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25/09/2026

A 72-year-old man who is known to have had a cardiac pacemaker inserted some years ago is admitted for
overnight monitoring to the Medical Admissions Ward following a collapse at home. He suffers a vacant
period while being monitored and the rhythm strip is shown below:

Which of the following most accurately describes what is shown on the rhythm strip?

A. Failure of atrial capture

B. Failure of atrial inhibition

C. Failure of ventricular capture

D. Retrograde atrial activation

E. Ventricular undersensing

24/09/2026

A 41-year-old woman presents to the Endocrinology Clinic complaining of flu-like symptoms, weight loss
and palpitations over the past 3–4 weeks. She has unintentionally lost 4 kg in weight. She takes no regular
medication and is usually well.
On examination, her blood pressure is 105/80 mmHg while her pulse is 102 bpm and regular. Her body mass
index is 22 kg/m . She is generally tender over the thyroid gland on palpation. There is no proptosis.

What is the most likely diagnosis?

A. Graves’ disease

B. Hashimoto’s disease

C. Secondary hyperthyroidism

D. Subacute thyroiditis

E. Toxic multinodular goitre

23/09/2026

A 54-year-old woman is referred to the Renal Clinic having suffered an episode of left renal colic. She has felt
increasingly unwell over the last few weeks, with lethargy and nausea. She was previously diagnosed with
Sjögren syndrome.
On examination, her blood pressure is 138/84 mmHg while her pulse is 75 bpm and regular. Her chest is
clear and her abdomen is soft and non-tender. Her body mass index is 22 kg/m .

What is the most likely diagnosis?

A. Bartter syndrome

B. Primary adrenal insufficiency

C. Renal tubular acidosis (RTA) type 1

D. RTA type 2

E. RTA type 4

22/09/2026

An 18-year-old woman presents to the Endocrinology Clinic for review. She is concerned as she has not
begun her menstrual periods. She is well, with no previous medical history of note, apart from the repair of
bilateral inguinal hernias when she was a baby.
On examination, her blood pressure is 118/80 mmHg while her pulse is 75 bpm and regular. She is 182 cm in
height and her body mass index is 22 kg/m . She has very sparse p***c hair, normal breast growth and
normal female external genitalia.

What is the most likely cause of this patient's amenorrhoea?

A. Androgen insensitivity syndrome (AIS)

B. Classical congenital adrenal hyperplasia (CAH)

C. Polycystic ovarian syndrome (PCOS)

D. Premature ovarian failure (POI)

20/09/2026

A 53-year-old man presents to the Nephrology Clinic for review. He has been experiencing night sweats and
weight loss over the last three months. He has developed a left varicocele. His General Practitioner has
detected 3+ of blood on urine analysis.
On examination, his blood pressure is 142/82 mmHg while his pulse is 82 bpm and regular. He looks pale
and his abdomen is soft and non-tender. His body mass index is 31 kg/m .

What is the next most useful investigation in this patient?

A Autoimmune profile

B Computed tomography (CT) abdomen and pelvis with contrast

C Cystoscopy

D Renal biopsy

E Testicular ultrasound (US) scan

19/09/2026

An 18-year-old man presents to the Emergency Department with a severe sore throat, fever, headache and
neck stiffness, which have worsened over the last 48 hours. He has just started his first year at university.
On examination, his temperature is 38.2 °C. His blood pressure is 112/80 mmHg while his pulse is 91 bpm
and regular. Bilateral cervical lymphadenopathy and an inflamed tonsillar bed are observed. Neck stiffness
and photophobia are also present.

What is the most likely cause of this man's symptoms?

A. Epstein–Barr virus (EBV)

B. Herpes simplex virus

C. Listeria

D. Meningococcus

E. Tuberculosis (TB)

18/09/2026

A 64-year-old man is reviewed in the Respiratory Clinic. He has been experiencing an exacerbation of chronic
obstructive pulmonary disease (COPD) and is tiring. He is retaining carbon dioxide (CO ) despite having been
started on non-invasive ventilation (NIV). A decision is made to move to invasive ventilation.

What is the most appropriate management option for this patient with respect to the ventilator settings?

A. Constant sedation should be maintained

B. Extrinsic positive end-respiratory pressure (ePEEP) should not exceed 12 cm H20

C. Inspiratory time should be prolonged

D. Minimum breath frequency of 20 bpm should be maintained

E. Minimum pH of 7.3 should be maintained

12/09/2026

A 73-year-old woman presents to the Respiratory Clinic for review. She has emphysema, which is being
treated with glycopyrrolate, formoterol and budesonide inhalers. She also has ischaemic heart disease and
hypertension.
On examination, her blood pressure is 122/82 mmHg while her pulse is 89 bpm and in atrial fibrillation (AF).
Her chest is hyperexpanded, with a quiet bilateral wheeze on auscultation. There is pitting oedema of both
ankles.

What is the most appropriate intervention for this patient?

A Diazepam as required (PRN)

B Home oxygen

C Morphine PRN

D Montelukast

E Theophylline

11/09/2026

A 32-year-old man presents to the Emergency Department complaining of painful cervical lymphadenopathy,
fever and sweating. He was recently diagnosed with human immunodeficiency virus (HIV) infection and
began antiretroviral therapy seven weeks ago. His CD4 count when commencing highly-active antiretroviral
therapy (HAART) was 85 cell/mm .
On examination, his temperature is 38.2 °C. His blood pressure is 122/80 mmHg while his pulse is 85 bpm
and regular. His chest is clear, while his abdomen is soft and non-tender. He has tender cervical
lymphadenopathy.

What is the most likely cause of this patient's lymphadenopathy?

A. Cryptococcus neoformans (C neoformans)

B. Herpes zoster

C. John Cunningham (JC) virus

D. Mycobacterium avium (M avium) complex

E. Pneumocystis jirovecii (P jirovecii)

10/09/2026

A 58-year-old man is recovering in the Coronary Care Unit following stenting for an anterior myocardial
infarction three days ago. His creatinine (Cr) has risen over the last 48 hours; over the past eight hours, his
urine output has fallen to < 30 ml/hour.
On examination, his blood pressure (BP) is 115/80 mmHg while his pulse is 74 bpm and regular. His chest is
clear. His central venous pressure is 9 cmH O.

What is the most appropriate intervention for this patient?

A. Dopamine

B. Furosemide

C. N-acetylcysteine

D. Renal replacement therapy (RRT)

E. Vasopressin

Address

Gibson House (1st Floor) Northwest Associates Ltd, 800 High Road
Dhaka
N170DH

Telephone

+8801979411927

Website

http://www.Medmonarchy.com/

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