100+ Free Dip Int Med(SA) Practice Questions

Explanation: According to current South African NDoH adult hospital guidelines and Southern African HIV Clinicians Society guidelines for cryptococcal meningitis, preferred induction therapy is IV Amphotericin B deoxycholate (1 mg/kg/day) plus oral Flucytosine (25 mg/kg 6-hourly) for 7 days, followed by oral Fluconazole 1200 mg daily for 7 days. This combination achieves faster CSF fungal clearance and lower 10-week mortality compared to fluconazole monotherapy or prolonged amphotericin B monotherapy.

Explanation: The standard preferred first-line ART regimen for HIV-positive adults and adolescents initiating therapy in South Africa (with normal renal function) is the fixed-dose combination TLD: Tenofovir Disoproxil Fumarate (TDF 300 mg) + Lamivudine (3TC 300 mg) + Dolutegravir (DTG 50 mg) taken once daily. TLD offers high genetic barrier to resistance, rapid viral suppression, and superior tolerability compared to NNTRI-based regimens.

Explanation: This patient is presenting with acute hypertensive pulmonary edema (acute decompensated heart failure). Immediate management requires IV loop diuretics (Furosemide 40-80 mg) to reduce preload and IV/sublingual nitrates (Nitroglycerin) to reduce both preload and afterload, along with high-flow oxygen and non-invasive positive pressure ventilation (CPAP/BiPAP).

Explanation: Severe acute asthma in pregnancy is a medical emergency that endangers both mother and fetus via maternal hypoxemia. Systemic corticosteroids (oral Prednisone 40-50 mg daily or IV Hydrocortisone) are essential and safe in acute asthma exacerbations during pregnancy to reduce airway inflammation and prevent respiratory arrest.

Explanation: In severe hyperkalemia with ECG changes (peaked T waves, QRS widening), the critical first step is administration of IV Calcium Gluconate (or Calcium Chloride) to antagonize potassium-induced membrane excitability and stabilize cardiac myocytes, preventing lethal dysrhythmias. Shift therapies (insulin/dextrose, nebulized salbutamol) and elimination therapies follow immediately.

Explanation: Initial fluid resuscitation in Diabetic Ketoacidosis (DKA) requires rapid restoration of intravascular volume using isotonic crystalloid, specifically 0.9% Sodium Chloride (Normal Saline) at 1000 mL (or 10-20 mL/kg) in the first hour. Dextrose is added to IV fluids only later when blood glucose drops below 14 mmol/L.

Explanation: In acute upper gastrointestinal bleeding with hemodynamic instability (hypotension, tachycardia), the paramount immediate priority is hemodynamic stabilization via resuscitation with isotonic crystalloids (and blood products as required) using two large-bore peripheral IV lines before endoscopy.

Explanation: In acute ischemic stroke within the 4.5-hour therapeutic window without hemorrhage on CT and no contraindications, IV thrombolysis with recombinant tissue plasminogen activator (Alteplase 0.9 mg/kg, max 90 mg) is the definitive standard of care to restore perfusion and improve neurological outcome.

Explanation: Methotrexate (with weekly folic acid supplementation) is the anchor first-line conventional synthetic DMARD of choice for newly diagnosed Rheumatoid Arthritis. Early initiation halts joint erosion and preserves functional status.

Explanation: Standard initial treatment for drug-susceptible pulmonary tuberculosis in adults in South Africa consists of a 2-month intensive phase with four drugs: Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol (RHZE), followed by a 4-month continuation phase with Rifampicin and Isoniazid (RH).