past paper questions

Question 1

A 19 year old man has pain in the ulnar aspect of his right hand since he threw a punch with his right fist. Which structure is most likely to have been injured?

Answer 1

Fifth metacarpal

Question 2

A 44 year old man is admitted for a day-case knee arthroscopy. He is first on the list and is scheduled for 09.00. He drank a cup of black coffee at 06.00. He has a history of oesophagitis and has suffered severe nausea and vomiting after general anaesthesia for a hernia repair. He is recovering from a cold but still has a hoarse voice.
His temperature is 37.2°C and BP 160/95 mmHg. His throat is inflamed. Which clinical feature is most likely to indicate postponing the operation?

Answer 2

Hypertension – SBP<180mmHg is ok

Question 3

A 30 year old man has 4 weeks of constipation, with rectal bleeding for the past 2 days. He describes bright red blood, separate from his stool.
His abdomen is non-tender and bowel sounds are present. Digital rectal examination is not performed as he cannot tolerate the procedure because of pain, but the anus looks normal.
Which is the most likely diagnosis?

Answer 3

Anal fissure

Question 4

The neighbours of an 80 year old man report 5 days of hearing him shouting in the middle of the night. The man lives alone and has told his neighbours that he has seen people trying to burgle him, but there is no evidence for this. He has no psychiatric history and is usually fit and well.
Which is the most likely diagnosis?

Answer 4

Delirium

Question 5

A 67 year old woman has an ulcer with a raised white margin on her left ear; it has been present for 3 years, growing slowly and never completely healing. She spent 20 years living in Australia before returning to the UK recently.
On examination, she has a small ulcerated area, 4mm x 6mm, on her left pinna.
Which is the most likely diagnosis?

Answer 5

Squamous cell carcinoma

Question 6

A 35 year old woman has an ill-defined lumpy area in the upper outer quadrant of her right breast which becomes larger and tender during the second half of her menstrual cycle.
Which is the most likely diagnosis?

Answer 6

Fibrocystic disease

Question 7

A 43 year old man is rescued from a house fire. There are no signs of burns to the face or neck, but he has soot deposits in his nose and mouth.
His temperature is 37.5°C, pulse rate 120 bpm, BP 135/86 mmHg, respiratory rate 20 breaths per minute and oxygen saturation 97% breathing air. He has widespread wheeze.
Which is the most appropriate management?

Answer 7

Non-rebreather mask and 100% oxygen

Question 8

A 28 year old man has had a painful red eye for five days.
He has a redness around the border of the sclera and cornea and the eye is watery. Fluorescein staining is normal. The pupil is irregular.
Which is the most likely diagnosis?

Answer 8

Anterior uveitis

Question 9

A 71 year old man is brought to the Emergency Department with increasing drowsiness and confusion for the past 12 hours. He is taking clozapine for schizophrenia and has a history of intravenous drug abuse.
He has a temperature of 39.8°C, pulse rate 110 bpm and BP of 110/70 mmHg, and his oxygen saturation is 91% on air. Heart sounds are normal. His GCS is 12/15 (eyes 3/4, motor 6/6, verbal 3/5). He has neck stiffness. He moves all four limbs equally. There is no rash.
Which is the most likely diagnosis?

Answer 9

Bacterial meningitis ?
Neuroleptic malignant syndrome

Question 10

A 56 year old woman with breast cancer has a mastectomy followed by adjuvant chemotherapy. Molecular profiling of the tumour is performed and further treatment with trastuzumab is considered.
When might this further treatment be indicated?

Answer 10

Tumour overexpresses HER2 protein

Question 11

A 24 year old man with long-standing atopic eczema develops a ash that is different from his usual eczema.
There are multiple eroded papules on the head and neck, in addition to excoriated eczema on the trunk and limbs.
Which is the most appropriate treatment for the acute eruption? bn

Answer 11

High-potency topical corticosteroid ointment
Oral acyclovir – HSV not impetiginized eczema apparently

?

Question 12

A 42 year old man reports that his left testicle has been swollen for the past 3 weeks. He is otherwise well. There is a firm, round swelling at the upper pole of the left testis.
Which is the most likely diagnosis?

Answer 12

Epididymal cyst

Question 13

A 64 year old man with a two year history of intermittent claudication presents with worsening lumbar back pain, not related to movement. He has type 2 diabetes mellitus.
Examination of his abdomen and spine is normal, but he has an absent right popliteal pulse and absent pulses in his left foot.
Which is the most appropriate initial investigation?

Answer 13

X-ray of lumbosacral spine
Ultrasound scan of abdomen – NOT related to movement (vascular hx🡪 AAA)

Question 14

An 80 year old woman has recurrent abdominal pain approximately 20 minutes after she has a meal. She has noticed weight loss of 14 kg over the past six months.
She is thin and has tarstained fingers. Her temperature is 36.5°C and pulse rate 85 bpm. She has an abdominal bruit.
Which is the most likely diagnosis?

Answer 14

Mesenteric angina

Question 15

A 59 year old man has a prolonged postoperative ileus after a sigmoid colectomy for diverticulitis.
Which is the most appropriate method of nutrition for this patient?

Answer 15

Intravenous total parenteral nutrition

Question 16

A 69 year old woman has constant dribbling of urine and has had to wear pads continuously for the last 12 month. She had radiotherapy for carcinoma of the cervix when she was 48 years old.
Her temperature is normal. Her bladder is not palpable or tender and neurological examination is normal.
Which is the most likely cause of her symptoms?

Answer 16

Vesicovaginal fistula

Question 17

A 65 year old woman has a hoarse voice for 4 weeks. She has lost 2 kg in weight over the past 2 months. She had a right hemithyroidectomy 10 years ago for a solitary nodule. She has an 80 pack-year smoking history.
There are no lymph nodes palpable in the neck. Chest X-ray is normal.
Which is the most important next investigation?

Answer 17

Ultrasound scan of neck

Question 18

A 23 year old woman has 8 weeks of intensely itchy transient circular weals on her trunk and limbs. Individual lesions last for less than 24 hours and resolve without any discolouration of the skin. She is otherwise fit and well.
Which is the best management advice?

Answer 18

Oral loratadine

Question 19

A 67 year old man has back pain that is not controlled by paracetamol (1 g four times daily). He is receiving palliative care for pancreatic cancer.
Which is the most appropriate next analgesic?

Answer 19

Regular codeine phosphate?? wouldnt that increase the paracetamol level past safety

Fentanyl patch
Lidocaine patch
Regular codeine phosphate
Regular controlled release morphine
Short acting morphine as required

Question 20

A 20 year old man has a painless lump arising from the lower pole of his right testis. His left testis is normal. An ultrasound scan shows a solid mass in his right testis and a radical orchidectomy is planned.
In addition to β-human chorionic gonadotropin (HCG), which tumour marker should be measured before the procedure?

Answer 20

Α-Fetoprotein (AFP)

Question 21

A 62 year old woman has blurred vision and extreme pain in her right eye of sudden onset. She is nauseated, has a headache and is seeing haloes around bright lights. The ocular pressure is reduced with drugs. The ophthalmologist explains to the patient that medical management alone is likely to be insufficient to reverse the problem.
Which I the most appropriate surgical treatment?

Answer 21

Laser peripheral iridectomy

Question 22

A 55 year old man undergoes endoscopy for haematemesis. A duodenal ulcer is seen with a clot visible in its base.
Which substance is the primary factor facilitating platelet adhesion?

Answer 22

Von Willebrand factor

Question 23

A 78 year old man has a serum creatinine of 148µmol/L (60-120). Three months ago, his serum creatinine was normal. He has prostate cancer with multiple bone metastases and recently had a pathological facture of the L4 vertebral body. He also has heart failure and diabetes mellitus. He takes amlodipine, bisoprolol, gliclazide, ibuprofen and morphine.
Which drug is the most likely cause of his deteriorating renal function?

Answer 23

Ibuprofen

Question 23

A 40 year old man has an extensive rash that started 2 days ago and is worsening. He is shivering and feeling generally unwell. He has no past medical history, but has recently been treated for a chest infection.
His skin is now red over most of the body, with some large blisters and some areas of erosion. There is extensive ulceration in the mouth, and the conjunctivae are injected.
Which is the most likely diagnosis?

Answer 23

Toxic epidermal necrolysis

Question 24

A 20 year old man has 14 weeks of cervical lymphadenopathy. He has a cough and has been sweating at night, and has lost 10% of his body weight. A lymph node biopsy reveals a proliferation of lymphoid cells, with scattered, large binucleate cells and prominent nucleoli.
Which is the most likely diagnosis?

Answer 24

Hodgkin lymphoma

Question 25

A 70 year old man has 24 hours of cramping abdominal pain, bloating and complete constipation. He has had 2 months of intermittent diarrhoea.
His abdomen is distended, with lower abdominal tenderness. He has an appendicectomy scar. Abdominal X-ray shows large bowel obstruction.
Which is the most likely underlying cause for his presentation?

Answer 25

Colorectal cancer – more likely in large bowel obstruction
Adhesions – more likely in small bowel obstruction

Question 26

A 53 year old woman develops pain, redness and swelling in her right calf 5 days after an operation for ovarian cancer. She has a history of type 2 diabetes mellitus. She is being treated with prophylactic dose low molecular weight heparin. Her BMI is 35 kg/m2.
Which is the most appropriate initial investigation?

Answer 26

Ultrasound scan of proximal leg vein

Question 26

A 50 year old woman has suddenly become short of breath. She has found it painful to swallow for two months, and she has coughed up a small amount of blood. She is distressed and cannot lie flat.
Her temperature is 37.5°C. Her respiratory rate is 40 breaths per minute and her oxygen saturation is 78% using 15L pe minute via a re-breather mask. She has inspiratory stridor.
What is the most appropriate action to take?

Answer 26

Endotracheal intubation

Question 27

A 20 year old woman has painful blisters on her vulva, associated with painful groin swellings. She has recently started a new relationship and takes the oral contraceptive pill.
She has tender blisters and erosions on the vulva, with perineal erythema and inguinal lymphadenopathy.
Which is the most likely diagnosis?

Answer 27

Primary genital herpes

Question 28

A 29 year old man presents after a fall on to his outstretched left arm.
The left shoulder is deformed and there is sensory loss over the deltoid muscle. The radial pulse is palpable and the patient is able to extend his wrist.
What nerve is most likely to have been damaged?

Answer 28

axillary

Question 29

An 88 year old woman has had a major stroke and has developed bilateral bronchopneumonia and acute kidney injury. Her breathing becomes noisy, with a water rattling noise with each inspiration. Her family become distressed by this noise and ask what is causing it.
Which is the most likely mechanism for this noisy breathing?

Answer 29

Pooling of saliva because of poor swallowing

Question 29

A tall 28 year old man is found to be hypertensive during a routine medical examination. His pulse rate is 72 bpm and BP 210/110 mmHg. There is evidence of a radiofemoral delay.
Chest X-ray shows notching of the ribs in the mid-clavicular line.
Which is the most likely underlying diagnosis?

Answer 29

Coarctation of the aorta

Question 30

A 70 year old man is brought to the Emergency Department having been found on the floor at his home by a neighbour. He is confused.
His temperature is 35.9°C, pulse rate 100 bpm, BP 110/70 mmHg and oxygen saturation 95% on high flow oxygen. He has inspiratory crackles at the right base. Urine dipstick analysis from a catheter sample shows blood 4+, protein 1+, leucocytes positive.

high urea, high creat, low calcium, high phosphate, high WBC, low Hb, high +++++ CK

Answer 30

Rhabdomyolysis

Question 31

A 45 year old window cleaner falls off a ladder and sustains a comminuted closed facture of his right calcaneum.
There is gross swelling and tenderness over all aspects of his heel.
Which is the most appropriate imaging to help to plan for surgery?

Answer 31

CT

Question 32

A 65 year old man receives a renal transplant. He is transferred back to the ward after four hours in recovery.
He ha a pulse rate 96 bpm and regular, BP of 115/70 mmHg, CVP +4 cmH2O and respiratory rate 18 breaths per minute. His chest is clear on auscultation. His urine output has been 15-20 mL per hour while in recovery. Drain output has been 120 mL since surgery.
Investigations:
Haemoglobin 90 g/L (130-175) (preoperative level 103 g/L)
Sodium 142 mmol/L (135-146)
Potassium 5.8 mmol/L (3.5-5.3)
Urea 31.9 mmol/L (2.5-7.8)
Creatinine 590 µmol/L (60-120)

Which is the next most appropriate management step?

Answer 32

Fluid challenge

Question 33

A 56 year old man has pain and tenderness in the right upper quadrant of his abdomen, 18 hours after endoscopic retrograde cholangiopancreatography and sphincterotomy for gallstones.
His temperature is 38.9°C, pulse ate 98 bpm and BP 114/78 mmHg.
Investigations:
Bilirubin 45µmol/L (<17)
Amylase 300 U/L (<220)
Which is the most likely diagnosis?

Answer 33

Acute pancreatitis

Question 34

A 70 year old woman is admitted with a one week history of worsening breathlessness.
She looks pale. She has a temperature of 36.2°C, pulse rate 100 bpm, BP of 132/68 mmHg, JVP +8 cm above the sternal angle and oxygen saturation 94% on 40% oxygen via a face mask. She has bilateral inspiratory crepitations to the midzones. She has a pansystolic murmur at the apex.
Investigations:
Haemoglobin 52 g/L (115-150)
MCV 120 fL (80-96)
White cell count 3.0 x 109/L (3.8-10.0)
Platelets 87 x 109/L (150-400)
Which is the most likely diagnosis?

Answer 34

AML

Question 35

A 35 year old man has pain in his left foot for three months; it is worse after playing football but improves when he keeps his foot still. Recently, the pain has become more persistent. He is unable to recall any specific injury that may have brough on the pain. He plays sport several times a week. He is otherwise fit and well. There is tenderness over the mid-foot.
What is the most likely diagnosis?

Answer 35

Metatarsal stress fracture

Question 36

A 72 year old man with lung cancer is admitted to the respiratory ward with recurrent haemoptysis. He is known to the palliative carer team and it is felt that he is near the end of his life. He says that he wants to have his terminal care on the respiratory ward because he knows and trusts the nurses. A ‘do not attempt resuscitation’ form is completed. He subsequently has further haemoptysis and becomes more breathless, so he is treated with an opioid infusion to relieve his dyspnoea. A doctor suggests that the local hospice is better equipped to care for the patient. His son agrees with the doctor, believing that the hospice is “the right place to die”.
Which should b the most important factor influencing the decision on whether to move him to a hospice?

Answer 36

pt prev opinion

Question 37

A 58 year old man has end-stage renal disease secondary to membranous nephropathy. His eGFR is 12 mL/min/1.73m2 (>60).
Options for renal replacement therapy are discussed with him.
Which treatment option is associated with the best long-term survival?

Answer 37

Living donor kidney transplant

Question 38

A 77 year old woman has 2 years of increasing urinary frequency, associated with urgency and occasional incontinence and nocturia. She has vague discomfort in her lower abdomen most of the time. She has attempted bladder training with only minor improvement.
Which class of drug is most likely to be beneficial?

Answer 38

anti muscarinic

Question 39

A 30 year old woman has 3 weeks of bilateral loin pain and dark urine. This was preceded by a sore throat. She had a similar less severe episode 2 years ago.
Her temperature is 37.1°C, pulse rate 80 bpm, BP 153/90 mmHg and JVP + 3 cm. She has mild ankle oedema. Heart sounds are normal and chest examination is unremarkable.
Investigations:
Sodium 136 mmol/L (135-146)
Potassium 4.8 mmol/L (3.5-5.3)
Urea 18 mmol/L (2.5-7.8)
Creatinine 250µmol/L (60-120)
Anti-neutrophil cytoplasmic antibody is negative.
Urinalysis: blood 4+, protein 3+.
Urinary albumin:creatinine ratio 192.2mg/mmol (<3.5)
Midstream urine: microscopy shows numerous red cells, no organisms on Gram stain.
Ultrasound scan shows normal sized unobstructed kidneys.
Which is the most appropriate diagnostic investigation?

Answer 39

renal biopsy

Question 39

A 24 year old man is bought to the Emergency Department by friends who found him unconscious in his flat. They think that he might have been taking some drugs but do not know which. He has a history of alcohol and drug abuse and depression.
His pulse rate is 86 bpm, BP 106/64 mmHg, respiratory rate 6 breaths per minute and oxygen saturation 88% in air.
He is given high flow oxygen.
Which drug is most likely to explain his clinical condition?

Answer 39

diamorphine

Question 40

A 60 year old man has been unable to hear with his left ear for 6 months.
Examination of both ear canals is normal. Tuning fork tests suggest sensorineural hearing loss in the left ear.
Which is the most likely diagnosis?

Answer 40

Acoustic neuroma

Question 41

A 19 year old woman has 5 days of headache and fevers. She returned last week from a 2 month elective in Kenya.
Her temperature is 38.2°C. She does not have neck stiffness. Urine dipstick analysis shows a trace of blood only.
Which is the most important initial investigation?

Answer 41

blood film

Question 42

A 40 year old man is receiving cytotoxic chemotherapy for the treatment of acute myeloid leukaemia.
While in hospital, he is noted to have a temperature of 38.5°C and a peripheral white cell count of 0.1 x 109/L (3.0-10.0), and his Hickman (central venous) line site is red and tender. Blood cultures from both the Hickman line and peripheral blood yield clumps of Gram positive cocci.
Which is the most likely organism?

Answer 42

Staphylococcus aureus

Question 43

A 39 year old woman has worsening tiredness for two weeks. She was previously well.
She appears mildly jaundiced. She has a pulse rate 96 bpm and BP of 112/76 mmHg.
Investigations:
Haemoglobin 48 g/L (115-150)
MCV 98 fL (80-96)
White cell count 6.2 x 109/L (3.8-10.0)
Bilirubin 41 µmol/L (<17)
Aspartate aminotransferase 27 IU/L (10-40)
Alkaline phosphatase 100 IU/L (25-115)
Lactate dehydrogenase 560 IU/L (70-250)
Blood film: red cell polychromasia, occasional spherocytes, no red cell fragments
Which is the most appropriate diagnostic investigation?

Answer 43

DAAT

Question 44

A 47 year old man has nausea and epigastric pain. He undergoes endoscopy and biopsy, and he is found to have a carcinoma of the lesser curve of the gastric body. His case is discussed at the multidisciplinary team meeting.
Which lymph node group is most likely to be the site of metastasis?

Answer 44

Coeliac

Question 45

A 24 year old man has had a high speed motorcycle crash. A cervical spine fracture is suspected and a series of cervical spine X-rays is requested.
Which X-ray view is most likely to reveal a vertebral body crush facture?

Answer 45

Lateral

Question 46

A 78 year old man has 1 month of painless haematuria.
Physical examination is unremarkable. Cystoscopy shows a tumour in the bladder. A biopsy is taken.
Which is the most likely histological diagnosis?

Answer 46

Transitional cell carcinoma

Question 47

A 75 year old man develops difficulty speaking and swallowing two days after a right carotid endarterectomy.
On examination of his cranial nerves, his tongue deviates to the right on protrusion.
Which is the most likely cause of this problem?

Answer 47

Damage to the hypoglossal nerve

Question 48

A 75 year old man has increased urinary frequency, nocturia (four times per night), poor urine flow and reduced urinary volumes over the past six months. Urinalysis shows glucose trace, blood and protein negative.
Investigations: electrolytes: normal
serum creatinine 387 µmol/L (60-120)
random blood glucose 5.6 mmol/L
Which is the most likely cause of his renal impairment?

Answer 48

Obstructive uropathy – BPH?

Chronic pyelonephritis
Diabetic nephropathy
Obstructive uropathy – BPH?
Polycystic kidney disease
Renovascular disease

Question 49

An 18 year old man attends the Emergency Department after cutting the volar radial border of his left index finger with a knife while cutting up an apple. There was immediate arterial bleeding.
Other than the digital artery, which is the most likely structure to have been damaged?

Answer 49

digital nerve

Question 50

An 82 year old man is confused and agitated in the recovery room following a transurethral resection for benign prostatic hyperplasia. He had a spinal anaesthetic containing bupivacaine and diamorphine hydrochloride. Hypotonic glycine was used for irrigation for the procedure, and he absorbed 1200 mL of glycine fluid. He was given prophylactic gentamicin at the start of the procedure.
His temperature is 36.2°C, pulse rate 82 bpm, BP 178/92 mmHg, respiratory rate 20 breaths per minute and oxygen saturation 96% breathing 28% oxygen.
Which is the most likely cause of his confusion?

Answer 50

hyponatremia

Question 50

A 20 year old woman presents to the Emergency Department complaining of muscle pain, malaise and headache. She visited her father’s family in India 2 weeks ago where she suffered a bout of diarrhoea. She took appropriate malarial prophylaxis medication.
Her temperature is 39.5°C and pulse rate 62 bpm.
Which I the most likely diagnosis?

Answer 50

enteric fever

Question 51

While playing squash, a 30 year old man was hit by a racquet just below his left knee. Since then he can neither evert nor dorsiflex his left foot. There is a loss of sensation over the front and outer half of his left leg and the dorsum of his left foot. The knee and ankle reflexes are normal.
Which nerve is most likely to be injured?

Answer 51

common peroneal

Question 52

A 71 year old man dies in hospital 36 hours after admission with a chest infection. He was an inpatient briefly 2 weeks ago, when he had an inconclusive bronchoscopy and pleural biopsy. He had been receiving an occupational pension for pneumoconiosis and was living alone, refusing help from social services.
Which is the most important reason for referring to the coroner/procurator fiscal?

Answer 52

Death due to industrial disease

Question 53

A 67 year old woman has weakness in her left arm and shoulder. She has recently undergone a left mastectomy and lymph node dissection for breast carcinoma.
She has reduced abduction in her left shoulder and winging of the scapula.
Which nerve is most likely to have been damaged?

Answer 53

Long thoracic nerve

Question 54

A 67 year old man with lung cancer requires 60 mL of 10 mg/5 mL oral morphine solution per day to control his pain. His GP would like to convert this to regular controlled release morphine.
Which is the correct dose of controlled release morphine required to manage his pain?

Answer 54

60 mg twice daily

Question 55

A 21 year old man presents to his GP with an erythematous rash on his glans penis. He also reports tiredness and increased thirst over the past 1 month. He has been waking up to pass urine three or four times per night and also has daytime urinary frequency but no other urinary symptoms.
Which is the most likely diagnosis?

Answer 55

DM

Question 56

A 72 year old woman has severe lower gastrointestinal haemorrhage. Colonoscopy shows active bleeding from a caecal carcinoma that cannot be controlled endoscopically. A decision is made to proceed to embolisation.
Which artery must be accessed for embolisation?

Answer 56

Superior mesenteric

Question 57

A 63 year old man has right-sided weakness and difficulty speaking that lasts for 25 minutes and resolves completely. He has a history of hypertension and is an ex-smoker.
He has an audible bruit high on the left side of his neck. Ct scan of the head is normal.
Which is the most appropriate next imaging?

Answer 57

Carotid Doppler ultrasonography

Question 58

A 65 year old woman attend for routine breast screening. She has no symptoms of breast disease, no relevant family history and is not on any medication. She has a normal breast examination. The mammogram shows and area of focal microcalcification.
Which is the most common pathological cause?

Answer 58

Ductal carcinoma in situ (DCIS)

Question 59

A 70 year old man attends his general practitioner with pain in his left foot. He has pain in his left calf when walking that has been progressively worsening over the past three months. Now he has pain at night. He has a past medical history of ischaemic heart disease and stopped smoking six years ago after a myocardial infarction.
He has a pulse rate 88 bpm and BP of 160/88 mmHg. His left foot is cold and there are no palpable pulses below the femoral artery.
Which is the most likely diagnosis?

Answer 59

acute limb ischaemia

Question 60

A 64 year old woman collapses on the ward. The nurses repot that she had breathlessness just before her collapse. She was admitted that morning with cellulitis and had received her first dose of antibiotics in the Emergency Department.
Her pulse rate is 100 bpm, BP 80/40 mmHg, respiratory rate 32 beaths per minute and oxygen saturation 94% on 10 L/min oxygen.
Which is the most appropriate immediate treatment?

Answer 60

0.9% Sodium chloride fluid bolus
Adrenaline – lol silly

Question 61

A 62 year old man becomes progressively hypotensive six hours after a right hemicolectomy. He has a past history of type 2 diabetes and hypertension. He received prophylactic antibiotics per-operatively. His observation charts show a rising heart rate before his BP started to fall.
He now has a pulse rate of 120 bpm and BP of 80/54 mmHg. He looks pale and his peripheries are cool. A fluid bolus of 500 mL of 0.9% sodium chloride results in a rise in systolic blood pressure to 100 mmHg and a reduction of his heart rate to 96bpm. His urine output in his catheter bag is <30mL/h.
Which type of shock is most likely in this case?

Answer 61

hypovolaemic

Question 62

A 72 year old woman is admitted with three days of cough and fever. She has been unwell for the past two to three months with lethargy, arthralgia and anorexia. She has hypertension. Her creatinine concentration two months previously was 71 µmol/L (60-120).
She has a temperature of 38°C, pulse rate 87 bpm and BP of 132/70 mmHg, and her oxygen saturation is 98% on 40% oxygen via a face mask. She has coarse inspiratory crackles at the right base. Urinalysis shows protein 4+, blood 1+.
Investigations:
sodium 132 mmol/L (135-146)
potassium 5.3 mmol/L (3.5-5.3)
urea 14.7 mmol/L (2.5-7.8)
creatinine 275 µmol/L (60-120)
eGFR 25/mL/min/1.73 m2 (>60)
albumin 28 g/L (35-50)
urinary protein:creatinine ratio 340 mg/mmol (<20)
urinary sodium 18 mmol/L
Ultrasound scan shows that both kidneys are 11 cm in diameter and not obstructed.
Which feature favours an intrarenal, as opposed to a prerenal, cause for her acute kidney injury?

Answer 62

Systolic BP >130 mmHg

Question 63

A 60 year old man has reduced urine output 24 hours after gastrectomy and splenectomy for a gastric tumour. He is receiving 0.18% sodium chloride/4% glucose at 80 mL/h.
His temperature is 37.0°C, pulse rate 88 bpm, BP 121/67 mmHg and CVP 4 cmH20. His urine output has been 10-20 mL/h for the past 4 hours. Clinical examination is normal.
Which is the most appropriate immediate management?

Answer 63

Replace urinary catheter

Question 64

An 87 year old man falls and fractures his left neck of femur. He is admitted to hospital, and told that he needs to undergo a hemiarthroplasty. The doctor taking consent from him explains what the operation involves.
Which is the best description of this procedure?

Answer 64

Replacement of the head and neck of the femur

Question 65

A 75 year old woman has a 1.5cm left breast lump. She has a history of hypertension and COPD.
Investigations:
Core biopsy: grade 3 invasive ductal carcinoma that is oestrogen receptor negative
Ultrasound scan of axillary: negative
Which is the most appropriate initial treatment?

Answer 65

Wide local excision and sentinel node biopsy – grade 3 not stage 3

Question 66

A 19 year old man is admitted to hospital following a motor bike collision where he sustained a severe head injury.
He is on a ventilator and his brain scan shows extensive damage. His pupils are fixed, dilated and non responsive. He is not sedated.
Which investigation needs to be performed before he becomes a heart beating organ donor?

Answer 66

brain stem death tests

Question 67

An 84 year old woman has cut her leg following a fall in the garden. She cannot provide any immunisation history.
There is a deep laceration. The laceration is cleaned and sutured, and she is given analgesia and antibiotics.
Which is the most appropriate additional treatment?

Answer 67

immunoglobulin

Question 68

A 72 year old man had a laparotomy for a perforated colonic diverticulum 4 hours ago. He has been given 1 g of paracetamol and 10 mg of morphine sulfate within the past hour.
His temperature is 37.2°C, pulse rate 108 bpm, BP 96/62 mmHg, respiratory rate 6 breaths per minute and oxygen saturation 87% breathing 40% oxygen. He is drowsy but easily rousable and talking coherently.
His inspired oxygen is increased.
Which is the most appropriate immediate management?

Answer 68

naloxone

Question 68

A 64 year old man has weight loss of 10kg over the last three months. He drinks six units of alcohol and smokes 20 cigarettes per day. He is jaundiced and has 2 cm hepatomegaly.
What is the most likely primary site of malignancy?

Answer 68

Liver? oesopjhagus? stomach?

Question 69

A 55 year old man is rescued from a collapsed building where he has been trapped for 12 hours without water.
He has a temperature of 35.6°C, pulse ate 100 bpm and BP of 90/42 mmHg. His JVP is not visible. His abdomen is non tender.
Investigations:
Haemoglobin 168 g/L (130-175)
Sodium 148 mmol/L (135-146)
Potassium 6.22 mmol/L (3.5-5.3)
Urea 25.1 mmol/L (2.5-7.8)
Creatinine 184 µmol/L (60-120)
Creatine kinase 840 U/L (25-200)
Which is the most likely cause of this biochemical picture?

Answer 69

hypovolaemia

Question 70

A 35 year old man has a gradual onset of hesitancy and poor urinary flow. He has a past history of urinary tract infection, which he developed while on holiday. Urinalysis is normal. Digital rectal examination reveals a small, firm, non-tender prostate.
Which is the most likely underlying cause for his symptoms?

Answer 70

Urethral stricture

Question 71

A 21 year old man has 4 days of a widespread rash and malaise. He has had several male sexual partners over the past few months.
There is a macular rash over his body, including his palms, soles and scalp, a few palpable lymph nodes in his groin and a small popular lesion on the glans of his penis.
Which is the most likely diagnosis?

Answer 71

Syphilis

Question 71

A 68 year old man is receiving palliative care for bone metastases. He complains of pain in his right arm which paracetamol and ibuprofen fail to relieve. Morphine sulphate is suggested to him, but he is concerned about the side effects of morphine.
Which is the most frequent side effect?

Answer 71

Constipation

Question 72

A 66 year old man has had left sided abdominal discomfort for the pat 1 month.
He has widespread purpura and a palpable spleen measuring 17 cm from the left costal margin. There is no hepatomegaly or lymphadenopathy.
Investigations:
Haemoglobin 85 g/L (130-175)
White cell count 0.5 x 109/L (3.0-10.0)
Platelet count 38 x 109/L (150-400)
INR 1.0 (1.0)
Activated partial thromboplastin time 31 s (22-41)
Which is the most likely diagnosis?

Answer 72

Myelofibrosis

Question 73

An 18 year old man is worried about his cancer risk. His paternal grandfather died of colorectal cancer at 42 years of age and his 36 year old father has just been diagnosed with colorectal cancer. The son’s colonoscopy shows hundreds of colonic polyps, and biopsies from several of the polyps show adenomatous change with low grade dysplasia.
Which is the most appropriate strategy to prevent colon cancer in this situation?

Answer 73

Panproctocolectomy

Question 74

A 75 yar old man is found collapsed at home and is brought to the Emergency Department. He has right sided weakness and reduced consciousness. He has a history of type 2 diabetes mellitus, atrial fibrillation and hypertension. He is taking warfarin.
Investigations:
INR is 4.6 (<1.0).
CT scan of the head shows a large intracranial haemorrhage. His is given intravenous vitamin K.
Which is the most appropriate next additional treatment?

Answer 74

Prothrombin complex concentrate

Question 75

A 70 year old man has bright red rectal bleeding. Rigid sigmoidoscopy reveals a smooth and pedunculated polyp, 1 cm in diameter and 3 cm from the anal margin.
Which type of tumour is this polyp most likely to be?

Answer 75

Adenoma

Question 76

A 55 year old woman ha two months of increasing ankle oedema. She has felt tied and lethargic and has also noticed occasional blood and mucus in her stools.
Her BP is 168/90 mmHg and JVP +2 cm above the sternal angle. She has oedema to mid-calf bilaterally.
Investigations:
Urea 8.0 mmol/L (2.5-7.8)
Creatinine 124 µmol/L (60-120)
Albumin 22 g/L (35-50)
Urinary protein: creatinine ratio 754 mg/mmol (<30)
Which is the most likely diagnosis?

Answer 76

Membranous nephropathy

Question 77

A 77 year old man has been unable to pass urine for 12 hours and has severe suprapubic pain.
His bladder is palpable to the level of the umbilicus. He is catheterised and 1.5 L of urine is drained. A digital rectal examination shows an enlarged prostate and empty rectum.
Which is the most appropriate first-line class of drug to prescribe?

Answer 77

α-Adrenoceptor blocker

Question 78

A 25 year old man has urinary hesitancy and a sensation of incomplete voiding, just after recovering from a severe urinary infection. He has primary progressive multiple sclerosis but lives independently.
An ultrasound scan of his bladder indicates 400 mL of urine after voiding. Urinalysis reveals heavy growth of Proteus species.
Which is the most appropriate long term management?

Answer 78

Intermittent self catheterisation?? what about his MS

Suprapubic catheterisation

Question 78

A 40 year old woman attends the ear, nose and throat clinic with a series of episodes of vertigo over the past 3 years. Each episode is preceded by a feeling of fullness in her left ear. The attacks last several hours and leave her with left sided tinnitus and deafness. She sometimes vomits during the attacks. An audiogram shows a left sided sensorineural hearing loss.
Which is the most likely diagnosis?

Answer 78

Ménière’s disease

Question 79

A 60 year old man presents with weight loss and a cough productive of mucus mixed with blood. He is a smoker and has a history of chronic cough. His voice has recently become very weak. On examination, his left vocal cord is paralysed but the rest of the larynx is normal.
What is the most likely cause of the vocal cord paralysis?

Answer 79

Carcinoma of the left main bronchus

Question 80

A 64 year old man had a mitral valve replacement two years ago. He attends the Anticoagulant Clinic three days after his son’s wedding where he consumed 30 units of alcohol. He has a previous history of excess alcohol consumption.
His international normalised ratio (INR) is 8.5 (1.0) and he has a few old bruises on his legs. There is no haematuria and no epistaxis or other evidence of bleeding. Abdominal examination shows mild tenderness with sparse bowel sounds.
His warfarin has been temporarily discontinued.
Which is the most appropriate treatment?

Answer 80

Vitamin K orally

Question 81

A 22 year old woman has a painless swelling in the left side of her neck. She first discovered the lump several months ago and noticed that it became slightly more prominent after a recent cold.
She looks well. Her temperature is 37.2°C. There is a 3 cm x 4 cm oval, non-tender, fluctuant mass along the lower third of the anteromedial border of the sternocleidomastoid muscle.
Which is the most likely diagnosis?

Answer 81

branchial cyst

Question 82

A 28 year old man has a headache, intermittent fever, sore throat and diarrhoea.
He has a temperature of 37.7°C. His facies are red and there are two small aphthous ulcers on his left buccal mucosa. He also has a maculopapular erythematous rash on his upper trunk, red hands and folliculitis on his chest. His liver and spleen are just palpable and he has mild neck stiffness.
Investigations:
haemoglobin 135 g/L (130-175)
white cell count 3.3 x 109/L (3.0-10.0)
platelets 84 x 109/L (150-400)
Which next investigation is most likely to lead to a diagnosis?

Answer 82

HIV serology

Question 83

A 23 year old woman has 2 days of localised right-sided loin pain, and visible haematuria but no dysuria.
Her temperature is 36.5°C and BP 158/86 mmHg. There is a mass that is just palpable in the right loin. Urinalysis shows blood 4+, protein 1+, leucocytes 1+ and nitrites negative.
Investigations:
Haemoglobin 135 g/L (115-150)
Urea 6.2 mmol/L (2.5-7.8)
Serum creatinine 98 µmol/L (60-120)
Which is the most likely diagnosis?

Answer 83

Adult polycystic kidney disease
or
Renal cell carcinoma. ( single mass?)

Question 84

A 27 year old man is brought to the Emergency Department having fallen from a ladder. He has a compound fracture of his right femur.
He is maintaining his airway and has cold peripheries with a capillary refill time of 4 seconds. His pulse rate is 135 bpm, BP 89/55 mmHg, respiratory rate 32 breaths per minute and oxygen saturation 98% breathing 15 L/min oxygen via a non-rebreathing mask.
Fluid resuscitation is started with Hartmann’s solution.
Which is the most appropriate initial treatment for his pain?

Answer 84

Intravenous paracetamol?
IV morphine?

Question 84

A 90 year old woman is admitted with a urinary tract infection and acute kidney injury. She has a history of peripheral vascular disease, hypertension, CKD stage and osteoarthritis. She takes amlodipine (5 mg once daily), clopidogrel (75 mg once daily), docusate sodium (100 mg three times daily), morphine sulfate (20 mg twice daily), and paracetamol (1 g four times daily).
Her temperature is 37.5°C, pulse rate 90 bpm and BP 130/85 mmHg.
Investigations:
Creatinine 201 µmol/L (60-120)
eGFR 18 mL/min/1.73m2 (>60)
Which of her medications is most likely to accumulate?

Answer 84

Morphine sulfate

Question 85

A 68 year old woman develops a temperature while receiving a blood transfusion. She was admitted eight hours previously with one month of lethargy and breathlessness on exertion. She has ischaemic heart disease.
Admission investigations:
Haemoglobin 56 g/L (115-150)
MCV 76 fL (80-96)
She was advised to have a two unit blood transfusion. The first unit was prescribed over two hours with furosemide 20 mg orally.
Her temperature is 38.0°C, pulse rate 76 bpm, BP 137/80 mmHg, and oxygen saturation 95% breathing air.
The nurses have stopped the transfusion and given the patient paracetamol. The patient has no other symptoms.
Which is the most appropriate next step?

Answer 85

Check identity of patient and details of the unit of blood

Question 86

A 34 year old man has fevers, rigors and collapse.
His temperature is 39.1°C, pulse rate 105 bpm, BP 92/56 mmHg and respiratory rate 25 breaths per minute. He has widespread purpura and evidence of papilloedema.
He is treated with fluids and broad-spectrum antibiotics.
Investigations:
Haemoglobin 85 g/L (130-175)
White cell count 75.2 x 109/L (3.0-10.0)
Platelets 38 x 109/L (150-400)
Neutrophils 73.2 x 109/L (2.0-7.5)
Blood culture Escherichia coli isolated
Which is the most likely cause of his high white cell count?

Answer 86

Acute leukaemia

Question 87

A 40 year old woman with a malignant brain tumour is invited to consider participation in a phase 3 clinical trial of a new agent. She asks the purpose of phase 3 clinical trials.
Which is the key purpose of a phase 3 clinical trial?

Answer 87

To test efficacy of the new agent compared with standard care

Question 88

A 19 year old man presents to the Emergency Department with 48 hours of fever, sore throat and a generalised rash that began on his face and has spread downwards.
His temperature is 39.1°C, pulse rate 112 bpm and BP 106/65 mmHg. He has a widespread blanching rash and conjunctivitis. There are white spots in his mouth.
Which is the major mode of transmission of the pathogen?

Answer 88

Respiratory droplet

Question 89

A 38 year old woman is scheduled to have an elective hysterectomy for menorrhagia. She smokes 20 cigarettes a day and is not taking any medications.
Her haemoglobin concentration is 98 g/L (115-150).
Which preoperative test is it essential to undertake?

Answer 89

Blood group and save serum

Question 90

A 65 year old man has 3 weeks of progressive ankle oedema.
His BP is 125/85 mmHg and oxygen saturation 98% breathing air. He has marked bilateral pitting ankle oedema and reduced chest expansion.
Investigations:
Creatinine 85 µmol/L (60-120)
Urinary protein: creatinine ratio 300 mg/mmol (<30)
Fasting glucose 5.7 mmol/L (3.0-6.0)
Albumin 22 g/L (35-50)
Total cholesterol 9 mmol/L (<5.0)
Which treatment is most likely to reduce the amount of urinary protein?

Answer 90

ramipril?

Question 91

74 y/o patient on an assortment of medications for the past 10 years, presents with a #NOF low impact (think she kicks a football to her grandson and has a fracture) subtrochanteric femur #. Which drug is the most likely cause

Answer 91

Alendronic acid – Bisphosphonates associated with atypical femur fractures

Question 92

Bradycardia during cystoscopy

Answer 92

atropine

Question 93

A 60 year old male with B symptoms with lymphadenopathy, anaemia raised neutrophils but no raised lymphocytes, raised LDH

Answer 93

Lymphoma

Question 94

Patient has hyperkeratosis suggesting Tinea pedis, what is the causative organism?

Answer 94

Trichophyton rubreum – aka athletes foot

Question 95

Patient had anaemia with normal ferritin in male with CKD, what do you do next?

Answer 95

EPO

Question 96

SVC symptoms with lung mass in right upper lung. What is diagnostic investigation?

Answer 96

CT chest

Question 97

DEEP abdominal pain and right loin pain, vomiting 1 hour, now hypotensive, cap refill 5s. pmhx hypertension and hypercholesteremia

Answer 97

Ruptured AAA

Question 98

Epigastric pain in the mornings, settles with a morning cup of milk. Tender on palpation. Low Hb and low MCV

Answer 98

duodenal ulcer

Question 99

Immunosuppressed patient with hx radiotherapy to lumbar spine/abdo, pain on swallowing. No regurgitation. Blood tests show neutropaenia.

Answer 99

oes stricture

Question 100

Partygoer vomited 3 times, 4th time vomited a cup of bright red blood. What is the most likely cause?

Answer 100

mallory weiss

Question 101

Prostate metastases to the spine, sclerotic, back pain, no nerve impingement, no fractures, PO morphine is not working.

Answer 101

radiotherapy

Question 102

Overdose, dilated pupils with widened QRS. Patient refuses to disclose what medication was overdosed. What was the agent?

Answer 102

amitriptyline

Question 103

History of atopy, with pollen being the trigger. Now spring and both eyes are watery, red and sore. – allergic conjunctivitis v

Answer 103

Antihistamine eye drop

Question 104

Main DMARD for rheumatoid arthritis (yes they said dmard in the question)

Answer 104

methotrexate

Question 105

Correct statin target 3 months after starting treatment:

Answer 105

> 40% reduction in non-HDL cholesterol

Question 106

Bilateral resting tremor, falls, shuffling (small stepping) gait, no bradykinesia, bilateral cogwheel rigidity, increase tone at the wrists. Taking chlorpromazine, statin and antihypertensive.

Answer 106

Drug induced

Question 107

Delirium and usually well, patient wandering the wards at night and refuses to go to bed - mx

Answer 107

Orientation techniques

Question 108

24hrs post MI, new mid systolic murmur, raised JVP, breathless, afebrile

Answer 108

pericarditis

Question 109

URTI a week ago, presents with flushing, diarrhoea and palpitations. Tender enlarged mass at neck, isotope shows diffusely reduced uptake. TSH is low, T4 and T3 are raised.

Answer 109

Viral (subacte/dq) thyroiditis

Question 110

Insulin before surgery. Patient with type 1 diabetes and taking both long acting and short acting. What should be done to prepare them for surgery?

Answer 110

usually can just adjust
if poor control/long surgery - VRII

Question 111

82 year old female had stroke, found to have AF, currently taking aspirin 75mg for previous MI.

Answer 111

Change aspirin to apixaban

Question 112

Transfusion reaction. 10 minutes, pyrexia, loin pain, normotensive

Answer 112

ABO incompatibility

Question 113

A female patient woke up with leg weakness at 0700, daughter saw them last at 2300 and she was normal. Now 0800 she has progressive aphasia. 0830 CT scan shows infarct and no haemorrhage. She has a past history of AF.

Answer 113

Give alteplase

Question 114

A male and young patient in his 20s presents with sudden and painful vision loss however notes that this has happened before a few weeks ago and recovered after four weeks.

Answer 114

Optic neuritis –

Question 115

Patient with diabetes, only controlled on diet, and presents with visual loss.

Answer 115

Send to ophthalmologist

Question 116

Old man had a 3/7 hx of a fall, since then unable to weight bear. Physiotherapist unable to assess him due to patient being in pain when touched, but x-ray only showed minor degenerative changes only. What do you do?

Answer 116

CT hip and pelvis

Question 117

House fire inhaled. Patient needs increased ventilatory pressures, what is the reason?

Answer 117

surfactant insufficency

Question 118

House fire inhaled. Patient needs increased ventilatory pressures, what is the reason?

Answer 118

Wrist extensors

Question 119

Breastfeeding female patient with 2cm breast abscess for 48 hours. Normal observations. Patient was told to keep feeding as normal. Abscess was drained with needle and sent for MC&S. What to do now?

Answer 119

Flucloxacillin – antibiotics are needed after abscess

Question 120

CKD patient with raised calcium, low phosphate (does not give PTH – was phosphate given to us in this Q?). 6 years ago, her blood tests also showed a raised calcium.

Answer 120

Primary hyperparathyroidism-

Question 121

Patient with BPH symptoms in hospital, what do you start him on?

Answer 121

Catheterise

Question 122

A 40 year old patient worried about getting cancer. Mum received a diagnosis of unilateral breast cancer at 67, brother has metastatic melanoma 5 years ago, uncle with lung cancer at XX age, grandparent with colorectal cancer at 82

Answer 122

Send for BRCA1

Question 123

Parkinson’s patient with recurrent pneumonia, on multiple medications for 10 years, which HCP to refer to

Answer 123

Speech and language therapy

Question 124

A middle-aged man with headache, intermittent left-sided claudication, history of a TIA. He has 220/80 BP and has AKI. Biochemistry (presumably U&E) is normal. Ultrasound showing one kidney is 10cm and the other is 7cm. A scan also showed no obstruction in the ureters.

Answer 124

Urine metanephrines

Question 125

Pleural effusion with cancer – palliative female patient who had mesothelioma and was only going to live for a few more weeks.

Answer 125

Aspiration (thoracocentesis)

Question 126

Difficult to control epistaxis in a patient with recent chemotherapy. Hb 79 platelets 2, low BP

Answer 126

platelet transfusion

Question 127

Patient who was 62 years old and had hypertension on amlodipine, and the ECG was positive according to the voltage criteria for LVH. What to add next?

Answer 127

Bisoprolol

Question 128

Fluid replacement for a female patient 62kg. How much maintenance potassium to add to their fluids in a day?

Answer 128

60mmol

Question 129

Male and young patient with painful left testes pain all through with swelling. Cremasteric reflex is present.

Answer 129

Epididymo-orchitis

Question 130

3 month history of left sided testicular mass and a recent onset of abdominal pain/swelling (can’t remember), which is most likely to be raised? (I think afp was already mentioned to be raised)

Answer 130

bHCG

Question 131

Patient started medication for tuberculosis, on rifampicin, isoniazid, pyrazinamide and ethambutol. What else should be prescribed prophylactically?

Answer 131

Pyridoxine

Question 132

Displaced intracapsular NOF fracture, in a 68 year old man who fell off motorbike, controlled HTN, no other health issues. Most appropriate surgery?

Answer 132

total hip arthroplasty

Question 133

Patient had trauma and initially was speaking to the ambulance staff but deteriorates and on arrival to ED, they present with low GCS. On pain, they would groan, move to localised pain, and have no eye movement. They have no facial trauma.

Answer 133

Oropharyngeal

Question 134

Parotid gland swelling 6 months, not tethered to skin, face weakness and numbness, dribbling fluids.

Answer 134

Pleomorphic adenoma

Question 135

Asthma with RR 30, Exhaustion, PEF 45%, HR 120 what is a sign of life-threatening asthma from the above?

Answer 135

Exhaustion

Question 136

A COPD patient is breathless with 86% oxygen saturations, what should be given initially?

Answer 136

15L/minute via non-rebreathe

Question 137

Patient had SBP with shifting dullness and was treated. Patient currently on furosemide and spironolactone. What other medication should be given?

Answer 137

drain? they put pred but i cnt find anygthing

Question 138

Patient is tired, can’t finish food. This happens at end of the day. 6-month history. Diagnosis?

Answer 138

myasthenia gravis

Question 139

Photosensitive rash with purple dusky colour on both eyelids, photosensitive. 4-month history of progressive weakness, can’t climb stairs and get out of a chair

Answer 139

dermatomyositis

Question 140

T1DM patient went out, boozed, collapsed at home, then had seizure in emergency department. What are your next investigations?

Answer 140

Capillary Glucose

Question 141

UC involving only the rectum and sigmoid colon. 4 month history of bloody diarrhoea. What is initial treatment? (doesn’t specify how often)

Answer 141

topical mesalazine

Question 142

Patient 8 weeks pregnant, wants an abortion and you as the GP agree to this. Patient is HIV positive however does not wish to disclose her HIV status in the referral.

Answer 142

Accept her wish and refer her

Question 143

Patient with Diabetes started metformin 4 weeks ago, since starting she has been having diarrhoea, bloods sugars are still unchecked (didn’t specify values).

Answer 143

Change to modified-release metformin

Question 144

Painless end-of-stream haematuria in a 68 year old patient. Normal observations. Where is the pathology?

Answer 144

Bladder cancer

Question 145

A 66 year old man 5 cm Scalp laceration after hitting head and was on rivaroxaban, he can’t remember how he hurt himself.

Answer 145

CT head

Question 146

Young constipated patient, pain after defaecation, bright red blood

Answer 146

anal fissure

Question 147

Patient with a painless ulcer after unprotected MSM sex

Answer 147

Treponema pallidum

Question 148

Cord compression syndrome, loss of sensation around the mid abdomen (it said around umbilicus specifically), and bilateral weakness and brisk reflexes, UMN signs in both lower limbs, incontinence. Where is the lesion?

Answer 148

above L1 = UMN sx in legs

Question 149

Dermatology psoriasis picture. What management. Now using emollients

Answer 149

Vit d analogue and topical potent steroids

Question 150

Patient has Multiple sclerosis, is complaining of spasticity.

Answer 150

Carbamazepine

Question 151

RUQ pain, known biliary stones, with previous colic, now constant, temp 38.2, raised bilirubin, mildly raised amylase

Answer 151

Cholecystitis

Question 152

38 yo patient with bilateral conductive hearing loss, worsened during pregnancy. Especially at 2000 Hz

Answer 152

otosclerosis

Question 153

Patient comes to GP with vaginal discharge, fishy odour. She is going away on a wine tasting weekend tomorrow. What treatment?

Answer 153

Topical clindamycin

Question 154

Paracetamol overdose. Patient took it 18 hours ago, took 32 500mg tablets. 80kg male. What is your next step?

Answer 154

IV N-acetylcysteine immediately

Question 155

Patient on long term steroids, now presents with progressive bilateral visual disturbances. Loss of the red reflex bilaterally.

Answer 155

cataracts

Question 156

Patient with pale stool, floats on pan and difficult to flush. Xray showed epigastric calcifications. Has been hospitalised many times for epigastric pain.

Answer 156

Impaired exocrine function of the pancreas

Question 157

Patient had splenectomy, on long-term penicillin now. What infection are they most susceptible to?

Answer 157

Strep pneumoniae

Question 158

Alcoholic patient with purpura. APTT extremely raised, 5x upper limit. PT 1x upper limit, reduced fibrinogen and raised d-dimer.

Answer 158

DIC

Question 159

Warfarin patient, had a fall. INR 5.3 and has orbital bleeding. Vit K has been given, what is your next step?

Answer 159

prothrombin complex concentre

Question 160

Shoulder and hip stiffness and pain. Hard to get out of chair. Can’t remember if CK normal or high. (was normal)

Answer 160

PMR

Question 161

Diabetes and 3 day hx of 4/5 strength in the upper limbs, 3/5 strength in the hips, 4/5 in the lower limbs and tingling all throughout. Reduced ankle reflexes. Normal sensation. Patient unable to keep eyes closed against resistance.

Answer 161

GBS

Question 162

18 yo female walked into A&E and feels unwell. Definitely no mention of an IV port. Known diabetic, BM 1.9. What do you give her?

Answer 162

oral cos awake? then IM then IV

Question 163

Patient due for colonic resection surgery, when do you give prophylactic antibiotics

Answer 163

4-8 hours before

Question 164

Pt 5 days post-op on epidural pain relief, was feeling well in bed, had clammy hands, warm feet, BP 90/60, normal HR. 30ml urine produced in past 2 hours

Answer 164

Saline 500ml challenge

Question 165

Man returned from India with meningism. LP showed low opening pressure, normal glucose, high protein, lymphocyte predominant cells 90%.

Answer 165

viral

Question 166

A patient with XXX symptoms, had a lung biopsy of a peripheral lesion, with histology results of: glandular cells with cellular atypia, something about nuclei and something else.

Answer 166

adenocarcinoma

Question 167

Stable angina patient, relieved by her sublingual GTN and was on statin?. What else do you add?

Answer 167

Beta blocker

Question 168

Hyponatraemia question with urinary sodium >20, serum sodium 122 and JVP was not raised, BP was normal.

Answer 168

Fluid restrict

Question 169

Went on holiday and swam in the ocean, now pain when pressing on tragus and canal looks macerated. Nothing wrong with tympanic membrane. What’s the treatment?

Answer 169

Steroid and abx drops

Question 170

Patient has stroke, impacted mobility a lot. Son wants them to go to care home, patient wants to go back home. What do you do next?

Answer 170

assess capacity

Question 171

Patient had stage IIIB colon cancer removed. 1cm margin clear of cancer cells. 1/16 LNs removed positive. What do you do now?

Answer 171

chemo

Question 172

Patient with #NOF with pain uncontrolled pain. Was on IV paracetamol but it did not relieve pain. What is the next analgesia to offer?

Answer 172

IV morphine