A 58-year-old main with known chronic obstructive pulmonary disease (COPD), diagnosed eight months ago, attends your clinic with persistent shortness of breath despite stopping smoking. He is also using his salbutamol inhaler (given upon diagnosis) more frequently than before. His lung function tests shows FEV1 = 65% of the predicted value. His oxygen saturation is 95% on room air, respiratory rate (RR) is 18 breaths per minute and his temperature is 37.1⁰C.

A 56-year-old man presents with a 2 week history of diarrhoea which has not settled following an episode of “food poisoning”.

A 19-year-old woman collapses at a concert and is witnessed to have a tonic-clonic seizure lasting 2 minutes. When the paramedics arrive and ask her questions, she mumbles but no-one can understand what she is saying. Only when the paramedics applies pressure to her nail bed she opens her eyes and reach out with her other hand to rub her nail and then pushes him away.

From the list below select her Glasgow Coma Scale (GCS).

A 52-year-old man presents to accident and emergency unit after collapsing at home. He appears pale with cold extremities. Blood pressure (BP) is 97/73mmHg, heart rate (HR) is 110 beats per minute, temperature is 36.9⁰C and his electrocardiogram (ECG) shows normal findings. Blood culture and urine culture are negative for any findings. He reports returning from a weekend break in Langkawi, but forgot to take his medications for his active systemic lupus erythematosus (SLE) with him.

A diabetic patient presented to his general practitioner complaining of seeing double. On examination the doctor noted a drooping upper eyelid of the right eye. The eye itself looked laterally and downward. The pupil was unreactive to light. Which cranial nerve is most likely affected?

A 26-year-old had fever, headache and severe abdominal pain and vomiting for past 3 days. On examination, his GCS was 15 and he was febriled at 38° C. White blood cell count (WBC) was low together with a reduced platelet count. What investigation would be most helpful towards reaching a diagnosis?

An elderly woman with known congestive heart failure presents with severe dyspnoea at rest. The most appropriate treatment at this stage would beAngiotension

A 73-year-old woman with rheumatoid arthritis on methotrexate treatment presented with malaise and fever associated with chills and rigor. Her right wrist was very warm, red and swollen. What is the likely cause for the lesion on her wrist?

A 17-year-old student is brought in by ambulance

complaining of severe shortness of breath. He is known to be asthmatic and

takes salbutamol and beclometasone regularly. This is his first hospital

admission with an acute asthma attack.

A 64-year-old man is brought into the Emergency Department in a confused and agitated state. His wife states that over the last month he has lost a considerable amount of weight and has complained of increasing fatigue. He also has been passing water far more frequently recently and has started to take a jug of water to bed at night. His routine blood tests are returned as:

Sodium 150 mmol/l Potassium 5 mmol/l

Creatinine 105 µmol/l Urea 9 mmol/l

Calcium 2.5 mmol/l Albumin 45 g/l

Glucose 27 mmol/l Chloride 90 mmol/l

CRP 5 mg/l

A 43-year-old man with underlying diabetes mellitus presented to the hospital 4 hours after developing sudden shortness of breath and sweating. His electrocardiogram is shown above. Select the gold standard management for this patient.

An elderly man presented to the ward with painful swelling of the right wrist and elbow for 3 days duration. He was unable to move the joints due to severe pain. He had similar encounter 5 months ago after consuming a few cans of beer during a party. Examination revealed inflamed right wrist and elbow with reduced range of movements. There was no neurological deficit and any other significant findings.

A 65-year-old man with underlying end stage renal disease on haemodialysis presented to emergency department with severe vomiting, confusion and twitching of his muscles. On examination of the cardiorespiratory system, percussion revealed stony dullness on both lower zones of his chest and pericardial rub on auscultation of the praecordium. His blood investigations are as below:

Blood urea 48 mmol/L

Serum Sodium 128 mmol/L

Serum Potassium 5.9 mmol/L

Creatinine 649 umol/L

A 48-year-old man with underlying hyperlipidaemia presented to emergency department with 2 hours duration of central chest pain. His vital signs were stable. His electrocardigram showed T waves inversion in leads II, III and AVF. Troponin-T came back normal.