1. Photograph showing a lesion on the face, what is the diagnosis ??

pyogenic
granuloma/keratoacanthoma

2. Treatment of athlete’s foot: Terbinafine cream or an imidazole cream

3. Lesion on wrist ?Milia. What is the treatment? Piercing with sterile lancet > Retinoid, Adapalene >
Dermabrasion

4. Question describing a skin lesion ?pityriasis rosea. What is the treatment? Self-limiting

5. Calculate the numbers needed to treat – 1/ARR

6. Calculate prevalence – old+new cases/total population

7. Calculate relative risk reduction = 1 – RR or (EER-CER)/CER

8. Question on positive predicted value = TP/TP+FP

9. Question on forest plot

10. Question on calculating median in 10 different numbers

11. Question on how to fill a death certificate in a 98 year old man who bilateral crepitations and cough:

a. lobar pneumonia

b. Age(could be 1b)

c. Bronchopneumonia (could be 1a)

12. Which DMARD medication when given will you monitor blood pressure = Leflunomide

13. Which of these vaccinations will you give at 2 months of age = 6in1, MenB, Rota

14. Young boy who is withdrawn and has magical thinking = Schizotypal > schizophrenia

15. COPD patient with mucus production and on theophylline and steroid inhaler. Which medication will
you add? Antibiotic and prednisolone

16. A child with diarrhea and petechial hemorrhage, what bug can cause such clinical findings? a.
salmonella b. E coli

17. A patient with diabetes type 1 who is vomiting and cant eat. How will you administer insulin? GKI-
sliding scale

18. A woman complaining of rib and vertebral pain, what is the diagnosis? a. osteoporosis b.
osteomalacia c. Pagets disease

19. DEXA scan of 0.1 what will you do? = expectant management
20. Patient who had an abortion and wants COCP, how will you advice her regarding the use of this
contraception a. contraception choice is ok but use condoms for 7 days. N.B:-(TOP/miscarriage <24w,
contraception started within 5days needs no additional method)

21. Type in the dose in (mls) of heparin to be administered. The patient weight is 80kg, dose of heparin
to be administered is 15mls/kg and the strength of heparin in the Vial is 1500/5ml

22. Photograph showing blood in the anterior chamber of the eye, what will you do? a. Routine referral
to ophthalmology b. Emergency referral to eye casualty c. Do nothing

Now One month ago

Na normal Normal
K 5.2 4.0
Creatinine elevated Normal
23. The above is the lab result of a patient. What is the diagnosis? a. Acute renal failure b. Chronic renal
failure c. Nephrotic syndrome d. Nephritic syndrome

23. A 6 yr old boy who is adopted and walks with a limp. What is the diagnosis = ??Perthes disease

24. A 5 yr old girl with problems mobilizing the hip, what is the diagnosis?

25. Bilateral pain in the head = tension headache

26. Elderly man confused with abnormal gait = subdural hematoma, normal pressure hydrocephalus

27. Child with diarrhea and now has fecal impaction, what laxative will you give? Macrogol

28. What disease is not part of the national screening programme? a. PKU b. Congenital adrenal
hyperplasia c. Eye test

29. Eye signs in a woman who is sweaty and is agitated? a. ptosis b. lid retraction

30. Which of these patient should be included in a D1500 form? Terminal illness with < 6 months to
live

31. Concerning elevated PSA and national screening, which of the following is correct:

a. All patient with PSA elevation will have CA prostate

b. PSA monitoring will decrease death from CA prostate

c. 2/3 of patients will not have CA prostate if PSA is elevated (now 75% will be false positive)

32. Hypertensive patient presenting with BPH .what medication will you use? Tamsulosin (alpha
blockers generally)
33. Woman with dry mouth, what medication will you give?

a. Hyoscine

b. Difflam

c. Pilocarpine

34. List of groups of people who are not allowed to fly:

a. Boy with ORIF without a cast

b. Man 5 days post MI (If PCI, would be 5 days, uncomplicated 7-10, complicated 4-6 weeks, CABG 10-
14 days)

35. Drug to treat ascites= spironolactone

36. Test for Chlamydia=??early morning urine (first catch urine)

37. Picture of penis with an ulcer and patient has palpable inguinal lymphadenopathy, what is the
diagnosis (LGV>>Chancroid [unilateral LN enlargement in chancroid])

38. Patient with flicking eye movement, what is the treatment= botulinum toxin (blepharospasm)

39. Elderly woman with BP readings showing stage 1 hypertension on 3 different occasions in the
surgery, No symptoms. ECG: looks normal (but shows tall r waves in the anterior leads) question is what
to do?

Treat or not to treat and arrange home BP monitoring. I think the ECG indicates left ventricular
hypertrophy which may reflect end organ damage and therefor I chose to treat with calcium channel
blockers (due to age) (if LVH or RVH, indicated end organ damage and treat)

40. Patient with painful shoulder arc post trauma = acromioclavicular impingement (rotator cuff injury)

41. Question on symptoms of ?Carpal tunnel syndrome (lesion of median nerve at what level, wrist or
higher) (loss of pronation with above-wrist injury, also weak flexion and ulnar deviation. At the wrist
will cause classical CTS only)

42. Commonest organism causing community acquired pneumonia Streptococcus pneumoniae

43. First line treatment to induce remission in Crohn's disease. Prednisolone, second line is ASA
(azathioprine and mercaptopurine for maintaining remission, methotrexate second line)

44. Asthma < 5 on SABA+ICS ?next step LTRA (if still not effective after, stop LTRA and carry go)

45. Asthma stable on SABA + ICS develops coryzal symptoms leading to wheeze. How to treat?

a. Add LABA
b Increase ICS

c. Oral prednisolone 20mg OD-5days

d. Oral prednisolone 40mg OD -5-7 days (assumes adult patient. Other option is quadruple ICS for up
to 14 days)

46. Young girl with threadworm symptoms = Enterobius vermicularis, sometimes called
pinworms

47. Image of seborrhoeic keratosis (stuck-on appearance)

48. Investigation for nut allergy in a patient.

a. Skin prick

b. IgE test (No RAST in the options) (This is second line)

49. Patient on triple whammy' medications. Which med to stop? (ACEI/ARB +Diuretic + NSAIDS)

50. Anaphylaxis in a 4 year old child. Dose of adrenaline. = 0.15mg (0.5 mg in adult, 0.3mg in 6-12)

51. Patient with creatinine 180. Which medication to stop = metformin [consider stopping at egfr <45
(cr= 130), stop at egfr<30 (cr= 150)]

52. Post splenectomy vaccination [PPV23 (and 5 yearly), MenC, Hib, men ACWY after 1 month, 2 doses
of Men B if not previously taken, 1 month apart. Yearly influ]

53. Patient requests to see how BP machines in the surgery are calibrated. What kind of law? = ?
Freedom of information act

54. Patient with hematuria after swimming in a river while on holiday in Africa = Schistosomiasis

55. Woman who is 6 weeks post-partum requests an immediate, short term and easily reversible
contraception = ?POP

56. Contraception for patient with menorrhagia and fibroid = ?Mirena (< 3cm size)

57. Investigation for an unwell patient on risperidone Ans: FBC (agranulocytosis)

58. Treatment to reduce PSA = Finasteride

59. Drug treatment for galactorrhea. (Cabergoline> bromocriptine)

60. Lab results with low FSH, LH, Testosterone, TSH = ?hypogonadotropic hypogonadism

61. Man with chronic low back pain, complains of erectile dysfunction

a. ?drug induced
b. ?psychogenic

c. ?disc prolapse

62. 17 year old female athlete with painful knees worse on jumping and settles at rest a. ?
chondromalacia patellae

63. Patient with eye symptoms and history of ankylosing spondylitis = anterior uveitis

64. Child with 3wk history of decreased hearing with bilateral blue ear drums which are fixed/no
movement. What management?

a. ?Amox

b. ?ENT referral

65. Patient on carbimazole develops cough and sore throat. What to do?

a. FBC

b. Refer to secondary care

66. Question on interpreting rinne and weber test on patient =unilateral conductive hearing loss (rinne
negative, weber lateralizes to affected ear)

67. Child with convergent squint performs a cover test. What do you see? (How does the affected eye
move when the unaffected eye is covered?) Abnormal eye moves outward to the fixation

68. Alcoholic discharged from Detox with a medication has nausea and vomiting after drinking =
disulfiram (or metronidazole)

69. Replacement for heroin addict = Buprenorphine (methadone is not in options)

70. Down's syndrome patient is at risk of hypothyroidism

71. Huntington's patient, Mum wants to know the chances of son being a carrier/affected. ANS: 50%
chance of being affected

72. Results: fasting and OGTT = ?normal (Fasting >= 7.0, 2HPP >=11.1 HbA1c >= 48%)

73. Female known gallstones with epigastric pains radiating to the back, vomiting, has absent bowel
sounds

a. Acute pancreatitis

b. Gallstone ileus

74. Female with pains in the right upper quadrant = cholecystitis (murphy’s sign positive)
75. Female with stress incontinence, after MSU what is the next step? (one of the options is bladder
diary for 3 days,) there is no pelvic floor exercise in the options . Diary to assess severity

76. Female with no symptoms of UTI but MSSU shows staph epidermidis, what do you do?

a. Treat as UTI

b. No treatment

77. Female travelling to Pakistan and wants antibiotics to protect against travelers' diarrhoea.

a. Doxycycline

b. Metronidazole

C. Ciprofloxacin ( 3 days prescription or azithromycin if pregnant)

d. Vancomycin

78. Unwell child with purpuric rash and cold extremities, CRT 3 seconds, no fever. What to do. ?Treat as
meningococcal septicemia (call ambulance, give Ben Pen)

79. Child with meningococcal septicemia but with known anaphylaxis to penicillin. What is the
alternative antibiotic to give? Chloramphenicol or Cefotaxime

**80. Child with multiple soft mobile non-tender lymph nodes in the anterior triangle of the neck with
unilateral ear problem? What to do? refer to ENT urgently

81. Female trying to conceive, has irregular cycle of 28 - 45 days, what initial test to do? (Ideal Ans:
LH/FSH on day 2-5)

a. 21 day progesterone ????? (day 28 in 35-day cycle and repeat weekly until bleeding starts)

b. 28 day progesterone

82. Female with atypical pleural plaques on CXR = ?mesothelioma (Likely Asbestos exposure)

83. Question on a Forest plot

84. Drawing of a pedigree chart: asked to identify which symbol identifies a dead affected male. Shaded
Box with diagonal line

85. Patient with heart failure on medications including ramipril, but still symptomatic which drug do you
add next?

a. Amlodipine

b. Bisoprolol
86. Young woman who has fever, feeling unwell, has low blood pressure, presently on a period, known
to be on COCP. Toxic shock syndrome

87. Patient requesting bupropion to help quit smoking. When should he stop smoking? (avoid
bupropion in eating disorder, epilepsy , pregnancy and breastfeeding, bipolar, CNS tumor)

a. 10 days into treatment

b. 3 days into treatment

c. When he no longer feels like smoking

d. Immediately

88. What is the meaning of PGD (Patient Group directive e.g vaccinations)

89. Patient on Sildenafil, which of these medications is contraindicated? Nicorandil

90. Woman with relapsing-remitting multiple sclerosis wants a medication to induce remission of her
symptoms, which do you give? ?methylprednisolone

91. Child with symptoms suggestive of ADHD

92. Child on Ritalin (methylphenidate: treatment for ADHD). What do you monitor? = Blood pressure

93. Patient with bilateral hilar lymphadenopathy on CXR = sarcoidosis

94. Interpretation of a data (diagram) showing Number needed to harm (1/Absolute risk Increase
[ARI])

95. Question on calculation of positive predictive value. (TP/TP+FP)

96. Diagram showing a Prescription of antibiotics for a child: question is what part of the prescription is
wrong? (must write age of child if less than 12 year-old)

a. Date of birth

b. Dose

c. Total quantity in milliliters

97. Question on DS-1500. Options lists different patients with different pathologies that all applied for a
DS-1500. Which one of them qualifies for it? ?55 year old man with motor neurone disease and is on a
ventilator.

98. GMC's guidance on? declaration of candor. Which scenario would it apply in? (when mistake has
been made to patient)

a. Patient who was erroneously given the wrong vaccination

b. Wrong data published about the surgery

c. Information about the findings of an SEA

99. Patient with unilateral limb pains on walking ?intermittent claudication

100. Patient with IBS has tried several laxatives without improvement. Which other laxative to try ? ?
Macrogols (linaclotide was not in options)

101. Female with anti-phospholipid syndrome, what is she at risk of? = venous thromboembolism

102. Male child with a 24 hour history of bilateral scrotal tenderness = ?testicular torsion (ANS: Orchitis/
epididymitis)

103. Jaundice in a newborn less than 24 hours old (Ans: pathologic, send to hospital)

104. Bilateral swollen eyelids with yellow discharge in a 4 day old baby. What is the commonest
causative organism? ??Adeno virus. Ophthalmia neonatorum mostly due to chlamydia/gonorrhea
(also gram negative bacteria, herpes simplex, adenovirus)

104. Early or late onset hypogonadism vs low testosterone – Kallman’s syndrome

105. Myoclonus seizures on waking up – Na Valproate > Lamotrigine, Clonazepam

106. Diabetes insipidus bloods – High serum osmolality and low urine osmolality

107. SIADH bloods – Low serum osmolality and high urine osmolality

108. Finasteride to be prescribed with? Cyproterone acetate

109. 15yr old Boy crashed stolen car and sustained fracture? Involve parents and police against his
wishes? Respect boys wishes? Inform police

110. Who signs death certificate OOH or you that saw last 4 weeks ago? Px’s GP

111. DS1500 form invalidated by? 3years

112. Fit note invalidated by? 6 months duration at first issue

113. Type 1 diabetic with sudden visual loss with flashes and floaters - vitreous detachment

114. Curtain drop loss that resolves in 2 hours? amaurosis fugax vision loss

115. Trigeminal neuralgia first line of carbamazepine

116. Low probability of rheumatoid arthritis if crp and esr normal - false

117. Osteochondritis dissecans – intermittent swelling and locking of knee

118. Borderline personality disorder – Dialetical behavioural therapy

119. Edinburgh scale for PND

120. Likely UTI in child

121. Treatment of actinic keratosis – 5FU(Efudix), Diclofenac(Solaraze), Imiquimod

122. Facial cellulitis – Co-amoxiclav, Metronidazole + Clarithromycin

123. Treatment of severe chicken pox – IV acyclovir

124. Genital herpes viral culture swab

125. Bulbar palsy or ca oeso as cause of gurgling noise and dysphasia post 1st swallow - MND

126. High MCV in coeliac - True

127. Colic with formula feed swap without allergy features, advise

128. UTI treatment while on prophylactic trimethoprim – Use a different Abx for Rx

131. Beneficence or virtue or autonomy or maleficence

132. Cerebellar signs, dysarthria – DANISH

133. Tests for dorsal column function? Romberg

134. 10m old with no repetitive words but normal gross and fine motor – Delayed speech development

135. Obese boy, mental retardation and loves food? Prader-willi

136. Gmc good medical practice if you declare medical stuff on social media u r a doctor, put your name.

137. Palpitations ECG? SVT or sinus tachycardia

138. 17 year old with intermittent palpitations for 1 month, very athletic, soft systolic murmur on left
sternal edge. Echo will show? HOCM, Coac of aorta or normal heart.

139. Family tree for autosomal dominant dx

140. Woman's Risk of child being cf carrier if her brother had a child with cf – 50% of 50% = 25%

141. Monitoring in amiodarone – TFT, LFT every 6months. ECG annually

142. Gfr monitoring in dabigatran – U&E yearly unless abnormal (Every six months if the person is older
than 75 years, or is frail. At least every six months if the person has a creatinine clearance (CrCl) between 30–60
mL/min. If the CrCl is less than 60 mL/min, the frequency of monitoring (in months) can be guided by the CrCl
divided by 10. Note: dabigatran is contraindicated if CrCL is less than 30 mL/min
143. Twice weekly palpitations. Normal ecg, bloods. What next? 7day cardiac event monitor or echo or
24 HR tape

144. Recurrent genital herpes treatment – Acyclovir 800mg tds x2days or 200mg 5ds x5days or 400mg
tds x5days

145. When scrape biopsy of skin lesion is done -

146. Renal ca scenario

147. ALL scenario

148. What inv next in parotid swelling, dry eyes? Schirmer test for Sjogren syndrome

149. Painful passive shoulder movement post fall. Pain worse with abduction and Ext rotation? Adhesive
capsulitis, Supraspinatus tear or subscapularis

150. Neck Of Femur features of shortening and Ext rotation

151. Premature menopause, ideal treatment is cyclical/sequential HRT

152. Unprotected sex on day 16 post natal and who is exclusively breastfeeding, what intervention is
required? Nothing

153. Total dose supply needed for medication

154. Treatment for hot flushes in woman with previous breast ca? Any of Clonidine, SSRIs, SNRIs,
Gabapentin, CBT

155. Stopping fluoxetine and starting citalopram. Stop fluoxetine, start SSRI at a low dose 4–7 days
later

156. Abruptio placenta pain what to give if to give before hospital – Analgesia?

157. Positive hcg, Imp 1w late, bleeding now stopped. What to with scanning? repeat a urine pregnancy
test after 7–10 days(as <6wks) Refer to EPAU if >6wks. All as long as there is no abd pain.

158. What GA for nuchal screening? 11w to 13w6d

159. When does acute cough resolve? 21days

160. Therapeutic manoeuvre for bppv – epley

161. . An elderly man catheterized today and patient wife rang next day saying that he has pain at the
tip of the penis, what is the diagnosis?

a. paraphimosis b. UTI c. Blanitis

162. Picture showing swelling on the eye lid for the last 9 months, what is the diagnosis?
a. Stye b. Meibomian cyst

163. Child on SABA + inhaled steroids and still symptomatic, what is the next line of medication to give?
LTRA

164. Adult on SABA and inhaled steroids, which is the next drug to give? LTRA(nice) or LABA(sign)

165. Patient with normal Rhine test on the right ear but bone conduction is greater on left ear, what is
the diagnosis? Left conductive deafness

166. Boy with glue ear for 3 months what will you do?

a. expectant management b. Antibiotic c. request for grommets

167. Anaphylaxis in a 4year old boy, how many mls of adrenalin in a vial of 1:10,00 of adrenalin will you
give? = 0.15mls

168. Patient who is about to have a procedure done and after given a local anesthetic he becomes
unresponsive, what do you do? a. Tell him to breath in a bag b. Give adrenaline

169. What will you give to induce remission in a case of bloody diarrhoea? Mesalazine

170. Patient with multiple sclerosis, what medication will induce remission? Methylprednisolone

171. Picture of a woman leg who has diabetes, what is the diagnosis = Necrobiosis lipoidica
diabeticorum

172. What medication will enhance digoxin toxicity?

a. indapamide b. amlodipine c. ramipril

173. Picture showing diffuse rash on the trunk. What is the diagnosis?

a. Stevens Johnson syndrome b. Erythema multiforme – target lesion

174. A man sleeps hanging his arm over a chair, what nerve will be affected? Radial nerve/Saturday
night’s palsy

175. Lesion of a nerve at the elbow, what movement will be affected?

a. extension of the wrist b. pronation C. supination d. touching the little finger with the thumb

176. Child with abdominal pain for days and after playing football noticed swelling of the scrotum. What
is the diagnosis?

a. Testicular torsion b. epididimytis

177. Blocked nose with watery discharge. What is the diagnosis? nasal polyps
178. Blocked nose with bloody discharge. What is the diagnosis? nasopharyngeal carcinoma