A 21-year-old student on an internship with The Guardian travel section has recently returned from a backpacking holiday in West Africa. For the last few days he has been having headaches, flu-like symptoms and muscle aches, and now he has started rigoring. Which investigation should be performed to rule out malaria?

A 35-year-old homeless man presents to the emergency department in a state of unconsciousness. He was fitting when the ambulance crew got to him 20 minutes ago, and a friend at the scene estimated that he had started fitting "around 15 minutes before". His friend informed the ambulance crew that he is a known epileptic and you find a pack of phenytoin on him. He looks dishevelled and smells of alcohol. He has a blood pressure of 170/95 mmHg and temperature 37.9°C. On examination there is a quiet systolic murmur, though it is difficult to fully characterise. Which of the following investigations will be most useful at this stage?

A 45-year-old man presents with intermittent difficulty in swallowing for the last 4 months. This is associated with severe retrosternal pain and regurgitation. He has no risk factors or sinister signs for malignancy. What is the most important investigation in this case?

A 69-year-old man recently diagnosed with metastatic prostate cancer presents with weakness in his legs and urinary retention. He has had back pain for years but in the last 24 hours this has become very severe in his lower back. On examination he has a sensory deficit, loss of anal tone and poor sensation in the skin around the anus. When catheterised he has a residual volume of 1.5 L. Which of the following is the most informative initial investigation?

A 52-year-old man with hyperthyroidism, vitiligo and a 30 pack/year smoking history, presents to hospital with an acute clumsiness of his right hand. Neurological examination reveals normal cranial nerves, and the only abnormal feature on the limb examination is some past pointing and dysdiadochokinesis in the right hand. Diffusion-weighted magnetic resonance imaging (MRI) reveals a small right-sided cerebellar infarct. Which of the following investigations is unlikely to be helpful?

A 59-year-old woman with known polycythaemia vera presents to the emergency department with right upper quadrant pain, tender hepatomegaly and gross ascites, which has come on suddenly. There is no jaundice. What is the next most appropriate investigation?

A 65-year-old man with a longstanding diagnosis of chronic obstructive pulmonary disease has been reviewed by his GP for deteriorating liver function tests and clinical signs and symptoms of cirrhosis. What investigation should the GP arrange?

A 22-year-old-woman presents to AE with a 4-day history of chest pain. She has been unwell with an influenza-like illness for the last week. The ECG shows widespread ST elevation in the inferior, anterior and lateral leads. What ECG changes would you expect to see in the next week or two?

While on call you are called by a nurse to a patient on the ward complaining of light headedness and palpitations. When you arrive the patient is not conscious but has a patent airway and is breathing with oxygen saturation at 97 per cent. You try to palpate a pulse but are unable to find the radial or carotid. The registrar arrives and after hearing your report of the patient decides to shock the patient who recovers. What is the patient most likely to have been suffering?

A 62-year-old male presents with palpitations, which are shown on ECG to be atrial fibrillation with a ventricular rate of approximately 130/minute. He has mild central chest discomfort but is not acutely distressed. He first noticed these about 3 hours before coming to hospital. As far as is known this is his first episode of this kind. Which of the following would you prefer as first-line therapy?

A 57-year-old male is admitted complaining of headaches and blurring of vision. His blood pressure is found to be 240/150 mmHg and he has bilateral papilloedema, but is fully orientated and coherent. He had been known to be hypertensive for about five years and his blood pressure control had been good on three drugs. However, he had decided to stop all medication two months before this event. Which of the folJowing would be your preferred parenteral medication at this point?

A 61-year-old man presents with a 2-hour history of moderately severe retrosternal chest pain, which does not radiate and is not affected by respiration or posture. He complains of general malaise and nausea, but has not vomited. His ECG shows ST segment depression and T wave inversion in the inferior leads. Troponin levels are not elevated. He has already been given oxygen, aspirin and intravenous GTN; he is an occasional user of sublingual GTN and takes regular bisoprolol for stable angina. What would be the most appropriate next step in his management?

A 28-year-old man has been newly diagnosed with asthma. He has never been admitted to hospital with an asthma exacerbation and experiences symptoms once or twice a week. You discuss the treatment options with him. His peak expiratory flow reading is currently 85 per cent of the normal predicted value expected for his age and height. Which of the following is the most appropriate first step in treatment?

You see an SO-year-old man who presents to accident and emergency with epigastric pain. The pain started 3 days ago and today he noticed that the colour of his stools has changed to a 'tarryblack' colour. Associated symptoms include nausea and lethargy. The patient is a smoker of 20 cigarettes a day and has recently finished eradication treatment for a duodenal ulcer. The patient is alert and orientated with a pulse rate of 99 and blood pressure of 98/69, respiratory rate of 18, oxygen saturations of 98 per cent on room air and temperature of 37.2°C. On examination, the abdomen is soft with marked tenderness in the epigastric region and bowel sounds are present. The rectum is empty, on PR examination, with some traces of malaena. The patient has been started on high flow oxygen and has been given some oral analgesia. The most appropriate next step in managing this patient is:

A 49-year-old woman attends your clinic suffering from chronic renal failure due to progressive glomerular disease. She appears well and her blood pressure is 141/92rnmHg. Blood tests reveal elevated phosphate, serum creatinine and urea, while calcium levels are low. Her estimated glomerular filtration rate is 35mL/min/1. 73m2. You also notice the patient's cholesterol levels are moderately raised. The most appropriate management is:

A 32-year-old man presents to accident and emergency with a 1-day history of pain in the right knee. He also mentions that he has had a fever and is feeling generally unwell. On examination, the right knee is swollen, warm and extremely painful to move. What is the most appropriate next step?

A 77-year-old woman presents to accident and emergency complaining of severe unilateral headache over the left side of her head. On examination, the left side of her scalp is painful to touch. Blood tests reveal a raised ESR and CRP. What is the most appropriate management?