Medical Registration Examination (Mauritius)

A 60-year-old man presents with 2 hours of crushing central chest pain. His ECG shows ST-segment elevation in leads II, III, and aVF, and right-sided lead V4R shows 1.5 mm ST elevation. His blood pressure is 84/56 mmHg, heart rate is 58 bpm, the jugular venous pressure is raised, and both lung fields are clear. While emergency reperfusion is being arranged, which additional step is most appropriate for his hypotension?

• ASublingual glyceryl trinitrate to relieve ischemic chest pain
• BIntravenous furosemide to reduce the raised jugular venous pressure
• CCautious intravenous fluid boluses (for example 250 mL of crystalloid) with hemodynamic m…
• DOral metoprolol to reduce myocardial oxygen demand

A 65-year-old woman with a history of ischemic cardiomyopathy presents with acute shortness of breath, orthopnea, and bilateral ankle edema. Her blood pressure is 150/90 mmHg, heart rate is 102 bpm, respiratory rate is 28 breaths/min, and oxygen saturation is 88% on room air. Auscultation reveals bilateral basal crackles extending halfway up both lung fields. Which medication is contraindicated during this acute decompensated state?

• AIntravenous furosemide
• BIntravenous nitroglycerin
• CSupplemental oxygen via face mask
• DInitiation of oral bisoprolol

A 72-year-old man with a history of hypertension and type 2 diabetes presents for a routine check-up. An ECG confirms newly discovered, asymptomatic atrial fibrillation with a ventricular rate of 115 bpm. His blood pressure is 135/82 mmHg. Echocardiography shows normal left ventricular ejection fraction (55%) and left atrial enlargement. What is the most appropriate long-term stroke prevention strategy based on his CHA2DS2-VASc score?

• ANo antithrombotic therapy required
• BDirect oral anticoagulant (DOAC) such as apixaban
• CAspirin 81 mg daily monotherapy
• DDual antiplatelet therapy with aspirin and clopidogrel

A 34-year-old man is evaluated for treatment-resistant hypertension. Despite adherence to amlodipine, ramipril, and indapamide, his blood pressure remains 165/102 mmHg. Laboratory evaluation shows serum sodium of 144 mmol/L, serum potassium of 2.9 mmol/L, and bicarbonate of 30 mmol/L. What is the most appropriate initial diagnostic screening test?

• A24-hour urinary free cortisol excretion
• BRenal artery Doppler ultrasound
• CPlasma aldosterone-to-renin ratio (ARR)
• DPlasma free metanephrines

A 22-year-old university student known to have bronchial asthma presents to the casualty department with severe dyspnea, wheezing, and inability to speak in complete sentences. Her respiratory rate is 32 breaths/min, pulse is 120 bpm, and peak expiratory flow (PEF) is 40% of her predicted value. Along with controlled supplemental oxygen, which immediate pharmacological combination represents the standard first-line management?

• AIntravenous aminophylline infusion plus inhaled fluticasone
• BSubcutaneous epinephrine injection plus oral montelukast
• CIntravenous magnesium sulfate infusion alone
• DNebulized salbutamol and ipratropium bromide plus systemic corticosteroids

A 68-year-old man presents with a 4-day history of productive cough, fever, and right-sided pleuritic chest pain. He is alert and oriented. Temperature is 38.8 °C, blood pressure 105/65 mmHg, heart rate 94 bpm, and respiratory rate 32 breaths/min. Chest radiography shows right lower lobe consolidation, and serum urea is 8.2 mmol/L. What is his CURB-65 score, and what does it indicate?

• AScore 1; low risk, usually suitable for home treatment
• BScore 2; intermediate risk, consider hospital-based care
• CScore 3; high risk, manage in hospital as severe pneumonia
• DScore 4; high risk, with his blood pressure counted as a criterion

A 64-year-old chronic smoker with severe COPD is admitted with increased dyspnea, sputum volume, and sputum purulence. On 4 L/min nasal oxygen, he becomes progressively somnolent. Arterial blood gas (ABG) shows pH 7.24, PaCO2 68 mmHg, PaO2 88 mmHg, and HCO3- 29 mmol/L. What is the most appropriate next step in managing his respiratory status?

• ATitrate oxygen to achieve SaO2 88%–92% and initiate non-invasive positive pressure ventil…
• BIncrease oxygen flow to 10 L/min via a non-rebreather mask
• CAdminister intravenous sodium bicarbonate to correct acidosis
• DPerform immediate elective tracheostomy

A 45-year-old woman presents with sudden-onset right pleuritic chest pain and dyspnea 10 days after undergoing an uncomplicated laparoscopic cholecystectomy. Her heart rate is 110 bpm, respiratory rate is 24 breaths/min, and blood pressure is 125/80 mmHg. Her right calf is warm and swollen. D-dimer is elevated at 1,800 ng/mL. What is the definitive imaging investigation of choice to confirm the suspected diagnosis?

• ATransthoracic echocardiogram
• BVentilation-perfusion (V/Q) lung scan
• CStandard portable chest radiograph
• DComputed tomography pulmonary angiography (CTPA)

A 42-year-old man undergoes upper gastrointestinal endoscopy for chronic burning epigastric pain that improves with meals. Endoscopy reveals a 1.5 cm active duodenal ulcer, and a rapid urease test is positive for Helicobacter pylori. What is the recommended first-line pharmacological regimen for eradication?

• AProton pump inhibitor monotherapy for 6 months
• BProton pump inhibitor (PPI) + amoxicillin + clarithromycin for 14 days
• CAmoxicillin and metronidazole for 5 days without acid suppression
• DOral sucralfate suspension and antacids on demand

A 52-year-old man with alcoholic liver cirrhosis presents with acute hematemesis and melena. On admission, his blood pressure is 88/55 mmHg, pulse is 118 bpm, and he appears pale and diaphoretic. While fluid resuscitation with isotonic crystalloids is initiated and blood products are cross-matched, which pharmacological agent should be administered immediately to reduce portal venous pressure?

• AOral propranolol
• BIntravenous furosemide
• CIntravenous terlipressin
• DSubcutaneous low-molecular-weight heparin

A 38-year-old woman presents to the casualty unit with severe, constant epigastric pain radiating directly through to her back, accompanied by nausea and recurrent vomiting. The pain began 6 hours after a heavy meal. Physical examination reveals marked epigastric tenderness with guarding. Which serum biochemical marker is most sensitive and specific for confirming acute pancreatitis?

• ASerum alanine aminotransferase (ALT)
• BSerum alkaline phosphatase (ALP)
• CSerum creatine kinase-MB (CK-MB)
• DSerum lipase

A 26-year-old woman is being investigated for chronic watery diarrhea, weight loss, intermittent right lower quadrant abdominal pain, and recurrent aphthous stomatitis. Colonoscopy demonstrates patchy mucosal ulceration, cobblestone appearance, and deep longitudinal fissures separated by normal-appearing mucosa (skip lesions) involving the terminal ileum and ascending colon. Histopathology reveals non-caseating granulomas. What is the most likely diagnosis?

• AUlcerative colitis
• BCrohn's disease
• CCeliac disease
• DIntestinal tuberculosis

An 80-year-old nursing home resident with severe gastroenteritis and 3 days of persistent vomiting is found to have acute kidney injury with a serum creatinine of 340 umol/L (baseline 85 umol/L). Urinary sodium is 12 mmol/L, fractional excretion of sodium (FENa) is 0.4%, and the BUN-to-creatinine ratio (calculated in mg/dL) is 25:1. Urinalysis shows high specific gravity (>1.025) and no casts. What is the underlying pathophysiological category of acute kidney injury?

• APrerenal azotemia due to volume depletion
• BAcute tubular necrosis (ATN)
• CAcute interstitial nephritis (AIN)
• DPost-renal obstructive uropathy

A 56-year-old man with stage 5 chronic kidney disease (eGFR 12 mL/min/1.73 m2) on maintenance hemodialysis is evaluated for bone pain. Laboratory results reveal serum calcium of 2.05 mmol/L (normal 2.15–2.55), serum phosphate of 2.30 mmol/L (normal 0.8–1.45), and intact parathyroid hormone (iPTH) of 620 pg/mL (normal 15–65). What is the primary underlying mechanism driving this patient's parathyroid elevation?

• APrimary autonomous adenoma of the parathyroid gland
• BExcessive dietary calcium intake causing parathyroid gland stimulation
• CDecreased renal phosphate excretion and reduced 1-alpha-hydroxylation of vitamin D
• DInappropriate renal calcium wasting from proximal tubular dysfunction

A 19-year-old woman with type 1 diabetes is brought to the emergency department with abdominal pain, Kussmaul breathing, and fruity-smelling breath. Point-of-care glucose is 26 mmol/L. ABG shows pH 7.12, HCO3- 9 mmol/L, and anion gap 24 mEq/L. Blood ketones are 5.8 mmol/L. Her serum potassium is reported as 3.1 mmol/L. What is the critical first step regarding insulin and electrolyte management?

• AAdminister an immediate bolus of intravenous regular insulin at 0.15 U/kg
• BAdminister 100 mL of 8.4% sodium bicarbonate before any fluids
• CStart a subcutaneous long-acting insulin analog immediately
• DInitiate aggressive isotonic saline and potassium replacement, holding insulin until pota…

A 54-year-old overweight man with recently diagnosed type 2 diabetes mellitus (HbA1c 8.2%) has normal renal function (eGFR >90 mL/min/1.73 m2). Lifestyle modifications have been initiated. What is the internationally recommended first-line oral antihyperglycemic medication in the absence of contraindications?

• AGliclazide
• BMetformin
• CPioglitazone
• DAcarbose

A 30-year-old woman with untreated Graves' disease is admitted in a state of thyroid storm triggered by an acute respiratory infection. She has a temperature of 40.2 °C, heart rate of 150 bpm in atrial fibrillation, marked agitation, jaundice, and delirium. In what sequence should specific pharmacotherapies be administered to block new hormone synthesis and release?

• AAdminister propylthiouracil (PTU) at least 1 hour before saturated solution of potassium…
• BAdminister potassium iodide (Lugol's solution) at least 1 hour before propylthiouracil (P…
• CAdminister intravenous levothyroxine followed by high-dose dexamethasone
• DAdminister radioactive iodine (I-131) followed by propranolol

A 41-year-old woman presents with profound fatigue, 10 kg unintended weight loss, dizziness on standing, and salt cravings. Physical examination reveals generalized hyperpigmentation prominent in palmar creases and buccal mucosa, along with postural hypotension (supine BP 100/65 mmHg, standing BP 80/50 mmHg). Serum sodium is 126 mmol/L and potassium is 5.8 mmol/L. What is the definitive diagnostic test to establish the diagnosis?

• AOvernight 1 mg dexamethasone suppression test
• BRandom afternoon serum cortisol measurement
• CShort Synacthen (cosyntropin / ACTH stimulation) test
• DWater deprivation test

A 62-year-old man arrives at the emergency department with acute right-sided hemiplegia and expressive aphasia that started exactly 90 minutes ago. Non-contrast brain CT confirms absence of intracranial hemorrhage. His blood pressure is 170/95 mmHg, and blood glucose is 6.8 mmol/L. He has no history of recent trauma, surgery, or bleeding diathesis. What is the most appropriate acute therapy?

• AHigh-dose intravenous heparin infusion
• BOral aspirin 300 mg monotherapy and admission to the ward
• CAggressive blood pressure reduction to systolic <120 mmHg with sodium nitroprusside
• DImmediate intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA /…

A 28-year-old known epileptic is brought to the resuscitation bay actively experiencing generalized tonic-clonic convulsions. Paramedics report the seizure has been continuous for 12 minutes without return of consciousness. The airway is opened and high-flow oxygen is applied. What is the immediate pharmacological agent of choice to terminate the seizure?

• AIntravenous phenytoin infusion over 1 hour
• BIntravenous lorazepam or intramuscular midazolam
• COral carbamazepine suspension via nasogastric tube
• DIntravenous propofol infusion with endotracheal intubation

A 23-year-old university student is admitted with high fever, photophobia, severe headache, and neck stiffness. Kernig and Brudzinski signs are positive. Lumbar puncture demonstrates cloudy cerebrospinal fluid (CSF) with opening pressure 280 mm H2O, WBC 1,500/uL with 90% neutrophils, protein 2.8 g/L (elevated), and CSF-to-serum glucose ratio 0.20 (decreased). Which empirical antibiotic regimen should be started immediately?

• AOral ciprofloxacin plus oral rifampicin
• BIntravenous acyclovir monotherapy
• CIntravenous ceftriaxone plus vancomycin plus adjunctive dexamethasone
• DIntravenous benzylpenicillin alone without steroids

A 69-year-old retired schoolteacher presents with an asymmetric pill-rolling tremor of his left hand at rest, progressive slowness when buttoning his shirt, and difficulty rising from deep chairs. Physical examination shows lead-pipe and cogwheel rigidity of the upper extremities and a shuffling, short-stepped gait with reduced arm swing. What is the fundamental neuropathological hallmark of this disease?

• ALoss of dopaminergic neurons in the substantia nigra pars compacta with intracellular Lew…
• BDegeneration of upper and lower motor neurons in the anterior horn cells
• CExtracellular beta-amyloid plaques and neurofibrillary tau tangles in the hippocampus
• DAutoimmune demyelinating plaques distributed throughout the central white matter

A 32-year-old resident in Mauritius presents during the summer season with high fever, severe retro-orbital pain, generalized myalgia, arthralgia ('breakbone fever'), and a maculopapular rash. On day 4 of illness his fever settles (defervescence), but he develops persistent abdominal pain, recurrent vomiting, and mucosal bleeding from his gums. Hematocrit increases from 38% to 48%, and platelet count drops to 45,000/uL. What clinical phase of dengue is he entering, and what is the primary pathophysiological risk?

• AFebrile phase characterized by transient viremia without hemodynamic threat
• BConvalescent phase characterized by fluid overload and resorption
• CChronic persistent phase with secondary bacterial superinfection
• DCritical phase characterized by systemic capillary leakage and plasma leakage

A 29-year-old traveler returning to Mauritius from Madagascar presents with high-grade fever, chills, confusion, and dark urine ('blackwater fever'). Blood film microscopy reveals ring forms of Plasmodium falciparum with 8% parasitemia. Total serum bilirubin is 75 umol/L, creatinine is 250 umol/L, and blood glucose is 2.5 mmol/L. According to WHO guidelines, what is the first-line therapeutic agent for severe falciparum malaria?

• AOral chloroquine phosphate
• BIntravenous artesunate
• CIntravenous quinine dihydrochloride with cardiac monitoring
• DOral atovaquone-proguanil

A 48-year-old man is diagnosed with pulmonary tuberculosis based on sputum smear microscopy showing acid-fast bacilli and positive GeneXpert MTB/RIF without rifampicin resistance. What is the standard first-line treatment regimen for drug-susceptible pulmonary tuberculosis?

• A6 months of isoniazid and ethambutol monotherapy
• B9 months of rifampicin, ciprofloxacin, and amikacin
• C2 months of isoniazid, rifampicin, pyrazinamide, and ethambutol, followed by 4 months of…
• D12 months of streptomycin and pyrazinamide

A 35-year-old man with newly diagnosed HIV infection (CD4+ T-cell count 85 cells/uL) presents with a 3-week history of dry cough, progressive exertional dyspnea, and low-grade fever. Arterial blood gas shows PaO2 of 62 mmHg on room air (room air alveolar-arterial oxygen gradient >35 mmHg). Chest radiography demonstrates bilateral diffuse perihilar ground-glass interstitial infiltrates. What is the definitive initial antimicrobial therapy and essential adjunctive medication?

• AIntravenous ganciclovir alone
• BOral clarithromycin plus ethambutol
• CInhaled pentamidine monotherapy without steroids
• DHigh-dose trimethoprim-sulfamethoxazole (co-trimoxazole) plus adjunctive oral or intraven…

A 24-year-old woman is found to have microcytic hypochromic anemia on routine pre-employment blood tests. Her hemoglobin is 98 g/L, MCV is 68 fL, and red cell distribution width (RDW) is 19.5% (elevated). Serum ferritin is 8 ug/L (normal 15–200 ug/L), and total iron-binding capacity (TIBC) is elevated at 85 umol/L. What is the diagnosis?

• ABeta-thalassemia minor / trait
• BIron deficiency anemia
• CAnemia of chronic disease
• DSideroblastic anemia

A 50-year-old businessman who recently completed a 12-hour flight presents with unilateral left lower extremity pain and swelling. Compression duplex ultrasonography demonstrates a non-compressible left popliteal vein with an acute intraluminal thrombus. He has no past medical history, normal renal and liver function, and no active bleeding. What is the most appropriate initial oral anticoagulant treatment?

• AA direct oral anticoagulant (DOAC) such as rivaroxaban or apixaban
• BWarfarin monotherapy without heparin bridging
• CAspirin 300 mg daily
• DIntravenous unfractionated heparin without transition to oral agents

A 25-year-old woman presents with persistent symmetrical joint pain in her hands, a malar butterfly rash sparing the nasolabial folds, and photosensitivity. Urinalysis shows 3+ proteinuria and active sediment with red blood cell casts. Laboratory tests demonstrate positive antinuclear antibodies (ANA 1:640, speckled pattern). Which autoantibody is most specific for confirming systemic lupus erythematosus (SLE) and correlates with disease activity and renal involvement?

• AAnti-Ro (SSA) antibodies
• BRheumatoid factor (RF)
• CAnti-double-stranded DNA (anti-dsDNA) antibodies
• DAnti-centromere antibodies

A 21-year-old woman is brought to casualty 5 hours after deliberately ingesting 30 tablets of paracetamol (500 mg each, total 15 g). Her serum paracetamol concentration at 5 hours post-ingestion is 180 mg/L (1,200 umol/L), which plots well above the treatment line on the Rumack-Matthew nomogram. What is the specific antidote mechanism of intravenous N-acetylcysteine (NAC)?

• ADirect competitive inhibition of hepatic cytochrome P450 CYP2E1 enzymes
• BChelation of circulating free paracetamol to facilitate renal excretion
• CBinding opioid receptors to reverse respiratory depression
• DReplenishing hepatic glutathione stores to detoxify the toxic metabolite NAPQI

A 24-year-old motorcyclist is brought to the trauma center following a high-speed collision. He is agitated, combative, and bleeding profusely from a scalp laceration. According to the Advanced Trauma Life Support (ATLS) protocol, which initial sequence of life-saving priorities must be strictly followed during the primary survey?

• ACirculation, Airway, Breathing, Defibrillation, Secondary survey head-to-toe examination
• BAirway with cervical spine motion restriction, Breathing and ventilation, Circulation wit…
• CHead-to-toe physical examination, full-body CT trauma scan, laboratory cross-match, airwa…
• DDefinitive surgical repair of laceration, intravenous analgesia, neurological examination…

A 30-year-old unrestrained driver involved in a motor vehicle accident presents in severe respiratory distress. Vital signs are: blood pressure 75/40 mmHg, heart rate 138 bpm, and respiratory rate 36 breaths/min. On physical examination, the trachea is deviated to the right, neck veins are distended, and there is hyperresonance with completely absent breath sounds over the entire left hemithorax. What is the immediate, life-saving management step?

• APerform immediate needle thoracocentesis / decompression on the left side
• BSend the patient for an emergency portable chest radiograph
• CPerform emergency endotracheal intubation
• DAdminister 2 liters of normal saline bolus through two large-bore IV cannulae

A 35-year-old construction worker falls from scaffolding and sustains a severe pelvic fracture with extensive retroperitoneal hematoma. On admission, his heart rate is 135 bpm, blood pressure is 82/50 mmHg, pulse pressure is narrowed, urine output is 10 mL/h, and he is pale and lethargic. Approximately what percentage of total circulating blood volume has this patient lost (ATLS Class III hemorrhagic shock)?

• ALess than 15% (<750 mL)
• B15% to 30% (750 to 1,500 mL)
• C31% to 40% (1,500 to 2,000 mL)
• DGreater than 40% (>2,000 mL)

A 19-year-old man presents with a 24-hour history of abdominal pain that began as a dull ache around the umbilicus and then migrated to the right lower quadrant, where it became sharp and constant. On examination there is maximal tenderness and rebound tenderness at McBurney's point, and pressure in the left iliac fossa elicits pain in the right iliac fossa (positive Rovsing's sign). What is the definitive management?

• AColonoscopy to exclude cecal pathology before any operation
• BUpper gastrointestinal endoscopy to look for a peptic ulcer
• CDischarge with oral analgesia and review in one week
• DAppendicectomy (laparoscopic or open) with perioperative antibiotics

A 60-year-old woman who underwent an open hysterectomy 5 years ago presents with colicky generalized abdominal pain, bilious vomiting, progressive abdominal distension, and absolute obstipation for 36 hours. Abdominal radiography reveals centrally located, multiple dilated loops of bowel (>3 cm in diameter) with prominent valvulae conniventes extending across the full lumen and a 'string-of-pearls' air-fluid sign. What is the most common underlying cause of this condition?

• APostoperative intra-abdominal adhesions
• BIncarcerated femoral hernia
• CSigmoid colon adenocarcinoma
• DIntussusception

A 55-year-old man with a long-standing history of dyspepsia taking NSAIDs for osteoarthritis presents with sudden, excruciating epigastric pain that began 2 hours ago. He is lying completely motionless. On examination, his abdomen is scaphoid, exquisitely tender throughout, and exhibits 'board-like' muscular rigidity with absent bowel sounds. An erect chest radiograph reveals a thin crescent of radiolucency beneath the right hemidiaphragm. What is the immediate definitive surgical approach?

• AConservative management with high-dose intravenous proton pump inhibitors alone
• BUrgent flexible upper endoscopy to cauterize the ulcer base
• CEmergency exploratory laparotomy or laparoscopy with peritoneal washout and Graham omenta…
• DPercutaneous peritoneal drainage under local anesthesia

A 68-year-old woman presents with severe right upper quadrant abdominal pain, spiking fevers with rigors (39.5 °C), jaundice, mental confusion, and blood pressure of 85/50 mmHg (Reynolds' pentad). Laboratory tests confirm leukocytosis (22,000/uL), total bilirubin of 95 umol/L, and elevated alkaline phosphatase. Abdominal ultrasound demonstrates common bile duct dilatation (14 mm) with choledocholithiasis. Following resuscitation with fluids and IV broad-spectrum antibiotics, what is the definitive urgent intervention?

• AElective open cholecystectomy in 4 to 6 weeks
• BUrgent biliary decompression via Endoscopic Retrograde Cholangiopancreatography (ERCP)
• CIntravenous corticosteroid pulse therapy
• DMagnetic Resonance Cholangiopancreatography (MRCP) without intervention

A 48-year-old manual laborer presents with a groin swelling that bulges when lifting heavy crates and disappears when lying flat. On anatomical examination, the hernia sac emerges through the deep inguinal ring, lateral to the inferior epigastric vessels, and traverses the entire inguinal canal inside the spermatic cord toward the scrotum. Which type of groin hernia is this?

• ADirect inguinal hernia
• BFemoral hernia
• CObturator hernia
• DIndirect inguinal hernia

A 70 kg man sustains deep partial-thickness burns involving his entire anterior torso, both entire upper extremities, and the anterior surface of both lower extremities. Using the Wallace Rule of Nines, calculate his total body surface area (TBSA) burned, and determine the volume of Ringer's lactate required in the first 8 hours post-injury using the standard Parkland formula (4 mL x kg x %TBSA).

• ATBSA 36%; 5,040 mL in the first 8 hours
• BTBSA 45%; 6,300 mL in the first 8 hours
• CTBSA 54%; 7,560 mL in the first 8 hours
• DTBSA 54%; 15,120 mL in the first 8 hours

A 58-year-old man develops a temperature of 38.0 °C on postoperative day 1 after an elective open hemicolectomy. He is breathing shallowly because of incisional pain, with respiratory rate 22/min and oxygen saturation 93% on room air. There are reduced breath sounds with fine crackles at both lung bases. The wound is clean and dry, there is no calf swelling, and the abdomen is appropriately tender only around the incision. Which complication best explains these findings?

• ABasal atelectasis from pain-limited shallow breathing
• BSurgical site infection
• CDeep vein thrombosis
• DAnastomotic leak with generalized peritonitis

A 22-year-old footballer sustains a closed mid-shaft tibial fracture that is immobilized in a plaster backslab. Six hours later, he complains of severe, excruciating pain in his lower leg that is refractory to intravenous morphine. On examination, the anterior compartment is tense and woody, and passive plantarflexion of the great toe elicits excruciating pain. Dorsalis pedis pulses remain palpable. What is the most appropriate and urgent next step?

• AAdminister higher doses of intravenous opioids and elevate the leg above the heart
• BPerform urgent computed tomography angiography of the lower limb
• CApply a circular fiberglass cast to ensure rigid fracture reduction
• DEmergency decompressive fasciotomy of all four lower leg compartments

A 32-year-old motorcyclist sustains an open fracture of the right tibia with a 4 cm laceration over the anterior shin, moderate soft-tissue damage, and no gross contamination. Distal neurovascular status is intact. Under the Gustilo-Anderson classification this is a type II open fracture. What is the immediate standard of emergency management?

• AImmediate primary skin wound closure in the emergency room under local anesthesia
• BIntravenous antibiotic prophylaxis, tetanus prophylaxis as indicated, sterile dressing an…
• CApplication of a closed plaster cast and delayed elective surgery in 2 weeks
• DOral antibiotics and outpatient review in the fracture clinic the next day

An 82-year-old woman with osteoporosis falls at home and cannot stand. Radiographs confirm a displaced intracapsular fracture of the femoral neck (Garden stage IV). Why is prosthetic replacement (hemiarthroplasty or total hip arthroplasty) preferred over internal fixation with percutaneous cannulated screws in this patient?

• AHigh risk of avascular necrosis (AVN) of the femoral head and non-union due to disruption…
• BCannulated screws are technically impossible to insert in patients over 75 years
• CInternal fixation requires a longer postoperative immobilization period of 6 months
• DFemoral neck fractures never heal without exogenous bone graft

A 24-year-old boxer is struck in the right temporal region. He experienced brief loss of consciousness, followed by a 2-hour 'lucid interval' where he felt entirely normal. He then rapidly develops worsening headache, confusion, a dilated sluggish right pupil, and left-sided hemiparesis. Non-contrast brain CT demonstrates a hyperdense biconvex (lenticular) extra-axial collection that does not cross cranial suture lines. Which blood vessel is lacerated?

• ABridging subdural cortical veins
• BBasilar artery
• CMiddle meningeal artery
• DInternal carotid artery

A 52-year-old woman discovers a painless, hard 2.5 cm lump in the upper outer quadrant of her right breast with overlying skin tethering. What is the standard diagnostic algorithm required to achieve a definitive diagnosis in any suspected breast malignancy?

• AImmediate surgical lumpectomy without prior imaging or biopsy
• BTriple assessment: clinical breast examination, bilateral breast imaging (mammography/ult…
• CSerum CA 15-3 tumor marker assay and reassurance
• DFine needle aspiration cytology alone without imaging

A 44-year-old woman presents with an asymptomatic 2 cm solitary nodule in the right lobe of her thyroid gland. What is the initial laboratory investigation of choice in the diagnostic workup of a thyroid nodule?

• ASerum thyroglobulin
• BSerum calcitonin
• C24-hour radioactive iodine uptake scan
• DSerum thyroid-stimulating hormone (TSH)

A 72-year-old man presents with severe lower abdominal pain and inability to pass urine for the past 14 hours. He has an 18-month history of hesitancy, weak stream, and nocturia. On examination, a tender, dull mass is palpable rising from the pelvis up to the umbilicus. Digital rectal examination reveals an enlarged, smooth, non-tender prostate with preserved median sulcus. What is the immediate first-line management?

• AImmediate transurethral catheterization to relieve bladder distension
• BIntravenous administration of loop diuretics
• CEmergency transurethral resection of the prostate (TURP)
• DPrescription of oral finasteride and review in one week