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%

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

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