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Phase 3 Medicine 2026
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A 63 year old previously well woman presents to the Emergency Department with sudden onset of severe constant generalised abdominal pain. T 37.1°C, PR 154/min irregularly irregular, BP 110/80mmHg. Her abdomen is mildly tender generally. An erect chest X-ray reveals no evidence of free gas. Which of the following is the most important management?
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Stem 2:A 53 year old man with diabetes presents with a painful ulcer over his left medial malleolus. He has reduced proprioception of his left great toe and absent ankle reflexes. Peripheral pulses are diminished and the ankle-brachial index is 0.4.
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A 22 year old man injures his right knee being tackled during a soccer game. He is unable to continue to play and over the following day the knee becomes increasing painful and swollen. On occasions he has noticed that he is initially unable to straighten his leg. On examination there is an effusion in the knee. There is no lateral or medial instability and anterior and posterior draw tests are negative. Extension of the knee with a valgus stress to the knee and external rotation of the foot results in pain and an audible click. Which one of the following structures is most likely to have been injured?
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A 38 year old woman is experiencing "pins and needles" around her mouth 48 hours after a total thyroidectomy for a multinodular goitre. Which of the following is the most appropriate management?
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An 85 year old man is brought to the Emergency Department from a nursing home. He presents with an acutely painful, pale right lower leg. He cannot move his right foot and there is complete numbness. There is evidence of fixed mottling of the skin and a doughy consistency to the muscles. The patient is mentally competent and consents to recommended treatment but his son is against any surgical intervention. Which of the following is the most appropriate management?
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A 35 year old man is brought by ambulance after sustaining full thickness burns to his chest and arms in a house fire. He was trapped for 10 minutes. On examination, PR 120/min, BP 115/80mmHg, RR 35/min, O2Sat 87%. He has noisy breathing on presentation. Which of the following treatment options is the priority?
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A 20 year old woman with a history of recurrent tonsillitis presents to the Emergency Department with right sided submandibular pain, odynophagia, and a "hot potato" dysphonia. On examination, her temperature is 38.5°C and she has evidence of tender non-fluctuant right cervical lymphadenopathy. Oral cavity examination is difficult because of trismus. Which of the following is the most likely diagnosis?
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Theme: Leg Ulcers For each patient with a leg ulcer, select the most likely diagnosis. Stem 1:A 70 year old woman presents with an enlarging ulcer over the anterior aspect of the lower third of her right leg. There is a hard nodule at one edge, with surrounding pigmentation and fibrosis. The ulcer has not healed despite 12 months of bed rest and leg elevation.
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A 26 year old man is admitted with a moderate sized spontaneous pneumothorax. An intercostal catheter has been inserted and he is placed on drainage with an underwater seal. Which of following indicates when it is safe to remove the catheter?
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An 82 year old man on the surgical ward goes into urinary retention. Bladder ultrasound reveals an 800ml residual. An attempt to catheterise him with a 14Fr urinary catheter fails as it cannot be passed successfully. Which of the following is best next step?
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