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Azerbaijan Healthcare Certification study materials
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Azerbaijan Healthcare Certification practice questions

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Question 1Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 58-year-old man has crushing central chest pain radiating to the left arm and ST elevation in leads II, III and aVF. Which coronary artery is most likely occluded?

  1. Left anterior descending artery
  2. Left main coronary artery
  3. Left circumflex artery
  4. Right coronary artery Correct answer.

Explanation

ST elevation in the inferior leads II, III and aVF localises injury to the inferior wall, which is supplied by the right coronary artery in most people. The right coronary artery also supplies the AV node, so inferior infarction may be complicated by bradyarrhythmia.

Question 2Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

Which finding is the most characteristic of nephrotic syndrome?

  1. Sterile pyuria with eosinophiluria
  2. Haematuria with red cell casts
  3. Urinary protein excretion above 3.5 g per day Correct answer.
  4. Metabolic alkalosis with hypokalaemia

Explanation

Nephrotic syndrome is defined by heavy proteinuria, conventionally more than 3.5 g per day, together with hypoalbuminaemia, oedema and hyperlipidaemia. The glomerular lesion increases permeability to protein while retaining cells, so haematuria is not the leading feature.

Question 3Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 3-year-old child has a barking cough, hoarse voice and inspiratory stridor that began after a coryzal illness. What is the most likely diagnosis?

  1. Croup Correct answer.
  2. Epiglottitis
  3. Bronchiolitis
  4. Foreign body aspiration

Explanation

Croup is a viral laryngotracheitis that produces a barking cough, hoarseness and inspiratory stridor, usually following a few days of coryza. The subglottic oedema narrows the airway and creates the characteristic stridor.

Question 4Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

Which organism is the most common cause of community-acquired pneumonia in adults?

  1. Streptococcus pneumoniae Correct answer.
  2. Legionella pneumophila
  3. Pneumocystis jirovecii
  4. Mycoplasma pneumoniae

Explanation

Streptococcus pneumoniae remains the single most frequently identified cause of community-acquired pneumonia in adults. It classically produces a lobar consolidation with rusty sputum and responds to penicillins.

Question 5Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A woman at 34 weeks of gestation has painless bright red vaginal bleeding. Her uterus is soft and non-tender. What is the most likely diagnosis?

  1. Uterine rupture
  2. Placental abruption
  3. Placenta praevia Correct answer.
  4. Vasa praevia

Explanation

Painless bright red bleeding in late pregnancy with a soft, non-tender uterus is typical of placenta praevia, where the placenta lies over or near the cervical os. Abruption, by contrast, usually causes painful bleeding with a tense uterus.

Question 6Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

Which laboratory value is the most reliable early indicator of acute pancreatitis?

  1. Serum amylase raised above the upper limit of normal
  2. Serum lactate raised above the upper limit of normal
  3. Serum lipase raised above three times the upper limit of normal Correct answer.
  4. Serum alkaline phosphatase raised above the upper limit of normal

Explanation

Lipase is more specific than amylase for pancreatic injury and stays elevated longer, so a rise above three times the upper reference limit strongly supports acute pancreatitis. Amylase can also rise in salivary, bowel and renal disease.

Question 7Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 70-year-old woman has a wrist fracture after a fall from standing height. Which underlying condition most commonly predisposes to this injury?

  1. Osteomalacia
  2. Osteoporosis Correct answer.
  3. Osteogenesis imperfecta
  4. Paget disease

Explanation

Osteoporosis reduces bone mineral density and causes fragility fractures, typically of the distal radius, hip and vertebral bodies, after low-energy trauma. It is common in postmenopausal women because of oestrogen deficiency.

Question 8Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

Which vaccine is contraindicated in a child with severe combined immunodeficiency?

  1. Tetanus toxoid vaccine
  2. Inactivated influenza vaccine
  3. Hepatitis B surface antigen vaccine
  4. Live attenuated measles vaccine Correct answer.

Explanation

Live attenuated vaccines can replicate and cause disseminated infection in severely immunocompromised children, so they are withheld in severe combined immunodeficiency. Inactivated vaccines and toxoids are safe because they cannot replicate.

Question 9Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 45-year-old man has a fasting plasma glucose of 7.8 mmol/L on two occasions. What is the diagnosis?

  1. Diabetes mellitus Correct answer.
  2. Impaired fasting glucose
  3. Normal glucose tolerance
  4. Reactive hypoglycaemia

Explanation

A fasting plasma glucose of 7.0 mmol/L or more, confirmed on a second occasion, establishes the diagnosis of diabetes mellitus. Impaired fasting glucose lies between 6.1 and 6.9 mmol/L.

Question 10Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

Which feature best distinguishes an ischaemic stroke from a haemorrhagic stroke at the bedside?

  1. A sudden onset of symptoms
  2. Imaging showing haemorrhage is required, as clinical signs alone cannot reliably separate them Correct answer.
  3. Unilateral limb weakness
  4. A history of hypertension

Explanation

Clinical features overlap heavily between ischaemic and haemorrhagic stroke, so neuroimaging, usually CT, is required before thrombolysis or anticoagulation. Both types can present with sudden focal deficit and occur in hypertensive patients.

Question 11Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 25-year-old woman has a 6-week history of fatigue, weight loss, heat intolerance and palpitations. Examination shows a diffuse goitre and tremor. Which antibody is most specific for this disorder?

  1. Antithyroid peroxidase antibody
  2. Antinuclear antibody
  3. Thyroid stimulating hormone receptor antibody Correct answer.
  4. Rheumatoid factor

Explanation

The features describe Graves disease, in which thyroid stimulating hormone receptor antibodies stimulate the gland and cause hyperthyroidism. These antibodies are the most specific marker, whereas peroxidase antibodies occur in several thyroid conditions.

Question 12Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 60-year-old smoker has painless visible haematuria. What is the most appropriate initial investigation?

  1. Renal ultrasound alone
  2. Cystoscopy with upper urinary tract imaging Correct answer.
  3. Urine culture alone
  4. Serum prostate specific antigen

Explanation

Painless visible haematuria in an older smoker raises concern for urothelial malignancy and requires direct visualisation of the bladder plus imaging of the upper tracts. Cystoscopy detects bladder tumours that imaging alone may miss.

Question 13Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

Which finding on arterial blood gas indicates a primary metabolic acidosis with appropriate respiratory compensation?

  1. Normal bicarbonate with a normal arterial carbon dioxide
  2. Low bicarbonate with a compensatory fall in arterial carbon dioxide Correct answer.
  3. Raised bicarbonate with a raised arterial carbon dioxide
  4. Low bicarbonate with a raised arterial carbon dioxide

Explanation

In metabolic acidosis the low bicarbonate is offset by hyperventilation, which lowers arterial carbon dioxide. A rising carbon dioxide instead suggests a coexisting respiratory acidosis or inadequate compensation.

Question 14Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 28-year-old woman at 38 weeks has a generalised tonic-clonic seizure and a blood pressure of 170/110 mmHg. What is the first-line drug for seizure control?

  1. Phenytoin
  2. Diazepam
  3. Labetalol
  4. Magnesium sulfate Correct answer.

Explanation

The presentation is eclampsia, and magnesium sulfate is the first-line treatment for both control and prevention of eclamptic seizures. It acts as a central nervous system depressant and vasodilator and is more effective than phenytoin or diazepam here.

Question 15Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 2-year-old child has a temperature of 39.5 degrees Celsius, irritability and a bulging fontanelle. Lumbar puncture shows a raised neutrophil count with low glucose. What is the most likely organism?

  1. Haemophilus influenzae type b
  2. Neisseria meningitidis
  3. Streptococcus pneumoniae Correct answer.
  4. Listeria monocytogenes

Explanation

Bacterial meningitis in a young child shows neutrophilic pleocytosis with low cerebrospinal fluid glucose, and Streptococcus pneumoniae is a leading cause beyond the neonatal period. Neisseria meningitidis is also common but often presents with a purpuric rash.

Question 16Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

Which electrocardiographic change is most characteristic of hyperkalaemia?

  1. Prominent U waves
  2. Delta waves
  3. Prolonged QT interval
  4. Tall peaked T waves Correct answer.

Explanation

Hyperkalaemia initially produces tall, narrow-based peaked T waves and later widens the QRS complex. These changes reflect altered myocardial repolarisation and can progress to ventricular arrhythmia.

Question 17Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 35-year-old woman has recurrent epistaxis and mucocutaneous telangiectasia, and her father had similar problems. Which diagnosis is most likely?

  1. Hereditary haemorrhagic telangiectasia Correct answer.
  2. Immune thrombocytopenia
  3. Von Willebrand disease
  4. Haemophilia A

Explanation

The combination of recurrent epistaxis, mucocutaneous telangiectasia and an autosomal dominant family history points to hereditary haemorrhagic telangiectasia. The disorder results from abnormal vascular development rather than a clotting factor defect.

Question 18Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

Which drug is the first-line treatment for a patient with newly diagnosed type 2 diabetes and no contraindications?

  1. Glibenclamide
  2. Pioglitazone
  3. Insulin glargine
  4. Metformin Correct answer.

Explanation

Metformin is recommended as initial pharmacotherapy in type 2 diabetes because it lowers glucose effectively, is weight-neutral and has a low risk of hypoglycaemia. It also reduces cardiovascular events in overweight patients.

Question 19Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 55-year-old man has sudden severe epigastric pain radiating to the back with vomiting and a raised serum lipase. What is the most appropriate initial fluid strategy?

  1. Moderate crystalloid resuscitation guided by urine output and vital signs Correct answer.
  2. Hypertonic saline infusion
  3. Rapid large-volume fluid loading to achieve a fixed high urine output
  4. Fluid restriction until the pain settles

Explanation

Acute pancreatitis requires moderate goal-directed crystalloid resuscitation, monitored by urine output and haemodynamic response. Aggressive fixed-volume loading has been associated with worse respiratory outcomes, so fluid is titrated rather than given to a fixed target.

Question 20Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

Which clinical feature most strongly suggests a diagnosis of acute appendicitis rather than gastroenteritis?

  1. Generalised abdominal cramps
  2. Migration of pain from the periumbilical region to the right iliac fossa Correct answer.
  3. Vomiting before any abdominal pain
  4. Watery diarrhoea

Explanation

Appendiceal inflammation classically begins with vague periumbilical pain that localises to the right iliac fossa as the parietal peritoneum becomes involved. Gastroenteritis instead produces diffuse cramps and diarrhoea without this pattern of migration.

Question 21Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 65-year-old woman has a high calcium, low phosphate and raised parathyroid hormone level. Which diagnosis fits best?

  1. Hypoparathyroidism
  2. Primary hyperparathyroidism Correct answer.
  3. Malignancy-associated hypercalcaemia
  4. Vitamin D deficiency

Explanation

Primary hyperparathyroidism causes hypercalcaemia with inappropriately raised parathyroid hormone and low phosphate because parathyroid hormone increases renal phosphate excretion. Malignancy usually suppresses parathyroid hormone, and vitamin D deficiency lowers calcium.

Question 22Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A newborn develops jaundice within the first 24 hours of life. Which condition must be excluded first?

  1. Haemolytic disease of the newborn Correct answer.
  2. Breastfeeding jaundice
  3. Physiological jaundice
  4. Gilbert syndrome

Explanation

Jaundice appearing within the first 24 hours is always pathological and most often reflects haemolysis, such as rhesus or ABO incompatibility. Rapid haemolysis risks kernicterus, so blood groups and a direct antiglobulin test are urgent.

Question 23Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 30-year-old woman has a deep vein thrombosis and a history of recurrent miscarriage. Which acquired risk factor should be tested for?

  1. Antithrombin deficiency
  2. Factor V Leiden mutation
  3. Antiphospholipid antibodies Correct answer.
  4. Protein C deficiency

Explanation

Recurrent pregnancy loss combined with venous thrombosis suggests antiphospholipid syndrome, an acquired thrombophilia diagnosed by persistently positive antiphospholipid antibodies. The inherited thrombophilias do not explain recurrent miscarriage as strongly.

Question 24Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 70-year-old man has painless jaundice and a palpable non-tender gallbladder. What is the most likely diagnosis?

  1. Gallstone impaction in the cystic duct
  2. Acute cholangitis
  3. Acute cholecystitis
  4. Pancreatic head carcinoma Correct answer.

Explanation

A palpable, non-tender gallbladder with painless obstructive jaundice is Courvoisier law and suggests malignant obstruction, most often carcinoma of the pancreatic head. The gradual obstruction allows the gallbladder to distend without inflammation.

Question 25Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A woman at 32 weeks has a blood pressure of 150/95 mmHg and 2+ proteinuria on two occasions four hours apart. What is the diagnosis?

  1. White coat hypertension
  2. Chronic hypertension
  3. Pre-eclampsia Correct answer.
  4. Gestational hypertension

Explanation

New hypertension after 20 weeks of gestation together with significant proteinuria defines pre-eclampsia. Gestational hypertension requires raised blood pressure without proteinuria or other organ involvement.

Question 26Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

Which finding on urinalysis most strongly suggests nephrotic rather than nephritic syndrome?

  1. Heavy proteinuria with hypoalbuminaemia Correct answer.
  2. Haematuria with red cell casts
  3. Raised serum creatinine with fluid overload
  4. Hypertension with oliguria

Explanation

Nephrotic syndrome is defined by proteinuria above 3.5 g per day with low serum albumin, oedema and hyperlipidaemia, and the sediment is often bland. Nephritic syndrome instead features haematuria, red cell casts, hypertension and variable renal impairment. The distinction guides both prognosis and the need for biopsy.

Question 27Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 3-year-old child has a barking cough, hoarse voice and inspiratory stridor that worsens at night. What is the most likely diagnosis?

  1. Epiglottitis
  2. Foreign body aspiration
  3. Bronchiolitis
  4. Croup Correct answer.

Explanation

Croup, or acute laryngotracheobronchitis, classically affects children aged six months to three years with a barking cough, hoarseness and inspiratory stridor that is worse at night. It is usually viral and responds to a single dose of dexamethasone. Sudden onset in a well child without fever suggests an inhaled foreign body instead.

Question 28Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

Which is the most effective single method of preventing transmission of bloodborne pathogens during surgery?

  1. Double gloving with sterile technique Correct answer.
  2. Changing gowns between cases
  3. Using antiseptic hand rub before gloves
  4. Wearing a face shield alone

Explanation

Double gloving reduces perforation-related exposure and, combined with sterile technique, gives the strongest barrier against bloodborne transmission in the operating theatre. Face protection and hand hygiene are adjuncts but do not replace an intact glove barrier. Glove perforation is common and often unnoticed.

Question 29Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

Which hormone is primarily responsible for maintaining the corpus luteum in early pregnancy?

  1. Oestradiol
  2. Human chorionic gonadotrophin Correct answer.
  3. Follicle-stimulating hormone
  4. Progesterone

Explanation

Human chorionic gonadotrophin from the syncytiotrophoblast rescues the corpus luteum, which then secretes progesterone to sustain the pregnancy until the placenta takes over. Progesterone is the effector hormone but is produced in response to hCG. Falling hCG is the basis of early pregnancy loss.

Question 30Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

Which clinical feature is most characteristic of a simple febrile seizure in a child aged 18 months?

  1. Focal jerking of one arm
  2. Generalised tonic-clonic activity lasting under 15 minutes Correct answer.
  3. Post-ictal hemiparesis
  4. Seizure lasting 40 minutes

Explanation

Simple febrile seizures are generalised, last less than 15 minutes and occur once in 24 hours in a child aged six months to five years with fever but no intracranial infection. Focal features, prolonged duration or focal post-ictal deficit define complex febrile seizures and warrant further evaluation. Most simple febrile seizures need no long-term treatment.

Question 31Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 40-year-old man has a blood pressure of 158/98 mmHg on three separate visits. What is the most appropriate initial management?

  1. Immediate intravenous labetalol
  2. No treatment with review in one year
  3. High-dose loop diuretic alone
  4. Lifestyle modification plus a thiazide-type diuretic Correct answer.

Explanation

Confirmed stage 2 hypertension in a low-risk adult is managed with lifestyle measures plus a single first-line agent such as a thiazide, ACE inhibitor, ARB or calcium channel blocker. Intravenous therapy is reserved for hypertensive emergencies with target-organ damage. Repeat assessment and monitoring of response follow.

Question 32Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

Which is the most common cause of acute surgical abdomen requiring laparotomy in a 70-year-old with atrial fibrillation?

  1. Perforated peptic ulcer
  2. Acute cholecystitis
  3. Acute appendicitis
  4. Acute mesenteric ischaemia from embolic occlusion Correct answer.

Explanation

Atrial fibrillation predisposes to embolic occlusion of the superior mesenteric artery, producing pain out of proportion to examination findings. Early recognition matters because bowel infarction develops quickly. Appendicitis and biliary disease are common but not specifically linked to atrial fibrillation.

Question 33Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 62-year-old man has progressive exertional dyspnoea, orthopnoea and bilateral basal crackles, and echocardiography shows an ejection fraction of 30 percent. Which drug class improves survival in this condition?

  1. Angiotensin-converting enzyme inhibitors Correct answer.
  2. Dihydropyridine calcium channel blockers
  3. Digoxin
  4. Frusemide alone

Explanation

ACE inhibitors reduce mortality and hospitalisation in heart failure with reduced ejection fraction and are a cornerstone of therapy alongside beta-blockers and mineralocorticoid antagonists. Diuretics relieve congestion but do not improve survival. Digoxin reduces hospitalisation without a mortality benefit.

Question 34Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 55-year-old woman has proximal muscle weakness, a raised creatine kinase and a heliotrope rash over the eyelids. Which investigation is most useful to confirm the diagnosis?

  1. Nerve conduction studies
  2. Thyroid function tests
  3. Serum calcium measurement
  4. Muscle biopsy with autoantibody testing Correct answer.

Explanation

The combination of proximal weakness, raised muscle enzymes and a heliotrope rash suggests dermatomyositis. Muscle biopsy and myositis-specific autoantibodies such as anti-Jo-1 or anti-Mi-2 support the diagnosis and help exclude mimics. Adults also need screening for underlying malignancy.

Question 35Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 24-year-old woman has a 6 cm simple ovarian cyst with no solid components. What is the most appropriate management?

  1. Observation with repeat ultrasound Correct answer.
  2. Diagnostic laparotomy
  3. Immediate bilateral oophorectomy
  4. Chemotherapy

Explanation

Simple cysts under 7 cm in premenopausal women are almost always functional and usually resolve within a few cycles, so observation with repeat imaging is appropriate. Surgical removal is reserved for persistent, symptomatic or complex lesions. Premenopausal status and absence of solid components or ascites make malignancy unlikely.

Question 36Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 48-year-old man has a 12 mm ulcerated skin lesion on the back with a Breslow thickness of 2.5 mm. Which factor most strongly predicts survival?

  1. Patient occupation
  2. Family history of eczema
  3. Lesion colour
  4. Breslow thickness Correct answer.

Explanation

Breslow thickness, together with ulceration and mitotic rate, is the strongest prognostic determinant in cutaneous melanoma and guides sentinel node biopsy. Thicker lesions carry a higher risk of metastasis. Colour and occupation are not validated prognostic factors.

Question 37Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 30-year-old woman at 34 weeks has a fundal height of 28 cm and a small-for-dates fetus on ultrasound. Which condition is most important to exclude?

  1. Gestational diabetes
  2. Polyhydramnios
  3. Multiple pregnancy
  4. Fetal growth restriction from placental insufficiency Correct answer.

Explanation

A fundal height lagging dates with a small fetus suggests fetal growth restriction, most often from uteroplacental insufficiency. Umbilical artery Doppler and serial growth scans guide timing of delivery. Polyhydramnios and multiple pregnancy would usually produce a larger, not smaller, uterus.

Question 38Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 70-year-old woman has severe hip pain after a fall and her leg is shortened and externally rotated. What is the most likely diagnosis?

  1. Fractured neck of femur Correct answer.
  2. Fractured patella
  3. Posterior hip dislocation
  4. Torn medial meniscus

Explanation

A displaced femoral neck fracture classically presents with a shortened, externally rotated limb after a low-energy fall in an elderly patient. Posterior dislocation instead produces shortening with internal rotation and adduction. Early surgery reduces mortality and complications.

Question 39Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 35-year-old man has a raised serum creatinine, a low urine sodium and a fractional excretion of sodium below 1 percent. Which cause of acute kidney injury fits best?

  1. Pre-renal hypoperfusion Correct answer.
  2. Acute interstitial nephritis
  3. Acute tubular necrosis
  4. Obstructive uropathy

Explanation

A low fractional excretion of sodium with concentrated urine indicates avid tubular sodium reabsorption, which is typical of pre-renal hypoperfusion. Acute tubular necrosis usually gives a fractional excretion above 2 percent with muddy brown casts. Fluid challenge and correction of the cause are the immediate steps.

Question 40Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 58-year-old man has haematemesis and melaena after several days of NSAID use. Which is the most appropriate first step in management?

  1. Immediate oral iron therapy
  2. Discharge with antacids
  3. Elective endoscopy in six weeks
  4. Resuscitation with intravenous fluids and urgent endoscopy Correct answer.

Explanation

Acute upper gastrointestinal bleeding requires airway and circulatory assessment, large-bore intravenous access and cross-matched blood before urgent endoscopy within 24 hours. Endoscopy allows identification and haemostatic treatment of the bleeding lesion. Oral iron treats anaemia later but does not address active bleeding.

Question 41Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 4-year-old child has periorbital oedema, frothy urine and a serum albumin of 22 g/L with heavy proteinuria. Which complication should be anticipated?

  1. Hyperkalaemia from tubular acidosis
  2. Pulmonary fibrosis
  3. Thrombosis from urinary loss of antithrombin III Correct answer.
  4. Hepatic encephalopathy

Explanation

Nephrotic syndrome causes urinary loss of anticoagulant proteins such as antithrombin III together with haemoconcentration, producing a hypercoagulable state, especially in children with minimal change disease. Infection from lost immunoglobulins is another major risk. Both complications require monitoring during relapses.

Question 42Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 28-year-old woman has irregular menses, hirsutism and a raised luteinising to follicle-stimulating hormone ratio with polycystic ovaries on ultrasound. Which metabolic abnormality is most commonly associated?

  1. Diabetes insipidus
  2. Insulin resistance Correct answer.
  3. Adrenal insufficiency
  4. Hyperthyroidism

Explanation

Polycystic ovary syndrome is strongly associated with insulin resistance, which drives hyperinsulinaemia, raised ovarian androgen production and an increased risk of type 2 diabetes. Weight reduction and metformin are used in selected patients. Screening with an oral glucose tolerance test is recommended.

Question 43Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 65-year-old man has sudden painless loss of vision in one eye described as a curtain descending, lasting 10 minutes before resolving. What is the most appropriate next step?

  1. Reassurance and routine review in six months
  2. Urgent assessment for carotid and cardiac embolic source Correct answer.
  3. Immediate laser photocoagulation
  4. Topical steroid eye drops

Explanation

Transient monocular visual loss is amaurosis fugax, a form of transient ischaemic attack carrying a high early stroke risk. Urgent carotid imaging and cardiac assessment allow timely endarterectomy or anticoagulation. Symptoms resolve but the risk of permanent stroke remains high in the following days.

Question 44Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 50-year-old woman has a thyroid nodule, and fine needle aspiration shows a follicular lesion. Which investigation is required to distinguish a follicular adenoma from carcinoma?

  1. Serum thyroglobulin
  2. Histological examination after surgical excision Correct answer.
  3. Repeat fine needle aspiration
  4. Radioiodine uptake scan

Explanation

Follicular adenoma and follicular carcinoma cannot be distinguished cytologically because the defining feature of malignancy is capsular or vascular invasion, which requires examination of the whole lesion. Diagnostic lobectomy therefore provides the answer. Repeat cytology or biochemistry cannot demonstrate invasion.

Question 45Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 72-year-old man has a distended painless abdomen, a fluid thrill and a serum-ascites albumin gradient of 1.5 g/dL. What is the most likely cause?

  1. Peritoneal carcinomatosis
  2. Tuberculous peritonitis
  3. Pancreatic ascites
  4. Portal hypertension from cirrhosis Correct answer.

Explanation

A serum-ascites albumin gradient of 1.1 g/dL or more indicates portal hypertension, most often from cirrhosis. Low-gradient ascites instead suggests peritoneal malignancy, tuberculosis or pancreatic disease. Diagnostic paracentesis with cell count and culture should accompany the gradient.

Question 46Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 60-year-old woman with type 2 diabetes has a serum creatinine that has doubled over three days after starting an ACE inhibitor and a diuretic. What is the most appropriate immediate action?

  1. Double the ACE inhibitor dose
  2. Reassure and repeat testing in one month
  3. Add a second diuretic
  4. Stop the ACE inhibitor and diuretic and assess volume status Correct answer.

Explanation

A rapid doubling of creatinine after starting an ACE inhibitor with a diuretic usually reflects volume depletion or reduced renal perfusion, and the precipitating drugs should be withheld while volume status and renal function are reassessed. The combination can also cause hyperkalaemia. Renovascular disease should be considered if the rise persists.

Question 47Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 32-year-old woman at 36 weeks has sudden painless vaginal bleeding with a soft uterus and a fundal height greater than dates. What is the most appropriate initial management step?

  1. Stabilise the mother and arrange urgent ultrasound before any vaginal examination Correct answer.
  2. Perform a digital vaginal examination to assess dilatation
  3. Give oxytocin to induce labour
  4. Discharge home with repeat review in one week

Explanation

Painless bleeding with a high fundal height suggests placenta praevia, and digital vaginal examination can provoke catastrophic haemorrhage. Management is maternal resuscitation, ultrasound localisation of the placenta and caesarean delivery when indicated. Placental abruption instead presents with a painful, tense uterus.

Question 48Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 45-year-old man has a pH of 7.25, a bicarbonate of 10 mmol/L, a sodium of 140 mmol/L and a chloride of 115 mmol/L with normal anion gap. Which cause of metabolic acidosis fits best?

  1. Lactic acidosis
  2. Diabetic ketoacidosis
  3. Methanol ingestion
  4. Severe diarrhoea Correct answer.

Explanation

A normal anion gap hyperchloraemic acidosis with gastrointestinal bicarbonate loss points to diarrhoea or renal tubular acidosis. Ketoacidosis, lactic acidosis and methanol poisoning all raise the anion gap through accumulation of unmeasured acids. Urine anion gap helps distinguish renal from gastrointestinal causes.

Question 49Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 25-year-old woman has a blood pressure of 190/120 mmHg with headache, visual disturbance and a platelet count of 80 x 10^9/L at 30 weeks of gestation. Which management is most appropriate?

  1. Oral methyldopa alone with outpatient review
  2. Fluid restriction and bed rest
  3. Expectant management until 40 weeks
  4. Intravenous antihypertensives, magnesium sulphate and urgent delivery planning Correct answer.

Explanation

Severe hypertension with thrombocytopenia and neurological symptoms indicates severe pre-eclampsia with features of haemolysis, elevated liver enzymes and low platelets. Treatment requires controlled blood pressure reduction, magnesium sulphate for seizure prophylaxis and planned delivery, usually by caesarean section, after maternal stabilisation. Delivery is the definitive treatment.

Question 50Basic and clinical medical sciences (internal medicine, surgery, pediatrics, obstetrics and gynecology)

A 68-year-old man develops fever, hypotension and abdominal pain five days after emergency laparotomy. Which source should be investigated first?

  1. Anastomotic leak with intra-abdominal sepsis Correct answer.
  2. Urinary tract infection
  3. Acute myocardial infarction
  4. Deep vein thrombosis

Explanation

Fever with hypotension in the early postoperative period after bowel surgery most often reflects an anastomotic leak or intra-abdominal collection. Prompt CT imaging, resuscitation and usually reoperation are required. Sepsis from an abdominal source carries high mortality if treatment is delayed.