PG Dreamer

A 74-year-old woman is admitted to the emergency department following a brief syncopal episode. Her ECG shows a regular bradycardia at 36 beats per minute. There is a complete lack of correlation between the P waves and the QRS complexes; the P-P intervals are regular and the R-R intervals are regular. What is the most appropriate definitive management for this patient?

A) Intravenous Atropine 500 mcg

B) Intravenous Amiodarone infusion

C) Permanent pacemaker insertion

D) Urgent DC cardioversion

E) Oral Beta-blocker therapy

A 30-year-old male traveler returns from sub-Saharan Africa with a high-grade fever, chills, and altered mental status. A thick and thin blood film confirms Plasmodium falciparum malaria with a parasitemia level of 6%. According to guidelines, what constitutes the preferred first-line management for this patient?

A) Oral Chloroquine phosphate

B) Oral Artemether-lumefantrine

C) Intravenous Artesunate

D) Oral Quinine sulfate

E) Intravenous Quinidine gluconate

A 22-year-old woman is brought to the clinic 6 hours after ingesting a large, toxic quantity of paracetamol. She is currently asymptomatic except for mild nausea. What is the primary mechanism of hepatotoxicity in paracetamol overdose?

A) Direct destruction of hepatic cells by unchanged paracetamol

B) Depletion of glutathione reserves leading to accumulation of NAPQI

C) Severe metabolic acidosis causing tissue necrosis

D) Massive immune-mediated hypersensitivity reaction

E) Inhibition of the electron transport chain in hepatic mitochondria

A 45-year-old chronic alcoholic man is admitted with severe malnutrition and neglect. Intravenous dextrose and saline are commenced. The ward team is closely monitoring him for refeeding syndrome. Which of the following biochemical abnormalities is considered the hallmark and most critical diagnostic feature of refeeding syndrome?

A) Hyperkalemia

B) Hypokalemia

C) Hypophosphatemia

D) Hypocalcemia

E) Hypermagnesemia

A 48-year-old man with a history of treated pulmonary tuberculosis presents with progressive abdominal distension, ankle swelling, and exertional breathlessness. On examination, his jugular venous pressure is elevated and paradoxically rises during inspiration . A sharp, high-pitched sound is heard early in diastole just after the second heart sound. What is the most likely diagnosis?

A) Dilated Cardiomyopathy

B) Constrictive Pericarditis

C) Restrictive Cardiomyopathy

D) Cardiac Tamponade

E) Tricuspid Stenosis

A 22-year-old male presents with macroscopic hematuria that began 24 hours after developing a sore throat and fever. He reports no dysuria or frequency. His blood pressure is 135/85 mmHg, and his serum creatinine is normal. Urinalysis confirms hematuria and 1+ proteinuria. What is the most likely diagnosis?

A) Post-streptococcal glomerulonephritis (PSGN)

B) IgA Nephropathy (Berger's Disease)

C) Acute pyelonephritis

D) Granulomatosis with polyangiitis

E) Minimal change disease

A 68-year-old male presents with a 1-year history of progressive exertional dyspnea and a dry cough. On examination, he has bilateral, fine, end-inspiratory crackles at both lung bases and marked digital clubbing. What is the most likely diagnosis?

A) Bronchial Asthma

B) Idiopathic Pulmonary Fibrosis (IPF)

C) Hypersensitivity Pneumonitis

D) Sarcoidosis

E) Bronchiectasis

A 58-year-old male presents with generalized, severe pruritus that is characteristically worsened after a hot bath. On examination, he is noted to have a plethoric face and palpable splenomegaly. A complete blood count reveals a hemoglobin of 19.5 g/dL, hematocrit of 61%, and elevated white cells and platelets. Which mutation is identified in over 95% of patients with this condition?

A) BCR-ABL fusion gene

B) JAK2 V617F mutation

C) BRAF V600E mutation

D) PML-RARA translocation

E) FLT3 mutation

A 24-year-old male is brought to the emergency room actively experiencing a generalized tonic-clonic seizure. His family states the seizure started 10 minutes ago in the car. Intravenous access is secured immediately. What is the initial drug treatment of choice to terminate the seizure?

A) Intravenous Phenytoin load

B) Intravenous Lorazepam

C) Intravenous Sodium Valproate

D) Intramuscular Phenobarbital

E) Continuous Propofol infusion

A 44-year-old woman undergoes transsphenoidal surgery for a non-functioning pituitary macroadenoma. Twenty-four hours post-operatively, she begins producing large volumes of dilute urine (5 liters/day) and complains of intense thirst. Her serum sodium is 149 mmol/L and urine osmolality is 120 mOsm/kg. What is the management of choice?

A) Intravenous infusion of 0.9% normal saline

B) Oral administration of Desmopressin (DDAVP)

C) Intravenous administration of loop diuretics (Furosemide)

D) Rigid fluid restriction to 1 liter/day

E) Administration of Thiazide diuretics