Brian is a 65 year old Type 2 Diabetic. He is brought into A&E after being found collapsed at home with decreased consciousness. His eyes open with sternal rub, he is making groaning noises and his hand localize to yours when you try trapezius squeeze. What is his GCS?

Sita, 72 presents to her GP with bilateral leg oedema, nocturnal dyspnoea and worsening SoB. Her BNP is 3400. She is diagnosed with heart failure. Which of the following medications should be started? (select 3 answers)

Mario, 61 is referred for spirometry after complaining of chronic SoB. Does this show an obstructive or restrictive picture of respiratory disease?

Esmée is admitted to A&E very SoB and cyanosed. An ABG shows:

pH - 7.29 (7.35-7.45)

pO2 - 6.5 (>11)

pCO2 - 7.2 (3.5-6.0)

Lactate 1.2 (<1.5)

HCO3 27 (22-28)

What is the interpretation of the ABG?

You are asked to examine Cheun, 43 in A&E. You find he has RR26, O2 sats 91%, HR 110, Temp 36.2. The chest is clear with equal air entry bilaterally. It is resonant to percussion. Which of the following is the most likely diagnosis based on these findings?

Munir, 79, comes into his GP complaining of dizziness. His GP refers him for a lying-standing blood pressure. His lying BP is 136/87

Which of the following standing readings would indicate a postural drop?

Jukka-Pekka, 45, presents with sudden cramping pain in the right side. On examination, you note that his sclera are jaundiced, he is very tender to touch in the abdomen and his temperature is 38.6, BP 95/50, HR 110. What is the most likely diagnosis?

Piotr, 91 is admitted with severe abdominal pain, which came on quite suddenly. He has not passed stool in 5 days. What is the most significant diagnosis on this X-ray?

Ayo, 80, attends her annual GP check. She reports she feels well, with no symptoms to report. Her blood pressure is raised at 156/98. Her eGFR is found to be 19, with a creatinine of 186. Her last check, the year before, showed an eGFR of 32 and creatinine of 130. What is the most likely diagnosis?

Myla, a 19 year old student is referred to a GI specialist to diagnose a 2 month history of abdominal pain, weight loss and bloody stools. She undergoes a colonoscopy, showing large patches of thick, cobblestone appearance of inflammation throughout the colon. A biopsy finds transmural thickness inflammation with non-caseating granulomas. What is her diagnosis?

Anya, a 62 year old professor attends her GP after being diagnosed with T2DM. She has been reading up on her condition on the internet and wants to know what the best measure of the current control of her diabetes is. How will you answer?

Nadia, 64, presents to A&E after tripping over a rug at 9:15am. She banged her head on the radiator on the way down. It is now 11:30am. Which of the following is NOT an indication for CT head?

Barry, 77, is referred to a cardiologist with worsening episodes of angina, SoB on exertion. On examination, he has a slow rising pulse. His BP is 103/99. He also reports episodes of dizziness when he walks more than 20 yards. What murmur are you likely to hear?

Khalil, 71 attends his GP with shortness of breath, R sided crackles and a temperature of 38.6. He has a RR of 32. His blood pressure is 88/49 and HR is 110. He is oriented. His GP uses point of care testing to check his bloods - WCC 21.4, CRP 220, urea 6.9, creatinine 310.

How should Khalil be managed?

Levi, 24 attends A&E with SoB and coughing up sputum, feeling very unwell. He has a background of Cystic Fibrosis. He has R basal crackles, HR 125, BP 88/50, Temp 39.2, RR 36, sats 98% on O2. Which of the following should be done first?

Ricardo, 78 comes to his GP complaining of SoB and coughing up green sputum the last 2 weeks. He has a background of longstanding COPD. He has RR22, O2 92%, HR 88, BP110/80, Temp 37.6. He has a penicillin allergy. Which of the following is the best management plan?

Sheila is admitted to A&E with crushing central chest pain and ST elevation on leads V1-5. Which of the following is the most appropriate prescription for pain relief this situation?

Yvonne, 55, presents with a six month history of severe abdominal bloating and cramps, fatigue and 7kg wt loss. There has been no blood in stools. She also has mouth ulcers and recent tests show low ferritin/transferrin. She has recently been diagnosed with hypothyroidism. Which of the test is most diagnostic for the most likely diagnosis?

Ansley, 76, presents to her GP with a concerning tremor. She says she has noticed for about a year now, and it bothers her because she is often spilling her cup of tea in a morning. She has noticed that the tremor is eased with alcohol. She has BG COPD. She reports no other symptoms and is still able to mobilise well. Which is the most likely cause of the tremor?

Svetlana, 68, is brought to A+E by ambulance after sudden onset left side arm and leg weakness. She reports this was happening whilst she was walking into the kitchen 2hrs ago. Clinical diagnosis of a stroke is made. Patient is otherwise mostly well, takes amlodipine for HTN. All bloods and obs are currently within normal ranges.

Which investigation should be performed next?

Berenice, 84, attends her GP practice as she has suddenly gone dizzy and is staggering to one side when walking. Berenice has a background of hypertension and type 2 diabetes. What is the most likely diagnosis?

Aphrodite, 67, has presented to her GP with headache. It occurs predominantly on the left, and has been getting progressively more severe and more frequent over a few months and now occurs every day. There is no diurnal variation. She often gets pain in her jaw when chewing food, and finds it is extremely tender to brush her hair. More recently she has been feeling generally washed out and fatigued, which is abnormal for her. She has come to her GP concerned regarding an episode of loss of vision in her left eye which lasted for a few hours before resolving.

Which investigation would be most suggestive of the most likely diagnosis?

Chinua, 27, has been brought to A&E after a collapse on a night out. His friends did not see him collapse, but they found him in the bathroom unconscious and called an ambulance.

On examination, he is drowsy and disorientated, but opens his eyes to voice. There is no focal neurology. He appears to have bitten his tongue, and on abdominal examination you notice that he has been incontinent of urine.

He has no known past medical history. His mother has type 2 diabetes and his sister suffers from migraines.

What is the most likely cause of his loss of consciousness?

Antonio, 83, gentleman has presented to the GP for a review. He suffered from a right sided partial anterior circulation stroke (PACS) 6 months ago, and has some residual symptoms. His other past medical history includes type 2 diabetes, hypercholesterolaemia, and hypertension.

Which of the following is the most likely finding on neurological examination?

Amrita, 77, presents to her GP with movement problems. She feels that her legs are weak and has been experiencing increasing falls. She believes her memory is not quite what it used to be, but puts this down to age.

She has a past medical history of hypertension, alcohol abuse, osteoarthritis, ischaemic heart disease, and age related macular degeneration.

On examination, she has a festinating gait and a right sided 3-5Hz resting pill-rolling tremor of the hand with tone increased throughout movement. The left hand is normal.

What is the most likely diagnosis?

Busarakham, 52, has presented to A&E with loss of consciousness following collapse. Her husband gives the admitting doctor a history of severe, sudden onset of headache which the patient initially described as the worst headache she had ever experienced.

This was followed by nausea, vomiting, and a decreasing level of consciousness. On examination, she has a GCS of 6 with a patent airway. Her cardiorespiratory examination is normal, but further neurological examination is not possible.

What is the most likely diagnosis?

Hirohito, 70, has presented to his GP with numbness in both his feet. He has problems with heat sensation and is stumbling over steps. He sees practice nurse to care for some heel ulcers.

He has no weight loss, fevers, or back pain and his bladder and bowel function is normal. On examination, he has reduced light touch, pain, temperature, vibration & proprioception to the knees bilaterally. There is also some reduced vibration and sharp-dull discrimination in the fingers. He has 5/5 power in all muscle groups bilaterally.

His past medical history includes type 2 diabetes, chronic kidney disease, and hypertension.

Where is the most likely location of the lesion?

Isapoinhkyaki, 75, visits her GP complaining of problems with her vision. She feels that over the past month she is seeing colours less brightly, and is finding it difficult to recognise faces. This seems to be happening mainly in her right eye. There’s been no pain associated with this. She has a past medical history of diabetes for which she takes metformin, and hypertension for which she takes amlodipine.

On fundoscopy there is loss of red reflex of the right eye, and the lens appears white in colour, but there are no intra-orbital abnormalities. Left eye examination is normal.

What is the most likely diagnosis?

What is the condition?

What is the condition?