Sample questions

Question 1

A 36 year old woman attends the Emergency Department with epigastric pain and vomiting. Three days before she took an overdose of some tablets and excess alcohol. She does not remember which tablets she took, as she was drunk at the time. She has low mood and has recently been prescribed an anti-depressant by his GP.

Investigations:
Serum creatinine 190 micromol/L (45-95)
Serum total bilirubin 24 µmol/L (<17)
Serum aspartate aminotransferase 75 U/L (10–40)
Prothrombin time 43 seconds (10–12)

Which drug is the most likely cause of these abnormalities?

  1. Amitriptyline
  2. Aspirin
  3. Fluoxetine
  4. Mirtazapine
  5. Paracetamol
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Question 2

A 72 year old man has worsening muscle weakness and lethargy over the last month. He had a recent hospital admission for heart failure and was discharged on an increased dose of furosemide. He also takes ramipril, bisoprolol and aspirin. He has a blood sample taken for serum electrolytes.

What is the most likely pattern to be found?

  1. Na 130 mmol/L, K 2.5 mmol/L

  2. Na 130 mmol/L, K 5.0 mmol/L

  3. Na 140 mmol/L, K 4.5 mmol/L

  4. Na 150 mmol/L, K 2.5 mmol/L

  5. Na 150 mmol/L, K 3.5 mmol/L

     

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Question 3

An 89 year old man has a basal cell carcinoma on his forehead which requires excision. He has dementia and the clinic nurse feels he is not competent to give consent for surgery.

What is the most appropriate action for obtaining consent?

  1. Ask a psychiatrist to assess his cognitive function

  2. Ask his general practitioner to sign the consent form

  3. Ask his wife to sign the consent form

  4. Ask the patient to sign the consent form

  5. Ask the surgeon to assess his mental capacity

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Question 4

A 21 year old woman sustained an undisplaced fracture of the midshaft of her left tibia. The fracture has been treated conservatively with a plaster cast. Two days later she has increasingly severe pain in her leg. Her toes are warm and pulses are present.

What is the most important immediate action?

  1. Elevate the limb

  2. Refer to orthopaedics

  3. Remove the plaster cast

  4. Replace the cast with increased padding

  5. Re-x-ray the fracture site

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Question 5

A 14 year old girl attends the GP surgery requesting the oral contraceptive pill (OCP). She says she is sexually active and her boyfriend is in the year above her at school. Her parents are unaware of her the appointment and her request.

What is the most appropriate action?

  1. Advise her about safe sex and prescribe the OCP

  2. Contact her parents

  3. Contact the local safeguarding team

  4. Contact the police

  5. Explain it is illegal to prescribe the OCP for her

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Question 6

A 22 year old man has had a painful, red right eye with blurring of vision for one day. He had a similar episode one year ago.  He has had episodic back pain and stiffness for four years which is relieved by exercise and ibuprofen.

What is the most likely cause of his red eye?

  1. Chorioretinitis

  2. Conjunctivitis

  3. Episcleritis

  4. Iritis

  5. Keratitis

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Question 7

A healthy baby boy has been born at term. His mother had confirmed acute hepatitis B during this pregnancy.

What preventative intervention should be given to the baby?

  1. Full course of hepatitis B vaccine
  2. Full course of hepatitis B vaccine and hepatitis B immunoglobulin
  3. Hepatitis B immunoglobulin 
  4. Hepatitis B vaccine as a single dose
  5. Confirm hepatitis B status as first step
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Question 8

A 66 year old man sees his GP about tiredness and lower back pain for the last two months. He has no other symptoms. He drinks no alcohol and does not smoke. He has type 2 diabetes and hypertension. He takes metformin and ramipril. His pulse is 88 bpm and BP 138/82mmHg, clinical examination is normal.

Investigations:
Haemoglobin 78g/L (130–175)
White cell count 3.4 × 109/L (4.0–10.0)
Platelet count 80 × 109/L (150–400)
Serum corrected calcium 2.71 mmol/L (2.2–2.6)
Serum albumin 36 g/L (37–49)

An x-ray of the lumbar spine shows generalised osteopenia and vertebral collapse at multiple levels.

What is the most appropriate next investigation?

  1. Serum angiotensin converting enzyme

  2. Serum parathyroid hormone

  3. Serum prostate specific antigen

  4. Serum protein electrophoresis

  5. Serum vitamin D

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Question 9

A 17 year old woman has a 1 cm painless lump in the upper outer quadrant of her right breast.  There is no history of trauma. She takes the oral contraceptive pill.  Her maternal grandmother had breast cancer. 

What is the most appropriate initial investigation?

  1. Excision biopsy

  2. Fine needle aspiration cytology

  3. Magnetic resonance imaging 

  4. Mammography

  5. Ultrasound scan of the breast

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Question 10

A 72 year old man is scheduled to have a colonoscopy to investigate the cause of his iron deficiency anaemia.

What is the most appropriate preparation that should be administered prior to colonoscopy?

  1. Bisacodyl daily for one week before procedure
  2. Glycerine suppository given 48 hours prior to procedure
  3. Lactulose for one week before procedure 
  4. Magnesium citrate once 24 hours before procedure
  5. Senna for a week before procedure
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Question 11

A 40 year old man attends the Emergency Department after an overdose of his antidepressant tablets. He has bipolar affective disorder. He feels hopeless and is ambivalent about being alive He appears depressed. He is medically fit for discharge.

What is the most appropriate next management?

  1. Arrange liaison psychiatric assessment
  2. Arrange psychiatric outpatient follow-up
  3. Discharge to the care of his general practitioner
  4. Referral to local alcohol treatment team
  5. Referral to clinical psychologist
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Question 12

A six week old girl is admitted to hospital with bronchiolitis. She is medically stable. There were no problems in pregnancy and her birth history was normal. She is an only child. Her mother tells the nursing staff that she cannot cope with her new baby daughter

What is the most appropriate initial management?

  1. Arrange temporary foster care
  2. Contact social services
  3. Refer back to her GP
  4. Refer her to safeguarding team
  5. Organise a Place of Safety order
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Question 13

A four week old boy has had episodes of vomiting since birth. The vomiting occurs soon after feeding, irrespective of the amount he takes. He does not vomit after every feed. He is otherwise well and is gaining weight appropriately. 

What is the most likely diagnosis?

A. Cows milk protein allergy
B. Gastro-oesophageal reflux
C. Lactose intolerance
D. Pyloric stenosis
E. Urinary tract infection

 
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Question 14

A 19 year old man has exercise-induced asthma. This has previously been well-controlled using a salbutamol inhaler as required. He now has daily episodes of exercise-induced asthma.

What is the most appropriate next step in his management?

  1. Regular inhaled beclometasone dipropionate
  2. Regular inhaled sodium cromoglicate
  3. Regular inhaled salbutamol
  4. Regular inhaled salmeterol
  5. Regular oral aminophylline
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Question 15

A 50 year old man was recently sacked from his job. He has been brought to hospital after being found wandering on the streets. He becomes increasingly agitated and is suspicious that staff are ‘experimenting’ on him. He is confused, has nystagmus and an ataxic gait.

What is the most likely diagnosis?

  1. Alcohol intoxication
  2. Delusional disorder
  3. Lewy Body dementia
  4. Panic disorder
  5. Wernicke-Korsakoff syndrome
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Question 16

A 19 year old woman has had progressive bilateral iliac fossa pain and dyspareunia for three days. She has an offensive vaginal discharge and feels unwell and feverish. She has a temperature of 39° C. An antimicrobial regimen has been started.
Which organisms are most likely to lead to this presentation?

  1. Neisseria gonorrhoeae and Candida albicans
  2. Neisseria gonorrhoeae, Candida albicans and Gardnerella vaginalis
  3. Neisseria gonorrhoeae and Chlamydia trachomatis
  4. Neisseria gonorrhoeae, Chlamydia trachomatis and Candida albicans
  5. Neisseria gonorrhoeae, Chlamydia trachomatis and Gardnerella vaginalis
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Question 17

An 85 year old man is brought to the Emergency Department after a fall at his home. He had been on the floor all night, and was incontinent of urine. He had a myocardial infarction eight years ago. He takes aspirin, atorvastatin and ramipril.. His pulse rate is 94 bpm and BP 106/76 mmHg.

Investigations:

  • White cell count 14.3 × 10⁹/L (4.0–11.0)
  • Serum urea 30.4 mmol/L (2.5–7.8)
  • Serum creatinine 158 micromol/L (60–120)
  • Serum creatinine kinase 11025 U/L (25–155)

An electrocardiogram shows Q waves in lead III.


What is the most likely cause of his raised creatinine kinase?

  1. Acute kidney injury
  2. Acute myocardial infarction
  3. Dermatomyositis
  4. Rhabdomyolysis
  5. Urinary Tract Infection
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Question 18

A 30 year old man has had weakness in his left arm and leg for three days. He is HIV positive with a CD4 count of 50 cells/mm3. He is not taking anti-retroviral therapy. His BP is 140/90 mmHg, pulse of 95 bpm and temperature is 37.5° C. He has power of 3/5 in his left arm and 4/5 in his left leg but no other focal neurological signs. A CT brain scan shows ring enhancing lesions with surrounding oedema.


What is the most appropriate antimicrobial therapy to prescribe?

  1. Amphotericin and ceftazidime
  2. Dexamethasone and acyclovir
  3. Ganciclovir and ceftazidime
  4. Isoniazid and rifampicin
  5. Pyrimethamine and sulphadiazine
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Question 19

A 16 year old boy has been brought to his GP by his mother as she is concerned that he has no friends and does not play with other children. He likes to collect model cars and now has 1,000. He appears to be indifferent to either praise or criticism from his mother or teachers.


What is the most likely diagnosis?

  1. Attachment disorder
  2. Attention deficit hyperactivity disorder
  3. Autistic spectrum disorder
  4. Obsessive compulsive disorder
  5. Schizoid personality disorder
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Question 20

An 18 year old woman attends her GP because she feels she is overweight. For the last 18 months she has reduced her food intake and has been exercising for two hours each day. She has amenorrhoea. Her body mass index is 15.5 kg/m2 and her BP is 90/60 mmHg.


What is the most appropriate management?

  1. Prescribe antidepressants
  2. Refer for psychodynamic therapy
  3. Refer to acute medical services
  4. Refer to dietician
  5. Refer to eating disorder service
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Question 21

A 28 year old woman wishes to discuss contraception. She has menorrhagia but is otherwise well. She has previously had a pulmonary embolism in pregnancy.


What is the most appropriate contraception?

  1. Combined oral contraceptive pill
  2. Copper intrauterine contraceptive device
  3. Levonorgestrel-releasing intrauterine system (Mirena coil)
  4. Progestogen implant
  5. Progestogen-only pill
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Question 22

A 65 year old man had closure of colostomy performed five days ago. His temp is 36.5°C, pulse rate is 76 bpm, BP is 124/82 mmHg and respiratory rate is 15/min. There is a tender, localised fluctuant swelling four cm in diameter in the wound.


What is the most appropriate management?

  1. Abdominal support
  2. Antibiotics
  3. Laparotomy
  4. Local exploration of wound
  5. Observation
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Question 23

10,000 women underwent cervical cytology. 1000 had abnormal cells and had a second smear test. 100 of these women were confirmed as having pre-malignant cells and underwent laser ablation. 10 women who were not identified as needing a second cervical smear developed cervical cancer within 6-12 months.


What term describes the group of 10 women who were not identified as needing a second smear, but very soon developed cervical cancer?

  1. Case control group
  2. False negative group
  3. Incident group
  4. True negative group
  5. True positive group
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Question 24

A 38 year old man has disturbing thoughts about his house being infected by germs. He is anxious about his safety, and checks the door locks repeatedly before going to bed. For the last eight weeks he has been washing his hands every time he touches the lock, 20-30 times a day.


What is the most appropriate management?

  1. Antidepressant
  2. Antipsychotic
  3. Anxiolytic
  4. Cognitive behaviour therapy
  5. Psychodynamic psychotherapy
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Question 25

An eight year old girl has asthma, and is taking low-dose inhaled corticosteroids twice daily and a short-acting bronchodilator as required. She is concordant with her treatment and her inhaler technique is good. For three months she has had frequent cough at night and mild exercise-induced wheeze.


What is the most appropriate next step in her treatment?

  1. Add leukotriene receptor antagonist
  2. Add long-acting bronchodilator
  3. Add oral modified release theophylline
  4. Add short course of oral corticosteroid
  5. Increase dose of inhaled corticosteroid
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Question 26

A 32 year old woman has had vaginal bleeding for two days. She is eight weeks pregnant. She has had two previous first trimester miscarriages. Ultrasound scan confirms fetal heart activity.


What is the most appropriate treatment?

  1. Admission to hospital
  2. Aspirin
  3. Bed rest for four weeks
  4. Cervical cerclage
  5. No treatment indicated
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Question 27

A 32 year old woman has had three episodes of slurred speech and two separate episodes of transient weakness of both legs in the past two years. Recently she had an episode of loss of vision on the left which lasted two hours. Her vision since has been normal. She has had low mood and has taken Citalopram for the last five years. She is a non smoker and does not drink alcohol. On each occasion symptoms have lasted for a few weeks and then gradually resolved, in between episodes she remains well. Examination does not show any neurological abnormalities.


What is the most likely cause for her symptoms?

  1. Acephalgic migraine
  2. Depression
  3. Multiple sclerosis
  4. Recurrent Stroke
  5. Side effects of Citalopram
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Question 28

An 84 year old woman has recently become incontinent. She has Alzheimer’s dementia. Her daughter says her mother is more confused than usual. She also describes visual hallucinations and disturbed sleep pattern. Her daughter says these symptoms have been worsening for the last week. She recently started taking paracetamol for arthritis. Abbreviated mental test score in clinic was 2/10.


What is the most likely underlying reason for her deterioration?

  1. Analgesia related confusion
  2. Depression
  3. Encephalitis
  4. Urinary tract infection
  5. Worsening Dementia
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Question 29

A 38 year old man has worsening vertigo and tremor. His symptoms are more marked in the morning. He has longstanding alcohol dependence and drinks 60 units of alcohol per week.


What is the most likely diagnosis?

  1. Acute alcohol withdrawal syndrome
  2. Anxiety
  3. Benign positional vertigo
  4. Cerebellar degeneration
  5. Temporal lobe epilepsy
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Question 30

A 22 month old year old girl has had left earache for two days. The earache subsided about two hours ago with the onset of a purulent discharge which relieved the pain. Her temperature is 39.2°C


What is the most appropriate antibiotic?

  1. Amoxicillin
  2. Ciprofloxacin
  3. Clindamycin
  4. Erythromycin
  5. Flucloxacillin
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Question 31

A 78 year old man has collapsed. He had an upper respiratory tract infection three days ago and has had a severe headache for 12 hours. His Glasgow Coma Scale is 10 and some neck stiffness. His temperature is 39.2°C, pulse 122 bpm, BP 84/60 mmHg, respiratory rate 34 breaths/minute and oxygen saturations 91% breathing air. His chest is clear. He has been started on high-flow oxygen and intravenous fluids.


Which is the most appropriate initial investigation?

  1. Blood cultures
  2. Chest X-ray
  3. CT brain scan
  4. Lumbar puncture
  5. MR brain scan
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Question 32

A 16 year old boy was in a comatose state having taken methadone. He was given naloxone in the Emergency Department and rapidly became alert. Two hours later he is drowsier, with a Glasgow Coma Scale of 10. His temperature is 36.5˚C, pulse 82 bpm, BP 108/72, respiratory rate 10 breaths per minute and oxygen saturations of 94% breathing air.


Which is the most likely cause of the drop in Glasgow Coma Scale?

  1. Methadone hepatotoxicity causing acute liver failure
  2. Methadone is eliminated from the body more slowly than naloxone
  3. Naloxone is a partial agonist at the central nervous system opioid receptor
  4. Patient has taken another drug that has caused an intracranial bleed
  5. Patient has taken another drug that is absorbed more slowly than methadone
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Question 33

A 32 year old woman has had a febrile illness and swelling of the small joints of her hands, feet, wrists and knees for two days. She has a maculopapular rash and a few palpable, small cervical lymph nodes. She has no significant past medical history. There is no history of travel outside the UK. She has two young children.


What is the most likely diagnosis?

  1. Psoriasis
  2. Reactive arthritis
  3. Rheumatoid arthritis
  4. Sarcoidosis
  5. Systemic lupus erythematosus
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Question 34

A 78 year old woman has had pain in her left thigh and calf on walking for eight weeks. The pain is relieved with rest. She has a 40 pack year smoking history. Her left popliteal and pedal pulses are not palpable. A hand held Doppler reveals monophasic waveform in her left Dorsalis Pedis artery


What is the most likely site of arterial pathology?

  1. Anterior Tibial
  2. Dorsalis Pedis
  3. External Iliac
  4. Internal Iliac
  5. Profunda Femoris
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Question 35

A 53 year old woman has anorexia and increasing breathlessness. She has stage 4 adenocarcinoma of the lung and now requires full support with her activities of daily living. She takes diazepam, etoclopramide and zopiclone.

Investigations:

  • Serum sodium 122 mmol/L (134-146)
  • Serum potassium 3.2 mmol/L (3.5-5.3)
  • Serum urea 6.2 mmol/L (2.5-7.8)
  • Serum creatinine 58 mmol/L (45-95)

What is the most appropriate management of her electrolyte disturbance?

  1. Demeclocycline orally
  2. DDAVP nasally
  3. Fluid restriction
  4. No treatment indicated
  5. 1.8% sodium chloride by intravenous infusion
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Question 36

A three day old baby boy is noted to have ambiguous genitalia at his postnatal check. Investigations are arranged prior to his discharge from hospital.

Investigations:

  • Sodium 125 mmol/L (136-146)
  • Potassium 5.2 mmol/L (3.5–5.3)
  • Chloride 102 mmol/L (102-112)
  • Urea 5.0 mmol/L (2.5–7.8)
  • Creatinine 70 micromol/L (60–120)
  • Bicarbonate 22 mmol/L. (17-25)

What is the most likely diagnosis

  1. Acute renal failure
  2. Congenital adrenal hyperplasia
  3. Diabetes insipidus
  4. Hyponatraemic dehydration
  5. Renal tubular acidosis
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Question 37

A two year old boy has a fall from his tricycle, hurting his left arm. He stood up and started to cry but then went pale, unconscious and rigid. He recovered after 1-2 minutes. He had a similar episode three months ago after falling down some steps.

He is pale initially but after an hour is back to his normal self.


What is the most appropriate investigation?

  1. Computed tomography scan of the head
  2. Electroencephalogram
  3. Full blood count
  4. No investigation indicated
  5. Skeletal survey
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Question 38

A 16 year old girl has an enlarging mass on the right side of her neck for the last six weeks. She has no other symptoms.

She has a two x two cm lymph node in the right anterior triangle of the neck and several smaller cervical lymph nodes. Her tonsils are enlarged and covered by a grey membrane.


What is the most likely diagnosis?

  1. Infectious mononucleosis
  2. Leukaemia
  3. Lymphoma
  4. Sarcoidosis
  5. Tuberculosis
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Question 39

A 66 year old man had an anterior resection five days ago. He now has increased abdominal pain. His temperature is 38.5°C and pulse is 120 bpm and BP is 90/60 mmHg. His abdomen is tender and there is generalised rigidity.


What is the most likely diagnosis?

  1. Hypovolaemia
  2. Leaking anastomosis
  3. Secondary haemorrhage
  4. Urinary tract infection
  5. Wound infection
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Question 40

An 83 year old woman is admitted with a chest infection and confusion. She is having visual hallucinations. She is restless, and verbally abusive towards the staff who she believes are trying to poison her. There is no significant previous psychiatric history.


What is the most likely diagnosis?

  1. Delirium
  2. Delusional disorder
  3. Charles Bonnet syndrome
  4. Parkinsons disease dementia
  5. Psychotic depression
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