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WorksheetsGEM Module 3 Mock
Total questions: 100
Worksheet time: 2hrs 40mins
Name
Class
Date
1.
A 55-year-old man is diagnosed with lung cancer. During a surgical procedure, he suffers an injury to a nerve that hooks under the arch of the aorta. Which of the following findings is most likely on examination?
a)
Weakness of the trapezius muscle
b)
Hoarseness of voice and dysphagia
c)
Inability to shrug the shoulders
d)
Winged scapula
e)
Diaphragmatic paralysis
2.
A medical student is revising the embryological origins of heart structures. Which of the following adult structures is derived from the sinus venosus?
a)
Trabeculated part of the left ventricle
b)
Ascending aorta
c)
Mitral valve
d)
Smooth posterior wall of the right atrium
e)
Muscular interventricular septum
3.
During a tutorial on aortic arch derivatives, a student is asked about the fate of the fourth pharyngeal arch artery. Which of the following is the correct paired derivative?
a)
Left: Arch of the aorta; Right: Proximal right subclavian artery
b)
Left: Ductus arteriosus; Right: Degenerates
c)
Left: Common carotid artery; Right: Common carotid artery
d)
Left: Degenerates; Right: Arch of the aorta
e)
Left: Proximal left subclavian; Right: Ductus arteriosus
4.
A newborn is diagnosed with a post-ductal coarctation of the aorta. Which of the following classic signs is most likely to be found on physical examination?
a)
Cyanosis of the lower limbs
b)
Radio-femoral delay
c)
Loud, single second heart sound
d)
Mid-diastolic murmur
e)
Pansystolic murmur at the apex
5.
Which of the following structures is the postnatal remnant of the umbilical vein?
a)
Ligamentum arteriosum
b)
Ligamentum venosum
c)
Medial umbilical ligaments
d)
Ligamentum teres
e)
Fossa ovalis
6.
A 25-year-old athlete has a resting heart rate of 45 bpm and a stroke volume of 120 mL. What is his approximate cardiac output?
a)
4.0 L/min
b)
5.4 L/min
c)
6.0 L/min
d)
6.8 L/min
e)
7.2 L/min
7.
A patient with a history of hypertension has a blood pressure reading of 170/100 mmHg. What is his calculated mean arterial pressure (MAP)?
a)
113 mmHg
b)
123 mmHg
c)
135 mmHg
d)
140 mmHg
e)
157 mmHg
8.
A 60-year-old man with heart failure is found to have elevated levels of B-type natriuretic peptide (BNP). From which cardiac cells is BNP primarily secreted?
a)
Atrial myocytes
b)
Sino-atrial (SA) node cells
c)
Ventricular myocytes
d)
Coronary artery endothelial cells
e)
Purkinje fibres
9.
Which of the following best describes the primary mechanism of increased coronary blood flow during exercise?
a)
Sympathetic alpha-adrenergic mediated vasoconstriction
b)
A sharp rise in diastolic blood pressure
c)
Metabolic hyperaemia due to local vasodilators
d)
A significant increase in systolic blood pressure
e)
Parasympathetic vasodilatory signals
10.
According to the Starling forces, which of the following changes would most directly promote the formation of peripheral oedema?
a)
A decrease in interstitial hydrostatic pressure (Pi)
b)
An increase in plasma oncotic pressure (πc)
c)
A decrease in capillary hydrostatic pressure (Pc)
d)
An increase in capillary hydrostatic pressure (Pc)
e)
A decrease in interstitial oncotic pressure (πi)
11.
During heavy exercise, what is the approximate percentage of cardiac output directed to skeletal muscle?
a)
0.1
b)
0.21
c)
0.4
d)
0.71
e)
0.85
12.
The Frank-Starling mechanism describes the relationship between:
a)
Heart rate and cardiac output
b)
Afterload and stroke volume
c)
End-diastolic volume and stroke volume
d)
Sympathetic tone and contractility
e)
Blood pressure and peripheral resistance
13.
What is the primary ion channel responsible for the pacemaker potential (phase 4 depolarization) in the SA node?
a)
Rapid Sodium Channels (Naᵥ1.5)
b)
L-type Calcium Channels
c)
Funny Channels (HCN)
d)
Inward Rectifier Potassium Channels (K₁)
e)
Transient Outward Potassium Channels (Iₜₒ)
14.
A patient has a pathological condition that leads to a significant decrease in plasma oncotic pressure (πc). According to Starling forces, what is the most likely consequence?
a)
Increased reabsorption of fluid from the interstitium
b)
Decreased filtration of fluid into the interstitium
c)
Peripheral oedema
d)
Pulmonary vasoconstriction
e)
Increased lymph flow
15.
In the cardiac action potential of a ventricular myocyte, which phase is primarily responsible for the plateau?
a)
Phase 0: Rapid upstroke
b)
Phase 1: Early repolarization
c)
Phase 2: Plateau
d)
Phase 3: Repolarization
e)
Phase 4: Resting membrane potential
16.
A 70-year-old man with atrial fibrillation and a history of a mechanical heart valve is prescribed warfarin. What is the primary mechanism of action of this drug?
a)
Direct inhibition of factor Xa
b)
Inhibition of vitamin K epoxide reductase
c)
Direct inhibition of thrombin (Factor IIa)
d)
Activation of antithrombin III
e)
Inhibition of ADP receptors on platelets
17.
A 58-year-old woman with heart failure with reduced ejection fraction (HFrEF) is started on a medication. Two weeks later, she develops a persistent, dry cough. Which medication is most likely responsible?
a)
Bisoprolol
b)
Spironolactone
c)
Lisinopril
d)
Furosemide
e)
Digoxin
18.
A patient with stable angina uses a sublingual spray for acute chest pain relief. The spray provides rapid venodilation, reducing preload and myocardial oxygen demand. Which drug class does this spray belong to?
a)
Beta-blockers
b)
Calcium channel blockers
c)
Organic nitrates
d)
Sodium channel blockers
e)
Potassium channel openers
19.
A patient with a history of myocardial infarction is prescribed a "beta-blocker" for secondary prevention. What is the primary electrophysiological effect of this drug class on the SA node?
a)
Blockade of L-type calcium channels
b)
Blockade of fast sodium channels
c)
Activation of the funny current (If)
d)
Blockade of beta-1 adrenoceptors
e)
Opening of potassium channels
20.
A 45-year-old man is started on amiodarone for recurrent ventricular tachycardia. Which of the following is a serious long-term adverse effect associated with this drug?
a)
Torsades de Pointes
b)
Pulmonary fibrosis
c)
Systemic lupus erythematosus
d)
Agranulocytosis
e)
Hepatitis
21.
Which of the following medications is used to maintain patency of the ductus arteriosus in a neonate with a duct-dependent congenital heart lesion?
a)
Indomethacin
b)
Prostaglandin E1
c)
Ibuprofen
d)
Captopril
e)
Spironolactone
22.
A patient with hypercholesterolaemia is prescribed atorvastatin. What is the primary mechanism by which this drug lowers plasma LDL cholesterol?
a)
Inhibition of cholesterol absorption in the jejunum
b)
Inhibition of HMG-CoA reductase
c)
Binding of bile acids in the intestine
d)
Activation of lipoprotein lipase
e)
Inhibition of PCSK9
23.
A patient with deep vein thrombosis (DVT) is started on a drug that directly inhibits Factor Xa. Which of the following is most likely?
a)
Warfarin
b)
Enoxaparin
c)
Dabigatran
d)
Rivaroxaban
e)
Clopidogrel
24.
A patient with HFrEF is initiated on a new medication that combines a neprilysin inhibitor with an ARB. Which of the following is this drug?
a)
Valsartan
b)
Sacubitril/Valsartan
c)
Enalapril
d)
Spironolactone
e)
Ivabradine
25.
Which antiarrhythmic drug is a Class 1C agent, has slow dissociation from sodium channels, and is contraindicated in patients with structural heart disease due to pro-arrhythmic risk?
a)
Lidocaine
b)
Amiodarone
c)
Flecainide
d)
Sotalol
e)
Adenosine
26.
A patient is prescribed Ticagrelor. What is its mechanism of action?
a)
Irreversible inhibition of cyclooxygenase-1 (COX-1)
b)
Irreversible blockade of the P2Y12 ADP receptor
c)
Reversible blockade of the P2Y12 ADP receptor
d)
Blockade of glycoprotein IIb/IIIa receptors
e)
Inhibition of phosphodiesterase
27.
A patient with a STEMI is treated with a fibrin-specific thrombolytic agent with a half-life of 5 minutes. Which drug is this?
a)
Streptokinase
b)
Alteplase (tPA)
c)
Tenecteplase
d)
Heparin
e)
Aspirin
28.
Which of the following drugs used for angina acts by selectively blocking the funny current (If) in the SA node to reduce heart rate without affecting contractility?
a)
Bisoprolol
b)
Verapamil
c)
Ivabradine
d)
Isosorbide mononitrate
e)
Amlodipine
29.
A patient on Digoxin for heart failure presents with nausea, confusion, and yellow vision. What is the most important electrolyte to check, as an abnormality can potentiate this toxicity?
a)
Sodium
b)
Potassium
c)
Calcium
d)
Magnesium
e)
Chloride
30.
According to NICE guidelines, which first-line antihypertensive is recommended for a patient under 55 years who is not of Black African or Caribbean family origin?
a)
Calcium Channel Blocker (e.g., Amlodipine)
b)
Thiazide-like diuretic (e.g., Indapamide)
c)
ACE Inhibitor (e.g., Ramipril)
d)
Beta-blocker (e.g., Bisoprolol)
e)
Alpha-blocker (e.g., Doxazosin)
31.
A 2-day-old newborn develops cyanosis. Echocardiography reveals that the aorta arises from the right ventricle and the pulmonary artery from the left ventricle. What is the most likely diagnosis?
a)
Tetralogy of Fallot
b)
Transposition of the Great Arteries
c)
Tricuspid Atresia
d)
Total Anomalous Pulmonary Venous Return
e)
Persistent Truncus Arteriosus
32.
A 50-year-old man with long-standing hypertension presents with a sudden tearing chest pain radiating to his back. A CT angiogram confirms a diagnosis of aortic dissection. What is the most common underlying histopathological finding in the aorta of such patients?
a)
Atherosclerotic plaque rupture
b)
Cystic medial degeneration
c)
Hyaline arteriolosclerosis
d)
Fibrinoid necrosis
e)
Hyperplastic arteriolosclerosis
33.
A premature newborn is found to have a patent ductus arteriosus (PDA). Which pharmacological treatment is first-line to promote closure?
a)
Prostaglandin E1
b)
Indomethacin
c)
Furosemide
d)
Spironolactone
e)
Captopril
34.
A 65-year-old man with a history of smoking presents with intermittent claudication. The ankle-brachial pressure index (ABPI) is measured. Which value would confirm a diagnosis of peripheral arterial disease?
a)
1.2
b)
1
c)
0.9
d)
0.8
e)
0.7
35.
A 40-year-old woman presents with dyspnoea and is found to have a fixed, split second heart sound (S2). Echocardiography shows a left-to-right shunt at the atrial level. What is the most likely diagnosis?
a)
Ventricular Septal Defect (VSD)
b)
Atrial Septal Defect (ASD)
c)
Patent Ductus Arteriosus (PDA)
d)
Tetralogy of Fallot
e)
Aortic Stenosis
36.
A 10-day-old baby presents with collapse, metabolic acidosis, and absent femoral pulses. Which congenital heart lesion is most likely?
a)
Transposition of the Great Arteries
b)
Tetralogy of Fallot
c)
Coarctation of the Aorta
d)
Large Ventricular Septal Defect
e)
Eisenmenger's syndrome
37.
A patient with infective endocarditis develops a new, loud, pansystolic murmur. The murmur is best heard at the apex and radiates to the axilla. Which valve is most likely affected?
a)
Aortic Valve
b)
Pulmonary Valve
c)
Tricuspid Valve
d)
Mitral Valve
e)
All of the above
38.
Which of the following is a key pathological feature of malignant hypertension?
a)
Hyaline arteriolosclerosis
b)
Fibrinoid necrosis and hyperplastic arteriolosclerosis
c)
Fatty streaks
d)
Medial calcification
e)
Atheromatous plaques
39.
A patient with Tetralogy of Fallot has a "tet spell". What is the underlying physiological mechanism for the acute increase in cyanosis during these spells?
a)
Increased left-to-right shunt
b)
Infundibular spasm increasing right-to-left shunt
c)
Closure of the ventricular septal defect
d)
Development of pulmonary hypertension
e)
Onset of atrial fibrillation
40.
A 70-year-old man with a history of extensive atherosclerosis suffers a sudden cardiac death. At autopsy, a large transmural infarction is found in the anterior wall of the left ventricle and the anterior two-thirds of the interventricular septum. Which coronary artery was most likely occluded?
a)
Right Coronary Artery (RCA)
b)
Left Anterior Descending (LAD) artery
c)
Left Circumflex (LCx) artery
d)
Posterior Descending Artery (PDA)
e)
Left Main Stem
41.
Which of the following congenital heart defects results from the failure of the conotruncal ridges to spiral during development?
a)
Atrial Septal Defect
b)
Ventricular Septal Defect
c)
Patent Ductus Arteriosus
d)
Transposition of the Great Arteries
e)
Coarctation of the Aorta
42.
A 60-year-old patient with heart failure has a ventricular gallop (S3) on auscultation. What does this finding typically indicate?
a)
Atrial contraction against a stiff ventricle
b)
Rapid ventricular filling in a dilated ventricle
c)
Aortic valve stenosis
d)
Mitral valve prolapse
e)
Pericardial knock
43.
According to the NICE guidelines, what is the recommended duration of antibiotic treatment for acute uncomplicated cystitis?
a)
1 day
b)
3 days
c)
5 days
d)
7 days
e)
10 days
44.
Which of the following is a core mechanism of antibacterial resistance involving the acquisition of an altered penicillin-binding protein (PBP-2a)?
a)
ESBL production
b)
MRSA
c)
Efflux pump upregulation
d)
Porin loss
e)
Target site modification in VRE
45.
A qualitative research study explores the lived experience of patients after a myocardial infarction. Which methodological approach is most appropriate for this aim?
a)
Randomised Controlled Trial
b)
Systematic Review
c)
Semi-structured interviews
d)
Cohort Study
e)
Lab-based experiment
46.
In the context of qualitative research, what does the term "saturation" refer to?
a)
The point at which statistical power is achieved.
b)
The point at which no new themes or concepts are emerging from the data.
c)
The full immersion of the researcher in the field.
d)
The point when all potential participants have been recruited.
e)
The achievement of a high response rate.
47.
Which of the following is one of the four pillars of medical ethics?
a)
Consent
b)
Confidentiality
c)
Autonomy
d)
Capacity
e)
Negligence
48.
A 16-year-old patient with type 1 diabetes is admitted with ketoacidosis. She has capacity but refuses life-saving insulin therapy. What is the most appropriate immediate action?
a)
Respect her autonomy and withhold treatment.
b)
Administer insulin under the Mental Capacity Act.
c)
Seek a court order to mandate treatment.
d)
Involve the hospital legal team immediately.
e)
Attempt to explore her reasons and persuade her, involving her parents if she consents.
49.
A doctor discovers that a patient with newly diagnosed epilepsy is a bus driver and continues to drive. The patient refuses to inform the Driver and Vehicle Licensing Agency (DVLA). What is the doctor's primary duty?
a)
Respect patient confidentiality absolutely.
b)
Inform the DVLA immediately without telling the patient.
c)
Encourage the patient to inform the DVLA and document this advice.
d)
Inform the patient's employer directly.
e)
Take no action as the patient is responsible.
50.
For valid consent to be given, which of the following is NOT a required element?
a)
The consent must be given voluntarily.
b)
The patient must have capacity.
c)
The consent must be in writing.
d)
The patient must be informed.
e)
The patient must understand the information.
51.
A 55-year-old man is admitted with central chest pain. His ECG shows ST elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
a)
Left Anterior Descending (LAD)
b)
Left Circumflex (LCx)
c)
Right Coronary Artery (RCA)
d)
Left Main Stem
e)
Posterior Descending Artery (PDA)
52.
A 70-year-old woman presents with fast, irregularly irregular narrow-complex tachycardia on her ECG. There are no discernible P waves. What is the most likely diagnosis?
a)
Atrial Flutter
b)
Atrial Fibrillation
c)
Ventricular Tachycardia
d)
Sinus Tachycardia
e)
Multifocal Atrial Tachycardia
53.
A patient's ECG shows a PR interval that progressively lengthens until a QRS complex is dropped. This cycle then repeats. What is this rhythm?
a)
First-degree AV block
b)
Second-degree AV block, Mobitz type I (Wenckebach)
c)
Second-degree AV block, Mobitz type II
d)
Third-degree (complete) AV block
e)
Sinus arrhythmia
54.
Which of the following Vaughan-Williams class of antiarrhythmic drugs works primarily by blocking potassium channels, thereby prolonging the action potential duration and refractory period?
a)
Class I
b)
Class II
c)
Class III
d)
Class IV
e)
Class V
55.
A patient with a wide-complex tachycardia is diagnosed with Ventricular Tachycardia (VT). What is the most important initial principle of management?
a)
Always assume it is SVT with aberrancy.
b)
Treat with Verapamil.
c)
Always assume it is VT until proven otherwise.
d)
Apply vagal manoeuvres first.
e)
Wait for cardiology review before acting.
56.
A 60-year-old man with heart failure is prescribed Digoxin. What is its primary positive inotropic mechanism of action?
a)
Beta-1 adrenoceptor agonism
b)
Inhibition of phosphodiesterase
c)
Inhibition of Na+/K+ ATPase
d)
Blockade of angiotensin II
e)
Opening of potassium channels
57.
Which of the following is a key compensatory mechanism in the early stages of heart failure that later becomes maladaptive?
a)
Release of Natriuretic Peptides
b)
Activation of the Renin-Angiotensin-Aldosterone System (RAAS)
c)
Production of Nitric Oxide (NO)
d)
Vagal stimulation
e)
Coronary vasodilation
58.
A patient with heart failure has a low ejection fraction (HFrEF). Which drug class, when started at a very low dose, has a mortality benefit by up-regulating beta-receptors and reducing sympathetic toxicity?
a)
ACE Inhibitors
b)
Beta-blockers
c)
Loop Diuretics
d)
Digoxin
e)
Nitrates
59.
What is the primary site of action of Furosemide in the nephron?
a)
Proximal Convoluted Tubule
b)
Thin Descending Limb of Loop of Henle
c)
Thick Ascending Limb of Loop of Henle
d)
Distal Convoluted Tubule
e)
Collecting Duct
60.
A patient with chronic kidney disease and hyperkalaemia should avoid which of the following antihypertensive drug classes?
a)
Loop Diuretics
b)
Calcium Channel Blockers
c)
ACE Inhibitors
d)
Thiazide Diuretics
e)
Alpha-blockers
61.
A 45-year-old man has a blood pressure of 145/95 mmHg. He has no other comorbidities. According to NICE guidelines, what is the stage of his hypertension?
a)
Normal
b)
Elevated
c)
Stage 1 Hypertension
d)
Stage 2 Hypertension
e)
Hypertensive Crisis
62.
Which of the following is a modifiable risk factor for Peripheral Arterial Disease (PAD)?
a)
Age
b)
Male Sex
c)
Family History
d)
Smoking
e)
Ethnicity
63.
The QRISK3 calculator is used to estimate what?
a)
10-year risk of a cardiovascular event
b)
5-year risk of cancer
c)
1-year risk of mortality
d)
30-day risk of post-operative complications
e)
Lifetime risk of diabetes
64.
A patient with PAD and an LDL cholesterol of 4.5 mmol/L is started on high-intensity statin therapy. What is the target reduction in LDL-C or the target level for very high-risk patients?
a)
Reduce by 10% or target < 3.0 mmol/L
b)
Reduce by 30-40% or target < 1.8 mmol/L
c)
Reduce by 50% or target < 2.0 mmol/L
d)
No specific target, any reduction is beneficial
e)
Normalise HDL levels
65.
Which of the following is the most sensitive diagnostic test for Peripheral Arterial Disease?
a)
Femoral pulse palpation
b)
Ankle-Brachial Pressure Index (ABPI) < 0.9
c)
Presence of intermittent claudication
d)
Capillary refill time
e)
Skin temperature
66.
A 75-year-old woman with PAD is prescribed Clopidogrel. What is its mechanism of action?
a)
Irreversible inhibition of COX-1
b)
Irreversible blockade of the P2Y12 ADP receptor
c)
Reversible blockade of the P2Y12 ADP receptor
d)
Blockade of glycoprotein IIb/IIIa receptors
e)
Inhibition of thrombin
67.
The BASIL trial influences management in critical limb ischaemia. What did it find regarding vein bypass vs. endovascular therapy for patients with a life expectancy >2 years?
a)
Endovascular therapy is always superior.
b)
Vein bypass should be considered first.
c)
Medical management alone is sufficient.
d)
Amputation is the first-line option.
e)
There was no difference in outcomes.
68.
Which of the following is a key principle of antibiotic stewardship?
a)
Always use the broadest-spectrum antibiotic available.
b)
Continue antibiotics until the patient feels completely well.
c)
Document the indication, dose, route, and review date.
d)
Use IV antibiotics for all serious infections until discharge.
e)
Prescribe antibiotics for all upper respiratory tract infections.
69.
Which mechanism of antibacterial resistance involves the active transport of a drug out of the bacterial cell?
a)
Enzymatic destruction
b)
Target modification
c)
Reduced permeability
d)
Efflux pumps
e)
Biofilm formation
70.
A qualitative researcher is concerned about the potential influence of their own professional background on the data analysis. Which concept best describes the process of managing this influence?
a)
Saturation
b)
Triangulation
c)
Reflexivity
d)
Member checking
e)
Purposive sampling
71.
In the context of qualitative research appraisal, which of the following questions is part of the CASP checklist?
a)
Was a power calculation performed?
b)
Was the sample size justified?
c)
Was there a control group?
d)
Was the p-value < 0.05?
e)
Was the study double-blinded?
72.
A patient with capacity refuses a life-saving blood transfusion based on religious beliefs. According to the four pillars of medical ethics, which principle is paramount in this situation?
a)
Beneficence
b)
Non-maleficence
c)
Justice
d)
Autonomy
e)
Confidentiality
73.
A doctor is asked by the police to disclose information about a patient who is a victim of a crime. The patient has capacity and explicitly refuses consent for the disclosure. What should the doctor do?
a)
Disclose the information as the police have requested it.
b)
Disclose only the information that is already in the public domain.
c)
Refuse to disclose without the patient's consent, unless a statutory requirement or court order exists.
d)
Disclose the information but inform the patient afterwards.
e)
Ask the patient's family for consent instead.
74.
A 2-year-old child has not started walking. At what age is this considered a definite "red flag" requiring referral?
a)
12 months
b)
15 months
c)
18 months
d)
24 months
e)
36 months
75.
Which of the following primitive reflexes should disappear by 6 months of age?
a)
Rooting reflex
b)
Moro reflex
c)
Gag reflex
d)
Corneal reflex
e)
Pupillary reflex
76.
A 1-day-old newborn is cyanotic. An echocardiogram shows transposition of the great arteries. What is the immediate life-saving pharmacological management?
a)
Administer Indomethacin.
b)
Start a Prostaglandin E1 infusion.
c)
Give a dose of Furosemide.
d)
Administer Adenosine.
e)
Start a Beta-blocker.
77.
A term "well" newborn becomes acutely cyanotic and breathless on day 2 of life. Which "T" lesion is most likely?
a)
Tetralogy of Fallot
b)
Transposition of the Great Arteries
c)
Tricuspid Atresia
d)
Total Anomalous Pulmonary Venous Return (TAPVR)
e)
Truncus Arteriosus
78.
A 6-month-old infant with a large Ventricular Septal Defect (VSD) presents with failure to thrive and sweaty, tachypnoeic feeds. What is the underlying pathophysiology?
a)
Right-to-left shunt causing cyanosis
b)
Left-to-right shunt causing pulmonary overcirculation
c)
Pulmonary stenosis causing right ventricular hypertrophy
d)
Aortic obstruction causing systemic hypoperfusion
e)
Myocardial dysfunction causing low output
79.
A 5-year-old child is brought to the GP. The mother is concerned that he is not as social as his peers and has limited speech. He has a history of no social smile by 3 months and no pointing by 12 months. What is the most likely concern?
a)
Global Developmental Delay
b)
Autism Spectrum Disorder
c)
Hearing Impairment
d)
Cerebral Palsy
e)
Intellectual Disability
80.
A 70-year-old man is admitted with a massive pulmonary embolism. He is given a thrombolytic agent. What is the most serious potential complication of this therapy?
a)
Allergic reaction
b)
Hypotension
c)
Intracranial haemorrhage
d)
Nausea and vomiting
e)
Fever
81.
A patient is prescribed Spironolactone. What is its mechanism of action as a diuretic?
a)
Inhibition of the Na+-K+-2Cl- cotransporter
b)
Inhibition of the Na+-Cl- symporter
c)
Antagonism of the aldosterone receptor
d)
Inhibition of carbonic anhydrase
e)
Blockade of epithelial sodium channels (ENaC)
82.
Which of the following is a characteristic feature of the action potential in the SA node?
a)
A stable, negative resting membrane potential of -90mV
b)
A rapid upstroke (Phase 0) mediated by fast sodium channels
c)
A prominent plateau (Phase 2)
d)
Spontaneous phase 4 diastolic depolarization
e)
A long duration (>200ms)
83.
A 60-year-old patient has a regular narrow-complex tachycardia at a rate of 150 bpm. Carotid sinus massage slows the rhythm transiently, revealing saw-tooth waves on the ECG. What is the diagnosis?
a)
Atrial Fibrillation
b)
Atrial Flutter
c)
AV Nodal Re-entrant Tachycardia (AVNRT)
d)
Sinus Tachycardia
e)
Ventricular Tachycardia
84.
Which of the following drugs is a Class 1B antiarrhythmic with fast dissociation from sodium channels and is used for ventricular arrhythmias, especially in the acute ischaemic setting?
a)
Flecainide
b)
Lidocaine
c)
Amiodarone
d)
Sotalol
e)
Disopyramide
85.
A patient with heart failure is started on Hydralazine and Isosorbide Dinitrate. In which patient population is this combination particularly recommended?
a)
Patients of Black African/Caribbean origin
b)
Patients with asthma
c)
Patients with renal failure
d)
Patients with diabetes
e)
Patients with gout
86.
What is the primary mechanism of action of Clopidogrel?
a)
Irreversible inhibition of cyclooxygenase-1 (COX-1)
b)
Irreversible blockade of the P2Y12 ADP receptor
c)
Reversible blockade of the P2Y12 ADP receptor
d)
Blockade of glycoprotein IIb/IIIa receptors
e)
Inhibition of phosphodiesterase
87.
A patient with a prosthetic heart valve requires anticoagulation. Which drug is a direct thrombin inhibitor?
a)
Warfarin
b)
Enoxaparin
c)
Dabigatran
d)
Rivaroxaban
e)
Apixaban
88.
Which of the following is a key pathological feature of unstable angina?
a)
Stable, fixed atheromatous plaque
b)
Erosion or rupture of an atheromatous plaque with superimposed non-occlusive thrombus
c)
Complete occlusion of a coronary artery by thrombus
d)
Coronary vasospasm without plaque
e)
Myocardial necrosis
89.
A 55-year-old man with a history of smoking presents with severe rest pain in his right foot and necrotic ulcers on his toes. His ABPI is 0.5. What is his most likely Fontaine stage?
a)
Stage I
b)
Stage IIa
c)
Stage IIb
d)
Stage III
e)
Stage IV
90.
In a qualitative study, the researcher returns the interview transcripts to the participants to check for accuracy. What is this process called?
a)
Triangulation
b)
Reflexivity
c)
Member checking
d)
Purposive sampling
e)
Saturation
91.
Which of the following is a component of the four-prism framework for evaluating the quality of qualitative research?
a)
Randomisation
b)
Blinding
c)
Transferability
d)
Power calculation
e)
p-value
92.
A doctor is considering disclosing confidential information about a patient who lacks capacity to their family member for care planning purposes. Under what condition is this generally permissible?
a)
It is never permissible.
b)
Only if the family member is the next of kin.
c)
It is permissible if it is in the patient's best interests.
d)
Only with a court order.
e)
Only if the patient had previously given written consent.
93.
A 4-year-old child is scheduled for an elective tonsillectomy. Who is the appropriate person to give valid consent for the procedure?
a)
The child, if they agree.
b)
The parent or legal guardian.
c)
The GP.
d)
The hospital manager.
e)
The anaesthetist.
94.
A 1-month-old baby has a loud, pansystolic murmur heard best at the left sternal border. What is the most common type of Ventricular Septal Defect (VSD)?
a)
Inlet VSD
b)
Outlet VSD
c)
Muscular VSD
d)
Perimembranous VSD
e)
Gerbode VSD
95.
A 65-year-old patient with atrial fibrillation is started on Rivaroxaban. What is a major advantage of this drug over Warfarin?
a)
It has a specific reversal agent.
b)
It requires regular INR monitoring.
c)
It has numerous drug and food interactions.
d)
It has a rapid onset of action and does not require routine coagulation monitoring.
e)
It is safer in pregnancy.
96.
A patient presents with chest pain and ST-elevation is seen in leads V1-V4. Which coronary artery is most likely occluded?
a)
Right Coronary Artery (RCA)
b)
Left Circumflex (LCx) artery
c)
Left Anterior Descending (LAD) artery
d)
Posterior Descending Artery (PDA)
e)
Obtuse Marginal artery
97.
Which of the following antianginal drugs primarily reduces preload through venodilation?
a)
Bisoprolol
b)
Amlodipine
c)
Glyceryl Trinitrate (GTN)
d)
Ivabradine
e)
Nicorandil
98.
A 50-year-old patient with hypercholesterolaemia is intolerant to statins due to severe myalgia. Which oral non-statin agent could be considered as an add-on or alternative?
a)
Colestyramine
b)
Ezetimibe
c)
Fenofibrate
d)
Alirocumab
e)
Omega-3 fatty acids
99.
A 30-year-old woman presents with palpitations. Her ECG shows a narrow-complex tachycardia with a rate of 180 bpm. P waves are visible immediately after the QRS complex, appearing as a "pseudo S-wave" in the inferior leads. What is the most likely diagnosis?
a)
Atrial Fibrillation
b)
Atrial Flutter
c)
AV Nodal Re-entrant Tachycardia (AVNRT)
d)
Atrial Tachycardia
e)
Ventricular Tachycardia
100.
A researcher is conducting a study on patient attitudes towards a new clinic service. They specifically recruit patients who have used the service, as they are most likely to provide rich, relevant information. What is this sampling technique called?
a)
Random Sampling
b)
Convenience Sampling
c)
Purposive Sampling
d)
Snowball Sampling
e)
Stratified Sampling
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