WAVE3 CLIN1. 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
WAVE3 CLIN2. 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
WAVE3 CLIN3. 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
WAVE3 CLIN4. 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
WAVE3 CLIN5. 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
WAVE3 CLIN6. 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
WAVE3 CLIN7. 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
WAVE3 CLIN8. 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
WAVE3 CLIN9. A 26-year-old with known migraine without aura has her usual unilateral throbbing headache building over 2 hours, with photophobia and vomiting. She is talking normally, has no fever, a supple neck, and a normal neurological examination including fundi. She asks whether this is a 'warning bleed'. What is the most appropriate action?A. Treat as migraine in primary care with safety-netting for thunderclap or new neurological signsB. Call 999 for suspected subarachnoid haemorrhageC. Same-day CT head from the treatment room before any analgesiaD. Start oral nimodipine while awaiting neurologyCheck
WAVE3 CLIN10. A 7-year-old has bilateral lower-leg aches in the evening after football, never in the morning, never limping at school, and growing well. Joints are cool, with a full range of movement. Bloods done by a worried locum last week (FBC, CRP, ESR) are normal. What is the most appropriate next step?A. Reassure, advise simple analgesia and stretching, and safety-net for limp, morning stiffness or unilateral symptomsB. Urgent paediatric orthopaedics for possible SUFEC. Immediate hospital admission to exclude septic arthritisD. Start methotrexate while awaiting rheumatologyCheck