A patient with a gunshot wound has a pneumothorax, and 15 minutes after tube thoracostomy insertion, there is blood in the underwater seal drain (2L). What is the most appropriate thing to do?

A) Thoracotomy
B) Tube thoracostomy
C) CT chest
D) X-ray

A patient has a penetrating wound on the leg. It is erythematous, warm, and painful. He is started on parenteral antibiotics. After 3 days, the pain and tenderness worsen. Why did the treatment fail?

A) Abscess formation
B) Medical noncompliance
C) Resistant organism
D) Poor wound hygiene

A patient presents with inability to write (agraphia) and difficulty distinguishing between left and right. What is the most likely site of hemorrhagic stroke?

A) Parietal lobe
B) Temporal lobe
C) Frontal lobe
D) Occipital lobe

A patient with a history of pancreatitis 5 weeks ago now presents with epigastric tenderness, vomiting, inability to tolerate food, and epigastric fullness. What is the most appropriate investigation?

A) Abdominal ultrasound (US)
B) Abdominal CT
C) Laparoscopy
D) MRI

A 35-year-old patient presents with a medial leg ulcer. The most likely diagnosis is?

A) Diabetes
B) Venous hypertension
C) Atherosclerosis
D) Buerger's disease

A neonate was found to have ambiguous genitalia with high 17-hydroxyprogesterone. What is the likely mode of inheritance?

A) Autosomal dominant
B) Autosomal recessive
C) X-linked dominant
D) X-linked recessive

A 25-year-old patient involved in a motor vehicle accident (MVA) presents with head trauma and is vitally unstable: BP 90/55 mmHg, HR 120 bpm. What is the most appropriate next step in management?

A) Primary survey (ABCDE)
B) Head CT scan
C) Head-to-toe examination
D) Resuscitate with IV fluids and oxygen

A doctor prescribed a high medication dose to a pediatric patient. The nurse noticed but did nothing, assuming the doctor intended that dose, and the patient was harmed. How can this issue be prevented in future?

A) Computerized prescribing with dose alerts
B) Rely on the nurse to question orders
C) Disciplinary action against the nurse
D) A verbal reminder to the doctor

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A 29-year-old married patient has a positive Pap smear showing ASCUS (Atypical Squamous Cells of Undetermined Significance). What is the next step?

A) Repeat Pap smear
B) Colposcopy
C) HPV test
D) Re-evaluate after 6 months

Which valvular lesion is considered high risk in pregnancy?

A) Mitral stenosis
B) Mitral regurgitation
C) Aortic regurgitation
D) Tricuspid regurgitation

A 4-year-old boy presents with convulsion and altered consciousness following a recent viral infection and fever. Examination shows no focal neurological deficits.
CSF results: leukocytes mainly lymphocytes, normal protein, slightly decreased glucose. What is the most appropriate management?

A) Azithromycin
B) Vancomycin and ceftriaxone
C) Antifungal therapy
D) Acyclovir

A 6-year-old girl is brought in after her mother witnessed a brief myoclonic tonic seizure during sleep with full recovery afterward. Recently, similar brief jerks were noted during hair brushing. EEG shows centro-temporal spikes. What is the most likely diagnosis?

A) Childhood absence epilepsy
B) Rolandic epilepsy
C) Lennox-Gastaut syndrome
D) Juvenile myoclonic epilepsy

A 36-year-old patient presents with a neck mass that has been present for 3 years. Physical examination confirmed a palpable left thyroid gland with no palpable cervical lymph nodes. The neck ultrasound shows a left thyroid nodule occupying most of the left lobe, measuring 3.4 x 3.8 cm, with mixed cystic and solid components. The right lobe is normal. Fine needle aspiration findings are coded as Bethesda IV (suspicious for follicular neoplasm). Which of the following is the most appropriate management?

A) Thyroid scan
B) Total thyroidectomy
C) Left hemithyroidectomy
D) Repeat fine needle aspiration

A 22-year-old man presents with a 2-day history of dysuria and urethral discharge. He reports recent sexual activity with a new female partner. He is afebrile, and physical examination is unremarkable. What is the most appropriate treatment?

A) Gentamicin
B) Azithromycin
C) Ceftriaxone
D) Nitrofurantoin

A 30-year-old male, a chronic smoker, accidentally finds a lung nodule on an X-ray. Which risk factor increases the likelihood of the nodule being cancerous?

A) Age
B) Diameter of the nodule more than 2.5 cm
C) Upper lobe site
D) Hypercalcemia

A pregnant woman at 15 weeks gestation has a known seizure disorder and is currently taking phenytoin. Her last seizure attack occurred 6 years ago. What should be done regarding her medication?

A) Switch the medication
B) Continue the medication
C) Decrease the dose
D) Increase the dose