A 65-year-old woman is brought to the Emergency Department of a tertiary care hospital with rapid onset shortness of breath and left shoulder and arm ache.
Blood pressure 100/50 mmHg Heart rate 90 /min Respiratory rate 25 /min Temperature 36.9 °C
Which of the following is the most appropriate treatment after the initial Emergency Department management?

2. A 52-year-old man was diagnosed in the Emergency Department with an aeute inferior wall myocardial infarction. An intravenous morphine bolus and IV nitroglycerine infusion were administered for severe on-going chest discomfort. 20 minutes later, and while preparing the patient for a primary percutaneous coronary intervention, his condition became worse. His JVP at this time was elevated and his lungs were clear.

Initial Emergency Department Record: Blood pressure 120/70 mmHg Heart rate 90 /min (regular)
Respiratory rate 22 /min
Oxygen saturation 96% (room air)

30 Minutes Later:
Blood pressure 75/40 mmHg Heart rate 105 /min (regular)

Which of the following is the most likely cause of the hypotension?

3. What would you expect to see in the ECG reading of a patient with inferior myocardial infarction?

A 55-year-old pEtient presents to the clinic with leg pain brought on by walking and relieved by rest. The patient reports a history of many years of smoking. Physical examination confirms loss of hair over the IDwer shins as well as dystrophic nails.
An ankle-brachial index 0.80
Which of the following is the most likely diagnosis?

5. Which of the following drugs interacts with carvedilol?

6. Diabetic patient developed fever, productive cough and SOB. Labs show high WBC. CXR (picture was given which showed lower lobe infiltrates + air-fluid level). The drug that will be given to the patient acts on which of the following?

7. A patient with a known case of nephritic syndrome on angiotensin converting enzyme inhibitors. His food is usually rich with protein. What would you expect to see in the results of a lab investigation of the patient's blood?

8. Man eating rice only, he has gingival and tongue lesions. Which of the following deficiency you will find ?

9. A patient presented to the ER with atrial fibrillation and a blood pressure reading of 80/60 mmHg. What is the recommended treatment for this patient?

10. A middle-aged man presented to the ER with cyanosis. A chest x-ray showed prominent pulmonary arteries and vascular marking. What is the most likely diagnosis?

11. Which of the following statement about charcoal is incorrect?

A 60-year-old man is admitted to the Coronary Care Unit with an acute myocardial infarction. His hemodynamic parameters 2 hours later are:
Blood pressure 80150 mmHg Heart rate 40 /min Respiratory rate 18 /min Temperature 36.6° C Oxygen saturation 95% on room air
Which of the following would be the appropriate management?

13. A 73-year-old man comes to the Primary Health Care Clinic with severe shortness of breath at night and swelling of the ankles. He has reduced his activity over the past year because of chest pain when he exerts himself. Physical examination confirms crackles over both lungs, enlargement of the liver, and pitting edema of the ankles. ECG, cardiac enzymes and blood electrolytes are normal.

Blood pressure 140/90 mmHg Heart rate 95 /min Respiratory rate 24 /min Temperature 36.6° C

Which of the following is the most appropriate to be included in immediate management?

A 67-year-old man is brought to the Emergency Department by his family with confusion and a decreased level of consciousness. The family reported his being feverish and feeling unwell for 2 days that was also associated with diarrhoea and poor oral intake. The patient has bronchial asthma. hypertension and an old myocardial infarction. He has not been able to take his regular
medications for 2 days due to the acute illness. On examination, the JVP is not visible, heart sounds are normal, no cardiac murmurs and lungs are clear with no rhonchi or crepitation. The patient's extremities are cold and peripheral pulses feeble (see report).
Blood pressure 83/45 mmHg Heart rate 120 /min (regular) Respiratory rate 20 /min Oxygen saturation 95% (room air)
ECG: Sinus tachycardia and evidence of an old inferior myocardial infarction.
Which of the following is the most appropriate next step in management?

A 60-year-old patient presents to the hospital, complaining of a sudden onset of chest pain radiating to the back. The blood pressure is low in the left arm and the left femoral pulse is not palpable (see reports).
Chest X-ray: A left pleural effusion.
ECG: Left ventricular hypertrophy. Which of the following is most likely to confirm the diagnosis?

A 55-year-old patient presents to the clinic with leg pain brought on by walking and relieved by rest. The patient reports a history of many years of smoking. Physical examination confirms hair loss over the IDwer shins and dystrophic nails.
An ankle-brachial index of 0.80
Which of the following is the most likely diagnosis?

17. In which of the following conditions the gastric lavage is indicated?

18. Which of the following is the mainstay of treatment of allergic rhinitis?

19. A patient presents with sudden facial swelling with stridor but without any sign of urticaria and pruritis. The administration of glucocorticoid was unsuccessful. What will the be most likely diagnosis?

20. Which of the following best describes the clinical presentation of sneezing; rhinorrhea; obstruction of the nasal passages; conjunctival, nasal, and pharyngeal itching; and lacrimation

21. A 20-year-old male presents in an emergency department with sudden swelling in face tongue, eyes, and airway. What will be your most likely diagnosis?

22. A 52-year-old man was diagnosed in the Emergency Department with an aeute inferior wall myocardial infarction. An intravenous morphine bolus and IV nitroglycerine infusion were administered for severe on-going chest discomfort. 20 minutes later, and while preparing the patient for a primary percutaneous coronary intervention, his condition became worse. His JVP at this time was elevated and his lungs were clear.

Initial Emergency Department Record: Blood pressure 120/70 mmHg Heart rate 90 /min (regular)
Respiratory rate 22 /min
Oxygen saturation 96% (room air)

30 Minutes Later:
Blood pressure 75/40 mmHg Heart rate 105 /min (regular)

Which of the following is the most likely cause of the hypotension?

23. Which of the following is not the adverse effect of emergency intubation?

24. A 15-year-old boy presents in an emergency department with rash and shortness of breath, upon examination he is tachycardiac and having wheezes bilaterally. Based on the symptoms and sign what will be your initial diagnosis?

25. A 55-year-old man presents to the Emergency Department with continuous retrosternal chest pain. An ECG was obtained (see image). Which of the following is the most likely diagnosis?

A 15-year-old boy presents to the clinic for an annual physical assessment. The patient has normal growth and development and is able to do usual activities. His elder brother died due to a sudden cardiac death while walking to work. On physical examination, there is no cardiac murmur. Pulses are equal in all extremities.
Which condition must be excluded before any sport is allowed?

27. Why it is recommended that patients who suffer from anaphylaxis be placed in the supine position before receiving epinephrine?

28. Which of the following sentence defines empty ventricle syndrome?

A 77-year-old woman with poorly controlled long-standing type 2 diabetes and hypertension is complaining of dizziness when standing up rapidly. Current medications include aspirin, atenolol, insulin, metformin and multivitamins.
Sitting: Blood pressure 140/85 mmHg
Standing: Blood pressure 115/80 mmHg Heart rate 95 /min (unchanged on standing) Respiratory rate 18 /min Temperature 36.6° C
Which of the following is the most likely explanation?

30. Immune deficient pt : what vaccine could be given :

31. Which of the following sentence define urticaria?

A 77-year-old woman with poorly controlled long-standing type 2 diabetes and hypertension is complaining of dizziness when standing up rapidly. Current medications include aspirin, atenolol, insulin, metformin, and multivitamins.
Sitting: Blood pressure 140/85 mmHg
Standing: Blood pressure 115/80 mmHg Heart rate 95 /min (unchanged on standing) Respiratory rate 18 /min Temperature 36.6° C
Which of the following is the most likely explanation?

33. A patient presents with tinnitus, respiratory alkalosis, and metabolic acidosis. What is the most likely diagnosis?

34. A patient with atrial fibrillation is on warfarin 5 mg daily, the latest INR is 7.0 on routine evaluation. There is no evidence of abnormal bleeding.

Which of the following is the most appropriate action?

35. Best prophylactic against traveler’s diarrhea :

A 46-year-old man recovering from an acute myocardial infarction 10 days ago. He develops a sharp pain behind the sternum which is made worse by coughing. The patient gets relief when sitting forward. On examination, a scratchy superficial sound is heard at the left sternal edge, and heart sounds are muffled. There is ascites and a 2 cm raised JVP is confirmed.
Which of the following ECG changes would most likely be found?

37. Which of the following is the very important cause of anaphylaxis in healthcare professionals?

38. Patient with ventilator-associated pneumonia. The culture showed lactose non-ferment- ing, gram-negative motile bacilli producing greenish colony + Oxidase positive. What is the organism?

39. Patient with ventilator-associated pneumonia. The culture showed lactose non-ferment- ing, gram-negative motile bacilli producing greenish colony + Oxidase positive. What is the organism?

40. 3. A patient with tuberculosis on medication for 3 months. He developed pins and needles sensation of his lower limbs. Deficiency of which of the following caused his symptoms?

41. An 81-year-old diabetic presents to the clinic with a recent onset of redness of the skin on the left lower extremity. The redness worsens when the leg is in a dependent position. On examination, pedal pulses in the left leg are diminished. The leg is cold and there is no tenderness on palpitation.

Which of the following is the most likely diagnosis?

42. A 70-year-old man, with no past medical history, presents to the Emergency Department 4 hours after the onset of a severe crushing substernal chest pain radiating to the neck and left arm (see report).

Electrocardiography:
Significant ST-segment elevation in leads I, AVL, VS, and V6. Where is the most likely site of cardiac infarction?

43. The most obvious serum biomarker to assay anaphylaxis is, histamine, which has an extremely short half-life with a measurable time-window that expires in how much time from the onset of anaphylaxis?

44. A patient presented with insomnia 2 months post myocardial infarction. What is the recommended treatment for this patient?

A 55-year-old man who is a heavy smoker is being evaluated for increasing bilateral lower limb swellings. Chest examination confirms resonant lungs with reduced breath sounds and occasional rhonchi. The apex beat could not be easily located. No cardiac murmur is heard, but P2 is markedly loud. The JVP is elevated, and bilateral pitting edema was confirmed.
Which of the following is the most likely cause of lower limb swelling?

A 29-year-old woman presents to the Emergency Department complaining of being unable to sleep flat for the last 2 nights due to difficulty in breathing. She has just delivered 1 week earlier. Physical examination confirms a laterally displaced apex beat and the presence of a third heart sound. The jugular veins were distended and bilateral lung crackles could be easily heard.
Which of the following is the most likely diagnosis?

47. Which of the following is a more practical and useful biomarker to assay anaphylaxis?

A 40-year-old man is brought to the Emergency Department with progressive difficulty in breathing. History reveals. he is being treated for bronchogenic carcinoma. On examination, the JVP is elevated; lungs clear and heart sounds are very quiet.
Blood pressure 88/50 mmHg Heart rate 125 /min (regular) Respiratory rate 24 /min Temperature 36.8 C
Which of the following is the most appropriate test to confirm the diagnosis?

A 40-year-old man is brought to the Emergency Department with progressive difficulty in breathing. History reveals. he is being treated for bronchogenic carcinoma. On examination, the JVP is elevated; lungs are clear, and heart sounds are very quiet.
Blood pressure 88/50 mmHg Heart rate 125 /min (regular) Respiratory rate 24 /min Temperature 36.8 C
Which of the following is the most appropriate test to confirm the diagnosis?

50. Which of the following is the diagnostic criteria for chronic granulomatous disease?

51. Enteric fever resistance to chloramphenicol, what’s next?

52. A 55-year-old man had a myocardial infarction 6 days before. He suddenly develops dyspnoea, cough and frothy sputum. For the first time a harsh systolic murmur is heard over the precordium. Which of the following is the most likely cause of this development?

A 60-year-old man presents to the Emergency Department with epigastric pain radiating to the back. He is a smoker and has long-standing diabetes and hypertension. Abdominal examination reveals a pulsatile supra-umbilical mass.
Which of the following is the most likely diagnosis?

54. A 70-year-old patient has a sudden onset of pain in the left lower limb. The pain is severe and associated with numbness. The patient had an acute myocardial infarction 2 weeks before and was discharged 24 hours before this presentation. The left leg is cold and pale, the right leg is normal.

Which of the following .is the most likely diagnosis?

55. What is the cause to use every year influenza vaccine?

A 55-year-old man who is a heavy smoker is being evaluated for increasing bilateral lower limb swellings. Chest examination confirms resonant lungs with reduced breath sounds and occasional rhonchi. The apex beat could not be easily located. No cardiac murmur is heard, but P2 is markedly loud. The JVP is elevated and bilateral pitting edema was confirmed.
Which of the following is the most likely cause of the lower limb swelling?

A 55-year-old man who is a heavy smoker is being evaluated for increasing bilateral lower limb swellings. Chest examination confirms resonant lungs with reduced breath sounds and occasional rhonchi. The apex beat could not be easily located. No cardiac murmur is heard, but P2 is markedly loud. The JVP is elevated and bilateral pitting edema was confirmed.
Which of the following is the most likely cause of the lower limb swelling?

A 58-year-old hypertensive patient presented with a 10-day history of a left-sided hemiparesis. The CT scan of the brain confirmed an area of infarction. There was no significant finding on a clinical examination apart from his hemiparesis. The patient had already started physiotherapy, and is taking 20 mg lisinopril and hydrochlorothiazide once daily.
Blood pressure 140/90 mmHg Heart rate 76 /min Respiratory rate 18 /min Temperature 36.6° C Oxygen saturation 95% on room air
Which of the following is the best management?

59. HIV patient ... (symptoms of intestinal obstruction) did intestinal resection. They found tumor white in color nearly encircling the wall. What is the tumor?

60. Which of the following is included in the long term management of hereditary angioedema?

61. 2. Patient with ventilator associated pneumonia. Culture showed lactose non-ferment- ing, gram negative motile bacilli producing greenish colony + Oxidase positive. What is the organism?

A middle-aged man presents with a cough and fever lasting several weeks. Posteroan- terior chest radiograph shows a prominent
paratracheal area on the right, lymphadenopa- thy, a cavitary opacity in the right upper lobe, and a focal consolidation in the middle lung zone on the right. CXR shown below. What is the dx?

A 55-year-old pEtient presents to the clinic with leg pain brought on by walking and relieved by rest. The patient reports a history of many years of smoking. Physical examination confirms loss of hair over the IDwer shins as well as dystrophic nails.
An ankle-brachial index 0.80
Which of the following is the most likely diagnosis?

A 77-year-old woman with poorly controlled long-standing type 2 diabetes and hypertension is complaining of dizziness when standing up rapidly. Current medications include aspirin, atenolol, insulin, metformin and multivitamins.
Sitting: Blood pressure 140/85 mmHg
Standing: Blood pressure 115/80 mmHg Heart rate 95 /min (unchanged on standing) Respiratory rate 18 /min Temperature 36.6° C
Which of the following is the most likely explanation?

A 35-year-old woman presents with bilateral leg deep vein thrombosis. She has a history of recurrent still births (see lab result).
Test Result Normal Value
APTT 55 30-40 sec
Which of the following is the most likely diagnosis?

66. Which of the following is the best initial management of altered mental status in case of unclear etiology?

67. A 40-year-old man presents to the Emergency Department after fainting while exercising. He reports past episodes of chest pain, which have occurred both at rest and with exercise. On examination of the chest, there is II/IV systolic ejection murmur heard at the left sternal border, which does not radiate. The intensity of the murmur increases when the patient bears down or stands up. The lung fields are clear (see report).

Blood pressure 125/75 mmHg Heart rate 110 /min Respiratory rate 18 /min Temperature 36.6° C

ECG:

Non-specific ST and T wave changes with left atrial enlargement. Which of the following is the most likely diagnosis?

A 75-year-old man who has been followed up routinely for hypertension and type 2 diabetes mellitus was found to have an irregular pulse which was not found 6 months earlier. In addition to hypertension and diabetes, his past history confirms a previous transient ischemic attack. He is currently asymptomatic and is compliant with his medications.
ECG: Atrial fibrillation at rate of 70 beats per minute.
Which of the following is the most appropriate management plan?

69. Which of the following manifestations are among the most common presentations of anaphylaxis (>90% of cases)?

70. What should the immediate management be in case of opioid overdose?

A 61-year-old woman has had type 2 diabetes for 12 years. She takes insulin and d smoke. She was recently started on enalapril 10 mg daily for hypertension but coulc it because of a cough (see lab results).
Blood pressure 160/95 mmHg Heart rate 84 /min
Test Result Normal Value Creatinine 142 44-115 pmol/L
24 Urine Analysis: Test Result Normal Values Creatinine clearance 66 100-140 mUmin 24-hour urine protein 1500 0-150 mg/24 hr
Which of the following is the most appropriate therapy?

72. Neonate presents with recurrent skin infections with Staphylococcal infections what will be your diagnosis?

73. Which of the following drugs will increase the chance of survival of patients with heart failure?

A 60-year-old man presents to the Emergency Department with heavy retrosternal chest discomfort. The discomfort started 3 days earlier as intermittent brief episodes which became more frequent and prolonged over the last 24 hours. In the Emergency Department he experienced a similar type of discomfort (5/10 on the pain scale of 1-10) which responded well to sublingual nitroglycerin. serial cardiac enzymes are normal (see report).
ECG: An initial ECG showed ST segment depression of 0.2 mV in the antero-lateral chest leads, which later normalized completely.
Which of the following is the most likely diagnosis?

A 67-year-old man is brought to the Emergency Department by his family with confusion and a decreased level of consciousness. The family reported his being feverish and feeling unwell for 2 days that was also associated with diarrhoea and poor oral intake. The patient has bronchial asthma. hypertension and an old myocardial infarction. He has not been able to take his regular
medications for 2 days due to the acute illness. On examination, the JVP is not visible, heart sounds are normal, no cardiac murmurs and lungs are clear with no rhonchi or crepitation. The patient's extremities are cold and peripheral pulses feeble (see report).
Blood pressure 83/45 mmHg Heart rate 120 /min (regular) Respiratory rate 20 /min Oxygen saturation 95% (room air)
ECG: Sinus tachycardia and evidence of an old inferior myocardial infarction.
Which of the following is the most appropriate next step in management?

76. Which of the following is given as a prophylactic antiarrhythmic agent after myocardial infarction?

77. What is the optimal duration of antibiotic treatment in strep throat?

A 60-year-old man presents to the Emergency Department with epigastric pain radiating to the back. He is a smoker and has long-standing diabetes and hypertension. Abdominal examination reveals a pulsatile supra-umbilical mass.
Which of the following is the most likely diagnosis?

79. A 55-year-old diabetic and hypertensive patient presents with a history of bilateral intermittent leg pain brought on by walking for 300 meters and relieved by rest. What is the most likely diagnosis?

80. A 70-year-old man is brought to the clinic with an acute confessional state. On examination, he has postural hypotension and dry mucus membranes.

Test Result Normal Value Calcium 3.41 2.15-2.62 mmol/L

Which of the following is the most appropriate initial treatment?

81. Which of the following is not considered as the initial management of Anaphylaxis?

82. Which of the following confirmatory test can be performed to confirm clinical suspicions if a particular drug or food is suspected?

83. Which of the following is not the sign of Laryngeal edema?

84. Young adult came complaining of painless penile ulcer, what is the appropriate investigation to do?

85. In which of the following condition the N- acetylcysteine should be used in case of acetaminophen overdose?

86. A patient presented with chest pain, fever and arthralgia. He suffered a myocardial infarction 5 weeks earlier. What is the most likely diagnosis?

87. UTI case patient resistant to B LACTAMS, sensitive to fluoroquinolones, chloramphenicol, aminoglycosides which drug is contraindicated:

A 60-year-old man presents to the Emergency Department with epigastric pain radiating to the back. He is a smoker and has long-standing diabetes and hypertension. Abdominal examination reveals a pulsatile supra-umbilical mass.
Which of the following is the most likely diagnosis?

A 40-year-old man is brought to the Emergency Department with progressive difficulty in breathing. History reveals. he is being treated for bronchogenic carcinoma. On examination, the JVP is elevated; lungs clear and heart sounds are very quiet.
Blood pressure 88/50 mmHg Heart rate 125 /min (regular) Respiratory rate 24 /min Temperature 36.8 C
Which of the following is the most appropriate test to confirm the diagnosis?

90. A patient presents with recurrent episodes of watery eyes sneezing, itchy nose, itchy eyes, inflamed boggy nasal mucosa, pale or violaceous turbinates and nasal polyps what will be your most likely diagnosis?

91. A 65-year-old patient presents with 2 hours of chest pain that feels like indigestion. In the past medical history, hypertension has been diagnosed, but no evidence of myocardial infarction or angina. This Emergency Department does not have facilities for a percutaneous transluminal angioplasty (see report).

Blood pressure 170/94 mmHg Heart rate 104 /min Respiratory rate 18 /min Temperature 36.6° C
Oxygen saturation 95% on room air

ECG:
ST segment elevation in the anterolateral leads.

Which of the following is the most appropriate initial intervention?

92. Angioedema resulting in death by mechanical obstruction occurs at which of the following level?

93. Which of the following medications is contraindicated in hypertensive patients who are using sildenafil?

94. Patient has UTI organism grows on both antiseptic & detergent

A 67-year-old man is brought to the Emergency Department by his family with confusion and a decreased level of consciousness. The family reported his being feverish and feeling unwell for 2 days that was also associated with diarrhoea and poor oral intake. The patient has bronchial asthma. hypertension and an old myocardial infarction. He has not been able to take his regular
medications for 2 days due to the acute illness. On examination, the JVP is not visible, heart sounds are normal, no cardiac murmurs and lungs are clear with no rhonchi or crepitation. The patient's extremities are cold and peripheral pulses feeble (see report).
Blood pressure 83/45 mmHg Heart rate 120 /min (regular) Respiratory rate 20 /min Oxygen saturation 95% (room air)
ECG: Sinus tachycardia and evidence of an old inferior myocardial infarction.
Which of the following is the most appropriate next step in management?

96. Which of the following should not be used in case of benzodiazepine overdose?

97. A 52-year-old man has been diagnosed in the Emergency Department with an acute inferior wall myocardial infarction. An intravenous morphine bolus and IV nitroglycerine infusion were administered for severe ongoing chest discomfort. 20 minutes later, and while preparing the patient for a primary percutaneous coronary intervention, his condition became worse. His JVP at this time was elevated, and his lungs were clear.

Initial Emergency Department Record: Blood pressure 120/70 mmHg Heart rate 90 /min (regular)
Respiratory rate 22 /min
Oxygen saturation 96% (room air)

30 Minutes Later:
Blood pressure 75/40 mmHg Heart rate 105 /min (regular)

Which of the following is the most likely cause of hypotension?