Exit MCQ Pegawai Perubatan Siswazah 2020

The patient's presentation is consistent with acute pulmonary edema, likely due to congestive heart failure (CHF). The presence of pink, frothy sputum, rales on lung examination, and bilateral perihilar infiltrates on chest radiograph all suggest fluid overload in the lungs. The elevated blood pressure, enlarged cardiac silhouette, and pitting edema further support the diagnosis of CHF. The most appropriate medical intervention for CHF with acute pulmonary edema is a combination of nitroglycerin and a loop diuretic. Nitroglycerin helps to reduce preload and afterload, improving cardiac function and relieving symptoms. A loop diuretic, such as furosemide, helps to eliminate excess fluid and reduce pulmonary congestion.

The Rovsing sign is a clinical sign used to diagnose appendicitis. It is characterized by pain in the right lower quadrant (RLQ) of the abdomen when pressure is applied to the left lower quadrant (LLQ). In this case, the patient experiences RLQ pain when the LLQ is palpated, indicating a positive Rovsing sign. This sign is suggestive of appendicitis, as the pain is likely due to inflammation of the appendix. The other options (Blumberg sign, Psoas sign, Obturator sign, and Raynaud sign) are not associated with RLQ pain or appendicitis.

The patient's symptoms of sudden onset left arm weakness that resolved within a short period of time, along with his risk factors of hypertension and diabetes, are consistent with a transient ischemic attack (TIA). A TIA is a temporary disruption of blood flow to a certain part of the brain, causing temporary neurological symptoms. The fact that the patient's neurologic examination is unremarkable further supports this diagnosis. Thrombotic stroke and migraine with focal neurologic deficit would typically have longer-lasting symptoms, while conversion disorder and Todd paralysis would not have resolved on their own.

The patient's ECG shows a wide QRS complex with a regular rhythm, indicating ventricular tachycardia (VT). VT can be a life-threatening arrhythmia and immediate treatment is needed. Intravenous magnesium sulfate is the treatment of choice for stable VT. Therefore, the next step in management would be to administer IV magnesium sulfate stat to the patient.

Preoxygenation is an important step in Rapid Sequence Intubation (RSI) to increase the oxygen reserve in the lungs before inducing apnea. The aim of preoxygenation is to replace the nitrogen in the lungs with oxygen, increasing the arterial pressure of oxygen. This helps to delay the onset of desaturation during the apneic period, providing a longer safe apnea time. Increasing tidal volume and respiratory rate are not tools to improve preoxygenation, and preoxygenation cannot prevent the development of respiratory acidosis during the apneic period.

Despite the lack of tenderness and bony deformities in the cervical spine, imaging is still necessary in this case. The patient is an elderly man who fell down a flight of steps, which puts him at risk for cervical spine injury. The presence of a long board and cervical collar further indicates the possibility of cervical spine injury. Imaging is needed to rule out any fractures or other injuries that may not be evident on physical examination.

The patient's presentation with a sudden intense headache, loss of consciousness, and a history of previous sudden headaches suggests a subarachnoid hemorrhage (SAH). The normal CT scan from the previous week does not rule out SAH, as early bleeding may not be visible on imaging. The non-contrast head CT obtained in the ED may show signs of SAH, such as blood in the subarachnoid space or ventricles. Meningoencephalitis, normal pressure hydrocephalus, epidural hematoma, and subdural hematoma are less likely based on the clinical presentation and imaging findings.

The most appropriate next step in management is to confirm the rhythm in two leads, begin CPR, and then administer epinephrine and atropine. This is because the rhythm shown on the cardiac monitor is pulseless electrical activity (PEA), which is a non-shockable rhythm. In PEA, there is electrical activity in the heart, but it does not result in a palpable pulse. The initial management of PEA involves confirming the rhythm in two leads to rule out any reversible causes, such as hypovolemia or hypoxia, and then starting CPR. Epinephrine and atropine are medications commonly used in the ACLS algorithm for the management of PEA.

The ECG shows peaked T waves, widened QRS complex, and loss of P waves, which are consistent with hyperkalemia. Hyperkalemia can cause cardiac conduction abnormalities, leading to changes in the ECG. The patient's symptoms of fatigue, confusion, and decreased appetite are also consistent with hyperkalemia.

The patient's presentation is consistent with Ludwig angina, a rapidly progressive cellulitis of the submandibular space. The presence of fever, drooling, trismus, and a swollen neck, along with the foul taste in the mouth and tenderness over the lower second and third molars, suggest an odontogenic source of infection. The "bull-necked" appearance with tense and markedly tender oedema and brawny induration of the upper neck indicates significant involvement of the deep neck spaces. These findings indicate a potential for airway compromise. Therefore, the most appropriate next step in management would be to secure the patient's airway, start IV antibiotics to cover the likely polymicrobial flora, and obtain an ENT consult for further evaluation and management.

The patient's symptoms of difficulty breathing, wheezing, and use of an inhaler suggest that she may be experiencing an asthma exacerbation. Peak expiratory flow (PEF) is a measurement of how well air flows out of the lungs and can help assess the severity of asthma. It is a useful tool in monitoring and managing asthma. Therefore, measuring the patient's PEF would be the next appropriate step in evaluating her condition. Chest radiograph, β-Natriuretic peptide level, rectal temperature, and ABG are not indicated based on the given history and physical examination findings.

The patient in this scenario is presenting with signs of severe trauma, including low blood pressure, tachycardia, low oxygen saturation, and unresponsiveness. These findings indicate that the patient is in a critical condition and requires immediate intervention. Orotracheal intubation is the most appropriate next step in management as it ensures the patient's airway is secured and allows for effective ventilation and oxygenation. This is crucial in preventing further deterioration and providing necessary support for the patient's vital functions.

The ECG shows a progressive lengthening of the PR interval until a QRS complex is dropped, indicating a second-degree AV block. Specifically, it is a second-degree Mobitz I (Wenckebach) AV block, as evidenced by the progressive prolongation of the PR interval until a QRS complex is dropped. This is a common finding in older individuals and is often benign, but it can also be associated with underlying cardiac pathology.

The patient in this scenario is exhibiting symptoms of anticholinergic syndrome. This is indicated by his dilated pupils, flushed face, dry mucous membranes and skin, and confusion with mumbling speech. Anticholinergic syndrome is caused by the inhibition of the neurotransmitter acetylcholine in the central and peripheral nervous systems. This can result from the use of medications with anticholinergic properties, such as certain antidepressants or antihistamines.

The critical next step in electrical cardioversion is to turn on the synchronization mode. This is important because atrial flutter with 2:1 AV block can cause the ventricles to beat at a rapid rate, and if electrical cardioversion is performed without synchronization, it can result in ventricular fibrillation. By turning on the synchronization mode, the defibrillator will deliver the electrical shock during the appropriate phase of the cardiac cycle, minimizing the risk of inducing a lethal arrhythmia.

Based on the given information, the patient is a 55-year-old man with a history of hypertension and smoking. He presents with three episodes of severe chest pain that radiated to his left shoulder, which occurred while he was reading the newspaper. These symptoms are consistent with unstable angina, as they occurred at rest and are not relieved by rest. The patient's blood pressure and heart rate are within normal limits, and the ECG and troponin I are negative, ruling out ST-elevation MI. Therefore, the best diagnosis for this patient is unstable angina.

The patient's presentation of pain in the right upper quadrant (RUQ) that worsens with eating and radiates to the right side of the midback, along with the presence of gallstones on abdominal ultrasound, is consistent with biliary colic. Biliary colic is caused by temporary obstruction of the cystic duct by a gallstone, leading to intermittent pain. The absence of a thickened wall or pericholecystic fluid on ultrasound suggests that there is no inflammation or infection, ruling out cholecystitis and cholangitis as the diagnosis. Urolithiasis and peptic ulcer disease do not typically present with RUQ pain.

The most likely diagnosis in this case is epidural hematoma. The presence of a right-sided fixed and dilated pupil, along with the history of a car accident and subsequent collapse, suggests that there is a space-occupying lesion in the brain causing increased intracranial pressure. The head CT scan would likely show a biconvex or lens-shaped hematoma, which is characteristic of an epidural hematoma. This type of hematoma typically occurs due to a tear in the middle meningeal artery after a traumatic head injury.

The patient in option A has received adequate preoxygenation and is ready for induction and paralysis of RSI because they have a saturation of 100% on a nasal cannula, which indicates that their oxygen levels are fully saturated. Additionally, they were asked to breathe for 3 minutes after adding an NRM, which further ensures that their oxygen levels are optimized before the procedure.

The best position to achieve maximum preoxygenation in this patient is option A. Placing the patient flat on the gurney at chest level of the intubating clinician with the head in the sniffing position helps to align the airway and facilitate optimal oxygenation. This position allows for proper visualization of the vocal cords during intubation and helps prevent airway obstruction. Additionally, it minimizes the risk of aspiration and provides better control of the airway during the procedure.

The given answer states that PCI (percutaneous coronary intervention) and thrombolytic therapy are equally effective within the first 3 hours of chest pain onset. This means that both treatment options have similar efficacy in relieving the symptoms and managing the condition in the early stages of chest pain. However, it does not provide any information about the management if the patient has persistent chest pain for more than 12 hours or if thrombolytic therapy fails.

The patient's presentation with sudden severe abdominal pain, a large pulsatile mass on palpation, diaphoresis, and hypotension is highly concerning for a ruptured abdominal aortic aneurysm (AAA). This is a surgical emergency that requires immediate intervention. The most appropriate next step in management is to call surgery and have them prepare the operating room for an exploratory laparotomy. This procedure allows for direct visualization of the aorta and repair of the ruptured AAA, which is necessary to prevent further hemorrhage and improve the patient's chances of survival.

In the management of a disaster at ground zero, the correct statement is that the Medical Team, Police, and other rescue teams will be in the Yellow zone area. This means that these teams will be stationed in an area designated as the Yellow zone, which is likely a safer area compared to the Red zone where the Search and Rescue Team operates. The Yellow zone is where initial medical assessments and treatments can be provided to victims before they are transported to the hospital.

Bruising in toddlers and young school-aged children around the shins is not a feature that should raise suspicion of non-accidental trauma. This is because bruising in this area is commonly seen in active children who are learning to walk and run, and it is often due to accidental bumps and falls. The other features mentioned in options A, B, and C, such as vague or inconsistent stories regarding the mechanism of injury, delays in presentation, and injuries inconsistent with the developmental age of the child, are all red flags that should raise suspicion of non-accidental trauma. Therefore, option D is the correct answer.

The statement "synchronize cardioversion must be avoided as this is stable tachycardia" is false in the management of this patient. Stable tachycardia can be treated with synchronized cardioversion if the patient is hemodynamically unstable or if there are signs of end-organ damage. This patient's presentation of sudden onset palpitations, elevated blood pressure, and rapid pulse rate indicates the need for immediate intervention to restore normal heart rhythm and prevent complications.

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The patient's presentation is consistent with a possible pulmonary embolism (PE), as evidenced by the acute onset chest pain, tachycardia, and swollen and tender right calf (suggesting a deep vein thrombosis). The most appropriate next step in management is to start heparin therapy prior to diagnostic study. This is because the patient is hemodynamically stable and anticoagulation with heparin is the first-line treatment for PE. Diagnostic studies such as a ventilation-perfusion scan or CT angiogram can be ordered after initiating heparin therapy to confirm the diagnosis. Administering thrombolytics would not be appropriate as the patient is stable and there is no evidence of hemodynamic instability. Ordering a D-dimer alone would not be sufficient to confirm the diagnosis of PE.

The patient presents with sudden onset of epigastric pain associated with a presyncopal attack. His low blood pressure, cool periphery, and thready pulse volume suggest hypovolemia and possible shock. The next best management would be to insert a large IV cannula and run 250ml of normal saline 0.9% to restore intravascular volume and improve blood pressure. This initial resuscitation is crucial before considering other interventions such as thrombolytic drugs or referral for coronary angiogram.

The correct answer is "Posterior fat sign is absent in normal patient." This means that in a normal patient, the x-ray will not show any indication of a posterior fat pad sign. This is important because the absence of this sign can help differentiate between a normal patient and a patient with a pathological condition.

The correct answer is that insulin must be started as soon as possible once the diagnosis is made. This is because insulin is the mainstay of treatment for diabetic ketoacidosis (DKA). It helps to lower blood glucose levels and reverse the metabolic acidosis associated with DKA. It also promotes the movement of potassium back into cells, helping to correct the potassium imbalance often seen in DKA. Therefore, prompt initiation of insulin therapy is crucial in the management of DKA.