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Date Completed: 15/05/2023
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Clinical Features of Primary Adrenal Insufficiency
Which of the following clinical features is typical of Addison's disease:
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Infectious Disease caused by Clostridium Perfringens
Clostridium perfringens primarily causes which of the following infectious diseases:
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Innervation of the Diaphragm
A 29 year old male presents to ED having sustained a penetrating injury to the neck. On further exploration, it is found that he has transec
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Anatomical Relations of the Thyroid Gland
A 34 year old woman presents to ED complaining of a hoarse voice. She underwent a thyroidectomy 2 weeks ago. Which of the following nerves w
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Pathway of the Gag Reflex
Which of the following nerves is the efferent pathway of the gag reflex:
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Production and Function of Antidiuretic Hormone
Regarding antidiuretic hormone (ADH) which of the following statements is CORRECT:
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Levator Ani Muscle
A 65 year old lady complains of faecal incontinence. Dysfunction of which of the following structures is most likely a contributing factor t
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Opioids: Mechanism of Action
Opioid analgesics act primarily at which of the following opioid receptors:
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Quinolones: Drug Interactions
There is an increased risk of tendon damage when quinolones are given concomitantly with which of the following class of drugs:
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Blood Supply of the Colon
A 72 year old man presents to ED with severe abdominal pain and diarrhoea. Imaging shows occlusion of the inferior mesenteric artery. Which
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Attachments of the Subscapularis Muscle
A 74 year old man is brought into ED after falling down the stairs. He is complaining of pain in his left arm. X-ray shows fracture of the g
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Heart Sounds during the Cardiac Cycle
What does the second heart sound correspond to on the ECG waveform:
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Management of Atrial Fibrillation
A 70 year old man is brought to ED by ambulance with sudden onset chest pain, palpitations and shortness of breath. His HR is 160 bpm and BP
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Clinical Features of SIADH
Which of the following is the most likely diagnosis in a euvolaemic patient who has the following biochemical abnormalities; hyponatraemia,
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Cutaneous Innervation of the Upper Limb
A 82 year old woman is brought to the ED by her son. She complains of numbness in her fingers, her son was concerned this may have been a st
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Causes of SIADH
An 82 year old patient presents with muscle weakness, fatigue and nausea. Blood tests demonstrate hyponatraemia. Further tests show low seru
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Function of the Brachialis Muscle
You are asked to review a 45 year old carpenter who presents with weakness and pain in his left arm. You decide to test the strength of his
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Mechanism of the Baroreceptor Reflex
When an elderly dehydrated patient is moved from a supine to a standing position, her blood pressure decreases and heart rate increases. Whi
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Transport across a Cell Membrane
Which of the following is characterised by transporting a substance against its electrochemical gradient, powered by moving another substanc
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Management of Encephalitis
A 50 year old woman present to ED complaining of a generalised headache over the last 24 hours which is getting worse, associated with a fev
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Coagulation Cascade
Regarding the coagulation cascade, the tenase complex in the intrinsic pathway is the:
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Characteristics of Cryptococcus
Regarding Cryptococcus neoformans, which of the following statements is INCORRECT:
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Infectious Disease caused by Legionella Pneumophila
Regarding Legionellosis, which of the following statements is CORRECT:
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Interpretation of Standard Error of Mean
Regarding standard error of the mean (SEM), which of the following statements is CORRECT:
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Nerves of the Lumbar Plexus
The ilioinguinal nerve supplies skin over which of the following regions:
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Function of Parathyroid Hormone
Which of the following is an effect of parathyroid hormone (PTH) on bone:
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Clinical Effects of Frontal Lobe Lesion
A 69 year old patient is brought to ED with acute onset facial weakness on the right side, and difficulty with speech. He is able to respond
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Central vs Peripheral Chemoreceptors
Which of the following is most important in eliciting a ventilatory response to changes in PCO2:
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Surface Tension in Alveoli
Regarding the alveolar air-fluid interface, which of the following statements is INCORRECT:
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Management of Tuberculosis
A patient on treatment for tuberculosis infection presents to ED. Regarding the management of TB, the continuation phase of treatment using
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Clinical Effects of Frontal Lobe Lesion
Which of the following clinical features is most suggestive of a lesion of the frontal lobe:
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Innervation of the Posterior Forearm Muscles
You are performing a neurological examination on a patient who complains of weakness of the left arm. You note muscle wasting in the poster
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Origin of the Vertebral Artery
The vertebral artery is a branch of which of the following blood vessels:
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Adenosine: Contraindications
A patient presents to ED with palpitations and shortness of breath. ECG shows a supraventricular tachycardia (SVT). You are considering the
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Surface Anatomy of the Lung
In quiet respiration, the position of the right oblique fissure can be marked by a line on the thoracic wall that:
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Production of the Thyroid Hormones
Regarding the thyroid hormones, which of the following statements is CORRECT:
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Organelles of Eukaryotic Cells
Regarding the human cell, which of the following cell organelles serves as a store for intracellular Ca2+:
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Clinical Effects of Frontal Lobe Lesion
A 55 year old woman presents to ED complaining of headaches. On examination the patient is found to have weakness of the left side of her bo
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Clinical Features of Measles
A 8 year old unvaccinated girl, originally from Hungary, is brought to ED by her parents who are concerned about a non-itchy rash. She has
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Calculation of Number Needed to Treat
A new chemotherapy drug is being tested. The intervention reduces the risk of death from 10 in 1000 to 5 in 1000. What is the number needed
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Disturbance of Acid-Base Balance
Which of the following conditions is most likely to cause the following blood gas result (on air): pH = 7.34 PaO2 = 9 kPa PaCO2 =
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Clinical Features of Chickenpox
Regarding chickenpox, which of the following statements is CORRECT:
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Structure of the Gut Wall
Regarding basic gastrointestinal anatomy, which of the following statements is INCORRECT:
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Cutaneous Innervation of the Lower Limb
A 65 year old man presents to the ED complaining of loss of sensation over the lateral thigh. This area is primarily supplied by which of th
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Changes in Alveolar Pressure
Regarding pressures and airflow during the normal breathing cycle, which of the following statements is INCORRECT:
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Central vs Peripheral Chemoreceptors
Regarding chemical control of respiration, which of the following statements is CORRECT:
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Measurement of Renal Clearance
Regarding renal clearance, which of the following statements is CORRECT:
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Movements of the Thoracic Wall
The 'pump handle' movement of the thoracic wall describes which of the following movements:
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Action Potential of the Ventricular Myocyte
In ventricular myocytes, repolarisation occurs because of a:
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Anatomical Course of the Median Nerve
A 21 year old male presents to ED having sustained a stab wound to the left antecubital fossa. Which of the following structures would most
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Mechanism of Carbohydrate Digestion
Regarding carbohydrate digestion, which of the following statements is CORRECT:
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Isotonic vs Isometric Contraction
Regarding skeletal muscle contraction, which of the following statements is CORRECT:
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Blood Supply of the Pancreas
The arterial supply to the pancreas is mainly derived from which of the following:
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Chronic Lymphocytic Leukaemia
Which of the following leukaemias is most common in adults in the UK:
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Clinical Features of Genital Herpes
A 21 year old female patient presents to ED complaining of a painful blistering rash on her genitals and swollen inguinal lymph nodes, follo
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Management of Urinary Tract Infection
A 65 year old man presents to ED complaining of fever and rigors. He explains that he has pain in his perineal area, dysuria and pain on def
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Risk Factors for Meningococcal Disease
A patient presents to ED with a fever and a headache. You notice that in the patient’s notes it states they are particularly susceptible t
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Structure of the Sympathetic Nervous System
Sympathetic preganglionic neurones originate in which of the following locations:
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Metronidazole: Indications
Which of the following antibiotics is used first line to treat tetanus:
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Obstructive vs Restrictive Lung Disease
A patient with known COPD presents to ED with worsening breathlessness. You are looking at her old notes and noticed recent spirometry resul
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Structure of the Glomerular Filtration Barrier
Regarding the glomerular filtration barrier, which of the following statements is CORRECT:
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Macrophages
Which of the following specialised macrophages is NOT paired correctly with its site in the body:
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Causative Agents of Myocarditis
A 45 year old lady presents to ED with malaise and severe breathlessness on exertion and lying down. About 2 weeks ago she suffered from a f
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Function of the Sternocleidomastoid Muscle
The sternocleidomastoid muscle acts to produce which of the following movements:
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Calculation of Interquartile Range
What is the interquartile range for the following data set; 11, 4, 6, 8, 3, 10, 8, 10, 4, 12, 31
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Arterial Waveforms during the Cardiac Cycle
What does the dicrotic notch on the arterial waveform represent:
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Origin of the Tibial Nerve
The tibial nerve receives nerve fibres from which of the following nerve roots:
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Clinical Effects of Obturator Nerve Injury
You are giving a teaching session to a group of final year medical students regarding lower limb neurology. Which of the following clinical
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Innervation of the Superior Tarsal Muscle
The superior tarsal muscle is innervated by which of the following:
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Penicillins: Pharmacology
Regarding penicillin antibiotics, which of the following statements is INCORRECT:
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Dermatomal Supply of the Upper Limb
A 43 year old tree surgeon is brought to the ED after falling approximately 10 metres from a tree. During assessment of the C-spine he comp
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Definition of Lung Volumes and Capacities
You are reviewing a patient who has presented with breathlessness. She tells you she has recently undergone lung function tests. Which of th
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Relative Fluid Distribution in Fluid Spaces
Regarding fluid balance, which of the following statements is CORRECT:
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Renal Handling of Sodium
Which of the following hormones acts to inhibit Na+ reabsorption in the distal nephron:
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Calculation of Mean Arterial Pressure
Which of the following best describes the mean arterial pressure (MAP):
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Attachments of the Temporalis Muscle
The temporalis muscle originates from which of the following structures:
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Life Cycle of Plasmodium Spp.
Regarding the Plasmodium spp. life cycle, which of the following is injected by the mosquito's bite:
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Management of Tetanus-Prone Wounds
You are leading a teaching session on tetanus prophylaxis. Regarding management of a tetanus-prone wound which of the following statements i
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Structure of the Gut Wall
In the gastrointestinal tract, where is the Meissner's nerve plexus found:
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Disturbance of Acid-Base Balance
A 35 year old man is brought to the emergency department having been found collapsed by his girlfriend. What is the most likely diagnosis ta
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Clinical Effects of Parietal Lobe Lesion
A 65 year old lady presents to ED complaining of visual loss. Examination demonstrates visual loss in the lower left quadrant in both visual
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Characteristics of Salmonella Spp.
Regarding Salmonella species which of the following statements is CORRECT:
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Macrolides: Pharmacology
Regarding macrolide antibiotics, which of the following statements is CORRECT:
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Clinical Features of Primary Adrenal Insufficiency
Which of the following features is NOT typical of primary adrenal insufficiency:
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Causes of Anaphylaxis
Which of the following drug classes is most commonly implicated in anaphylactic reactions:
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Blood Supply of the Heart
A 61 year old patient presents to ED with sudden onset central crushing chest pain. ECG demonstrates a STEMI and bradycardia with a heart ra
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Layers Penetrated During Lumbar Puncture
A 21 year old student is sent in to ED by his GP with suspected meningitis. You are about to perform a lumbar puncture. Which of the followi
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Anatomical Course of the Subclavian Artery
Regarding the subclavian artery, which of the following statement is INCORRECT:
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Haemolytic Anaemia
Which of the following clinical features is a feature of a chronic extravascular haemolytic anaemia:
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Movements of the Thoracic Wall
Normal quiet expiration is achieved by which of the following structures:
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Beta-Blockers: Contraindications
A 32 year old presents to ED with palpitations ongoing for the past 5 days. ECG demonstrates atrial fibrillation with a rate of 165 bpm with
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Regions of the Abdomen
The abdominal wall is divided into a simple four quadrant pattern by the vertical median plane intersecting with which of the following tran
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Anatomical Relations of the Oesophagus
The following structures all lie posterior to the oesophagus except for the:
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Propofol: Mechanism of Action
A 47 year old woman requires procedural sedation for DC cardioversion of atrial fibrillation. You plan to use propofol. Sedation is more lik
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Calculation of Confidence Intervals for Sample Mean
Regarding confidence intervals for the sample mean, which of the following statements is CORRECT:
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Definition of Lung Volumes and Capacities
Which of the following describes the volume of air that can be expelled at the end of a normal expiration:
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Microstructure of the Cardiac Myocyte
Action potentials are transmitted from myocyte to myocyte via which of the following:
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Clinical Effects of Oculomotor Nerve Lesion
A 68 year old woman, with a known brain tumour, presents to ED. Her left eye is directed outwards and downwards, she is unable to open her e
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Anatomy of the Thyroid Gland
Regarding the thyroid gland, which of the following statements is INCORRECT:
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Layers of the Sole of the Foot
A 65 year woman presents to ED with a laceration to her right foot. On further assessment, it is determined she has cut through the first la
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Clinical Effects of Spinal Accessory Nerve Lesion
A 35 year old woman presents to ED complaining of an inability to shrug her left shoulder or to turn her head to face the right side. The m
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Propofol: Indications
Which of the following is the most widely used intravenous anaesthetic in the UK:
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Function of the Obturator Nerve
A 43 year old window cleaner is brought to the ED after falling from a 5 metre platform. Imaging has shown multiple vertebral fractures and
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Positions of the Appendix
Which of the following best describes the attachment of the base of the appendix:
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Antimuscarinic Drugs: Side Effects
A 31 year old female patient presents to ED complaining of some symptoms she suspects are due to a drug that she has recently started. Her
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Cephalosporins: Pharmacology
Regarding cephalosporin antibiotics, which of the following statements is INCORRECT:
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Relative Fluid Distribution in Fluid Spaces
Which of the following fluid compartments contains the greatest volume of water:
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Right to Left Shunts in Physiology
Regarding right to left shunts, which of the following statements is CORRECT:
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Clinical Features of Legionnaires' Disease
A 45 year old, with a history of chronic alcohol abuse, attends ED complaining of a 10 day history of fever, persistent cough and shortness
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Innervation of the Parotid Gland
Sensory innervation of the parotid gland is provided by which of the following nerves:
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Function of the Spring Ligament
A 22 year old man has injured his right foot in an ice-skating accident. X-ray demonstrates an inferior displacement of the head of the tal
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Movements of the Shoulder Joint
A 35 year old woman was involved in a road traffic accident 8 weeks ago, where she suffered a fracture of the lateral border of the scapula.
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Neostigmine: Indications
Neostigmine is a reversal agent for which of the following class of drugs:
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Pharmacological Management of IBD
Regarding the management of ulcerative colitis, acute mild to moderate proctosigmoiditis should be treated initially with:
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Roots of the Pterygopalatine Ganglion
A 28 year old woman complains of dryness of the nose and the palate. A lesion is most likely affecting which of the following ganglia:
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Production and Function of Vitamin D
Regarding vitamin D, which of the following statements is CORRECT:
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Anatomy of the Thyroid Gland
Regarding the thyroid gland, which of the following statements is CORRECT:
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ALS Treatment Algorithm
A 65 year old patient who presented to ED with chest pain suddenly collapses in the waiting room. He is not breathing and has no pulse and y
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Routine Immunisation Schedule
Diphtheria, tetanus and polio vaccination is given at which of the following intervals in the UK routine childhood immunisation schedule:
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Blood Supply of the Heart
Which of the following best describes the territory of supply of the circumflex artery:
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Multiple Myeloma
A 65 year old woman presents with new-onset back pain. She is found to have osteopaenia, osteolytic lesions and vertebral collapse on radiol
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Metoclopramide: Side Effects
Which of the following is a well recognised adverse effect of metoclopramide:
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Clinical Features of Influenza
Regarding influenza, which of the following statements is INCORRECT:
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Function of Parathyroid Hormone
How does parathyroid hormone (PTH) affect renal handling of calcium:
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Control of the Defecation Reflex
When a person decides to defecate, all of the following actions occur EXCEPT for:
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Control of Gastric Acid Secretion
Secretion of hydrochloric acid from parietal cells is inhibited by all of the following hormones EXCEPT for:
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Lithium: Drug Interactions
Which of the following classes of drugs may predispose to lithium toxicity:
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Clinical Effects of Ulnar Nerve Injury
A 29 year old fell heavily while base-jumping and presents to ED with a painful right arm. X-ray shows a fracture of the medial epicondyle.
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Clinical Features of Anaphylaxis
Which of the following presentations is NOT consistent with the diagnosis of anaphylaxis following exposure to a known allergen:
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Immune Response
Regarding Class I major histocompatibility complex (MHC) molecules, which of the following statements is INCORRECT:
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Structure of the Juxtaglomerular Apparatus
The macula densa is located at which of the following sites:
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Obstructive vs Restrictive Lung Disease
A patient with known chronic liver disease and massive ascites presents to ED with worsening shortness of breath. Chest x-ray shows a pleura
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Mechanism of Vitamin B12 Absorption
Vitamin B12 is primarily absorbed in which part of the gastrointestinal tract:
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Innervation of the Gracilis Muscle
A 54 year old woman is brought into the ED following a multiple vehicle collision on the nearby motorway. She is haemodynamically stable and
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Measuring Spread using Standard Deviation
A range of two standard deviations above and below the mean includes what approximate percentage of the sample values:
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Ligaments of the Vertebral Column
Regarding the ligaments of the spinal column, which of the following statements is CORRECT:
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Lymphatic Drainage of the Penis
The lymphatics of the glans penis drain primarily to which of the following lymph nodes:
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Function of the Levator Palpebrae Superioris Muscle
Which of the following muscles is responsible for opening the eye:
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Anatomical Course of the Phrenic Nerve
A 31 year old male presents to ED with a penetrating wound to the neck. Imaging shows damage to the structure which runs down the neck on th
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Tetracyclines: Contraindications
Tetracycline antibiotics should be avoided in which of the following groups of patients:
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Clinical Effects of Ulnar Nerve Injury
An 18 year old gymnast presents to ED following a misjudged landing with an injury to her right upper limb. You perform a full examination o
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Phases of the Cardiac Cycle
In the ventricular ejection phase of the cardiac cycle, all of the following statements are true EXCEPT for:
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Central vs Peripheral Chemoreceptors
Regarding chemical control of respiration, which of the following statements is INCORRECT:
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Clinical Effects of Median Nerve Injury
A 24 year old carpenter presents to ED with an upper limb injury. He complains of weakness of flexion of the thumb, index and middle finger
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Contents of the Popliteal Fossa
A 26 year old male has sustained a stab wound to the popliteal fossa and has injured the most lateral structure within this region. Which o
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Factors affecting Airway Resistance
Regarding airway resistance, which of the following statements is CORRECT:
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Characteristics of Parainfluenza
Regarding parainfluenza virus, which of the following statements is INCORRECT:
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Clinical Effects of Tibial Nerve Injury
Which of the following clinical features would you NOT expect to see in a tibial nerve palsy:
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Borders of the Heart
The inferior border of the heart is formed predominantly by which of the following:
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Calculation of Positive Predictive Value
The results from the study investigating the accuracy of a new diagnostic test can be displayed in the following format. How is the positi
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