A 68-year-old man known to have ischemic heart disease came with a history of diffuse abdominal pain for one day. Abdominal X-ray showed a dilated small bowel and a thinned wall. Amylase was 600, serum pH was 7.23. What is the most likely diagnosis?
A) Pancreatitis
B) Intestinal obstruction
C) Perforated peptic ulcer
D) Mesenteric ischemia
A) Pancreatitis
B) Intestinal obstruction
C) Perforated peptic ulcer
D) Mesenteric ischemia
A woman is diagnosed with a molar pregnancy and asks about contraception options. Which is the most appropriate method to use after evacuation?
A) Intrauterine device (IUD)
B) Oral contraceptive pills (OCP)
C) Vaginal ring
D) Barrier method only
A) Intrauterine device (IUD)
B) Oral contraceptive pills (OCP)
C) Vaginal ring
D) Barrier method only
A child with cystic fibrosis (CF) is brought to the clinic. The mother asks if it is safe for her child to play with another child who also has cystic fibrosis. What is the best advice?
A) Yes, it is safe; they can play together freely
B) Avoid close contact to prevent cross-infection
C) Only if both children are on antibiotics
D) Only if they wear masks
A) Yes, it is safe; they can play together freely
B) Avoid close contact to prevent cross-infection
C) Only if both children are on antibiotics
D) Only if they wear masks
A diabetic mother gave birth to a baby who developed respiratory distress after 6 hours. On examination the baby has mild tachypnea only. What is the diagnosis?
A) Transient tachypnea of the newborn
B) Respiratory distress syndrome
C) Meconium aspiration syndrome
D) Congenital pneumonia
A) Transient tachypnea of the newborn
B) Respiratory distress syndrome
C) Meconium aspiration syndrome
D) Congenital pneumonia
A 69-year-old man with a 40-pack-year smoking history presents with shortness of breath, weight loss, and a large left-sided pleural effusion. Thoracentesis reveals 1,500 mL of bloody, exudative fluid by Light's criteria. What is the most appropriate next step?
A) Empirical broad-spectrum antibiotics
B) CT with contrast
C) Echo
D) Pleural biopsy
A) Empirical broad-spectrum antibiotics
B) CT with contrast
C) Echo
D) Pleural biopsy
A physician is counseling a mother about how to manage her young child's acute illness. After explaining the management steps, the physician is concerned that she may not have fully understood the instructions. He repeats the explanation and then asks the mother to repeat back what he has explained to her. Which communication technique is being used?
A) Call-out
B) Teach-back
C) Specific model
D) Shared decision-making
A) Call-out
B) Teach-back
C) Specific model
D) Shared decision-making
A 65-year-old man presents with sudden chest pain, tachycardia, and dyspnea. He describes the pain as severe, sharp, and tearing, radiating to his back. He has a history of hypertension. X-ray reveals a widened mediastinum. What is the likely diagnosis?
A) Aortic dissection
B) Pericarditis
C) Myocardial infarction
D) Cardiomyopathy
A) Aortic dissection
B) Pericarditis
C) Myocardial infarction
D) Cardiomyopathy
A 32-year-old woman has stage III choriocarcinoma with lung metastases and a WHO prognostic score of 10. What is the most appropriate treatment?
A) Total hysterectomy alone
B) Observation with serial hCG measurements
C) Methotrexate monotherapy
D) Multiagent chemotherapy
A) Total hysterectomy alone
B) Observation with serial hCG measurements
C) Methotrexate monotherapy
D) Multiagent chemotherapy
A patient has lower-GI bleeding. Upper GI endoscopy is normal. What is the most likely cause?
A) Diverticulosis
B) Angiodysplasia
C) Cancer
D) Haemorrhoids
A) Diverticulosis
B) Angiodysplasia
C) Cancer
D) Haemorrhoids
A patient with an unprovoked deep vein thrombosis has completed 3 months of warfarin. What is the most appropriate management?
A) Stop warfarin
B) Continue warfarin indefinitely
C) Continue warfarin till completing 6 months
D) Switch to aspirin
A) Stop warfarin
B) Continue warfarin indefinitely
C) Continue warfarin till completing 6 months
D) Switch to aspirin
A middle-aged hypertensive male who smokes has an LDL of 4.3 mmol/L and total cholesterol of 6.1 mmol/L with normal triglycerides; what is the appropriate treatment?
A) High intensity statin
B) Lifestyle modification and recheck
C) Moderate intensity statin
D) Smoking cessation only
A) High intensity statin
B) Lifestyle modification and recheck
C) Moderate intensity statin
D) Smoking cessation only
A patient came to the ER with a stab wound in the right thigh. He is drowsy with a GCS of 9/15. What is the initial management?
A) IV fluid
B) Control bleeding
C) Apply tourniquet
D) Endotracheal intubation
A) IV fluid
B) Control bleeding
C) Apply tourniquet
D) Endotracheal intubation
A patient presents with signs and symptoms of fluid overload, including bilateral lower limb edema, ascites, and distended jugular veins. Laboratory investigations show low serum sodium. What type of hyponatremia is most likely?
A) Euvolemic hyponatremia
B) Hypervolemic hyponatremia
C) Hypovolemic hyponatremia
D) Pseudohyponatremia
A) Euvolemic hyponatremia
B) Hypervolemic hyponatremia
C) Hypovolemic hyponatremia
D) Pseudohyponatremia
A young male who is asymptomatic presented with abnormal LFTs. He is a smoker and drinks alcohol on the weekends. Labs showed high AST, ALT (2:1 ratio), total bilirubin and slightly high iron TIBC and very high ferritin (450). What is the cause of his abnormal LFTs?
A) Hemochromatosis
B) Alcoholic hepatitis
C) Cholangitis
D) Primary biliary cirrhosis
A) Hemochromatosis
B) Alcoholic hepatitis
C) Cholangitis
D) Primary biliary cirrhosis
Five days after right thigh surgery, a man has pain and swelling around the wound. The dressing is saturated with foul-smelling green discharge. Which organism is the most likely cause?
A) Staphylococcus aureus
B) Clostridium perfringens
C) Streptococcus pyogenes
D) Pseudomonas aeruginosa
A) Staphylococcus aureus
B) Clostridium perfringens
C) Streptococcus pyogenes
D) Pseudomonas aeruginosa