Cardio

1. Bx
2. D
3. B
4. E
5. C
6. E
7. Bx
8. C
9. D
10. Dx
11. Cx
12. A
13. D
14. C
15. B
16. B
17. Ax
18. B
19. Bx
20. C
21. E/B x
22. A
23. D
24. C
25. E
26. D
27. A
28. D
29. Dx
30. C
31. C
32. C
33. A
34. Dx
35. A
36. E
37. Cx
38. C
39. E
40. Bx

72.5 %
GI
1. E
2. C
3. A
4. Ax
5. D/C
6. A
7. B
8. A
9. C
10. A/E x
11. B
12. A
13. A
14. Ex
15. A
16. C
17. Dx
18. E
19. B
20. D
21. C
22. D
23. E
24. A/D
25. C
26. C
27. EC X
28. D
29. Ax
30. C
31. A
32. B/C x
33. A/D x
34. E
35. Ax
36. D/B x
37. A
38. D/B
39. Ax
40. B

72.5%

Resp: 67.5%
Renal

1. C
2. Bx
3. A/E
4. Dx
5. Dx
6. A
7. Ax
8. C x – Pregnant UTI: 1st line nitrofurantoin (avoid near-term). 2 nd line: penicillin:
amoxicillin or cefalexin
9. Cx
10. Dx
11. E/Cx – acute renal failure: ureamia symptoms: nausea and vomiting, hyperventilation
due to accumulated H=. Odeama, easy bruising
12. B (PKD?). PKD is associated with mitral valve prolapse: mid-systolic click.
13. D Diabetic patient with now-onset proteinuria: control BP
14. C Renal cell cancer: haematuria, flank pain, mass + systemic cancer symptoms
15. A/D Medullary sponge kidney: congenital disorder. Causing formation of cystic sacs in
medulla of kidney. Caus sub-optimal urine flow -> predispose to recurrent UTI,
haematuria and renal calculi. Present rarely before 30
16. E. Chronic ibuprofen/NSAID use can cause a nephropathy. Presentation can include
anaemia, urinary tract infections and haematuria.
17. C/D
18. B Most bacteria convert nitrates to nitrites which, alongside leukocytes, are detected on
urine dipstick. Severe infections can result in sepsis, hypovolaemia and collapse.
19. E
20. E
21. A Alport’s syndrome: genetic condition causing defect in collagen synthesis. Nephritis,
sensorineural deafness, and occular problem: cataract or retinitis pigmentosa. Renal
abnormalities are progressive in such patients and include proteinuria, haematuria and
eventually renal failure
22. B
23. B
24. E. Wegener’s granulomatosis (E) is part of the small vasculitides that also includes other
diseases such as Churg–Strauss syndrome. Wegener’s typically affects the lungs and
kidneys although other body systems can be involved. The pathology of Wegener’s is
automimmune in nature. Antineutrophil cytoplasmic antibodies (ANCAs) attack small to
medium-sized blood vessels resulting in necrotizing granulomatous inflammation. There
is a broad spectrum of symptoms but specific to the renal system patients can be
asymptomatic to presenting with renal failure on presentation. Patients
characteristically have a crescentic necrotizing glomerulonephritis with the presence of
RBC casts.
25. B/D x
26. C
27. B
28. E
 29. C. x sevelamer – phosphate binder used in secondary hyperparathyroidism
30. E

75%

Endocrine

1. C
2. D
3. B/A x The patient appears to be suffering from cushingoid symptoms. After a history to
exclude causes such as high-dose steroid intake, the main differential diagnoses include an
adrenal tumour, an ectopic tumour producing ACTH (Cushing’s syndrome) or a pituitary
tumour (Cushing’s disease). Although a 24-hour urinary free cortisol level measurement (E)
does not confirm the exact diagnosis, it does indicate if there is a pathological excess of
cortisol (levels can vary up to 700 nmol/L in the morning to 280 nmol/L at midnight).
4. C
5. D
6. A x
7. A This patient is likely to be suffering from psychogenic polydipsia. The water deprivation
test (E) is the most appropriate investigation to confirm this diagnosis. In a normal patient,
the serum osmolality remains within the normal range (275–295 mOsm/kg), while the urine
osmolality rises to >600 mOsm/kg as water is reabsorbed. In diabetes insipidus, the serum
osmolality is elevated with no compensatory concentration of urine osmolality. If the patient
responds to desmopressin, this confirms cranial DI rather than nephrogenic DI, hence a
water deprivation test is the most appropriate answer
8. E
9. E
10. B This patient exhibits many of the signs present in hypocalcaemia (B) including tingling in
the fingers and toes and carpopedal spasm. In the latter, occlusion of the brachial artery,
which occurs when measuring blood pressure, causes muscle spasming of the hand and
forearm (Trosseau’s sign). Other signs include facial muscle twitching when the facial nerve
is tapped on the same side (Chvostek’s sign), prolonged QT interval, hyperreflexia and
stridor. Hypocalcaemia most commonly arises due to renal failure.
11. A x
12. D
13. C
14. E A more insidious disease progress towards insulin deficiency occurs in latent autoimmune
diabetes of adults (E) whereby patient’s begin to show symptoms and signs such as weight
loss, hyperglycaemia and ketonuria in adulthood. Despite diet and medication, these
symptoms tend to persist and islet cell antibodies are strongly predictive of disease.
15. A/E
16. D
17. B
18. C/E
19. E x McCune–Albright syndrome (B) is a genetic disorder that causes the uncontrolled
secretion of a number of endocrine glands causing abnormalities of the skin, bones and
hormonal disturbances. It is usually suspected when the following pathologies occur:
precocious puberty, cushingoid features, hyperpituitarism (acromegaly, gigantism), café-au-
lait spots and hypophasphataemia.
20. E
21. B
22. C
23. A. In diabetic ketoacidosis (A), the body enters a catabolic state as it perceives a lack of
energy stores. Ketones are produced from the breakdown of fat which causes an acidotic
state in the body. Patients commonly present with nausea, vomiting, dehydration and
abdominal pain. The acidosis is partially compensated by hyperventilation (Kussmaul
respiration) and the sweet breath is acetone as the body tries to equilibrate the serum pH.
24. C. Nelson syndrome (C) occurs in patients who undergo bilateral adrenalectomies, the loss of
negative feedback over time causes a macroadenoma to form in the pituitary which secretes
adrenocorticotropin (ACTH). A
25. C x In this case, the most likely answer is a hypoglycaemic coma (D). The history indicates
that the patient has been missing meals but adheres to her insulin regime. The raised insulin
level and absent C-peptide indicates no endogenous insulin production (which would
produce insulin and C-peptide) but exogenous insulin. The patient has therefore not eaten
sufficiently to maintain an adequate glucose level despite taking a recommended dose of
insulin. This differs from an insulin overdose (C) where an excess level of insulin is injected
causing an abnormally low glucose level.
26. D
27. Ax
28. B before but now C (IGF-1)
29. A
30. Ax
31. D
32. E. Pituitary apoplexy (E) is characterized by a sudden headache, vomiting, visual
disturbances and hormonal dysfunction. The cause is most commonly due to the abrupt
growth of a pituitary adenoma or pituitary infarction. The headache in apoplexy is usually
very abrupt and can be mistaken for a subarachnoid haemorrhage, although usually not as
severe. The presentation can be unilateral or generalized. Visual defects are most commonly
of the superior quadrant bitemporally. Visual disturbances, such as loss of vision and
opthalmoplegia affecting cranial nerves III, IV and VI, help differentiate apoplexy from other
intracranial pathology. Hypopituitarism can also follow an apoplexy although this is
dependent on degree of damage and often patients present feeling very tired or nauseous.
33. Bx
34. E A normal anion gap is 8-14 mmol/L

It is useful to consider in patients with a metabolic acidosis:

Causes of a normal anion gap or Causes of a raised anion gap metabolic

hyperchloraemic metabolic acidosis acidosis

 gastrointestinal bicarbonate  lactate: shock, hypoxia

loss: diarrhoea,  ketones: diabetic ketoacidosis,
ureterosigmoidostomy, fistula alcohol
 renal tubular acidosis  urate: renal failure
 drugs: e.g. acetazolamide  acid poisoning: salicylates,
  ammonium chloride injection methanol
 Addison's disease  5-oxoproline: chronic paracetamol
use

35. A

80%

Rheum

1. A
2. C/B
3. A (arthritis) Most patients will be offered NSAIDs (A) first by their GP, or over the counter,
but if these fail, referral to hospital rheumatology is required. If NSAIDs do not resolve
symptoms, therapy would be escalated to include methotrexate and one other disease-
modifying anti-rheumatic drug (DMARD), such as sulfasalazine plus a steroid
4. A/ D? Early in RA, distal interphalangeal joint is spared
5. E Approximately 5 per cent of patients with psoriasis develop arthritis. The pattern of
arthritis is variable but most commonly affects the distal interphalangeal joints and is
asymmetrical. Nail or skin changes of psoriasis are usually present, but may develop after
the arthritis. It is also important to note that psoriatic arthritis may present as a symmetrical
polyarthritis, resembling rheumatoid arthritis.
6. B
7. A
8. C
9. C
10. E Treatment of reactive arthritis is with NSAIDs and local steroid injection for symptomatic
control
11. B. Treatment of pseudo-gout is with aspiration of the joint and NSAIDs. Intra-articular
steroid injection can be used if pain is not controlled.
12. A
13. A Other features include enthesitis (such as the Archilles tendon enthesitis in this case),
costochondritis, peripheral joint involvement (usually asymmetrical and involving the large
joints), aortic regurgitation, apical pulmonary fibrosis and amyloidosis. The ESR and CRP are
usually raised. Initial x-rays may be unremarkable. However, later in the disease,
syndesmophytes (bony spurs due to inflammatory enthesitis) may be seen between
vertebrae resulting in the characteristic bamboo spine appearance. Ankylosing spondylosis is
managed with exercises, not bed rest. NSAIDs are given, unless there are contraindications,
for the management of pain.

14. C. The history and examination should raise the suspicion of cauda equina syndrome. This is
a medical emergency and permanent neurological deficit may occur without urgent
intervention. The shooting pain down the left leg, absence of ankle jerk reflex and urinary
retention suggest that the L5/ S1 disk has prolapsed into the cauda equina and nerve root.
 15. E/A
16. C
17. E
18. A
19. B Polymyositis (B) occurs due to inflammation of striated muscle, resulting in proximal
muscle weakness. It affects women more than men. The onset usually occurs over a period
of months and may include systemic features such as lethargy and weight loss. The proximal
muscles of the shoulder and pelvis girdle become weak and wasted.
Dematomyositis: ‘dermatomyositis’ (A). These include a heliotrope (lilac) rash over the
eyelids, scaly red papules over the knuckles, elbows or knees (Gottron’s papules), a macular
rash over the back and shoulders (shawl sign) or painful cracking over the tips of the fingers
(mechanic’s hands).
20. A SLE: afroacrribean woman in 30-40. Caused by vasculitis, pholoarthralgia, photosenstivie
rahes, pleural effusion, mouth ulcer, renal problems raynauds Raised ESR normal CRP
21. C
22. D. Pulmonary fibrosis is RA: extra-articular manifestation o methotraxate
23. D
24. B
25. A
26. Ex
27. C
28. Ex
29. X Felty’s syndrome (A) is splenomegaly and neutropenia in a patient with rheumatoid
arthritis.
Still’s disease (C) is systemic juvenile idiopathic arthritis and is characterized by swinging
pyrexia, rash and arthritis
30. A
31. B The most appropriate treatment of acute episodes is with a strong NSAID (B) such as
indomethacin. If NSAIDs are contraindicated, for example in peptic ulcer disease, colchicine
can be used. For patients with recurrent attacks of gout, such as this case, serum urate
should be reduced with conservative measures and long-term allopurinol
32. E bercet triad: The classic triad of symptoms are oral ulcers, genital ulcers and anterior
uveitis. Also has arthritis. skin pathergy test is when a needle prick leads to papule formation
within 48 hours and is specific to Behçet’s disease. Can get erythema nodosum
33. A
34. E Paget’s disease (E) is a disorder of bone remodelling, in which the constant resorption and
formation of bone can lead to deformity. Sites that are typically affected include the skull,
spine, pelvis, femur and tibia. Typical deformities include skull changes and bowed tibia.
Remodeling of bone causes nerve compression => CN8 causing neurosensory deafness
35. A

Haematology

1. E
2. D
3. A
4. B
5. A
6. B. Macrocytosis anemia: b12 def, folate def, hypothyroidism, liver disease.
 B12 Def: weakness, glossitis paraesthesia.
7. C
Anaemia of chronic disease: Low serum iron, high ferritin, low TIBC. Ferritin storage are high
because pathogens don’t like iron rich environment.
8. A
9. D/A

 DIC: low platelets

 prolonged APTT, prothrombin and bleeding time
 fibrin degradation products are often raised

10. C. Beta thalassemia: microcytic anaemia with increased haemoglobin A2

11. B. Ferritin is only accurate if there is normal CRP because they are acute phase reactants/
12. D. Tear drop cells are also called dacrocyte for myelofibrosis.
13. B x. TRALI occurs within six hour of transfusion. Look out for 02 oxygen, rigor before and
dyspnoea
14. C x Pernicious anaemia (E) is an autoimmune disease whereby antibodies bind intrinsic
factor produced by the parietal cells in the gastric fundus. Intrinsic factor is essential in the
absorption of vitamin B12 via the ileum
15. E
16. D/c A thrombotic thrombocytopenic purpura (E) is the pentad of fever, thrombocytopenia,
microangiopathic haemolytic anaemia, renal failure and neurological symptoms.
17. A
18. C x Auer rod: acute myeloid leukemia. T(15:17) translocation
Phaladelphia chromosome (9:22( chronic myeloid leukemia
19. D x EBV triad: sore throat, lymphadenopathy, pyrexia. Diagnose with monospot test
20. E
21. B
22. B/E x Sodium mebisulphite smear: test for sickle cell. Coombs: investigate cause of
haemolytic anemia. Schilling test investigates b12 deficiency
23. B
24. D x Polycythemia rubra vera: low EOP but high red cell mass
25. E
26. D
27. C Aplastic anemia: bone marrow failure causing pancytopenia and hypocellular bone
marrow. Patients usually present with features of missing cell lineages, such as symptoms of
anaemia, infections and bleeding from thrombocytopenia.
28. D
29. B Chronic myeloid leuk: first line imatinib
30. B X patients with AF => INR target between 2.0 and 3.0
31. BX
32. A The reticulocyte test (A) would show reduced counts in aplastic anaemia while it is raised
in hypersplenism.
33. C X Perinicious anaemia: autoimmune disease. Anti-intrinsic factor antibody binds to intrinsic
factor produced by parietal cell in fundus.
 34. C In order to diagnose an acute leukaemia, defined as ≥20 per cent of bone marrow cells
being blasts, an examination of a bone marrow aspirate under microscopy (C) is necessary
35. A. XMyeloma cell: light chain deposition called bence jones protein

77%

Neuro

1. D
2. B
3. E
4. C x Roughly 80 per cent of strokes are infarcts, 20 per cent haemorrhagic and in this case
there is a plausible embolic explanation coupled with only mild hypertension. Haemorrhagic
strokes tend to occur in younger patients with severe hypertension and a family history
(pointing to an anatomical anomaly). However, they cannot be differentiated clinically and a
CT is required to confirm the stroke subtype.
5. D
6. A/B
7. A x MS features of a better prognosis include onset under 25 years (A), optic neuritis or
sensory, rather than cerebellar symptoms on initial presentation (B), a long interval (>1 year)
between relapses (D) and few lesions on MRI (E). Full recovery from relapses is also a
positive feature. Progressive MS carries a poorer prognosis compared to relapsing–remitting
MS.
8. Ax
9. E
10. C painless, unilateral visual loss of short duration described as ‘a black curtain descending’,
caused by retinal artery emboli, with a likely cardiac source as a consequence of atrial
fibrillation.
11. Ax
12. Dx
13. C
14. B
15. D
16. E
17. E
18. B
Phenytoin: Overdose: nystagmus, diplopia, dizziness, ataxia, confusion
19. D
20. D
21. Ex
22. C
23. C
24. C
25. D
26. E
27. A
28. D Intronuclear opthamoplegia is a problem in the communication between CN VI (abducens)
of the right eye and CN III (occulomotor) of the left eye
29. C
30. B
31. A x Causes of absent ankle jerks and upgoing plantars is a common question as it implies
both upper and lower motor neuron involvement
32. A
33. B
34. D/A x
35. A.
Neurofibramatosis 1: café au lait spot, axillary fkreckles and neurofibrosma, harmatoma on
iris (lisch nodules)

Neurofibromatosis 2: bilateral acoustic neuromas

Tuberous sclerosis: ash leaf spots, shagreen patches ( patch with orange peel texture in
lumbar region

36. D/E. Subarachnoid hem: Blood along the sulci and fissures on CT
37. E
38. Ax
39. A
40. B x Romberg test: test proprioception problem.

77%

Oncology
1. B x
2. B
3. D/B x
4. E x hypercalcemia OF MALIGNANCY: IV rehydration and bisphosphonate
(pamidronate)
5. A normal hypercalcemia: IV saline rehydration
6. D Adjuvant therapy: given after surgical resection to reduce reuccurance. Neo-
adjuvant: before resection to reduce size
7. E
8. B x testes cancer: 95% germ cell: seminoma and non-seminoma. Low gradeL treat
with orchidectomy plus radiotherapy. High grade (spread to lymph node)
orchidectomy and BEP – bleomycin, etoposide, cisplastin)
9. C. Esophageal cancer: lower third – adenocarcinoma with RF of reflux. Squamous cell
carcinoma – upper two thirds. RF smoking and alcohol
10. A
11. B x Lung Ca; Small cell: very aggressive – disseminated at presentation. Chemo
sensitive. Even with traeetmemnt, median survival is one year
12. D
13. A
14. B/C x Step 1 – Non-opioid analgesia, e.g. paracetamol, NSAIDs
Step 2 – Weak opioid analgesia, e.g. codeine, tramadol
 Step 3 – Strong opioids, e.g. morphine, diamorphine, fentanyl

15. A
Opioid pain control: Starting opioid naïve patient: 5-10mg of oral solution every 4 hours.
Breakthrough pain: give an equal dose (5-10mg) PRN
When 24hr dose is established, split regular dose into 2 modified release dose every 12
hours. 1/6 of regular dose became rescue med
16. B
17. D
18. C Skin extravasation: when drug goes into another compartment and not vein. Can
result in mild skin reaction to necrosis. Offending drug should be stopped, arms
elevated and affected area marked
19. D. SIADH excess reabsorption of water results in a low serum osmolality (<260
mosmol/kg) but a high urinary osmolality (>500 mosmol/kg). Symptoms of SIADH
vary and include confusion, nausea and irritability. When the serum sodium
concentration drops below 115 mmol/L, the patient is at risk of seizures and comas
20. E treat SIADH with fluid restriction (1L/day) or demeclocycline (vasopressin inhibitor)
Desmopressin is for cranial DI.
21. B
22. A Tumour lysis syndrome: high urea, potassium and phosphate and low calcium.
HUS: haemolytic anemia, thrombocytopenia and renall failure
23. A
24. C. Superioir vena cava obstruction cause y tumour. Pemberton’s sign positive: raised
arm cause increase facial plethora, distended neck vain and increased JVP and
dyspnoea
25. C. Carcinoid tumour: produced by APUD cell. Usually asymptomatic but cause
appendicitis, intussusception and obstruction.
Carcinoid syndrome: tumour of liver ets: facial flushing, abdopain, and diarrhoe and
pulmonary stenosis. Diagnosis, radiological imaging of liver mets and 5 HIAA.
80%

Derm
1. A x Skin apendages house: hair follicles, glands (sebaceous and sweat glands)
2. C x Epi
3. B x Psoriasis mgx
1. Topical steroids and vit d analogue
2. Topical tar
3. Dithranol
4. Resistant psoriasis: topical retinoid, phototherapy or oral drugs: methotrexate,
cyclosporin
4. B
5. D
6. C
7. E
8. C x warfarin causes alopecia
9. D
10. B. Contact dermatitis is type 4 hypersensitivity reaction. Contact dermatitis is a type IV
delayed type hypersensitivity reaction (D) which is antibody-independent
 11. A x dermatitis herpetiformis: itchy blistering lesion seen with coeliac patient. Treat with
Dapsone ( sulphonamid abx). Avoid gluten food
12. A x
13. A x neurofibromatosis is autosomal dominant
14. B/E x
15. A x pyoderma gangrenosum: boilds rapidly expand, burst and leave ulcerated area with
purple, undertemined border. Sign of UC, chron’s
16. B/D x Pyoderma gangrenosum is IV steroid therapy
17. A x
18. C. Lupus pernio: sarcoidosis
19. C/E Bowen’s disease: skin CARCINOMA in situ.
20. B Tuberous sclerosis is an autosomal dominant condition characterized by a triad of
cutaneous abnormalities, mental retardation and seizures. Ash leaf hypopigmentation,
shagreen patches
21. E. NIANCIN IS B3 : PELLAGRA: DERMATITIS, DIARRHOEA, DEMENTIA
22. B
23. C/D
24. A x Lupus vulgaris: tuberculosis of cutaneous tissue. Give’ aplle jelly’ appreance on
diascopy. Treat with RIPE
25. A x SSC: appear in sun damaged skin, expanding nodules with everted edges
26. E x superficial spreading melanoma is most common form of malignant melanoma
27. E
28. C x Cutaneous lympho resembles psoriasis in initial stages
29. A
30. D/A x peutz jeghers syndrome: autosomal dominant condition: hamartomatous polyps
in GI tract. 50% die from GI cancer. Give pigmented lesion on lips and oral mucosa
31. B/C. Tinea capitis: topical terbinafine or imidazoles. If multiple sites: oral terbinafine
32. A x Molluscum contagniosum: pox virus
33. A x Acne: Mild: topical retinoids or benzoyl peroxide
Moderarte: combine retinoid or benzoyl peroxide together. topical antibiotic or oral
(erythromycin or tetracycline)
34. C
35. A Drug induced lupus: anti-histone antibody: drugs: hydralazine, methydopa, pencilline,
COCP, trimethoprim
36. D. Nodule: raised lump >0.5 cm. Plaque: raised flat top lesion >2cm in diameter
Papule raised lump <0/5 cm
37. D x Erythema multiform: idiopathic 50%, infection: herpes, strep (rheumatic fever),
sarcoid, penicillin
38. E x erythema nodosum causes:diabetes, IBD, leukameia and lymphoma), drugs
(penicillin, OCP, sulphanamides), pregnancy, trauma, venous insufficiency
39. C x erythema chronicum migrans: lyme disease
40. E

50%

Infectious diseases
1. A
Dengue: maculopapular rash, facial flushing, flu like symptoms
2. C. Malaria is diagnosed through blood film
3. D/E x. Falciparum malaria: quinine to treat PO or IV
4. C x The symptoms of fevers, night sweats and weight loss in an Indian male are
characterisitic of post-primary pulmonary tuberculosis. Primary TB is asymptomatic
5. E Most common community pneumonia: strep pneumoniae
6. B Oral metronidazole for c.diff
7. A
8. B
9. C/A. Rota virus for children in school with diarrhoea outbreak
10. C
11. A
12. A/B
13. A/D X STI men: large amount of urethral yellow discharge is gonnorrhoea
14. D
15. E Syphylis: pen v
16. A
17. C Hep A infection management is conservative
18. B x Infectious mononucleosis: Epstein-barr virus: Triad: fever, lymphadenopathy and sore
throat
19. C
20. B Mumps caused by paramyxovirus. Fever, swelling of parotid glands.
21. A: Lyme: borrelia burgdorferi: spread by ixodid ticks. Flu like illness, with erythema chronic
migrans. Second stage occurs weeks later with neruo problem – encephalitis or
neuropathies, arthritis or cardiac manifestation
22. D. TB diagnose with ziehl neilsen staining
23. E. Strep pneu and n.meningitidis are common in adult menigitis
24. A Leishmaniasis: transmitted by sandflies. Cause cuneous lesion after bite.
Cryptosporidiosis: parasitic infection: fever and diarrhoea
Schistosomiasis: water borne worm
25. D X leishmaniasis cause Leishman-donovan bodies in bone marrow, spleen, lymph node
26. B Schistosomiasis: water born fluke. Cause itchy rash (swimmers itch) and eosinophilia.
Worm penetrate through skind and into the liver: causing katayama fever – fever, rash,
myalgia, diarrhoea and hepatomegaly
27. E X Giardia: PROLNGED WATER DIARRHOEA
28. C TYPHOID: salmonella typhi: maculopapular rash (rose spots), low white cell count.
Confirmed on culture of blood, urine or stolll
29. A. Tetanus: clostridium tetani: fever, malaise: trismus (lockjaw), risis sardomicus (muscle
spasm smile) and arching of back: treate with metronidazole and IM human tetanus
immunoglobulin
30. B. MRSA: vanc. If allergic: teicoplanin or linezolid
31. E
32. A. Scabies treatment: permethrin cream
33. B
34. D
35. A. Jiroveci: HIV pneumonia: bilat. Perigiler interstial shadowing. CT shows ground glass
apperance
 36. B X Candida albicans (C) is a fungal infection that may colonize the oesophagus of patients
with HIV, causing dysphagia and retrosternal discomfort. It is treated with fluconazole or
ketoconazole.
37. D
38. D
39. B. HIV patient with eye symptoms: decrease visual acuity, floaters, headache and eye pain:
cytomegalovirus retinitis (owl eyes)
40. A. HIV menigitic symptoms on CT show multiple ring enhancing lesion: toxoplasmosis

85%

Emergencies

1. A. Abdoultrasound to screen acute pancreatitis

2. B/E X
3. E X Copper poisoning, metallic taste in mouth, green gum. Treat with d-pencillamine
like wilson’s
4. C x Ethanol intoxication cause hypoglycemia. Resus using glucose infusion
5. B. Opiate overdose: pinpoint pupils, resp depression and comatose state: naloxone
is antidote
6. B X sudden headache: rule out SAH even if it doesn’t have the occipital picture
7. C
8. D X Give GTN first for symptomatic relief in GP before aspirin 300mg
9. B X COPD exarcebation: increasing frequency of bronchodilator first - > oxygen -> IV
theophyllines
10. A
11. E
12. B NSAID use: gastric ulcer
13. D. Pulmonary oedema: cause dyspnoea and frothy sputum. Gallop rhymth: HF
14. C/B
15. B
16. B
17. B X myxoedema coma is precipitated by other factors. Symptoms: hypothermia,
hyponatraemia and confusion (coma is not needed)
18. A
19. E X
20. A
21. B
22. D
23. C
24. D X Crescendo angina: angina even at rest
25. A
26. C/D X Aortic dissection: CT scan is golden
27. D X
28. A X ANALPHYLAXIS: Adrenaline, chlorphenamine and hydrocortisone
Adult: 500mcg (0.5 mg) adrenaline 0.5 ml of 1:1000 dilution, 200mg hydrocor and 10
mg chlor
 29. E X
30. B
31. D X A cavernous sinus thrombosis therefore presents with an assortment of
headache, orbital pain, eye swelling and cranial nerve palsies affecting III, IV, VI and
part of V.
32. E Amitryptaline oD: anticholinergic: dilated pupil, skin flushing, hypotension with
arrythmia. IV bicarbonate is antidote
33. D X Fat embolism: following trauma of long bone. Mental state changes, petechia
and dyspnoe
34. D
35. C
 60%

Test:

1. D X ‘ Strep menigitis: cef and metro. STAPH: fluclox and cef

2. A In cushings patients. If there is bilateral adrenal gland atrophy: exogenous steroid
use
3. B topical acyclovir for cold sores
4. D ‘ Onycholysis cause: most common: trauma, psoriasis, hypothroidism
5. B Peutz-Jegher: autosomal dominant
6. B
7. E X DCM: ecg: ST change,, CXR: heart balooining, Echo: left or right ventricle
dilatation
8. E UC signs: finger clubbing, erythema nodosum, iritis (anterior uveitis and
sacroiliitis). Granuloma annulare is associated with DM
9. E/B Haemoptysis: TB, bronchiecstasis, aspergilloma, Wegener’s, lung cancer
abscess, farmers lung, PE, good pastures
10. E/D X Sarcoidosis: ERYTHEMA NODOSUM!!!, Splenomegaly, anterior uveitis,
hepactic granuloma, parotitis, lupus pernio.
11. D. Haemophilia: xlink recessive, everything normal except PTT
12. B
13. B/A Lacunar infarct: pure sensory or pure motor stroke
14. D people with patent foramen ovale have stroke
15. A
16. E Primary pulmonary hypertension: right axis deviatation, pepaked p wave,high
pulmonary pression. MG meds: phosphodiesterase inhibitor: sildenafil, bosentan
(endothelin receptor antagonist), Protascyclin IV and warfarin
17. X B/A Jaundice is visible when bilirubin hits 35umol/L
18. X D AAA is screened with Abdo ultrasound. Then its CT abdo
19. A meningococcal sept: IV ceft
20. X B/A erythroderma: rash of more than 50 percent of the body. Associated T-cell
lymphoma
21. D Loss joint space, subchrondral cyst and sclerosis, osteophytes are arthritis. RA: loss
joint space, erosion, soft tissue swelling and onsteopenia
22. C
23. B
24. X E/A Cutaneous hyperpigmentation: pregnancy, Addison, cushing and nelson.
Hypothyroidism cause hypopigmentation with pale and yellow-tinged skin
25. C Endocarditis: fever, Janeway, splinter hem, night sweats. Transeosophagoel echo
26. B
27. E
28. B
29. C Malignant melanoma: Breslow thickeness is for prognosis
30. D Pleural effusion: decreased air-entry, vocal frem and stony percussion
31. X E
32. C
33. D Hep cance RF: hep B and C, liver cirrhosis, aflatoxin (a mould)
34. A
35. E
36. E
37. D. Wolff Parkinson white: accessory bundle Kent. Short PR interval slow upstroke R
wave (delta waave)
38. D
39. X E Marfan hearts condition: aortic dissection, aortic dilatation, mitral valve prolapse
and calcification.
40. A ITP: after viral infection, mild thrombocytopenia, easy bruising and nose bleed
with petechiae. TTP: fever, thrombocytopenia, renal failure and neuro symptoms
41. A
42. C
43. A
44. B
45. D
46. C/E X AAtrial myxoma: atrial tumour: loud third heart sound or @tumour plop@
47. A
48. D X If suspect meningococcal sept> treat the PETICEMIA PART FIRST WITH IV CEFO
49. B spinal cord compression: heavy legs, a sensory level, upper moter neurone sign
ovee lesion whilst LMN sign below Lesions above L1 usually result in upper motor
neuron signs in the legs and a sensory level. Lesions below L1 usually cause lower
motor neuron signs in the legs and perianal numbn
50. E Multiple myeloma: light chain IgG deposition and urine bence jones protein.
Elevation level of M protein in blood or urine
51. C. EBV triad: sore throat, lymphadenopathy, fever. Cause hepatomegamly and
splenomegaly. Lymphocytosis. Confirmed with Monospot test
52. B
53. C
54. A
55. B
56. A
57. D X Iga Nephropathy can be after step throat or strenuous exercise
58. C
59. C X chronic kidney disease systolic pressure target 120-130 mmhg
60. C
61. B
62. E
 63. B X Visible haematuria: first is Urine MCS to exclude UTI, then repeat urine dipstick,
then albumin:creatinine ration for Diabetes. If all clear then cystoscopy for bladder
cancer
64. A
65. A ‘ X Henoch schonlein: itchy purpuric rash over thight and buttocks, sometimes feet
and sole. Arthralgia and haematuria. Treat with NSAID for arthralgia only. Sever then
steroid
 76%