30.    Patient GP (male, 28 years old, weight 58 kg) is diagnosed in hospital with infective endocarditis. His past medical history includes previous fractured wrist (3 years ago) and current use of illicit intravenous drugs. He has no known drug allergies.Which statement is CORRECT?

35.    Patient SK (male, 68 years old, weight 80 kg) presents to the GP with dysuria, nausea, dizziness, chills, and pain in his side. The GP carries out an examination and the observations are:•    Heart rate: 110 beats per minute•    Blood pressure: 88/55 mmHg•    Respiratory rate: 25 breaths per minute•    Temperature: 38.8°C•    Oxygen saturations: 96%The patient has no significant past medical history and is not taking any regular medication. He has an allergy to penicillin (anaphylaxis).What is the MOST APPROPRIATE treatment choice for Patient SK?

37.    Patient LH (male, 90 years old, weight 57 kg) is a nursing home resident with frailty. He has a long-term indwelling urinary catheter in situ due to benign prostatic hyperplasia causing bladder outlet obstruction. This was last changed 3 days ago. He currently takes only paracetamol 1 g when required four times daily and has no known drug allergies. Today he is unwell with lethargy, confusion, nausea, flank pain and a temperature of 38.2°C.Which initial management option is MOST APPROPRIATE?

39.    Patient AG (male, 23 years old, weight 82 kg) is known to have asthma; he has no other medical conditions. His regular medications are:•    Salbutamol pressurised metered dose inhaler 100 micrograms/puff 2 puffs when required•    Beclometasone (Clenil) 200 micrograms/puff 2 puffs twice dailyHis recorded best PEFR is 490 L/min.He has had a bad cold over the last few days and began to feel increasingly wheezy and short of breath. Today he feels extremely breathless and is struggling to complete sentences. His current PEFR is 240 L/min, respiratory rate is 28 breaths per minute, heart rate 110 beats per minute.Based on this information, pending further investigations and examinations, which statement is CORRECT?

19.    Patient JS (male, 71 years old, weight 93 kg) has presented with a painful, swollen joint affecting the big toe on his right foot. It is hot to the touch and red.Past medical history•    Hypertension•    Hypercholesterolaemia•    Heart failure•    Chronic Kidney Disease Stage 3a (eGFR 55 ml/min/1.73m2)Medication history•    Atorvastatin 20 mg once daily•    Furosemide 80 mg in the morning, 40 mg lunchtime (increased 2 weeks ago)•    Lisinopril 20 mg once daily•    Paracetamol 1 g four times daily•    Multivitamin ONE tablet once daily (buys over the counter)•    no known drug allergies A diagnosis of an acute flare of gout is made. What is the MOST LIKELY cause of this acute flare of gout in Patient JS?

9.    Patient KW (female, 35 years old, 74 kg) is in hospital with an episode of diverticulitis. She rates her current pain as 4/10 and would like to take something to help.Past medical history:•    Diverticulosis•    DepressionMedication history:•    Fluoxetine 20 mg once daily•    Allergy to ibuprofen, caused lip swelling and wheezeWhat would be MOST APPROPRIATE to offer in the FIRST instance?

15.    Patient PU (female, 55 years old, weight 80 kg) has become severely unwell with a skin problem, described in her notes as ‘detachment of around 5% of Body Surface Area with widespread erythematous macules’. This was preceded by an upper respiratory tract infection with a fever and headache, before the lesions suddenly developed.Which is the MOST LIKELY diagnosis?

23.    Patient GO (male, 33 years old, height 180 cm, weight 80 kg) has presented to Accident and Emergency following a paracetamol overdose. He has been started on an acetylcysteine infusion and has begun to feel unwell; he complains of difficulty breathing and he has developed a wheeze.Which management option would be the MOST APPROPRIATE for Patient GO?

7.    Patient LBA (male, 64 years old, weight 55 kg) is being treated for diabetic ketoacidosis (DKA) on the hospital admissions unit. You have a solution of 50 units of human soluble insulin (Actrapid®) made up to 50 ml with 0.9% sodium chloride solution. What rate should the infusion initially be given at?

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