Mock Questions and Answers

An infant aged 3 months presents with recurrent infections and feeding difficulties. He has
dysmorphic facial features and a cleft palate. A chest X-ray reveals an absent thymic shadow.
What is the most probable diagnosis?
A. Down's syndrome
B. Fragile X syndrome
C. DiGeorge syndrome
D. Marfan's syndrome
E. Edward's syndrome
ANSWER: DiGeorge syndrome

A 4-year-old boy is referred to a pediatrician with a 2 cm cervical lymph node that has been
enlarging over six weeks. He is well with no tenderness or fever. Examination reveals a firm,
non-tender, immobile cervical lymph node. The spleen is not palpable, and there are no other
enlarged lymph nodes. What is the most appropriate initial investigation?
A. Full blood count and blood film
B. Ultrasound of lymph node
C. Lactate dehydrogenase
D. Liver function test
E. Epstein-Barr virus and cytomegalovirus serology
ANSWER: Full blood count and blood film

An 8-year-old boy is brought to the emergency department with bruises on his lower back and a
dislocated left shoulder. He lives with his stepfather. The child is withdrawn and avoids eye
contact during conversation. What is the most likely diagnosis?
A. Non-accidental injury
B. Malnutrition
C. Thrombocytopenia
D. Osteogenesis imperfecta
E. Haemophilia
ANSWER: Non-accidental injury

A 4-week-old female infant presents with projectile, non-bilious vomiting after feeds and
constipation. An olive-sized mass is palpable on the right side of her abdomen. What is the most
appropriate next step?
A. Abdominal ultrasound
B. Abdominal X-ray
C. Intravenous fluids
D. Serum potassium level
E. Nasogastric tube insertion
ANSWER: Serum potassium level

A woman who already has a child with 17-alpha-hydroxylase deficiency is now pregnant again.
What is the chance that her new baby will have congenital adrenal hyperplasia?
A. 1:1
B. 1:2
C. 1:4
D. 1:8
E. 2:3
ANSWER: 1:4

An 11-year-old boy has joint hypermobility, hyperelastic skin, mild scoliosis, and blue sclerae.
What is the most likely diagnosis?
A. Fragile X syndrome
B. Prader-Willi syndrome
C. DiGeorge syndrome
D. Marfan's syndrome
E. Ehlers-Danlos syndrome
ANSWER: Ehlers-Danlos syndrome

A 17-year-old boy is brought to the emergency department unconscious after a road traffic
accident. What is the most appropriate action?
A. Resuscitate without consent
B. Wait for relatives to consent before beginning resuscitation
C. Inform health authorities due to complexity
D. Seek judicial review instructions
E. No action taken
ANSWER: Resuscitate without consent

A 34-year-old woman requests sterilization. Her youngest child has cerebral palsy. Despite her
husband's strong objections, she has decided on sterilization after considering all other
contraceptive options. What is the most appropriate action?
A. Perform a mental capacity assessment
B. Proceed with the patient's wishes and carry out sterilization
C. Seek judicial review instructions
D. Refer to social services
E. No action taken until both parties consent
ANSWER: Proceed with the patient's wishes and carry out sterilization
A 15-year-old girl seeks contraceptive advice. She is mentally competent and understands the
implications of her sexual relationship. What is the most appropriate action?
A. Inform her that contraception cannot be given until age 16
B. Inform her that her parents must be informed
C. Enquire about her sexual relationship including the partner's age
D. Inform her she would require a cervical smear if sexually active
E. Contact the police and local safeguarding officer
ANSWER: Enquire about her sexual relationship including the partner's age

A 55-year-old woman diagnosed with multiple sclerosis and on oral steroids presents after
ingesting more than 40 paracetamol tablets 3 hours ago. She refuses medical treatment as she
wants to end her life. What is the most appropriate action?
A. Admit and observe without intervention
B. Refer to psychiatrist to assess capacity to refuse treatment
C. Perform gastric lavage
D. Administer activated charcoal
E. Refer to social worker
ANSWER: Refer to psychiatrist to assess capacity to refuse treatment

A 16-year-old boy requires an appendectomy for suspected acute appendicitis. He consents to

the surgery, but his parents refuse due to opposition to surgery. The procedure has been
explained, and they understand the risks of not proceeding. What is the most appropriate
action?
A. Cancel the surgery after parental documentation
B. Obtain consent from the patient and proceed
C. Contact the local safeguarding officer
D. Involve social services
E. Contact the police
ANSWER: Obtain consent from the patient and proceed

A 65-year-old man is treated for abdominal sepsis with antibiotics and IV fluids. He has type 2
diabetes mellitus and is on a variable rate insulin infusion. Repeat blood tests show
hyponatremia. What is the most likely cause of these results?
A. Hypertension
B. Sepsis
C. Iatrogenic
D. Liver failure
E. Acute kidney injury
ANSWER: Iatrogenic
A 6-year-old boy presents with abdominal pain, mild fever, knee pain, and a swollen right knee.
He developed purpuric patches on his buttocks and legs that do not blanch on pressure.
Urinalysis shows microscopic hematuria and mild proteinuria. Blood tests show elevated IgA
levels. What is the most likely diagnosis?
A. Immune thrombocytopenic purpura
B. Haemolytic uraemic syndrome
C. Haemophilia
D. Henoch-Schönlein purpura
E. Meningitis
ANSWER: Henoch-Schönlein purpura

A 44-year-old man with a history of alcohol dependency presents with confusion, irritability,
unsteadiness, and ataxia. Blood glucose is 3.5 mmol/L. What is the most appropriate immediate
action?
A. Administer intravenous thiamine
B. Give a bolus of 50% glucose
C. Administer intravenous 5% dextrose
D. Provide normal saline
E. Order a CT scan of the head
ANSWER: Administer intravenous thiamine

A 45-year-old man is admitted to the ICU with worsening difficulty breathing, fever, stridor,
drooling, and muffled voice. Anaesthetist is concerned about airway compromise. What is the
most appropriate management?
A. Administer intramuscular adrenaline
B. Provide nebulised salbutamol
C. Administer intravenous salbutamol
D. Administer intravenous adrenaline
E. Start intravenous antibiotics
ANSWER: Start intravenous antibiotics

A 35-year-old woman returns from Bangkok with fever, headache, nausea, muscle and bone
pains, maculopapular rash, and elevated liver enzymes. Platelets are low. What is the most
likely diagnosis?
A. Malaria
B. Typhoid fever
C. Dengue fever
D. Seroconversion illness
E. Leptospirosis
ANSWER: Dengue fever

A 45-year-old man is post-rectal surgery and was on oxycodone. He started vomiting and is
suspected to have a mild intestinal obstruction. Unable to tolerate oral medications, what is the
most appropriate pain management?
A. Switch to fentanyl patch
B. Switch to intramuscular morphine
C. Switch to intravenous morphine
D. Switch to intramuscular codeine phosphate
E. Switch to oral codeine
ANSWER: Switch to intravenous morphine

A 19-year-old man presents with weight loss, thirst, and frequent urination. Several family
members have diabetes. Blood tests show elevated HbA1c and fasting glucose. What type of
diabetes does he have?
A. Wolfram Syndrome
B. Type 2 diabetes mellitus
C. Latent autoimmune diabetes of adults
D. Maturity onset diabetes of the young
E. Diabetic ketoacidosis
ANSWER: Maturity onset diabetes of the young

A 31-year-old woman has persistent nausea and vomiting at 10 weeks gestation. She is
dehydrated and has significantly raised beta-hCG levels. What is the most appropriate
investigation?
A. Amylase
B. Urine hCG
C. Endoscopy
D. Transvaginal ultrasound scan
E. Liver function test
ANSWER: Transvaginal ultrasound scan

A 48-year-old man presents with headaches, sweating, and lethargy. He is hypertensive on

multiple medications. IGF-1 levels are raised. HbA1c is 47 mmol/mol. What is the most likely
diagnosis?
A. Renal artery stenosis
B. Phaeochromocytoma
C. Type 2 diabetes mellitus
D. Hyperthyroidism
E. Acromegaly
ANSWER: Acromegaly

A 37-year-old woman believes her neighbors are using her shower when she's away. Her
husband shares this belief. They inform the police. What is the term for these symptoms?
A. Capgras syndrome
B. Cotard syndrome
C. Persecutory delusions
D. Folie à deux
E. Munchausen's syndrome
ANSWER: Folie à deux

A 29-year-old man is punched in the face and presents with periorbital ecchymosis,
enophthalmos, and diplopia on upward gaze. Which bone is likely fractured?
A. Maxilla
B. Frontal bone
C. Ethmoid bone
D. Mastoid bone
E. Sphenoid bone
ANSWER: Maxilla

A 24-year-old woman presents with thirst and frequent urination. Her father and grandfather
have diabetes. BMI is 29 kg/m². Blood tests show elevated HbA1c and fasting glucose. What
is the most appropriate management?
A. Start metformin
B. Start sulfonylurea
C. Advise lifestyle changes
D. Start insulin
E. Refer to secondary care diabetic clinic
ANSWER: Refer to secondary care diabetic clinic

A 39-year-old man ingests a significant amount of amitriptyline. He is agitated, confused,

tachycardic, hyperthermic, and has widened QRS complexes. ABG shows metabolic acidosis.
What is the most appropriate management?
A. Administer diazepam
B. Administer sodium bicarbonate
C. Give calcium gluconate
D. Administer glucagon
E. Provide crystalloid bolus
ANSWER: Administer sodium bicarbonate
A 44-year-old man was seen in the emergency department with severe lower back pain
worsening over two weeks. He cannot walk without support. Which worrisome feature warrants
urgent neurosurgical referral?
A. Shooting pain down the leg
B. Reduced sensation around the knee
C. Absent knee jerk reflex
D. Positive straight leg test
E. Saddle anesthesia
ANSWER: Saddle anesthesia

A 61-year-old man with painless frank hematuria and urinary urgency. DRE shows an enlarged
smooth prostate. Urine microscopy shows red cells but no white cells. What is the most
appropriate diagnostic test?
A. Urine culture
B. Transrectal ultrasound and biopsy
C. Ultrasound of kidneys, ureters, and bladder
D. Cystoscopy with biopsy
E. Prostate-specific antigen (PSA)
ANSWER: Cystoscopy with biopsy

A 34-year-old woman requests sterilization. Her youngest child has cerebral palsy. Despite her
husband's objections, she chooses sterilization after considering all options. What is the most
appropriate action?
A. Perform a mental capacity assessment
B. Proceed with the patient's wishes and carry out sterilization
C. Seek judicial review instructions
D. Refer to social services
E. No action taken until both parties consent
ANSWER: Proceed with the patient's wishes and carry out sterilization

A 29-year-old woman has bilateral breast tenderness worse before menstruation, resolving
afterward. Examination shows no palpable lumps. What is the most appropriate action?
A. Advise taking evening primrose oil
B. Advise wearing a supportive bra
C. Prescribe gabapentin
D. Prescribe amitriptyline
E. Prescribe pyridoxine
ANSWER: Advise wearing a supportive bra
A 78-year-old woman with Parkinson's disease has become increasingly agitated and
aggressive in her nursing home. Which medication is most appropriate to administer?
A. Risperidone
B. Haloperidol
C. Lorazepam
D. Olanzapine
E. Donepezil
ANSWER: Lorazepam

A 62-year-old man diagnosed with transitional cell carcinoma of the bladder has a history of
smoking and moderate alcohol use. What is the greatest risk factor?
A. Alcohol
B. Smoking
C. Age
D. Ethnicity
E. Gender
ANSWER: Smoking

A 34-year-old man had a car crash and is deteriorating with GCS falling from 13 to 7. What is
the most appropriate next step?
A. Order a CT scan
B. Perform burr hole surgery
C. Order an MRI
D. Intubate the patient
E. Administer IV fluids
ANSWER: Intubate the patient

A 50-year-old man with diabetes develops crushing central chest pain radiating to the neck and
arm, associated with nausea, vomiting, dyspnea, and palpitations. What is the most likely
diagnosis?
A. Angina
B. Costochondritis
C. Dissecting aneurysm
D. Myocardial infarction
E. Pulmonary embolism
ANSWER: Myocardial infarction

A 63-year-old man presents with bilateral lower limb edema, fatigue, and unintentional weight
loss. Ultrasound shows a solid mass in the right kidney. What is the most likely cause of the
edema?
A. Chronic venous insufficiency
B. Lymphatic obstruction
C. Nephrotic syndrome
D. Inferior vena cava syndrome
E. Right heart failure
ANSWER: Inferior vena cava syndrome

A 16-year-old girl on fluoxetine presents with acute confusion, agitation, shivering, sweating,
intermittent jerking, tachycardia, and dilated pupils. She ingested 30 tablets after an argument.
What is the most likely diagnosis?
A. Neuroleptic malignant syndrome
B. Anticholinergic poisoning
C. Malignant hyperthermia
D. Addisonian crisis
E. Serotonin syndrome
ANSWER: Serotonin syndrome

A 60-year-old male develops bilateral ankle swelling after starting a new antihypertensive
medication. Which medication is the likely cause?
A. Bendroflumethiazide
B. Bisoprolol
C. Diltiazem
D. Furosemide
E. Captopril
ANSWER: Diltiazem

A 30-year-old woman presents with sudden-onset vertigo worsened by head movements,

nausea, vomiting, and hearing loss in the left ear after a recent upper respiratory infection.
Examination reveals horizontal nystagmus. What is the most likely diagnosis?
A. Acoustic neuroma
B. Benign paroxysmal positional vertigo
C. Labyrinthitis
D. Meniere's disease
E. Vestibular migraine
ANSWER: Labyrinthitis

A 53-year-old man with chronic heart failure develops gout and is started on a new medication.
His gout improves, but he becomes short of breath with orthopnea. Which medication was he
likely started on?
A. Prednisolone
B. Paracetamol
C. Ibuprofen
D. Colchicine
E. Beta blockers
ANSWER: Ibuprofen

A 28-year-old woman with epilepsy plans to conceive soon and is to start sodium valproate.
What is the most appropriate form of contraception?
A. Combined oral contraceptive pill
B. Condoms
C. Depot medroxyprogesterone acetate
D. Levonorgestrel-releasing intrauterine system (Mirena coil)
E. Progestogen-only pill
ANSWER: Levonorgestrel-releasing intrauterine system (Mirena coil)

A 32-year-old patient has a deep cut on her palm and back of her wrist, resulting in inability to
extend the distal phalanx of her ring finger. What structure is most likely affected?
A. Extensor digitorum
B. Branch of ulnar nerve
C. Flexor digitorum profundus
D. Palmaris brevis
E. Branch of median nerve
ANSWER: Extensor digitorum

A 32-year-old man experienced chest pain 8 hours ago while playing football. ECG is normal,
troponin is normal, CK is elevated. What is the most appropriate next step?
A. Coronary angiography
B. Administer alteplase
C. Administer fondaparinux, aspirin, and clopidogrel
D. Discharge with outpatient cardiology review
E. Admit for 12-hour troponin levels
ANSWER: Discharge with outpatient cardiology review

A 14-year-old boy hits his head at school with swelling and tenderness of the right cheek and a
subconjunctival hemorrhage. He is stable and alert. What initial investigation would be helpful?
A. Computed tomography of head
B. Fundoscopy
C. Magnetic resonance imaging of head
D. Skull X-ray
E. Facial X-ray
ANSWER: Facial X-ray

A 65-year-old man develops fatigue and dyspnea 3 days after a myocardial infarction. A
pansystolic murmur is heard at the apex radiating to the axilla. What is the most likely
diagnosis?
A. Papillary muscle rupture
B. Ventricular aneurysm
C. Pericarditis
D. Pericardial effusion
E. Ventricular septal defect
ANSWER: Papillary muscle rupture

A 22-year-old man with severe learning disabilities is non-compliant with his lamotrigine for
epilepsy, resulting in seizures. He lacks capacity. What is the most appropriate action?
A. Administer medications via nasogastric tube
B. Arrange a best interest meeting
C. Apply to court for independent ruling
D. Change medications to liquid form
E. Stop lamotrigine
ANSWER: Arrange a best interest meeting

A 45-year-old man is found unconscious with burns to his face, neck, and upper torso after a
building fire. Soot is present in his oropharynx, and breathing is shallow. What is the most
appropriate immediate management?
A. High-flow oxygen via non-rebreather mask
B. Tracheal intubation
C. Cricothyroidotomy
D. Escharotomy of chest wall
E. Fluid resuscitation with Hartmann's solution
ANSWER: Tracheal intubation

A 49-year-old man has hypertension that worsened after starting ACE inhibitors, leading to
severe renal function decline. What is the most likely cause of his hypertension?
A. Chronic glomerulonephritis
B. Pheochromocytoma
C. Bilateral renal artery stenosis
D. Essential hypertension
E. Polycystic kidney disease
ANSWER: Bilateral renal artery stenosis
A 32-year-old man is in hypovolemic shock after a road traffic accident with abdominal bruises.
What mechanism explains his symptoms?
A. Increased sympathetic activity
B. Increased parasympathetic activity
C. Decreased cortisol secretion
D. Decreased circulating catecholamines
E. Increased vasodilation
ANSWER: Increased sympathetic activity

A 24-year-old woman with hypothyroidism on levothyroxine continues to feel tired. TSH is

elevated, free T4 is low-normal, cholesterol is high. What is the most appropriate management?
A. Repeat TSH in 6 months
B. Increase levothyroxine dosage
C. Decrease levothyroxine dosage
D. Offer a statin
E. Offer iron supplementation
ANSWER: Increase levothyroxine dosage

A 41-year-old woman has palpitations, weight loss, sweating, tremor, and elevated T4 and T3
with low TSH. She has swelling of the right thyroid lobe. Started on propranolol, what is the
most appropriate management?
A. Propylthiouracil
B. Thyroidectomy
C. Radioactive iodine
D. Carbimazole
E. No further action required
ANSWER: Carbimazole

A 74-year-old woman had a Colles fracture 3 weeks ago. What investigation is appropriate to
assess her risk for further fracture?
A. Radionuclide scan
B. Dual-energy X-ray absorptiometry (DEXA) scan
C. Fracture risk assessment tool
D. X-ray of wrist
E. No further investigations required
ANSWER: Dual-energy X-ray absorptiometry (DEXA) scan
You notice a colleague posted patient details on social media. The post includes the patient's
name, age, and presenting features, and the hospital is tagged. What is the most appropriate
action?
A. Inform the General Medical Council
B. Talk to your consultant or educational supervisor
C. No action as no photograph was included
D. Talk to your colleague, explain ethical concerns, escalate if needed
E. No action as the hospital was tagged
ANSWER: Talk to your colleague, explain ethical concerns, escalate if needed

A 38-year-old man with a swollen left ankle is admitted requiring IV flucloxacillin. Culture reveals
MRSA. What is the most appropriate treatment?
A. Vancomycin
B. Meropenem
C. Chlorhexidine gluconate
D. Amoxicillin
E. Piperacillin with tazobactam
ANSWER: Vancomycin

A 66-year-old man with Parkinson's disease experiences REM sleep behavior disorder. What is
the most appropriate initial treatment?
A. Melatonin
B. Clonazepam
C. Ropinirole
D. Citalopram
E. Cognitive behavioral therapy (CBT)
ANSWER: Clonazepam

A 59-year-old man shows signs of cardiac tamponade after a road traffic accident. What are the
features of cardiac tamponade?
A. Muffled heart sounds and decreased JVP
B. Muffled heart sounds and increased JVP
C. Muffled heart sounds and hypertension
D. Bradycardia and distended neck veins
E. Increased heart sounds and pulsus paradoxus
ANSWER: Muffled heart sounds and increased JVP

A 57-year-old man on amitriptyline for depression wants to discontinue due to dizziness and dry
eyes, though initial symptoms have resolved. What is the most appropriate next step?
A. Continue amitriptyline
B. Discontinue amitriptyline immediately
C. Add a benzodiazepine
D. Switch to an SSRI
E. Switch to an SNRI
ANSWER: Switch to an SSRI

A 55-year-old man presents with severe abdominal and back pain, pulsatile abdominal mass,
hypotension. What is the most appropriate initial management?
A. Urgent abdominal CT
B. Urgent abdominal ultrasound
C. IV fluids to bring systolic BP to 90 mmHg
D. IV fluids to bring systolic BP to 120 mmHg
E. Intramuscular dopamine
ANSWER: IV fluids to bring systolic BP to 90 mmHg

A 65-year-old man believes he is dead and smells rotten. He refuses to eat and has little social
interaction. No history of mental illness. What explains his symptoms?
A. Schizophrenia
B. Bipolar disorder
C. Depression
D. Dementia
E. Somatoform disorder
ANSWER: Depression

A 35-year-old man with severe learning disabilities needs elective herniorrhaphy but lacks
capacity to consent. He has no family. What is the most appropriate action?
A. Proceed with surgery without consent
B. Seek independent advocate
C. Contact safeguarding
D. Contact psychiatrist
E. Do not perform the surgery
ANSWER: Proceed with surgery without consent

A 38-year-old woman overdoses on amitriptyline and is confused, hypotensive, with QRS

prolongation. ABG shows metabolic acidosis. What is the most appropriate management?
A. IV fluids 0.45% saline
B. IV 500 ml of 0.9% saline
C. IV 250 ml of 0.9% saline bolus + sodium bicarbonate
D. IV 1000 ml of 0.9% saline with potassium chloride
E. IV 1000 ml of 0.18% saline
ANSWER: IV 250 ml of 0.9% saline bolus + sodium bicarbonate

A 40-year-old woman is scheduled for a hysterectomy. She has no significant medical history.
Which preoperative investigation is appropriate?
A. Full blood count
B. Liver function test
C. Coagulation profile
D. ECG
E. Urea and electrolytes
ANSWER: Full blood count

A 24-year-old man collapses at a music festival after taking MDMA. He is hyperthermic with
muscle rigidity despite cooling and fluids. What is the next step?
A. Administer lorazepam
B. Administer procyclidine
C. Administer dantrolene
D. Administer suxamethonium
E. Give paracetamol
ANSWER: Administer dantrolene

A 58-year-old man develops swelling in his right groin and hypotension after coronary
angiography. What is the most appropriate initial management?
A. Administer intravenous fluids
B. Transfuse packed red blood cells
C. Start a beta-blocker
D. Administer vasopressors
E. Apply pressure to the groin
ANSWER: Apply pressure to the groin

A 2-year-old girl develops sudden onset stridor and respiratory distress after playing with toys.
She becomes unconscious. What is the most appropriate management?
A. X-ray of neck
B. Remove foreign body with upper GI endoscopy
C. Remove foreign body under direct laryngoscopy
D. Provide high-flow oxygen by facemask
E. Deliver back blows
ANSWER: Remove foreign body under direct laryngoscopy
A 58-year-old woman with a large multinodular goiter causing dysphagia and voice changes.
Thyroid function tests are normal. What is the most appropriate next step?
A. Carbimazole
B. Radioiodine therapy
C. Subtotal thyroidectomy
D. Serial ultrasound monitoring
E. Low iodine diet
ANSWER: Subtotal thyroidectomy

An 18-year-old woman with metastatic breast cancer is bed-bound, unable to eat or drink, and
has a syringe driver for morphine and midazolam. Her daughter is concerned about her intake.
What is the most appropriate action?
A. Encourage drinking clear fluids and eating soft foods
B. Provide subcutaneous fluids
C. Provide intravenous fluids
D. Feed through a nasogastric tube
E. Encourage small sips of water and mouth care
ANSWER: Encourage small sips of water and mouth care

A 51-year-old woman has 9 months of prolonged, slightly irregular menstrual periods. The
uterus is normal in size with no adnexal masses. What is the most likely diagnosis?
A. Menopause
B. Perimenopause
C. Ovarian carcinoma
D. Cervical carcinoma
E. Premature ovarian failure
ANSWER: Perimenopause

A 33-year-old man has a head injury with initial GCS of 15, dropping to 12 after a few hours.
What is the most appropriate immediate action?
A. Computed tomography head scan
B. X-ray skull
C. Administer intravenous mannitol
D. Emergency burr hole
E. Shift to operating room
ANSWER: Computed tomography head scan

A 38-year-old man presents with a painless swelling of his left testis. Ultrasound shows a
heterogeneous lesion with areas of calcification. Biopsy reveals mature cartilage and glandular
epithelial tissue. What is the most likely diagnosis?
A. Leydig cell tumor
B. Lymphoma
C. Seminoma
D. Teratoma
E. Yolk sac tumor
ANSWER: Teratoma

A 61-year-old man has short-term memory impairment, difficulty with arithmetic, writing,
distinguishing right from left, and finger agnosia. Which brain region is involved?
A. Temporal lobe
B. Frontal lobe
C. Occipital lobe
D. Parietal lobe
E. Cerebellum
ANSWER: Parietal lobe

A 32-year-old woman has weakness in her hands and neck pain after a fall. Immobilized with a
cervical collar, which is the lowest vertebra that needs to be seen on lateral cervical X-ray?
A. C4/C5
B. C5/C6
C. C6/C7
D. C7/T1
E. C8/T1
ANSWER: C7/T1

A 22-year-old footballer collapses during a game. He is sweating and muttering

incomprehensibly. Vitals are stable. What is the most appropriate next action?
A. Computed tomography of head
B. Magnetic resonance imaging of head
C. Check blood glucose
D. Administer intravenous insulin
E. Provide intravenous fluids
ANSWER: Check blood glucose

A 44-year-old alcoholic is treated for intoxication and admits he can't spend a day without
drinking. Which statement suggests he is dependent on alcohol?
A. Drinks 10 units a week
B. Drunk driving
C. Does not feel remorse after drinking
D. Drinks wine to help sleep
E. Drinks alcohol immediately after waking up
ANSWER: Drinks alcohol immediately after waking up

A 50-year-old woman with lung cancer presents with urinary retention, postural hypotension,
diminished reflexes, and sluggish pupils. What explains her symptoms?
A. Paraneoplastic syndrome
B. Progression of lung cancer
C. Brain metastasis
D. Hyponatremia
E. Spinal cord compression
ANSWER: Paraneoplastic syndrome

A 60-year-old man has weight loss, mild abdominal pain, bloating, diarrhea, and anemia. What
is the most appropriate investigation?
A. Barium enema
B. Colonoscopy
C. Sigmoidoscopy
D. CT colonography
E. Carcinoembryonic antigen (CEA)
ANSWER: Colonoscopy

A 77-year-old woman has a minimally displaced distal radius fracture after a fall. What is the
most appropriate action?
A. Below elbow backslab plaster of Paris
B. Open reduction and internal fixation
C. Wrist splint
D. Closed reduction
E. Long arm plaster of Paris
ANSWER: Below elbow backslab plaster of Paris

A 20-year-old woman 6 hours post-Cesarean section has not passed urine and appears unwell
with abdominal tenderness. What is the most likely postoperative complication?
A. Urinary tract infection
B. Urinary tract injury
C. Pleurisy
D. Acute pyelonephritis
E. Paralytic ileus
ANSWER: Urinary tract injury
A 10-year-old boy with severe asthma has been given salbutamol nebulizers and oral
prednisolone. ABG shows respiratory acidosis. What is the diagnosis based on ABG findings?
A. Respiratory alkalosis
B. Respiratory acidosis
C. Mixed acidosis
D. Metabolic acidosis with respiratory compensation
E. Metabolic alkalosis with respiratory compensation
ANSWER: Respiratory acidosis

A 25-year-old man has 7 days of watery diarrhea with fresh blood, abdominal cramping,
urgency, fatigue, and lethargy. No travel history. What investigation will aid management?
A. Fecal fat test
B. Stool microscopy, culture, and sensitivity
C. Fecal antigen test
D. Fecal occult blood test
E. Colonoscopy
ANSWER: Stool microscopy, culture, and sensitivity

A 32-year-old man with no significant history is assessed preoperatively for elective

herniorrhaphy. Which preoperative investigations are recommended?
A. Chest X-ray
B. ECG
C. Coagulation profile
D. Renal function tests
E. No investigations required
ANSWER: No investigations required

A 52-year-old woman has abdominal bloating, pelvic pain, urinary urgency, and palpable
abdominal distension. What is the most appropriate next management step?
A. Request CA-125
B. Request a CT scan of the pelvis
C. Request an ultrasound of the abdomen and pelvis
D. Refer to gynecology
E. Request carcinoembryonic antigen (CEA)
ANSWER: Request CA-125

A study follows women prescribed a new drug after breast cancer surgery and those who
weren't, comparing recurrence rates over five years. What is the study design?
A. Case-control study
B. Prospective cohort study
C. Randomized controlled trial
D. Cross-sectional study
E. Qualitative study
ANSWER: Prospective cohort study

A 58-year-old man has progressive weakness with diminished reflexes and no sensory loss. He
has diabetes but no recent infections. What is the most likely diagnosis?
A. Guillain-Barré syndrome
B. Diabetic neuropathy
C. Spinal cord lesion
D. Myasthenia gravis
E. Multiple sclerosis
ANSWER: Guillain-Barré syndrome

A 27-year-old woman treated for PID with doxycycline and metronidazole now has worsening
abdominal tenderness and fever. What is the most appropriate investigation?
A. High vaginal swab
B. Urinalysis
C. Ultrasound scan of abdomen and pelvis
D. CT scan of abdomen and pelvis
E. MRI scan of abdomen and pelvis
ANSWER: Ultrasound scan of abdomen and pelvis

A 28-year-old man has sudden bone pain and gum bleeding, fatigue, pallor, ecchymoses, and
hepatosplenomegaly. Blood tests show anemia, high WBCs with blasts, and low platelets. What
is the most likely diagnosis?
A. Mantle cell lymphoma
B. Infectious lymphocytosis
C. Waldenstrom's macroglobulinemia
D. Acute myeloid leukemia
E. Acute lymphoblastic leukemia
ANSWER: Acute myeloid leukemia

A 44-year-old man is upset after hernia surgery due to pain and shouts at the doctors. Two
weeks later, he apologizes and is grateful. What is the most likely reason for his actions?
A. Adjustment disorder
B. Grief
C. Personality disorder
D. Post-traumatic stress disorder
E. Schizophrenia
ANSWER: Personality disorder

A 6-month-old baby has feeding difficulty, breathlessness, sweating during feeds, tachypnea,
bilateral crepitations, and a palpable liver edge. What is the underlying cause?
A. Respiratory syncytial virus
B. Atrioventricular septal defect
C. Coarctation of the aorta
D. Cystic fibrosis
E. Pneumonia
ANSWER: Atrioventricular septal defect

A 30-year-old man returns from India with grey membranes on his tonsils and uvula, fever, and
enlarged cervical lymph nodes. What is the most likely diagnosis?
A. Diphtheria
B. Infectious mononucleosis
C. Acute follicular tonsillitis
D. Scarlet fever
E. Agranulocytosis
ANSWER: Diphtheria

A 24-year-old man engages in receptive anal intercourse. Apart from HIV and hepatitis B
serology, which other screening test is important?
A. First void urine culture and sensitivity
B. Midstream urine culture and sensitivity
C. Rectal swab
D. Urethral swab
E. Pharyngeal swab
ANSWER: Rectal swab

A 71-year-old man has increasing breathlessness and fatigue five days after an anterior MI. A
pansystolic murmur is heard at the lower left sternal border. What is the most likely cause?
A. Acute pericarditis
B. Dressler syndrome
C. Left ventricular aneurysm
D. Mitral regurgitation
E. Ventricular septal rupture
ANSWER: Ventricular septal rupture
A 52-year-old woman has hot flushes and night sweats affecting her quality of life. Her last
menstrual period was 14 months ago. What is the most appropriate management?
A. Selective serotonin reuptake inhibitors
B. Continuous combined hormone replacement therapy
C. Cyclical hormone replacement therapy
D. Oral contraceptive pills
E. Lifestyle modifications only
ANSWER: Continuous combined hormone replacement therapy

A 55-year-old woman has aching chest pain worse on inspiration. GTN has no effect. Chest
X-ray and ECG are normal. CRP is elevated. What is the most likely diagnosis?
A. Costochondritis
B. Pericarditis
C. Acute coronary syndrome
D. Unstable angina
E. Pneumonia
ANSWER: Costochondritis

A 27-year-old woman has pelvic pain, dysmenorrhea, heavy periods, dyspareunia, and normal
ultrasound and laparoscopy. What is the most likely diagnosis?
A. Endometriosis
B. Uterine fibroid
C. Pelvic congestion syndrome
D. Pelvic inflammatory disease
E. Fibromyalgia
ANSWER: Pelvic congestion syndrome

A 20-year-old man has a burning red eye with sticky greenish discharge, eyelids stuck shut in
the morning. What anatomical structure is affected?
A. Iris
B. Ciliary body
C. Cornea
D. Conjunctiva
E. Sclera
ANSWER: Conjunctiva

A 73-year-old woman with advanced lung cancer has worsening breathlessness due to a large
pleural effusion. What is the most appropriate next step?
A. Increase dose of oral morphine
B. Administer subcutaneous midazolam
C. Perform pleural aspiration
D. Administer subcutaneous glycopyrronium
E. Switch to oral oxycodone
ANSWER: Perform pleural aspiration

A 40-year-old woman has difficulty sleeping due to noisy neighbors. Earplugs don't help. Work is
affected. What is the most appropriate action?
A. Prescribe a short course of zopiclone
B. Refer to sleep clinic
C. Advise on sleep hygiene
D. Advise patient to inform local authorities
E. Advise patient to inform the police
ANSWER: Advise patient to inform local authorities

A 94-year-old woman is found confused on the street. Blood tests are normal. Chest X-ray is
normal. What is the most appropriate action?
A. Request a CT of chest and abdomen
B. Refer to palliative care services
C. Refer to elderly care multidisciplinary team
D. Obtain collateral history from relatives or carers
E. Begin iron supplementation without further investigation
ANSWER: Obtain collateral history from relatives or carers

A 24-year-old woman has painful ulcers around her vulva after unprotected sex two weeks ago.
Examination reveals small, tender ulcers with erythematous base. What is the most appropriate
investigation?
A. High vaginal swab
B. Mid-stream urine culture
C. Serology for herpes simplex virus
D. Viral swab for herpes simplex
E. VDRL testing
ANSWER: Viral swab for herpes simplex

An 8-month-old boy has a fever, cough, slightly reduced food intake, respiratory rate of 50,
saturations 97%, and crackles throughout his chest. What is the most appropriate
management?
A. Nebulised salbutamol
B. Nebulised adrenaline
C. Nebulised saline
D. Oral steroids
E. No treatment necessary
ANSWER: No treatment necessary

A 58-year-old man with hypertension has average ABPM readings of 141/90 mmHg and a
QRISK2 score of 12%. Physical exam and blood tests are normal. What is the most appropriate
next step?
A. Refer to cardiology
B. Advise lifestyle modifications only
C. Arrange 24-hour urine catecholamines
D. Discuss initiating antihypertensive therapy
E. Schedule repeat ABPM in 1 year
ANSWER: Discuss initiating antihypertensive therapy

A 12-year-old girl has two days of epigastric pain, nausea, and diarrhea after a recent upper
respiratory infection. Examination reveals epigastric tenderness without rebound. What is the
most likely diagnosis?
A. Gastroenteritis
B. Dysentery
C. Appendicitis
D. Peptic ulcer disease
E. Irritable bowel syndrome
ANSWER: Gastroenteritis

A 38-year-old woman has a painful red eye with photophobia and slightly blurred vision.
Examination shows conjunctival redness around the cornea and a hazy cornea. The pupil is
irregular and reacts poorly to light. What is the most likely diagnosis?
A. Acute anterior uveitis
B. Conjunctivitis
C. Episcleritis
D. Glaucoma
E. Keratitis
ANSWER: Acute anterior uveitis

A 5-year-old child has a superficial burn covering 10% of the right thigh. First aid has been
provided. What is the most appropriate immediate pain management?
A. Inhaled diamorphine
B. Rectal diazepam
C. Intranasal fentanyl
D. Oral diazepam
E. Lidocaine injection
ANSWER: Intranasal fentanyl

A 50-year-old man had a proctocolectomy two weeks ago and now has fever, malaise,
abdominal pain, tachycardia, and high temperature. What is the most likely cause?
A. Pelvic hematoma
B. Urinary tract infection
C. Paralytic ileus
D. Pelvic vein thrombosis
E. Pelvic abscess
ANSWER: Pelvic abscess

A 44-year-old man with severe nausea and constipation is started on an antiemetic. He

develops parkinsonian symptoms. Which medication is responsible?
A. Domperidone
B. Metoclopramide
C. Cyclizine
D. Aprepitant
E. Ondansetron
ANSWER: Metoclopramide

A 64-year-old woman treated for breast cancer with tamoxifen should have which medication
added to her regimen?
A. Bisphosphonates
B. Calcium
C. Vitamin D
D. Calcitonin
E. Phosphate binders
ANSWER: Bisphosphonates

A 61-year-old man has sudden right calf pain and swelling. A previously present right popliteal
mass is no longer palpable. The calf is red, tender, and swollen. What is the most likely
diagnosis?
A. Deep vein thrombosis
B. Superficial thrombophlebitis
C. Achilles tendon rupture
D. Cellulitis
E. Baker's cyst rupture
ANSWER: Baker's cyst rupture
A 55-year-old man is in ICU after cardiac arrest. ABG shows respiratory acidosis. What is the
next step in management?
A. Administer bicarbonate
B. Provide intravenous fluids
C. Administer inotropic drugs
D. Increase ventilation
E. Increase FiO2
ANSWER: Increase ventilation

A 25-year-old mother with fragile X syndrome is pregnant with a male child. Her partner is
unaffected. What is the percentage chance her son will have fragile X syndrome?
A. 0%
B. 25%
C. 50%
D. 75%
E. 100%
ANSWER: 50%

A 31-year-old woman has chest pain and difficulty swallowing liquids and solids, worsening over
a year, and recurrent chest infections. What is the most likely diagnosis?
A. Schatzki ring
B. Plummer-Vinson syndrome
C. Achalasia cardia
D. Peptic stricture
E. Esophageal carcinoma
ANSWER: Achalasia cardia

A 20-year-old woman has excessive thirst and frequent urination. Serum glucose, calcium, and
kidney function are normal. Water deprivation test shows continued dilute urine. What is the
most likely diagnosis?
A. Primary polydipsia
B. Diabetes insipidus
C. Addison's disease
D. Conn's syndrome
E. Hypercalcemia
ANSWER: Diabetes insipidus

A previously healthy 20-year-old woman loses consciousness for about a minute without seizure
activity, feeling faint beforehand. ECG is normal. What is the most likely diagnosis?
A. Hypoglycemia
B. Vertigo
C. Prolonged QT syndrome
D. Vasovagal syncope
E. Paroxysmal supraventricular tachycardia
ANSWER: Vasovagal syncope

A 38-year-old man with schizophrenia hears voices telling him to hurt his ex-wife. He
occasionally feels like acting on them. What is the most appropriate action?
A. Breach confidentiality, inform police and ex-wife
B. Inform police without disclosing identity
C. Inform police but not ex-wife
D. Inform his GP
E. Take no action and maintain confidentiality
ANSWER: Breach confidentiality, inform police and ex-wife

A 33-year-old pregnant woman attends her booking appointment with questions about
vaccinations. What vaccines are offered to pregnant women in the UK?
A. Pertussis, diphtheria, and pneumococcal vaccines
B. Influenza and rubella vaccines
C. Influenza and pneumococcal vaccines
D. Pertussis and rubella vaccines
E. Influenza and pertussis vaccines
ANSWER: Influenza and pertussis vaccines

The respiratory medicine team in a hospital conducts an audit evaluating the timeliness of
initiating non-invasive ventilation (NIV) oxygen therapy post admission. The team reviews 20
cases and finds that, on average, there is a delay of two hours between the patient's admission
and the commencement of the therapy, with a guideline recommendation of initiating within one
hour. Recognising the potential impact on patient outcomes the team wants to address this
delay promptly. Which of the following actions should the team prioritize to ensure effective and
sustainable quality improvement?
A. Evaluate the financial implications of the findings
B. Increase sample size
C. Apply sustainable change and reaudit
D. Introduce a new patient feedback system for post-treatment satisfaction
E. Continue collecting data for a further 12 months
ANSWER: Apply sustainable change and reaudit
An 8-year-old child has oral burns and is found not to be breathing well. Intubation has failed.
His oxygen saturations are low. What single anatomical structure is likely to be pierced to help
this child recover?
A. Cricothyroid membrane
B. Dura mater
C. Thyroid gland
D. Conjoint tendon
E. Intercostal muscles
ANSWER: Cricothyroid membrane

A 34-year-old woman who is fully dilated in the labour ward has an abnormal CTG. A decision
for an emergency caesarean section is made; however, she refuses to sign the consent form as
she has a fear of surgical interventions. She understands the risk for her unborn child and it is
clear that she has mental capacity to make a decision. What is the single most appropriate
action?
A. Continue with a normal vaginal delivery
B. Proceed with an emergency caesarean section as it is in the patient's baby's best interest
C. Obtain consent from her partner
D. Seek legal advice
E. Obtain a court order
ANSWER: Continue with a normal vaginal delivery

A 61-year-old woman fell down her stairs and sustained a fractured neck of femur. She is
admitted to the hospital and has her surgery booked for the following day. Her blood test shows
the following:

Haemoglobin 77 g/L (115-160)

Mean cell volume 71 fL (76-96)

Mean cell haemoglobin concentration 300 g/L (300-360)

Platelets 160 x 10⁹/L (150-400)

What is the single most appropriate next action?

A. Investigate and postpone the surgery
B. Blood transfusion and proceed with surgery
C. Iron infusion and proceed with surgery
D. Continue with surgery with 2 units cross-matched blood on standby
E. Platelet transfusion and proceed with surgery
ANSWER: Blood transfusion and proceed with surgery

A 45-year-old man is brought to the Emergency Department by his wife after having cut his own
wrist with a kitchen knife while at home alone. He was feeling very low for the past few months
since he lost his job as an investment banker. He has not been sleeping well and eating less.
He started thinking of taking his own life as he feels he is unable to cope with the stressors of
life. He drinks around 30 units of alcohol a week. He does not use recreational drugs. He has no
children. He was not under the influence of alcohol when he slit his wrist earlier in the day. His
intention for cutting his wrist was to end his life. He does not regret his actions. His wounds
have been sutured by the A&E staff. What is the single most appropriate next step in action?
A. Refer to the on-call psychiatric liaison
B. Refer to the community mental health team
C. Refer to alcohol services
D. Discharge with GP follow-up
E. Refer to the on-call medical team
ANSWER: Refer to the on-call psychiatric liaison

A 62-year-old woman is admitted to the hospital for a minor surgical procedure. An intravenous
cannula is inserted in her upper limb for the administration of fluids and medication. A few hours
later, the nursing staff observes swelling, pallor, and coolness around the insertion site,
accompanied by discomfort reported by the patient. What is the most appropriate initial course
of action?
A. Apply a warm compress and leave the cannula in place
B. Infuse hypertonic saline through the same cannula
C. Remove the cannula and inject hyaluronidase at the site
D. Remove the cannula and lift the arm
E. Reinsert the cannula at a different site without removing the existing one
ANSWER: Remove the cannula and lift the arm

What anatomical structure is pierced during a midline port insertion during a laparoscopic
cholecystectomy?
A. External oblique muscle
B. Linea alba
C. Rectus abdominis
D. Conjoined tendon
E. Intercostal muscles
ANSWER: Linea alba
A 43-year-old lady presents with jaundice. Skin excoriations were seen on physical examination.
Blood tests reveal a raised alkaline phosphatase with mildly raised alanine transaminase.
Antimitochondrial antibodies are found to be positive. What is the single most likely diagnosis?
A. Hepatitis B
B. Hepatitis C
C. Primary biliary cirrhosis
D. Primary sclerosing cholangitis
E. Obstetric cholestasis
ANSWER: Primary biliary cirrhosis

A 56-year-old man attends the GP clinic for his routine medication review. His medical history
includes type 2 diabetes mellitus. He takes metformin 850 mg twice a day and gliclazide 40 mg
once a day. He had a clinic blood pressure of 150/88 mmHg a month ago and was asked to do
an ambulatory blood pressure reading, which the daytime average results are 134/84 mmHg.
His last blood results a week ago show the following:

Haemoglobin 137 g/L (130-180)

Urea 3 mmol/L (2.0-7)

Creatinine 71 µmol/L (70-150)

eGFR >90 mL/min

HbA1c 53 mmol/mol

What is the single most appropriate action?

A. Increase dose of metformin
B. Discuss starting ramipril in addition to lifestyle advice
C. Discuss starting amlodipine in addition to lifestyle advice
D. Add a SGLT2 inhibitor
E. Lifestyle advice and continue current medications
ANSWER: Lifestyle advice and continue current medications

A 45-year-old Asian woman attends the GP surgery for her blood results. She had her blood
test taken a week ago when she attended the surgery for symptoms of tiredness. She has a
strong family history of type 2 diabetes mellitus. She is a non-smoker and has a BMI of 19
kg/m². Her blood results show:
Fasting glucose 8.0 mmol/L

Haemoglobin 140 g/L (115-160 g/L)

Renal function normal

Her blood pressure taken in the clinic was 145/80 mmHg. She has no history of stroke or
myocardial infarction. What is the single most appropriate action?
A. Recheck fasting glucose in 2 weeks or check HbA1c
B. Commence amlodipine
C. Commence metformin
D. Commence statin
E. Reassure
ANSWER: Recheck fasting glucose in 2 weeks or check HbA1c

A 66-year-old man who was alcohol intoxicated fell and hit his head on the pavement 3 hours
ago. He presents to the Emergency Department with head pain and a bruise on his right temple.
His friends who were present with him give a history of loss of consciousness right after the fall,
which lasted 5 minutes. He does not take any regular medications. He is confused on verbal
response. He opens his eyes to speech. On motor response, he is able to obey commands. He
has a heart rate of 70 beats/minute, blood pressure of 130/80 mmHg, and a respiratory rate of
20 breaths/minute. What is the single most appropriate management?
A. Neurological examination every hour
B. Intubation
C. CT scan of head
D. MRI scan of head
E. Skull X-ray
ANSWER: CT scan of head

A 45-year-old man has a headache that started 12 hours after he underwent an appendectomy
under general anaesthesia. The headache is described as a constant, throbbing pain in the
frontal and temporal regions. It is not associated with any nausea, vomiting, or photophobia. His
past medical history is significant for hypertension. He has a temperature of 37.1°C, heart rate
of 70 beats/minute, blood pressure of 130/80 mmHg, respiratory rate of 18 breaths/minute, and
an oxygen saturation of 98%. His neurological examination is unremarkable. Which is the most
important action?
A. Administer oxygen
B. CT scan of the head
C. CSF analysis
D. Blood culture
E. Reassure
ANSWER: Reassure

A 45-year-old man with known type 1 diabetes mellitus has an ulcer on his right ankle with
agonizing burning pain. The pain has been gradually worsening over the past few months. The
pain is worse when he walks and during late hours of the night. He has regular inspection of his
feet and has normal sensation and palpable pulses. His glucose levels have not been well
controlled over the past year, and he is currently undergoing investigations for diabetic
retinopathy and diabetic nephropathy. What is the single most appropriate management for his
pain?
A. Capsaicin cream
B. Acupuncture
C. Nerve blocking agents
D. Ibuprofen
E. Amitriptyline
ANSWER: Amitriptyline

A 34-year-old woman has ongoing right upper quadrant pain which is worse after eating. An
ultrasound scan was requested due to her pain. It is reported as having a renal cyst measuring
2 cm at the superior pole of the right kidney. It is round and has a distinct outline with sharp, thin
posterior walls. There are no echoes within the cyst. There is no evidence of calcification or
septation. What is the single most appropriate action in regard to the renal cyst?
A. Arrange a CT renal scan
B. Reassure and no follow-up required for the renal cyst
C. Repeat the ultrasound in a year
D. Repeat the ultrasound in 6 months
E. Arrange an MRI scan of the abdomen
ANSWER: Reassure and no follow-up required for the renal cyst

A 16-year-old boy obtained a penetrating wound on his right foot during a hiking trip. The wound
developed into an ulcer a few days later. He is limping and refusing to weight bear with
worsening pain on his foot. He has recently developed a fever and feels very lethargic. His
medical history includes type 1 diabetes for which he takes insulin. On examination, there is
redness and increased warmth over the plantar aspect of the 1st metatarsal. He has a
temperature of 39.1°C and a heart rate of 108 beats/minute. What is the single most likely
causative organism?
A. Staphylococcus epidermidis
B. Staphylococcus aureus
C. Streptococcus pneumoniae
D. Streptococcus agalactiae
E. Pseudomonas aeruginosa
ANSWER: Staphylococcus aureus

Parents of a 6-month-old baby want to know the steps for CPR for their child as they have
recently attended a funeral of their neighbours' child who died very suddenly after an episode of
apnoea. They want to know what they can do if an event like this occurs. They specifically
would like to know how to administer breaths. What is the single most appropriate advice in
regards to CPR for their child?
A. Seal the mouth and nose of the infant with your mouth before blowing
B. Seal only the nose with your mouth before blowing
C. Seal only the nose with your mouth and close the lips to prevent air escape before blowing
D. Seal only the mouth with your mouth and pinch the nose before blowing
E. Seal only the mouth with your mouth before blowing and leaving nose unpinched
ANSWER: Seal the mouth and nose of the infant with your mouth before blowing

A 54-year-old smoker is seen in the Emergency Department with extensive wheeze and
breathlessness. He is known to have COPD. On auscultation, he has widespread wheezing
throughout his chest. He has a temperature of 36.7°C, heart rate of 115 beats/minute, blood
pressure of 130/80 mmHg, respiratory rate of 28 breaths/minute, and an oxygen saturation of
85%. He is started on 24% oxygen by Venturi face mask. What is the most appropriate next
step in management?
A. Oral amoxicillin
B. Intravenous co-amoxiclav
C. Intubation
D. Intravenous aminophylline
E. Salbutamol nebulizers
ANSWER: Salbutamol nebulizers

A 45-year-old diabetic man had recently started taking antihypertension therapy. Six months
later his fasting blood glucose is 14 mmol/L. What is the single most likely medication that would
have caused this?
A. Amlodipine
B. Bendroflumethiazide
C. Doxazosin
D. Losartan
E. Ramipril
ANSWER: Bendroflumethiazide
A 66-year-old type 2 diabetic man is seen in the cardiology clinic as he has been having
worsening shortness of breath over the past 8 weeks. He has a history of left ventricular failure
with reduced ejection volume seen on an echocardiogram. His regular medication includes
captopril, carvedilol, spironolactone, sitagliptin, and metformin. He has a body mass index of 29
kg/m². On examination, he has bilateral pulmonary crackles. His heart rate is 53 beats/minute.
His last HbA1c was 59 mmol/mol (<48). What is the single most appropriate medication to
prescribe?
A. Acarbose
B. Ivabradine
C. Dapagliflozin
D. Pioglitazone
E. Gliclazide
ANSWER: Dapagliflozin

A 10-month-old child who weighs 10 kilograms has been diagnosed with a urinary tract
infection. He has been prescribed trimethoprim at a dose of 4 mg/kg to be given twice daily. The
preparation of trimethoprim is 50 mg/5 ml. What dose will you advise the parents to give to the
child?
A. 10 ml BD
B. 4 ml BD
C. 4 ml OD
D. 5 ml BD
E. 5 ml OD
ANSWER: 4 ml BD

A 63-year-old man presents to the Emergency Department with a two-day history of black, tarry
stools and generalised weakness. His medical history includes chronic gastritis managed with
omeprazole. On examination, he appears pale and is sweating profusely. His vital signs are as
follows: blood pressure 85/50 mmHg, pulse 122 bpm, respiratory rate 22 breaths per minute,
and temperature 37.2°C. Laboratory tests reveal a haemoglobin level of 72 g/L (130-180) and
a haematocrit of 21% (40-50). The man has received four units of packed red blood cells and is
currently haemodynamically unstable. He is receiving intravenous fluids. What is the most
appropriate next step in the management of this patient?
A. Intravenous terlipressin
B. Urgent laparotomy
C. Urgent endoscopy
D. Angiography
E. Intravenous proton pump inhibitor
ANSWER: Urgent endoscopy
A 41-year-old man presents with visual symptoms and a headache. An ophthalmoscopic
examination shows papilloedema. Which anatomical site is most likely to be affected?
A. Retina
B. Optic disc
C. Optic radiation
D. Macula
E. Optic chiasma
ANSWER: Optic disc

A 35-year-old male typist suffered a wrist injury after falling on his right outstretched hand. He
was treated with a scaphoid cast with the probable diagnosis of a scaphoid fracture. The cast
was removed after 2 weeks from the injury for a repeat X-ray. After removing the cast, he noted
that he had difficulty in moving his right thumb, index, and middle finger. There was also a
tingling sensation in those fingers. What is the single most likely management that would
improve his symptoms?
A. Release of flexor retinaculum
B. Release of common flexor sheath
C. Release of palmar aponeurosis
D. Ulnar nerve release
E. Fasciotomy
ANSWER: Release of flexor retinaculum

A 65-year-old man presents to the cardiology clinic with complaints of dizziness and a recent fall
when he stands up and walks. He reports feeling clammy with blurred vision during these
episodes which resolve when lying down. His blood pressure is recorded as 138/80 mmHg
when lying down and 128/74 mmHg upon standing. He is currently on multiple medications
including ramipril, amlodipine, and indapamide. Auscultation of the heart and lungs is normal.
His 12-lead ECG is normal. Which of the following is the most appropriate next step in
management?
A. Ambulatory blood pressure monitoring
B. Tilt table test
C. Echocardiogram
D. Ambulatory ECG
E. Referral to a neurologist
ANSWER: Tilt table test

A 26-year-old woman is seen in the neurology clinic with a history of 3 episodes of convulsions.
Her husband has observed all three episodes. They last around 15 minutes and begin by her
losing awareness and becoming unresponsive. This is followed by strange and repeated
movements of her arms, legs, and pelvis. During the episodes, her eyes are closed. There was
no drooling of saliva and no incontinence in any of the episodes. What is the single most
appropriate investigation?
A. Electroencephalogram (EEG)
B. Video electroencephalogram (EEG)
C. Serum electrolytes
D. Blood glucose test
E. Magnetic resonance imaging of the head
ANSWER: Video electroencephalogram (EEG)

A 32-year-old man is found unconscious in a park late in the evening. Emergency services are
called, and on arrival, paramedics note that the man is breathing but unresponsive. His pupils
are markedly dilated. He is promptly transported to the hospital. In the Emergency Department,
his vital signs are as follows: blood pressure 110/70 mmHg, heart rate 120 bpm, respiratory rate
16 per minute, and oxygen saturation 98% on room air. His temperature is 37.2°C. He gains
consciousness and is restless and agitated. His Glasgow Coma Scale score is 10. There is no
evidence of head injury, trauma, or injection sites. A toxicology screen is performed, which
reveals an ethanol level of 40 mmol/L and a salicylate level of 10 mg/dL. An ECG is performed
and shows sinus tachycardia with no abnormalities. Which substance is most likely to have
been taken by this man?
A. Alcohol
B. Amphetamines
C. Amitriptyline
D. Morphine
E. Aspirin
ANSWER: Amphetamines

A 44-year-old woman complains of fatigue and easy skin bruising. She has put on 10 kg over
the past 12 weeks and now weighs 95 kg. She notices that she is constantly hungry. She feels
weak and finds it increasingly difficult to climb stairs or lift boxes at work. On examination, she
has purple striae on her abdomen. Her blood pressure is 161/91 mmHg. Recent blood results
are shown below:

Haemoglobin 125 g/L (115-160)

Sodium 142 mmol/L (135-145)
Potassium 3.3 mmol/L (3.5-5.0)

What is the single most appropriate initial investigation?

A. 24-hour urinary cortisol
B. Short ACTH stimulation test
C. Oral glucose tolerance test
D. Fasting glucose level
E. Thyroid function test
ANSWER: 24-hour urinary cortisol

A 25-year-old woman is brought into the Emergency Department after ingestion of 42

paracetamol tablets after receiving news that she failed her medical exams. She is confused
and disoriented. She is regretful of her actions. She was admitted in the medical ward and
N-acetylcysteine was given. Twenty-four hours later, her laboratory results show the following:

Serum alanine transferase (ALT) 159 U/L (5-35)

Serum alkaline phosphatase (ALP) 180 U/L (30-150)

Arterial pH of 7.2

Serum creatinine 263 µmol/L (70-150)

What is the single most appropriate management?

A. Discharge with advice
B. Administer potassium
C. Refer to psychiatric team
D. Repeat liver function test in 7 days
E. Refer to a liver specialist center
ANSWER: Refer to a liver specialist center

A 56-year-old male with an established lateral myocardial infarction as seen on ECG is taken to
the cardiology department for percutaneous coronary intervention (PCI). While in the
catheterisation laboratory, the nurse in charge noted that he became increasingly unwell and
pale. He eventually became unresponsive. An ABCDE assessment was immediately carried out
and his airway was secured via an oropharyngeal mask and oxygen was administered. His
vitals are as follows:

Blood pressure 75/50 mmHg

Heart rate 210 beats per minute

Respiratory rate 4 breaths per minute

Another ECG was performed and revealed a broad complex tachycardia. What is the single
next best step in management of this patient?
A. Intubation
B. Intravenous amiodarone
C. Intravenous adrenaline
D. Cardioversion
E. Magnesium sulphate
ANSWER: Cardioversion

A 40-year-old man has pain, redness, and swelling over the nasal end of his right lower eyelid.
The eye is watery with some purulent discharge. The redness extends onto the nasal
peri-orbital area and mucoid discharge can be expressed from the lacrimal punctum. What is
the single most appropriate clinical diagnosis?
A. Acute conjunctivitis
B. Acute dacryocystitis
C. Acute iritis
D. Retrobulbar neuritis
E. Scleritis
ANSWER: Acute dacryocystitis

A town has a population of 500,000 people. Over the past 5 years, 250 cases of pancreatic
cancer have been diagnosed. The local health authority seeks to determine the annual
incidence rate of pancreatic cancer per 1,000,000 people in this population. What is the annual
incidence rate?
A. 10 per 1,000,000
B. 50 per 1,000,000
C. 100 per 1,000,000
D. 1,000 per 1,000,000
E. 100,000 per 1,000,000
ANSWER: 100 per 1,000,000

A 61-year-old woman develops an ischaemic stroke a few hours after having her right hip
arthroplasty while in recovery. She was on regular clopidogrel for a previous ischaemic stroke 2
years ago but was told by the surgeon to stop clopidogrel 7 days before the elective surgery.
She has had no other medical problems in the past. With great distress, the husband would like
to know if there was any potential cause of the stroke. What is the single most appropriate
action for the surgeon?
A. Tell the husband that stopping clopidogrel is a possible reason and apologise for stopping
clopidogrel
B. Tell the husband that stopping clopidogrel is a possible reason but do not apologise for
stopping clopidogrel
C. Refer to patient advice and liaison service
D. Tell the husband that clopidogrel was stopped but bridging therapy was not started
E. Explain to the husband about the stroke but omit the details of stopping clopidogrel
ANSWER: Tell the husband that stopping clopidogrel is a possible reason but do not apologise
for stopping clopidogrel

A 27-year-old woman presents with tremors and anxiety. She has a history of significant weight
loss over the last 6 months. She has a heart rate of 112 beats/minute. Mild proptosis was seen
on examination. What is the single most likely mechanism that accounts for her symptoms?
A. Deficiency in thyroid hormone
B. Increased level of calcitonin
C. Increased metabolic rate
D. Insulin resistance
E. Reduced caloric intake
ANSWER: Increased metabolic rate

A 62-year-old man presents with tongue irritation, pain in his throat, and a constant white
coating of his tongue. He has a medical history of type II diabetes and COPD and is on
metformin 500 mg twice a day and an inhaled corticosteroid twice a day. On examination, he
has creamy, loosely adherent plaques with a fur-like appearance. The lesions extend to the
back of the tongue, the soft palate, and buccal mucosa. There is no tonsillar enlargement. What
is the single most appropriate management?
A. Fluconazole suspension
B. Oral co-trimoxazole
C. Chlorhexidine mouthwash
D. Hydrocortisone lozenges
E. Oral clotrimazole
ANSWER: Fluconazole suspension

A 29-year-old man with a medical history that includes late-onset asthma attends the clinic with
rhinorrhoea and bilateral painless nasal obstruction. He complains of a reduced sense of smell.
His symptoms have been ongoing for months. He has never suffered with any allergy as a child.
What is the single most likely diagnosis?
A. Septal abscess
B. Septal haematoma
C. Nasal polyp
D. Atrophic rhinitis
E. Allergic rhinitis
ANSWER: Nasal polyp
A 77-year-old man with a background of squamous cell carcinoma of the lung has been having
worsening chest pains over the past month. His GP had prescribed him morphine sulphate oral
solution (Oramorph 10 mg/5 ml) to be used as required for pain relief. Over time, the patient has
increased the frequency of morphine sulphate oral solution usage and now takes 10 mg every 4
hours. His GP has decided to offer him the same dose of morphine sulphate as a
modified-release tablet. What is the single most appropriate dose of modified-release and
frequency to prescribe?
A. 15 mg QDS
B. 30 mg OD
C. 30 mg BD
D. 60 mg OD
E. 60 mg BD
ANSWER: 30 mg BD

A 62-year-old man has been having severe headaches for the past 2 months. His headaches
are typically worse in the morning. His family reports behavioural changes over the past few
weeks. He also reports having issues with his memory. He was seen by his optician, who
incidentally noticed bilateral blurring of the optic margins, optic disc swelling, and venous
engorgement. He has no history of head trauma. What is the single most appropriate
investigation?
A. Lumbar puncture
B. ECG
C. CT scan of the brain
D. MRI scan of the brain
E. Serum osmolality
ANSWER: MRI scan of the brain

A 24-month-old child has been having smelly, loose stools and abdominal distention over a
period of months. He has not gained sufficient weight over the past few months. His mother
describes him as miserable. He eats the same foods as the rest of the family. He weighs 12.5
kg. His weight has dropped two pre-drawn centiles from the last time he was weighed 6 months
ago. He has no other health issues reported. On examination, he is pale-looking and thin. His
abdomen is distended. What condition should be investigated first?
A. Cystic fibrosis
B. Coeliac disease
C. Biliary atresia
D. Cow milk protein allergy
E. Galactosaemia
ANSWER: Coeliac disease
A 57-year-old woman presents to the clinic with a concern regarding her skin. She underwent a
mastectomy for breast cancer five years ago, followed by adjuvant chemotherapy and
radiotherapy, and has since been in remission. On examination, a distinct blue tinge is noted on
the skin overlying the mastectomy scar. This lesion is non-tender, measures approximately 3 cm
in diameter, and has an irregular border. There is no associated lymphadenopathy or systemic
symptoms. Which of the following is the most likely diagnosis?
A. Angiosarcoma
B. Melanoma
C. Lymphoma
D. Basal cell carcinoma
E. Dermatofibrosarcoma protuberans
ANSWER: Angiosarcoma

A 14-year-old boy is seen in the Emergency Department after a blunt abdominal injury from
falling off his bicycle. He has bruises on his left abdomen. On examination, his abdomen is very
tender. He has a heart rate of 90 beats/minute, a blood pressure of 100/70 mmHg, respiratory
rate of 22 breaths/minute, and oxygen saturation of 98%. An emergency CT with contrast of his
abdomen and pelvis was requested, which report shows a grade 2 splenic injury with
subcapsular splenic haematoma with no evidence of active contrast extravasation. What is the
single most appropriate action?
A. Admit and observe under the surgical team
B. Exploratory laparotomy with splenectomy
C. Exploratory laparoscopy
D. Splenic angioembolization
E. Discharge with analgesia
ANSWER: Admit and observe under the surgical team

A 72-year-old woman presents to the urgent care centre with a two-week history of a persistent
headache localised to the temples. She describes the headache as dull and throbbing. She has
also experienced pain while chewing food, which has caused her to avoid eating solid meals.
Additionally, she complains of aching in both shoulders, which worsens with movement. Her
inflammatory markers are raised, with an erythrocyte sedimentation rate (ESR) of 80 mm/hr.
What is the most appropriate next step in confirming the diagnosis?
A. Carotid Doppler scanning
B. Cranial MRI
C. Full blood count
D. Temporal artery biopsy
E. Bone marrow biopsy
ANSWER: Temporal artery biopsy
A 42-year-old pregnant woman at 38 weeks gestation has an eclamptic fit in the labour ward
which started 2 hours ago and stopped after 5 minutes. She had severe pre-eclampsia which
was diagnosed when she was 35 weeks gestation. She was given a loading dose of magnesium
sulfate several hours ago and is currently on a maintenance dose. When she was last
examined, there was loss of patellar reflexes and she was feeling nauseous and warm. What is
the single most appropriate next step?
A. A further bolus of 2 g magnesium sulfate
B. Increase infusion rate of magnesium sulfate
C. Intravenous hydralazine
D. Immediate delivery of baby
E. Administer calcium gluconate
ANSWER: Administer calcium gluconate

A 68-year-old man had undergone an elective transurethral resection of the prostate a few
hours ago. Following the procedure, he starts to become confused and has a seizure. His
medical history includes type 2 diabetes. His blood results show the following:

Sodium 119 mmol/L (135-145)

Potassium 6.1 mmol/L (3.5-5)

Urea 5 mmol/L (2.0-7)

Creatinine 85 µmol/L (70-150)

eGFR 90 mL/min

Glucose 7.0 mmol/L

Intravenous 3% sodium chloride was administered. A 12-lead ECG was performed which
shows sinus rhythm without hyperkalemic changes. Which of the following is the most
appropriate next step in the management of this patient?
A. Start intravenous calcium chloride
B. Start intravenous 0.9% sodium chloride
C. Start intravenous furosemide
D. Start insulin and glucose infusion
E. Nebulised salbutamol
ANSWER: Start intravenous furosemide
Which artery descends into the anterior interventricular groove?
A. Acute marginal branch
B. Left anterior descending artery
C. Septal branches
D. Circumflex artery
E. Right coronary artery
ANSWER: Left anterior descending artery

A 65-year-old man has chest pain. On initial assessment, he is noted to be pale. An ECG
reveals no connection between P waves and QRS complexes with a rate of 42 beats/minute.
What is the single most likely diagnosis?
A. Complete heart block
B. Ventricular tachycardia
C. First-degree heart block
D. Mobitz type I AV block
E. Mobitz type II AV block
ANSWER: Complete heart block

A 2-year-old boy presents to the Emergency Department with painless rectal bleeding for the
past 2 days. On examination, the child is afebrile, tachycardic, alert, playful, and feeding well.
Abdominal examination was normal. Which of the following is the single most likely diagnosis?
A. Intussusception
B. Ulcerative colitis
C. Hirschsprung's disease
D. Volvulus
E. Meckel's diverticulum
ANSWER: Meckel's diverticulum

A 26-year-old soldier, currently stationed in military barracks, presents with a two-week history
of a productive cough. He denies any recent travel or sick contacts. On examination, he is
afebrile with stable vital signs. Auscultation of the lungs reveals bilateral crackles. Which is the
most appropriate management?
A. Clarithromycin
B. Co-amoxiclav
C. Ciprofloxacin
D. Flucloxacillin
E. Azithromycin
ANSWER: Clarithromycin
A 44-year-old woman presents with memory loss, poor concentration, and inability to recognize
household objects. She has a right-handed involuntary writhing movement which has just
recently started. She reports occasional difficulty in walking. There is a strong family history with
similar symptoms. What is the single most likely diagnosis?
A. Friedreich's ataxia
B. Wilson's disease
C. Huntington's disease
D. Motor neuron disease
E. Charcot-Marie-Tooth disease
ANSWER: Huntington's disease

A 35-year-old woman complains of worsening fatigue over the past few months. Her medical
history includes type 2 diabetes mellitus, hypothyroidism, and iron deficiency anemia. She takes
50 mcg of levothyroxine once daily, 500 mg of metformin once daily, and ferrous sulphate 200
mg once a day. She has a BMI of 24 kg/m². She takes her levothyroxine in the morning and
her ferrous sulphate in the evening. A blood test was requested which shows the following:

Hemoglobin 120 g/L (115-160 g/L)

TSH 9.1 mU/L (0.5-5.7 mU/L)

Free thyroxine (T4) 4 pmol/L (9-18 pmol/L)

HbA1c 47 mmol/mol (<42 mmol/mol)

What is the single most appropriate action?

A. Encourage exercise
B. Increase dose of levothyroxine
C. Increase dose of metformin
D. Add sulfonylurea
E. Advise to take levothyroxine and ferrous sulphate together at the same time
ANSWER: Increase dose of levothyroxine

A 29-year-old woman who is working in the kitchen of a local restaurant presents to the hospital.
She gives a history of episodes of diarrhea and vomiting over the past 72 hours. She can still
take oral fluids. A stool sample was collected and sent for MCS testing. She is apyrexial and
fully alert. A decision is made to discharge her with adequate advice on rehydration. She wants
to know when she can return to work. What is the single most appropriate advice?
A. She can return to her next scheduled shift
B. 48 hours after all symptoms cleared
C. 24 hours after all symptoms cleared
D. 28 days from the start of symptoms
E. When all test results are negative
ANSWER: 48 hours after all symptoms cleared

A 4-year-old child presents to A&E with fever and stridor. He is unable to swallow his saliva. He
has a respiratory rate of 45 breaths/minute. What is the single most appropriate next step in
management?
A. Examine his throat
B. Secure his airways
C. Administer nebulised salbutamol
D. Administer intravenous penicillin and intravenous fluids
E. Administer intramuscular epinephrine
ANSWER: Secure his airways

A 34-year-old female presents to Accident & Emergency with the complaint of right calf pain.
Further questioning reveals that the patient had been started on the combined oral
contraceptive pill (COCP) three weeks ago. She takes no other medications and has no other
medical conditions. On examination, the patient's right leg appears swollen below the knee. She
was then given low molecular weight heparin (LMWH) subcutaneously. What is the single best
description for the mechanism of action of low molecular weight heparin?
A. Inhibition of antithrombin (AT) III
B. Inhibits the conversion of prothrombin to thrombin
C. Decreases the conversion of fibrinogen to fibrin
D. Activation of thrombin
E. Inhibits clotting factors in the liver
ANSWER: Inhibits the conversion of prothrombin to thrombin

An 80-year-old woman presents with dysphagia to both solids and liquids, regurgitation of stale
food, and halitosis. She has a history of a chronic cough. These symptoms have been
progressively worsening over the past few months. The patient denies any chest pain,
haematemesis, or melena. On physical examination, there is no evidence of a neck mass or
lymphadenopathy. Which of the following is the most likely diagnosis?
A. Achalasia
B. Pharyngeal pouch
C. Esophageal carcinoma
D. Benign esophageal stricture
E. Gastroesophageal reflux disease
ANSWER: Pharyngeal pouch
A 9-year-old girl with epilepsy is being managed in a paediatric clinic. She has been prescribed
carbamazepine. Her weight is currently 16 kg. She was started on 5 mg/kg once a day but now
requires carbamazepine 5 mg/kg twice a day. The medication is available in a 100 mg/5 ml oral
suspension. What is the appropriate volume of carbamazepine oral suspension to be
administered to this patient?
A. 1 ml twice a day
B. 2 ml twice a day
C. 4 ml twice a day
D. 8 ml twice a day
E. 16 ml twice a day
ANSWER: 4 ml twice a day

A 71-year-old grandmother attends the GP surgery for a medication review with her grandson.
During the consultation, the grandson mentions that he is worried as his grandmother still
continues to drive despite family members telling her that she should not drive. She has
Alzheimer's disease and she has refused to inform any authority that she continues to drive.
What is the single most appropriate action?
A. Inform the Driver and Vehicle Licensing Agency (DVLA)
B. Inform the police
C. Inform safeguarding
D. Continue to urge her to inform appropriate authorities
E. Advise her not to drive until she can retake her driving test
ANSWER: Inform the Driver and Vehicle Licensing Agency (DVLA)

A 32-year-old woman with a history of Crohn's disease presents to the Emergency Department
with recurrent episodes of abdominal pain and diarrhoea. She was started on prednisolone by
her GP a few days ago as she was having a flare-up of Crohn's disease. Her regular
medications include azathioprine and ferrous sulphate. Her surgical history includes
tonsillectomy when she was a child.

Investigations:

Haemoglobin 109 g/L (115-160)

White cell count 13 x 10⁹/L (4-11)

Platelets 630 x 10⁹/L (150-400)

CRP 91 mg/L (<10)

Which of the following is the single most likely reason for the thrombocytosis?
A. Azathioprine
B. Prednisolone
C. Tonsillectomy
D. Underlying malignancy
E. Chronic iron supplementation
ANSWER: Prednisolone

A 35-year-old man presents with burning retrosternal pain for the past few days. He has recently
completed a course of treatment for H. pylori. Endoscopy shows multiple ulcers along the lower
esophagus, stomach, and duodenum. What is the single next most appropriate investigation?
A. Computed tomography of the abdomen
B. Colonoscopy
C. Gastrin levels
D. Urease test
E. Barium swallow
ANSWER: Gastrin levels

A 29-year-old woman, 18 weeks pregnant, presents to the endocrinology clinic for a routine
follow-up. She has a history of Graves' disease and was taking propylthiouracil (PTU) during the
first trimester. Her current thyroid function tests show a normal free T4 and normal TSH. Which
of the following is the most appropriate management plan for her thyroid disorder at this stage of
pregnancy?
A. Continue propylthiouracil only
B. Switch to carbimazole and levothyroxine combination
C. Initiate levothyroxine only
D. Start radioiodine therapy
E. Start a combination of propylthiouracil and carbimazole
ANSWER: Continue propylthiouracil only

A 63-year-old man presents to the clinic after experiencing his first-ever seizure. He was found
by his wife, who reported that he had a convulsive episode lasting approximately 2 minutes.
Upon regaining consciousness, he appeared confused but gradually became alert and oriented
to time, place, and person. On examination, he is communicative and appears to understand
and follow commands. There is a noticeable inattention to stimuli presented on his left side.
Further neurological examination reveals brisk reflexes in the left arm compared to the right.
What is the single most likely diagnosis?
A. Cerebral tumor
B. Pituitary adenoma
C. Cerebellar abscess
D. Huntington's chorea
E. Parkinsonism
ANSWER: Cerebral tumor

In chronic renal failure, what is the main cause of vitamin D deficiency?

A. Decreased vitamin D absorption in intestines
B. Deficiency of 25 alpha-hydroxyvitamin D
C. Excess vitamin D loss in urine
D. Reduced activity of 1-alpha hydroxylation
E. Unavailability of vitamin D precursors
ANSWER: Reduced activity of 1-alpha hydroxylation

A 29-year-old woman presents to the GP clinic with concerns about not having had a menstrual
period since the birth of her daughter six months ago. She is exclusively breastfeeding and
reports no use of contraception. She is worried about the absence of her periods and wonders if
this is normal or if there could be an underlying issue. What is the most appropriate next step in
management?
A. Advise cessation of breastfeeding
B. Order a pelvic ultrasound
C. Perform serum prolactin and thyroid function tests
D. Perform serum FSH and LH
E. Reassure the patient
ANSWER: Reassure the patient

A 31-year-old man known case of alcohol abuse, is brought into Emergency by his friend from a
nightclub. The friend saw the patient suddenly collapse on the dance floor where his body went
stiff then there was twitching of his legs followed by involuntary voiding. When he gained
consciousness, he was drowsy and confused for several minutes before full recovery. What is
the single most likely diagnosis?
A. Complex partial seizure
B. Generalised myoclonic seizure
C. Generalised clonic seizure
D. Generalised tonic seizure
E. Generalised tonic-clonic seizure
ANSWER: Generalised tonic-clonic seizure
A 29-year-old lady with a history of intravenous drug use was investigated for symptoms of
malaise and loss of appetite. Blood tests showed:

HBsAg negative

Anti-HBc positive

Anti-HBs negative

HCV antibody reactive

HCV RNA detected

In addition to this, liver biopsy produced a histopathological sample that demonstrated

moderate necrosis and inflammation with definite steatosis. What is the single most likely cause
for these findings?
A. Past cytomegalovirus infection
B. Current human immunodeficiency virus infection
C. Previous hepatitis E virus infection
D. Current hepatitis B virus infection
E. Current hepatitis C virus infection
ANSWER: Current hepatitis C virus infection

A 33-year-old man presents to the GP surgery with complaints of a sudden onset of abdominal
pain since two days ago and feeling slightly drowsy. He denies any fever or vomiting but admits
to almost throwing up this morning. He also noticed that his urine today was darker than usual.
He is a non-smoker and takes sodium valproate for his epilepsy. His blood pressure is 125/85
mmHg, BMI is 23, and he is apyrexial. What is the single most appropriate investigation to be
carried out?
A. Plasma valproate concentration
B. Urea and electrolytes
C. Renal function test
D. Liver function test
E. Thyroid function test
ANSWER: Liver function test
A 35-year-old woman presents to the clinic with complaints of excessive thirst and frequent
urination. She reports drinking more than 4 litres of water daily and urinating almost every hour.
Her past medical history is notable for a recent diagnosis of depression, for which she is taking
medication. Clinical examination reveals no significant abnormalities. Initial baseline laboratory
tests were ordered to assess her condition, including serum and urine osmolality
measurements.

Investigations:

Serum sodium: 136 mmol/L (135-145)

Glucose (fasting): 4 mmol/L (3.5-5.5)

Urine osmolality: 120 mOsm/kg (50-1200)

Serum osmolality: 278 mOsm/kg (275-295)

Which of the following is the most likely diagnosis?

A. Diabetes mellitus
B. Diabetes insipidus
C. Cushing syndrome
D. Psychogenic polydipsia
E. Hypernatraemia
ANSWER: Psychogenic polydipsia

A 39-year-old man recently back from a three-month trip to North Africa, reports a 3-week
history of dark urine and fever. In recent days, he has felt epigastric pain. Physical examination
reveals a tender, enlarged liver extending 2 cm below the right costal margin, with no spleen
enlargement. His temperature is 39.5°C. Lab results are as follows:

Haemoglobin 101 g/L (130-180)

White cell count 14 x 10⁹/L (4-11)

Eosinophils 0.6 x 10⁹/L (0.04-0.44)

Platelets 70 x 10⁹/L (150-400)

Serum alkaline phosphatase (ALP) 260 U/L (30-150)

Serum alanine transferase (ALT) 102 U/L (5-35)

Serum urea 10 mmol/L (2.0-7)

Serum creatinine 193 µmol/L (70-150)

eGFR 58 mL/min (>90)

What is the single most likely diagnosis?

A. Malaria
B. Typhoid
C. Schistosomiasis
D. Dengue fever
E. Amoebiasis
ANSWER: Schistosomiasis

A 61-year-old man presents to the GP surgery with his wife as his wife is worried about his
recent change in weight over the past 3 months. He has been having a chronic cough for the
past 12 months and was diagnosed with COPD 6 years ago. He has a 25 pack-year smoking
history. His vitals are stable. His full blood count and renal function are within normal limits. A
chest X-ray shows evidence of a diffuse opacity overlying the left hilum. What is the single most
appropriate investigation to yield a diagnosis?
A. Transthoracic echocardiogram
B. CT scan of the chest
C. Lung function test
D. Bronchoscopy
E. Diagnostic pleural aspiration
ANSWER: Bronchoscopy

A 67-year-old man with advanced prostate cancer is on long-term treatment with oral tramadol
hydrochloride for pain. He was admitted to the hospital for treatment by the medical team
because of a 2-week history of productive cough and a high fever. During his admission, he
becomes more unwell and is unable to tolerate oral medication. The medical team would like to
determine the appropriate dose of subcutaneous morphine to administer for pain relief in the
hospital. He would normally take a total of 600 mg of tramadol hydrochloride a day. What is the
most appropriate total dose of background subcutaneous morphine to be administered over 24
hours?
A. 10 mg
B. 15 mg
C. 20 mg
D. 30 mg
E. 120 mg
ANSWER: 30 mg

A 29-year-old woman would like some advice about a concern related to her pregnancy. As the
second born in her family, she developed haemolytic disease of the newborn and hopes to
understand how likely it is to pass the condition on to her child. She is a primigravida in the 18th
week of gestation. Her blood group is O positive, and her husband's blood group is O negative.
Which of the following values describes the likelihood of her newborn developing the same
condition?
A. 0%
B. 25%
C. 50%
D. 75%
E. 100%
ANSWER: 0%

A 68-year-old woman presents to the clinic with a three-month history of progressive discomfort
and itching in the vulval area. She describes the sensation as both irritating and occasionally
burning, which worsens at night. On examination, there is noticeable white, patchy thickening of
the skin around the vulva with areas appearing shiny and atrophic. The woman denies any
recent change in detergents or use of new hygiene products. Which of the following is the most
likely diagnosis?
A. Psoriasis
B. Lichen sclerosus
C. Candidiasis
D. Contact dermatitis
E. Atrophic vaginitis
ANSWER: Lichen sclerosus