Q.1 A 25-year-old patient presents with sudden onset fever, chills, and a productive cough. What is the most likely diagnosis?
Asthma exacerbation
Community-acquired pneumonia
Acute bronchitis
Pulmonary embolism
Explanation - Sudden fever, chills, and productive cough are characteristic features of community-acquired pneumonia, unlike asthma or acute bronchitis which usually lack high fever and chills.
Correct answer is: Community-acquired pneumonia
Q.2 Which of the following is the first-line treatment for acute bacterial sinusitis in adults?
Amoxicillin
Azithromycin
Ceftriaxone
Levofloxacin
Explanation - Amoxicillin is the first-line antibiotic for uncomplicated acute bacterial sinusitis due to its efficacy and safety profile.
Correct answer is: Amoxicillin
Q.3 A child presents with sudden high fever, sore throat, and drooling. Which condition should be suspected immediately?
Tonsillitis
Epiglottitis
Strep throat
Laryngitis
Explanation - Drooling and high fever in a child with sore throat suggest epiglottitis, a life-threatening airway emergency that requires urgent attention.
Correct answer is: Epiglottitis
Q.4 Which of the following is the most appropriate initial test for a patient presenting with acute chest pain and suspicion of myocardial infarction?
Chest X-ray
Electrocardiogram (ECG)
Echocardiography
CT scan
Explanation - An ECG is the first-line diagnostic tool for acute myocardial infarction to identify ischemic changes and guide immediate management.
Correct answer is: Electrocardiogram (ECG)
Q.5 A 40-year-old presents with sudden onset unilateral facial droop, inability to close the eye, and drooling. What is the likely diagnosis?
Stroke
Bell's palsy
Migraine
Trigeminal neuralgia
Explanation - Bell's palsy presents with acute unilateral facial paralysis, often involving the forehead, distinguishing it from stroke which typically spares the forehead.
Correct answer is: Bell's palsy
Q.6 A patient presents with severe sore throat, fever, and difficulty swallowing. Examination shows tonsillar exudates and tender anterior cervical lymphadenopathy. Most likely diagnosis?
Viral pharyngitis
Bacterial pharyngitis
Mononucleosis
Peritonsillar abscess
Explanation - Tonsillar exudates, fever, and tender anterior cervical lymph nodes are classic signs of bacterial pharyngitis, often caused by Streptococcus pyogenes.
Correct answer is: Bacterial pharyngitis
Q.7 Which of the following is the first-line treatment for mild acute asthma exacerbation in adults?
Oral corticosteroids
Inhaled short-acting beta-agonist
Long-acting beta-agonist
Antibiotics
Explanation - Mild acute asthma attacks are initially managed with inhaled short-acting beta-agonists (e.g., salbutamol) to relieve bronchospasm.
Correct answer is: Inhaled short-acting beta-agonist
Q.8 A patient presents with fever, dysuria, and suprapubic discomfort. Urinalysis shows pyuria and bacteriuria. What is the most likely diagnosis?
Acute pyelonephritis
Acute cystitis
Prostatitis
Urethritis
Explanation - Fever, dysuria, suprapubic pain, pyuria, and bacteriuria indicate acute cystitis; pyelonephritis usually has flank pain and systemic symptoms.
Correct answer is: Acute cystitis
Q.9 Which of the following signs differentiates bacterial meningitis from viral meningitis in adults?
Fever
Neck stiffness
Altered mental status
Gradual onset and mild headache
Explanation - Bacterial meningitis often presents with more severe symptoms including altered mental status and rapid progression, unlike viral meningitis which is typically milder.
Correct answer is: Altered mental status
Q.10 A patient presents with sudden severe abdominal pain radiating to the back and hypotension. Which acute condition should be suspected?
Acute pancreatitis
Perforated ulcer
Abdominal aortic aneurysm rupture
Appendicitis
Explanation - Severe abdominal or back pain with hypotension in an older patient raises high suspicion for a ruptured abdominal aortic aneurysm, a surgical emergency.
Correct answer is: Abdominal aortic aneurysm rupture
Q.11 Which of the following is the most common cause of community-acquired acute gastroenteritis in adults?
Salmonella
Rotavirus
Norovirus
E. coli O157:H7
Explanation - Norovirus is the leading cause of acute gastroenteritis in adults, especially in outbreaks in communities or institutions.
Correct answer is: Norovirus
Q.12 A patient presents with acute onset high fever, hypotension, tachycardia, and confusion. What is the immediate management step?
Oral antibiotics
IV fluids and broad-spectrum antibiotics
Analgesics only
Wait for culture results
Explanation - Septic shock requires immediate resuscitation with IV fluids and empiric broad-spectrum antibiotics before culture results are available.
Correct answer is: IV fluids and broad-spectrum antibiotics
Q.13 Which of the following is the most likely cause of sudden unilateral ear pain, fever, and a bulging tympanic membrane in a child?
Otitis externa
Otitis media
Cholesteatoma
Foreign body in ear
Explanation - Acute otitis media commonly presents in children with ear pain, fever, and a bulging tympanic membrane on examination.
Correct answer is: Otitis media
Q.14 A 35-year-old patient presents with sudden onset palpitations, sweating, and tremor. Blood glucose is 45 mg/dL. What is the most likely cause?
Hyperthyroidism
Hypoglycemia
Pheochromocytoma
Anemia
Explanation - Symptoms of palpitations, sweating, and tremor with low blood glucose indicate hypoglycemia, which needs prompt treatment.
Correct answer is: Hypoglycemia
Q.15 Which of the following is the first-line therapy for acute migraine attack in adults?
Triptans
Propranolol
Amitriptyline
Sumatriptan
Explanation - Triptans are considered first-line treatment for acute migraine attacks to relieve headache and associated symptoms.
Correct answer is: Triptans
Q.16 A patient presents with fever, dysuria, flank pain, and nausea. Urine culture grows E. coli. Which condition is most likely?
Acute pyelonephritis
Acute cystitis
Prostatitis
Urethritis
Explanation - Flank pain, systemic symptoms, and positive urine culture indicate upper urinary tract infection, consistent with acute pyelonephritis.
Correct answer is: Acute pyelonephritis
Q.17 Which is the most common cause of sudden-onset, severe, unilateral headache with photophobia in adults?
Tension headache
Migraine
Cluster headache
Sinus headache
Explanation - Migraines often present with unilateral, pulsatile headache, photophobia, and sometimes nausea or aura.
Correct answer is: Migraine
Q.18 A patient presents with acute onset fever, productive cough with rusty sputum, and pleuritic chest pain. Which pathogen is most commonly implicated?
Streptococcus pneumoniae
Haemophilus influenzae
Klebsiella pneumoniae
Staphylococcus aureus
Explanation - Streptococcus pneumoniae is the most common cause of community-acquired pneumonia, especially with rusty-colored sputum.
Correct answer is: Streptococcus pneumoniae
Q.19 Which of the following is the most important initial step in managing a patient with acute anaphylaxis?
Oral antihistamines
IM epinephrine
IV corticosteroids
Oxygen therapy
Explanation - Intramuscular epinephrine is the first-line and life-saving treatment for acute anaphylaxis, while other measures are adjunctive.
Correct answer is: IM epinephrine
Q.20 A 60-year-old patient presents with sudden severe headache, nausea, and vomiting. Blood pressure is 220/120 mmHg. Which condition should be suspected?
Migraine
Hypertensive emergency
Subarachnoid hemorrhage
Cluster headache
Explanation - Severe headache with markedly elevated BP, nausea, and vomiting suggests hypertensive emergency, which requires immediate intervention.
Correct answer is: Hypertensive emergency
Q.21 Which of the following is the first-line therapy for acute gout attack?
Allopurinol
Colchicine
Febuxostat
Indomethacin
Explanation - NSAIDs like indomethacin are first-line therapy for acute gout attacks to relieve inflammation and pain.
Correct answer is: Indomethacin
Q.22 A patient presents with sudden onset shortness of breath, pleuritic chest pain, and hemoptysis. Which condition is most likely?
Pneumothorax
Pulmonary embolism
Pneumonia
Asthma exacerbation
Explanation - Acute dyspnea, pleuritic pain, and hemoptysis raise strong suspicion for pulmonary embolism, especially in patients with risk factors.
Correct answer is: Pulmonary embolism
Q.23 A child presents with high fever, rash starting on the face and spreading to the trunk, and Koplik spots. Likely diagnosis?
Measles
Rubella
Chickenpox
Scarlet fever
Explanation - Measles presents with prodromal fever, cough, coryza, conjunctivitis, Koplik spots, and a descending maculopapular rash.
Correct answer is: Measles
Q.24 A patient presents with severe sore throat, muffled voice, and uvular deviation. What is the most likely diagnosis?
Tonsillitis
Peritonsillar abscess
Pharyngitis
Laryngitis
Explanation - Unilateral tonsillar swelling, uvular deviation, muffled 'hot potato' voice, and sore throat indicate peritonsillar abscess.
Correct answer is: Peritonsillar abscess