A woman is brought to the Emergency Department after a traumatic injury. Examination and imaging reveal a posterior elbow dislocation with a complex comminuted radial head fracture. What should be the next step in management?

A) Apply a long-arm cast without reduction
B) Immediate closed reduction under adequate analgesia and sedation
C) Immediate open reduction and internal fixation
D) Apply a sling and refer to the outpatient clinic

A young man has a thigh swelling. Ultrasound shows a superficial abscess, and incision and drainage is planned. What is the most appropriate anesthesia?

A) Local anesthesia
B) General anesthesia
C) Epidural anesthesia
D) Peripheral nerve block

A 45-year-old woman presents with multiple large tender uterine fibroids and bleeding. She has completed childbearing and would like a non-surgical approach. Examination shows mild diffuse abdominal tenderness. What is the most appropriate management?

A) GnRH agonist
B) Uterine artery embolization
C) Inform her that surgery is best and she should have a total abdominal hysterectomy
D) Inform her that surgery is best and she should have a myomectomy

A patient presents with symptoms of hepatic encephalopathy. Which of the following will be raised in his blood?

A) Cortisol
B) Lactate
C) Ammonia
D) Bilirubin

An 11-month-old boy presented due to massive amounts of urine volume and severe thirst. There were 3 episodes of dehydration not related to vomiting or diarrhea. The boys in his family have similar complaints and symptoms. What is the most likely diagnosis?

A) Diabetes mellitus
B) Diabetes insipidus
C) Water intoxication
D) Nephrotic syndrome

A 33-year-old male with a history of gonorrhea years ago presents with symptoms of urinary obstruction. The physician attempted to insert a Foley catheter but couldn't due to severe strictures in the urethra. What is the best management?

A) Alpha blocker
B) Antibiotic
C) Cystoscope and dilation
D) Re-insert Foley catheter

A woman in her 30s undergoes carpal tunnel syndrome surgery. After the surgeon injects lidocaine with adrenaline, she develops severe pain and numbness in the hand. What is the most appropriate initial step?

A) Check her BP and HR
B) Do Doppler ultrasound
C) Assess her hand for signs of ischemia
D) Give a medication

A 46-year-old woman presents with sudden facial weakness and inability to speak. In her youth she had fleeting joint pains treated with aspirin. She is on Holter monitoring and an embolic stroke is suspected, with a transoesophageal echocardiogram ordered. What is the most likely cause of her arrhythmia?

A) Atrial flutter
B) Supraventricular tachycardia
C) Atrial fibrillation
D) Brugada syndrome

A 12-week-old child with Beckwith-Wiedemann syndrome has an increased risk for liver tumor. What tumor marker will you use?

A) Urine oxalic level
B) Urine HVA and VMA
C) PSA
D) AFP

A 58-year-old man with type 2 diabetes mellitus, hypertension and ischemic heart disease takes metformin, sitagliptin, aspirin, atorvastatin and lisinopril. He works as a car mechanic. For the last 4 months he has noticed exertional shortness of breath that interferes with his job but does not stop him from doing it; he is comfortable at rest. Which New York Heart Association (NYHA) class describes his symptoms?

A) Class I
B) Class II
C) Class III
D) Class IV

A 20-year-old primigravida presents to the Emergency Department at 30 weeks of gestation complaining of headache and blurred vision. Which of the following is the most appropriate antihypertensive medication?

A) Atenolol
B) Diazoxide
C) Labetalol
D) Sodium nitroprusside

A pregnant woman presents with massive uncontrollable vaginal bleeding that has led to coagulopathy. What is the most likely underlying cause?

A) Placenta previa
B) Placental abruption
C) Coagulation disorder
D) Uterine rupture

A 2-hour-old baby delivered by cesarean section has respiratory distress with no decrease in oxygen saturation. Chest X-ray shows fluid in the lung fissures. What is the most appropriate management?

A) Arterial blood gas
B) Blood culture
C) Intravenous antibiotics
D) 30% to 40% oxygen

A woman at 6 weeks of pregnancy presents with abdominal pain and bleeding. On examination the cervical os is open with mild bleeding. What is the next step?

A) Transvaginal ultrasound
B) Reassure and reassess in 10 days
C) Repeat beta-hCG
D) Admit for dilatation and curettage

A 25-year-old woman with multiple sclerosis is in remission on teriflunomide. She reports transient worsening of symptoms in hot weather or after a warm shower. She has no fever, new persistent neurological findings, or other symptoms. What is the most likely explanation?

A) Relapse of MS
B) Lhermitte sign
C) Uhthoff phenomenon
D) Acute disseminated encephalomyelitis (ADEM)

A patient is involved in a motor vehicle accident and presents with paradoxical movement of the chest wall. What is the most likely diagnosis?

A) Flail chest
B) Cardiac contusion
C) Pneumothorax
D) Hemothorax

A 55-year-old man develops a distal DVT after knee surgery while on IV heparin. Labs are normal except for a platelet count of 75 x 10^9/L. Renal function is normal. What is the most appropriate management?

A) Start apixaban
B) Transfuse 6 units of platelets
C) Start warfarin
D) Start enoxaparin

A 12-month-old boy cannot walk but can cruise around furniture. Examination and growth parameters are normal. What is the most appropriate management?

A) Reassure
B) Refer for developmental assessment
C) TSH
D) Check serum creatine kinase

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