1. A 30-year-old female attends A&E following a head injury. You assess her on arrival and her GCS is 14. The nurse looking after the patient calls you back to see her 30 minutes later. The GCS is now 10, the patient has a blown pupil, is vomiting and confused. The bleeding is most likely to be from:
(Please select 1 option)

A. Basillar artery
B. Berry aneurysm
C. Intrinsic cerebral vessels
D. Middle meningeal artery
E. Sigmoid sinus

 

2. A 38-year-old female presents with colicky right upper quadrant pain and jaundice and has noted dark urine and pale stool for 3 days. She has had several previous episodes of pain associated with fatty meals and on admission, her bilirubin is 120 μmol/L (1-22) and alkaline phosphatase is 550 IU/L (45-105). The remainder of her LFTs are normal. What is the most likely diagnosis?

A. Choledocholithiasis
B. Gilbert’s syndrome
C. Pancreatic cancer
D. Primary sclerosing cholangitis
E. Viral hepatitis

 

3. A 42-year-old woman is seen in the endocrine clinic and following investigation is diagnosed with Conn’s syndrome. Which of the features listed below is a typical finding in the diagnosis?

A. Elevated renin
B. Hyperkalaemia
C. Hyperglycaemia
D. Reduced urinary potassium excretion
E. Metabolic alkalosis

 

4. The position of the ‘transpyloric plane of Addison’ is located at a point half way between the supra-sternal notch of the manubrium and the symphysis pubis. Which of the following is found at this level?

A. Bifurcation of the aorta
B. Entry of the ureters into the bladder
C. Origin of the superior mesenteric artery
D. Passage of the inferior vena cava through the diaphragm
E. Termination of the inferior mesenteric vein

 

5. A 23-year-old hairdresser presents with a history suggestive of subarachnoid haemorrhage on the emergency medical intake. A CT scan is carried out and this is normal. To exclude a bleed, a lumbar puncture is carried out by the medical registrar. After piercing the interspinous ligament with the spinal needle, which of the following is the next structure to be passed through (next deepest structure)?

A. Arachnoid mater
B. Dura mater
C. Ligamentum flavum
D. Spinal cord
E. Supraspinous ligament

 

6. A 17-year-old girl underwent emergency splenectomy after a domestic accident. Which one of the following organisms is most likely to cause life-threatening infection in the future?

A. Actinomycosis
B. Haemophilus influenzae
C. Pseudomonas aeruginosa
D. Staphylococcus aureus
E. Streptococcus pneumoniae

 

7. You are called urgently to the resuscitation area of A&E to see a 24-year-old male. He was attacked with an axe and has a wound on the back of the head, near to the vertex. The sinus most likely to have been penetrated is the:

A. Cavernous sinus
B. Sigmoid sinus
C. Superior petrosal sinus
D. Superior sagital sinus
E. Transverse sinus

 

8. A 65-year-old lady with a history of recurrent DVT. She has been weaned off her warfarin and started on intravenous heparin prior to cardiac bypass for ischaemic heart disease. She seems to require very high doses of heparin to achieve adequate anticoagulation especially during surgery.
Which of the following conditions would explain her thrombophilia and her heparin resistance?

A. Activated Protein C resistance
B. Antithrombin III deficiency
C. Lupus anticoagulant
D. Protein C deficiency
E. Protein S deficiency

 

9. A 72-year-old male presented to his GP with depression after the death of his wife. His notes also reveal that he has a two-year history of urinary hesitancy and poor stream. His GP prescribed him some medication and the following day he developed acute urinary retention. Which of the following drugs is most likely to have precipitated the urinary retention?

A. Amitriptyline
B. Diazepam
C. Fluoxetine
D. Venlafaxine
E. Zopiclone

 

10. During a vascular examination of the lower limb you attempt to assess the presence of a femoral pulse. What is the posterior relation of the femoral artery which you compress the artery against to feel its pulsation?

A. Femoral nerve
B. Iliac bone
C. Inguinal ligament
D. Psoas tendon
E. Symphysis pubis

 

11. You are in the weekly breast clinic and an anxious young lady whose mother is currently being treated for breast cancer in your unit asks you about the risk factors for developing breast cancer.

Which of the following has been linked with a significantly increased risk of breast cancer?

A.Breast feeding

B. Late menarcheIncorrect answer selected

C. Late menopause

D. Multiparity

E. Oophorectomy

 

12. A young mother is concerned regarding immunising her baby with ‘live’ viruses. Which of the following vaccines commonly given in childhood is a live virus?

A. DiphtheriaIncorrect answer selected

B. Haemophilus influenzae type b

C. Measles/Mumps/Rubella

D. Pertussis

E. Tetanus

 

13. A 38-year-old lady is admitted with cellulitis surrounding a traumatic wound. She has never taken penicillin previously. She is placed on intravenous flucloxacillin and benzylpenicillin. Shortly after the second dose she becomes acutely short of breath and collapses. She is resuscitated successfully after administration of intravenous adrenaline. What type of reaction has this lady experienced?

A. Type I hypersensitivity

B. Type II hypersensitivity

C. Type III hypersensitivity

D. Type IV hypersensitivity

E. Type V hypersensitivity

 

14. A 78-year-old lady with chronic venous ulcers is reviewed in clinic and is found to have a new nodule on the edge of the ulcer. This is biopsied and found to be malignant. What is the name given to this condition?

A. Bowens disease

B. Curling’s ulcer

C. Cushing’s ulcer

D. Marjolin’s ulcer

E. Rodent ulcer

 

15. Which of the following operations is likely to be associated with the highest rate of postoperative infection?

A. Abdominal hysterectomy

B. Cholecystectomy

C. Colonic surgeryIncorrect answer selected

D. Knee replacement

E. Limb amputationThis is the correct answer

 

16. A 50-year-old lady presents to the breast clinic complaining of a lump in her left breast which has appeared suddenly in the last 2 weeks. She reports suffering peri-menopausal symptoms. She has no significant past medical or family history. Examination reveals a well circumscribed fluctuant 1.5cm oval lump. What is the most likely diagnosis?

A. Breast cancer

B. Breast cyst

C. Fibroadenoma

D. Galactocele

E. Mondor’s disease

 

17. A 32-year-old male presents to the casualty department after being involved in a fight in a pub where glasses have been broken. He has sustained a deep laceration to the thenar eminence. Which of the following structures is most at risk in this type of injury?

A. Adductor pollicis muscle

B. First dorsal interosseus muscle

C. Flexor digiti minimi brevis

D. Opponens digiti minimi

E. Ulnar artery

 

18. Which of the following vertebrae has the most prominent spinous process?

A. T1

B. T2

C. C7

D. T11

E. T12

 

19. You are carrying out a pleural aspiration for a patient with a persisting post-operative effusion. Which of the following structures do you want the needle to avoid?

A. External intercostal muscle

B. Internal intercostal muscle

C. Parietal pleura

D. Tranversus thoracis muscle

E. Visceral pleura

 

20. A 55-year-old woman has undergone right mastacetomy with axillary node clearance. Post operatively, she complains of numbness on the medial surface of the upper arm. Which nerve has been damaged?

A. Axillary nerve

B. Intercostobrachial nerve

C. Long thoracic nerve

D. Medial pectoral nerve

E. Thoracodorsal nerve

 

21. Which is the principle root inervation for the small muscles of the hand?

A. C5

B. C6

C. C7

D. C8

E. T1

 

22. Which one of the following organs is in direct contact with the anterior surface of the left kidney, without being separated from it by peritoneum?

A. Duodenum

B. Jejunum

C. Pancreas

D. Spleen

E. Stomach

 

23. A 35-year-old man presents to A+E complaining of severe pain in his lower back after lifting a heavy box at work. The pain radiates to his right buttock and thigh. He has had no urinary symptoms. On examination he can straight leg raise to 90 degrees on the left side but only to 30 degrees on the right. Sciatic stretch test is positive. He has difficulty plantarflexing his right ankle and has abnormal sensation on the plantar aspect of the foot. His right ankle reflex is absent but all other reflexes are normal. There is no other sensory disturbance. The likely diagnosis is?

A. Cauda equina syndrome

B. L3/L4 disc prolapse

C. L4/L5 disc prolapse

D. L5/S1 disc prolapse

E. Old Shuerman’s disease

 

24. A 27-year-old man attends the fracture clinic. He suffered an anterior dislocation of his shoulder whilst playing rugby three days before. This has been successfully manipulated back into joint in the emergency department. Since then his arm has been in a broad arm sling. When you examine him in the fracture clinic, he is unable to abduct his shoulder and there is a numb patch over the lateral side of his arm. Which nerve has been affected?

A. Axillary nerve

B. Musculocutaneous nerve

C. Nerve to subscapularis

D. Radial nerve

E. Upper cord of brachial plexus

 

25. In an anatomy viva you identify the foramen magnum as the largest of the skull’s foramina. Which of the following structures passes through the foramen magnum?

A. The glossopharyngeal nerves

B. The hypoglossal nerves

C. The internal carotid arteries

D. The vagus nerves

E. The vertebral arteries