CSIs

Question 1

Mr P has COPD and multiple other co-morbidities. Which of the following common comorbidities is not associated with a statistically significant increase in mortality for COPD patients?

1. Diabetes with neuropathy
2. Obstructive sleep apnoea
3. Coronary artery disease
4. Atrial fibrillation

Answer 1

Obstructive sleep apnoea

Question 2

Lower back pain can be treated in a number of ways. Two alternatives are brief intervention or extended intervention. The table below contains data from a study investigating the relative effect of these two treatment approaches on health and disability one year after treatment.

How many outcomes measures are significantly improved to a greater extent by the brief intervention compared with the extended intervention?
1. 1
1. 2
1. 3
1. 4

Answer 2

2

Question 3

Mr A has developed severe backpain due to nerve compression in his spinal cord at the level of the T12 vertebrae. How is this most likely to affect his micturition?

• Problems in both the initiation and termination of micturition
• Problems only in the initiation of micturition
• Problems only in the termination of micturition
• No problem in either initiation or termination of micturition

Answer 3

Problems in both the initiation and termination of micturition

Question 4

The figure below shows the potential pathways by which action potentials may travel. Identify the pathway by which an action potential due to a touch on the right hip would travel?

Answer 4

A

Question 5

The list below lists a set of pathophysiological changes in the cardiopulmonary system. How many of these potential pathophysiological changes could occur as a result of COPD?

1. Alveolar hypoxia
2. Peripheral oedema
3. Pulmonary hypertension
4. Right ventricular failure

Answer 5

All 4

Question 6

Which physiological change in airway smooth muscle tone (labelled 1-4) is mimicked by salbutamol?

Answer 6

2

Question 7

Chronic back pain is often difficult to treat and new treatments are being tested. One of these treatments is tanezumab. Below is a graph comparing the effect of tanezumab against tramadol and placebo on patient reported back pain score against time since start of treatment.

How many of the statements below describe the data accurately?

1. Tramadol is significantly better at than placebo at reducing back pain at all time points up to eight weeks
2. 10mg tanezumab is significantly better than placebo at reducing back pain at all time points up to sixteen weeks
3. 5mg tanezumab is significantly better than placebo at reducing back pain at all time points up to twelve weeks
4. 10mg tanezumab is significantly better than tramadol at reducing back pain at all time points up to sixteen weeks

Answer 7

2

Question 8

It is your first day as a FY1 and you need to obtain a blood sample from Mrs Shah. You wish to obtain your sample from the left ante-cubital fossa (ACF). Which of the following pathways correctly describes the route of the action potential when your venepuncture needle is used on Mrs Shah’s skin?

1. Mechanoreceptor in left ACF > Afferent nerve fibre (A-delta) > Dorsal Horn > Decussation at spinal cord > Ascent through spinothalamic tract > Thalamus > Right Cerebral Cortex
2. Mechanoreceptor in left ACF > Afferent nerve fibre (C fibre) > Dorsal Horn > Decussation at spinal cord> Ascent through spinothalamic tract > Thalamus > Right Cerebral Cortex
3. Mechanoreceptor in left ACF > Afferent nerve fibre (A-delta) > Dorsal Horn > Ascent through spinothalamic tract > Decussation at medulla > Thalamus > Right Cerebral Cortex
4. Mechanoreceptor in left ACF > Afferent nerve fibre (A-delta) > Dorsal Horn > Decussation at spinal cord> Ascent through spinothalamic tract > Thalamus > Left Cerebral Cortex

Answer 8

Mechanoreceptor in left ACF > Afferent nerve fibre (A-delta) > Dorsal Horn > Decussation at spinal cord > Ascent through spinothalamic tract > Thalamus > Right Cerebral Cortex

Question 9

A 55-year old man with COPD is started on BIPAP (non-invasive ventilation) due to type 2 respiratory failure. Which of the following are features of BIPAP?

1. BIPAP inspiratory pressure is higher than expiratory pressure
2. The iPAP (inspiratory positive airway pressure) component of BIPAP recruits under-ventilated or collapsed alveoli for gas exchange
3. BIPAP can be initiated outside of an ICU setting
4. BIPAP reduces the work of breathing

Answer 9

1,3 & 4

Question 10

Peripheral oedema can occur in COPD patients due to physiological changes in the cardiopulmonary system. Please place the following potential physiological changes in sequence of how they might lead to peripheral oedema.

A Right ventricular failure
B Alveolar hypoxia
C Changes to pulmonary vascular resistance
D Pulmonary hypertension

1. C –> B –>D –>A
2. B –>C –>D –>A
3. A –>B –>C –>D
4. D –>C –>B –>A

Answer 10

B –> C –> D –> A

Question 11

Mr K has COPD, and he frequently experiences ankle swelling because of his COPD. Alveolar hypoxia, pulmonary vascular resistance, right-ventricular afterload and peripheral oedema are some physiological features associated with the ankle swelling. Which of these physiological features directly reduces blood flow to the left atrium.

1. Alveolar hypoxia
2. Pulmonary vascular resistance
3. Right-ventricular afterload
4. Peripheral oedema

Answer 11

Pulmonary vascular resistance

Question 12

The initial management of an infective exacerbation of COPD may employ which of the following treatments?

1. Targeted oxygen therapy
2. Oral steroids
3. NIV
4. Nebulised bronchodilators

Answer 12

1, 2 & 4

Question 13

In cauda equina syndrome, the process of urination is affected and can often be an impending sign of cord compression. Understanding the process of urination is therefore vital to appreciate the impact of untreated cord compression. As you have learnt previously the autonomic system plays a major role in the process of urination. Which of the following combinations correctly describes the action of the autonomic nervous system on bladder function:

1. Detrusor muscle contraction & Urethral sphincter relaxation – Parasympathetic
2. Detrusor muscle contraction & Urethral sphincter contraction – Sympathetic
3. Detrusor muscle relaxation & Urethral sphincter contraction – Parasympathetic
4. Detrusor muscle contraction & Urethral sphincter relaxation – Sympathetic

Answer 13

Detrusor muscle contraction & Urethral sphincter relaxation – Parasympathetic

Question 14

You are an F2 doctor on your GP rotation. Which of the patients below has red flag symptoms of CES?

1. Mr Smith is 50 years old with lower back pain and numbness in both upper thighs
2. Mrs Singh is 35 years old with lower back pain and right foot paraesthesia
3. Ms Kanumba is 68 years old with lower back pain not controlled by paracetamol
4. Mr Wagner is 45 years old with lower back pain which is worse on movement

Answer 14

Mr Smith is 50 years old with lower back pain and numbness in both upper thighs

Question 15

During development, the body goes through a number of processes in order to prepare the body for adulthood and to ensure that organs are placed in the correct anatomical location. In the adult, at what vertebral level does the spinal cord end?

Answer 15

L1

Question 16

Early recognition of cauda equina syndrome (CES) is vital. Which is the investigation that a patient with suspected CES requires urgently (assume no contra-indications)?

1. Ultrasound of their spine
2. CT scan of their spine
3. MRI scan of their spine
4. Plain radiographs of their spine

Answer 16

MRI scan of their spine

Question 17

Eosinophils are white blood cells that are part of the innate immune response. The level of eosinophils in blood varies between people. The level of blood eosinophiles has been studied in relation to hospital readmissions for individuals with COPD. Some of this data is summarised in the table below.

Which of the statements below describe the data accurately?

1. Patients with low levels of eosinophils have significantly reduced levels of readmission for COPD
2. Patients with high levels of eosinophils have significantly reduced levels of readmission for COPD
3. Patients with high levels of eosinophils have significantly reduced levels of readmission for other causes
4. Patients with low levels of eosinophils have significantly reduced levels of readmission for other causes

Answer 17

1 & 4

Question 18

One of the factors that can produce poorer outcomes in treating COPD and other lung conditions is poor adherence to treatment. In the table below is a summary of data from a study examining factors affecting adherence to treatment.

How many of the statements below describe the data accurately?

1. Patients with low levels of education have significantly lower levels of adherence than patients with high levels of education.
2. Patients with poor treatment knowledge have significantly lower levels of adherence than patients with good treatment knowledge.
3. Patients who experience adverse drug events have significantly lower levels of adherence than patients who experience no adverse events
4. Patients with high education levels are more likely to have good treatment knowledge

Answer 18

1

Question 19

Mr J has COPD and has been admitted to hospital in acute decompensated type 2 respiratory failure. Which of the following arterial blood gases would be consistent with this?

Normal values are: PaO₂ 10-14 kPa, PaCO₂ 4.5-6 kPa, pH 7.35-7.45

1. PaO₂ 7.4 kPa, PaCO₂ 3.7 kPa, pH 7.48
2. PaO₂ 7.5 kPa, PaCO₂ 7.1 kPa, pH 7.29
3. PaO₂ 7.6 kPa, PaCO₂ 6.8 kPa, pH 7.37
4. PaO₂ 10.5 kPa, PaCO₂ 3.7, pH 7.25

Answer 19

PaO₂ 7.5 kPa, PaCO₂ 7.1 kPa, pH 7.29

Question 20

Thermo-transduction is the process of converting a thermal stimulus to an action potential, while chemo-transduction is the process of converting a chemical stimulus to an action potential. Both processes can be involved in pain sensation. TRPV1 is a molecule that can be associated with pain sensation. Which of the transduction processes mentioned above can TRPV1 be associated with?

1. Thermo-transduction only
2. Chemo-transduction only
3. Thermo-transduction and chemo-transduction
4. Neither thermo-transduction nor chemo-transduction

Answer 20

Thermo-transduction and chemo-transduction

Question 21

Mr Stiller has been found to have metabolic acidosis. What is the most likely sequence of events that will begin to occur within the next hour?

1. Increased Ventilation -> Increased CO₂ in blood -> Increased Carbonic acid -> Decreased pH
2. Increased Ventilation -> Decreased CO₂ in blood -> Decreased Carbonic acid -> Increased pH
3. Decreased Ventilation -> Decreased CO₂ in blood -> Decreased Carbonic acid -> Increased pH
4. Increased Ventilation -> Increased CO₂ in blood -> Decreased Carbonic acid -> Increased pH

Answer 21

Increased Ventilation -> Decreased CO₂ in blood -> Decreased Carbonic acid -> Increased pH

Question 22

Mrs King has breast cancer which was diagnosed three years ago. She was in remission post-treatment but relapsed six months ago. She suffers from lower back pain. This has been worse for the last three days. She describes weakness lifting her foot. You examine her with a chaperone, and you find left sided foot drop and altered peri-anal sensation. What’s the most important urgent investigation?

1. Spinal X-ray
2. CT scan of the spine
3. Bladder scan
4. Magnetic resonance imaging (MRI) scan of the spine

Answer 22

Magnetic resonance imaging (MRI) scan of the spine

Question 23

Mr Yonel (35) is seen at the specialist respiratory clinic due to cough and wheeze. He has a past medical history of eczema, gastric reflux and migraine. He drinks 18 units of alcohol a week and has never smoked. The consultant diagnoses him with COPD and thinks this is due to a genetic condition. Which genetic condition is likely to be the cause of Mr Yonel’s COPD?

1. Aromatic I-amino acid decarboxylase deficiency
2. Alpha-1-antitrypsin deficiency
3. ACAD9 deficiency
4. Cystic fibrosis

Answer 23

Alpha-1-antitrypsin deficiency

Question 24

Which diagram below (labelled A-D) represents the compensatory kidney response to respiratory acidosis?

Answer 24

A

Question 25

A 67-year-old woman with a history of COPD presents with 3 days of worsening dyspnoea and increased frequency of coughing. Her cough is now productive of green, purulent sputum. The patient has a 100-pack-year history of smoking. She has had intermittent, low-grade fever of 37.7°C (100°F) for the past 3 days and her appetite is poor. Her oxygen saturations on room air are 87%. She has required increased use of rescue bronchodilator therapy in addition to her maintenance medications to control symptoms. Which treatment package in the table below would you select for this patient?

Option: Treatment package
1. Adrenaline, short acting bronchodilator, intravenous fluid, antibiotic therapy
1. Inhaled corticosteroid, short acting bronchodilator, oxygen, leukotriene receptor antagonist
1. Short acting bronchodilator, oral corticosteroid, oxygen, antibiotic therapy
1. Beta blocker, diuretic, oxygen, aldosterone antagonist

Answer 25

Short acting bronchodilator, oral corticosteroid, oxygen, antibiotic therapy

Question 26

The medullary cone of the spinal cord ends at the L3 level in a neonate but generally ends at the L1 level in an adult. What is the cause for this shift?

1. Lengthening of the vertebral column
2. Degeneration of a portion of the spinal cord
3. Increase in the number of vertebrae
4. Fusion of lumbar vertebrae

Answer 26

Lengthening of the vertebral column

Question 27

There are few effective treatments for chronic lower back pain. In the table below are pain outcomes of a new therapy Neurofeedback training (NFT) compared to and in combination with cognitive behaviour therapy (CBT) in people with new chronic lower-back pain (early-chronic) and established chronic lower-back pain (late chronic). Back pain is measured by pain catastrophic score (PCS, lower is better) and pain self-efficacy questionnaire (PSEQ, higher is better). Which treatment(s) would be most effective at treating both early chronic and late chronic pain based on the two pain measures used?

1. NFT only
2. CBT only
3. Either CBT or a combination of CBT and NFT
4. The combination of CBT and NFT only

Answer 27

The combination of CBT and NFT only

Question 28

Why does pulmonary vasoconstriction occur in response to a reduced alveolar partial pressure of oxygen?

1. Alleviates pressure on the right side of the heart
2. Increases breathing rate and oxygen delivery to alveoli
3. Reduces the likelihood of pulmonary oedema
4. Ensures blood is diverted to better ventilated parts of the lung

Answer 28

Ensures blood is diverted to better ventilated parts of the lung

Question 29

In the diagram below which neurons are the first to transmit the convergent signal?

1. First order neurons
2. Second order neurons
3. Third order neurons
4. Fourth order neurons

Answer 29

Second order neurons

Question 30

A 24 year-old woman is brought to the Accident and Emergency department with an oxygen saturation of 88% on room air and pinpoint pupils on exam. A room air arterial blood gas is performed and reveals (normal range in brackets): pH 7.25 (7.35-7.45), PCO₂ 8kPa (4.7-6kPa), PO₂ 8.67kPa (11-13kPa), HCO₃^- 26 (22-26mEq/l), Base Excess 1 (-2 to +2 mmol/l). Blood tests reveal that her sodium is 137 (133-146 mmol/l) and chloride 100 (98-106 mmol/l). What is the interpretation of her arterial blood gas?

1. Respiratory acidosis
2. Metabolic acidosis
3. Respiratory alkalosis
4. Metabolic alkalosis

Answer 30

Respiratory acidosis

Question 31

Mr Craven presents with a persistent chesty cough with lots of thick phlegm. Which treatment could be prescribed to specifically target the thick phlegm?

1. Roflumilast
2. Theophylline
3. Salbutamol
4. Carbocisteine

Answer 31

Carbocisteine

Question 32

In which region of the adult spinal column (labelled A-D) in the diagram below would you expect the cauda equina to emerge from the spinal cord?

Answer 32

B

Question 33

What sort of pain signal is most likely being delivered to the somatosensory cortex in the diagram below?

1. Left sided dull pain
2. Right sided dull pain
3. Left sided sharp pain
4. Right sided sharp pain

Answer 33

Right sided dull pain

Question 34

The diagram below shows the autonomic and motor control of the bladder. In cauda equina syndrome, dysfunction in which group of neurons would result in urinary retention?

1. Parasympathetic neurons only
2. Sympathetic neurons only
3. Motor neurons only
4. Parasympathetic and motor neurones

Answer 34

Parasympathetic neurons only

Question 35

Which chest X-ray below (labelled A-D) is most representative of an infective exacerbation of COPD?

Answer 35

A

Question 36

The figure below is an axial cross-sectional MRI at the level of L5/S1 of a patient with cauda equina syndrome. Which arrow (labelled A-D) is indicating the vertebral canal that is affected by the irregular disc herniation causing cauda equina syndrome in this patient?

Answer 36

C

Question 37

James Goulding presented to his GP with a history of chronic back pain dating back several years. At presentation, he was suffering a severe flare-up of the back pain that was radiating down both legs. The pain continued for a further two weeks before Mr Goulding was admitted to hospital and determined to have a post-void bladder volume of 200ml (normal < 50ml). Mr Goulding also suffered a fall the same day whilst on his way for an MRI scan. The scan revealed severe spinal stenosis, at which point Mr Goulding was referred to neurosurgery with a diagnosis of cauda equina syndrome. How many red flag symptoms for cauda equina are present in the paragraph above?

Answer 37

2

Question 38

A 57 year-old woman presents with 2 days of fevers, dyspnoea and a cough productive of rust-coloured sputum. Her room air oxygen saturation in Accident and Emergency is found to be 85% and a room air arterial blood gas is performed while they are waiting for the chest x-ray to be done. The blood gas reveals (normal ranges in brackets): pH 7.54 (7.35-7.45), PCO₂ 3.3 (4.7-6kPa), PO₂ 8.67 (11-13kPa), HCO₃^- 22 (22-26mEq/l), Base excess -1 (-2 to +2 mmol/l). What is the interpretation of her arterial blood gas?

1. Respiratory acidosis
2. Metabolic acidosis
3. Respiratory alkalosis
4. Metabolic alkalosis

Answer 38

Respiratory alkalosis

Question 39

In the following study, patients with severe COPD were asked to record their daily peak expiratory flow rate (PEFR). Patients were divided into two groups depending on the variability in their PEFR– a stable group with less variability in weekly PEFR (< 0.3 slope) and an unstable group with more variability in weekly PEFR (> 0.3 slope). The graph below compares the time to first hospitalisation for the stable and unstable group compared to their PEFR variability per week. How does the data for the stable group of patients compare with the data for the unstable group?

1. The stable group has higher PEFR variability associated with shorter times to first hospitalisation compared with the unstable group
2. The stable group has lower PEFR variability associated with shorter times to first hospitalisation compared with the unstable group
3. The stable group has lower PEFR variability associated with longer times to first hospitalisation compared with the unstable group
4. The stable group has higher PEFR variability associated with longer times to first hospitalisation compared with the unstable group

Answer 39

The stable group has lower PEFR variability associated with longer times to first hospitalisation compared with the unstable group

Question 40

Decussation of the dorsal column–medial lemniscus pathway is believed to occur before birth. In which of the secondary brain vesicles (see figure below) does decussation of the dorsal column–medial lemniscus pathway occur?

1. Diencephalon
2. Mesencephalon
3. Metencephalon
4. Myelencephalon

Answer 40

Myelencephalon

Question 41

The figure below shows one of the pathophysiological changes that follows bacteria-induced intestinal epithelial cell damage. Which blood test would be most appropriate to detect this pathophysiological change?
1. C reactive protein
1. Faecal calprotectin
1. Full blood count
1. Ova, cysts and parasites

Answer 41

Faecal calprotectin

Question 42

There are several sub-types of gallstones. Chronological changes in the relative frequency of sub-types have been investigated in both males and females.

Which statement most accurately describes this data?
1. Pure cholesterol stones are the only subtype in which frequency is not significantly altered in both males and females during the study
1. Black pigment stones are the most common sub-type in both males and females throughout the study
1. Combination stones are the only subtype in which frequency changes significantly in both males and females during the study
1. Calcium bilirubinate stones show the greatest magnitude of significant change in both males and females during the study.

Answer 42

Calcium bilirubinate stones show the greatest magnitude of significant change in both males and females during the study.

Question 43

Faecal (stool) osmotic gap is calculated using the following formula:

Stool osmolarity (290mOSm/kg) – 2x stool(Na⁺+ K⁺).

Which results in the table below would be associated with a patient with diarrhoea due to lactose intolerance?

Answer 43

iii

Question 44

Mr F presents with diarrhoea lasting for over a month. History and testing reveal the following – high frequency, high volume watery diarrhoea with a low faecal osmotic gap. What test should be performed next?
1. Faecal leukocytes
1. Breath hydrogen test
1. Coeliac panel
1. Stool culture and sensitivity test

Answer 44

Stool culture and sensitivity test

Question 45

Oscar Candella (47 years old) presents with right upper quadrant abdominal pain for the past 2 days. Today he developed a fever and he tells you he noticed his eyes appeared more yellow. His heart rate is 111bpm. What is the most likely diagnosis based on his presentation?
1. Biliary colic
1. Acute cholecystitis
1. Ascending cholangitis
1. Pancreatitis

Answer 45

Ascending cholangitis

Question 46

Patients with Crohn’s disease can be treated with triple therapy consisting of infliximab, azathioprine and prednisolone. How many of these drugs can cause immunosuppression with prolonged use?
* 0
* 1
* 2
* 3

Answer 46

3

Question 47

The intestines express a large array of distinct transport proteins. The table below describes some of these transport proteins and how they control secretion and absorption of electrolytes. If we generated drugs that inhibited each of the transport proteins in the table below, how many could be effective treatments for diarrhoea?
1. 1
2. 2
3. 3
4. 4

Answer 47

2

Question 48

In the diagram below, where would the gallstone typically become stuck in Mirizzi’s syndrome?
1. A
2. B
3. C
4. D

Answer 48

A

Question 49

The data below summarises the incidence (IRR = incidence rate ratio) of Crohn’s disease by sex ratio (female:male) across a range of ages. What is the most accurate description of this data?
1. Crohn’s disease is more common in females than males of all ages
1. Crohn’s disease incidence increases with age
1. Crohn’s disease is more common in females than males older than 35
1. Crohn’s disease becomes more common in females than males with increasing age

Answer 49

Crohn’s disease is more common in females than males older than 35

Question 50

Protein losing enteropathy is a condition that can lead to diarrhoea. Which of the following tests would be most useful in evaluating the degree of protein loss?
1. Thyroid function tests (TFTs)
1. Liver function tests (LFTs)
1. Full blood Count (FBC)
1. Urea & Electrolytes (U&Es)

Answer 50

Liver function tests (LFTs)

Question 51

The three labelled sections below (1-3) are all histological sections of the colon. Can you identify which sections are from a healthy colon, ulcerative colitis (UC) patient and a Crohn’s disease (CD) patient?
1. 1= Healthy patient, 2 = UC patient, 3 = CD patient
1. 1= CD patient, 2 = Healthy patient, 3 = UC patient
1. 1= CD patient, 2 = UC patient, 3 = Healthy patient
1. 1= UC patient, 2 = CD patient, 3 = Healthy patient

Answer 51

1= CD patient, 2 = UC patient, 3 = Healthy patient

Question 52

Which of the four scenarios in the table below would be most likely to lead to gallstone formation?
1. 1
2. 2
3. 3
4. 4

Answer 52

2

Question 53

Gallstones often occur in the presence of other gastrointestinal disease. One disease which is a common co-morbidity is functional dyspepsia and irritable bowel syndrome (FD/IBS). A study has investigated the effect of the presence of functional dyspepsia and irritable bowel (FD/IBS) disease on the resolution of symptoms after cholecystectomy. The data is presented in the table below.
How many of the seven parameters in the table indicate that pain is significantly greater/worse in those patients with FD/IBS than in those without FD/IBs?
1. 3
2. 4
3. 5
4. 6

Answer 53

4

Question 54

A 38 year old female presents to A&E with a one day history of severe right upper quadrant and epigastric pain associated with nausea. She is awaiting a laparoscopic cholecystectomy for symptomatic gallstones.
Her blood tests show:
* Hb 135 g/L (115-165)
* WCC 7.7x109/L (3.6- 11.0)
* Neutrophils 4.2x109/L (1.8-7.5)
* Platelets 303x109/L (140-400)
* Creatinine 78 µmol/L (49-90)
* Urea 6.2 mmol/L (2.5-6.7)
* Potassium 3.9 mmol/L (3.5-5.0)
* Sodium 141 mmol/L (135-145)
* CRP 1.1 mg/L (0-5)
* AST 38 IU/L (15-42)
* ALP 67 IU/L (30-130)
* Bilirubin 11 µmol/L (0-21)
* Amylase 56 U/L (30-110)
What is the most likely diagnosis?
1. Biliary colic
1. Acute cholecystitis
1. Ascending cholangitis
1. Pancreatitis

Answer 54

Biliary colic

Question 55

Beth Atkins (47 years old) is reviewed as part of a general surgical ward round. She has no past medical or surgical history. The consultant informs the patient that her history and investigations strongly suggest that she is suffering with acute cholecystitis and therefore she would benefit from having a laparoscopic cholecystectomy. The consultant begins explaining the procedure including its risks and benefits. Which of the following points should be discussed as part of the consent process?
i - The treatment options including not proceeding with surgery
ii - The likelihood of success
iii - The clinicians that will be involved in her treatment
iv - The option to have a second opinion

1. i only
2. i & ii
3. i, ii and iii
4. All points should be discussed

Answer 55

i, ii and iii

Question 56

One specialist test for cholecystitis is a hepatobiliary iminodiacetic acid (HIDA) scan, also known as cholescintigraphy. Cholecystokinin (CCK) can be added to test the ejection fraction (EF) of the gallbladder. Which of the EF level(s) shown below (i-iv) would be considered abnormal, and indicate functional gallbladder disorder?
i - 50%
ii - 43%
iii - 38%
iv - 32%

1. iv only
2. iii and iv
3. All of them
4. None of them

Answer 56

iv only

Question 57

People are investigating potential markers to more easily track disease status in ulcerative colitis. One such marker is matrix metalloproteinase-9 (MMP-9). The data in the table below is a summary of the correlation between plasma MMP-9 levels and several other parameters which reflect disease status.
How many of the parameters show a significant positive correlation with MMP-9 levels?
1. 3
2. 4
3. 5
4. 6

Answer 57

3

Question 58

The diagram below shows an abdominal x-ray, with the large intestines overlaid in pink. At which position is gallstone ileus most likely to get impacted?

Answer 58

A

Question 59

The table below includes presenting history for 3 different individuals. Based on the presenting history, which of these individuals are more likely to be suffering with inflammatory bowel disease rather than irritable bowel syndrome?

• Anna Herbert
  
  • A 34-year-old mother of three presents to her family physician with a 3-week history of constipation with abdominal cramping pain in both lower quadrants. Over the last 4 days, she has been having frequent small, soft stools accompanied by some mucus.
• Asa Bloomfield
  
  • A 25-year-old white man presents to his general practitioner with cramping abdominal pain for 2 days. He reports having loose stools and losing 6.8 kg over a 3-month duration. He also reports increased fatigue.
• Kaitlin Jones
  
  • A 16-year-old girl presents to emergency care with perianal pain and discharge. She reports a 2-year history of intermittent bloody diarrhoea with nocturnal symptoms. On examination, she is apyrexial with normal vital signs.

1. Anna Herbert & Asa Bloomfield
2. Anna Herbert & Kaitlin Jones
3. Asa Bloomfield & Kaitlin Jones
4. All three individuals

Answer 59

Asa Bloomfield & Kaitlin Jones

Question 60

Which drug class would be most likely to prevent the gallbladder from contracting?
1. Bile acid sequestrants
1. Fibrates
1. Oestrogen containing hormone replacement therapy
1. Somatostatin analogues

Answer 60

Somatostatin analogues

Question 61

A 43-year-old patient presents to the emergency department with acute abdominal pain. He smells of alcohol and looks dishevelled. You go and see him urgently. He looks unwell and has severe epigastric pain. You inspect his abdomen.

What is the most likely diagnosis?
* Pancreatitis
* Ruptured abdominal aortic aneurysm
* Bowel ischaemia
* Pyelonephritis

Answer 61

Pancreatitis

Question 62

The four pictures below represent colonoscopy (panel A & B) and histology findings (panel 1 & 2) from either a Crohn’s disease patient or a patient with ulcerative colitis.

Which colonoscopy and histology findings are from a patient with Crohn’s disease?
* A1
* A2
* B1
* B2

Answer 62

B2

Question 63

Acute acalculous cholecystitis (AAC) is known to have a poorer prognosis than acute calculous cholecystitis (ACC). The figures below show the comparison of incidence of acute cholecystitis (AAC versus ACC) according to age. What are the significant findings in this data?
* The proportion of AAC patients over 50 is significantly greater that the proportion of ACC patients over 50
* The proportion of ACC patients over 50 is significantly greater that the proportion of AAC patients over 50
* The proportion of AAC patients under 50 is significantly greater that the proportion of ACC patients under 50
* The proportion of ACC patients under 50 is significantly greater that the proportion of AAC patients under 50

Answer 63

The proportion of AAC patients over 50 is significantly greater that the proportion of ACC patients over 50

Question 64

The ultrasound below shows the gall bladder and a part of the liver.

In which region (labelled A-D) are gallstones apparent in the ultrasound below?
* Region A
* Region B
* Region C
* Region D

Answer 64

Region C

Question 65

Mr Javier Ratchett developed a post-surgical urinary tract infection whilst staying in hospital. He was treated with appropriate anti-biotics whilst in hospital and left hospital once he had recovered. Four weeks after his initial admission, Mr Ratchett develops diarrhoea and abdominal pain. He presents to his GP and laboratory investigations reveal an elevated white cell count. Mr Ratchett was started on oral vancomycin. His stool sample tests positive for the C. Difficile toxin. How would you describe Mr Ratchett’s diarrhoea?
* Acute, inflammatory
* Acute, non-inflammatory
* Chronic, inflammatory
* Chronic, non-inflammatory

Answer 65

Acute, inflammatory

Question 66

How many of the transport proteins in the diagram below would you expect to find on the luminal side of the enterocyte cell?
* 3
* 4
* 5
* 6

Answer 66

5

Question 67

David John (70 years old) presented with four days of continuous right upper abdominal pain radiating to the left upper quadrant with nausea and vomiting, anorexia, flatulence, and bloating. Mr John has a past medical history of Crohn’s disease with a history of small bowel obstruction (SBO) and multiple surgeries. He felt these symptoms were like his SBO but he continued to have normal bowel movements. Mr John was tender to light palpation over the right upper quadrant and epigastric region. He had a normal temperature. No rigidity, rebound tenderness, or guarding was noted. Bloodwork showed elevated white blood cell count with neutrophilic shift. C reactive protein > 250. Normal lipase, liver enzymes and renal function. What is Mr John’s most likely diagnosis?
* Biliary colic
* Cholecystitis
* Ascending cholangitis
* Pancreatitis

Answer 67

Cholecystitis

Question 68

What would you expect to happen to the production or transport of bile if the enteroendocrine I-cells are stimulated to release cholesystokinin?
* Increased production of the rate limiting enzyme in bile acid production
* Increased amino acid conjugation to form bile salts
* Increased bile transport to the gallbladder
* Increased secretion of bile into the duodenum

Answer 68

Increased secretion of bile into the duodenum

Question 69

Inflammatory bowel disease is chronic condition, and it is known there is a complex interplay between knowledge, satisfaction with treatment and adherence to treatment. The table below represents the interaction between patient experience of inflammatory bowel disease (scored using a visual analogic scale from one to ten) and individual patient characteristics.

Which patient experience category was associated with the greatest number of significant differences across the various patient characteristics?
* Level of knowledge about IBD
* Level of satisfaction with current treatment
* Level of information about current treatment
* Level of adherence to current treatment

Answer 69

Level of satisfaction with current treatment

Question 70

Assume that an individual consumes 2 litres of fluid per day. The same individual loses about 0.1 litres of fluid per day via faeces. What percentage of the total fluid that enters the gastrointestinal tract per day is present in the faeces?
* About 99%
* About 50%
* About 5-10%
* About 1-2%

Answer 70

About 1-2%

Question 71

The table below includes presenting history for 3 different individuals.

Based on the presenting history, which of these individuals are more likely to be suffering with inflammatory bowel disease rather than irritable bowel syndrome?

• Anna Herbert & Asa Bloomfield
• Anna Herbert & Kaitlin Jones
• Kaitlin Jones & Asa Bloomfield
• All three individuals

Answer 71

Kaitlin Jones & Asa Bloomfield

Question 72

The table below contains information on several enteroendocrine cells of the gastrointestinal tract, including their major hormone secretion(s) and their predominant location. Active secretion from which enteroendocrine cell type would lead to inhibition of gallbladder contraction?
* D cell
* K cell
* L cell
* N cell

Answer 72

D cell

Question 73

Sally is 29 years old. She comes to hospital due to abdominal pain, diarrhea and fever. She has had these symptoms for 5 weeks. The doctor orders the following host of tests as part of the diagnostic work up;
* Full blood count
* Renal profile
* Liver profile
* Thyroid function tests
* C reactive protein
* Faecal test for ova, cysts and parasites
* Faecal calprotectin
* Vitamin B12 and folate

How many of these tests investigate for inflammation?
* 1
* 2
* 3
* 4

Answer 73

3

Question 74

The diagram below shows immunohistochemical identification of neutrophils (stained in red) in colonic biopsy specimens from individuals with ulcerative colitis (labelled A-D).
Which individual do you think would have the highest faecal calprotectin levels?
* Individual A
* Individual B
* Individual C
* Individual D

Answer 74

Individual A

Question 75

Lubiprostone is a drug which can stimulate chloride channels in the small intestine. How would this drug be used clinically?
* Laxative to promote malabsorption diarrhoea
* Anti-diarrhoeal to prevent malabsorption diarrhoea
* Laxative to promote secretory diarrhoea
* Anti-diarrhoeal to prevent secretory diarrhoea

Answer 75

Laxative to promote secretory diarrhoea

Question 76

In acute cholecystitis, which duct in the diagram below would most likely be blocked by gallstones?
* Duct A
* Duct B
* Duct C
* Duct D

Answer 76

Duct D

Question 77

Maude Clifton (78 years old) presented to Accident and Emergency with abdominal pain and weakness for a day. Past medical history included diabetes mellitus type 2 and breast cancer. Maude was hypotensive (blood pressure 70/40 mmHg) and febrile (39.3 °C). She was intermittently confused with mild right upper quadrant (RUQ) tenderness on palpation. Blood work showed leukocytosis, elevated creatinine, elevated liver enzymes, and elevated total bilirubin. What is Mrs Clifton’s most likely diagnosis?
* Biliary colic
* Cholecystitis
* Ascending cholangitis
* Pancreatitis

Answer 77

Ascending cholangitis

Question 78

Mr Bracknell has been diagnosed with cholesterol stones in his gallbladder. There were no pigment stones. How many of the following mechanisms could have played a role in the formation of his cholesterol stones?
* Cholesterol supersaturation
* Gallbladder hypomotility
* Pro-nucleation
* Multilammellar vesicle fusion

Answer 78

4

Question 79

The flow diagram below is one treatment algorithm for Crohn’s disease. Based solely on this algorithm, what drug class would be the third line treatment for mild to moderate disease if the first and second line treatments have failed?
* Immunosuppressants i.e. azathioprine or 6-mercaptopurine
* Infliximab
* Methotrexate
* Steroids i.e. oral/IV corticosteroids

Answer 79

Steroids i.e. oral/IV corticosteroids

Question 80

Which of the four scenarios in the table below would be most likely to lead to gallstone formation?

Answer 80

Scenario 2

Question 81

An individual possesses a genetic mutation in the thyroid stimulating hormone receptor that results in loss of function for that receptor. Which of the options in the table below would be the most likely set of thyroid function tests for this individual?

• Option 1
• Option 2
• Option 3
• Option 4

Answer 81

Option 1

Question 82

Figure 1 below shows the prevalence of non-suicidal self-harm (mean ± standard deviation) in men and boys (A) and women and girls (B), by age group. How many of the statements in the accompanying table (Table 1) accurately represent the data in Figure 1.

• 1
• 2
• 3
• 4

Answer 82

3

Question 83

The two types of mono amine oxidase (MAO A and MAO B) deaminate different sets of amines. The graph below shows the effect of a single dose of a drug on monoamine oxidase activity, showing percentage (%) inhibition against time following administration in rats brain extracts. What type of drug is utilised in this study?

• Non-selective monoamine oxidase inhibitor
• Reversible monoamine oxidase A inhibitor
• Irreversible monoamine oxidase A inhibitor
• Reversible monoamine oxidase B inhibitor

Answer 83

Reversible monoamine oxidase B inhibitor

Question 84

The figure below shows the interaction effect between cumulative exposure to adverse childhood experiences (ACEs) and average daytime cortisol levels on depressive symptoms in young adults. If you were to compare each ACE group with the other, which group showed a greater number of depressive symptoms irrespective of the average cortisol level?

• ACE = 3+ compared with ACE = 0
• ACE = 2 compared with ACE = 0
• ACE = 2 compared with ACE = 1
• ACE = 0 compared with ACE = 1

Answer 84

ACE = 2 compared with ACE = 1

Question 85

Jenny (35 years old) is employed as a welfare officer, but has felt unable to work for over three months. A new manager joined her team six months ago and has criticised her work performance on several occasions. Jenny has also felt low since her mother died 4 months ago, to whom she was very close. She has also been trying to respond to the demands of her 77-year-old, proud and independent father, who lives nearby – becoming increasingly infirm. Jenny has always had a difficult relationship with her father, who is often critical of her and always favoured her brother. The figure below shows a Venn diagram for the biopsychosocial model applied to mental health. Which aspects of this figure most closely relate to Jenny’s history described above?

• Social & environmental
• Social & environmental & biological
• Social & environmental and psychological
• Psychological and biological

Answer 85

Social & environmental and psychological

Question 86

You are working for a drug company screening antidepressants to identify their mechanism of action. You determine (i) the ability of the cells to take up neurotransmitters using an appropriate labelled transmitter and (ii) monoamine oxidase activity by an enzyme assay. The results generated are shown in the table, * p< 0.05. What drug class does Drug B most likely belong to?

• Monoamine oxidase inhibitor
• Post-synaptic serotonin receptor agonist
• Selective serotonin reuptake inhibitor
• Unclear from the data presented in the table

Answer 86

Unclear from the data presented in the table

Question 87

Which set of results would be found in a patient with primary hypothyroidism?

• A
• B
• C
• D

Answer 87

A

Question 88

A 4-year-old girl is infected with the pathogen expressing lipopolysaccharide on the cell surface. How many of the white blood cells in the accompanying table would directly phagocytose this pathogen?

• 2
• 3
• 4
• 5

Answer 88

3

Question 89

Each individual plot below shows the estimated effect of certain life events on life satisfaction at a given point in time. Time is labelled so that ‘0’ marks the point at which the life event took place. Negative and positive values denote years before and after the life event. How many life events are associated with a decrease in life satisfaction two year after the event has taken place compared to two years before the event has taken place?

• 1
• 2
• 3
• 4

Answer 89

3

Question 90

The figure below is from a study looking at the effect of different methods of levothyroxine administration (liquid gel or tablet) on plasma thyroid stimulating hormone [TSH] concentration after 6 months treatment. Patients were also stratified in terms of whether they took the medication correctly or whether they took the therapy incorrectly. Liquid levothyroxine was demonstrated to be the most effective method of administration when patients took the therapy correctly. Which combination of administration method and group in the figure below represent liquid levothyroxine treatment in patients taking the therapy correctly?

• Method of administration1/Group 1
• Method of administration1/Group 2
• Method of administration 2/Group 3
• Method of administration 2/Group 4

Answer 90

Method of administration 2/Group 3

Question 91

Mrs Angela Johnson (53-year-old) presents to her primary care provider with complaints of fatigue, weight gain, and constipation. She states that her weight has gradually increased over the last year despite no change in her activity level or eating habits. Upon questioning, the patient reports the following changes: thinning of her scalp hair, brittle nails, dry skin, and cold intolerance. The only medication she takes is a multivitamin daily. She has a positive family history for autoimmune disorders and stroke. How many classical symptoms of hypothyroidism is Mrs Johnson presenting with?

• 6
• 7
• 8
• 9

Answer 91

7

Question 92

The diagram below shows the immune response after first exposure to a particular microbe. Which number in the diagram represents B-cell co-stimulation?

• 1
• 2
• 3
• 4

Answer 92

4

Question 93

How many of the conditions in the table below can cause tiredness?

• 1
• 2
• 3
• 4

Answer 93

4

Question 94

A trial was undertaken to evaluate the effectiveness of topical chloramphenicol compared with placebo in preventing wound infection after minor dermatological surgery. The infection rate for the placebo group was predicted to be 10%. The smallest effect of clinical interest was considered to be an absolute decrease in incidence of infection of 5%. 473 participants were recruited to each study group. The proportion of participants with an infection in the topical chloramphenicol group was lower than for placebo (6.6% v 10.7%; p=0.012). How would you describe these results?

• Neither clinically or statistically significant
• Clinically significant but not statistically significant
• Statistically significant, but not clinically significant
• Both clinically significant and statistically significant

Answer 94

Statistically significant, but not clinically significant

Question 95

Below is a graph showing the interaction between disadvantage and depression score for people who are Hispanic, non-hispanic black and non-hispanic white in the USA for both those who have a college education (equivalent to UK university education) and those that do not. The higher the CES-d score the more depression symptoms shown. The higher the disadvantage index the more deprived the individual. For which group does a college education have the largest impact relative to increased disadvantage in reducing depressive symptoms?

• NH White
• NH Black
• Hispanic
• Cannot determine based on the data

Answer 95

NH Black

Question 96

The table below represents blood test results for Mr Sanjiv Mehta who presented with a two week history of feeling tired all the time, no matter how much sleep he managed to get. What would be your top differential diagnosis based on these blood results?

• Type 2 Diabetes Mellitus
• Hypothyroidism
• Viral infection
• Vitamin D deficiency

Answer 96

Viral infection

Question 97

A 47 year old man is diagnosed with Hashimoto’s thyroiditis associated with a progressive shrinking of the thyroid gland. Which follicular cell protein (labelled 1-4 in the figure below) would auto-antibodies block to produce this loss of thyroid tissue?

• 1
• 2
• 3
• 4

Answer 97

3

Question 98

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is one classification system that can be used to diagnose depression. The table below shows four individuals who are affected by a range of symptoms. Each of these individuals are affected by these symptoms on most days for most of the time and these symptoms have been present for over 2 weeks. How many of these individuals would receive a diagnosis of depression using DSM?

• 1
• 2
• 3
• 4

Answer 98

2

Question 99

The figure below shows the distribution of signs and symptoms comparing three study groups: Controls, Euthyroid patients and Hypothyroid patients. * = p < 0.05 for hypothyroid versus euthyroid; # = p < 0.05 for hypothyroid versus control. Which symptom(s) showed a significant difference between hypothyroid and euthyroid patients, but no corresponding significant difference between hypothyroid patients and controls?

• Cold intolerance only
• Constipation only
• Fatigue, weight gain and puffiness
• Fatigue, weight gain, cold intolerance and puffiness

Answer 99

Cold intolerance only

Question 100

The data in the table below is from a World Health Organisation study looking at sex differences in the prevalence of current depression and lifetime depression at a number of study centres across the world. In how many study centres is the prevalence of both current depression and lifetime depression higher in males?

• 0
• 1
• 2
• 3

Answer 100

1

Question 101

The graphs below show the impact of low-salt and high-salt diet for 7 days on the two components of blood pressure in a group of people with hypertension. Which of the four combinations shown below contained the highest percentage of patients with zero change in the respective blood pressure parameter after 7 days?

• Low salt intervention on systolic blood pressure
• Low salt intervention on diastolic blood pressure
• High salt intervention on systolic blood pressure
• High salt intervention on diastolic blood pressure

Answer 101

High salt intervention on diastolic blood pressure

Question 102

Studies suggest that a physiologically distinct pre-shock state can be identified as sepsis transitions to septic shock. The data below compared the ability of various physiological features (lactate, cardiovascular sequential organ failure assessment, Glasgow coma scale, heart rate, partial pressure of oxygen and fraction of inspired oxygen) to show significant changes during the progression of sepsis to pre-shock and subsequent septic shock. Based on the data in the table below, how many of these physiological features significantly distinguish a pre-shock state from septic shock and thus allow for earlier treatment intervention?

• 1
• 2
• 3
• 4

Values are given as mean ± standard deviation. ** = p < 0.01 – indicates a change in value from the preceding state is statistically significant with 99% confidence; * = p < 0.05 - – indicates a change in value from the preceding state is statistically significant with 95% confidence.

Answer 102

3

Question 103

Which of the common side effects of calcium channel blockers is least likely related to drug induced changes in vascular tone?

• Ankle swelling
• Constipation
• Headaches
• Palpitations

Answer 103

Constipation

Question 104

Based on the current National Institute for Health and Care Excellence [NICE] guidelines for hypertension, how many of the individuals in the table below should you consider starting on either an angiotensin converting enzyme inhibitor or angiotensin receptor blocker?

• 1
• 2
• 3
• 4

Answer 104

2

Question 105

A 12 year old boy is bought to the emergency department having been stung multiple times after disturbing a wasps nest. He initially complained of localised pain and swelling. 10 minutes later he started to complain of shortness of breath and he felt very weak and dizzy. 5 minutes later he collapsed and briefly lost consciousness at which point his parents bought him to accident and emergency. He was rushed into the emergency room as the doctors worried he was in ‘shock’. What is the most urgent treatment approach that should be utilised in this case?

• Cardiac stimulant drugs
• Fluid resuscitation
• Removal or excess fluid/air from pleural space
• Vasoconstrictor drugs

Answer 105

Vasoconstrictor drugs

Question 106

An artificial intelligence algorithm is designed to predict sepsis. The data in the table below shows a) the percentage of sepsis patients that were correctly predicted to be at high risk by either the algorithm or a qualified physician and b) percentage of patients that were identified as high risk by either the algorithm or a qualified physician, but did not subsequently develop sepsis. How would you compare the performance of the artificial intelligence programme versus the physician?

• The algorithm increases both the true positive rate and the false positive rate.
• The algorithm decreases both the true positive rate and the false positive rate
• The algorithm increases the true positive rate but decreases the false positive rate.
• The algorithm decreases the true positive rate but increases the false positive rate.

Answer 106

The algorithm increases the true positive rate but decreases the false positive rate.

Question 107

Over the course 6 months, 100 patients visit a GP surgery for an NHS Health Check. According to the latest NHS research, how many of these 100 individuals would you expect to be diagnosed with hypertension as a direct result of this health check?

• 1-3
• 4-6
• 7-9
• 10 or over

Answer 107

1-3

Question 108

In which abdominopelvic quadrant do diverticula most commonly develop?

• Right upper quadrant
• Left upper quadrant
• Right lower quadrant
• Left lower quadrant

Answer 108

Left lower quadrant

Question 109

A 47 year old woman is showing signs of confusion. A National Early Warning Score (NEWS) is conducted. She has a temperature of 36.4oC, a heart rate of 88 beats per minute, a systolic blood pressure of 101mmHg, a respiratory rate of 17 and oxygen saturation of 94. How many of these parameters would score above zero on the NEWS observation chart?

• 1
• 2
• 3
• 4

Answer 109

2

Question 110

Mr H has recently had an electrocardiogram [ECG] recording taken at his GP surgery– this is shown below. The accompanying table shows common ECG changes for four cardiovascular problems. Use this table to determine which condition Mrs F may be experiencing.

• Atrial fibrillation
• Second degree atrioventricular [AV] block
• Myocardial ischaemia
• Wolf Parkinson White syndrome

Answer 110

Myocardial ischaemia

Question 111

The table below provides information Over the course 6 months [ECG] electrodes (labelled A-D). Which letter represents V5?

• A
• B
• C
• D

Answer 111

D

Question 112

The table below describes some of the organs present in different divisions of the abdominopelvic region. Which number represents the right lumbar region?

• 1
• 2
• 3
• 4

Answer 112

4

Question 113

Which of the four scenarios in the table below would most likely be associated with a patient presenting with obstructive shock?

• 1
• 2
• 3
• 4

Answer 113

4

Question 114

The figure below shows data from a study where participants (AA= African American; non AA = non-African American) were randomly assigned to one of three intervention groups: a group offered advice only, a group that implemented traditional lifestyle measures and a group that implemented traditional lifestyle measures with dietary advice to stop hypertension (DASH).

For how many cohorts (AA women, AA men, non-AA women, non-AA men) was the combination of lifestyle measures with DASH always the most effective intervention in terms of the percentage of individuals achieving their intervention goals?

• 1
• 2
• 3
• 4

The figures (a-d) show the percentage of individuals achieving the intervention goals: a) = weight loss > 6.8kg b) = fruit and vegetable intake > 8 servings/day c) = saturated fat intake < 7% total calories d) = sodium intake <100mmol/day

Answer 114

3

Question 115

A 15 year old boy is brought to accident and emergency with a nasty case of flu. A National Early Warning Score (NEWS) is conducted. He has a temperature of 38.3oC and a heart rate of 120 beats per minute. His systolic blood pressure is 153mmHg. His respiratory rate is 17 and oxygen saturation is 97%. He is showing some signs of confusion. How frequently should this patient be monitored based on his NEWS score?

• Minimum 12 hourly
• Minimum 4-6 hourly
• Minimum 1 hourly
• Continuous monitorinG

Answer 115

Minimum 1 hourly

Question 116

The table below shows some haematology/biochemistry results from an individual recently admitted to accident and emergency. How many findings in the table below could indicate this patient has an infection?

• 1
• 2
• 3
• 4

Answer 116

2

Question 117

The table below provides information on four physiological parameters for four different individuals. How many of these individuals would be diagnosed with systemic inflammatory response syndrome?

• 1
• 2
• 3
• 4

Answer 117

3

Question 118

Which scenario in the table below is most likely associated with left ventricular hypertrophy due to hypertension?

• 1
• 2
• 3
• 4

Answer 118

4

Question 119

Mrs F has recently had an electrocardiogram [ECG] recording taken at her GP surgery– this is shown below. The accompanying table shows common ECG changes for four cardiovascular problems. Use this table to determine which condition Mrs F may be experiencing.

• Atrial fibrillation
• Second degree atrioventricular [AV] block
• Myocardial ischaemia
• Wolf Parkinson White syndrome

Answer 119

Atrial fibrillation

Question 120

Which aspect of the electrocardiogram [ECG] trace shown below is abnormal?

• PR interval
• Q wave
• QT segment
• ST segment

Answer 120

PR interval