1

A 37-year-old Thai male came to hospital due

to generalized tonic clonic seizure with comatos
e mental status. He had a history of progressive
generalized headache, worsening with lying on
bed with low graded fever for 1 week. His underl
ying disease is Human immunodeficiency virus i
nfection, last CD4-level is 54 cell/mm3. The phy
sical examination is E2VTM1, pupil 2mmSRTL bo
th, otherwise is within normal limits. The non-co
ntrast brain CT was shown below. What is most l
ikely diagnosis
1.Meningioma
2.Cryptococcal meningitis with
cryptococcoma
3.TB meningitis with tuberculoma
4.CNS lymphoma
5.Toxoplasma brain abscess
2
A Thai female, 27 years old, is
currently on treatment of acute my
elioid leukemia, M4 with induction
chemotherapy with intermittent blo
od transfusion in hospital. She had
a history of unsafe sex and recentl
y had rash as shown. What is the tr
ansmission method of this disease?
Air-borne
Droplet
Contact
Blood transfusion
Sexual transmission
3
A Thai male, 36 years old, had a
history of thoracic surgery with mitral
valve replacement due to mitral regur
gitation. He came to hospital due to hi
story of low graded fever for 3 weeks
without other symptoms of infection e
xcepts ulcer as shown. What is not th
e common pathogen caused his illnes
s?
Staphylococcus aureus
Eikenella corrodens
Actinobacillus actinomycetemcomitans
Streptoccoccus perfringens
Haemophilus parainfluenza
Cardiobacterium spp.
HACEK
Haemophilus species
Aggregatibacter
Cardiobacterium
Eikenella
Kingella
4
An elderly female, 79 years old, came
to hospital due to fatique, other history
is not significant. Physical examination
shown BP169/89, PR 110, thin skin, ma
rked obesity with round red face. She
has proximal muscle weakness. Her ba
ck is as shown. What is the investigati
on of choice in this patient?
24-hour urine collection for urinary free
cortisol excretion
ACTH level
ACTH stimulation test
Coritisol level
F/U tomorrow for the cortisol level in the
morning
5
A Thai adolescent male was found
lying on the roadside with comatose
status. He was brought to ED with h
is blood pressure 150/80, PR 110, R
R 40, pupil 5mm BRTL. His pocket h
as an empty pack of amitryptylline (
25) for at least ten tabs. His EKG is
at shown. What is the drug of choic
e for this patient?
Adrenaline
Sodium bicarbonate
Calcium gluconate
Atropine
2-PAMs
6
A Thai young female, 25 years old, came to hospital due to palpitati
on for 1 day. She had a history of significant weight loss with chronic
diarrhea. The physical examination shown enlarges thyroid gland, re
sting tremor and pitting edema 1+ both legs. Her thyroid function te
st is normal. She was sent for ultrasound thyroid which reported as
Multinodular goiter. What is the most appropriate next steps of man
agement in this patient?
Start antithyroid drug
Start thyroid hormone replacement therapy
Sent for fine needle aspiration
Sent for thyroid scan
Advice and reassure
7
A Thai healthy 27-year-old male came to hospital due to
progressive regurgitation of food and water from his
mouth for 2 week. His wife complained that his breath is
really bad odor. What is his likely diagnosis?
Gastroesophageal reflux
CA esophagus
Zenkers diverticulum
CA stomach
Achlalasia
8
A Thai male, 21 years old, came to hospital due to slipping off his s
hoes when walk for 1 day. His history is not significant. His physica
l examination is distal muscle weakness, otherwise is unremarkabl
e. His laboratory investigation is Hb 8.9, Hct 25%, WC 14,000 (Neu
80%, Lym 20%), Platelet 145,000, BUN/Cr 36/2.34, Na 125, K 1.5,
HCO3 16, Cl 98, Ca 9, P 2.8, Mg 2.1 What is his likely diagnosis?
Hypokalemic periodic paralysis
Guillare-barres syndrome
Myaestenia gravis
Ischemic stroke
Hypothyroidism
9
A Thai female, 56 years old, had a history of CA breast with comp
lete remission for 10 years. She came to hospital due to progress
ive back pain with lower extremities paralysis for 1 week. Her uri
nation and defecation cant be controlled. Her motor power is gra
de V at upper and grade 0 at lower extremities. Her anal sphincte
r is paralyzed. What is the investigation of choice in this patient?
Film LS spine AP, lateral
CT whole spine
CT LS spine with CT myelography
MRI whole spine
Tc 31 scan
10
A Thai 17-year-old male came to ED due to suicidal
attempt by ingesting 30 tabs of paracetamol 500 mg for
3 hours before ED approach. What is the appropriate fir
st line of management in this patient?
Activated charcoal
Sent blood for paracetamol level
NG lavage
Whole bowel irrigation
IV N-acetyl cystiene infusion
11
A Thai 23-year-old male with hist
ory of alcoholic dependent came
to ED due to loss of consciousnes
s after being hit by a bottle of be
er at his head. His BP is 60/30, PR
170, E3V2M5, His EKG is shown b
elow. What is the next appropriat
e management in this patient?
NSS 500 ml IV loading
Norepinephrine infusion
Cordarone 150 mg IV push
Defibrillation 200J
Synchronized cardioversion 100J
12
What is the most common valvular disease associated
with syncope?
Mitral stenosis
Mitral regurgitation
Mitral valve prolapses
Aortic stenosis
Aortic regurgitation
13
A Thai 26-year-old male came to
hospital due to chest pain at retrosternal
left side for 4 hours. His pain is dull-
aching without referring to other sites. P
ain is persistent for more than 2 hour wit
hout improving at rest. His pain is aggra
vated when hes working. His physical e
xamination is within normal limit. EKG is
shown below. What is further manageme
nt in this patient?
Repeat EKG 12 leads in the next 15 minutes
Chest X-rays
Sent patient for PCI
Reassure and sent him home
Give Omeprazole intravenous
14
A Thai female, 82 years old, came to
hospital due to bilateral knee pain with mark
ed swelling for more than 3 years. The pain i
s progressive and intermittent. Theres no ot
her joint with tenderness. She has no previo
us history of trauma and has no fever. She w
as treated for hypertension for 12 years with
HCTZ (25) 1 tab per day. The physical exam
ination shows ballotment positive both knee
with signs of inflammation. Crepitus positive
without limitation of ROM. Film knee is show
n below. What is likely of her diagnosis?
Chronic trophaceous gout
Inflammatory osteoarthritis
Post traumatic osteoarthritis
Rheumatoid arthritis
Gonococcal arthritis
15
A Thai female, 38 years old, came to hospital due to fatique with tachypn
ea for 1 day. She had diarrhea for more than 10 times. Her underlying dis
ease is Type 2 diabetes millitus and acute gouty attack, she currently tak
e Metformin (850)1x3, glipizide(5)1x2, colchicine(0.6) 1x1, allopurinol(100
) 1x1. The physical examination is within normal limit. Her DTX at ED is 25
8. Laboratory investigation; Hb 8.9, Hct 25%, WC 14,000 (Neu 80%, Lym 2
0%), Platelet 145,000, BUN/Cr 36/2.34, Na 135, K 4.5, HCO3 8 Cl 118, BS
302 What is her likely diagnosis?
Diabetic ketosis
Diabetic ketoacidosis
Acute diarrhea with hypokalemia
Hyperosmolar hyperglycemia emergency
Hyperventilation syndrome
16
A 36-year-old female came to hospital due to
tachypnea for 3 days. She had the
underlying of Rheumatoid arthritis for 10 yea
rs. She is now taking Methotrexate (250) 2ta
bs per week, Naproxen 1x2, Prednisolone (5)
4x3, Omeprazole (20) 1x1. She had non-prod
uctive cough with high grade fever with dysp
nea on exertion for 3 days. The physical exa
mination reveal SpO2 Room air 84%, coarse
crackle both lower lungs, no pitting edema, o
therwise unremarkable. The chest X-rays is s
hown below. What is most likely diagnosis?
Severe community-acquired bacterial pneumonia
Congestive heart failure
Pneumocystic jiroveci pneumonia
Active pulmonary tuberculosis
Interstitial lung disease
17
A 56-year-old male came to hospital due to generalized guarding abd
omen with history of Right lower quadrant tender of abdomen for 2 d
ays. The physical examinations reveal guarding abdomen. His underl
ying disease is ischemic stroke with left hemiparesis. His current med
ication is ASA(81) 1x1, Simvastatin(40) 1xhs, BCO 1x3, Folic 1x1. His
CBC is Hb 13.1, Hct 42%, WBC 15,500 (Neu 89%, Lymp 2%) , Platelet
245,000. What is the most appropriate management in this patient?
Off ASA 7 days before surgery
Off ASA 1 days before surgery
Surgery urgently after platelet transfusion
Immediate surgery without need of platelet transfusion
Surgery urgently after Vit K 10 mg IV and FFP 1000 ml IV
18
A 45-year-old female came to hospital due to tenderness at left knee
for 3 days. She had no underlying disease. She had a history of 1 st MT
P joint tenderness and warmth for 3-4 times before. She had no curre
nt medication. The physical examination is ballotment positive left kn
ee with signs of inflammation. The arthrocentesis reveals clear yellow
ish fluid. The knee fluid profile is WBC 25,500 ( Neu 67%, Lymp 33%)
, RBC 20,000 , no crystal found. What is her likely diagnosis?
Chronic trophaceous gout
Inflammatory osteoarthritis
Post traumatic osteoarthritis
Rheumatoid arthritis
Septic arthritis
19
A 68-year-old male with pontine infarction and
quadriparesis. He can move only his eyes and cant cont
rol his urination and defecation. What is the most comm
on acute complication after his disease occur?
Aspirate pneumonia
UTI
Muscle atrophy
Pressure ulcer
UGIB
20
A Thai female, 27 years old, complained about intermittent blo
ody diarrhea for 6 months. She also had history of constipation
sometime during this period. She already had weight loss from
45 to 35 kg in 6 months without intention. She also had stress
at work and had 2 children to bear up. What is the next appro
priate management?
Stool occult blood
Colonoscopy
Proctoscope
Thyroid function test
Norfloxacin and reassure
21
A Thalassemic 25-year-old female was frequently came to hospit
al due to anemia for blood transfusion. This admission, during blo
od transfusion, she had a high graded fever with chill 10 minutes
after the blood was transfused. BT 39oc, BP 130/90, PR 120, RR 1
6 , lung clear. She was relieved and suddenly resolved when you
gave her CPM 10 mg intravenous. What is likely her diagnosis?
Acute Febrile non-Hemolytic Reactions
Acute Hemolytic Transfusion Reactions
Allergic Transfusion Reactions
Transfusion associated sepsis
Transfusion-related Acute Lung Injury (TRALI)
22
What situation is appropriated for post-exposure prophylaxis
(PEPs) for HIV infection?
Medical student was accidentally puctured by the unknown needle in
the rubbish.
The healthy mans blood was accidentally flushed into the medical
students eyes.
The HIV infected patients urine is contacted with the medical students
hand which has a tiny wound.
The suture needle for the HIV infected patient was contacted and
caused abrasion wound in the medical students hand.
Medical student performed lumbar puncture in HIV infected patient and
the cerebrospinal fluid was flushed in to his oral cavity.
23
A Thai 28-year-old patient came to hospital due to low graded
fever with pleuritis cheast pain. Physical examination has decrea
sing breath sound at left side, otherwise unremarkable. The CXR i
s total pleural effusion left side with the pleural fluid profile; LDH
2430, TP 1240, glucose 16, pH 6.8, WC 2340 (Neu 24%, Lym 70%
). What is the next further laboratory appropriate for this patient?
Sputum AFB
ADA
Cytology
CT Thorax with contrast
Bronchoscopy
24
A Thai male 65-year-old with type II diabetes militus came to hospital due to
alteration of consciousness for 2 days. His Dextrose strip at ER = HI. The labor
atory test result; Hb 8.9, Hct 25%, WC 14,000 (Neu 80%, Lym 20%), Platelet 1
45,000, BUN/Cr 56/4.14, Na 145, K 2.5, HCO3 6 Cl 98, BS 912 What is his effec
tive serum osmolarity?
25
A Thai female, 24 years old, came to hospital due to severe headach
e at left hemicranial. The pain is aggravated by light and surroundin
g voice. She couldnt bear hearing someone talking aside her when t
he headache is ongoing. She had just take an acetaminophen 500 m
g 2 tabs 1 hour ago, but the symtom is not relieving. Which medicati
on should be started for prevention her further episode of headache
?
Acetaminophen
Tramadol
Propranolol
Sumatriptans
Ergotamine
26
A Thai female, 56 years old, came to hospital due to RUQ abdominal for 2
days. The pain is dull aching and she already had high graded fever for 1
day. She complained of chilling after the fever onset and insisted that sh
es never had an abdominal pain before. Her cousin told her that she has
yellowish skin. She had pruritic symptoms and her stool is become pale.
The physical examination reveals RUQ tenderness with rebound positive,
Murphys sign positive, Fitzs test positive. What is likely her diagnosis?
Liver abscess
Acute calculous cholecystitis with Mirizzis syndrome
Periampullary CA with Acute cholangitis
Acute cholelithiasis with acute cholangitis
Acute viral hepatitis A infection
27
A Thai male, 34 years old, came to hospital due to massive he
moptysis for 3 hours. He was diagnosed as pulmonary TB sme
ar positive and treated with intensive 2IRZE/4IR 2 years ago, t
he sputum is changed to smear negative. BP 120/80, PR 130,
RR 40. What is the next appropriate management for this pati
ent?
Emergency surgical lobectomy
Transamine intravenous
FFP resuscitation with VitK intravenous
PRC resuscitation
Consult X-ray intervention for pulmonary artery embolization
28
A Thai previously healthy male was witnessed cardiac
arrest. The first EKG is as shown. What is the next appro
priated management in this patient?
CPR
Synchronized cardioversion 150 J
Defibrillation 200 J
Cordarone 300 mg Intravenous push
Adenosine 6 mg Intravenous push
29
What is the further
investigation for the patie
nt with rash as shown?
KOH wet smear
Skin biopsy
No further investigation and
start antifungal cream
No further investigation and
start topical steroid cream
Blood sample for ANA,
antidsDNA, antiHIV
30
What lesion should be diagnosed as inflammatory acne?
Black comedo
White comedo
Cyst
Submandibular lymphadnopathy
31
The Thai male patient, 67 years old with CKD stage III,
admitted for 3 weeks with ventilator associated pneumonia. H
e is currently on volume ventilator with clinical desaturation a
nd septic shock. The sputum culture is Klebsiella pneumoniae
Extended spectrum Beta-lactamase producing strain. What is t
he most appropriate antibiotic should be given in this patient?
Doripenems
Piperacillin/Tazobactams
Cefoperazone/Sulbactams
Ciprofloxacin
Gentamicin
32
A Thai female, 65 years old, came to hospital due to comatose for 1 day. She c
omplained for intermittent low back pain at rest for 1 month. She had dyspnea
on exertion and had functional class III. Her body weight was decrease from 65
> 56 in 2 month. The physical exam is E1V2M5, pupil 2mm BRTL. She is intubat
ed and sent for CT brain non-contrast which reveal no abnormality. The laborat
ory was Hb 8.9, Hct 25%, WC 14,000 (Neu 80%, Lym 20%), Platelet 145,000, B
UN/Cr 36/2.34, Na 125, K 4.5, HCO3 20, Cl 98, Ca 14, P 2.8, Mg 2.1, AST/ALT 87
/54, ALP 150, alb/glob 4/9.8 What is the most appropriated definite treatment i
n this patient.
Intravenous antibiotics
3%NaCl
Intravenous fluid loading
PRC infusion with erythropoietin
Systemic chemotherapy
33
Which disease is associated with translocation of
chromosome 9 and 22 with fusion gene BCL-ABR?
Acute myeloid leukemia
Chronic myeloid leukemia
Acute promyelocytic leukemia
Acute lymphocytic leukemia
Chronic lymphocytic leukemia
34
A Thai male, 45 years old, came to hospital due to disorientation for 3 day. He
had no fever and no weakness or seizure symptoms before. He has no history of
diarrhea or nausea/vomiting. The physical examination reveals E3V4M5, fine cre
pitation both basal lungs, no localizing neuros sign, otherwise unremarkable. Th
e laboratory findings Hb 9.9, Hct 29%, WC 13,500 (Neu 90%, Lym 10%), Platelet
245,000, BUN/Cr 145/9.94, Na 145, K 5.5, HCO3 10, Cl 98, Ca 8, P 4.8, Mg 2.1, T
B/DB 0.6/0.2, AST/ALT 57/24, ALP 150, alb/glob 2.5/3.6. He was sent for ultrasou
nd KUB which report a multiple cystic lesion at both kidney. What is the most lik
ely diagnosis with the appropriate management?
Acute kidney injury due to urinary obstruction, Hemodialysis
Acute kidney injury due to volume depletion, Intraveous fluid infusion
Chronic kidney injury due to urinary obstruction, Hemodialysis
Acute kidney injury due to urinary obstruction, Urinary diversion
Acute on top Chronic kidney disease due to cystic kidney disease, Hemodialysis
35
A Thai male, 32 years old, was found generalized tonic clonic
seizure for 1/2 minutes and the stop spontaneoustly. His wife t
old that he was chewing gum without conscious before seizure
onset. After the seizure stop, he continued unconscious aroun
d 15 minutes and then waked up as normal. What is likely the
diagnosis?
Generalized tonic clonic seizure
Simple partial seizure
Complex partial seizure
Absence seizure
Myoclonus
36
A Thai female, 65 years old, came to hospital due to alteration of consciousnes
s for 1 day. She had high graded fever for 2 days and then become loss of me
ntal status. Her son told that she wont talk and unable to help herself in daily
activity. He has no history of weakness or siezure. The physical examination re
veals E3V4M5, stiffneck positive, no localizing neuros sign, otherwise unremar
kable. The CSF findings Protein 165, Glucose 25, DTX 155, WBC 255 (Neu56%,
Lym 24%) The CSF culture was positive for Streptococcus pneumoniae MIC for
penicillin is 0.03 mg/L. What is the appropriate management?
Ceftriaxone IV
Vancomycin IV plus Ceftriaxone IV
Ceftriaxone IV plus Dexamethasone IV
Vancomycin IV plus Dexamethasone IV
Meropenem IV plus Dexamethasone IV
37
What is the most associated factors for sexual
transmitted disease?
Oral herpes vesicle
Urethral discharge
HIV infection
Syphilis infection
Genital wart
38
A Thai female, 25 years old, came to hospital due to urethral pus wit
h foul smell for 4 days. She had high graded fever for 2 days afterwa
rd and then had generalized tenderness at multiple joint such as bot
h knees, both ankle and both wrist. The physical examination reveal
s multiple joint swelling with signs of inflammation at both knees, an
kles and wrists with limitation of ROM. What is the most common pat
hogen caused her illness?
Chlamydophila pneumoniae
Haemophilus influenza
Neisierria meningitides
Chlamydia trachomatis
Staphylococcus aureus
39
A Thai male, 15 years old, came to hospital due to snake bite
at left ankle for 4 hours. He couldnt see the snake and had no
symptoms and the wound is normal except for the fang mark
and localized swelling without blebs or pulse deficit. He had no
ptosis and V/S is stable. The laboratory is within normal limit e
xcept VCT > 30. What is the most appropriate management?
IV fluid loading
dT 1 course IM
Consult Surgery for decompressive fasciotomy
Antivenom for green pit viper IV
Antivenom for hematotoxin snake IV
40
A Thai 34-year-old female presented as progressive dyspnea on exertion
for 3 months. She had no underlying disease and has no previous medica
tion. She had no cough or progressive nocturnal dyspnea or orthopnea. S
he had no fever and localizing infection symptom. The physical examinati
on is within normal limitation. The laboratory findings is Hb 6.9, Hct 19%,
MCV 82, MCH 15, RDW 22, WC 13,500 (Neu 90%, Lym 10%), Platelet 145
,000. What is the next appropriate investigation for this patient?
Reticulocyte count
Direct Coombs Test
Stool occult blood
NG lavage
Peripheral blood smear
41
A Thai 54-year-old female, live in Bangkok, presented as chronic intermittent lo
w graded fever with chill and hyperpigmented urine for 3 months. She complain
ed of muscle strain all the time. She was diagnosed Dyslipidemia and Type II DM
and currently on MFM(500) 2x2, Glipizide(5) 1x2, Simvastatin(40) 1x1, Fenofibra
te(160) 1x2 The physical examination is within normal limitation. The laboratory
findings is Hb 6.9, Hct 19%, MCV 82, MCH 15, RDW 22, WC 13,500 (Neu 90%, Ly
m 10%), Platelet 145,000, BUN/Cr 45/2.5, Na 145, K 6.2, HCO3 20, Cl 101 UA no
cell, no cast, bil 2+, Hb 2+, TB/DB 2.1/0.8, AST/ALT 255/155, ALP 139, alb/glob 4
/3.5, CPK 300 What is the most likely diagnosis for this patient?
Hb H disease
Malarial infection
Rhabdomyolysis
G6PD-deficiency with intravascular hemolysis
Paroxysmal nocturnal hemoglobinuria
42
A Thai 64-year-old female presented as severe numbness at distal of a
ll fingers and toes for 6 months. She denied eating vegetable containi
ng food since she was a child. The physical examination revealed decr
ease pinprick sensation at all extremities at distal side, other neuros s
igns are unremarkable. The laboratory findings is Hb 8.9, Hct 29%, M
CV 122, MCH 15, RDW 22, WC 13,500 (Neu 90%, Lym 10%), Platelet 1
45,000. What is the most appropriate treatment for this patient?
B12 injection
B1 injection
Vit Bcomplex oral
Suggest vegetable food
Reassure
43
A Thai female, 65 years old, came to hospital due to alteration of co
nsciousness for 2 day. She had no fever and no history of weakness
or seizure. The physical examination is no pitting, not pale, no signs
of respiratory distress, otherwise unremarkable. The laboratory find
ings BUN/Cr 15/0.94, Na 104, K 3.5, HCO3 19, Cl 98, Ca 9, P 1.8, Mg
1.1. What is the most appropriate management for this patient?
3% NaCl injection IV 60 ml/hr x 2 hr then NSS IV 100 ml/hr
NSS IV loading 1L in 1 hour then NSS IV 100 ml/hr
Restrict oral fluid
Lasix 40 mg IV
Feed free water 200 ml x 4hour
44
A Thai male, 45 years old with smoking d
ependent 30 packs year and poor control
led hypertension, came to hospital due to
severe chest pain, worst in his life for 2 h
ours. He had no fever and no history of d
yspnea. The physical examination is BP 2
10/100, PR 130, RR 24, SpO2 90%, no pit
ting, not pale, lung clear both, no murmu
r, otherwise unremarkable. Chest X-rays i
s as shown. What is the most appropriate
investigation in this patient?
EKG 12 leads
U/S upper abdomen
CT pulmonary artery
D-dimer
Aorta angiogram
45
A Thai female, 65 years old, came to hospital due to progressive dys
pnea on exertion for 1 day. She complained bloody streak along with
her sputum for 3 months. Her body weight was decrease from 65 >
56 in 2 month. The physical exam is within normal limits excepts clu
bbing of finger. The laboratory was BUN/Cr 26/1.24, Na 135, K 4.5, H
CO3 20, Cl 98, Ca 13, P 2.8, Mg 2.1. Which malignancy is not associa
ted with her condition?
Squamous cell carcinoma of lung
Small cell carcinoma of lung
CA breast
Renal cell carcinoma
Multiple myeloma
46
A Thai female, 45 years old with poorly controlled T2DM, came to hos
pital due to marked tender at her calf for 2 day. She had low graded f
ever for 3 days and then the calf is swelling with warmth. The physica
l exam is swelling at left thigh with signs of inflammation without fluc
tuation or blebs. Theres no rash and petechiae/ecchymosis. Homans
sign positive. She was sent for X-ray leg AP, lateral which reveals no
abnormality. What is the next step of investigation?
U/S calf
U/S Doppler left leg
MRI leg
Serum CPK
Give Ceftriaxone 2gm IV OD without further investigation
47
A Thai male, 35 years old, came to
hospital due to acute febrile illness for
2 day. She went to Jantaburi district wi
th hiking in the mountain. The physical
exam is BP 122/89, PR 89, RR 12, not p
ale, no jaundice, no pitting, lung clear,
hyperpigmented ulcerated wound as s
hown, otherwise unremarkable. What i
s the most appropriate management?
Admit and IV doxycycline
Admit and oral doxycycline
Admit and IV ceftriaxone
OPD treatment with oral doxycycline
OPD treatment with oral augmentin
48
The Thai male patient, 57 years old with COPD, admitted for 3
weeks with ventilator associated pneumonia. The sputum cult
ure is Acinetobacter baumannii MDR. He was given meropene
m combine with colistins for 14 days, then he had watery diarr
hea without bloody discharge for 3 days What is not the most
appropriate treatment?
Start metronidazole
Start clindamycin
Prolong BD drip per feed
Decrease concentrate of BD feed
Give ORS oral
49
The Thai male patient, 47 years old with T2DM/
HT/DLP and smoking 30 pack year, came to hos
pital due to chest pain at left side for one hour.
The pain is dull aching without referring to anot
her site, aggravated by exertion and not better
when rest. He had a history of left hemiparesis
and was diagnosed for lacunar infarction at righ
t basal ganglion 1 month ago, V/S is BP 86/56, P
R 68, RR 14, lung clear both. EKG is as shown b
elow. What is the most appropriate managemen
t?
Start streptokinase IV drip
Give enoxaparin, ASA gr V, Plavix 4 tabs and admit
for the treatment of NSTE-ACS
Call PCI team emergency
Start Dopamine and wait until V/S stable for PCI team
NSS IV loading and start streptokinase IV drip
50
The Thai female patient, 27 years old, was diagnosed as
Gestational diabetes. She came to your OPD 2 months
after normal labor. What is the most appropriate investi
gation for evaluation of overt DM in this patient?
75 gm OGTT
50 gm OGTT
FBS
HbA1c
No need for investigation
51
A Thai male, 75 years old, came to hospital due to severe LLQ pain fo
r 2 days. The pain is sharp shooting referring to back. The pain is not
better when he rests. He developed low graded fever 1 days and had
severe nausea and vomiting. He had watery diarrhea without bloody
discharge. The physical exam is BP 110/80, PR 120, RR 16, not pale,
no jaundice, no pitting, lung clear, LLQ tender with rebound and guar
ding, otherwise unremarkable. What is the most likely diagnosis?
Acute gastroenteritis
Acute pyelonephritis
Acute cystitis
Renal abscess
Acute diverticulitis
52
A Thai male, 65 years old, came to hospital due to abdominal bloating fo
r 5 days. He complained generalized abdominal pain for 3 days with low
graded fever. He couldnt eat and defecation. Yesterdays, he vomited fo
r 5 times and had worsening abdominal pain. The physical exam is BP 9
0/60, PR 140, RR 16, not pale, no jaundice, no pitting, lung clear, genera
lized tender without rebound and guarding, marked distended abdomen
, otherwise unremarkable. What is the most appropriated investigation?
Film acute abdomen
U/S acute abdomen
EKG 12 leads
CT whole abdomen
Barium enema
53
The 57-year-old male patient was diagnosed for double vessel dis
ease. He was recently performed PCI with stent insertion at Right
coronary artery and Left circumflex artery. The echocardiogram
was performed and the result is LVEF 37% with inferior and later
al wall hypokinesia. He was sent to your OPD after PCI was succe
ss. Which medication do not decrease mortality in this patient?
Bisoprolol
Aspirin
Enalapril
Isosorbide dinitrate
Simvastatin