-old male presents to the GP with an intensely itchy rash on his elbows, knees, back, and buttocks. He is otherwise well, but mentions occasional abdominal bloating when questioned. What is the next most appropriate management step? A) Endoscopic small intestinal biopsy B) Gluten free diet C) Dapsone D) Serum IgA tissue transglutaminase antibody testing E) Skin biopsy

``` Miss Johnson (27) recently presented to you with fatigue, unintentional weight loss and myalgia following a second consecutive miscarriage. During your examination, you notice lymphadenopathy and a slight red rash across both cheeks. When questioned about her facial rash, she tells you that it becomes worse if she is outside on a sunny day. You order some investigations which show: ANA antibodies RBC of 3.5 x1012 Raised CRP and ESR levels What first-line treatment would you prescribe for Miss Johnson to use during acute flares? A) Ciclosporin B) Paracetamol C) Prednisolone D) Rituximab E) Methotrexate ```

``` Which of the following ECG changes occurs first during myocardial infarction? A) Tall P-waves B) Tall T-waves C) ST depression D) ST elevation ```

SBAs Flashcards

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