Section 2: Clinical Problem Solving (CPS)

The Clinical Problem Solving (CPS) paper within the Multi-Specialty Recruitment Assessment (MSRA).

Part 2a: Enhanced Matching (EMQ) Questions

Question 1

Blood in urine (1 of 2)

A 59 year old man complaining of sudden onset of severe pain in his left loin associated with visible haematuria. He returned from a holiday in Africa yesterday.

For each patient, what is the most likely diagnosis?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: Bladder cancer
• B: Glomerulonephritis
• C: Kidney stone
• D. March haematuria
• E: Prostatitis
• F: Renal cancer
• G: Urethritis
• H: Urinary tract infection

Question 2

Blood in urine (2 of 2)

A 19 year old man presenting with weight loss. On examination, he has a left varicocoele and visible haematuria.

For each patient, what is the most likely diagnosis?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: Bladder cancer
• B: Glomerulonephritis
• C: Kidney stone
• D: March haematuria
• E: Prostatitis
• F: Renal cancer
• G: Urethritis
• H: Urinary tract infection

Question 3

Dermatological to skin (1 of 2)

A 56 year old diabetic man has thickening and discolouration of all his toe nails, with itching and flaking skin between the toes. Skin scrapings culture trichophytum rubrum.

For each patient, what is the most appropriate treatment?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: Betamethasone valerate cream
• B: Flucloxacillin 500mg, four times daily C. Fusidic acid cream
• D: Hydrocortisone 1% cream
• E: Metronidazole gel
• F: Oxytetracycline 500mg, twice daily G. Permethrin 5% cream
• H: Terbinafine 250mg, daily

Question 4

Dermatological to skin (2 of 2)

A 28 year old female school teacher complains of a 3 day history of intense itching all over her body, particularly at night. Examination reveals excoriation marks on her skin and a rash in her finger web spaces.

For each patient, what is the most appropriate treatment?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: Betamethasone valerate cream
• B: Flucloxacillin 500mg, four times daily
• C. Fusidic acid cream
• D: Hydrocortisone 1% cream
• E: Metronidazole gel
• F: Oxytetracycline 500mg, twice daily
• G. Permethrin 5% cream
• H: Terbinafine 250mg, daily

Question 5

'Tired all the time' (1 of 2)

A 55 year old woman who complains that people say she looks tired. On examination she has thinning hair, dry skin and facial puffiness.

For each patient, which investigation could confirm the most likely diagnosis?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: 24-hour urinary catecholamines
• B: 24-hour urinary free cortisol
• C: Fasting glucose
• D: Fluid deprivation test with response to desmopressin
• E. Renal function tests
• F: Serum calcitonin
• G: Serum growth hormone suppression test
• H: Thyroid function tests

Question 6

'Tired all the time' (2 of 2)

A 35 year old man presents with tiredness. He explains that his ring is getting much tighter.

For each patient, which investigation could confirm the most likely diagnosis?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: 24-hour urinary catecholamines
• B: 24-hour urinary free cortisol
• C: Fasting glucose
• D: Fluid deprivation test with response to desmopressin
• E. Renal function tests
• F: Serum calcitonin
• G: Serum growth hormone suppression test
• H. Thyroid function tests

Question 7

Side effects of antibiotics (1 of 3)

A 52 year old man with a swollen, tender Achilles tendon following a course of antibiotics.

For each patient, what is the most likely causative drug?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: Amoxicillin
• B: Ciprofloxacin
• C: Clotrimazole
• D: Co-trimoxazole
• E: Erythromycin
• F: Flucloxacillin
• G: Fluconazole
• H: Minocycline
• I: Nitrofurantoin
• J: Trimethoprim

Question 8

Side effects of antibiotics (2 of 3)

A 19 year old female who develops a widespread rash following treatment with antibiotics for a sore throat associated with swollen neck glands and fatigue.

For each patient, what is the most likely causative drug?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: Amoxicillin
• B: Ciprofloxacin
• C: Clotrimazole
• D: Co-trimoxazole
• E: Erythromycin
• F: Flucloxacillin
• G: Fluconazole
• H: Minocycline
• I: Nitrofurantoin
• J: Trimethoprim

Question 9

Side effects of antibiotics (3 of 3)

A 20 year old man who develops pigmentation to his face during treatment for acne.

For each patient, what is the most likely causative drug?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: Amoxicillin
• B: Ciprofloxacin
• C: Clotrimazole
• D: Co-trimoxazole
• E: Erythromycin
• F: Flucloxacillin
• G: Fluconazole
• H: Minocycline
• I: Nitrofurantoin
• J: Trimethoprim

Question 10

Diarrhoea in children (1 of 2)

A 2 year old boy with a 3 day history of vomiting and profuse watery diarrhoea.

For each patient, what is the most likely diagnosis?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: Coeliac disease
• B: Constipation with overflow
• C. Cow's milk protein allergy
• D. E. Coli 0157 infection
• E: Lactose intolerance
• F: Pseudomembranous colitis
• G. Rotavirus infection
• H: Toddler's diarrhoea

Question 11

Diarrhoea in children (2 of 2)

A 3 year old girl who has been getting episodes of abdominal pain and is soiling her underwear with liquid stool for several weeks.

For each patient, what is the most likely diagnosis?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A. Coeliac disease
• B. Constipation with overflow
• C. Cow's milk protein allergy
• D. E. Coli 0157 infection
• E. Lactose intolerance
• F. Pseudomembranous colitis
• G. Rotavirus infection
• H. Toddler's diarrhoea

Question 12

Heart murmurs (1 of 2)

A 78 year old woman with breathlessness and intermittent dizziness. Examination reveals a loud ejection systolic murmur which radiates to her neck. Chest examination is otherwise normal.

For each patient, what is the most likely diagnosis?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: Aortic regurgitation
• B: Aortic sclerosis
• C: Aortic stenosis
• D: Atrial septal defect
• E. Mitral stenosis
• F: Mitral valve prolapse
• G: Tricuspid stenosis
• H: Ventricular septal defect

Question 13

Heart murmurs (2 of 2)

An 84 year old woman complaining of breathlessness and palpitations. She is concerned as she has recently coughed up blood. Examination reveals an irregularly irregular pulse and a diastolic murmur at the apex.

For each patient, what is the most likely diagnosis?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: Aortic regurgitation
• B: Aortic sclerosis
• C: Aortic stenosis
• D: Atrial septal defect
• E: Mitral stenosis
• F: Mitral valve prolapse
• G: Tricuspid stenosis
• H: Ventricular septal defect

Question 14

Upper abdominal pain (1 of 3)

A 54 year old male ex-smoker with upper abdominal pain which is worse after eating and is accompanied by an acidic taste in his mouth.

For each patient, what is the most likely diagnosis?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: Gallstones
• B: Gastric cancer
• C: Gastro-oesophageal reflux
• D: Hepatic abscess
• E: Hepatitis A
• F: Myocardial infarction
• G: Oesophageal cancer
• H: Pancreatic cancer
• I: Pancreatitis
• J: Strangulated spigelian hernia

Question 15

Upper abdominal pain (2 of 3)

A 40 year old overweight alcoholic woman presents with upper abdominal pain which is worse after eating and radiates through to her back.

For each patient, what is the most likely diagnosis?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: Gallstones
• B: Gastric cancer
• C: Gastro-oesophageal reflux
• D: Hepatic abscess
• E: Hepatitis A
• F: Myocardial infarction
• G: Oesophageal cancer
• H: Pancreatic cancer
• I: Pancreatitis
• J: Strangulated spigelian hernia

Question 16

Upper abdominal pain (3 of 3)

A 40 year old woman with episodes of spasmodic upper abdominal pain which is worse after eating and can keep her awake at night.

For each patient, what is the most likely diagnosis?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: Gallstones
• B: Gastric cancer
• C: Gastro-oesophageal reflux
• D: Hepatic abscess
• E: Hepatitis A
• F: Myocardial infarction
• G: Oesophageal cancer
• H: Pancreatic cancer
• I: Pancreatitis
• J: Strangulated spigelian hernia

Question 17

Swollen joint (1 of 3)

A 58 year old man with a history of hypertension and 1 day history of pain in his right foot. On examination, he has a tender swollen first metatarsal-phalangeal joint.

For each patient, what is the most likely diagnosis?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: Bursitis
• B: Gout
• C: Haemarthrosis
• D: Osteoarthritis
• E: Pseudogout
• F: Psoriatic arthropathy
• G: Rheumatoid arthritis
• H: Septic joint

Question 18

Swollen joint (2 of 3)

A 45 year old woman presents with stiff swollen joints affecting her left hand with pitting of her nails.

For each patient, what is the most likely diagnosis?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: Bursitis
• B: Gout
• C: Haemarthrosis
• D: Osteoarthritis
• E: Pseudogout
• F: Psoriatic arthropathy
• G: Rheumatoid arthritis
• H: Septic joint

Question 19

Swollen joint (3 of 3)

A 35 year old tiler with a 2 day history of a painful swollen right knee. On examination, there is a fluctuant swelling anterior to the patella.

For each patient, what is the most likely diagnosis?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: Bursitis
• B: Gout
• C: Haemarthrosis
• D: Osteoarthritis
• E: Pseudogout
• F: Psoriatic arthropathy
• G: Rheumatoid arthritis
• H: Septic joint

Question 20

Antibody Blood tests (1 of 2)

A 24 year old woman with a past medical history of recurrent miscarriages and deep vein thrombosis.

For each patient, what is the most appropriate investigation?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: Anti-centromere antibodies
• B: Anti-gliadin antibodies
• C: Anti-Jo antibodies
• D: Anti-mitochondrial antibodies
• E: Anti-neutrophil cytoplasmic antibodies
• F: Anti-nuclear antibodies
• G: Anti-phospholipid antibodies
• H: Anti-Ro antibodies
• I. Parietal cell antibodies

Question 21

Antibody Blood tests (2 of 2)

A 45 year old woman with fatigue, itch and jaundice. Investigations reveal abnormal LFTs.

For each patient, what is the most appropriate investigation?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: Anti-centromere antibodies
• B: Anti-gliadin antibodies
• C: Anti-Jo antibodies
• D: Anti-mitochondrial antibodies
• E: Anti-neutrophil cytoplasmic antibodies
• F: Anti-nuclear antibodies
• G: Anti-phospholipid antibodies
• H: Anti-Ro antibodies
• I: Parietal cell antibodies

Question 22

Movement symptoms (1 of 3)

A 55 year old accountant who presents in the afternoon, explaining that he had experienced difficulty moving his hand well enough to control his computer mouse that morning. His problem had resolved by lunchtime.

For each patient, what is the most likely diagnosis?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: Alzheimer's disease
• B: Essential tremor
• C: Multiple sclerosis
• D: Parkinson's disease
• E: Thyrotoxicosis
• F: Transient ischaemic attack
• G: Wernicke's encephalopathy
• H: Wilson's disease

Question 23

Movement symptoms (2 of 3)

A 63 year old man complains that over the past few months he is finding it difficult to turn over in bed and needs help to do up his shirt buttons in the morning.

For each patient, what is the most likely diagnosis?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: Alzheimer's disease
• B: Essential tremor
• C: Multiple sclerosis
• D: Parkinson's disease
• E: Thyrotoxicosis
• F: Transient ischaemic attack
• G: Wernicke's encephalopathy
• H: Wilson's disease

Question 24

Movement symptoms (3 of 3)

A 41 year old woman who has noticed that her hands shake. It happened occasionally, about 4 years ago, but now it seems to occur almost all the time. She had wondered if she might be drinking too much alcohol, but actually it seemed to help. Her mother had a similar problem.

For each patient, what is the most likely diagnosis?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: Alzheimer's disease
• B: Essential tremor
• C: Multiple sclerosis
• D: Parkinson's disease
• E: Thyrotoxicosis
• F: Transient ischaemic attack
• G: Wernicke's encephalopathy
• H: Wilson's disease

Question 25

Increasing breathlessness (1 of 2)

A 72 year old female with a history of bronchiectasis who presents with increasing breathlessness and mucopurulent sputum over a week. On examination of her chest she has left basal crepitations; her SpO2 is 96%, respiratory rate is 15/min, and temperature is 35.8°C.

For each patient, what is the most appropriate investigation?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: Bronchoscopy
• B: Blood tests (FBC and CRP)
• C: Chest ultrasound
• D: Chest x-ray
• E: Computerised Tomography Pulmonary Angiogram (CTPA)
• F. MRI of chest
• G: Pleural aspiration
• H: Sputum culture

Question 26

Increasing breathlessness (2 of 2)

A 36 year old man with a 2 day history of increased breathlessness and blood stained mucoid sputum. On examination his chest is clear, SpO2 is 93%, pulse is 106 beats per minute, and BMI is 36.

For each patient, what is the most appropriate investigation?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: Bronchoscopy
• B: Blood tests (FBC and CRP)
• C: Chest ultrasound
• D: Chest x-ray
• E: Computerised Tomography Pulmonary Angiogram (CTPA)
• F. MRI of chest
• G: Pleural aspiration
• H: Sputum culture

Question 27

Erectile dysfunction (1 of 2)

A 40 year old man with erectile dysfunction. He has been a smoker for 20 years and has recently stopped. He describes a pain in the buttock area when he walks briskly.

For each patient, what is the most likely diagnosis?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: Cauda equina syndrome
• B: Diabetes mellitus
• C: Drug-induced
• D: Hyperprolactinaemia
• E: Hypopituitarism
• F: Multiple sclerosis
• G: Peripheral vascular disease
• H: Psychological

Question 28

Erectile dysfunction (2 of 2)

A 30 year old man with erectile dysfunction. It has been recent in onset. He describes an episode of numbness in his left leg, which spread up his leg 3 months previously, lasted 2 weeks and then resolved. He also had an episode of blurred vision last year, which resolved after a few days. He takes omeprazole for oesophageal reflux and cetirizine for urticaria.

For each patient, what is the most likely diagnosis?

Select one option only from the list.

Each option may be selected once, more than once, or not at all.

• A: Cauda equina syndrome
• B: Diabetes mellitus
• C: Drug-induced
• D: Hyperprolactinaemia
• E: Hypopituitarism
• F: Multiple sclerosis
• G: Peripheral vascular disease
• H: Psychological

Part 2a: Single Best Answer (SBA) Questions

Question 29

Chest pain

A 53 year old woman with SLE presents with dull central chest pains and gradually increasing shortness of breath. Examination reveals a raised JVP, soft heart sounds and a blood pressure of 120/60, which drops to 100/60 on inspiration.

Select the single most appropriate investigation from the list below. Select one option only.

• A: Cardiac angiography
• B: Cardiac MRI
• C: ECG
• D: Echo
• E: Exercise ECG

Question 30

Treatment of type 2 diabetes

A 60 year old woman who has had type 2 diabetes for 3 years and has been diet controlled so far. Her BP is 155/95 and her body mass index is 32. Her HBA1c has risen to 70 mmol/mol (8.6%). Target range < 48 mmol/mol (6.5%).

Select the single most appropriate treatment from the list below. Select one option only.

• A: Acarbose
• B: Exanetide
• C: Gliclazide
• D: Insulin
• E: Metformin
• F: Pioglitazone
• G: Vildagliptin

Question 31

Investigations

A 75 year old man presents with fatigue. He had a partial gastrectomy 40 years ago. The results of a full blood count are shown below (normal range in brackets).

Results of a full blood count

Select the single most appropriate investigation that is likely to lead to the correct diagnosis from the list below. Select one option only.

• A: Haemoglobin electrophoresis
• B: Liver function test (LFT)
• C: Serum ferritin
• D: Serum vitamin B12

• E. Thyroid function test (TFT)

Question 32

Abdominal pain

A 9 year old boy presents to the Emergency Department (ED) with a 1 day history of intermittent diarrhoea and central abdominal pain which is now moving to the right iliac fossa. On examination, he is pyrexial with guarding in the right iliac fossa.

Select the single most appropriate investigation from the list below. Select one option only.

• A: Abdominal x-ray
• B: CT abdomen pelvis
• C: MRI abdomen pelvis
• D: USS abdomen pelvis
• E: White cell scan

Question 33

Cerebral Ischaemia

A 72 year old man is admitted to the Emergency Department within 1 hour of sudden onset of right-sided weakness and speech difficulties. He has no significant past medical history and is on no medication. Brain imaging reveals an area of ischaemia in the left middle cerebral hemisphere.

Select the single most appropriate immediate treatment from the list below. Select one option only.

• A: Alteplase
• B: Clopidogrel
• C: Dabigatrin
• D: Low molecular weight heparin
• E: Warfarin

Question 34

Loin pain

A 48 year old male presents with left loin pain, having recently had an episode of diarrhoea and vomiting. The pain was severe several hours ago, but has mostly settled now. Examination is unremarkable and urinalysis shows some blood, but no glucose, protein or nitrite.

Select the single most appropriate investigation from the list below. Select one option only.

• A: CT scan of kidney, ureters and bladder
• B: Full blood count
• C: Prostate specific antigen
• D: Serum calcium
• E: Stool culture
• F: Ultrasound scan of pelvis

Question 35

Ear problem

A 25 year old man presents with a 6 day history of an itchy discharging left ear. He is not in pain. On examination he has patches of eczema on his trunk and arms. Examination of his ears reveals a moist left external auditory canal. His tympanic membranes appear normal.

Select the single most appropriate treatment from the list below. Select one option only.

• A: Oral antibiotics
• B: Topical antibiotic and steroid drops
• C: Topical antibiotic and steroid drops and oral antibiotics
• D: Topical antibiotic drops and oral steroids
• E: Topical antifungal drops

Question 36

Analgesia

A 52 year old man presents with abrupt onset of acute redness, severe pain and swelling in his right first metatarso-phalangeal (MTP) joint.

Select the single most appropriate treatment option from the list below. Select one option only.

• A: Amitriptyline hydrochloride
• B: Capsaicin
• C: Dihydrocodeine tartrate
• D: Morphine sulphate
• E: Naproxen
• F: Paracetamol

Question 37

Scrotal swelling

A 25 year old man presents with a left scrotal swelling. He states that he and his partner have been struggling to conceive for 2 years. The swelling seems to disappear when he lies down.

Select the single most likely diagnosis from the list below. Select one option only.

• A: Epididymal cyst
• B: Hydrocele
• C: Inguinal hernia
• D: Seminoma
• E: Varicocele

Question 38

Lung tumours

A 59 year old man had a pleural biopsy 1 year ago for pleural thickening and effusion, which was inconclusive. He now presents with a large mass over the entry site of the biopsy needle.

Select the single most likely diagnosis from the list below. Select one option only.

• A: Bronchial carcinoma
• B: Carcinoid tumour
• C: Mesothelioma
• D: Secondary metastases
• E: Squamous cell carcinoma

Question 39

Reduced vision

A 70 year old woman complains that her left eye is acutely watering, painful and red with some blurring of her vision. Her visual acuity is reduced, but the pupillary reaction is normal.

Select the single most likely diagnosis from the list below. Select one option only.

• A: Conjunctivitis
• B: Dendritic ulcer
• C: Floaters
• D: Stye
• E: Subconjunctival haemorrhage
• F: Temporal arteritis

Question 40

Sexual health

A 30 year old woman presents with a history of menorrhagia. She has completed her family.

Select the single most appropriate choice of contraception from the list below. Select one option only.

• A: Combined oral contraceptive pill
• B: Female sterilisation
• C: Intra uterine contraceptive device
• D: Intra uterine system (Mirena)
• E: Oral progesterone only contraceptives

• F: Progesterone only contraceptive injection

Question 41

Amenorrhoea

A 39 year old woman presents with a 6 month history of amenorrhoea. She has schizophrenia. She denies sexual intercourse over the past 2 years and reports some episodes of lactation. Follicle-stimulating hormone (FSH) and luteinising hormone (LH) are within normal limits, prolactin is 1125 (normal range < 500).

Select the single most likely cause of her symptoms from the list below. Select one option only.

• A: Adverse reaction to antipsychotic medication
• B: Early menopause
• C: Pregnancy
• D: Prolactinoma
• E: Stress due to schizophrenia

Question 42

Nasal symptoms

A 14 year old boy presents with a one month history of bilateral nasal blockage, sneezing and a clear bilateral nasal discharge. The family have recently purchased a cat.

Select the single most appropriate management option from the list below. Select one option only.

• A: Intramuscular methylprednisolone
• B: Intranasal beclometasone
• C: Intranasal ipratropium
• D: Intranasal xylometazoline
• E: Oral montelukast

Question 43

Painless jaundice

Select the single most likely diagnosis from the list below. Select one option only.

• A: Alcohol-induced hepatitis
• B: Cancer of the head of pancreas
• C: Cholelithiasis
• D: Haemochromatosis
• E: Viral hepatitis
• F: Wilson's disease

Question 44

Management of lower back pain

A 28 year old man presents with a 1 day history of right-sided low back pain. On examination, he has a straight leg raise of 55° on the right side and 85° on the left side, with a bilateral negative sciatic stretch test. There is no bony tenderness and no neurological signs of note.

Select the single most appropriate management option from the list below. Select one option only.

• A: Prescribe diazepam
• B: Prescribe tramadol
• C: Refer to physiotherapy
• D: Self-management advice
• E: X-ray of the lumbar spine

Question 45

Breathlessness

A 35 year old woman presents with worsening difficulty breathing. On examination, she is talking in single words at a time, and appears blue around the lips. Her respiratory rate is 28, oxygen saturations 92% and her heart rate is 120 beats per minute. Auscultation of her chest reveals widespread wheeze and poor air entry to the lung bases.

Select the single most appropriate immediate management option from the list below. Select one option only.

• A: Amoxicillin 500mg, orally
• B: Beclametasone 200mcg, Inhaler 2 puffs via spacer
• C: Prednisolone 40mg, orally
• D: Salbutamol 5mg, nebuliser
• E: Tazocin 4.5g, IV

Question 46

Endocrine disease

A 28 year old woman has lost 15 kg in weight over the past 2 months. She also has a fine tremor and amenorrhoea.

Select the single most likely diagnosis from the list below. Select one option only.

• A: Addison's disease
• B: Graves' disease
• C: Polycystic ovary syndrome
• D: Primary hyperparathyroidism
• E: Primary hypothyroidism
• F: Type 1 diabetes mellitus

Question 47

Paediatric diagnosis

A 6 month old boy, born at term by normal delivery, presents with coryza, dry cough and tachypnoea. On examination he has a temperature 37.5°C with intercostal and subcostal recession. On auscultation there are mild crepitations throughout both lung fields.

Select the single most likely diagnosis from the list below. Select one option only.

• A: Acute asthma
• B: Bronchiolitis
• C: Congestive heart failure
• D: Cystic fibrosis
• E: Pneumonia

Question 48

Diagnosis of dysrhythmia

A 64 year old man having a routine blood pressure check whose pulse rate is 68. The rate is noted to increase during inhalation and decrease during exhalation.

Select the single most likely cause of his irregular pulse from the list below. Select one option only.

• A: Complete heart block
• B: Sinus arrhythmia
• C: Sinus bradycardia
• D: Sinus rhythm
• E:Supraventricular tachycardia
• F: Ventricular fibrillation

End