Free Trial Exam - Palverum Medical Exams

1

Rett syndrome is characterised by:

Neurology Pediatric Neurology

A. Developmental delay from birth

B. Affects males only

C. Chorea and cognitive decline

D. Progressive muscle weakness

E. Normal early development followed by regression with loss of hand use and stereotyped hand movements

2

Clinical Context
A 26-year-old man, recent immigrant from Nepal, with type 1 diabetes mellitus, no childhood vaccinations. PPD test showed 12 mm induration. No TB symptoms (no fever, cough, night sweats, or haemoptysis).
An x-ray of the chest is shown. Which of the following is the most appropriate next step in management?
Note: This patient's chest x-ray does not show any abnormalities that suggest active pulmonary tuberculosis (TB).

Internal Medicine Infectious Diseases

A. Administer isoniazid and rifapentine for 3 months

B. Collect sputum sample for culture

C. Administer rifampin and isoniazid for 2 months

D. No further management is indicated

E. Obtain CT scan of the chest

3

Lightning strike injury is characterised by:

Emergency Medicine Environmental Emergencies

A. Burns only

B. Cardiac arrest only

C. Neurological injury only

D. Cardiac and respiratory arrest, burns, and neurological injury

E. Local pain only

4

Massive pulmonary embolism is characterised by:

Emergency Medicine Respiratory Emergencies

A. Pleuritic pain and haemoptysis only

B. Fever and productive cough

C. Wheeze and dyspnoea

D. Haemodynamic instability with acute right heart failure

E. Chest pain with ST elevation

5

Patient Information
Age: 32 years | Gender: M | Prior Health: Previously healthy
Chief Concern:
1-week history of upper back pain, dyspnea, and a sensation of pressure in his chest
History:
No palpitations, fevers, or chills
Emigrated from Ecuador when he was 5 years old
Does not smoke or drink alcohol
Takes no medications
Temp Pulse Resp Ht Wt BMI
37.2°C (99.0°F) 73/min 15/min 194 cm (6 ft 4 in) 70.3 kg (155 lb) 19 kg/m²
BP — Right Arm BP — Left Arm
152/86 mmHg 130/72 mmHg
Pulmonary examination shows faint inspiratory wheezing bilaterally.
A CT scan of the chest with contrast is shown. Which of the following is the most likely underlying cause of this patient's condition?
Note: This axial CT shows an ascending aortic aneurysm.

Temp	Pulse	Resp	Ht	Wt	BMI
37.2°C (99.0°F)	73/min	15/min	194 cm (6 ft 4 in)	70.3 kg (155 lb)	19 kg/m²

BP — Right Arm	BP — Left Arm
152/86 mmHg	130/72 mmHg

Internal Medicine Cardiology

A. Infection with Trypanosoma cruzi

B. Cystic medial necrosis

C. Large-vessel vasculitis

D. Atherosclerotic plaque formation

E. Congenital narrowing of the aortic arch

6

Patient Information
Age: 44 years | Gender: M | Site of Care: Office (routine health maintenance)
Chief Concern:
Whitish lesions recently appeared on his tongue — painless but "look weird"
History:
No history of serious illness, no medications
Sexually active with one female and two male partners in the past year — inconsistent condom use
Immunizations up-to-date
Does not smoke or drink alcohol
10 years ago: one-time experimentation with intravenous drugs
HIV antibody test CD4+ count Hepatitis B & C serology
Positive 380/mm³ Negative
Vital signs within normal limits. A photograph of his mouth is shown. The lesions are nontender and do not come off when scraped with a tongue blade. The remainder of the examination shows no abnormalities. In addition to initiating combined antiretroviral therapy, which of the following is the most appropriate next step in management of the oral lesions?

HIV antibody test	CD4+ count	Hepatitis B & C serology
Positive	380/mm³	Negative

Internal Medicine Infectious Diseases

A. Intralesional chemotherapy — علاج كيميائي داخل الآفة

B. Topical nystatin therapy — علاج موضعي بالنيستاتين

C. Surgical excision — استئصال جراحي

D. Oral clobetasol therapy — علاج بالكلوبيتازول الفموي

E. No additional management is indicated — لا يلزم تدبير إضافي

7

A 22-year-old woman is brought to the emergency department after sustaining multiple traumatic injuries. She has a penetrating injury near the right orbit and an abdominal wound with active bleeding. On arrival, she is obtunded, with SpO₂ 70%, heart rate 180/min, and blood pressure 70/50 mmHg. Examination reveals a distended abdomen, absent breath sounds on the right, and a pulsatile femoral hematoma. Which of the following interventions should be performed first for proper management of this patient?

Emergency Medicine Trauma & Injuries

A. Administer a 1-liter bolus of crystalloid intravenous fluids while deferring definitive airway management in a patient with severe hypoxemia and hemodynamic instability.

B. Secure the airway immediately with rapid-sequence endotracheal intubation to support oxygenation and ventilation in a patient with severe hypoxemia and altered mental status.

C. Perform immediate needle thoracostomy on the right side to relieve tension pneumothorax before addressing the airway in a patient with absent breath sounds and hypoxemia.

D. Proceed to immediate exploratory laparotomy to control intra-abdominal hemorrhage without first securing the airway in a patient with hemodynamic instability.

E. Apply direct pressure to the femoral hematoma to control external bleeding while delaying airway management in a patient with severe hypoxemia and altered mental status.

8

Reverse triage in disasters means:

Emergency Medicine Disaster and Field Medicine

A. Always treat the most severely injured first

B. Treating the apparently dead first in specific situations like lightning and drowning

C. Treating the least injured first

D. Delaying treatment for all patients

E. Always treating children first

9

Brown-Sequard syndrome from hemisection of the spinal cord causes:

Neurology

A. Ipsilateral loss of proprioception

B. Contralateral loss of proprioception

C. Ipsilateral loss of pain and temperature

D. Contralateral muscle wasting

E. Bilateral paralysis only

10

Adrenal crisis is characterised by:

Emergency Medicine Endocrine Emergencies

A. Hypertension and hyperglycaemia

B. Hypercalcaemia and hypophosphataemia

C. Hypernatraemia and hypokalaemia

D. Severe hypotension, hyponatraemia, hyperkalaemia, and hypoglycaemia

E. Hypercalcaemia and hypotension