A 72 year old man presents with progressive breathlessness and wheeze over several years. He has a 50-pack year smoking history. A CT scan of his chest identifies that he has severe pulmonary emphysema.

Which part of the respiratory tract is most likely to be affected?

A 62 year old man undergoes urgent open abdominal aortic aneurysm repair. The aneurysmal sac is seen at laparotomy to extend proximally to the diaphragmatic crura.

What major blood vessel crosses the aorta and will need dividing (cutting) in this situation?

A mother notices that when her 3 month old boy is passing urine, it emerges from half-way down the inferior surface of the shaft of the penis. She consults her GP, who makes a diagnosis of hypospadias.

What hormone normally stimulates the development of the male external genitalia from the common embryological structures?

A 63 year old man is admitted to hospital in the small hours of the morning with acute severe breathlessness. He has a history of two previous myocardial infarctions. On examination he is pale, cyanosed and sweaty, with a low volume pulse. His blood pressure is 105/65 mmHg. He has coarse bilateral basal lung crackles. An arterial blood gas analysis whilst breathing 35% oxygen shows: pH 7.29 (7.36 - 7.44) PaO 9.5 kPa (11.3 - 12.6) PaCO 3.3 kPa (4.7 - 6.0) HCO 18 mmol/L (24 - 28).

What disturbance has led to acidosis?

A 19 year old student is about to perform a bungee jump during her gap year travels. The anxiety produces a potent sympathetic nervous system response.

What is the main neurotransmitter released by the post-ganglionic sympathetic neurones?

A 35 year old woman attends for review two weeks after laparotomy to remove a benign ovarian cyst. Although initially there was some superficial wound infection, the incision is now beginning to heal.

What cell type is the most important at this stage in the wound healing process?

A 45 year old woman with known gallstones develops abdominal pain and vomiting. After examination, a clinical diagnosis of cholecystitis is made.

In which abdominal region would you expect to find maximal tenderness on palpation?

A 46 year old man is diagnosed with primary hypertension, for which he is started on treatment with an ACE inhibitor.

What is the main mechanism by which an ACE inhibitor reduces blood pressure?

A woman in the third trimester of pregnancy, asks her doctor how her baby would be screened for cystic fibrosis once it is born.

How would the doctor respond?

A 37 year old woman presents to her GP with menorrhagia. Investigations show her to be significantly anaemic, with a haemoglobin concentration of 71 g/L (normal 120-150). She has noticed that she has been unable to exercise normally in the gym for the last few weeks because of breathlessness.

What best explains her limited exercise capacity?

A 74 year old woman who lives in a nursing home is due to be admitted for a total knee replacement. As part of her preoperative screening she has tests done to identify if she is a carrier of methicillin-resistant staphylococcus aureus (MRSA).

Where is the most likely site to be colonised with MRSA?

A 29 year old woman is undergoing investigation of infertility after 3 years of unsuccessful attempts to conceive. Tests show her to have a low ovarian reserve.

At what stage of life do the ovaries contain the greatest number of oocytes?

.A 47 year old man presents with a 3 month history of severe upper abdominal pain radiating through to the back. For many years he has had very high levels of alcohol consumption. After investigations, a diagnosis of chronic pancreatitis is made.

What gastrointestinal process will be most affected by this condition?