A 56 year old woman has presented to A&E with sudden onset drowsiness, nausea and vomiting. She is hypoxic, with hypotension and tachycardia. On examination she has reduced level of consciousness and pinpoint pupils. You notice that she has a past medical history of osteoarthritis and has had input with your trust’s ‘Crisis Team’ in the past two weeks. Which of the following medications is she most likely to have taken in overdose?

A Paracetamol

B Aspirin

C Codeine

D Amitriptyline

E Naproxen

A 66 year old gentleman with a past medical history of epilepsy was admitted to the acute medical unit 2 months ago with shortness of breath and tachycardia. He subsequently had a CT pulmonary angiogram which identified a pulmonary embolism. As a result of this he was started on warfarin as anticoagulation. Initially he met his target INR of 2.5, however this gradually began to increase and today he has presented with an INR of 6. Which of the following medications could be causing such an effect on this gentleman’s INR?

A Carbamazepine

B Phenytoin

C Sodium valproate

D Rifampicin

E Chronic alcohol intake

A 69 year old gentleman presents with bradykinesia and a resting tremor which has been getting worse for around ten months. He is concerned because he is finding difficulty writing in his diaries. Seen in clinic, he is diagnosed with Parkinson’s disease and commenced on therapy. Six months later, his wife attends with him for review, appearing very upset. She states that he has spent much of their savings on online casino games and is undertaking ‘impulsive, irrational’ behaviour. Which of the following Parkinson’s Disease medications is most likely to be contributing to this behaviour?

A Amantadine

B Co-beneldopa

C Co-careldopa

D Selegiline

E Ropinirole

A 51 year old gentleman, who was previously fit and well, presents to clinic with leg pains, which are worse at night. These pains are exacerbated by a change in temperature, such as moving his legs from under his duvet. The pain is described as a ‘shooting’ pain from his feet to his calves. The pain is not relieved by paracetamol. Which of the following options is the most appropriate medical treatments to commence?

A Naproxen

B Amitriptyline

C Fentanyl patch

D Codeine

E Tramadol

A 59 year old man is admitted to the gastroenterology ward with reduced consciousness and jaundice. He has had previous ultrasound scans which showed liver cirrhosis and ascites. Today he is confused and disoriented. He has not opened his bowels today. What is the most appropriate laxative treatment to offer this gentleman?

A No treatment

B Lactulose

C Senna

D Sodium docusate

E Methylcellulose

A 34 year old gentleman presents to A&E with palpitations which he states have been going on for 3 days. He has an ECG which shows atrial fibrillation, however he leaves the A&E department before any treatment can be commenced, as he states the palpitations have stopped. His GP undertakes a second ECG three days later, which shows normal sinus rhythm. He states that this is the third time this has happened. He asks to be put on some treatment so that this does not happen again. He has no history of ischaemic heart disease. Which would be the most appropriate medical therapy to commence at this point?

A DC cardioversion

B Verapamil

C Digoxin

D Warfarin

E Sotalol

A 54 year old man who has recently moved to the region from his home of Trinidad & Tobago presents to his new GP for registration appointment. There it is noted that his blood pressure is 156/91. Repeat measurements confirm essential hypertension. What would be the most appropriate anti-hypertensive to commence at this stage for this gentleman?

A Amlodipine

B Lisinopril

C Propranolol

D Losartan

E Bendroflumethiazide