Medical Exams Questions Bank

Exam Papers

Medical exam questions are a crucial tool for evaluating a student’s knowledge and understanding of the various concepts and principles in medicine. These questions come in various formats, including multiple choice questions, short answer questions, and essay questions, and are used to assess a student’s ability to apply their knowledge to real-world situations.

As a medical student, it is important to familiarize yourself with medical exam questions, as they will play a crucial role in your academic and professional success. By practicing and taking these questions, you will develop your critical thinking skills, improve your ability to apply your knowledge to practical situations, and gain a deeper understanding of the subjects you are studying.

Here are a list of questions across a broad range of clinical subjects. Use it to really test your breadth of knowledge like an exam paper.

Jump to the sample questions here:

Free Neurology Questions for Medical Student Exams

A 44 year old builder presents with weakness over the past 48 hours

A neurological exam reveals the following (N=normal):


Upper Limbs


Lower Limbs













Power (MRC)













Fine touch
















– (absent)

– (absent)



– (absent)

– (absent)

+ with reinforcement






– (absent)

– (absent)



– (absent)

– (absent)


Which of the following is the most likely diagnosis?

a. Polio
b. Motor Neurone disease
c. Myasthenia gravis
d. Stroke
e. Multiple sclerosis
f. Creutzfeldt Jacob disease
g. Guillain Barre Syndrome

Show the answer

g. Guillain Barre Syndrome

Check your hypothesis against the clinical signs:


any sign of UMN lesion or hypotonia (cerebellar?) NO

but there is some reduced tone in the left arm:


He is weak and its come on over the past few days: this is classical of GBS: an ascending peripheral motor and sensory poylneuropathy.


Normal: as expected


Normal: So can it still be GBS???

YES! The sensory signs are often vary vague: there may be only back pain as the presenting feature.


Clinical tip: no reflexes suggests a lower motor neurone problem. Could it me MND? Very unlikely: there’s only LMN signs and the onset of the illness is too acute.

Other things

GBS: measure the Forced Vital Capacity:

If this is low: the patient may need ventilation.

Also remember: cardiac conduction deficits (monitor the patient on a cardiac monitor)

Remember FVC monitoring in GBS.

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Free Respiratory Questions for Medical Student Exams

A 64 year old man presents to hospital with his first epileptic seizure whilst sat reading a newspaper at home.

Drug history – Nil

A clinical examination reveals the following:

  • Temp 371
  • BP 182/102
  • O2 Sats 99% Air
  • GCS 15/15
  • Finger prick blood glucose 3.9 mmol/l
  • No Jaundice, Anaemia, Clubbing, Cyanosis, Lymphadenopathy (J/A/C/C/L)
  • CVS: NAD
  • GI: NAD

Neurological examination: including cranial nerves and fundoscopy: NAD

His blood tests show the following:






129 (134-145 mmol/l)


4.9 (3.5-5.2 mmol/l)


7.2 (4-10 mmol/l)


88 (60-100mmol/l)

eGFR(estimated glomerular filtration rate)


His chest X-ray shows a ill defined lesion in the left midzone.

What is the most likely aetiology of his seizure?

a. Brain Metastases
b. Hypercalcaemia
c. Syndrome of inappropriate ADH secretion (SIADH)
d. Hyponatraemia not caused by SIADH
e. Idiopathic epilepsy

Show the answer

a. Brain Metastases

A difficult question because of the volume of data to interpret.

List everything that is pathological:

  1. Seizure
  2. Low Sodium at 129 mmol/l
  3. Hypertension
  4. Ill defined lesion in left mid zone on CXR

Again the principle of Occam’s razor* applies here.

Take them in turn.

  1. The seizure may be idiopathic/ relate to a structural/ drug/ metabolic disturbance.
  2. The sodium isn’t particularly low enough to provoke a seizure (Once the Na+ gets <120 and more seriously <110 the risk of seizure is greatly increased. As such the sodium on its own is not a strong risk factor for a seizure). Causes: drugs (he is on none/ SIADH of any cause)
  3. The hypertension is most likely to be idiopathic: there are no clues to an underlying endocrine cause
  4. The ill defined chest X-ray lesion could represent a malignancy (1o/ 2o)/ infection (bacterial/ viral/ tuberculosis etc)

The fact that there is no clear cause for the seizure from the data provided makes the most likely diagnosis lung cancer with an SIADH (e.g. small cell). This makes the most likely cause of the seizure brain metastases.

Any of the answers could be correct but this is the "best" answer:

*Occam’s Razor has been described as ‘diagnostic parsimony’ and essentially means that the single / fewest number of causes that accounts for all of the symptoms and signs is the most likely explanation.
In this case for example

  • the seizure may be secondary to alcohol withdrawal
  • The hyponatraemia related to the patient taking his wife’s antidepressants
  • The chest X-ray could represent a previous childhood tuberculosis infection

Occam’s razor would state that a single explanation that would account for all 3 problems is more likely:

  • lung cancer, with an associated SIADH and brain metastasis as a single explanation would be more likely

Clearly Occam’s razor is not always useful or correct, but it’s a helpful concept. It also commonly crops up in clinical vivas.

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Free Surgery Questions for Medical Student Exams

An obese 63 year old lady presents with jaundice. There is no history of abdominal pain. Examination of her abdomen reveals a palpable gall bladder. There is evidence of extensive pruritis.

She tells you she drinks 42 units of alcohol a week.

Her blood results are as follows

Albumin 32 (35-50)

Alk Phos 456 (<110)

ALT 88 (<40)

Bilirubin 120 (<20)

INR 1.6

GGT 400 (0-70)

What’s the most likely diagnosis?

a. Gallstones
b. Paracetamol Overdose
c. Pancreatic cancer
d. Alcoholic Hepatitis
e. Primary billiary cirrhosis

Show the answer

c. Pancreatic cancer

No marks for anything other than this: the famous Courvoisier’s law:

In the presence of a palpable gallbladder (GB) in painless jaundice the diagnosis is unlikely to be gallstones.


Gallstones cause chronic GB fibrosis. A distended GB suggests a more acute obstruction

Why not PBC or alcohol?

The LFT’s show an “obstructive picture (high Alk Phos/ GGT/ Bili + reasonably low ALT). Alcohol would not do this or give the distended GB. PBC could give the obstructive picture but you’d be less likely to find the palpable GB.

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At the Bedside: Free Questions for Medical Student Exams

A 62 year old man presents with a swollen right calf 3 weeks after undergoing a total left hip replacement. He is known to have rheumatoid arthritis.

An Emergency Department doctor tells you that he feels the patient can be discharged. He tells you this because he shows you the D-Dimer result, which is “negative”. The result is shown below.

D-Dimer 0.08 (Normal range 0-0.18)

Which of the following statements is true about D-Dimer testing in general patients with a suspected DVT?

a. Following a clinical assessment, clinicians should not rely on the test as a basis to ‘discharge’ or ‘investigate’
b. It is of no use in patients who have had recent surgery (e.g. within the last 12 weeks)
c. It is of no clinical use in patients with malignancy and secondary metastases
d. It can be used to discharge patients based on their underlying estimated clinical risk score
e. None of the listed answers are correct.

Show the answer

d. It can be used to discharge patients based on their underlying estimated clinical risk score

D-dimer test can be used to exclude DVT in patients who are assessed to be in the category of “low clinical risk” of DVT.

An individuals pre-test risk can be estimated using a “Wells score”. A patient who is clinically “low risk” with a negative D dimmer can be reassured.

The Wells score is shown below.

Active Cancer


Paralysis Paresis or plaster to extremity


Bedridden for 3 days/ surgery within last 12 weeks


Localised tenderness along distribution of deep venous system


Entire leg swollen


Calf swelling >3cm compared to the other leg


Pitting oedema confined to the symptomatic leg


Previous DVT


Collateral superficial veins (non-varicose)


Alternative diagnosis at least as likely as DVT


<0=Low Pre-test Probability

1-2=Moderate Pre-test Probability

>3=High pre-test probability

Check D-dimer

Check D-dimer


The Wells score and an example of its clinical application in terms of planning investigations into a DVT

Although you clearly cant memorise a wells score its clear from the score itself that patients with numerous risk factors (e.g a man with lung cancer with a swollen right leg with pitting oedema) that a negative D-dimer is not sensitive enough to rule the diagnosis out.

D-dimer is still of some use in patients with a low pre-test probability score.

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Free Clinical Pharmacology and Toxicology questions for Medical Student Exams

Look at the following sample prescription (you may use your BNF for this question)

Mr Pan has been bitten by a dog and his family doctor is a little concerned. Having cleaned the wound he gives a course of antibiotics.

Patient ID

Mr A Pan


1 Boat Street


Hospital no:234567

Special Instructions










625 mg


For 7 days

Times to be given





What is the most important error on this prescription?

a. Incorrect route
b. Contraindicated drug
c. Co-amoxiclav is not indicated for this condition
d. Incorrect frequency
e. Incorrrect dose

Show the answer

b. Contraindicated drug

The trick here is the penicillin allergy which means penicillin and its derivatives are all essentially contraindicated until a further allergy history is taken, i.e:

  • Ampicillin
  • Amoxicillin (formerly amoxycillin)
  • Flucloxacillin
  • Piperacillin (Tazocin ®)
  • Cephalosporins

Cephalosporins (e.g. cefuroxime, cefotaxime, cefalexin) also have a cross reactivity in penicillin allergy that may approach 10%. Therefore for exam purposes I would also consider these drugs contraindicated (e.g. cefuroxime). The true incidence of anaphylaxis with cephalosporins seems to be much lower.

For exam purposes in these instances senior support or microbiological advice is often suggested if no alternative is obvious.
Alternative drugs in patients with a penicillin allergy include quinolones (e.g. ciprofloxacin), macrolides (e.g. clarithromycin), tetracyclines (e.g. doxycycline), aminoglycosides (e.g. gentamycin), metronidazole, vancomycin, and teicoplanin.

Although co-amoxiclav is normally given 3 times a day, 4 times a day is still within a reasonable dose range. This is an easy way to "outfox" a student with a more important error.

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Free Haematology Questions for Medical Student Exams

A 63 year old male who was previously fit and well presents with easy bruising and profusely bleeding gums when he cleans his teeth. He has had the symptoms for 5 weeks.

On examination he has numerous ecchymoses and purpura. You can feel no palpable lymph nodes.

His wife arrives in the clinic late. She explains that he’s a forgetful chap and forgot to tell you he’s taking warfarin for atrial fibrillation. She also tells you he has recently been prescribed some antibiotics for a sore throat.

She shows you his INR book with the readings from the previous 6 weeks



3 days ago


3 weeks ago


5 weeks ago


7 weeks ago


13 weeks ago


What is the most likely explanation for his symptoms?

a. Cranberry juice ingestion
b. Antibiotics affecting warfarin
c. Accidental overdosing of warfarin
d. None of the above

Show the answer

d. None of the above

The key question is "what is the explanation for his symptoms", not "what is the effect of antibiotics on warfarin"

His INR is stable. This therefore does NOT explain his symptoms over the past 5 weeks and an alternative cause should be sought. The INR represents one measurement of the clotting cascade, but represents only one aspect of clotting.

His INR level does not explain his bruising, therefore there must be another explanation.

There is a simple way of remembering drugs that effect the metabolism of warfarin, and the oral contraceptive pill.

The full list of enzyme inducers and enzyme inhibitors regarding hepatic metabolism can be remembered from the following two acronyms:


Enzyme Inducers

Enzyme Inhibitors

Phenytoin (Antiepileptic)

Omeprazole (Proton pump inhibitor)

Carbamazepine (Antiepileptic/ neuropathic pain)

Disulfiram (treatment of alcohol dependence)


Erthyromycin (Macrolide)

Rifampicin (Tuberculosis Rx)

Valproate (anti epileptic)

Alcohol (chronic alcohol misuse)

Isoniazid (Tuberculosis Rx)


Cimetidine/ Ciprofloxacin


Ethanol (acute ethanol ingestion)

Sulphonamides (e.g. Trimethoprim)

For example: a patient taking warfarin may well have a higher than expected INR if he is put onto trimethoprim, and the opposite if he is put onto carbamazepine.

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Free Oncology Questions for Medical Student Exams

From the following list select the 3 tumour markers that are of clinical use in the "work up" of a patient with an unknown suspected primary malignancy:
(e.g. weight loss/ malaise)

Please select 3 answers only: 3 marks available

a. Beta HCG
b. CA 19-9
c. AFP (alfa fetoprotein)
d. CA 153
e. Thyroglobulin
f. PSA (prostate specific antigen)
g. CA125

Show the answers

a. Beta HCG
c. AFP (alfa fetoprotein)
f. PSA (prostate specific antigen)

The other tests are not specifically designed as "screening tests" for patients. For example a man losing weight should not simply have a CEA, CA19-9 and Ca 125(!) checked as:

  • there is no replacement for clinical examination and planned investigations
  • "negative results" do not negate the need for further investigation
  • "positive results" do not necessarily infer any diagnostic specificity.

A careful history, examination, investigations and clinical assessment is much more important than just requesting lots of tests.

PSA, HCG and AFP are different as a result of their sensitivity and specificity and relative prevalences of each of the conditions they act as "markers" for namely: prostate cancer, Choriocarcinoma and hepatoma.

The other tests are not validated as ‘cancer screening’ tools and should not be used in this way.

Commonly cited tumour markers:


Associated with



Hepatoma: also some seminomatous testicular tumours

Remember high risk populations including hepatitis virus and alcoholics


Colorectal cancer

Note its use in follow up rather than diagnosis


Thyroid Medullary cancer

Diagnosis and follow up


Ovarian cancer


Urinary Catecholamines


Remember to consider this in patients presenting with palpitations and resistant hypertension

Protein Electrophoresis


Any questions that include the test "immunoglobulins and protein electrophoresis" is essentially looking for the monoclonal production of immmunoglobulin seen in myeloma

Ca 19-9

Pancreatic Cancer

Levels of >10,000 can correlate with metastatic spread in this aggressive tumour

Beta HCG


Almost ‘always’ elevated. Also elevated in germ cell tumours


Prostate cancer


Urinary 5HIAA


Symptoms often imply metastases

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Free Endocrinology Questions for Medical Student Exams

Which of these symptoms of hypoadrenalism will distinguish between primary adrenal failure and secondary (pituitary) adrenal insufficiency?

a. Postural Hypotension
b. Weight Loss
c. Fatigue
d. Hypoglycaemia
e. Skin Pigmentation

Show the answer

e. Skin Pigmentation

Most of the symptoms of adrenal insufficiency (e.g. hypotension, weight loss) result from low cortisol levels and therefore do not distinguish between adrenal or pituitary failure.

This question tests your understanding of the hypothalamic-pituitary-adrenal axis. This is another example where negative feedback is used to control hormone release.

ACTH is released from the pituitary gland. It acts on the adrenal glands stimulating cortisol release.

In primary adrenal failure (Addison’s disease), there is destruction of the adrenal glands and therefore they do not produce cortisol. In an attempt to stimulate the failed adrenal glands, the pituitary gland secretes high levels of ACTH.

ACTH is synthesised within the anterior pituitary gland from pro-opiomelanocortin (POMC). The cleavage of the POMC molecule results in the production of ACTH as well as a number of molecules including forms of MSH (melanocyte stimulating hormone). In fact, alpha-MSH is identical to the start of the ACTH molecule.

High levels of circulating ACTH act as MSH causing increased pigmentation.

Look in the buccal mucosa and at the palmar creases.

If the cause of hypoadrenalism is from pituitary failure, neither ACTH nor MSH will be released, hence there’s no increase in pigmentation.

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At the bedside: Free Questions for Medical Student Exams

A 27 year old female presents with a headache. She has had it for 3 days. She has no other symptoms. She has a normal CT brain.

Her lumbar puncture shows the following.

CSF Opening Pressure (10-20cm H20)


Macroscopic appearance


Bottle 1

Bottle 3

RBC 150 mm3, WCC 0mm3

RBC 0mm3,WCC 0mm3

Gram stain



No growth





What is the most likely diagnosis?

a. Benign Intracranial Hypertension
b. Tension headache with traumatic Lumbar Puncture
c. Sub arachnoid haemarrage missed on CT
d. Stroke
e. Sub Arachnoid Haemorrage
f. TB Meningitis

Show the answer

a. Benign Intracranial Hypertension

The pressure is very high! The CT was normal essentially excluding raised intracranial pressure secondary to an obstructive hydrocephalus (e.g. meningioma obstructing the 4th ventricle draining CSF). The red cells are high in the first sample of CSF but as further CSF is tapped off, this clears. This supports a slightly “traumatic” tap. Xanthochromia testing in the sample is negative, providing no evidence of a prior bleed into the CSF which has then been broken down into xanthochromia.

To diagnose a S.A.H. you have to have either blood or altered blood in the CSF. As a rule of thumb you should have "no" red cells in the CSF if its not a traumatic tap and there is no other pathological processes.

The diagnosis is BIH. This is reasonably common in young people and is not benign: untreated it can threaten sight. Treatment is via means to reduce CSF pressure e.g. repeated lumbar punctures.

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Free Renal Questions for Medical Student Exams

A 42 year old man develops a sore throat. He does not consult his GP but takes some over the counter painkillers and an anti-inflammatory. 1 week later he has a non itchy rash starting on his feet then spreading to his trunk. The rash has the appearance of tiny teardrops.

He is correctly diagnosed with guttate psoriasis.

The patient is put on penicillin orally 250mg QDS for 1 week. He then starts passing small volumes of urine. His urine is described as "orangey brown" . He continues taking a non steroidal anti inflammatory drug (ibuprofen 800mg TDS).

What is the most likely explanation for this?

a. Post infective glomerulonephritis
b. Rheumatic fever
c. Secondary to penicillin
d. Interstitial nephritis secondary to anti inflammatory medication
e. None of the listed answers

Show the answer

a. Post infective glomerulonephritis

Penicillin is the standard treatment for guttate psorias: treat the streptococci infection. S Its likely that its a type III (antigen antibody complexes getting stuck in the kidney) hypersensitivity reaction, although the steptococci may also produce toxins which result in direct renal injury. The haematuria in posrt strep GN may be "frank" or microscopic.

So the history is is classical of post streptococcal Glomerulonephritis!

In this situation he has had a recent streptococcus infection causing guttate psoriasis. For an exam: post streptococcal: think post strep GN.

Urinalysis would probably show blood and protein (e.g. Blood 3+ Protein3+) The management is generally supportive without the use of prednisolone or a renal biopsy, unless there is renal impairment etc.

Although interstitial nephritis could occur and present like this, its less likely than the classic association of post strep GN. Interstitial nephritis is commonly caused by drugs(NSAIDs and others, hypersensitivity) and presents with malaise/ eosinophillia/ renal impairment. They usually have no/ minimal proteinuria as its a disease of the renal tubules, not the glomeruli.

Glomerular injury (in glomerulonephritis) damages the capillaries and/ or glomerular basement membrane. This renal damage allows red blood cells and larger plasma proteins to "leak" through the glomeruli and into the proximal convoluted tubule and out in the urine.

THIS IS WHY blood and protein in the urine is such an important finding on urinalysis, and why a urinalysis is such a helpful test/ marker of renal disease.

  • 3+ blood 3+ protein on urinalysis? think: Infection (UTI)? Glomerulonephritis
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Free Cardiology Questions for Medical Student Exams

A 76 year old man presents with atrial fibrillation which is permanent. He is lucid and has specifically made an appointment with you to discuss the best way of stopping him "dying " as a result of the AF.

Hypertension (treated), Mild COPD. Nil else of note.

Verapamil (as treatment for AF)
PRN inhalers

Lives alone. Independent. Can carry out all ADL’s (activities of daily living)

What is the anticoagulation schedule you would recommend to prevent stroke?

a. Clopidrogel
b. Warfarin
c. Aspirin
d. No anticoagulation
e. Warfarin and Aspirin

Show the answer

b. Warfarin

Based on NICE Guidance 36 (AF) and the CHADS 2 scoring system.

The CHADS2 score is an excellent aide memoir to anticoagulation in AF. It is based on:


Stands for



Congestive heart failure









Diabetes Mellitus



Previous stroke/ TIA

2 points

2 or over=Warfarin
1= Warfarin or aspirin

This means our chap here will score:

1 for being >75
1 for being hypertensive

This means he should be treated with warfarin (assuming he has no contraindications)

A link to the original publication citation in circulation is available here.(link will open in a new window)

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Free Respiratory Questions for Medical Student Exams

A 45 year old female presents to A&E with mild pleuritic right sided chest pain. A Chest X ray reveals a small (<1cm) ring of air outside the lung at the apex. What is the correct management?

a. Chest drain (Seldinger technique)
b. Aspiration under ultrasound guidance
c. Aspiration without ultrasound
d. Observation initially
e. Chest drain (trochar technique)

Show the answer

d. Observation initially

The pneumothorax is small. Its likely to resolve with no treatment. You can simply repeat the CXR after a period (e.g. 24-48 hours)Aspiration may be successful but is risky in such small effusions.

The British Thoracic Society suggest for a larger pneumothorax:

  • Aspirate effusions >2cm in diameter
  • Then repeat the CXR
  • If unsuccessful: consider either repeat aspiration or chest drain.

In essence this means that in anyone with a spontaneous pneumothorax of >2cm you should consider an aspiration first.

The full British Thoracic Society (BTS) guidelines for pneumothorax are available by clicking the link here .

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Free Infectious Diseases Questions for Medical Student Exams

A 37 year old intravenous drug user is referred by his GP for a suspected Bells Palsy. On examining his inner ear there are a number of vesicles visible on his ear drum. His cranial nerve examination reveals a weakness of the whole of the left side of his face.

The most likely diagnosis is:

a. Steven Johnson Syndrome
b. HIV
c. Stroke
d. Ramsay Hunt Syndrome
e. Bells Palsy

Show the answer

d. Ramsay Hunt Syndrome

Firstly this is a lower motor neuron (LMN) facial (CN VII) palsy: facial weakness of the whole of the face.*

Bell’s is a lower motor neurone lesion which is idiopathic in nature.

The aetiology is probably thought to be a herpes virus and there is some evidence to support the use of short course oral corticosteroids and aciclovir.

  • about 50% of people will get better with no treatment
  • steroids for approximately 1 week seem to help 50% of cases
  • the benefit of aciclovir remains controversial

However: Ramsay Hunt is a facial nerve palsy caused by associated herpes zoster infection (as manifested in this case by the vesicles). When a patient presents with a CNVII weakness, this is one of the key reasons to perform otoscopy, as otherwise you may miss the vesicles.

*Remember in UMN lesions the upper half of the face is spared as there is bilateral UMN innervation. You would not expect this in Ramsay hunt as its a LMN lesion.

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Free Psychiatry Questions for Medical Student Exams

Match the symptoms with the correct terminology. You can use each answer as many times as you like:

"I can see cats running up and down the walls"


"Every day at work I shout at my junior doctors at the drop of a hat if even the simplest and most insignificant thing is out of place or not how I like it. I have subsequently been suspended"


"I keep on feeling the need to wash my hands. I know its not necessary because my hands are clean."


"Sometimes I’m incredibly happy then sometimes I’m incredibly sad and a simple thing like us winning a football game or running out of bread can set it off."


"I think I can fly"


"The car over there driving down the street has no wheels" (whilst looking at a car driving normally down the street)


"I have un-refreshing sleep and no longer enjoy playing football or going to the pub"


"I need to pray 14 times a day to satisfy my religious belief. However it is beginning to affect the way I bring up my children and the time I spend with them"


Show the answer

  • Delusions: A belief firmly held despite evidence to the contrary. Must be inappropriate in terms of cultural beliefs. For example if believing in reincarnation is culturally appropriate, it is not a delusion.

"I think I can fly"

  • Hallucinations are sensory perceptions (e.g. visual auditory) occurring in the absence of an external stimulus: in contrast to illusions which are misperceptions of external stimuli

"I can see cats running up and down the walls"

  • Compulsions are repetitive and behaviours with a degree of apparent purpose, and are therefore associated with obsessional behaviour which comprises of thoughts that enter the mind. People often try to (unsuccessfully) resist obsessions.
  • Overvalued ideas are thoughts which can then lead to changes in behaviour or actions which are neither obsessional nor delusional. Praying an unusually large amount of time is an example: the praying may be consistent with the religious belief but not the extent which its being taken.

"I need to pray 14 times a day to satisfy my religious belief. However it is beginning to affect the way I bring up my children and the time I spend with them"

  • Mood disorders encompass the usual depression anxiety and other more normal emotions of elation irritability, emotional lability etc.

"Every day at work I shout at my junior doctors at the drop of a hat if even the simplest and most insignificant thing is out of place or not how I like it. I have subsequently been suspended"

  • Illusion: misperception of a “real” external stimulus e.g. seeing the a car travelling with no wheels (although the car is there). Differentiated from a hallucination by the fact it is a "misperception" of a real physical stimulus.

"The car over there driving down the street has no wheels" (whilst looking at a car driving normally down the street)

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Free Statistics and Epidemiology Questions for Medical Student Exams

A new diagnostic test is used to screen 100000 patients for bowel cancer.

The test was ‘positive’ in 900 patients. Of those, 600 were subsequently found to have bowel cancer, the other 300 after extensive investigation were pronounced disease free. There were additional 100 cases of bowel cancer not picked up by the study.

What is the tests approximate sensitivity? (You’ll need either a pen and paper or a calculator or a keen brain):

a. 0.6
b. 0.66
c. 0.7
d. 0.75
e. 0.85

Show the answer

e. 0.85

Fill out the tables below


Disease present

Disease absent


Test positive



= total number of people with a positive test (A+B)

Test negative



= total number of people with a negative test (C+D)


=number of people with disease (A+C)

= total no of people without disease (B+D)

=total of all patients

Sensitivity = A / (A + C)


Disease present

Disease absent

Test positive



Test negative



Sensitivity is therefore 600/ (600+100)= 600/700 = 6/7 =0.85 [85%]

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Free Rheumatology Questions for Medical Student Exams

A 64 year old male presents with a symmetrical arthritis of both "hands (history from the GP letter) with early morning stiffness.
His X-rays of his hands done before clinic show the following:

Periarticular osteoporosis of the MCP joints
Erosion on the ulnar styloid
Symmetrical distribution of disease
Reduced joint space at the carpal bones

What is the most likely diagnosis?

a. Ankylosing Spondylitis
b. Rheumatoid arthritis
c. Gout
d. Secondary Osteoarthritis
e. Psoriatic Arthritis

Show the answer

b. Rheumatoid arthritis

Symmetrical disease?
This is classical of RA X-ray changes that include

  1. Erosions
  2. Reduced joint space
  3. Peri-articular osteoporosis
  4. Nodules

So from the initial history of disease [small joints, both hands], the likely diagnoses would be

  • RA
  • PsA
  • (less likely) gout.

Erosive changes are not specific to RA however but the findings were symmetrical

  • both gout and PsA tend to be asymmetrical

Don’t be put off by the fact he’s male, although RA is roughly 3x commoner in women. You cont get a mention of which joints are affected here: RA has a penchant for the wrists and MCP joints. Erosions of the ulnar styloid are very common.

Common x-ray changes of the different arthritides are shown below.

Non Inflammatory


Primary OA: Asymmetrical

There are classically 4 signs of OA on an X-ray: Occurs in classic joints eight bearing e.g. Hips& Knees. May not be symmetrical.

  1. Subchondral bone sclerosis
  2. Cystic Change
  3. Osteophytes
  4. Reduced Joint Space

Gout: Asymmetrical

The classical signs of gout on an Xray are: Erosions with sclerotic margins. Asymmetrical.

  1. A relatively preserved joint space
  2. Minimal periarticular osteoporosis
  3. Nodules (these are in fact tophi)

Charcot Joints:

  1. Destruction of the joint
  2. Disorganisation (bones not arranged in the correct /usual arrangement through gross destruction e.g. cuniforms of the foot.
  3. Increased density (sclerosis)
  4. Debris (boney debris from a destroyed joint: often with well defined margins
  5. Dislocation

Psoriatic Arthritis: Asymmetrical

The X-ray Changes are similar to rheumatoid but they differ in their distribution, and the formation of pencil in cup deformities along with osteolysis.

  1. Asymmetrical distribution of disease
  2. Often affects PIP and DIP joints
  3. relative absence of peri-articular osteoporosis
  4. Erosions seen at the distal interphalangeal joints joints
  5. Reduced joint space
  6. Pencil in cup deformity (arthritis mutilans with telescoping of the fingers)- this is a result of osteolysis
  7. Loss of the terminal tufts of the phalanges (acro-osteolysis)
  8. Sacroiliac and spondylitic changes (similar to those of Ank. Spond.)

Secondary OA

As per primary OA but occurring in a joint that has been previously damaged from any other disease process (inflammatory disease etc)

Rheumatoid Arthritis: Symmetrical

  1. Erosions
  2. Reduced joint space
  3. Periarticular osteoporosis
  4. Nodules

Septic Arthritis: Asymmetrical

  1. Periarticular osteoporosis
  2. Loss of joint space
  3. Deformity/subluxation
  4. Erosions
  5. Effusion
  6. Usually just 1 joint

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Free Clinical Immunology Questions for Medical Student Exams

Match the Hypersensitivity reactions with the Gell and Coombs classification:

  • IgE mediated (hayfever)
  • Membrane bound antigen i.e. Antibody mediated cell lysis/ receptor activation/ receptor blocking
  • Circulating immune complexes: e.g. Henoch Schonlein Purpura (IgA immune complexes)
  • T Cell mediated e.g. Transplant rejection
Type I
Type II
Type III
Type IV

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This system of hypersensitivity was devised by Messrs Gell and Coombs in the 1960’s, and is a helpful way of thinking about immunological reactions

Hypersensitivity Type


Type I

IgE mediated e.g. atopy

Type II

Antibody dependent: antibody reacts with host receptors and may act to "block" or "stimulate" the receptor. e.g. myasthenia gravis (blocks)

Type III

Immune complex: the antigen-antibody complexes "stick" in the walls of small vessels [skin/kidney] leading to complement activation and up regulation of the immune response

Type IV

Delayed Hypersensitivity e.g. granulomatous reaction in TB

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Free Gastroenterology Questions for Medical Student Exams

A medical student sustains a needlestick injury from an intravenous drug user. Unfortunately this user is Hepatitis C positive.

Regarding Hepatitis C which of the following statements is true?

a. Vaccination to hepatitis C is routinely available to healthcare professionals and confers some protection
b. The chance of transmission of hepatitis C is around 3%
c. The chance of transmission is around 0.3%
d. Hepatitis C if transmitted will lead to liver failure in that individual
e. The chance of transmission is around 30%

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b. The chance of transmission of hepatitis C is around 3%

The chances of transmission are as follows:




Risk assessment needed prior to administering post exposure prophylaxis

Hep C 3%1

PCR testing for Hep C virus will give most accurate and reliable indication of transmission

Hep B 30%

Consider repeat Hep B booster/ IvIG (local policies)

The rule of 3’s

The risk is higher with hollow bore needles than with normal needles (e.g. suturing). This data varies widely across specialities. Individuals vaccinated against Hepatitis B have a lower risk of transmission following a needle stick.

The prevalence of needle stick injuries has been estimated to be as high as 33% in a 6 month period for healthcare workers.3

Hep B is the most transmissible of all 3 conditions. As a healthcare professional with a transmittable disease it may preclude you from working in certain specialities e.g. some surgical specialities.

Remember the prevalence of Hepatitis B, HIV and Hepatitis C in the UK is still low (<1% for each).

1. The risk of Hep C transmission rate varies from 3-5%. If a person is exposed, the usual practice is to PCR the blood for the hepatits C virus .
MS Sulkowski et al. Needlestick transmission of hepatitis C. JAMA 2002 287: 2406-2413.

2. A study of 75 medical students and interns in New York
F Resnic, MA Noerdlinger
. Occupational exposure among medical students and house staff at a New York City medical center. Archives of Internal Medicine 1995 155: 75-80.

A good review can be read from Bandolier here

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Free Dermatology Question For Medical Student Exams

Look at this skin rash. It measures 6cm in length and is occurring over the extensor aspect of the upper forearm

Image modified by medicaleducator and used under a GNU licence

Which of the following treatments is likely to result in the resolution of the rash?

a. Coal Tar
b. Mesalazine
c. Flucloxacillin
d. Topical ibuprofen
e. Topical capsaicin

Show the answer

a. Coal Tar

This is the classic salmon pink rash of psoriasis. You can see the surface has a scaly appearance.

As the rash in psoriasis is palpable and spread over an area of >0.5cm it is called a plaque not a macule – (If it was an impalpable area of colour change it would be called a patch).

Skin psoriasis is treated by emmollients, vitamin D analogues, coal tars, dithranol, topical steroids and oral retinoids. Methotrexate and Anti TNF therapy in addition to other immune modulating therapies are used in severe cases. Remember the four main types:

  1. plaque (seen here)
  2. pustular (pustules often occuring on the hands and feet)
  3. guttate ( teardrop lesions -sometimes occuring following a streptococcal infection)
  4. erythrodermic (diffuse skin involvement – potentially lifethreatening)

Capsaicin is a Rubefacient: a topical skin irritant. Its use is based on the principle that irritation of the skin produces a "distracting" effect from the pain from OA/ neuropathy (e.g. post herpetic neuralgia).
It is used topically for osteoarthritis and neuropathic pain.

Capsaican is the "active" ingredient in chillies which gives them their heat. Its use over a rash like psoriasis would be liable to produce excruciating pain and significant inflammation.

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