1.A 43-year-old man presents with a painless lump in his groin that appeared 2 weeks ago. He claims that the lump protrudes on defecation and he also reports becoming constipated recently. On examination, the lump is reduced and a finger is placed over the midpoint of the inguinal ligament. When the patient is asked to cough, the lump reappears. What is the most likely diagnosis?
ADirect inguinal hernia
BIndirect inguinal hernia
CFemoral hernia
DObturator hernia
ESpigelian hernia
2.Which of the following murmurs is associated with severe aortic regurgitation?
AAustin-Flint
BGraham-Steell
CGibson
DCarey-Coombs
EBarlow
3.A 67-year-old man is brought into A&E having been involved in a road traffic accident. On examination, he opens his eyes to pain, makes a few grunting noises and withdraws his legs from painful stimuli. What is his GCS?
4.A 2-year-old boy is brought to the GP after his father noticed some swelling around his eyes. On examination, there is periorbital and pedal oedema. A urine dipstick is positive for proteins and negative for blood. What is the most likely diagnosis?
AIgA nephropathy
BMembranous glomerulonephritis
CRapidly progressive glomerulonephritis
DMinimal change glomerulonephritis
EHenochâSchönlein purpura
5.A 54-year-old man is brought into A&E with a suspected acute coronary syndrome. An ECG is performed, which reveals ST elevation in leads I, aVL, V5 and V6. Which coronary artery has been occluded?
ALeft main stem
BLeft anterior descending coronary artery
CLeft circumflex coronary artery
DRight coronary artery
EPosterior descending artery
6.A 46-year-old housewife visits her GP complaining of pain in the joints of her hands that has gradually got worse over 3 months. It has started affecting her ability to complete daily tasks such as cooking for her children. Both of her hands are affected equally and the pain and stiffness is worst in the morning but gets better when she starts using her hands. On closer inspection, her hands do not appear to be deformed although her metacarpophalangeal joints and proximal interphalangeal joints appear slightly swollen, warm and tender. What is the most likely diagnosis?
AReactive arthritis
BOsteoarthritis
CRheumatoid arthritis
DPsoriatic arthritis
ESeptic arthritis
7.A 56-year-old man with a history of alcoholism complains of intermittent epigastric pain that radiates through to his back. When questioned, he admits to losing about 3 kg in weight over the past 6 months and says that his stools have become pale and difficult to flush away. Which investigation would you request to aid the diagnosis?
ASerum amylase
BBlood cultures
CFaecal elastase
DCA 19-9
EOGD
8.A 25-year-old female has suffered from shortness of breath over the past 2 months. She gets particularly breathless when she exerts herself, and has had to stop going on her morning jog. She has not experienced a cough, fever or chest pain. She has no past medical history of note, however, her periods have become quite heavy over the past 3 or 4 months. What is the most likely diagnosis?
AHyperthyroidism
BAnaemia
CPneumonia
DCOPD
EAsthma
9.A 46-year-old man, with a history of type-1 diabetes, visits the GP for an HbA1c reading. He has recently been feeling more tired than usual and has noticed that the skin on his hands has become darker over the past few months. On examination, hepatomegaly and a tanned complexion (despite not having been on any recent holidays) are noted. Haemochromatosis is suspected and iron studies are requested. Which set of results would be consistent with haemochromatosis?
AHigh serum iron, high ferritin, high transferrin, low transferrin saturation, low TIBC
BHigh serum iron, low ferritin, low transferrin, high transferrin saturation, low TIBC
CHigh serum iron, high ferritin, high transferrin, high transferrin saturation, low TIBC
DHigh serum iron, high ferritin, low transferrin, high transferrin saturation, high TIBC
EHigh serum iron, high ferritin, low transferrin, high transferrin saturation, low TIBC
10.A 72-year-old woman has recently suffered a fracture of her right distal radius after falling on an outstretched hand. She is at high risk of osteoporosis because she is post-menopausal and has undergone several decades of steroid treatment for her asthma. A DEXA scan is performed. Which result would be diagnostic of osteoporosis?
AT-score of â1.5 or worse
BT-score of â2 or worse
CT-score of â2.5 or worse
DT-score of â3 or worse
ET-score of â3.5 or worse
11.A 52-year-old man was watching TV yesterday when he suddenly become very aware of his heart beating rapidly. This lasted around 45 mins and then subsided spontaneously. It has happened several times over the past 2 months. An ECG reveals no abnormalities. However, due to the strong suspicion of atrial fibrillation, the patient is placed on a 24-hr tape, which confirms the diagnosis. Which scoring system should be used to determine the benefit of long-term anticoagulation in this patient?
AQRISK2 score
BABCD2 score
CGRACE score
DCHA2DS2-VASc score
ECURB-65 score
12.Which of the following is not a feature of background diabetic retinopathy?
AHard exudates
BCotton wool spots
CMicroaneurysms
DBlot haemorrhages
ELeakage of lipids from blood vessels
13.A 53-year-old man, who has recently recovered from a diarrhoeal illness, comes to A&E with a 1-week history of gradually worsening weakness in his legs. A neurological examination reveals reduced tone, reduced reflexes and impaired sensation in both lower limbs. He adds that the weakness began in his feet and has gradually progressed up his legs. GuillainâBarrĂ© syndrome is suspected. Which of the following parameters should be closely monitored in this patient?
ABody temperature
BSerum osmolality
CSerum potassium
DForced vital capacity
EUrine output
14.A 14-year-old school boy was diagnosed with asthma 6 months ago. He was given a salbutamol inhaler to use PRN, however, he continued to have regular episodes of breathlessness. He was started on a regular inhaled corticosteroid (beclomethasone) 3 months ago. Although the frequency of his attacks has reduced with the medication, he is still experiencing bouts of breathlessness about four times per week. What would be the next most appropriate step in his management?
AIncrease the dose of salbutamol
BChange the inhaled corticosteroid
CAdd an oral corticosteroid
DAdd a long-acting beta agonist
EMontelukast therapy
15.Which of the following is the most common cause of chronic kidney disease?
AHypertension
BDiabetes mellitus
CGlomerulonephritis
DPyelonephritis
EPolycystic kidney disease
16.A 46-year-old woman has been suffering from frequent headaches over the past 4 months, along with some blurring of vision. She also mentions ...