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Question 1. A 45‑year‑old man presents with crushing substernal chest pain radiating to the left arm. ECG shows ST‑segment elevation in leads II, III, aVF. Which of the following is the most appropriate next step? A) Administer oral aspirin and arrange outpatient stress testing B) Immediate thrombolytic therapy if PCI is unavailable within 90 min C) Begin high‑dose intravenous steroids D) Obtain a chest CT before any treatment Answer: B Explanation: Inferior STEMI requires reperfusion; if primary PCI cannot be performed promptly, fibrinolysis is indicated. Question 2. A 23‑year‑old female with a history of asthma arrives with wheezing and a peak expiratory flow of 30 % predicted. Which medication should be given first? A) Intravenous magnesium sulfate B) Inhaled albuterol via metered‑dose inhaler with spacer C) Oral prednisone 60 mg daily D) Intravenous aminophylline Answer: B Explanation: First‑line therapy for acute asthma is inhaled β 2 ‑agonist; a spacer improves drug delivery.
Question 3. A 68‑year‑old patient with atrial fibrillation and rapid ventricular response is hypotensive (BP 85/50 mm Hg). Which drug is most appropriate for rate control? A) Diltiazem infusion B) Metoprolol intravenous bolus C) Digoxin loading dose D) Amiodarone infusion Answer: B Explanation: In hypotension, β‑blockers are preferred over calcium channel blockers; metoprolol can be titrated quickly. Question 4. A 4‑year‑old boy is brought after a fall from a tree. He is alert, but has a tender scalp laceration and a Glasgow Coma Scale of 15. Which imaging study is indicated? A) Non‑contrast head CT B) MRI of the brain C) No imaging required D) Cervical spine CT only Answer: C
Answer: C Explanation: Airway compromise with stridor and expanding neck hematoma points to tracheal injury. Question 7. In a patient with suspected sepsis, which of the following is the most appropriate initial fluid resuscitation strategy? A) 500 mL normal saline over 2 hours B) 30 mL/kg crystalloid bolus within the first 3 hours C) Albumin 5 % 1 L over 6 hours D) No fluids until blood cultures are obtained Answer: B Explanation: Early goal‑directed therapy for sepsis recommends 30 mL/kg of crystalloid within the first 3 hours. Question 8. A 70‑year‑old woman with a history of COPD presents with sudden onset dyspnea and pleuritic chest pain. ECG shows sinus tachycardia; bedside US shows right‑ventricular dilation. What is the most likely diagnosis? A) Acute myocardial infarction B) Pulmonary embolism C) Pneumothorax D) Acute decompensated heart failure
Answer: B Explanation: Right‑ventricular strain on ultrasound in a patient with risk factors suggests massive pulmonary embolism. Question 9. A 2‑month‑old infant presents with fever, irritability, and a bulging fontanelle. Which of the following is the most appropriate next step? A) Oral amoxicillin and discharge B) Lumbar puncture after initiating empiric antibiotics C) Immediate CT scan of the head before any lumbar puncture D) Observation for 24 hours Answer: B Explanation: Suspected meningitis requires prompt empiric antibiotics, then lumbar puncture for diagnosis. Question 10. A 55‑year‑old man with known coronary artery disease presents with crushing chest pain. He receives aspirin, nitroglycerin, and a high‑intensity statin. Which medication should be added to reduce mortality? A) Intravenous heparin B) Oral clopidogrel loading dose C) Intravenous morphine D) Subcutaneous enoxaparin
Answer: A Explanation: The femoral artery lies in the groin region and is the most common source of brisk arterial bleeding in anterior thigh injuries. Question 13. A 30‑year‑old pregnant woman at 32 weeks gestation presents with right upper quadrant pain, nausea, and a temperature of 38.5 °C. Ultrasound shows gallstones with a thickened wall. What is the best management? A) Immediate laparoscopic cholecystectomy B) Conservative management with IV fluids and antibiotics, defer surgery until postpartum C) Endoscopic retrograde cholangiopancreatography (ERCP) now D) Immediate open cholecystectomy Answer: B Explanation: In pregnancy, acute cholecystitis is managed conservatively; surgery is postponed unless complications develop. Question 14. A 19‑year‑old male presents after a motorbike crash with hypotension, muffled heart sounds, and jugular venous distention. Which bedside maneuver is most diagnostic? A) Rapid sequence intubation B) Pericardiocentesis without imaging C) Focused cardiac ultrasound showing pericardial effusion (tamponade) D) Needle decompression of the chest
Answer: C Explanation: Beck’s triad suggests cardiac tamponade; bedside US confirms diagnosis and guides pericardiocentesis. Question 15. Which of the following is the most appropriate dose of intranasal midazolam for a pediatric patient weighing 15 kg experiencing status epilepticus? A) 0.1 mg/kg B) 0.2 mg/kg C) 0.5 mg/kg D) 1 mg/kg Answer: B Explanation: Intranasal midazolam is given at 0.2 mg/kg for rapid seizure control in children. Question 16. A 70‑year‑old man with a history of hypertension presents with sudden, severe, tearing chest pain radiating to the back. CT angiography shows an intimal flap in the descending aorta. Which class of medication should be started immediately? A) Beta‑blocker (e.g., esmolol) B) Calcium channel blocker (e.g., nicardipine) C) ACE inhibitor (e.g., lisinopril)
D) Nebulized albuterol Answer: B Explanation: IM epinephrine is the first‑line treatment for anaphylaxis. Question 19. A 34‑year‑old male presents with sudden onset unilateral facial droop, slurred speech, and right‑hand weakness. CT head is negative for hemorrhage. What is the next best step? A) Begin high‑dose IV steroids B) Initiate tissue plasminogen activator (tPA) within 3 hours of symptom onset C) Order a lumbar puncture D) Observe and repeat CT in 24 hours Answer: B Explanation: In the absence of hemorrhage, the patient meets criteria for thrombolysis for acute ischemic stroke. Question 20. A 60‑year‑old woman with severe COPD presents with hypercapnic respiratory failure (pH 7.25, PaCO₂ 80 mm Hg). Which ventilatory strategy is preferred? A) Immediate endotracheal intubation and mechanical ventilation B) Non‑invasive positive pressure ventilation (NPPV) with BiPAP C) High‑flow nasal cannula only
D) Supplemental oxygen via simple mask Answer: B Explanation: NPPV is first‑line for COPD exacerbations with hypercapnia to avoid intubation. Question 21. A 28‑year‑old woman presents after a suspected opioid overdose. Her pupils are pinpoint, respirations are 8/min, and she is unresponsive. Which medication should be administered? A) Naloxone 0.4 mg IV push, repeat as needed B) Flumazenil 0.2 mg IV C) Atropine 1 mg IV D) Diazepam 5 mg IV Answer: A Explanation: Naloxone reverses opioid-induced respiratory depression; dosing is titrated to effect. Question 22. A patient with a known history of atrial fibrillation presents with palpitations and a rapid ventricular response. He is hemodynamically stable. Which medication can be used for chemical cardioversion? A) Amiodarone infusion B) Procainamide bolus
B) Intravenous glucose only C) High‑dose steroids D) Immediate hemodialysis Answer: A Explanation: Hepatic encephalopathy is treated with lactulose, rifaximin, and thiamine to prevent Wernicke’s encephalopathy. Question 25. A 22‑year‑old male presents after a high‑speed motor vehicle collision with a “seat‑belt sign” across his abdomen and diffuse tenderness. Which imaging study is most appropriate? A) Focused Assessment with Sonography for Trauma (FAST) B) Plain abdominal radiograph C) Immediate exploratory laparotomy without imaging D) MRI abdomen Answer: A Explanation: FAST quickly detects intra‑abdominal free fluid in trauma patients. Question 26. Which of the following is the most appropriate initial management of a patient with a suspected septic arthritis of the knee? A) Oral NSAIDs and observation
B) Immediate arthrocentesis and empirical IV antibiotics C) Immobilization in a splint D) Intra‑articular steroid injection Answer: B Explanation: Prompt joint aspiration for diagnosis and early antibiotics are critical to prevent joint damage. Question 27. A 30‑year‑old woman presents with unilateral throbbing headache, photophobia, and neck stiffness. CT head is normal. What is the next best diagnostic step? A) Begin high‑dose steroids B) Perform lumbar puncture for CSF analysis C) Order a magnetic resonance angiography (MRA) D) Discharge with analgesics Answer: B Explanation: Normal CT does not rule out meningitis; lumbar puncture is required for definitive diagnosis. Question 28. A 70‑year‑old man presents with a painful, swollen right ankle after a low‑energy fall. X‑ray shows a displaced intra‑articular fracture of the distal tibia. Which surgical procedure is indicated?
210/120 mm Hg. CT scan shows a subarachnoid hemorrhage. Which medication should be administered early to reduce re‑bleeding risk? A) Intravenous labetalol B) Oral amlodipine C) Intravenous nitroglycerin D) Subcutaneous heparin Answer: A Explanation: Rapid blood‑pressure control with a short‑acting IV agent like labetalol reduces re‑bleeding risk in SAH. Question 31. A 6‑year‑old child ingests a button battery that is lodged in the esophagus for >2 hours. What is the immediate management? A) Observe for spontaneous passage B) Perform emergent endoscopic removal C) Give activated charcoal D) Induce emesis Answer: B Explanation: Esophageal button batteries cause rapid tissue necrosis; emergent endoscopic removal is mandatory.
Question 32. A 38‑year‑old man presents with a painful, swollen left testicle after a sports injury. On exam, the testis is high riding and has a transverse bruise. Which diagnosis is most likely? A) Testicular torsion B) Epididymitis C) Testicular rupture D) Hydrocele Answer: C Explanation: High‑riding, swollen testis with a transverse bruise suggests testicular rupture requiring surgical exploration. Question 33. A 22‑year‑old woman presents with a sudden onset of unilateral vision loss and a painful red eye. Slit‑lamp examination reveals a hazy cornea and a fixed, mid‑dilated pupil. What is the most likely diagnosis? A) Acute angle‑closure glaucoma B) Corneal ulcer C) Conjunctivitis D) Retinal detachment Answer: A Explanation: Acute angle‑closure glaucoma presents with a painful red eye, hazy cornea, and a mid‑dilated non‑reactive pupil.
Explanation: Refractory anaphylaxis requires repeat dosing of IM epinephrine every 5‑ 15 minutes. Question 36. A 70‑year‑old woman on warfarin presents with a spontaneous intramuscular hematoma of the thigh causing compartment syndrome. Which intervention is indicated? A) Immediate fasciotomy without reversal of anticoagulation B) Administration of vitamin K and prothrombin complex concentrate (PCC) followed by fasciotomy C) Observation and serial exams only D) Intravenous tranexamic acid alone Answer: B Explanation: Reversal of anticoagulation with vitamin K and PCC is required before emergent fasciotomy. Question 37. A 2‑year‑old child presents with a fever, cough, and wheezing. The child’s oxygen saturation is 88 % on room air. Which therapy should be initiated first? A) Intravenous magnesium sulfate B) Nebulized albuterol with oxygen C) Oral dexamethasone only D) Immediate intubation
Answer: B Explanation: Initial management of acute wheezing with hypoxia is nebulized β2‑agonist plus supplemental oxygen. Question 38. A 45‑year‑old man presents after a fall with a “butterfly” rash on his face, joint pain, and renal insufficiency. Which laboratory test is most specific for systemic lupus erythematosus? A) Anti‑dsDNA antibodies B) Rheumatoid factor C) Anti‑CCP antibodies D) Antineutrophil cytoplasmic antibodies (ANCA) Answer: A Explanation: Anti‑double‑stranded DNA antibodies are highly specific for SLE and correlate with disease activity. Question 39. A 60‑year‑old man with a known abdominal aortic aneurysm (AAA) presents with sudden severe back pain and a drop in blood pressure. Which imaging modality is fastest to confirm rupture? A) Contrast‑enhanced CT abdomen B) Bedside ultrasound C) MRI abdomen D) Plain abdominal X‑ray
