I85PREP
⌘ K
DOH Doctor Exam study materials
DOH Doctor Exam study resources

DOH Doctor Exam practice questions

One question at a time. Build your DOH Doctor Exam understanding.

First 50 of 199 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

Continue in the practice tool above to load more questions, 50 at a time.

Question 1Internal Medicine

A 60-year-old woman with newly diagnosed primary hypertension asks about lifestyle changes. Which change is most likely to lower her blood pressure?

  1. Increase caffeine consumption
  2. Add table salt to meals
  3. Stop regular aerobic exercise
  4. Reduce dietary sodium intake Correct answer.

Explanation

Reducing dietary sodium lowers blood pressure in most adults with hypertension and is a core lifestyle recommendation. Other effective measures include weight loss, the DASH diet, and regular aerobic exercise.

Question 2Internal Medicine

Which laboratory result is diagnostic of diabetes mellitus in a symptomatic adult?

  1. Fasting plasma glucose 100 mg/dL
  2. 2-hour OGTT glucose 130 mg/dL
  3. HbA1c 6.8% Correct answer.
  4. Random plasma glucose 150 mg/dL without symptoms

Explanation

Diabetes is diagnosed when HbA1c is at least 6.5%, fasting glucose is at least 126 mg/dL, 2-hour OGTT glucose is at least 200 mg/dL, or random glucose is at least 200 mg/dL with symptoms. A value of 6.8% therefore meets the HbA1c criterion.

Question 3Internal Medicine

A 30-year-old woman has microcytic anemia. Which test is best to confirm iron deficiency?

  1. Hemoglobin electrophoresis
  2. Serum ferritin Correct answer.
  3. Reticulocyte count
  4. Serum vitamin B12

Explanation

A low serum ferritin is the most specific routine test for iron deficiency in otherwise healthy adults. Because ferritin is an acute-phase reactant, inflammation can raise it despite iron deficiency.

Question 4Internal Medicine

Which laboratory pattern is most consistent with primary hypothyroidism?

  1. High TSH and high free T4
  2. Low TSH and low free T4
  3. High TSH and low free T4 Correct answer.
  4. Low TSH and high free T4

Explanation

In primary hypothyroidism, the thyroid gland fails to produce adequate hormone, so free T4 is low and pituitary TSH rises through loss of negative feedback. Low TSH with low free T4 suggests central hypothyroidism instead.

Question 5Internal Medicine

A 45-year-old man has a duodenal ulcer. Which infection should be tested for and treated?

  1. Candida albicans
  2. H. pylori Correct answer.
  3. Giardia lamblia
  4. Cytomegalovirus

Explanation

Helicobacter pylori is a major cause of duodenal ulcer disease, and eradication reduces ulcer recurrence. Guidelines recommend testing for H. pylori in patients with peptic ulcer disease and treating when positive.

Question 6Internal Medicine

Which joint is most commonly affected in an initial attack of gout?

  1. First MTP joint Correct answer.
  2. Thoracic facet joint
  3. Glenohumeral joint
  4. Hip joint

Explanation

The first metatarsophalangeal joint is the classic site of an initial gout attack, a presentation known as podagra. Gout results from monosodium urate crystal deposition in and around joints.

Question 7Internal Medicine

A 65-year-old smoker with COPD has persistent breathlessness and frequent exacerbations. Which medication improves symptoms and reduces exacerbations?

  1. Inhaled long-acting bronchodilator Correct answer.
  2. Oral decongestant for congestion
  3. ACE inhibitor for blood pressure
  4. Oral beta-blocker for symptom control

Explanation

Inhaled long-acting bronchodilators, often a LABA or LAMA, are cornerstone maintenance therapy in COPD and reduce symptoms and exacerbations. They are preferred over oral decongestants and are not replaced by cardiovascular drugs.

Question 8Internal Medicine

Which finding best supports a prerenal cause of acute kidney injury?

  1. Muddy brown casts on urine microscopy
  2. Urine sodium greater than 40 mmol/L
  3. Fractional excretion of sodium below 1% Correct answer.
  4. Serum creatinine rise of 0.5 mg/dL

Explanation

A fractional excretion of sodium below 1% suggests avid renal sodium retention due to hypoperfusion, supporting a prerenal cause. Muddy brown casts point toward acute tubular necrosis, an intrinsic renal process.

Question 9Internal Medicine

A 70-year-old man with heart failure and ejection fraction 30% remains symptomatic despite an ACE inhibitor and beta-blocker. Which added drug reduces mortality?

  1. Calcium channel blocker amlodipine
  2. Cardiac glycoside digoxin
  3. Spironolactone Correct answer.
  4. Loop diuretic furosemide

Explanation

Mineralocorticoid receptor antagonists such as spironolactone reduce mortality in HFrEF when added to standard therapy. Loop diuretics relieve congestion but have not been shown to improve survival.

Question 10Internal Medicine

A 68-year-old woman with nonvalvular atrial fibrillation has a CHA2DS2-VASc score of 3. Which therapy best reduces her stroke risk?

  1. Aspirin alone
  2. Clopidogrel alone
  3. No antithrombotic therapy
  4. Oral anticoagulation Correct answer.

Explanation

A CHA2DS2-VASc score of 3 indicates high stroke risk, and oral anticoagulation is recommended for stroke prevention. Antiplatelet monotherapy is inferior to anticoagulation for atrial fibrillation stroke prevention.

Question 11Internal Medicine

A 22-year-old with type 1 diabetes presents in diabetic ketoacidosis. After intravenous fluids are started, which step is essential next?

  1. Oral metformin
  2. Intravenous regular insulin infusion Correct answer.
  3. Subcutaneous insulin glargine alone
  4. Sodium bicarbonate infusion

Explanation

DKA requires intravenous regular insulin infusion after fluids are begun and potassium is checked, because insulin stops ketogenesis and lowers glucose. Bicarbonate is reserved for very severe acidosis and is not routine.

Question 12Internal Medicine

A 60-year-old man with community-acquired pneumonia has a CURB-65 score of 2. What is the most appropriate disposition?

  1. Discharge home without antibiotics
  2. Direct ICU admission
  3. Outpatient oral antibiotics
  4. Hospital admission Correct answer.

Explanation

A CURB-65 score of 2 indicates moderate risk, and hospital admission is generally recommended for monitoring and treatment. Scores of 0 to 1 often allow outpatient care, while scores of 3 or more suggest severe pneumonia.

Question 13Internal Medicine

A patient with cirrhosis and ascites develops spontaneous bacterial peritonitis. Which empiric antibiotic is most appropriate?

  1. Vancomycin
  2. Metronidazole
  3. Cefotaxime Correct answer.
  4. Fluconazole

Explanation

Spontaneous bacterial peritonitis is typically caused by enteric gram-negative organisms, so a third-generation cephalosporin such as cefotaxime is first-line empiric therapy. Albumin is often added when renal impairment is present.

Question 14Internal Medicine

A patient with chronic kidney disease has a potassium level of 6.8 mmol/L and peaked T waves. Which treatment stabilizes the cardiac membrane first?

  1. Insulin with glucose
  2. Intravenous calcium gluconate Correct answer.
  3. Oral sodium polystyrene sulfonate
  4. Intravenous furosemide

Explanation

Intravenous calcium salts act within minutes to stabilize the myocardial membrane in hyperkalemia with ECG changes. Insulin with glucose and other measures shift or remove potassium but do not provide the same immediate membrane stabilization.

Question 15Internal Medicine

A 70-year-old man has acute ischemic stroke symptoms that began 2 hours ago. Head CT shows no hemorrhage, and there are no contraindications. Which treatment is indicated?

  1. Aspirin alone
  2. Observation without therapy
  3. Unfractionated heparin infusion
  4. Intravenous thrombolysis Correct answer.

Explanation

Intravenous thrombolysis with alteplase or tenecteplase is indicated for eligible patients with disabling ischemic stroke within the treatment window after hemorrhage is excluded. Aspirin is usually started after thrombolysis is considered or completed.

Question 16Internal Medicine

Which finding is most characteristic of rheumatoid arthritis?

  1. Monoarthritis of the knee
  2. Asymmetric sacroiliitis
  3. Distal interphalangeal joint osteophytes
  4. Symmetric small-joint synovitis Correct answer.

Explanation

Rheumatoid arthritis classically causes symmetric inflammatory synovitis of small joints such as the metacarpophalangeal and proximal interphalangeal joints. Distal interphalangeal osteophytes and asymmetric sacroiliitis suggest osteoarthritis and spondyloarthritis, respectively.

Question 17Internal Medicine

A patient with stage 4 chronic kidney disease has anemia. Which test is most important before starting an erythropoiesis-stimulating agent?

  1. Bone marrow biopsy
  2. Serum haptoglobin
  3. Direct Coombs test
  4. Iron studies Correct answer.

Explanation

Iron deficiency is common in chronic kidney disease, and erythropoiesis-stimulating agents are ineffective without adequate iron stores. Iron studies should therefore be checked and iron repletion considered before or during ESA therapy.

Question 18Internal Medicine

A 45-year-old woman with acute gallstone pancreatitis has severe abdominal pain and vomiting. Which initial fluid strategy is recommended?

  1. No intravenous fluids
  2. Hypertonic saline infusion
  3. Restrictive fluid intake
  4. Isotonic crystalloid Correct answer.

Explanation

Early moderate fluid resuscitation with isotonic crystalloid is recommended in acute pancreatitis to maintain organ perfusion and avoid hypovolemia. Overly aggressive or restrictive strategies may worsen outcomes.

Question 19Internal Medicine

A patient with septic shock remains hypotensive after adequate intravenous fluids. Which vasopressor is first-line?

  1. Dopamine
  2. Phenylephrine
  3. Norepinephrine Correct answer.
  4. Vasopressin

Explanation

Norepinephrine is the first-line vasopressor in septic shock because it increases vascular tone and cardiac output with fewer arrhythmias than dopamine. Vasopressin is often added later to reduce norepinephrine requirements.

Question 20Internal Medicine

A patient with type 2 diabetes and heart failure with reduced ejection fraction needs additional glucose-lowering therapy. Which drug class improves heart failure outcomes?

  1. DPP-4 inhibitor therapy
  2. Sulfonylurea therapy
  3. SGLT2 inhibitor Correct answer.
  4. Pioglitazone therapy

Explanation

SGLT2 inhibitors reduce heart failure hospitalization and cardiovascular death in patients with heart failure with reduced ejection fraction. Pioglitazone can cause fluid retention and is avoided in symptomatic heart failure.

Question 21Internal Medicine

A 70-year-old man with SIADH has a sodium level of 118 mmol/L and new confusion. Which management is most appropriate?

  1. Demeclocycline as first-line therapy
  2. Rapid correction by 20 mmol/L within 24 hours
  3. Encouraging free water intake
  4. Hypertonic saline with fluid restriction Correct answer.

Explanation

Severe symptomatic hyponatremia requires hypertonic saline to raise sodium cautiously while fluid restriction limits further dilution. Correction should be limited to about 8 to 10 mmol/L in the first 24 hours to avoid osmotic demyelination.

Question 22Internal Medicine

A patient has a platelet count of 20,000/µL, schistocytes on smear, and normal PT and PTT. Which diagnosis is most likely?

  1. Disseminated intravascular coagulation
  2. Immune thrombocytopenic purpura
  3. Heparin-induced thrombocytopenia
  4. Thrombotic thrombocytopenic purpura Correct answer.

Explanation

Thrombotic thrombocytopenic purpura causes microangiopathic hemolytic anemia with schistocytes, thrombocytopenia, and often neurologic or renal findings, while PT and PTT are usually normal. DIC typically prolongs PT and PTT.

Question 23Internal Medicine

A patient with adrenal crisis has hypotension and hyponatremia. After drawing cortisol, which treatment should be given immediately?

  1. Intravenous thyroxine
  2. Intravenous hydrocortisone Correct answer.
  3. Intravenous insulin
  4. Oral fludrocortisone alone

Explanation

Adrenal crisis is treated immediately with intravenous hydrocortisone plus isotonic saline; hydrocortisone provides both glucocorticoid and mineralocorticoid activity at stress doses. Fludrocortisone alone is inadequate for acute crisis.

Question 24Internal Medicine

A patient with fever and a new regurgitant murmur has blood cultures growing Staphylococcus aureus. Which complication most often requires early surgery?

  1. Aortic root abscess Correct answer.
  2. Tricuspid valve infection
  3. Pulmonary valve infection
  4. Mitral stenosis

Explanation

Perivalvular abscess, especially at the aortic root, is a serious complication of infective endocarditis that often requires early surgical debridement and valve replacement. Right-sided valve infection in injection drug use is more often managed medically unless complications occur.

Question 25Internal Medicine

A patient with autoimmune hepatitis has elevated ALT and IgG. Which antibody is most characteristic?

  1. Anti-hepatitis B surface antibody
  2. Anti-smooth muscle antibody Correct answer.
  3. Anti-mitochondrial antibody
  4. Anti-tissue transglutaminase antibody

Explanation

Anti-smooth muscle antibody, often with antinuclear antibody, is characteristic of type 1 autoimmune hepatitis. Anti-mitochondrial antibody is associated with primary biliary cholangitis instead.

Question 26Internal Medicine

A 45-year-old woman has fatigue, cold intolerance, weight gain, and constipation. Which laboratory pattern confirms primary hypothyroidism?

  1. High TSH with low free T4 Correct answer.
  2. Normal TSH with low total T3
  3. Low TSH with low free T4
  4. High TSH with high free T4

Explanation

In primary hypothyroidism the thyroid gland fails, so free T4 falls and loss of negative feedback drives the pituitary to secrete more TSH. The combination of a raised TSH with a low free T4 therefore defines primary thyroid failure. A low or inappropriately normal TSH with low free T4 instead points to a pituitary or hypothalamic cause.

Question 27Internal Medicine

A 38-year-old woman has fatigue and microcytic anemia. Which laboratory test is the most sensitive single initial test for iron deficiency?

  1. Mean corpuscular volume
  2. Serum iron
  3. Total iron-binding capacity
  4. Serum ferritin Correct answer.

Explanation

Ferritin is the storage protein for iron and falls early as body stores are depleted, making it the most sensitive single indicator of iron deficiency. Because ferritin rises as an acute-phase reactant, a value within the normal range does not exclude deficiency when inflammation is present. Serum iron and total iron-binding capacity fluctuate diurnally and are less reliable.

Question 28Internal Medicine

A 30-year-old woman has recurrent unilateral throbbing headaches with nausea and light sensitivity that last several hours. Which medication is most appropriate for aborting an acute attack?

  1. Sumatriptan Correct answer.
  2. Topiramate
  3. Propranolol
  4. Amitriptyline

Explanation

Triptans are serotonin receptor agonists that constrict cranial vessels and inhibit trigeminal peptide release, and they are first-line for moderate to severe acute migraine. They are most effective when taken early in the attack. Propranolol, topiramate, and amitriptyline are preventive agents taken daily to reduce attack frequency.

Question 29Internal Medicine

A 24-year-old nonpregnant woman has dysuria, urinary frequency, and suprapubic discomfort for two days, without fever or flank pain. Which regimen is first-line?

  1. Ceftriaxone 1 g intramuscularly once
  2. Levofloxacin for 14 days
  3. Amoxicillin-clavulanate for 14 days
  4. Nitrofurantoin for 5 days Correct answer.

Explanation

Uncomplicated cystitis is treated with a short course of an agent that concentrates in urine, and nitrofurantoin for five days is a recommended first-line option. Fluoroquinones are reserved for more invasive infection because of collateral ecological damage and tendon and cardiac toxicity. A single parenteral ceftriaxone dose is a regimen for pyelonephritis rather than simple cystitis.

Question 30Internal Medicine

A 40-year-old woman has pleuritic chest pain and dyspnea. CT pulmonary angiography shows a small segmental pulmonary embolism. She is normotensive, not hypoxemic, has normal right ventricular size, no cancer, no heart failure, no prior venous thromboembolism, and normal renal function. Which management is most appropriate?

  1. Systemic thrombolysis with alteplase
  2. Inferior vena cava filter placement
  3. Admission for intravenous unfractionated heparin
  4. Outpatient DOAC therapy Correct answer.

Explanation

Patients with pulmonary embolism who are hemodynamically stable, have no right ventricular dysfunction, and lack major risk markers are low risk and can be treated at home with a direct oral anticoagulant. Outpatient management avoids admission without increasing recurrence or bleeding when follow-up is reliable. Escalation to intensive therapy is reserved for hypotension, right ventricular strain, or contraindications to anticoagulation.

Question 31Internal Medicine

A 28-year-old man develops periorbital and leg edema over two weeks. He has 4+ proteinuria, a low serum albumin, normal blood pressure, normal complement levels, and no red cell casts. Which diagnosis is most likely?

  1. Minimal change disease Correct answer.
  2. IgA nephropathy
  3. Membranous nephropathy
  4. Post-infectious glomerulonephritis

Explanation

Abrupt-onset nephrotic syndrome in a young adult with a bland urine sediment, preserved blood pressure, and normal complement is most consistent with minimal change disease. Biopsy typically shows normal light microscopy with diffuse podocyte foot process effacement, and the condition responds well to corticosteroids. Hematuria, hypertension, or low complement would point toward a proliferative glomerulonephritis instead.

Question 32Internal Medicine

A 65-year-old man with squamous cell lung cancer has a corrected calcium of 3.4 mmol/L, confusion, and constipation. He has received intravenous saline. Which agent is most appropriate next?

  1. Oral calcitriol
  2. Hydrochlorothiazide daily
  3. Intravenous furosemide as the sole agent
  4. Intravenous zoledronic acid Correct answer.

Explanation

Malignancy-associated hypercalcemia is driven by tumor secretion of parathyroid hormone-related peptide, which increases bone resorption. An intravenous bisphosphonate such as zoledronic acid inhibits osteoclast activity and is the mainstay of treatment, although the effect takes two to four days to peak. Calcitonin is sometimes added for rapid control but is never used alone.

Question 33Internal Medicine

A 35-year-old man has sharp chest pain that worsens with inspiration and lying flat and improves when he leans forward. ECG shows diffuse concave ST elevation with PR depression. Which initial therapy is most appropriate?

  1. Ibuprofen plus colchicine Correct answer.
  2. High-dose corticosteroids alone
  3. Fibrinolytic therapy
  4. Pericardiocentesis

Explanation

The presentation is acute idiopathic or viral pericarditis, treated with an NSAID for inflammation plus colchicine to reduce the risk of recurrence. Corticosteroids are avoided as initial therapy because they increase recurrence rates and are reserved for specific autoimmune or uremic causes. Fibrinolysis is inappropriate without myocardial infarction, and drainage is not indicated without a significant effusion.

Question 34Internal Medicine

A 58-year-old man with cirrhosis becomes confused and has asterixis one day after a gastrointestinal bleed. Which initial pharmacologic treatment is most appropriate?

  1. Intravenous lorazepam for agitation
  2. Rifaximin alone
  3. Dietary protein restriction to 20 g per day
  4. Lactulose titrated to two soft stools daily Correct answer.

Explanation

Lactulose is first-line for hepatic encephalopathy because colonic acidification traps ammonia and osmotic laxation removes nitrogenous substrate, titrated to two or three soft stools per day. Rifaximin is added mainly to prevent recurrence after a second episode. Protein restriction is outdated and worsens malnutrition; current practice maintains normal protein intake.

Question 35Internal Medicine

A 50-year-old man with known cirrhosis has hematemesis and hypotension. After fluid resuscitation, which combination is most appropriate to start before endoscopy?

  1. Octreotide plus intravenous ceftriaxone Correct answer.
  2. Proton pump inhibitor infusion plus oral iron
  3. Vitamin K plus fresh frozen plasma
  4. Nadolol plus spironolactone

Explanation

When variceal hemorrhage is suspected, a splanchnic vasoconstrictor such as octreotide is started immediately to reduce portal pressure, together with prophylactic antibiotics. Ceftriaxone lowers the risk of bacterial peritonitis and improves survival in cirrhotic patients with gastrointestinal bleeding. Endoscopic band ligation follows once the patient is stabilized.

Question 36Internal Medicine

A 74-year-old man has a harsh crescendo-decrescendo systolic murmur at the right upper sternal border radiating to the carotids, with a delayed and diminished carotid upstroke. Which symptom combination most strongly indicates severe disease?

  1. Fever, weight loss, and night sweats
  2. Pleuritic pain and a pericardial friction rub
  3. Palpitations, tremor, and heat intolerance
  4. Exertional angina, syncope, and dyspnea Correct answer.

Explanation

The murmur and parvus et tardus carotid upstroke indicate aortic stenosis, and the classic triad of angina, syncope, and exertional dyspnea marks severe disease. Once these symptoms appear, prognosis without valve replacement is poor, with high mortality within a few years. The finding is an indication for intervention even before symptoms progress further.

Question 37Internal Medicine

A 45-year-old man with a healed duodenal ulcer completed a course of Helicobacter pylori eradication therapy and now feels well. Which test is most appropriate to confirm eradication?

  1. Rapid urease testing during repeat endoscopy
  2. Stool antigen testing while still on a PPI
  3. Urea breath test 4 weeks after antibiotics Correct answer.
  4. Serum IgG antibody testing

Explanation

Eradication is confirmed with a urea breath test or stool antigen test performed at least four weeks after antibiotics have finished and at least two weeks after stopping a proton pump inhibitor. These tests detect active infection rather than past exposure. Serology remains positive for years and cannot be used to confirm cure.

Question 38Internal Medicine

A 62-year-old man received unfractionated heparin for seven days after hip surgery. His platelet count falls from 260,000/µL to 95,000/µL, and he develops a new deep vein thrombosis in the left leg. Which management is most appropriate?

  1. Switch to low-molecular-weight heparin at a higher dose
  2. Stop heparin and start argatroban Correct answer.
  3. Platelet transfusion to keep the count above 100,000/µL
  4. Warfarin started alone immediately

Explanation

A platelet count falling by more than half after five to ten days of heparin exposure, accompanied by new thrombosis, indicates immune-mediated heparin-induced thrombocytopenia. Despite the low platelets, the disorder is strongly prothrombotic, so all heparin products must be stopped and a non-heparin anticoagulant such as argatroban started. Warfarin is withheld until platelets recover because early initiation can cause venous limb gangrene.

Question 39Internal Medicine

A 58-year-old hypertensive man has sudden tearing chest pain radiating to the back. CT angiography shows a Stanford type B aortic dissection, with blood pressure 190/110 mmHg and heart rate 105 beats/min. Which is the most appropriate first pharmacologic step?

  1. Oral lisinopril with observation
  2. Intravenous nitroprusside as the sole agent
  3. Intravenous hydralazine as needed for hypertension
  4. Esmolol titrated to a heart rate near 60/min Correct answer.

Explanation

The immediate goal in aortic dissection is to reduce the rate of pressure rise against the aortic wall, so intravenous beta blockade with esmolol is started first to bring the heart rate to around 60 beats/min. A vasodilator is then added to lower systolic pressure to roughly 100 to 120 mmHg if the patient tolerates it. Giving a vasodilator alone produces reflex tachycardia that increases shear stress on the intimal tear.

Question 40Internal Medicine

A 40-year-old woman has episodic headache, palpitations, and diaphoresis with blood pressure 210/120 mmHg. Plasma free metanephrines are markedly elevated. Which is the most appropriate first step for blood pressure control before surgery?

  1. ACE inhibitor with lisinopril
  2. Sodium nitroprusside infusion as the first drug
  3. Beta blockade with propranolol first
  4. Phenoxybenzamine alpha blockade Correct answer.

Explanation

Preoperative preparation for pheochromocytoma begins with alpha blockade, usually phenoxybenzamine for 10 to 14 days, which also permits expansion of the chronically contracted plasma volume. Beta blockers are added only after adequate alpha blockade to control reflex tachycardia. Starting a beta blocker first leaves alpha-mediated vasoconstriction unopposed and can precipitate a hypertensive crisis.

Question 41Surgery

A 22-year-old man has 12 hours of abdominal pain that began around the umbilicus and has moved to the right lower quadrant. Which historical feature best supports acute appendicitis?

  1. Migration to the right lower quadrant Correct answer.
  2. Radiation to the left shoulder
  3. Pain beginning in the right upper quadrant
  4. Relief of pain after meals

Explanation

Appendiceal pain starts as dull periumbilical discomfort from visceral afferent stimulation and later localizes to the right lower quadrant as parietal peritoneum becomes inflamed. This migration is a classic historical clue.

Question 42Surgery

Which is the most common cause of large bowel obstruction in adults?

  1. Colorectal cancer Correct answer.
  2. Acute diverticulitis
  3. Adhesions
  4. Sigmoid volvulus

Explanation

Colorectal carcinoma is the leading cause of large bowel obstruction in adults. Adhesions are the commonest cause of small bowel obstruction, while diverticulitis and volvulus are less frequent causes of colonic obstruction.

Question 43Surgery

Which clinical finding is most characteristic of acute cholecystitis?

  1. Rebound tenderness in the left lower quadrant
  2. Absent bowel sounds with distension
  3. Painless jaundice
  4. Positive Murphy sign Correct answer.

Explanation

Murphy sign is inspiratory arrest during right upper quadrant palpation caused by an inflamed gallbladder meeting the examiner's hand. It is a classic sign of acute cholecystitis.

Question 44Surgery

In the trauma primary survey, which sequence is correct?

  1. Circulation, airway, breathing, disability, exposure
  2. Disability, airway, breathing, circulation, exposure
  3. Airway, breathing, circulation, disability, exposure Correct answer.
  4. Breathing, airway, circulation, exposure, disability

Explanation

The primary survey follows an ABCDE sequence: airway, breathing, circulation, disability, and exposure. Immediate life threats are addressed in that order before the secondary survey.

Question 45Surgery

A 35-year-old man has sudden severe flank pain radiating to the groin with microscopic hematuria. Which is the preferred first-line imaging test for suspected ureteric stone?

  1. Abdominal ultrasound
  2. Non-contrast CT Correct answer.
  3. Intravenous urography
  4. Plain abdominal radiograph

Explanation

Non-contrast CT of the kidneys, ureters, and bladder is highly sensitive for urinary stones and quickly shows stone size and location. Ultrasound is preferred when radiation must be avoided, such as in pregnancy.

Question 46Surgery

A 45-year-old woman has a palpable breast lump. What does triple assessment of the breast lump include?

  1. Ultrasound, MRI, and genetic testing
  2. Clinical examination, tumor markers, and bone scan
  3. Mammography, chemotherapy, and radiotherapy
  4. Clinical examination, imaging, and tissue sampling Correct answer.

Explanation

Triple assessment combines clinical breast examination, breast imaging, and tissue diagnosis by cytology or core biopsy. This approach gives high diagnostic accuracy for a palpable lump.

Question 47Surgery

A 9-month-old boy has intermittent inconsolable crying, drawing up of the legs, and red currant jelly stool. Which diagnosis is most likely?

  1. Intussusception Correct answer.
  2. Hirschsprung disease
  3. Meckel diverticulum
  4. Pyloric stenosis

Explanation

Intussusception classically affects infants aged 6–18 months with episodic colicky pain, vomiting, and red currant jelly stool. Ultrasound showing a target sign supports the diagnosis.

Question 48Surgery

A 60-year-old man with a long-standing inguinal hernia presents with a painful, irreducible swelling and vomiting. Which feature most suggests strangulation?

  1. The hernia reduces with gentle pressure
  2. A soft, nontender swelling
  3. A cough impulse is present
  4. Skin erythema and systemic toxicity Correct answer.

Explanation

Strangulation is suggested by severe pain, an irreducible hernia, overlying erythema, tenderness, and systemic signs such as fever or tachycardia. A soft reducible hernia without toxicity is not strangulated.

Question 49Surgery

A 50-year-old man with severe epigastric pain has a serum lipase three times the upper limit of normal. Which finding best indicates severe acute pancreatitis?

  1. Vomiting
  2. Pain radiating to the back
  3. Elevated amylase
  4. Organ failure beyond 48 hours Correct answer.

Explanation

The revised Atlanta classification defines severe pancreatitis by persistent organ failure lasting more than 48 hours. Pain, vomiting, and raised pancreatic enzymes are common but do not define severity.

Question 50Surgery

A trauma patient becomes hypotensive and hypoxic with absent breath sounds on the right and distended neck veins. What is the immediate management?

  1. Urgent chest radiograph
  2. Pericardiocentesis
  3. Needle decompression Correct answer.
  4. Endotracheal intubation

Explanation

Tension pneumothorax is a clinical diagnosis and requires immediate needle decompression before imaging. Delaying treatment for a chest radiograph can lead to cardiac arrest.