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Sample Tunisia Medical Residency Practice Questions
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1A patient has acute chest pain and ST elevation in leads II, III, and aVF. Which myocardial territory is primarily represented by these leads?
A.Anterior
B.Inferior
C.Lateral
D.Septal
Explanation: Leads II, III, and aVF view the inferior myocardial territory. The culprit artery still requires clinical and angiographic assessment because coronary dominance and anatomy vary.
2High-sensitivity troponin is elevated in a patient with chronic kidney disease. Which additional finding most supports an acute myocardial infarction rather than interpreting the isolated elevation as diagnostic?
A.An unchanged value over repeated measurements without ischemic evidence
B.An elevated creatinine concentration alone
C.A troponin rise or fall together with clinical evidence of acute myocardial ischemia
D.A normal hemoglobin concentration
Explanation: An acute myocardial infarction requires acute myocardial injury together with evidence of ischemia. A single elevated troponin can reflect chronic or nonischemic injury and must be interpreted with serial results and the clinical picture.
3For this CHA2DS2-VA calculation, assign 1 point each for hypertension, diabetes, and age 65–74, and 2 points for previous stroke. A 72-year-old patient with atrial fibrillation has all four factors and no others. What is the score, and what is its implication under the 2024 ESC approach if anticoagulation is otherwise suitable?
A.3; aspirin alone is the recommended stroke-prevention strategy
B.4; the previous stroke counts as a single point
C.6; age 72 contributes two points
D.5; oral anticoagulation is recommended after individual assessment
Explanation: The score is 1 + 1 + 1 + 2 = 5. The ESC approach recommends anticoagulation for eligible patients at this risk level, with assessment of contraindications, bleeding risks, and patient circumstances.
4An adult reports poor asthma control despite a prescribed inhaled controller. Before routinely increasing the treatment step, what should be checked?
A.Inhaler technique, adherence, triggers, and whether the symptoms are actually due to asthma
B.Increase controller intensity solely from the prescribed dose without checking actual use
C.Add maintenance oral corticosteroids before reviewing inhaler use
D.Replace the inhaled corticosteroid with LABA monotherapy
Explanation: GINA recommends checking common causes of apparent treatment failure before stepping up. Incorrect technique, poor adherence, exposures, and alternative explanations can all produce persistent symptoms despite an adequate prescription.
5A COPD exacerbation persists despite initial treatment. Blood gas shows pH 7.28 and elevated PaCO2. The patient is cooperative, protects the airway, and has no vomiting or shock. Which respiratory-support plan is most appropriate?
A.High-flow oxygen alone without monitoring or an escalation plan
B.A monitored trial of noninvasive ventilation with prompt escalation if it fails
C.Immediate intubation solely because PaCO2 is elevated despite the favorable clinical assessment
D.Bicarbonate as a replacement for ventilatory support
Explanation: Acute hypercapnic respiratory acidosis in an appropriate COPD patient is an important indication for noninvasive ventilation. Close monitoring and readiness to intubate if deterioration or treatment failure occurs are integral to the plan.
6A stable adult has a high clinical probability of pulmonary embolism. There is no contraindication to iodinated contrast. Which investigation is generally the appropriate definitive next test?
A.A D-dimer alone to exclude embolism
B.A plain chest radiograph alone
C.CT pulmonary angiography
D.A resting ECG alone
Explanation: High clinical probability generally calls for diagnostic imaging rather than relying on a D-dimer exclusion strategy. CT pulmonary angiography visualizes the pulmonary arteries, while clinical circumstances may require an alternative imaging pathway.
7An adult with septic shock remains hypotensive despite appropriate fluid assessment and resuscitation. No significant cardiac dysfunction is identified. Which drug is generally the first-line vasopressor?
A.Dopamine
B.Phenylephrine
C.Dobutamine alone
D.Norepinephrine
Explanation: The Surviving Sepsis Campaign recommends norepinephrine as the usual first-line vasopressor in adult septic shock. The hemodynamic phenotype and response guide subsequent agents; concomitant cardiac dysfunction requires additional consideration.
8Soon after an injection, a patient develops widespread urticaria, stridor, and hypotension. Which drug should be given promptly as the first-line treatment of anaphylaxis?
A.Intramuscular adrenaline in the anterolateral thigh
B.Oral antihistamine alone
C.Intravenous corticosteroid alone
D.Inhaled salbutamol alone
Explanation: Intramuscular adrenaline is the first-line drug for anaphylaxis, alongside emergency airway and circulatory support. Antihistamines, corticosteroids, and bronchodilators do not replace its immediate treatment of airway swelling and shock.
9Intravenous calcium is administered for severe hyperkalemia with toxic ECG changes. Which statement best describes its purpose?
A.It removes potassium through the bowel
B.It protects cardiac excitability while separate treatment lowers potassium
C.It directly eliminates potassium by dialysis
D.It shifts potassium into cells by stimulating insulin release
Explanation: Calcium counteracts the dangerous electrophysiological effects of hyperkalemia without lowering the serum potassium concentration. Potassium-shifting and removal measures are therefore still required, with continued ECG and biochemical monitoring.
10An adult with ketoacidosis has sodium 134, chloride 98, and bicarbonate 10 mmol/L. Using anion gap = sodium − chloride − bicarbonate, and the laboratory's reference interval of 8–12 mmol/L, which interpretation is correct?
A.16 mmol/L; within the stated reference interval
B.36 mmol/L; isolated respiratory acidosis
C.26 mmol/L; an elevated gap compatible with unmeasured ketoanions
D.8 mmol/L; a normal-gap acidosis
Explanation: The calculation is 134 - 98 - 10 = 26 mmol/L. This exceeds the supplied laboratory interval and is compatible with ketoanion accumulation; blood gas and clinical findings remain necessary for the complete acid-base assessment.
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