Clinical

Pharmacology

Drug Side effects

What to use for what
Interactions

1. Trigeminal neuralgia - ​carbamazepine

2. Achilles’ tendon - ​ciprofloxacin
3. Pregnant woman takes drug causes her upward deviation of eyes and weird neck
movement or something - ​metoclopramide
4. One was a woman gets headache flushing nausea at a wine tasting - ​metronidazole
5. Also what anti acne drug causes pigmentation - ​minocycline
6. One emq was what test do you order 2 weeks after you start:
a. Statin - LFTs
b. ACE-i - U&Es
c. SSRI - nothing
7. Woman takes medication and it gives her raynauds like symptoms, gets vasospasm
in her hands in the cold and goes back to normal when rewarmed - options were
cocodamol, diclofenac, can’t remember the rest - ​OCP/b-blockers
8. Guy with mouth ulcers and perianal ulcers, what caused it - options were alendronic
acid, omeprazole, cocodamol etc - ​Nicorandil
9. Erythromycin ​(P450 inhibitor) and ​statin​ interaction causing diarrhea and Abdo pain
(mentioned already).
10. Similarly guy on Tx for cellulitis gets Abdo pain vomiting increasing with each dose (I
put ​Erythromycin​)
11. Vague Q about lady hirsute with diarrhoea which drug? (​metformin​ cos she's
probably Pcos and diabetic)
12. Girl given erythromycin for infection and develops neuropsychiatric Sx - ​Acute
porphyria
13. Dry cough - ​Ramipril
14. Ankle oedema - ​Amlodopine

Dermatology

1. Childhood rashes, like slapped cheek - ​Parvovirus B19

2. Which rash causes pustules and redness on face and is worse in sun and after spicy
food - ​acne rosacea
3. Which rash is pustules and papules and sometimes painful made worse by shaving?
Folliculitis
4. Itchy rash around eyes and in groin? I think eyes and groin one i said ​seborrhoic
dermatitis​ cause its like the more sebum areas or whatever
5. Itchy scaly scalp? ​Seborrhoic dermatitis
6. Oval lesions on trunk? ​Pityriasis rosea
 7. Honey crusted lesion on child's chin? ​Impetigo
8. Slow growing nose lesion telangiectasia - ​bcc
9. Acne 16 year old and gets skin pigmentation.. minocyline wasn't an option but
another tetracycline was so put that - ​Oxytetracycline
10. Lady in her 70s with bilateral pigmented legs and hyperkeratinised round 3cm area
on leg. Atopic seborrhoeic asteatoic discoid eczema.. I put atopic thinking might be
associated with other autoimmune like vitiligo etc but idk could be discoid as it's
classical round or coin shaped lesions I think its ​discoid​ as its round 3cm
areas*******
11. 18 yr old girl with eruption of pustules papules (i think on face) then spots on chest
back abdomen..what do u give? I thought it was viral probably chicken pox so do
nothing. Options included Fluclox prednisolone
12. Axilary freckling, small lumps on skin (neurofibromas essentially) -
Neurofibramatosis
13. Rash on face spicy food and alcohol - ​Acne rosaea
14. Lesion on back looks stuck on - seb keraotosis
15. Itchy scalp - seb dermatitis

GUM

1. 50s man with slight Penile discharge anal pain and dysuria...​gonococcal urethritis
(can't think of anything else that would give discharge) then Q immediately after with
young man 20s nitrite negative and penile discharge which was also ​gonococcal
urethritis
2. Girl with labial ulcers and lymphadenoathy..put ​chlamydia​ thinking lymphogranuloma
venerum as gonococcal doesn't give lymph nodes I believe
3. Itchy scaly labia with keratinisation..I put ​lichen simplex​ (as associated with atopic
eczema) despite atopic/discoid/seborrheic being options. Think the Q wanted to
target that specific diagnosis not the general one
4. Man with multiple penile blisters and systemically unwell? ​HSV
5. man with 50 mouth ulcers and lots of penile ulcers - ​behcets

Respiratory

1. Asthma management
2. New asthma diagnosed using blue inhaler 3 times a week. What next - ​steroid
inhaler
3. Asthmatic not controlled on a laba/ics - ​LTRA
4. A 60 year old with pleural thickening and had a biopsy a year ago, now has come 1
year later back with a lump at the site of the biopsy - options were carcinoid, small
cell cancer, ​mesothelioma,​ no. Small cell cancer, bronchial cancer
5. 50 year old with SOB and coughing with one episode haemoptysis and described to
have “weak lungs” as a child - options were ​TB​, cryptogenic fibrosing alveleolitis,
eosinophilic bronchitis, sarcoidosis etc
 6. Resp a little harder eg which is best urgent investigation in man with barn door lung
cancer bronchoscopy or percutaneous biopsy or ​CT​ or CXR. I put bronchoscopy as
percutaneous biopsy might not effectively reach tissue etc. In hind sight CT Would
maybe be best as it delineates where the cancer is before u go for histological
diagnosis
7. Man 2 day hx of mucoid bloody sputum and breathless. O2 93% Hr 106 apyrexial (I
think) chest clear..options sputum bloods (fbc crp) ​CXR​..I said CXR as his obs were
off and figured you can assess other organ systems quickly with it too
8. 70s lady with bronchiectasis known with relatively normal resp exam and short hx of
mucopurulent sputum..do u do CXR or sputum sample or other options (can't
remember). I put ​sputum sample​ as she wasn't compromised from resp point of
view and in view of a known Dx
9. Man with asthma every may and June gets Sx what investigations? Answer: none
cos Dx is based on clinical history. Eg options were RAST FBC Ig testing etc -
spiromety, peak flow
10. Patient with COPD has already taken ipatropium and needs next step - ​depends on
FEV1, if less that 50% than ICS/LAMA or ICS/LABA, if more than 50% thean
LABA or LAMA only
11. Bronchcietaisis normal obs mucopurulent sputum and breathless which investigation
Cxr/bronchoscopy/ ​CT /​ bloods/MRI etc/spirometry/CTPA
12. Obese man tachy and breathless SATs 93%, no fever and well clear lungs
I put ​CTPA
13. 19 year old always blocked nose and cold weather causes sob always get infection
on chest - Asthma investigation spirometry reversibility

Ophthalmology

1. One was a guy with 2 day hx of temporal headache develops, sudden loss of vision -
temporal arteritis
2. One was this guy who has been feeling crap for a while and had an episode of
curtain over his vision lasted 45 mins - ​amaurosis​ cause it only lasted 45 mins
3. One eye question she had visual acuity of 6/60, findings otherwise normal.
4. The other she had lost her vision. Findings otherwise normal
5. Many with gradual blurred vision struggles driving at night against head lights in
particular? ​cataract
6. Lady with struggling reading but vision improves with dark tinted glasses. I put
cataract​ again (not sure)
7. Floaters - ​PVD
8. Billateral ptosis - ​MG
9. Patient with motor disturbance few months ago and episode of optic neuritis - ​MS
O&G

1. 21yo girl on pop but misses it often. Wants to go away for a year. Best contraception
-​ long term​ (qs from mcq bank)
2. 40s woman wants contraception and also has heavy periods - ​IUS
3. Patient on the injected progesterone who had rifampicin 2 weeks ago and
unprotected intercourse last night. What do you do - ​Emergency contraception
4. Fibroids​ in Afrocarribean lady with bleeding
5. Postmen lady with bleeding - ​Endometrial ca
6. Irregular bleeding and non cyclical abdo pain and bloating (polyps or fibroid?)
7. 50s lady with urgency and Abdo bloating. I put ​ca 125 ​thinking ovarian with pressure
effect..literally zero info to go on (almost like they expect u to be on their line of
thought from the get go)
8. Pregnant lady never had chicken box and grandad has shingles who lives at home
with her. What do u do: Give VZV vaccine, Give immunoglobulin, Do nothing - ​check
immunity
9. 39 black lady heavy bleeding and dysuria?frequently afebrile, I put ​fibroids ​(grown
and irritating bladds ??)

Rheumatology

1. 62 year old guy 5 months with lower back pain and malaise and tenderness over
lumbar spine, which antibody test would u do? ​HLA B27
2. Woman with malaise and painful joints especially in hands and a rash on face. Which
antibody. I said ​ds dna ​cause SLE but could be rheumatoid who knows
3. Someone on methotrexate gets a sore throat, what du do? ​Bloods​, review in 24hrs,
admit, stop treatment…
4. Guy with back pain - ​B27
5. Guy with joint pain - ​anti ccp
6. Muscle ache and raised ESR - ​polymyalgia rheumatica

ENT

1. Centor criteria type questions so abx or not etc

2. Hoarse voice in copd - ​smoking
3. Hoarse voice in a singer vocal nodules - ​voice overuse
4. Lots of referral questions like a quinsy type picture. Options: Routine op ent, Urgent
op ent, ​Admit to hospital
5. hoarse voice and 2cm firm nodule on thyroid, otherwise well - ​cancer
6. Unilateral lymphadenopathy and ulcerated tonsils in smoker (likely ​Ca​ so needs
urgent ENT ref)
 7. Centor criteria for whether abx (​phenoxymethylpenicillin​) or not for tonsilitis. If low
score tonsilitis what do you give?​ Simple analgesia
8. Sore throat and difficulty swallowing - peritonsillar abscess

Orthopaedics

1. Quite a few about ​shoulder pain​ diagnosis one stiff painful in the morning, another
pain radiating from l shoulder down l arm and sometimes down r arm options angina
adhesive capsulitis cervical spondylitis or muscle pain
2. Bilaterla shoting arm pain - cervical spondulitis
3. Guy ​with back pain last 6 months and now night time buttock Pain, what do you do -
immediate hosp, urgent ortho, urgent physio, urgent pain management, urgent
rheum, routine rheum, routine ortho, routine physio or routine pain management
4. Wrist OA uncontrolled after physio and PO paracetamol..what next? Topical
ibuprofen or ​oral​? Can't remember what I put but I think I put oral in the end worrying
about poor absorption. Guy had no other problems so didn't worry about gi ulcer risk
etc
5. Morton neuroma​* had the classical click between 3 and 4 metatarsal heads
6. Which Ix in girl running lots and incidentally training for marathon. Complaining of mid
foot pain but on examination she has forefoot pain on lateral aspect of foot and point
tenderness. I said plain radiograph (revise Ottawa rules for XR maybe for this one)
7. Man training for marathon with pain superior and lateral to tibia..worst when heel
striking. I put ​iliotibial band syndrome
8. Woman with morton neuron which investigation..wasn't sure between Us Or CT. I put
USS ​in the end but idk

Endocrinology

1. Thyroid, Addison’s, cushings type and pick the investigation you need
2. Tired all the time. Hand feels funny when you shake it. What endocrine investigation -
TFT
3. Endo heavy Qs about Addison cushions (after being on steroids) hypothyroid
Symptoms and investigation.
4. Diabetic with 1 year Abdo pain and bloating...TTG for coeliac
5. Man with newly diagnosed diabetes 51 yr started on metformin and bloods from 2
weeks ago come back with AKI. He's well in himself otherwise what do you do?
Options: Stop metformin and start gliclazie, Admit hospital, Start insulin, Do nothing
etc - I put​ admit hospital
6. Another diabetic guy with hypo Sx but conscious..what do u give. Options: IV
Glucose, IM glucagon, ​Oral glucose 20g tablet,​ Long acting carb like bread, Insulin
7. Postural hypotension with reduced potassium and raised sodium - ​Addisons
disease
8. Headache and HTN (had postural drop too) - phaeochrmocytoma

Paediatrics
1. Child ortho standard qus- one was sufe one was perthes
2. Child 5 years old, 3 months constipation, has been having liquid stools in pants.
Which laxative? ​Movicol paediatric plain
3. 2 year old with diarrhoea with Food bits in it, normal weight and height for his age -
toddlers diarrhoea
4. Young child non blanching rash, high temp (indicating meningitis) what do you give -
IM benzylpenicillin
5. Child with sore throat and rash (that’s all they give) - ​scarlet fever
6. Child with mucosal white spots and fever then rash - ​measles
7. Young sport girl has anterior knee pain, above tibia - ​osgood schalter
8. Perthes ​Q about atraumatic hip pain in boy with shortened leg
9. SUFE ​in BMI 26 boy after jumping on trampoline
10. Osgood Shlatter​ in teenage girl playing hockey with tibial tuberosity tenderness
11. Know henoche schlein purpura..post Urti kid with rash and pains..
12. Other similar style Q was child with leg pain and rash and diarrhoea..easy to mistake
it for henoch but I put ​Haem Uraemic Syndrome​ cos that's e coli 0157 mediated and
u get GI Sx (I think!!)
13. Cow milk protein allergy​ in 5 month with 6 weeks of Abdo pain colic diarrhoea and
itchy skin
14. Child with diarrhoea which laxative senna lactulose macrogol husk (answer is
macrogol ​first line I believe)
15. Child with intermittent constipation and watery stool. (​Overflow constipation​ with
diarrhoea)
16. Fever > 5 days, red tongue - ​Kawasaki disease
17. Questions on childhood anemia
Kid from Nigeria hb 76 = was sickle
Normal kid just below hb = thalssemia trait
Rellay low hb and mcv but iron okay ?? Coeliac
18. Questions on failure to thrive in7 year old child with loose stools what investigation.
I put tissue transglutaminase
Other options
Anti- gastric / intrinsic factor
Schillings test
Ferrtin
Stool culture etc
19. Sorethroat and rough rash in child - ​Scarlet fever
20. Blisters on face around eye - Ans: ​oral aciclovir
21. Similar questions long history of infection s since childhood was probably ​cystic
fibrosis
22. Some bait anaphylacxis one just put im adrenaline
23. Non projectile vomitting (i.e. pyloric stenoissi), what Ix - ?USS (there was CT and
MRI as options)
24. Pt has red current jelly stool (intersussecption), what Ix - ?MRI (USS and CT also
options)
Urology

1. Patient with dysuria and apyurial urine sample, what does he have
2. 80 year old with terminal dribbling and palpable bladder- ​?bladder outflow
obstruction, ?prostate cancer (had both options)
3. Guy with kidney stones feeling tired - ​hyperparathyroid
4. Patient with urinary retention has catheter inserted, what drug would you give him? -
tamsulosin? Other option was oxybutynin
5. Haematuria and loin pain - renal stones
6. Back pain and hesitancy - prostatic carcinoma

Gastroenterology

1. A guy feeling tired and abdo Pain, no diarrhoea, low folate and ferritin but not anemic
- ​coeliac​/IBD/IBS/mesenteric adenitis
2. Alcoholic with abdo swelling, leg swelling, overload, what do you treat him with? -
options were ​spironolactone​, furosemide etc
3. Tired and Abdo pain no diarrhoea is ​coeliac​.
4. Diarrhoea in a guy who likes fishing and is on holiday, giardia/leptospirosis
5. Patient came back after holiday with abdo pain and diarrhoea for 2 days - ​Travellers
Diarrhoea
6. Something about lake swimmer coming back from holiday with diarrhoea -
leptospirosis?
7. Patient came back from india and presents with 4 month history of diarrhea - ​giardia
8. Patient presents with abdo pain and general malaise after ocming back form fishing
trip - leptospirosis

Neurology

1. Headache 1 day and confusion, GCS 14, temp 37.9, what do you do - ​CT Head​ or
bloods?
2. 1 q barn door ​NPH​ (confusion ataxia urine incont)
3. Old male 89 had stroke right sided weakness admitted right sided pneumonia (they
hinting aspirations) wife asks how to prevent further problems: Salt referral, Dietary
referral, Physiotherapy referral
4. 57 yo male with dementia gait abormailty and urinary incontinence ((I baffled lol)
Options: Dementia, ​Creftvelz Jacob disease​ (I guessed this), Delirium, Lewy body,
Vascular, Korsakoff psychosis, Werinece encpeh
5. Old man came in with fall at home and sees little ppl/ childern? I put ​lewy body
6. What causes ataxia and word finding and nystagmus. Was ​thiamine b1 deficiency
Cardiology

1. Guy with a murmur and papules on his finger, what do you do - ​blood cultures
(infective endocarditis)
2. Cardio easy just know murmurs
3. Man with myopia Sob and palpitations..wtf was this..​marfans​? Or HOCM or some
other less likely Dx
4. Pt comes to GP with ankle swelling, decreased excersoe tolerance, and SOB (heart
failure), what do you do? I put urgent echo, but could also be that you refer to A&E
5. Pt comes in with externtional chest pain relives with rest what do you do? - was
between starting anti-anginal treatment or refer to caridology
6. 46 y/o comes in with palpialtions that self resovle but she experiences dizziness with
them, what do you do - either between reassure or send for cardio referral

Surgery

1. A guy who had IDA and change in bowel habits and over 60 -​ colon cancer
2. 60 year old with LIF, and fever, diarrhoea, had an episode last year which went away
- ​diverticulitis
3. 7 year old with central abdominal pain only - options were ​appendicitis​, mesenteric
addenitis, migraine (abdo), intussuseption, something else
4. 7 year old with central abdo pain and sore throat/swollen lymph nodes - ​mesenteric
adenitis
5. a woman 20s, recurrent abdominal pain preceded by a craving to have a sugary
sweet - ​abdominal migraine
6. Some guy hurt anlke can weight bare and no tenderness I put no further investigation
had x-ray and MRI and ultrasound
7. Hurt calf running 2 days ago present bruise just above ankle - Between
gastrocnemius tear or Achilles tendonitis
8. Gave you blood results and with high lactate and pt having abdo pain (esasenaitlly
ischaemic bowel) what Ix - i put CT, there was AXR, MRI as well

Psychiatry

1. 75 year old thinks his family are going to kill him, low mood - ​Lewy body dementia​,
severe depression, schizoaffective disorder
2. Lewy body dementia (hallucinations in dementia pt)
3. Psych depressed man with suicidal intent worried about being alone what do you do?
I said ​urgent psych assessment ​(cos he's high risk)
4. Young lady bmi 17 lost 15 kg in last 6monyhs all bloods normal 2 weeks ago,
Options: Psych review, Dietary referral, Prescription supplements, Eating disorder
urgent refferal
5. New onset depressive symtppoms, whast drug start on? - sertraline
6. Cant sleep + depressive syptoms, what drug? - ​Mirtazipine
 7. Patient has exam, has had anxiety like symptoms, happen on her last time, what
drug? - ​Sertraline

Haematology

1. Man nose bleeding and fe def anaemia...I put ​Hereditary haemorrhagic

telangiectasia​ (can't remember options)
2. Ix in lady with micro anaemia.. I put ​ferritin ​(cos Fe deficiency is commonest cause)
3. Young girl presents with bruising on head and legs, last week had nose bleed - ALL,
NAI, ​vWD

SJT

1. One was a Down syndrome patient whos due for cardiac surgery and his brother
calls cause he wants ro cancel it. straight forward options - tell him not his choice,
speak to brother, speak to them both, etc
2. One confusing question about translators. French speaking woman with husband not
translating properly, options were *refuse to continue until independent translator.
*ask him to translate word for word. *make another appt with a translator. *ask her to
come back with someone else
3. Lots about people doing dodgy things and what you'd do about it. With a few
including answers like report to gmc, report to local prescribing authority? (some gp
giving abx for jokes or another giving anti-htn not according to guidelines), seek
advice from bma, seek advice from MDU.
4. Revise what stuff you should report to popo. Some woman came in with her husband
with a cut and bruised lip and he said she had a seizure at night when it was leading
to domestic violence.
5. confidentiality for kids - there was a que on a mum asking about contraception for her
14yo. Another que about a divorced dad asking for info about a kid who's in hospital
with mum
6. Freshie Qs. Options: Tell nurses to ask you to clarify what your colleague is saying,
Talk to colleague about how he's settling in UK outside of work, Ask colleague if he
has problems with understanding others, Offer to mentor colleague and give him
feedback on comm skills
7. Bad breath BO. Options: Leave deodorant and mouthwash on his desk, Write
anonymous note telling him about it, Tell him directly about it
8. Like a patients son thinks she’s neglecting herself and she doesnt want help
9. I had a pt 19 year old in GP who you suspect leukaemia, parents sitting outside,
you’ve ordered bloods - tell him you suspect leukaemia, don’t say anything until
bloods back, call him back with results, ask if he wants to bring his parents in before
discussing
10. Colleague struggling to sleep and worries about on call and coming in on days off
because of worry?
-do his shift on call
- review his clerkings and tutor him
-discuss with f2s
-discuss your Ed supervisor
- discuss his clin supervisor
- tell him to take annual leave

Colleague takes to long in Ed clerking sees half patients, she your friend other
colleagues say chat to her?
Tell Ed consultant
Tell her clin supervisor
Tell them to chat to her themselves
Chat to her
Tell her to raise with her clinical supervisor

Consultant always says team is useless in front of patient s and relatives?

Tell nurse in charge to tell pts and relatives you good.

Tell consultant straight
Tell other f2s
Tell GMC
Tell HR
Record audio consultant in secret
Monitor consultant behavior next few weeks

Consultant always undermine f2 girl and comments on her clothes?

Tell HR
Report to GMC
Let her deal with it
Discuss with other f2s
It's just banter

Old woman with capacity has cancer likely on ogd. Consultant tells family and they
say don't tell her today as she will be tired from ogd. You re doing cannula and she
ask you what result was?
Tell her endoscopy result.
Tell her family said not to tell you today
Tell her your tired today and you'll say tomorrow
Tell her does she want someone to be with her to break news.
Tell her we still waiting for histology

Nurses mum admitted on ward next door she ask you wag1 and she distressed and
worried.

Tell her it's in appropriate

Tell her to seek support from her NIC
Check her results
Tell her chat to nurses
Tell her what is worried her.

Colleague coming 1 hour late to hand over and you have theatre tickets?
Tell nurses to Bell him if issues and leave
Meet wife straight at theatre
Get to theatre/home when you can and stay
Get another f2 to cover
Get the reg to cover

In clinic and arrange d to leave early for dental appointment that was long to get,
nurse ask you to see a few extra this morning as other f2 is I'll.
Apologize and say you need to leave.
Cancel the extra patients
Say you'll see them in afternoon
See extra patients and miss dentist
Get her to book them with reg
Over book the I'll f2s next clinic with these patients

Your in GP and have mandatory teaching at hospital in 30mins and takes 25min to
get there . Reception call say please see urgent patients that just arrived, she already
called GPs and they told her too busy and to call you.
Apologize and leave for teaching.
Speak to other GPs directly
Tell her to call other GPs
See one and tell her to call hospital saying you'll be late
See all and get to teaching when you can
Call foundation program director and discuss
Difficult consultant daughter self harming long and you already behind time, before
she leaves mum says she got increasing chest pain last few weeks intermittent she
think it due to daughter s stress.

Tell her to go immedialtey to a+e

See her. And take history
Tell her to make another appointment
Call reception and see if any other GP can see her today.
See her this afternoon.

You on psych and your friends admitted to ward. Find out she been abused by uncle
and you and your family know him well and he got good reputation.

Leave mdt immediately stating conflict of interest

Discuss your relationship with uncle and friend
When you see friend on ward explain confidentiality rules.

You on GP and partner having relationship with your friend that he treated for
depression and eating disorder when she left uni, her mum comes to see you and
worried about her daughter having relationship with older man.

Tell mum it's the GP

Speak to GP if he having relationship and tell him to stop
Tell senior partner
Tell your trainer in next tutorial
Tell GMC

You came 30mins late to clinic, ed call you and want fax urgent ly for a patient of
yours. You ask receptionist and she shouts back angrily do it yourself?
Do it yourself this time
Tell her you need assistance as running late
As another receptionist
Say you too late and she has to do it
See patients and send fax later