1. A 50-year-old man sustains an uncomplicated myocardial infarction. During the last part of the hospital stay, he is managing to do all his own self-care, including showering and shaving, without symptoms.

On discharge to his home, what should he be permitted to do?

1. Activities of no higher than 2 METS
2. Sexual activity
3. Walking at 6 km per hour
4. Activities of 3 to 4 METS

2. A 52-year-old male is referred to you with Guillain-Barré syndrome. His symptoms started 1 week ago and are still progressing. He is now unable to walk or manage at home, so you arrange admission to hospital.

What would be the most appropriate treatment at this stage?

1. Oral corticosteroids
2. Supportive care
3. A falls prevention programme
4. Intravenous immunoglobulin

3. In the lumbar spine, which movement is most limited?

1. Flexion
2. Lateral bending
3. Rotation
4. Extension

4. Which abnormality is often associated with a high Q angle of the patella?

1. Varus deformities of the knee
2. Osteonecrosis of the tibial plateau
3. A low-riding patella (patella infra)
4. Recurrent subluxation of the patella

5. What are common clinical features of lateral medullary (Wallenberg) syndrome?

1. Hemiparesis, aphasia and facial weakness
2. Dysarthria, dysphagia and diplopia
3. Facial weakness, hemineglect and hemiataxia
4. Hemianaesthesia, ataxia and dysphagia

6. You are asked to manage the rehabilitation of a 75-year-old man who has suffered an ischaemic infarct in the territory of the middle cerebral artery. He is complaining of stiffness and pain in the right forearm and is having difficulty with hand function. On clinical examination, you note spasticity in the right upper limb.

What is the typical pattern of upper limb spasticity in this setting?

1. Shoulder adduction, internal rotation, elbow flexion and pronation, wrist and finger flexion with thumb adduction
2. Shoulder adduction, external rotation, elbow flexion and pronation, wrist and finger flexion with thumb adduction
3. Shoulder adduction, internal rotation, elbow flexion and pronation, wrist and finger flexion with thumb abduction
4. Shoulder adduction, internal rotation, elbow flexion and supination, wrist and finger flexion with thumb abduction

7. Patients who suffer a stroke are at higher risk of another stroke than the general population. On your ward round, you see a patient who has had his first ischaemic stroke. He asks you about his prognosis following the stroke.

What should you tell your patient?

1. A coronary event is an unlikely cause of death
2. The annual risk of recurrent stroke is highest within the first year after stroke
3. Age is a poor predictor of death after stroke
4. Lacunar syndromes have the same life expectancy as partial anterior circulation infarct (PACI) syndromes

8. In a child with myelomeningocele, at which lower limit of normal innervation will the rate of hip dislocation be the highest?

1. T-12
2. L-1
3. L-2
4. L-4