Neurology1. A 34-year-old piano teacher attends after waking with a drooping left mouth. She cannot wrinkle the left forehead or close the left eye fully. Taste is altered on the left of the tongue. There is no limb weakness, no rash in the ear canal, and no other cranial-nerve deficit. Which pattern does this describe?A. Lower motor neurone facial (VII) palsy affecting the whole hemiface including the foreheadB. Upper motor neurone facial weakness from a lacunar strokeC. Isolated trigeminal motor neuropathyD. Oculomotor (III) palsyCheck
Children and young people2. A 14-month-old is brought from nursery with a fever. He is pale and miserable. A rash of purple spots on the legs does not blanch with a glass. Capillary refill is 4 seconds. According to NICE NG143, which traffic-light category applies?A. High-risk (red) features requiring emergency careB. Intermediate-risk (amber) only because capillary refill is prolongedC. Low-risk (green) if the child is still drinkingD. Home safety-netting without face-to-face reviewCheck
Clinical3. A 52-year-old with rheumatoid arthritis collects a methotrexate prescription. Which prescribing feature is the key safety requirement in UK primary care?A. Once-weekly dosing using 2.5 mg tablets onlyB. Once-daily dosing of 10 mg tablets to improve adherenceC. Combining methotrexate with trimethoprim long term for UTI prophylaxisD. Stopping folic acid because it reduces methotrexate efficacyCheck
Clinical4. A 67-year-old with a 40 pack-year history has exertional breathlessness and a chronic productive cough. Which investigation finding best supports a diagnosis of COPD?A. Post-bronchodilator FEV1/FVC ratio below 0.7 with compatible symptomsB. A single peak-flow reading of 80 percent predictedC. A chest X-ray showing hyperinflation aloneD. A raised blood eosinophil countCheck
Clinical5. A 58-year-old van-free car driver had a 20-minute episode of left-arm weakness yesterday. Symptoms have fully resolved. TIA clinic starts antiplatelet therapy today. He asks when he may drive his private car. According to GOV.UK Assessing fitness to drive (neurological disorders page, content fetched 8 September 2026; medical professionals' PDF dated November 2025), what should you advise for a Group 1 licence?A. Stop driving for 1 month and do not notify DVLA if recovery is completeB. Notify DVLA immediately and stop driving for 12 monthsC. Continue driving if the residual NIHSS score is zero todayD. Surrender the licence and reapply after a 24-hour HolterCheck
Clinical6. A 12-year-old boy who has recently gained weight attends with a 10-day left knee ache and a limp. The knee looks normal. Internal rotation of the hip is limited and painful. He is otherwise well, afebrile, and walking with an antalgic gait. What is the most appropriate next action?A. Urgent orthopaedic assessment the same day, non-weight-bearingB. Reassure that this is Osgood-Schlatter disease and review in 6 weeksC. Routine paediatric rheumatology for possible oligoarticular JIAD. Start oral flucloxacillin for presumed osteomyelitisCheck
Clinical7. A 28-year-old with newly confirmed asthma (compatible history plus raised FeNO and variable peak flow) has mild daytime wheeze only. According to NICE NG245 (BTS/NICE/SIGN 2024), what is first-line inhaled treatment?A. As-needed low-dose ICS/formoterol (AIR therapy)B. Salbutamol metered-dose inhaler only as requiredC. Regular high-dose ICS plus oral montelukast from day oneD. Nebulised salbutamol to keep at homeCheck
Clinical8. A 41-year-old care-home night worker has intense nocturnal itch and burrows in the finger webs. You diagnose classical scabies. Which management step is essential?A. Treat the patient and all household and close contacts even if they have no itchB. Treat only those with visible burrows to avoid unnecessary insecticideC. Advise that a single wash of bed linen without insecticide is sufficientD. Start oral flucloxacillin as primary treatment of the miteCheck
Evidence-based practice9. A 52-year-old man, Tomasz Kowalczyk, is randomised to a 12-week weight-management programme. Eighteen percent of the intervention arm never attend. Analysts still include every randomised participant in the original groups. What does this analysis primarily estimate?A. The effect of offering the programme as randomised, including people who never attended a sessionB. The biological effect only in people who attended every session, which some claim is the sole unbiased estimate of efficacyC. Whether the randomisation sequence was generated with undisclosed block sizes of four throughout recruitmentD. The accuracy of a diagnostic index test against an agreed reference standard in the same sampleE. How much publication bias is present when small trials are missing from a funnel plot of effect versus precisionCheck
Evidence-based practice10. A 41-year-old woman, Sian Pritchard, asks what ‘specificity’ means after reading a paper on a practice natriuretic-peptide cut-off. Which statement is correct?A. The chance she personally has heart failure if this particular test comes back positive in clinicB. The proportion of people without the target condition who test negative on that cut-offC. The proportion of people who truly have the condition who also test positive on the same cut-offD. How much the odds of disease rise after a positive test, which is the definition of LR+E. The number of similar people you need to treat to prevent one extra clinical eventCheck