A 25 year old woman presents with a change to her periods. She is experiencing heavy, painful bleeding for the first time. Which of the following is the least appropriate investigation?

A) Urine beta-HCG
B) FBC
C) Serum free testosterone
D) TSH
E) LH/FSH ratio

Which of the following is not an absolute contraindication for the combined oral contraceptive pill?

A) Migraine
B) Diabetes
C) Hypertension
D) Knee replacement surgery
E) Breast feeding 4 weeks post-partum

A woman is unsure of the name of the contraception she is using, she describes it as "I take a tablet every day of the month without breaks, I know it is important I take it at the same time every day."

Which of the following is she most likely to be using?

A) Mirena
B) Cerazette
C) Nexplanon
D) Yasmin
E) Microgynon 30

You are a medical student on attachment in ICU. The arterial blood gas (ABG) machine in A&E is currently broken so staff are coming up from A&E to use your machine. You read one set of results as follows:

pH: 7.2
pCO2: 5kPa
pO2: 12 kPa
HCO3-: 18

Which of the following clinical scenarios best fits the ABG results presented above?

A) Aspirin overdose.
B) Opiate overdose.
C) COPD.
D) Panic attack.
E) Pneumonia.

A 24 year old woman presents to her GP with a 3 month history of bloating, abdominal discomfort and diarrhoea. Along with an examination the GP decides that a diagnosis of coeliac disease is most likely, which of the following is most associated with coeliac disease?

A) AFP
B) Anti-mitochondrial antibodies
C) Anti-GBM antibodies
D) c-ANCA
E) IgA Endomysial antibodies

A new drug is undergoing testing, at 10am 100mg is given to a patient. At 10pm a blood sample is taken from the patient and the patient is found to have 12.5mg of the drug circulating.

Which of the following best describes the half-life of this drug?

A) 2 hours
B) 4 hours
C) 6 hours
D) 8 hours
E) 10 hours

A patient presents to A&E with acute onset chest pain radiating into the neck and left arm. The patient is short of breath and sweating and reports some nausea. An ECG is preformed showing ST elevation in leads II, III and AVF. Where is the infarction most likely to be situated and which cardiac territory is affected?

A) Right coronary artery affecting the inferior territory of the heart.
B) Left anterior descending artery affecting the anterior territory of the heart.
C) Left circumflex artery affecting the lateral territory of the heart.
D) Left circumflex artery affecting the septum of the heart.
E) Left anterior descending artery affecting the inferior territory of the heart.

P.S. Sorry about not actually having an ECG for this question. If anyone knows of a site with ECG pictures licensed under the creative commons act, let me know.

A gentleman aged 55 years old is found to have hypertension, which of the following is the best drug treatment for him to start on?

A) Nifedipine
B) Ramipril
C) Losartan
D) Doxazosin
E) Bendroflumethiazide

A 55 year old gentleman moves house and registers with a new GP, a health check is arranged and his blood pressure is found to be 145/95. Which of the following most accurately describes this gentleman?

A) He has normal blood pressure, no action should be taken.
B) He is hypertensive and should be started on medication.
C) He is hypertensive and should be advised on life style changes.
D) He is hypertensive and should be offered ambulatory blood pressure monitoring.
E) He is hypotensive and should be started on medication.

Which of the following accurately describes the current screening test used in the UK to check for TB exposure?

A) Blood culture.
B) Chest CT.
C) Chest x-ray.
D) A circle of needles punctures the forearm through which tuberculin is injected.
E) A quantity of tuberculin is injected intradermally.

A patient is found to have a pleural effusion, a sample of the fluid is taken and sent to the laboratory for testing. The report states the patient has an exudate fluid [over 30g/L of protein], which is the most likely cause of this patients pleural effusion?

A) Left ventricular failure.
B) Metastatic breast cancer.
C) Superior vena cava obstruction.
D) Liver cirrhosis.
E) Hypothyroidism.

A young man developed sudden shortness of breath and a sharp pain during inspiration while playing basketball. He presented to A&E and the above chest x-ray was taken. What is the most likely diagnosis?

A) Tension pneumothorax.
B) Acute asthma attack.
C) Pulmonary embolus.
D) Spontaneous pneumothorax.
E) Hyperventilation secondary to panic attack.

This is a PA chest x-ray is of a 19 year old female, showing extensive abnormalities of the lung parenchyma, most pronounced by the central tram-track opacities. Apart from respiratory symptoms, what else is she likely to present with?

A) Obesity.
B) Diarrhoea.
C) Hypertension.
D) Tremor.
E) Recurrent epistaxis. 

Which of the following is not seen on this chest x-ray?

A) Right sided pneumothorax.
B) Left sided pleural effusion.
C) Obliteration of left hilum.
D) Breast shadow.
E) Patient is rotated to the right.

Which of the following types of malignancy is least likely to metastasise to the lung?

A) Breast
B) Bone
C) Thyroid
D) Renal
E) Hepatic

A 16 year old boy presents to A&E with a tight feeling in his chest and a bilateral wheeze. He is a known asthmatic and reports that he usually takes a blue inhaler, he can't remember the name, as and when he needs it. However today, his inhaler did not relieve his symptoms.

What is the single best treatment option for this patient once this acute attack has been treated?
A) Switch to Salbutamol P.R.N inhaler with spacer.
B) Switch to Salmeterol inhaler twice a day.
C) Add Beclometasone inhaler once a day.
D) Add Salmeterol inhaler twice a day.
E) Add oral Prednisolone, 5mg every other day.

Which of the following spirometry results would indicate COPD?

A) FEV1 = 4.3, FVC = 5.0, ratio = 86%
B) FEV1 = 2.8, FVC = 3.1, ratio = 90%
C) FEV1 = 3.8, FVC = 3.8, ratio = 100%
D) FEV1 = 3.3, FVC = 4.3, ratio = 76%
E) FEV1 = 1.8, FVC = 3.1, ratio = 60%

Match the drug to it's target and the expected physiological effect:

A) Propranolol - beta adrenoreceptor - slowed sino-atrial node conduction
B) Domperidone - histamine receptor - antiemetic
C) Aspirin - thromboxane A2 - increased platelet aggregation
D) Salbutamol - alpha adrenoreceptor - dilates bronchial smooth muscle
E) Methotrexate - DNA transcriptase - decreased nucleic acid synthesis

66 year old gentleman presents to A&E following a collapse, his wife is with him. She explains that they were at a wedding when her husband complained of feeling dizzy and then fell to the floor, he has been unresponsive since then. She tells you that her husband is generally fit and well but does mention that he has been a life long smoker. On general examination he is pale and has a fast, thready pulse and his blood pressure is unrecordable on the automatic machine. He is unable to answer any of your questions and is clutching at his abdomen in severe pain.

What is the best course of action? 

A) Analgesia to facilitate a better history.

B) Refer to surgeons for emergency surgery.

C) Perform an ECG.

D) Obtain abdominal US scan. 

E) Perform abdominal examination.

Mrs Jones went to see her GP as she had noticed she had lost weight even though she felt she was eating more. On examination Mrs Jones had sweaty, erythematous plams, a rapid and bounding pulse and upper lid retraction.

Following further examination and investigations a diagnosis of Graves' disease was made, which of the following is most closely linked with Graves' disease?

A) Diarrhoea

B) Increased free T3

C) Dysphagia

D) Fever

E) Pretibial myxoedema

Which of the following statements best defines a fibroadenoma:

A) Smooth, spherical or elliptical mass.
B) Firm and lumpy mass with large lobules.
C) Can present at any age, but more common in old age.
D) Often associated with lactation.
E) Warm and erythematous mass.

Proteinuria (>3g/24h), odema and hypoalbuminaemia (albumin <25g/L) is the classical triad of signs for which of the following conditions?

A) Nephritic syndrome
B) Urinary tract infection
C) Acute renal failure
D) Nephrotic syndrome
E) Over use of potassium-sparing diuretics

Which of the following is true about Warfarin?

A) Warfarin inhibits Vitamin E dependant clotting factors 6 and 8.
B) Warfarin promotes production of endogenous anticoagulants such as protein S.
C) Warfarin inhibits carboxylation of clotting factors 9 and 10.
D) Warfarin inhibits only the extrinsic pathway and so Heparin is commonly prescribed as well.
E) Warfarin is used in the acute setting for thrombolysis.

With regards to anaemia, which of the following is correct?

A) Folate deficiency causes a macrocytic anaemia.

B) Sickle cell disease commonly presents with fatigue due to haemolysis of red blood cells.

C) Normocytic anaemia does not have a malignant cause.

D) Iron deficiency is a rare cause of microcytic anaemia.

E) Acute blood loss results in a microcytic anaemia.

Which of the following findings is the strongest predictive factor for pulmonary embolus?

A) Dyspnoea

B) Fever

C) Haemoptysis

D) Heart rate over 100 beats per minute

E) Known malignancy