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.