Healthcare Licensing Centralized Examination (Armenia)

A 58-year-old man with hypertension and hyperlipidemia presents with 90 minutes of severe crushing retrosternal chest pain radiating to his left shoulder and jaw, accompanied by diaphoresis. An immediate 12-lead ECG demonstrates 3 mm ST-segment elevation in leads V1 through V4. The nearest percutaneous coronary intervention (PCI)-capable medical center is 25 minutes away. What is the most appropriate reperfusion strategy?

• AAdminister intravenous unfractionated heparin and monitor cardiac troponins without reper…
• BTransfer immediately for primary percutaneous coronary intervention within the recommende…
• CAdminister fibrinolytic therapy and defer angiography for 48 hours despite timely PCI acc…
• DPerform computed tomography coronary angiography before antiplatelet therapy

A 52-year-old man has a blood pressure of 210/120 mmHg and a mild tension-type headache but no visual disturbance, chest pain, dyspnea, focal neurologic deficit, papilledema, acute kidney injury, or troponin elevation. What is the most appropriate management approach?

• AUse intravenous nitroprusside to lower mean arterial pressure by 50% within 1 hour
• BStart or adjust oral antihypertensive therapy and arrange prompt outpatient reassessment
• CGive intravenous labetalol and obtain an emergency contrast head CT despite no neurologic…
• DAdminister immediate-release sublingual nifedipine to normalize the pressure rapidly

A 24-year-old woman with persistent asthma presents with acute dyspnea and expiratory wheezing. She has used her salbutamol inhaler four times in the past 2 hours with little relief. Respiratory rate is 26/min, bilateral wheezing is present, and peak expiratory flow is 55% of predicted. What is the immediate first-line management?

• ASubcutaneous epinephrine and immediate endotracheal intubation
• BRepeated inhaled short-acting beta-2 agonist through a spacer or nebulizer plus early sys…
• CIntravenous magnesium sulfate as monotherapy without an inhaled bronchodilator
• DOral montelukast and chest physiotherapy

A 19-year-old woman with type 1 diabetes has abdominal pain, vomiting, and Kussmaul respirations. Blood glucose is 420 mg/dL, arterial pH 7.18, bicarbonate 10 mEq/L, anion gap 24 mEq/L, beta-hydroxybutyrate is positive, and serum potassium is 4.8 mEq/L. Which treatment plan addresses the three central components of diabetic ketoacidosis management?

• ARoutine bicarbonate bolus, subcutaneous basal insulin alone, and oral potassium
• BIsotonic intravenous fluid, continuous intravenous regular insulin, and monitored potassi…
• CInitial dextrose bolus, high-dose furosemide, and empiric antibiotics
• DFluid restriction, subcutaneous regular insulin, and a cephalosporin

A trauma patient has no uncontrolled catastrophic external hemorrhage. In what order should the structured primary survey proceed while immediately treating life-threatening findings?

• ACirculation, Airway, Breathing, Disability, Exposure
• BAirway with cervical-spine protection, Breathing, Circulation with hemorrhage control, Di…
• CBreathing, Airway, Circulation, Exposure, Disability
• DDisability, Circulation, Breathing, Airway, Exposure

A 25-year-old man with a stab wound to the right chest is severely dyspneic and hypotensive. The right hemithorax has absent breath sounds and hyperresonance, with distended neck veins and leftward tracheal deviation. What is the immediate intervention?

• ATransfer for chest CT before treatment
• BBegin high-pressure positive-pressure ventilation before pleural decompression
• CImmediate right pleural decompression, followed by tube thoracostomy
• DPerform subxiphoid pericardiocentesis

A trauma patient with active hemorrhage remains hypotensive despite initial resuscitation, and the hospital activates a ratio-based massive transfusion protocol. Which option represents a commonly used balanced blood-component strategy while definitive hemorrhage control proceeds?

• AFour units of red blood cells to one unit of plasma with no platelets
• BTen units of red blood cells to one unit each of plasma and platelets plus large-volume s…
• CApproximately 1 unit of red blood cells to 1 unit of plasma to 1 adult dose of platelets,…
• DRed blood cells alone until hemoglobin reaches 12 g/dL

A full-term newborn remains apneic after warming, drying, positioning, and stimulation. The heart rate is 70/min. According to current neonatal resuscitation guidance, what is the immediate next step?

• AStart chest compressions immediately at a 3:1 ratio
• BGive intravenous epinephrine through an umbilical venous catheter
• CBegin effective positive-pressure ventilation with room air and apply pulse oximetry
• DAdminister endotracheal sodium bicarbonate

A previously healthy 20-month-old child has one generalized tonic-clonic seizure lasting 3 minutes during a fever of 39.4°C. The child is now alert and playful with a normal neurologic examination and no meningeal signs. What is the most appropriate management?

• ADiagnose epilepsy and prescribe daily phenobarbital or valproate for 2 years
• BTreat as bacterial meningitis with 14 days of empiric intravenous antibiotics without fur…
• CDiagnose a simple febrile seizure, evaluate and treat the fever source, reassure the fami…
• DObtain emergency brain MRI and continuous EEG in every case

A patient at 36 weeks of pregnancy has preeclampsia with blood pressure 175/115 mmHg, severe headache, right-upper-quadrant pain, elevated transaminases, and platelets of 85,000/mcL. Which immediate pharmacologic plan addresses seizure prevention and acute severe hypertension?

• AIntravenous diazepam plus a bitten sublingual nifedipine capsule
• BOral furosemide plus intramuscular phenytoin
• CIntravenous magnesium sulfate plus a rapid-acting agent such as intravenous labetalol or…
• DIntravenous sodium nitroprusside plus subcutaneous heparin

Which combination describes high-quality adult chest compressions during cardiopulmonary resuscitation?

• ARate 60/min, depth 2 cm, and continuous positive-pressure ventilation
• BRate 160/min, depth 8 cm, and prolonged pauses for rhythm analysis
• CCompressions only when a spontaneous femoral pulse is felt
• DRate 100 to 120/min, depth at least 5 cm while avoiding depths over 6 cm, full recoil, an…

A 62-year-old man collapses and is pulseless. Monitor pads show coarse ventricular fibrillation. What is the correct initial adult cardiac-arrest sequence?

• AGive atropine and perform synchronized cardioversion at 50 J
• BComplete endotracheal intubation before the first shock
• CGive calcium and sodium bicarbonate before rhythm treatment
• DDefibrillate immediately, resume CPR for 2 minutes, obtain vascular access, give epinephr…

During pulseless electrical activity, which list contains the reversible causes that should be sought while high-quality CPR and epinephrine continue?

• AHypertension, hyperglycemia, hypercalcemia; trauma, tachycardia, and tremor
• BHyperthyroidism and hypernatremia; tetanus, typhoid, and tuberculosis
• CHypercholesterolemia; tinnitus, tonsillitis, and toxoplasmosis
• DHypovolemia, hypoxia, hydrogen-ion excess, hypo- or hyperkalemia, hypothermia; tension pn…

A 70-year-old man with suspected urosepsis is confused, febrile, and hypotensive at 78/44 mmHg with lactate 4.5 mmol/L. Which initial management bundle is most appropriate?

• AGive oral ciprofloxacin and observe for 4 hours before reassessment
• BInfuse concentrated dextrose and use dopamine as the routine first-line vasopressor
• CWithhold fluid and use dobutamine alone
• DObtain cultures without delaying treatment, give prompt broad-spectrum intravenous antimi…

Minutes after receiving penicillin, an adult develops wheeze, generalized urticaria, and a blood pressure of 72/40 mmHg. What is the priority medication and route?

• AIntramuscular epinephrine into the mid-anterolateral thigh
• BIntravenous diphenhydramine as the only initial treatment
• CNebulized salbutamol without epinephrine
• DSubcutaneous hydrocortisone

A family exposed to a faulty indoor heater has headache, dizziness, nausea, and confusion. One adult has a carboxyhemoglobin level of 28%. What is the most appropriate immediate treatment?

• ARemove them from exposure and administer 100% oxygen while assessing for hyperbaric-oxyge…
• BWait for repeat carboxyhemoglobin testing before giving oxygen
• CAdminister intravenous sodium bicarbonate as the antidote
• DGive supplemental oxygen only if pulse oximetry is below 90%

A 60-kg adult reports taking 15 g of acetaminophen 4 hours ago. The measured concentration plots above the treatment line on the Rumack-Matthew nomogram. What treatment is indicated?

• AStart N-acetylcysteine promptly
• BGive activated charcoal alone and discharge the patient
• CAdminister flumazenil
• DWithhold treatment unless aminotransferases are already elevated

An unresponsive patient has pinpoint pupils and a respiratory rate of 4/min after suspected opioid use. After opening the airway and supporting ventilation, which antidote should be administered?

• ANaloxone
• BAtropine
• CFomepizole
• DN-acetylcysteine

A farm worker exposed to an organophosphate insecticide has salivation, lacrimation, diarrhea, bronchial secretions, miosis, and muscle fasciculations. Which antidotal regimen is appropriate?

• AAtropine plus pralidoxime
• BNaloxone plus flumazenil
• CMethylene blue plus hydroxocobalamin
• DN-acetylcysteine plus fomepizole

During START triage after a mass-casualty incident, an adult cannot walk. After the airway is opened, the respiratory rate is 34/min. Which triage category is appropriate?

• AImmediate (red)
• BDelayed (yellow)
• CMinor (green)
• DDeceased/expectant (black)

A physician diagnoses a communicable disease that Armenian law designates for mandatory notification because it endangers the population. What does the healthcare-worker ethics code require?

• AImmediately notify the competent authorities and cooperate with them
• BWait for the patient's permission before any notification
• CInform the media so that the public can identify the patient
• DTake no action unless another member of the public has already become ill

A competent patient declines a nonurgent treatment because it conflicts with a sincerely held religious belief. The physician thinks the belief is unwise. Which response best follows Armenia's healthcare-worker ethics code?

• ARidicule the belief so the patient understands that medicine takes priority
• BRespect the patient's dignity and belief, avoid imposing personal values, and discuss med…
• CEnd the clinical relationship immediately without arranging continuity of care
• DTell the patient's employer in order to create pressure to accept treatment

An unconscious patient needs emergency treatment and cannot consent to disclosure. No legal representative or designated contact can be reached. Which disclosure of medical-secret information is permitted under Armenia's medical-care law?

• ASending the diagnosis to the patient's employer out of courtesy
• BPosting clinical details online after removing only the patient's first name
• CSharing information necessary for the patient's care with the healthcare workers providin…
• DDiscussing the case with a curious neighbor who promises confidentiality

A competent adult is considering a planned medical intervention. Which consent process accurately reflects Armenia's medical-care law?

• AObtain consent without explaining the diagnosis, purpose, risks, or alternatives
• BAsk a family member to decide even though the patient can decide personally
• CTreat silence as consent whenever the intervention is invasive
• DGive the required information and obtain the patient's consent; use written consent when…

A clinician is offered an unproven high-risk procedure outside the clinician's qualification when a supported, lower-risk option is available. Which course best follows Armenia's healthcare-worker ethics code?

• APerform it because novelty alone proves clinical benefit
• BUse evidence-based practice, choose proportionate and professionally necessary care, and…
• CProceed if the patient signs a form waiving every professional duty
• DUse whichever option produces the highest fee

A physician advertises by publicly disparaging a colleague's competence in order to draw the colleague's patients to the physician's own clinic. How does Armenia's healthcare-worker ethics code treat this conduct?

• AIt is required whenever two clinics compete
• BIt is acceptable if the physician expects a financial benefit
• CIt is prohibited; healthcare workers must respect colleagues and may not discredit anothe…
• DIt is acceptable whenever the statement is posted outside working hours

A medical-device vendor offers a physician an expensive personal gift in exchange for influencing the hospital to buy the vendor's product. Which response is ethically appropriate?

• AAccept it if the product is already used somewhere in the hospital
• BAccept it but do not record it
• CAsk the vendor to give the same gift to the physician's family instead
• DRefuse it because gifts tied to professional duties or influence create a prohibited conf…

An unconscious adult requires an intervention that cannot be delayed, but the patient cannot express a will and no legal representative or designated contact is available. Under Armenia's medical-care law, how is the decision made?

• ANo one may authorize care until the patient regains consciousness
• BAny bystander may give binding consent
• CThe hospital administrator must decide every such clinical emergency
• DA medical consilium decides when possible; if convening one is impossible, the treating p…