(Th Options . Convert from intravenous to oral rou Do not cease medication Gradual withdrawal of medication Immediate cessation of medication Stop for 1 week preoperatively Stop for 4 days preoperatively Stop for 4 days preoperatively, and replace with rapidly reversible equivalent H. Stop for 48 hours preoperatively 16 : Cessation of medication anmoap> ‘The following scenarios all refer to issues conceming the cessation of medication prior to surgery. Select the single most appropriate answer from the list above. The items may be used once, more than once or not at all. = 62 year old man is on warfarin, as part of the medication ofaterial ETS y, Ge fibrillation. He is on the waiting list as for a laparoscopic ge dod cholecystectomy. Ce eg ttl hy 74 year old man is on clopidogrel, as part of the management of ischaemic heart disease. She is on the waiting list for a reversal of * Hartmanns procedure. (ASqweny CLah eS -yet coo IE ED stop) 21 year old man attends A&E with abdominal pain and the passage of », bloody motions up to seven times per day. As part of his management, [) he is started on intravenous hydrocortisone. Following 2 days of conservative management, the patient's symptoms have only marginally improved, and stool cultures and positive for Escherichia Coli. i on weeds BBS BP aayey DP OS 1 boo Sepp owen pons tnee theme: Managemen ‘A Acemprosate G Methadone i Buprenorphine H_ Naloxone © Bupropion 1 Naltrexone Buspirone J Urinalysis for substance Diazepam identification and observation Lofexidine cf witharawal symptoms lostructi cribed below choose the SINGLE most For each of the patients «propriate treatment from the list of options above. Each option may beused once, inore then once ar nat at all 7 - usage 4. A45-year-old man, having been involved in a road traffic [)._sccident, was motivated 1o abstain from alcohol. He has successfully undergone detoxification but is having problems dealing with craving O 5. A24-year-old man has presented to A&E demanding J. methadone 40 mg as he says he is withdrawing from his heroin addiction, He has no previous drug records but claims he takes i 20 mg intravenous heroin a day. oO 37-year-old teacher, with no obvious findings on medical check-up, is requesting help to give up cigarette smoking ‘A 69-year-old woman has been on temazepam 20 mg as ight-time sedation for the past 20 years. Recently, she watched 'V programune reporting that these tableis are addictive, but { a says she would not like to come off them. Oo 8 FF 2 25:year-old heroin addict is undergoing inpatient detoxification, aiming for abstinence. What medication would 1s use to deal with her opioid withdrawal? 4 WE cen pair Shope pation mere DS Mehignctons Apt ue ake RW ctl pe VERY Nate nesions A. Antifibrinolytics (trenexamie acid) D, Endometrial ablation . Gonadotropin-relessing hormone analogues B Hysterectomy G. Hysteroscopic laser/resection of fibroids 4, Intrauterine or systemic progestogens | Myomectomy J. Polypectomy K, Non-steroidel antiinflammatory drugs (mefanamic acid) 1. Uterine artery emboiization ‘oreach ofthe foliowing scenarios, select the most appropriate menagement »ption, Each option may be used once, moze than once or not at al, ayomnaoe NSO ramnegic A 16-year-old gic, who is normally fit and well, attends her GP j i complaining of heavy and painful periods. She i requesting treatment for these complaint. She denies being sexually active. A 43-year-old woman has sufered with heavy periods for many ‘Sears, and has tried many medica treatments withou! success. She is Constantly flooding andat imes cannot eave her house cue to heavy bleeding. She has completed her family of five children and her lat Blood tet showed Raemogobn TET gl, the eek thatshe Cannot cope with the bleeding anymore, and her husband is asking || fora ireaiment that can guarantee success A 29-year-old woman presents to her GP with troublesome heayy | Petiods. The medical treatments that she has tried have made litle Aifference. She s known to have large uterine intramural fibroids. You “onéirm that she is curently tying for more children. . ‘A A2-year-old overweight smoker attends with heavy petiods, A scat aslo | reveals a normal uterus. She would like a long-tenty treatment with sinmal side-effects that would offer treatment for the menos and provide contraception, She is unsure whether she would like ‘more children. She adamant that she doesnot want surgery, 2 sh is tetfied ofthe prospect. we 4A 41-year-old woman, who has completed her family, has sufered 3 fomexiremely heavy periods for many years. No medical treatment | have worked. She admits that she would rather avoid surgery. After 3 discussion, you collectively decide on a procedure that would not, equite open surgery or general anaesthetic.A) Abdominal utrasound 8) Blood cuture ©) Bronchoscopy D) Cerdige enzymes =) xR F) CT scen ® ec Hy FEC Do +) Oesophago-gastro-duodenescopy (OGD) K) Wid scan For ach patient described ‘below, choose the SINGLE next most ohoe mate test from the above list of options. Each option may be used once, more than once, or not at al E 4,08 year old man has had malaise for five deys and fever for two 1) Rays, He has a cough and there is duliness to percussion at the eh lung base, KA $0 year old woman returned by air to the UK from Australia, Three ‘S~ days later she pw sharp chest pain and breathlessness, Hor Cons and ECG ere normal © A tall, thin, young man has sudden Pain in the chest and becomes /S "breathless while cycting. 1.4.48 year old manual worker p/w a two-hour h/o chest pain radiating (F into his left arm. His ECG is normal “Ta 52 year ot obseo man hasbeen having epee anteror chest '2 pain particularly at night, for three. weeleA Reutealcoholichepatiis Comm 8 yma ofthe head ofthe = Giber's C Chareotstiad (escending —G_ Primary biliery irhosis cholangitis) 4 Instructions For each of the patients described below choose the SINGLE most appropriate diagnosis from the list of optians above. Each option sed once, more than once oF not ata 19], | 834year-old wornan with known infaramatony bowel di complains of intermittent jaundice itching, right hypachondriec pein and weight loss. She has a raised alkaline Phosphatase evel [ 2.e: A26-year-old man presented with 4-year history of = ‘ecasiona mld aundice that became worse during ch ibfection, Fle has moderate unconjugated hyperbiirabieemia and iver biopsy is momma. 2E- A st-yearold woman presented with Aweekhistory of At jeundice and weight loss, She has a raised temperate, past Crythems, spider nacvi and hepatomegaly, with mild ascites. ‘The reruls of blood tests show a rised whit cell count and deranged LFTs. 2.2: 1.58-year-old man presents with weight lots, increasing oat pin He tad'an ancrir resection of F Jaane and {pe vearum 4 years ago. He bas hep ‘tain phosphatase vel 2+ i gayenvold man presents wih foe jundie andeiceth — C a 1 (Charu toed pain,Options A. 26-hour C Ante sugary ERE Sen of chest and abdomen 2 antagonists G. History and cin manometry ft9t0n pump inhibitors duce alcoho) M. Upper gastro N. Weight loss For each of the following clinical so @Ppropriate next option may be us intake Sp in management ‘once, more than once he oesophagus cal exeminstion intestinal endoscopy Pot 08 the single mosy fi rom > 48.¥ea0 016 woman Presta With history 0 bending over. Th Near a MPPEr Bestrointestinal endoscopy and abnormalities. Depitesr month tial of PPs, sh and is demanding thay ‘Something be done Sect Ol ballerina has his tisease with demonstra seve Sndoscopy. Although of mPloMs, she has been Unable tof "© gastrointesting) “4 Year old woman ig refered for an opinio Physicians. She has boce oved Sted for recurrent Proved wrewarding. esr the Physician has Wk disease and tsed, which has Pneumonia, which astutely recorded g Accordingly, upper Bastrointes side effects, has Ory Of severe er o°soph agi fect 2 History of signitiane nh the above tse oF not at al With various PPIs due fF options. Rech by one oF the. Respiratory f isphagia,ition is unremarkable. Be > cateei (Theme Tal anes Options A. Apply direct pressure B. Apply tourniquet . Cervical spine immobilisation D. Chest drain insertion E. CT scan of head E. Limb elevation G. Nasotracheal intubation HL. Needle cricathyroidotomy 1. Needle thoracostomy J. Oropharyngeal airway K. Orotracheal intubation io M. N. Pericardiocenthesis Remove foreign body Seal wound on chest ©. Tracheostomy From the list above pick the single most appropriate next step in ‘management forthe following clinical scenarios. Each option may be used once, more than once, oF not at all as 2 yea old manis brought to ARE with severe cio injuries flee j following a road traffic accident. On examination, his hear rate is 92" “wae bpm, blood pressure is 110/70 mmHg and GCS score is 12/15, Air PsN entry is equal bilaterally and his oxygen saturation drops from 92% to 80%. His nostrils and mouth are filled with blood clots and debris that "™ are not cleared with vigorous suction De 48 year old woman is brought to A&E after being involved in a road *\. "1 ° traffic accident. On examination, the trachea is shifted tothe left side and the neck veins are engorged. Her heart rate is 120 bpm and het blood pressure is 90/50mmtig. There is no air entry on the tight side ofthe chest. Tse Pravin cle qiuversbey RIES MCJ), sstursion are 80% on 1SL va amask wis eservoir bag. The neck ‘eins are collapsed. Further examination of his chest eveals dlleees ‘on percussion and absent breath sounds, affecting the hemithoran WasTeernn ) Options ‘A. Abdominal X-ray B. Arterial blood gas enalysis ©. Capillary glucose D.CXR E. Ctscan of abdomen F. CP scan of head G.BCG H. Intravenous administration of naloxone L Rewarming. J. Serum toxicology From the list above pick the single most appropriate next step in ‘muzagement forte following clinical scenarios. Each option may be Used once, more than onee, or not at al Bt 10 Sea old man is brought to A&E after being found collapsed at ea tome, On aval is GCS sore is 7/15 and hei intubated is pupils Fare equal ilateraly and enc neha ie 52bpm and BP is 140/90mmHe. Capillary glucose and blood gases we wtbrn nommalliits. Crcomte GUSH cule Geet a C1 Hen Ten 48 year old woman with type I diabetes melitus is brought to A&E 22 with altered lvel of eonsclousnewe Tes hag} says that she has ‘9, een unwell forthe past couple of days with a ches infection, She has > een vomiting and complaining of abdominal pain forthe past few hours. On examination, her heat rate is 110bpm and her BP is 110/70menfig. She is clinically dehydrated. Capillary glucose is 30mmol and ECG is within nomal limits, Cn wae kw 35 Youare called to review a 78 year old woman onthe orthopedic ward Who has become increasingly drowsy following a total knew ‘placement earlier that day. Her heat rate is 68bpm, her BP is 100/80mmEg and her oxygen saturations are 80%. You not 8 PCA line. You decide to insert oropharyngeal a that sheee Options A. Aortie dissuption B. Cardiac temponsde Diaphragmatic rupture Fail chest Haemothorex Massive haemothorax. Myocardial contusion Oesophageal rupture Open pneumothorax Pulmonary contusion ‘Simple pnuemothorax Tension pneumothorax Tracheobronchial diseuption Traumatic asphyxia ZEPRSrmommOA The following patients have all had thoracic injuries. Please select the :most appropriate diagnosis from the above list. Each options may be used once, more than onee, oF not at al SO pests 34 26 year old soldier is bit by shrapnel, resulting in a large defect tothe, side of hid chest. examination, he is severely éyspnocic, tachycardic and hypotensive. “4 His trachea is displaced to the right. Percussion reveals the left side of the chest to be hyper-resonant, with decreased air entry on auscultation. dense, BS 65 year old lady is brought to the A&E having been involved in a road traffic accident; it was head-on collision in which she was driver. Her signs are initially stable, and examination only reveals bruising over and to the left of the stemum. CXR is normal. A few hours later she develops ireegular tachycardia confirmed by electrocardiogram to be atrial fibrillation. 36) sO yn old ules presents tothe AME departs having ben by falling scaffolding, He did not initially attend the A&E; hee He bas cal irony bilaterally nd norm PSs. Cx veal ene 210 6onthe teh One 9 tee — ope AF iTheme Mood disorders options Fromrspse Atypical depression Bipolar affective disorder Cyelothymia Depression —mitd Depression - moderate Depression - severe Dysthymia Hypomania Mania ‘Masked depression 1 Schizophrenia L Seasonal affective disorder 2M. Somatic syndrome N. “This does not meet the cite forany of the above For each of the following scenarios, select the most appropriate diagnosis Each oh se 4 ho 4 ‘option may be used once, more than once of not atl AA 2Ayearold man asks his GP fora sick note from work. He says ‘hat he fees dow, slethange and has stopped enjaving paying the plceolo (hls main hobiy). He was admited to a psyhiatric hospital last year following sn episode of mania A 19-year-old map has been happier and move postive than usual, ‘with more energy than he has ever felt before fo darreason He He has been geting more work cone a the oFicePoURy and Rar socializing with his fends 38 su, “A 60-year-old woman is admitted to hospital after tohave poor eve contact When asked how she sfeling sheadmitsto. ef uate feeling low im mood, having very litle energy and losing enjoyment “SE “yWes med {atu ln all her usual hobbies. she nas also found it dificult toconcenitateyf Neth an gee feels that she is no good et anything, feels guily over minor Sues" ova tesye ra and feols very negative about the future re aatlaumshons A ssyearola woman who attends the cine ha recent Deen . dlapicsed wits Acepresveegio Shecomplais ofunitentonsly MANE fo Wwuctenss ‘rling aly in oemoming sacetGeret mset anda ose = SA. Geng Sppet ong 8 ig nwt in he at mow, She es ht be ee Mes mprows a he aay season 5 Affine the GP Lactose Spares A 4o.yearold woman presents othe GP with low mood. Of note, she Wel Spr hhas an increased appetite and has gone up two dress sizes. She also complains fast she cannot get out of bed wnt the afternoon as she's uma. syclone sorted oq ae Negget Aegresion Leck of Ai cppeatee “2 ee, ~ bow movelConstipation Endometriosis ibroid degeneration Functional pain Initable bowel syndrome (Ovarian cysts Primary dysmenorthoce Primary menorthagia Renal caleulas| Secondary dysmenorthoea, 1M. Secondary menomhagia rarrmoheon ‘or each of the following scenarios, select the most lkely underlying cause, ‘seh option may be used once, more than once or not at all _. A 3s:year-o8 accountant presents with heavy, palnfol periods and 28 eget tc Se reps ntemensinledngand postal 4S rnnewitocase! etl beeing Sbe hada casrean section ae nal hes afer having cats concn fg. A 2tyearollsewes complains of feeling generlyunwel with 1 cena) yale and pal equa. She and > Sora at TF ying cule for dear witout her came ar feu leding an portal been Fee oe nei inte 62 estan, Dood presi 1s Se gtd near 37° Gop A 33-year-old manager presents with colicky lower abdominal pain, join pain and pain on passing water. She also admits to passing bloodstained urine. Her Observations are pulse 68 beats/min, blood pressure 128/92 mab and temperature 36,8°C. She has never been {in hospital before. | 37-year-old shop asistant complains of very painful periods since a ELE Gergoop cision of tn ransormaion zone) procedure, Te pain generally starts on the day of, or the day before, menstruation, fad lasts for 2 days 4 14 Az-yearcold teacher as been attending the gynaecology clinic fot 7 years complenig of pelvic pain and dspateunia, whlch ha nat © improved despite various medications. She has had two laparoscopic, three hysteroscopies and multiple ultrasound scans, all of whieh yevealed no pathology, She 4s convinced that her partners unfathfal nd she has contracted an infection because of this, but multiple Swabs have revealed no evidence of infection.von (PCR) Blood for polymerase eh 1 (Creactive protein Chest Xzay Cerebrospinal fuid (CSP) for microscopy, culture and sensitivity | SP for PCR Pall hlood count | Limb Xray ‘Urine for microscopy, culture and sensitivity | ~moMM DOE For each of the following children with 2 fever, select the investigation ‘most likely to lead to a diagnosis, Each option may be used once, more =! 2yeaccl gil presents with a day history of fever The ines 49 areed wah & cough Her respatory tte Is 45/min, satartongy | 9485‘ emperatre 369° ana coplany veil tne 1s. Taer> dre creations tthe et base on auscuration, Urine negative on | dipstick | jg A dyearoia gl presents with a fves for 2 days. She drowsy and | Se Fatt asics Hada sere causing wtching of tenuis eghbebedyfordiain. ¢ |” seve ap Her jsprtory rte 50min, stuatons 9399 In iy tempera Eves oh oF 38.3°C and capillary rel me 2s, Urine is negative on dipstick, ay 3 sche & DUR 14 A Smonth-old boy is admitted with persstint ieiabity. He ss Jethargic and isnot feeding as well as usual, is respmiony mate is J | 30min, saturations 9796 in a, temperature 380°C and capillay ell time 2 Urine reveals leucocytes and nitits on dipticle j 43-year-old boy presents with a L-day history of being unvell. He ppeas shocked nd hat 3 Stour rath mace up of uaa q | nd purpural spots. His espiratory rate is 30/min, saturations 9436 in ar, temperature 39.0°C and capillay rfl time s, Urine reveals Teucocytes on dipstick 11- AByeacold gil sadmlte vith afevesfor2 Gays Sheishasstogped (| Sephe lve 26 yalling and cies when changing her dates: Hee espatoy res AY Os aaa Fin sturt ns 99 ea ape SBC ance el : mylar Met Toeathgas time 1s. Urine is clear on dipstick Lepre etic tegens yom af4 Anyi Neural tube abnormei2# fone mastow supp Hi Neuraleptc malig 1 Cheese reaction 1 Neutropenia Discontinuation syndrome 4 Obesity Hypothyroidism K Serotonin syndrome Liver dysfunction Instructions Ferecch ofthe patients 1rchoose the SINGLE m ppropriate side-effect from the ist of options above. Each option may . beused once, mare than once or not at ct 2. A M-year-old woman has been taking lithium forthe past © AYERS. Gen ue Syebnypes Severin, Cyn voe wenasn LSE Ly Sieben ssi + S°3+ A 27-year-old woman has developed symptoms of ieritability restlessness, sweating, increased mmuscle tone and myoclonus leher medications ar being switched, “s- - A29-year-old woman with bipolar afective disorders taking Cen eatacta semi-sodium valproate fr prophylais of her Tlnes, This poses" “ST . if she gets pregnant SS Ariskone should be aware ofin a 62-year-old man on p, 7 amitriptyline. Oo S$ A side-effect of MAO inhibitors tat should be borne in mind. [] C MAREE + Tycamise Compa) S tvses adel Secetoris Sqaawe Honk. Camp qcuedied) ~ R mute Ae ¥ dysnliaceene Diseases af the respivatary system Atylsing spondyits E _Goodpasture's syndrome B Chug-Steusssyndiome —F_ Motor neurone disease 'C. Cryptogenic organising Progressive massive fibrosis preumor (pM) 0. Btinsicallegiclveitis Tropical puimonary eosinophilia Instructions Foreach of the patients described below choose the SINGLE most ‘2° ~opriote answer from the lst of options above. Each option may be set once, mere than once ar not ct af. Seal Cala babe Timers 5} A non-smoker who had worked in coal mine for 20 years brn dl nesingsortas of beth ed exercise tolerance and a dry cough, His chest X-ray shows round Shri mates inthe upper lobes with ental cavitation, Lang fumeton testing demonstatesa mixed restrictive and obstructive ventilatory defect with iteversible iow limitation and reduced gas transfer. ao °8- A 56-year-old man presents with breathlessness, which © predominantly occurs when he is supine. He also has sgmpioms faleep apnoea and daytime headache and sompolesce “Sproncuy shows decreased tidal volume and wal eapacy, (CJ fp. A 35-year-old man hasbeen given diagnosis ofallergicthiniis pales {i gitune:Exarinaton revealed a peripheral neopathy with "Epabiny shy Lingling and numbness ina ‘glove and stocking’ distribution, SENG Stn athe) ‘kin lesions are present in the form of tender subcutaneous TIN sede ge ‘ochles. The patient is responding wello corticosteroids. J x So A 48-year-old firmer presented with fever, malas, cough and sBorines of breath, On examination the patient was ’ chypnocic, wih coazse end inspiratory crackles nnd wheeze throughout his ches. He was janosed. He alo complained of eight los. His chest Xray shows fy shadowing and theresa polymotphonvelesrleucocytosi,—]‘Options A Apexbeat 6 Superfcalinguinal ing B_Chest-aininsertion 1 Termination ofthe spinal cord © Femoralartery puseis(elt | Transpyloric plane D Fundusofthe gabladder 3, Veracavalopening niowhe diaphragm E _ McBumney's point F stellate ganglion Instructions For eachof the locations described below choose the SINGLE most pproprate landmark rote ist of eptins above Fach ePton aya tsed once, more than once or not at al 61. Lilevel C “22 fsdoin betwen th sopaseraal notch and pubic pms [- 43. Tipof the ninth costal catlage C eq ust above the mid-ngsinal point t CE. if intercostal space in the anterior axilary tine C| 68 ~ A 1s-yearotd boy present | $7. vouaeaskedioseea thous bby. es dysmorphi with rod D. 47x¥ (13) B A7X¥ (18) EB 47x¥ 21) G. 69XX¥ HL. Fragile X syndrome For each of the following scenarios, select the most likely karyotype. Each ‘option may be used once, mnore than once oF not at al 66. You are performing the postnatal check on a 3-day-old gidl. She has swollen hands and feet, and you find it dificuls to palpate her femoral Pulses. “Tuynge's Syactane Scarnato arte) 62 . You are asked to see a L-hour-old baby. He is dysmorphic, with a small chin and low-set ears. He also has 2 small head and rocker-bottom feet. ( Etsewd's) is to the general paediatrics clinic, He and ‘his family are concerned as he has not entered puberty yet. He i tall for his age and has small, firm testes. He is a shy boy and has had some behavioural problems at school. (Klin atten a) face. On examination you notice that he is very floppy. (ass | 7* 4 s.year-old boy presents to the outpatient clinic, He has learning difficulties, a large head and large testicles, He has quite a characteristic facial appearance, with a prominent forehead and large ears \g nee Wi- Pate >on BeesDepsunent with two day history 0 a, pain, sot ost appropriate management? A. teimaspration = B. Strintixinab COnl hinds predissone > D. Short courte of methotrexate E Depomederane injection -2= an 28-year-old man is investigated for rcurent lower back pin. dingnosis of enkyosing {pondylts is suspected. Which one ofthe following investigations is most useful? =A ESR B. Xeay of the sacroiliac joints © G BLAB2T esting D, Xmy ofthe thoraci spine CT ofthefumber spine ___ Which one ofthe following antibodies is most pect for limited etancous systemic sclerosis? 6A. Anti lantobodies © BL Rheumatoid factor ©. AstiSel-70 anibodies D, Anti-centomere antibodies" © Anisuclear factorPan ons license, Which ome ofthe el Mania D. Dementia BE. Depresion & PS A 3S.yearold man with «history of schiznphrena is brought to the Fmergeney Department by worted frends due to drowsiness, On examination hes generally gid. A diagnosis of ‘neuroleptic malignant syndrome is suspeced. Each ane ofthe following isa feature of neuroleptic malignant sycome, excep. apeee es AL Renal fitre eae ae Skew Tootime SFR BL Pyrexie C.Blevated creatine kinase © D. Usually occurs aie prolonged teatment > B, Tachyeardia FE s1-yearold female presents with day history af ary cough and shores of ath. This was preceded by fsikesympioms. On examination there is symmetrieal, erythematous ‘sh with target lesions over the wile body. Whit isthe likely organism causing the symproms? De Cngldemne meal bene © A. Pseudomonas BL Staphyfococeus evens ©. Mycoplasma pneumoniae — Co © D. Chiamydia pneumoniae cng ionella prevomophilaTheme: (0 Options A Aosogrem B Chesteain C Cehest D OR Lung function Instructions ants cescrived below choase the SINGLE mast Foreach ofthe pat ‘appropriote management fo may be used nce, more ther the ist of pas above. Fach option 20 not all Ze = A.yenold man el down thesis and bitte ie of is gta ano ig lower bare xq en “ag.- tinyasaltvoy appara wmode Caprese A egies no ee ‘unwell, with breathlessness. ~—s RI-« A 7o-yeurold women with a history of fallin jure her back ood pustains a acre ina lumbar transverse Pee (Bo + 4 51-year-old man involved in high-speed RTA has blstera) hes rains inserted, These have stared raining st 200 mini. 9 a 20-year-old man, planned for ope hoe sessined a chest injury causing a smal apie yl are preumtae : Complications of caes tion Aspiration puewsivsuts Endometzitis Felal head compression Pleurisy Pulmonary embolism Retained products of conception Spontaneous pneumothorax Urinary tract infection Urinary tract injury ‘Uterine rupture progommgos For each of the following scenarios, select the most appropriate diagnosis, | Each option may be used once, more than once or not at al i See ee saturations 9296 in ait, blood pressure 105/84 malig, pulse 120 beats) seen eens ce se ia ad yA ang ese ad enc nc ee ee Ned sates aces oe ree ea res Fava bin) 2 Tate deceleration develops with slow recovery. She has had ont previous ISCS for a breech baby. : 3G. The woman in case 4 becomes acutely short of breath in the recowely | Zawcw SECO bay and is coughing after a general anaesthetic. On auscultation, 7 Fart Prams she has rechiced alr entry at the right lung base and diffuse wheeze. * fdanwta~ Observations include 2 heart rate of 88 beats/min, blood pres 112/76 mmllg, temperature 37.8°C and saturations 9196 i |options ‘A. Developmental dysplasia of the hp D, Ligament strain E, Osgood-Schlatter disease F Osteomyelitis G. Perthes’ disease HL. Septic arthritis | 1. Sllpped upper femoral epiphysis | J. Spontaneous haemarthrosis K Talipes equinovarus | Lo Transient synovitis Gerd taste ts children presenting with a limp, select the most for each of the following ide used once, mote than once or not at likely diagnosis, Each option may all A 14.yearcold boy presents with 2 limp and left knee pain of 24 hous! BR. Guiaton He is systemically well and is afebrile. On examination, he Gppeate overwelght. His lft eg is externally rotated and shorter than the right. tT \t ‘limp, The groin pain jou notice a leg-length fe There is no history | beet) 98- A éyearold boy presents with groin pain and fs eigerbated with exercise, On examination, y discrepancy. He is systemically well and afeball Smedieal problems. (4 G&nteaieyy oo) fee aq A Veyearold boy presents sith hip pain and a timp of acute onset fhe denies pain al fest. He has been wnvrell for the few-days prior to gy vat (rr aE a ee ciover and acoryaal iiness. Helsrekucant |" F you to move the affected leg which bas « decreased range of with a limp. Since waking this his left leg. He has a temperature of | 44 ‘You attempt to examine the | ‘bat this elicits severe pain. | | _ An 18month-old boy. presents To~ "morning, he has not been using 39.5°C and looks systemically unwel range of movement of the affected limb, ‘The left knee is red, hot and swollen. ‘4.16-month-old boy presents with a limp. His mother has noticed that, ? 5 t ~ ' Cache started walang 2 months ago, he has hada limp, although bes not appear to cause him any discomfort. He ts systemically well and is afebrile Frasias enh = Certain bee Arce easy 9 OSS |“Topealpiloeapine + oa prednisolone A © B._ Topica plocarpine + topical steeds C.Topical steroids b. Tope itecapine + inrvenos settee [S E opie! seride + intravenous setazolamide ‘An 84-yearold man presents wi lot of vision in his eft eye since the mering. He is “therwdsessymptomatic und of note bas had no assoeated eye pain or headaches, is past neces! str includes ichaerc heart disease bathe i otherwise well. On examination be thes ao vision in his eft eye. Te le pul responds poorly to light but the consensual ht reaction is normal. Fundoscopy reveal red spot over a pale and opaque retina, What the fost ikely diagnosis? arena A. Vitrous haemortage © Bein! detachment © C._sehaemic opie neuropathy © Dy. Cental inl vein occlusion © B Central retinal artery vectasion fy 2zerett man demands «CTs fh abmenin sn Hts eon eas {cancer despite previous negative investigations. This is an example of «A. Tipoctondil disorder” * © B, Conversion disorder! goes Ce. Minchasen’s syndrome > Git ants sj) + sen de cer sina Wenge Siete FD, Dissociative disorder © E. Somatsation disorder a aw unyehed all Gas thing, bymnsenh= Dr Cea e Chet Ce Sram, Saunier Raw 4 Sb phe awhwice D bySere, HH || . : . ese HAY Redeblane ote ges eeay N stovearol fale poser wih he pesturmed ad reprte ts follows (CSF culture Gram postive beeilit “Whats the most likely eaussive organisa? 6A. Ceyptocoeeus ct 1B. Haemophilus infuencoe 2 Which one ofthe fllosing isthe most ikely responsible organisa? © A. Salmonella © B. Shigella © C Campylobacter), D. cal © B, Bacillus cere A 23-year-old nurse is reviewed in ocupational health followings ncedle stick injury from than known to bea ctrer of hepatitis B. Which one of the following would appear fst ‘ring acute hepatitis infection? mA HRs yp B © B HbeAg FC ati sa HBs lnshepain in pregnancy Fc pyloneghits Be ies comacton® S. emotes D- Gpovioarnioniti & ete symdrome 6, Labout G Gomctse cokes Be Orrcental abrpion 1 Pa igang J, Row ys pais astunetion wiry tac infection i Xj, bere upeate i ow ach of the folowing Sere select the most Likely Aas || cow Seeds ae HN ONES norm i asaya ee rogsmnan haem sau etn gc pn on fling ng He ee sie De examination, F nase a oes Oe © eet ner loa she 3 a anaemia upper yer enzymes a feels sein of 302 aes comets ly ell oan of ais PA ay cael cod ac ed quency ns dome muore generalize’ specially me Fe has fet oceasions eS meeauay, ACTS SSaou 1. sa-year-otd womall pA © reports having had 4 not attend Sromaneous Tupeoe OE ‘membranes of Mig what would RAPP and ead already & agers Helowes ob. resnives 8% the ele hy 18 Nour per ay eat. SE cee oA sa “yy thst a ota OU and Ha tend the Fa oes snow aed A oe peat eu 8 32- oral woranot 03 ale aus eae te alee sng manos eal nse 20 SS pegesns sh ay oon’ pen ay el So garg Gwe iy a gba IP i ae evden ete ey ee ont 28 OB San painin an gen haa Degen i ee | ip avival get meaner go whe ‘blood 7 cond ot a) eke CalTheme 9b: options ‘A. Acquired hypothyroidism D. Congenital hypothyroidism Cushing's disease Cushing's syndrome , Hiyperinsulinaemia secondary to diabetes Lawrence-Moon-Biedl syndrome (Obesity secondary to behavioural disordet Polyeystic ovarian syndrome Prader-Willl syndrome Primary obesity feyelic antidepressant use gener or each of the following patents who are cial Obese #8 OST, atu ach option may be used ance Tore than anes oF mnot at all oq An eal tay cna [As a baby, he was opoy and A Bye fe now has egring dicate, and 8 Se DN aia despite measures By his parents fide food 008 ‘of reach. we Rggearala boy i dinically obese, His body mass index is above 1h AS eae de. He has no other medical problems 57 ‘examination is 2 arkable. His mother says that she has te bhi lose weight. tit B30x fad a renal transplant last year and his being bullied. ‘old boy Is clinically obese and ‘mothers worrled that he is nas put a lot of weight on sd and is becoming [A.17 year-old gin is clinically obese. Si (12. Agee tne last year. She says that she is always tres sore constipated. Py hese. She has not started het periods 11g AMeyeavod gis clini ‘high insulin jet aaa has severe gene. Arnong ber vestigations: Tevel is found. Jaatly Jee ae ~Bieteped Get the shortest in his class. He E_ Seasds gtr | e [Praca itt os Coreg RAS fea ent’ ed everything to help ey Siggshe planste seit e fomily. She currently tales sndiinn welpracie r At yearald female wih ahr of primary gneiss for adie nthe tnoooticrupy. Wha dvs shoud be given regain he provnon one ube dsfoas? © A. Folic acid 400 meg per day once pregnancy has been confirmed c Folic acid 1 mg per day once pregnancy has been confirmed » C. Folic acid 5 mg per day starting now © D. Folicacid 10mg per day staringnow Jf © E, Folic acid 400 meg per day starting now 7S Which one of the following causes of pneumonia is most associated with the development of Stevens-Johnson syndrome? A Legion © B Mycopisme By © C. Coxiella ©. Stpococut cE, Klebsiella 6 78-year-old nursing home resident is reviewed due to the development of an intensely itchy rash, On examination white linear lesions are seen on the wrists and elbows, and red papules are present on the penis. What is the most appropriate management? a © A. Topical permethrin ff} © B._ Referral to GUM elinie © C, Topical betnovate © D.. Topical ketoconazole © E, Topical selenium sulphideith fothargy sa nave, Blo tests Urea 34 mmol Creatinine 430 ume ‘Wha isthe best way to determine if the renal feilure is acute or chronic? © A. 2 rereainine © B. Serum ealeium level © C. Haemoglobin concentration =D. Renalultrasound = © E, Parathyroid hormone level 1/9, Wie one ofthe ftlowing types of glomerlonephits is ssociiod wih fsion of podocytes on eletran microscopy? © A. Membranous glomerlonepbiis © BL IgA nephropathy © C._ Focal segmental glomeralsclersis © D. Mesangocapillary pomerulonephrts Ease ae > E, Minimal change glomerulenepbits U4 wien on oft fllowing my buf inthe prevention of alum eal ones? © A. Pyridoxine © B, Allopurino! © G Lithium ©, Ferrous sulphate > B Wineidedinetics Fy Comper eevee of© A. Boythromyein © B. Ciprofloxacin © C. Metronidazole D. Cefixime F. Doxycycline +7 Adl-year-old woman presents as she has noted an offensive, fishy vaginal discharge. She ~~” describes a grey, watery discharge. What is the most likely diagnosis? © A. Trichomonas vaginalis © B. Candida © C. Chlamyaia D Bacterial vaginosis © E. Physiological discharge 722Z 74-year-old female presents with headache and neck stiffness to the Emergency \_ __ Department. Following a lumbar puncture the patient was started on IV ceftriaxone. CSF calture grows Listeria monocytogenes. What is the most appropriate treatment? © A. AaétVamorielin >, Changeto1V anoxicilin + gentamicin “Py © © AdAIV ciprftoxacin © DL Add co-amoxilav © BContinve IV ceftiaxon as monotherapy123 (24 ‘Which one ofthe following is cast likely to cause massive splenomesely? Myeloibrosis Gaucher's syndrome (Chronic myeloid leukaemia Visceral leishmaniasis ‘A.45-year-old man with a history of aleubol exces is diagnosed as having grade 3 ‘esophageal varices on endoscopy. Othe following options, what i the most appropriate management to provent variceal bleeding? « } a A. 2 « D. Proprancol C Pruserstion -- Wepawste —_ As sesapresra, Isosorbide mononitate Awecsseapit SUM mHLE may Endoscopic sclerotherapy Teipnessin Lansoprazole‘theme: Caagulation disorders A Antighosphoipid anbody — D_Hzemornse syndrome E Haemophile 8 5 ee Pale coagulation G Vitamin K deficiency Excessive fibrinolysis H von Willebrand's disease instructions For cach of the paints described below choose the SINGLE most hike ‘agnasis trom the Ist of options above ach option may be used OF tore than ance or not a Fated eat 127 A6-yar-old adolescent mndereo}G appendicectomy ¥a5 fy ee lend unusually during an after the sep Aout cepaltion ests show a prolonged APTT Bus PTand ‘bleeding time are norm. ire A Deyearld women presented with menorthagiato her GP | prolonged “ctawinent ‘APT L and prolonged bleeding time, ‘bos Km ‘A malnourished | child from Ghana was taken to his GP with 124 reenrrent episodes of epistaxis. ‘Coagulation tests show @ Trolonged PL and APTT, wb ara ‘bleeding time. 4 a aéyearold pregnant woman developed a U7). Vat 128 qsiture revealed Gram-negative rods. She developed a high semperatur, followed by bleeding fom Ber nose and the ‘yenepuncture sites. A coagulation profile shows a dlevated & “RPT, PT and thrombin ne; her D-dimer levels raised 2 theres an associated thrombocytopenia24 AGS yearsd fle with hrown history of ea fille resents fr wana help. 4 She is found to have a blood pressure of 170/100 mmiig, Her current medications are frusemide end aspirin, What is the most appropriate medication to add? 6 « - ‘A. Bendroflumethiazide ‘Spironolactone Bisoprolol Versparsil Bate poe ef [30 A26:yearsld man wth isto ofberdiary hasmorhagi lange is planing o ‘Start a family. What is the mode of inheritance? = ‘A. Axtosomal dominant wth incomplete penetrance B. Autosomel eodominant ©. Autosomal recessive with incomplete penetrance D. Autosomal dominant Py ‘Atosomal recessive Which of the following results establishes a diagnosis of diabetes mellitus? ys A 6 'A. Asymptomatic patont with fasting glucose 7:9 mmol/L on one occasion B. Symptomatic patient with fasting glucose 6 8 mmol/L on two occasions C. Glycosuria +44 D. Asymptomatic patient with random glucose 22.0 mmol/L on one occasion S 1B. Symptomatic patent with random glucose 12.0 mmol/L on one oscasion —((—sear ld gic witha 4 week Hisosy of nasa and ebdominal dear, Kouine 15% ioc teats revesl the following. Hb 1099/81 wac 67*10% Platelets 346 *10°7 Cateum 2.33 mm Tuma asl D vy we CT sau EE rece Mecoute sun Whats the most likely diagnosis? © AL Alooboli iver disease © B. Cholangiocarcinome 7G Pregnancy © D. Gallstones CE. Primary biliary citosis ‘A 34-year-old man from Zimbabwe is admitted with abdominal pun to the Emergency Department. An abdominal xray reveals bladder calcification, What isthe mos likely 433 © A. Schistosoma mansoni © BL Sarcoidosis m © C. Leishmaniasis © D. Tuberculosis © E. Schistosoma haematobium134 132 Diagnosis of sudden hearing oss: options ‘A. Acoustie neuroma F Cochlear vessel thrombosis B Acute otitis media G Ototoxity C Barotsuma HE Petrous temporal fracture D_ Blastinjury I Poststapedectomy sudden sense newral hearing toss Cental ragged perforation of the J Wax obstrction eardrum Instruction Tor each patient descibed below, choose the SINGLE most lke diagnosis fom the above listof options. ach option may be sed once, more than ance, or not atall ¢, ‘445 year old man with acute renal failure who i receiving gentamicin for peritonitis is noticed after 10 days to be hard of hearing 4.40 year old man with poor pers al hygiene presents with a hearing loss following a shower and hair wash |A45 year old man with corneal anesthesia is notioed to have sudden sensor neural hearing Joss on the same side asthe anaesthetic cornea. A petrous temporal bone x-ray shows widening of the internal acoustic meats. [A.21 year old man with bruising to the mastoid process presents to the accident andl emergency department following a fll and complains tht his hearing s ducedA [Aailny To | Mancloctaneous | Radial Common permeal nen Saat fas Wty of FRACTURE sour now fas decreased ensaion one atl peck zI of the deltoid muscle. 4 + ied FRACTURE of la ora evel of lula & ow lat is dvsoon& sncaton eet cing) tos on the lateral side ofhislowleg. had FRACTORI of medal epcondyjle & now come with deceased sensation of io | inger. 1) [yy Pohas come FRACTURE oFhumeras Ccomenwikkwelofwistdrop CC Jug | Old man hada al & FRACTURE or dislocation of hip now has weakness in isOptions ‘A Autoantibodies = zB Glandular fever screening |B | Blood caine TF [iver faneton ests (LFT) [© | Borrelia bargdoderi antibodies ——~(G_| Stool culture D|Fullbloodcout@BC) HT | Varicella zoster antibodies Instcuction For each child described below, choose the SINGLE most appropriate diagnos the above list of options. Each option may be used once more than once, oF 90 [7 TA Give year ofd girl presents with a three day history of fever, cough and runny ‘nose. | This is followed by nor-blanching pinpoint spots on both legs. G1) DB py rete ay ae —_ >| 18 yer old gi presents with four wek history of begin unw with mild fever, joint | Yep pain and a maculopapular rsh on bth ides of her face oe TH tase yar 1 bay presnis with Tver, drowsins,voniting and widepread, non | ys Bancingrashontisarms andes. BS (Me njeccenen) is with a 10 day history of fever swollen cervical lymph| teaagaser Ki . |14é | nodes, macclopapular rash and swollen hands and ee | [0 year old Bay fist presented with fever and sore tvoa, Fs genecal praciioner ig (wed im with short coun of amon, Two days I he develops 2 ee EE Beit bem paws - ia widespread maculopapular rash. & Bevis bympowe “eB vin") ' “Management of childhood eczema Options: A Desensitization injections Hospital admission 1b Eimollient and a short course of1% G Oral antihistamine hydrocortisone (topical) C_ Emollient and 01% HH Oral fucioxacilin betamethasone (topical) D__ Frequent use of emollient L._ Prolonged high dose oral steroid Gluten ce diet M_ Skin sensitivity testing Instruction or each patent descibed below, chow the SINGLE most appropsote management sentegy rom he above ist of option. ack option may be eed onc, ore once ont atal ‘A tourth month ld bote fed baby boy develops is mother has a story of 148 sadhana, and his older sibling had a similar problem. His mother has taken steps to avoid exposure to soap and wool. ‘Arne month old baby gt has had severe flexural eczema for sx months, Het 1.44 mother has followed the general practitioner's (GP's) advice and ‘used emollients: and topical hydrocortisone. Despite this treatment the eczemals worse, C_ ee am eight yer od boy wih angling eczema has a intense of flare up of i 452 eczema, There is erythema, excoriation and exudates in the flexures. The seeping lesions have no responded to pia betamethasone skin sab hs tee ake ‘Arnine month old baby boy has poosy controled zens despite appropriie ic} preston om he Ps mbes to ther en unr fe yer, The babs skin condition has een deter Hei utsng from intense pure and lack of sleep Hismotherisexhasted, GrPractures in children: Options A. Fracture of davicle F Non accidental injury B_ Fractureofmid radius and ulna G_Scaphofd fracture © Fractureotneck of humerus“ H_Subluxation of radial head (palled elbow) 1D. Fractureofshaft ofhumenss I Supracondylar fracture of humerus Greens stick fracture of distal radius Instruction For each patient described below, choose the SINGLE most likely diagnosis from the above list of options. Each option may be used once, more than once, or not atall 152 [Py Ascven day old bby, bor after a dfeult home delivery isnot moving Iieftarm. He cries each time he i picked up. 163 A theee year old girl tripped while holding her mother’s hand she has not used her right arm since, 4 =r An eight year old boy fell rom a tree He is in ssvere pain. The radial 1H © pulses not palpable on the injured arm. a ‘A.16 year old boy fell on his outstretched hand. His forearm was put in a oO plaster a week ago at another hospital and he has got it wet. He has come 2 Ce the accident and emergency department fo have i repsite. th sys Jhis intial x- rays were normal. On repeat x ~ ray, an abnormality is found, 156 A four year old boy fll in the playground. He has been using. his = forearm normally but complains of pain. There is no deformity or selling and there is minimal tenderness on examination. A three month old baby, whose mother says e has bees yng sine he (53 rolled off the bed two days ago is found to have bruises on his legs. @Organisms of dug Options + mone > c H Amox Become sone diprop Chlorphena (Chlorpheniramine) Codeine Dowpram Ephedrine Ipecacuanha Lpratropium bromide Instruction For each patient described below, choose the SINGLE drug which acts by the Noradrenaline (norepinepasi Oxygen Satbutamol Simple linctus Sodium cromoglycate Treophyline “Trimethoprim ‘mechanism from the above list of options. Each option may be used once, more once or not at al. 15 This drug selectively stimulates betar~ adrenoceptors 459 Tis drgantagoizes moscainicrceptors He 160 This drug interferes with bacterial ell wall synthesis. A “/6| This drug increased the activity of the respiratory muscles. (>Options A. Chlamydialimewnoglobin A (ga) -F Joint Xay B_ DNA antibodies G Rheumatoid factor © Full blood count (FBC) Hi Serumuric acid 1D Jointaspiration and microbiology T__ Viral Titers [E_ Joint aspiration fr calcium pyrophosphate ‘ Instruction For each patient described below, choose the SINGLE most appropriate initial diagnostic test from the above list of option. Fach option may be used once, more than ‘once, oF not at all 62. N13 year old gil presents with Pallor nose bleeding and a pinfl swollen ight elbow 163, ‘6 6s (66 andietinee, FRE CEASE Pl, fe Lesctaamin paplesioe “HAtaind ‘A 60 year old woman with » 20 year history of sheumtoid arts presents With a pyrexia of and a ot swollen, painfl sight wrist. ‘N60 year ld man with high alcohol intake presents with swelling pln and heat nthe Nene right knee and swelling of the proximal interphalangeal finger joints. HF ee hey |A30 year old woman presents vith swelling ofthe small ons ofthe hands and waits with morning stiffness. Examination shows synovial swelling. Ge 14.20 year old woman presents with dysuria, conjunctivitis and a swollen, paintal right kee itea's —SypetioueSatna! history of a Options [A ] Acute leukaemia 6] Heredia spheroonods # | : - |B Aplastic anaemia Tron deficiency anaemia _——— see es © [Auioininanchaemoiyie —/T | Methsemoglobinaemia a es D | Beta thalasamia major | Sickle cell disease | [| Beta talssseria minor K | Vitamin Biz deficiency anaemia | GéPD deficiency Instruction For each patient described below, choose the Single most likely diagnosis from the options above. Each option may be used once, more than once, or not at all [7 ~ [ai year old woman has a longstanding haemogitin (1) of between 102] | e/a. Cintal examination is nosmal. Red cells are hypochromic and | microcytc. ron studies ae normal. She is expected to remain well and to| (62) develop no additional problems. i 1 7 oe ca a Wer gi a ing Ha aan] mild jaundice and several painful episodes involving the limbs and the| abdomen, precipitated by respiratory infections. A previously enlarged | spleen is no longer palpable. “J "A 28year old woman has been anacnc nce infancy at which tne jaundice (3 | ws. Orerhe yeas hand has ben noted inert | and the spleen has become enlarged. Her Hb varies between 7-11 g/dl. She is (ae — le | Zio’ | Wa year od woman developed increasing lethargy over 12 months She also noted a sore tongue. After a further year she has stared to notice numbness ane parasthesiae ofr fet nwesigtion evens a Hbof 70 g/dl, [& ‘An 80 year ole man is been angemicfor to years and has received several | blood transfusions. There has been excessive bruising and recurrent chest | ci Intec |= ww Complications of diabetes mellitus (DM) Options: ‘A. Autonomineuropathy HL Nephropathy B Central selina veinthromboss 1 Optic neuritis Coronary heart lisease Peripheral vascular dsese D_ Diabeticketoncdess K _Protiferate retinopathy TE Hyperosmolarnon-ktoticcome 1. Retinal detachment F Hypoglycemia Mi Somatieneuropathy G. Intablebowelsyndrome(IBS) NN Tranientischemic tac (11A) Instruction i) For each patient described below, choose the SINGLE most likely complication of Giabetes mellitus (DM) from the above list of options, Hach option may be used once, more once or not at all. |A-40 year old woman with a 20 year history of type I diabetes melitus (OM) 142 4 presents with a three week history of severe hypoglycemic episodes, There has peen no recent change i he nsutn therapy, diet. oF level of exercise sn 60 year old man with typeI diabetes mefitus (OM) presents with progressive 1g, tenis tt omega ings, He en eed wi eae FC oral hypoglycemic drugs for ve years, but has recently been found to have hypertension for which a thiazide diuretic hasbeen prescribed. ~ targus TS hase pgp year old inan with 0 20 year history of type diabetes mellitus (DM) is (py, relered to the gastroenterology clinic because he has recently developed cas - $9 year old woman with a 20 year history of typeI diabetes melizus (OM) jresunts Because she has a number of recent episodes of loss of consciousness 17S. These have mainly occutted whilst waiting forthe bus home. She has checked ther blood glucose and excluded hypoglycemia, (vasovngal trace) 1h Bb year old man with a 12 year history of fype 1 Diabetes mellitus (DM) has Sudan toll visual loss in his right eye. He has not attended a generat 1-ZE practitioner (GP) regularly, but appeais well and has not had previous symptomsa L ° & Lisrepr Tiretsphen case Imipramine otowes by pope epine ‘Soaum Wtepatsse Methyope yeaa Hycrcnonte sors (Birtoceee ccuati cawigtnic) * Propaol flowed by seranypenzamine etx lax ivoncarise Prerouberzpine owed hi soparcl lecaimde, Fer of tho paterts described belom choos he SINGLE mast vst medication fern ete phon above, Each ‘pon maybe sed ence, more nah oc he i ie (4 1% Jal 182, Atal 65 yea ot mn presen wth difcuty sng mciraton associated wth poor soar, He fas no sir of weit oss ere dones any sur, One examinations Hos preset of faasammnig kee Ff ‘A 3 year olf kngwn abet wth chvoric eral fale Ie exarinod ang ove a Blood pressure ot ‘ecrbemnty ‘870 yea old woman compas ofa chron tenporal neadach associated wih Muring of von, She "apots history of seeing mps ofa stun ghee eepealy of ght Hes Sood pecenso ana ce "60m "py SSsyee concen anc corse ol pnd poe ty Sn A) 0 "scing reveals spades o arson wen came and post varous tes, aang ony Bo oes, conte £4.28 Yat ot wavide 3 pars 141s ound eho 2 lod pres Stn mb teks gestion conver tt wren ‘A year lf man has been Usted for parc mocks by hs GP forever 6 moths wout much ‘improvement He comsians of excessive owes, fusing tnd dasthen On easton Nee tens have a ood presse of tear TOnnig nthe patents cnc ths alow dey Kee ed a Sateen at nen atiPrevention of falls. Options. A. Advice about posture F Personal alarm B Exercise therapy G Prescribe bisphosphonate © yosight testing 1H Review antihypertensive, Mecication D Modification tothehome «(Review diabetic medication. E Neckcollar J Review psychotropic. Medication Sieeping Tablets) Instruction. For each patient described below, choose the SINGLE most appropriate intervention from the above lis of options. Fach option may be used once, more than once, or not atl 183 (84 |A.75 year old widow lives alone. She has been found lying on the floor several times lately and is brought to the Accident and Emergency Department. She is known to take aspirin (75 mg daily), Dendroflumethiaziade (25 mg daly), Paracetamol (2-4 tables daily) and nitrazepam (S mg at might). ‘An 82 year old woman is brought to the accident and Emergency Department after a fall at home, Electrocardiogram. (EGG) and physical examination are normal. She takes spironolactone for mild oedema, Gibenclamide (0 mg daily) for type 2 diabetes and uses ibuprofen get fora painful shoulder. ‘An Bt year old women collapses when trying to put curtains in her ‘bedroom. She ie physical well and ialco no medication apart from multivitamins, She reports several episodes of dizziness in similar 1g Meme AL yetemnbes iv ws) * Ye— | 136 (3% 123 (39° Investigation of sudden visual Toss : options ‘A. Dopplerassessmentofcaroid Hi Magnetic resonance imaging (MRD of axe opticnerves 1b Eehoossdiogam 1 ngrsieresonance imaging of pasta lobes ectoencepalopram EG) Magnetic resonance maging (MR of pitlary ' b feythocytesedimenatonsate Magnetic resonance aging (MRD of \ (ESR) ‘temporal lobes: | 1 totopebrainsean L_ ofbitlgoniometiy \ Lumber puncte ME Visual evoked responses | Magnetic resorance mae | (94 of expt lobes instetion vor ach patent deebed tlow, chose te SINGS appropriate pe cee sere cr used once snore than ones or nok tal sro yo tan pet with cet aac of ho NG tos of vision in one eye only. AY see i man pret wi oud vena SA seldgpee—beprnl —r——_. ee ace ey -paternl resp yard an pest wih sncing nea as OS and be teperal eeianoi verb year ld woman sets wit ude los of on BS ight ye, ets om teva and examination ves Woes SNS scalp on both sides.6 Renal failure Interpretation of test results : Options A. Acute glomerulonephrits © Gout B Acute tubular necrosis 1H Hyperparathyroidism © Analgesicnephropathy 1 Multiple myeloma D_ Civonicpyelonephitis J Obstructive uropathy 1 Diaheticnephrapathy K Renal tubularadidosis Familial polyeystickidney Instruction Foreach described belovs, choose the SINGLE most appropriate likely diagnosis e from the sbove list above. Each option may be used once, more than once ot notatall (40 gn-48 yor old man with ting lena, hypertension periph! seuopthy and retinopathy has a wrinary protein ofS g/ 24 hours lai |A.72 year old man with a longstanding history of dficlly passing urine presents with an 18 hour history of ana He hasan enlarged bladder with a plhsma ure of 6 mol. 192.65 year old man presents with dyspnoea and low back pain. He has 2 Le hemoglobin (8) of 8 g/dl. ~ serum calcium 82 mmolll erythrocyte sedimentation rate (ESR) 109 mou and creatinine 5261 e(a4 0 Diagnosis of anxiety : Options A Acute stress disorder G_ Phaeochromocytoma B_ Agoraphobia H__ Post traumatic stress disorder (PTSD) C Alcohol withdrawal 1 Psychotic disorder D_ Generalized anxiety disorder J. Social phobia E Obsessive compulsive disorder. _K Substance misuse (OCD) F Panic disorder L_ Thyrotoxicosis Instruction For each patient described below, choose the SINGLE most diagnosis from the above the list above. Each option may be used once, more than once, or not at all 193 A30 year old woman has experienced restlessness, muscle tension and sleep disturbance on most days over the last six months. She worries excessively {1D about a number of everyday events and activities and is unable to control these feelings, impairing her ability to hold down her job. A.26 year old political refuge has sought asylum in the UK and complains of poor concentration. He keeps getting thoughts of his family whom he saw killed in a political coup. He is unable to sleep and feels hopeless about his survival. Because of this he is afraid to go out. 195. E420 yor old mani becoming concemed about the safety of his family. He (% has been checking the locks of the door every hour during the night. He becomes very anxious if his wife tries to stop him. A 48 year old woman, always socially withdrawn, has stopped going out of the house since the sudden death of her husband. She complains of ‘palpitations. Breathlessness and restlessness as soon as she steps out of the house, She has to rush back and allay her anxiety with a drinka2 (48 a9 ‘Theme Obs & Gynae Treatnent 2) Calcium supplement b)HRT ¢) Vaginal hbricant 4) Vaginal estrogen ) A60 yrold female who attined menopause 2 yrs ago. Family history of osteoporosis present, She is worried and has come for counseling. A 32yr old pt with family history of osteoporosis and she has Inctose intolerance. A pt who hus postmenopausal dyspareunia, urine culture is negative, py She is not willing to take systemic hormones.| with cuwer ¥, During the sau pesiod 1250 cases of cancer Y are registered | bby death certification, The one year survival rate is zero percent, 55 [A town hes a population of 804,000. Ina five year period 100 people present ‘What isthe annual prevalence of éancer ¥ per million in this population? 20