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OET Medicine practice questions

One question at a time. Build your OET Medicine understanding.

First 50 of 200 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

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Question 1Listening

A patient tells the doctor: 'I've been getting these crushing chest pains when I climb the stairs, but they ease off after a couple of minutes' rest.' Which term best describes what the patient is reporting?

  1. Silent myocardial infarction
  2. Pulmonary embolism
  3. Pericarditis
  4. Stable angina Correct answer.

Explanation

Pain that is provoked by exertion and relieved within minutes by rest is the classic description of stable angina, reflecting reversible myocardial ischaemia. The predictable exertional trigger and rapid relief are the key features the candidate must recognise in the consultation.

Question 2Listening

During a consultation the GP says: 'Your HbA1c has come back at 52 mmol/mol, so we'd like to start you on metformin.' What is the doctor doing at this point in the interview?

  1. Signposting a physical examination
  2. Explaining a diagnosis and proposing management Correct answer.
  3. Closing the consultation
  4. Taking a social history

Explanation

The doctor is sharing a test result, naming the condition it indicates and offering first-line treatment, which is the explanation-and-planning phase of the consultation. Recognising this phase helps candidates predict the kind of language that will follow.

Question 3Listening

A nurse tells a colleague: 'Mr Okafor's obs are fine, but he's been a bit off his food since the surgery.' What does 'off his food' mean in this clinical context?

  1. He has a reduced appetite Correct answer.
  2. He is nil by mouth
  3. He is vomiting after every meal
  4. He is allergic to hospital meals

Explanation

'Off his food' is an informal British and Australian expression meaning eating less than usual or having a poor appetite. Candidates must decode such colloquial phrasing because it carries clinically relevant information about nutrition and recovery.

Question 4Listening

A patient says: 'I've had this niggle in my lower back for about three weeks now.' Which feature of the pain history is the patient mainly supplying?

  1. Aggravating factors
  2. Radiation
  3. Character
  4. Duration Correct answer.

Explanation

The patient is stating how long the symptom has been present, which is the duration element of a pain history. Other elements such as character, radiation and aggravating factors would need separate questions from the clinician.

Question 5Listening

In a discharge planning meeting, a physiotherapist says: 'She's not safe on her feet yet, so we'll keep her on the ward for another day.' What is the physiotherapist recommending?

  1. Ordering an X-ray of the feet
  2. Changing the patient's medication
  3. Referring the patient to social services
  4. Delaying discharge because of mobility risk Correct answer.

Explanation

'Not safe on her feet' means the patient's standing and walking ability is still unsafe, usually because of falls risk, so discharge is postponed. The candidate must link the idiomatic phrase to the clinical decision being made.

Question 6Listening

A doctor asks a patient: 'Have you noticed any blood in your stools, or any black tarry motions?' Which condition is the doctor primarily screening for with this question?

  1. Coeliac disease
  2. Irritable bowel syndrome
  3. Gastrointestinal bleeding Correct answer.
  4. Haemorrhoids only

Explanation

Fresh blood in stool and black tarry melaena are the two classic indicators of upper or lower gastrointestinal bleeding. Asking about both allows the clinician to gauge severity and site of possible blood loss.

Question 7Listening

A midwife says to a colleague: 'She's 38 weeks and her waters have gone.' What has happened to the patient?

  1. Her labour has been induced
  2. She has started breastfeeding
  3. Her membranes have ruptured Correct answer.
  4. She has had a show of blood

Explanation

'Waters have gone' is the common way of saying the membranes have ruptured, which may precede labour. Understanding this phrase is essential for following obstetric handover conversations.

Question 8Listening

A receptionist tells a GP: 'Mrs Patel is here for her follow-up and says she's been a bit chesty since the antibiotics.' What does 'chesty' most likely indicate?

  1. Angina on exertion
  2. Anxiety about the chest
  3. Chest wall injury
  4. A productive cough or chest congestion Correct answer.

Explanation

'Chesty' is an informal term for cough with sputum or chest congestion, often used after a respiratory infection. It signals ongoing airway symptoms rather than cardiac or musculoskeletal problems.

Question 9Listening

A consultant says during a ward round: 'Let's keep him nil by mouth and get the surgical team to review him this morning.' What is the immediate purpose of the nil-by-mouth instruction?

  1. To prepare the patient for a chest X-ray
  2. To prevent the patient choking on tablets
  3. To reduce the patient's fluid overload
  4. To keep the patient fasted in case surgery is needed Correct answer.

Explanation

Withholding oral intake while awaiting surgical review keeps the patient fasted so that anaesthesia can proceed safely if an operation is required. The instruction is precautionary and time-limited.

Question 10Listening

A GP tells a patient: 'Your blood pressure is a little high today, but I don't want to hang my hat on a single reading.' What is the doctor implying?

  1. Treatment should start immediately
  2. The reading is definitely diagnostic of hypertension
  3. The machine must be faulty
  4. The result needs confirmation with further measurements Correct answer.

Explanation

The idiom 'hang my hat on' means to rely on something as a firm basis for a decision. The doctor is signalling that one elevated reading is insufficient and that repeat or ambulatory measurements are needed before diagnosing hypertension.

Question 11Listening

A patient with newly diagnosed type 2 diabetes says: 'So does this mean I'll end up on insulin injections?' Which response best reflects the doctor giving balanced information without false reassurance?

  1. 'Yes, everyone with diabetes eventually needs insulin.'
  2. 'Insulin is nothing to be frightened of, it's just a small needle.'
  3. 'Not necessarily; many people manage well on tablets and lifestyle changes, though some do need insulin later.' Correct answer.
  4. 'Don't worry about that now, let's just focus on today.'

Explanation

An effective answer acknowledges the patient's concern, avoids absolute predictions and gives accurate information about the range of treatment pathways. This supports informed understanding without overpromising or alarming the patient.

Question 12Listening

During a telephone triage call, the nurse says: 'I'd like you to go to the emergency department now, and if your chest pain gets worse on the way, call an ambulance.' What is the nurse doing?

  1. Taking a drug history
  2. Giving safety-netting advice Correct answer.
  3. Arranging a routine appointment
  4. Obtaining informed consent

Explanation

Safety-netting tells the patient what to do if symptoms worsen or change while following the current plan. It is a core communication skill in triage and is assessed through recognition of its purpose.

Question 13Listening

A patient describes: 'It started in the middle of my chest and then it felt like a band tightening around me and spreading to my left arm.' Which feature of the pain history is the patient emphasising?

  1. Associated nausea
  2. Onset time only
  3. Radiation and character Correct answer.
  4. Relieving factors

Explanation

The description gives both the quality of the pain, a tightening band, and its spread to the left arm, which is radiation. Both features are highly relevant to a possible cardiac cause and should be documented precisely.

Question 14Listening

A junior doctor summarises a patient at handover: 'Bed 12, 74-year-old man, day two post-hip replacement, afebrile but his CRP is trending up and the wound looks a bit angry.' What concern is being communicated?

  1. A dislocated prosthesis
  2. A pulmonary embolism
  3. Urinary retention
  4. Possible wound infection Correct answer.

Explanation

Rising inflammatory markers combined with an inflamed-looking wound after surgery raise suspicion of a surgical site infection. The colloquial 'angry' describes erythema and inflammation around the wound.

Question 15Listening

A GP says to a patient: 'I think we should get you in for a spirometry test to see how your lungs are working.' Which purpose does the doctor state for the test?

  1. To visualise the lung tissue
  2. To detect an infection
  3. To assess lung function Correct answer.
  4. To measure blood oxygen levels

Explanation

Spirometry measures how much and how quickly air can be exhaled, giving information about lung function and airflow obstruction. The doctor's explanation links the test to how the lungs are working rather than to imaging or blood tests.

Question 16Listening

A patient says: 'The tablets helped for a while, but then the headaches came back with a vengeance.' How is the patient describing the recurrence?

  1. As mild and gradual
  2. As sudden and severe Correct answer.
  3. As a side effect of the tablets
  4. As unrelated to the tablets

Explanation

'With a vengeance' is an idiom meaning with great force or severity, so the patient is saying the headaches returned intensely. Recognising this helps the clinician judge symptom severity and treatment response.

Question 17Listening

A nurse asks a patient: 'Do you have any trouble passing water?' Why is this phrasing used rather than asking directly about urination?

  1. It avoids discussing a sensitive topic
  2. It is the only medically accurate term
  3. It uses everyday language the patient is more likely to understand Correct answer.
  4. It refers specifically to bowel function

Explanation

Plain, familiar phrasing improves patient comprehension and encourages an accurate answer, especially for patients unfamiliar with clinical terms. This is a deliberate communication strategy rather than evasion.

Question 18Listening

A consultant says: 'The patient's renal function is on a knife edge, so we need to avoid any nephrotoxic drugs.' What does the consultant mean?

  1. Renal function cannot be measured
  2. Renal function is critically unstable Correct answer.
  3. Renal function has fully recovered
  4. Renal function is normal for age

Explanation

'On a knife edge' describes a precarious, finely balanced situation that could deteriorate quickly. Here it warns that kidney function is critically unstable and that nephrotoxic drugs could tip the patient into acute kidney injury.

Question 19Listening

During a consultation a patient says: 'I don't want to make a fuss, but I've been feeling really low since my wife died.' What is the most appropriate way for the doctor to respond?

  1. Advise the patient to come back if things get worse
  2. Change the subject to the presenting physical complaint
  3. Acknowledge the loss and explore the patient's mood and support Correct answer.
  4. Reassure the patient that feeling low is normal and move on

Explanation

The patient has disclosed significant psychological distress and bereavement, so the doctor should acknowledge the loss and gently explore mood, duration and available support. Responding with empathy and further enquiry is the appropriate consultation behaviour.

Question 20Listening

A patient asks: 'Will this operation cure me for good?' The surgeon replies: 'In most cases it controls the problem very well, but I can't promise it won't come back.' What communication principle is the surgeon applying?

  1. Giving false reassurance to reduce anxiety
  2. Being honest about prognosis without overpromising Correct answer.
  3. Delegating the explanation to a nurse
  4. Avoiding discussion of risk

Explanation

The surgeon gives a realistic picture of likely benefit while openly acknowledging uncertainty about recurrence. This balances hope with honesty, which is central to good consent discussions.

Question 21Listening

A patient with asthma says: 'I only use the blue inhaler when things get bad, maybe twice a week.' Why is this detail clinically important?

  1. It proves the patient has chronic obstructive pulmonary disease
  2. Reliever use frequency indicates the level of asthma control Correct answer.
  3. It shows the patient is using the inhaler incorrectly
  4. It means the preventer inhaler is unnecessary

Explanation

How often a short-acting reliever is needed reflects underlying airway inflammation and symptom control, and regular use suggests the preventer therapy may need review. This is a key point in asthma consultations.

Question 22Listening

A nurse hands over: 'He's for the high-dependency unit because he's been dropping his sats despite fifteen litres.' What does 'dropping his sats' mean?

  1. His blood pressure is falling
  2. His oxygen saturation is falling Correct answer.
  3. His blood glucose is falling
  4. His temperature is rising

Explanation

'Sats' is shorthand for oxygen saturations measured by pulse oximetry, so 'dropping his sats' means his oxygen levels are falling despite high-flow oxygen. This is a red flag requiring escalation.

Question 23Listening

A GP says to a patient who has just been told a scan showed a suspicious lung shadow: 'Before we go any further, what's your understanding of what I've just told you?' Why does the doctor ask this?

  1. To check the patient's comprehension before adding more information Correct answer.
  2. To test whether the patient has read the report
  3. To delay discussing the diagnosis
  4. To confirm the patient's identity

Explanation

Asking the patient to restate their understanding is a recognised technique for checking comprehension and addressing misconceptions before giving further information. This is especially important when breaking significant news.

Question 24Listening

A patient is describing a family history: 'My mother had a growth removed from her bowel in her fifties, and her sister had the same thing.' Which interpretation is most clinically relevant?

  1. A family history of colorectal disease warranting further risk assessment Correct answer.
  2. A family history of cardiac disease
  3. A family history of breast disease
  4. A family history of thyroid disease

Explanation

A bowel growth removed in middle age, mirrored in a sibling, raises the possibility of a familial predisposition to colorectal neoplasia. The clinician should clarify the histology and consider referral for risk assessment.

Question 25Listening

A junior doctor reports: 'The patient's bloods show a raised white cell count and a left shift.' What does the 'left shift' suggest?

  1. A chronic anaemia
  2. A bleeding disorder
  3. An allergic reaction
  4. An acute inflammatory or infective process Correct answer.

Explanation

A left shift refers to an increase in immature neutrophil forms in the peripheral blood, typically reflecting acute inflammation or infection. Combined with a raised white cell count, it supports an acute infective or inflammatory picture.

Question 26Listening

A practice nurse is explaining the bowel cancer screening programme to a patient. She says: 'You'll get a kit through the post every two years; you collect a small sample and send it back in the prepaid envelope.' What is the patient being asked to provide?

  1. A blood sample for tumour markers
  2. A stool sample for faecal immunochemical testing Correct answer.
  3. A sputum sample for culture
  4. A urine sample for cytology

Explanation

The NHS bowel cancer screening programme in England uses a home faecal immunochemical test (FIT) kit every two years for eligible adults. The patient collects a stool sample and returns it by post; the laboratory detects hidden blood. This is not a blood, urine or sputum test.

Question 27Listening

A GP is speaking to a patient with suspected irritable bowel syndrome. She says: 'I'd like you to keep a food and symptom diary for the next four weeks, noting what you eat and when your symptoms flare.' What is the main purpose of this request?

  1. To identify possible dietary triggers Correct answer.
  2. To measure calorie intake for weight loss
  3. To assess adherence to a gluten-free diet
  4. To confirm a diagnosis of coeliac disease

Explanation

A food and symptom diary helps the patient and clinician look for temporal associations between specific foods and symptom flares. It is a behavioural and observational tool, not a diagnostic test for coeliac disease. It does not measure adherence or calories unless those are the stated goals.

Question 28Listening

A patient in the emergency department says: 'It feels like someone is standing on my chest, and the pain is going down my left arm.' Which symptom pattern is the patient describing?

  1. Pleuritic chest pain
  2. Gastro-oesophageal reflux
  3. Musculoskeletal chest pain
  4. Typical cardiac chest pain Correct answer.

Explanation

Central chest pressure with radiation to the left arm is a classic description of cardiac ischaemic pain. Pleuritic pain is sharp and worse on inspiration; musculoskeletal pain is reproducible on palpation; reflux usually causes burning retrosternal discomfort after meals.

Question 29Listening

A district nurse is teaching a patient to inject insulin. She says: 'Pinch up a fold of skin and push the needle straight in at ninety degrees.' Why is this technique recommended for this patient?

  1. To ensure the insulin reaches subcutaneous tissue rather than muscle Correct answer.
  2. To allow the insulin to be absorbed more slowly
  3. To prevent bruising at the injection site
  4. To reduce the risk of needle-stick injury to the nurse

Explanation

Pinching a skin fold and injecting at 90 degrees helps ensure the needle enters subcutaneous fat, especially in slimmer patients. Intramuscular injection would alter absorption and is avoided. Needle-stick injury and bruising are not the primary rationale for this technique.

Question 30Listening

A physiotherapist is talking to a patient with chronic obstructive pulmonary disease. She says: 'Try breathing in through your nose and out through pursed lips, as if you were blowing out a candle.' What is this technique called?

  1. Diaphragmatic breathing
  2. Autogenic drainage
  3. Incentive spirometry
  4. Pursed-lip breathing Correct answer.

Explanation

Pursed-lip breathing is a controlled breathing technique that creates back-pressure, helping to keep small airways open during expiration. It is commonly taught to patients with COPD to reduce breathlessness. Diaphragmatic breathing focuses on abdominal movement; incentive spirometry uses a device; autogenic drainage is an airway clearance technique.

Question 31Listening

A GP is speaking to a patient who has been experiencing episodes of dizziness on standing. He says: 'I'd like you to have your blood pressure checked lying down and then again after you stand up.' What is this test designed to detect?

  1. Malignant hypertension
  2. Postural hypotension Correct answer.
  3. White-coat hypertension
  4. Resistant hypertension

Explanation

Measuring blood pressure supine and after standing is the standard way to detect postural (orthostatic) hypotension, a fall in systolic pressure on standing. White-coat hypertension is elevated clinic pressure with normal home readings; resistant hypertension persists despite multiple drugs; malignant hypertension is severely elevated with organ damage.

Question 32Listening

A nurse is admitting a patient with a suspected fractured neck of femur. She says: 'I'm going to put a cannula in your hand and start you on some fluids while we wait for the X-ray.' Why are intravenous fluids being started before a definitive diagnosis?

  1. To reduce the risk of fat embolism
  2. To flush the kidneys of contrast dye
  3. To maintain hydration and perfusion while the patient is starved for surgery Correct answer.
  4. To lower the blood pressure before anaesthesia

Explanation

Patients with a suspected hip fracture are often kept nil by mouth in anticipation of surgery, so intravenous fluids are given to maintain hydration and circulation. This is part of the orthogeriatric pathway. Contrast, fat embolism and deliberate hypotension are not the reasons for routine fluids here.

Question 33Listening

A health visitor is discussing infant feeding with a new mother. She says: 'Offer your baby breast milk or formula milk only for the first six months; no water or other drinks.' What is the main reason for this advice?

  1. To reduce the risk of ear infection
  2. To prevent lactose intolerance
  3. To avoid displacing nutrient-rich milk with low-calorie fluids Correct answer.
  4. To encourage the baby to sleep through the night

Explanation

Exclusive milk feeding for around the first six months ensures the infant receives adequate energy and nutrients; giving water or other drinks can displace milk intake. It is not primarily about lactose intolerance, ear infection or sleep. Solid foods are introduced at around six months alongside continued milk feeding.

Question 34Listening

A patient with rheumatoid arthritis says: 'The nurse told me to take my methotrexate on the same day each week and to avoid alcohol.' Why is the weekly rather than daily dosing important?

  1. Weekly dosing reduces the risk of severe bone marrow and liver toxicity Correct answer.
  2. Weekly dosing prevents injection-site reactions
  3. Weekly dosing eliminates the need for folic acid
  4. Weekly dosing improves pain relief within hours

Explanation

Methotrexate for inflammatory arthritis is taken once weekly; daily dosing can cause serious bone marrow suppression and hepatotoxicity. Folic acid is usually co-prescribed to reduce side effects. The weekly schedule is not about faster pain relief or injection-site reactions.

Question 35Listening

A GP is reviewing a patient with type 2 diabetes. The patient says: 'I've been reading that I should check my feet every day.' What is the GP most likely to say about this advice?

  1. It is only necessary if you have pain in your feet
  2. It is useful only for patients who have lost sensation
  3. It helps detect early problems such as cuts or blisters that could lead to ulceration Correct answer.
  4. It replaces the need for an annual foot check

Explanation

Daily foot inspection helps people with diabetes identify minor injuries or skin changes early, when neuropathy and poor circulation increase the risk of ulceration. It is recommended for all, not only those with pain or loss of sensation, and does not replace the annual professional foot check.

Question 36Listening

A nurse is talking to a patient who has just been prescribed warfarin. She says: 'You need to keep your intake of green leafy vegetables consistent rather than avoiding them altogether.' Why is this advice given?

  1. Vitamin K enhances the effect of warfarin
  2. Green vegetables reduce the risk of bleeding
  3. Green vegetables are a source of iron that warfarin requires
  4. Vitamin K intake affects warfarin's anticoagulant effect, so consistency helps keep the INR stable Correct answer.

Explanation

Warfarin works by inhibiting vitamin K-dependent clotting factors. Sudden changes in vitamin K intake from green vegetables can alter the INR, so patients are advised to keep intake steady rather than eliminate these foods. Vitamin K does not enhance warfarin and is not required by it.

Question 37Listening

A patient with asthma tells the practice nurse: 'I've been using my reliever inhaler most days and waking at night with a cough.' What is the most appropriate interpretation of this information?

  1. The reliever inhaler is no longer effective
  2. The patient has developed a chest infection
  3. The patient is using the inhaler incorrectly
  4. The patient's asthma control is poor and treatment should be reviewed Correct answer.

Explanation

Frequent reliever use and night-time symptoms are indicators of inadequate asthma control. This should prompt a review of preventer therapy and inhaler technique, rather than assuming infection or device failure. The information suggests uncontrolled asthma, not simply poor technique.

Question 38Listening

A GP is speaking to a patient with chronic kidney disease. He says: 'You should avoid taking non-steroidal anti-inflammatory drugs such as ibuprofen unless I specifically advise it.' What is the main reason for this advice?

  1. NSAIDs increase the risk of bleeding in all patients
  2. NSAIDs can reduce renal blood flow and worsen kidney function Correct answer.
  3. NSAIDs cause liver failure in kidney disease
  4. NSAIDs interfere with phosphate binders

Explanation

NSAIDs inhibit prostaglandin synthesis, which can reduce renal perfusion, particularly in patients with existing kidney disease or dehydration. They may cause acute kidney injury. The main concern is not bleeding, phosphate binders or liver failure.

Question 39Listening

A midwife is speaking to a woman at her antenatal appointment. She says: 'You should feel your baby move right up to and during labour; if the movements reduce, contact us straight away.' Why is this advice emphasised?

  1. Counting movements predicts the baby's sex
  2. Fetal movements are a reliable measure of gestational age
  3. Movements indicate the mother's blood sugar level
  4. Reduced fetal movements can be a sign of fetal compromise Correct answer.

Explanation

A reduction in fetal movements may indicate placental insufficiency or fetal hypoxia and warrants urgent assessment. Movements are not used to date a pregnancy, determine sex or measure maternal glucose. The advice aims to prompt timely contact with maternity services.

Question 40Listening

A psychiatrist is talking to a patient who has been prescribed lithium. He says: 'It's important to keep your fluid intake steady and to have regular blood tests.' What is the main reason for monitoring blood levels of lithium?

  1. The therapeutic range is narrow and toxicity can occur at levels only slightly above it Correct answer.
  2. Lithium levels predict the risk of thyroid disease
  3. Lithium levels indicate the patient's hydration status
  4. Blood tests are used to adjust the dose for weight gain

Explanation

Lithium has a narrow therapeutic index; levels just above the therapeutic range can cause toxicity, including tremor, confusion and renal effects. Regular monitoring helps keep levels safe. It is not primarily a measure of hydration, weight or thyroid risk, although thyroid function is monitored separately.

Question 41Listening

A practice nurse is advising a patient with type 1 diabetes about sick-day rules. She says: 'Even if you can't eat, you should continue your basal insulin and check your blood glucose more often.' Why is this advice given?

  1. Illness increases insulin requirements and stopping insulin risks diabetic ketoacidosis Correct answer.
  2. Basal insulin should be stopped when appetite is poor
  3. Blood glucose falls during illness so insulin should be reduced
  4. Sick-day rules apply only to type 2 diabetes

Explanation

During illness, stress hormones increase insulin resistance, so insulin requirements often rise even when food intake falls. Omitting basal insulin can lead to ketoacidosis. Blood glucose should be checked more frequently. Sick-day rules apply to type 1 diabetes and often to insulin-treated type 2 diabetes.

Question 42Listening

A GP is discussing the results of a spirometry test with a patient. He says: 'Your FEV1/FVC ratio is below 0.7 and your FEV1 has not improved much after the bronchodilator.' What does this suggest?

  1. Persistent airflow obstruction consistent with COPD Correct answer.
  2. Reversible airflow obstruction typical of asthma
  3. Normal lung function
  4. Restrictive lung disease

Explanation

A post-bronchodilator FEV1/FVC ratio below 0.7 indicates persistent airflow obstruction, which is the spirometric hallmark of COPD. Significant reversibility would suggest asthma. Restrictive disease shows a reduced FVC with a preserved or raised ratio, and normal function would have a ratio above 0.7.

Question 43Listening

A nurse is talking to a patient who has been started on a fentanyl patch for chronic pain. She says: 'This patch is not for sudden flare-ups of pain.' What is the reason for this instruction?

  1. Fentanyl patches are only licensed for cancer pain
  2. The patch releases medication slowly and is not designed for rapid pain relief Correct answer.
  3. The patch must be removed before taking any other painkiller
  4. The patch causes tolerance if used for flare-ups

Explanation

Transdermal fentanyl provides continuous background analgesia over 72 hours; it has a slow onset and is unsuitable for acute breakthrough pain. A short-acting analgesic is used for flare-ups. The patch is not removed before every other analgesic, and it is used in chronic non-cancer pain as well as cancer pain.

Question 44Listening

A patient with heart failure says: 'I've noticed I'm more breathless when I lie flat and I need to sleep on three pillows.' What is this symptom called?

  1. Orthopnoea Correct answer.
  2. Paroxysmal nocturnal dyspnoea
  3. Trepopnoea
  4. Platypnoea

Explanation

Orthopnoea is breathlessness on lying flat, often relieved by propping up on pillows; it is a classic symptom of heart failure. Paroxysmal nocturnal dyspnoea is waking at night with breathlessness. Platypnoea is breathlessness on standing, and trepopnoea is breathlessness in one lateral position.

Question 45Listening

A GP is talking to a patient about the results of a DEXA scan. He says: 'Your T-score is -2.8 at the hip.' What does this indicate?

  1. A fracture of the hip
  2. Osteoporosis at the hip Correct answer.
  3. Normal bone density
  4. Osteopenia at the hip

Explanation

A T-score of -2.5 or below is classified as osteoporosis. A T-score between -1.0 and -2.5 indicates osteopenia, and above -1.0 is normal. The scan measures bone mineral density and does not itself diagnose a fracture.

Question 46Listening

A nurse is speaking to a patient who has just had a cataract operation. She says: 'Avoid rubbing your eye and don't do any heavy lifting for a week.' What complication is this advice intended to reduce?

  1. Wound dehiscence and raised intraocular pressure Correct answer.
  2. Retinal detachment
  3. Endophthalmitis
  4. Dry eye

Explanation

After cataract surgery, rubbing the eye or straining can increase intraocular pressure and stress the incision, risking wound problems. Retinal detachment is a possible but less directly related complication; endophthalmitis is infection; dry eye is common but not the main reason for avoiding lifting.

Question 47Listening

A consultant is teaching a junior doctor about prescribing in renal impairment. He says: 'For drugs that are renally cleared, you often need to adjust the dose or interval.' Why is this necessary?

  1. Dose adjustment is needed only for nephrotoxic drugs
  2. Reduced clearance can lead to drug accumulation and toxicity Correct answer.
  3. Renal impairment increases hepatic metabolism of all drugs
  4. Therapeutic drug monitoring is required for every drug

Explanation

When kidney function is reduced, renally excreted drugs are cleared more slowly, so accumulation can cause toxicity. Dose or interval adjustment helps maintain safe plasma levels. Not all drugs require adjustment, and monitoring is only needed for certain drugs with narrow therapeutic indices.

Question 48Listening

A practice nurse is giving advice to a patient with gout. She says: 'Try to lose weight gradually and avoid crash diets.' Why is sudden weight loss discouraged in gout?

  1. Crash diets cause dehydration and reduce uric acid
  2. Rapid weight loss can raise uric acid levels and trigger a flare Correct answer.
  3. Gradual weight loss has no effect on gout
  4. Weight loss increases the risk of kidney stones

Explanation

Rapid weight loss, especially with fasting or high-protein diets, can increase uric acid production and precipitate an acute gout attack. Gradual weight loss is preferred. Crash diets do not reduce uric acid, and gradual loss can lower uric acid over time.

Question 49Listening

A GP is discussing the results of a urine albumin-to-creatinine ratio (ACR) with a patient who has diabetes. He says: 'Your ACR is raised on two separate samples.' What does this indicate?

  1. Dehydration
  2. Diabetic kidney disease Correct answer.
  3. A urinary tract infection
  4. Normal kidney function

Explanation

Persistently raised albumin-to-creatinine ratio on two occasions indicates albuminuria, a marker of diabetic kidney disease. A single raised result could be due to infection, exercise or dehydration, but two samples support a chronic change. Normal kidney function would have a normal ACR.

Question 50Listening

A patient with epilepsy is talking to a nurse about her medication. She says: 'I want to try for a baby.' Why is it important to review her anti-epileptic drugs before conception?

  1. All anti-epileptic drugs must be stopped during pregnancy
  2. Anti-epileptic drugs prevent conception
  3. Some anti-epileptic drugs increase the risk of congenital malformations Correct answer.
  4. Pregnancy reduces the effectiveness of all anti-epileptic drugs

Explanation

Certain anti-epileptic drugs, particularly sodium valproate, are associated with a higher risk of congenital malformations and neurodevelopmental disorders. Pre-conception review allows consideration of alternative medication and folic acid supplementation. Not all drugs need to be stopped, and they do not prevent conception.