Qatar Healthcare Practitioner Licensing Exam (QCHP / DHP) · Clinical Medicine and Surgery

Internal Medicine and Emergency Therapeutics

109 practice questions, each with the answer and an explanation.

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All 109 questions

  1. A 62-year-old male with long-standing hypertension presents with crushing substernal chest pressure radiating to his left jaw. ECG reveals 3 mm ST-segment elevation in leads V1 through V4. What is the…
  2. A 54-year-old female presents to the emergency department with fever, right flank pain, and dysuria. Blood pressure is 82/50 mmHg, heart rate is 124 bpm, and serum lactate is 3.8 mmol/L. Following ini…
  3. A 70-year-old male with chronic obstructive pulmonary disease (COPD) presents with worsening dyspnea, increased sputum volume, and purulence. Arterial blood gas shows pH 7.31, PaCO2 58 mmHg, and PaO2…
  4. A 35-year-old woman presents with palpitations, heat intolerance, weight loss, and bilateral exophthalmos. Thyroid examination reveals a diffusely enlarged, non-tender goiter with an audible bruit. Wh…
  5. A 28-year-old type 1 diabetic is admitted with nausea, vomiting, abdominal pain, and Kussmaul breathing. Laboratory findings reveal blood glucose 380 mg/dL, arterial pH 7.18, serum bicarbonate 10 mEq/…
  6. A 45-year-old male with alcohol use disorder presents with confusion, ataxia, and horizontal nystagmus. What medication must be administered parenterally BEFORE any intravenous dextrose infusion to pr…
  7. A 68-year-old male presents with sudden-onset right hemiparesis and expressive aphasia that began 2 hours ago. Non-contrast head CT scan rules out intracranial hemorrhage. Blood pressure is 165/95 mmH…
  8. A 50-year-old male with chronic hepatitis B cirrhosis presents with hematemesis and melena. Blood pressure is 88/54 mmHg, pulse is 118 bpm. What vasoactive pharmacologic agent should be initiated imme…
  9. A 42-year-old female presents with persistent fatigue, cold intolerance, constipation, and facial puffiness. Serum TSH is 18.5 mIU/L (elevated) and free T4 is 0.5 ng/dL (low). What is the appropriate…
  10. A 60-year-old male with chronic kidney disease stage 4 presents with severe generalized muscle weakness. ECG demonstrates tall, peaked, narrow T waves with a widened QRS complex. Serum potassium is 7.…
  11. A 24-year-old medical resident sustains a deep needle-stick puncture contaminated with blood from an untreated HIV-positive inpatient. What is the recommended post-exposure prophylaxis (PEP) protocol?
  12. A 72-year-old woman presents with sudden severe left-sided headache, pain over her scalp while brushing her hair, and jaw pain while chewing solid food (jaw claudication). ESR is 98 mm/hr. What immedi…
  13. A 48-year-old male with chronic hepatitis C cirrhosis presents with fever, generalized abdominal pain, and worsening ascites. Paracentesis yields cloudy peritoneal fluid. Analysis demonstrates an abso…
  14. Which anti-hyperglycemic drug class is strongly recommended by ADA/EASD guidelines for type 2 diabetic patients with established atherosclerotic cardiovascular disease or heart failure, independent of…
  15. A 32-year-old male with persistent fever, weight loss, and night sweats is found to have generalized painless rubbery lymphadenopathy. Excisional cervical lymph node biopsy demonstrates large multinuc…
  16. A 58-year-old male presents with acute severe tearing chest pain radiating straight through to his mid-scapular back. Blood pressure is 185/105 mmHg in the right arm and 140/85 mmHg in the left arm. H…
  17. A 23-year-old college student presents with high fever, severe headache, photophobia, and neck stiffness. Lumbar puncture reveals opening pressure 280 mm H2O, WBC 2,800/mm^3 (92% neutrophils), glucose…
  18. What is the first-line pharmacologic treatment for community-acquired Legionnaires' disease (Legionella pneumophila pneumonia)?
  19. A 65-year-old male with persistent non-valvular atrial fibrillation has a CHA2DS2-VASc score of 4 (hypertension, age 65-74, diabetes mellitus, vascular disease). What is the recommended strategy for l…
  20. A 52-year-old male presents with recurrent episodes of nocturnal bronchospasm, chronic dry cough, hoarseness, and water brash. Upper endoscopy reveals linear mucosal breaks in the distal esophageal mu…
  21. A 36-year-old female presents with symmetric polyarthritis involving the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of both hands, morning stiffness lasting > 1 hour, and subc…
  22. A 29-year-old woman presents with severe bloody diarrhea, tenesmus, and cramping abdominal pain. Colonoscopy reveals continuous mucosal inflammation with diffuse erythema, friability, and superficial…
  23. A 64-year-old male smoker presents with painless gross hematuria throughout urination. Urine culture is negative. What is the mandatory next step in the diagnostic investigation to rule out transition…
  24. A 74-year-old female presents with progressive memory loss, spatial disorientation, and difficulty managing finances over the past 2 years. Physical examination is non-focal. Non-contrast brain MRI de…
  25. A 30-year-old woman with Systemic Lupus Erythematosus (SLE) presents for routine follow-up. Urinalysis reveals 3+ protein and red blood cell casts. 24-hour urine protein is 2.8 g. Serum creatinine is…
  26. What is the first-line oral medical treatment for a patient diagnosed with uncomplicated primary Raynaud's phenomenon refractory to non-pharmacologic cold-avoidance measures?
  27. A 54-year-old male presents with acute substernal chest pressure. ECG demonstrates 3 mm ST elevation in leads II, III, and aVF with clear lungs and BP 82/50 mmHg. After receiving 0.4 mg sublingual nit…
  28. A 67-year-old female with chronic kidney disease (baseline eGFR 28 mL/min) is admitted for severe community-acquired pneumonia. Arterial blood gas on room air reveals: pH 7.22, PaCO2 25 mmHg, HCO3- 10…
  29. A 42-year-old male is brought to emergency after a motorcycle collision with blunt chest trauma. BP is 78/48 mmHg, heart rate 132 bpm, neck veins distended, breath sounds bilateral and equal. FAST exa…
  30. A 35-year-old diabetic male develops sudden severe left lower leg pain, erythema, and marked crepitus within 18 hours of a contaminated puncture wound. Radiographs show soft tissue gas tracking along…
  31. A 60-year-old male with long-standing cirrhosis is admitted with hematemesis. Pulse is 118 bpm, BP 88/54 mmHg. After initiating volume resuscitation and octreotide infusion, emergent upper endoscopy r…
  32. A patient has serum sodium 140 mmol/L, chloride 100 mmol/L and bicarbonate 24 mmol/L. What is the anion gap?
  33. A patient has serum sodium 138 mmol/L, chloride 98 mmol/L and bicarbonate 14 mmol/L. What is the anion gap?
  34. A patient has serum sodium 135 mmol/L, chloride 95 mmol/L and bicarbonate 10 mmol/L. What is the anion gap?
  35. A patient has serum sodium 142 mmol/L, chloride 104 mmol/L and bicarbonate 22 mmol/L. What is the anion gap?
  36. A patient has serum sodium 145 mmol/L, chloride 100 mmol/L and bicarbonate 12 mmol/L. What is the anion gap?
  37. A patient has serum sodium 136 mmol/L, chloride 96 mmol/L and bicarbonate 16 mmol/L. What is the anion gap?
  38. A patient's total serum calcium is 7.0 mg/dL with albumin 2.0 g/dL. What is the corrected calcium (add 0.8 mg/dL per 1 g/dL that albumin is below 4 g/dL)?
  39. A patient's total serum calcium is 7.5 mg/dL with albumin 3.0 g/dL. What is the corrected calcium (add 0.8 mg/dL per 1 g/dL that albumin is below 4 g/dL)?
  40. A patient's total serum calcium is 6.8 mg/dL with albumin 2.5 g/dL. What is the corrected calcium (add 0.8 mg/dL per 1 g/dL that albumin is below 4 g/dL)?
  41. A patient's total serum calcium is 8.0 mg/dL with albumin 3.5 g/dL. What is the corrected calcium (add 0.8 mg/dL per 1 g/dL that albumin is below 4 g/dL)?
  42. A patient's total serum calcium is 7.2 mg/dL with albumin 1.5 g/dL. What is the corrected calcium (add 0.8 mg/dL per 1 g/dL that albumin is below 4 g/dL)?
  43. A patient in the emergency department has blood pressure 120/80 mmHg. What is the mean arterial pressure?
  44. A patient in the emergency department has blood pressure 90/60 mmHg. What is the mean arterial pressure?
  45. A patient in the emergency department has blood pressure 150/90 mmHg. What is the mean arterial pressure?
  46. A patient in the emergency department has blood pressure 100/50 mmHg. What is the mean arterial pressure?
  47. A patient in the emergency department has blood pressure 130/70 mmHg. What is the mean arterial pressure?
  48. A patient in the emergency department has blood pressure 84/48 mmHg. What is the mean arterial pressure?
  49. A 60-year-old man weighs 70 kg and has serum creatinine 1.2 mg/dL. Using Cockcroft-Gault, what is his estimated creatinine clearance (mL/min)?
  50. A 70-year-old man weighs 60 kg and has serum creatinine 1.0 mg/dL. Using Cockcroft-Gault, what is his estimated creatinine clearance (mL/min)?
  51. A 50-year-old man weighs 80 kg and has serum creatinine 1.0 mg/dL. Using Cockcroft-Gault, what is his estimated creatinine clearance (mL/min)?
  52. A 40-year-old man weighs 75 kg and has serum creatinine 0.9 mg/dL. Using Cockcroft-Gault, what is his estimated creatinine clearance (mL/min)?
  53. A 80-year-old man weighs 55 kg and has serum creatinine 1.1 mg/dL. Using Cockcroft-Gault, what is his estimated creatinine clearance (mL/min)?
  54. Serum sodium is 140 mmol/L, glucose 180 mg/dL and urea nitrogen 28 mg/dL. What is the calculated serum osmolality?
  55. Serum sodium is 135 mmol/L, glucose 90 mg/dL and urea nitrogen 14 mg/dL. What is the calculated serum osmolality?
  56. Serum sodium is 150 mmol/L, glucose 360 mg/dL and urea nitrogen 56 mg/dL. What is the calculated serum osmolality?
  57. Serum sodium is 130 mmol/L, glucose 540 mg/dL and urea nitrogen 28 mg/dL. What is the calculated serum osmolality?
  58. Serum sodium is 142 mmol/L, glucose 108 mg/dL and urea nitrogen 42 mg/dL. What is the calculated serum osmolality?
  59. A patient weighs 70 kg and is 1.75 m tall. Which BMI category does this place the patient in?
  60. A patient weighs 85 kg and is 1.80 m tall. Which BMI category does this place the patient in?
  61. A patient weighs 60 kg and is 1.60 m tall. Which BMI category does this place the patient in?
  62. A patient weighs 95 kg and is 1.70 m tall. Which BMI category does this place the patient in?
  63. A patient weighs 50 kg and is 1.65 m tall. Which BMI category does this place the patient in?
  64. A 58-year-old man has crushing chest pain, and the ECG shows ST elevation in V1-V4. Which artery is most likely occluded?
  65. A patient with a confirmed STEMI is allergic to aspirin. Which drug class is the standard alternative antiplatelet loading option at this stage?
  66. Which finding is the hallmark of diabetic ketoacidosis on arterial blood gas?
  67. A patient with diabetic ketoacidosis has a serum potassium of 2.9 mmol/L. What should be done before starting insulin?
  68. What is the first-line treatment for anaphylaxis?
  69. A patient has atrial fibrillation with a rapid ventricular rate and is haemodynamically unstable. What is the management?
  70. Which anticoagulant is preferred for stroke prevention in non-valvular atrial fibrillation according to current guidelines?
  71. A patient has pulmonary embolism with haemodynamic collapse. Which treatment is indicated?
  72. What is the first-line treatment of an acute asthma exacerbation in the emergency department?
  73. Which test is best to confirm a diagnosis of Helicobacter pylori infection before eradication therapy?
  74. A cirrhotic patient with ascites develops fever and abdominal pain. Ascitic fluid shows more than 250 neutrophils per microlitre. What is the diagnosis?
  75. Which drug is used first-line to reduce the risk of recurrent hepatic encephalopathy?
  76. A patient presents with haematemesis from oesophageal varices. Which drug is started early to lower portal pressure?
  77. What is the most common cause of community-acquired pneumonia in adults?
  78. Which scoring system is commonly used to assess severity of community-acquired pneumonia and guide admission?
  79. A patient with a COPD exacerbation has pH 7.28 and pCO2 70 mmHg. What is the preferred respiratory support?
  80. Which investigation is first-line to evaluate suspected heart failure in a primary care setting?
  81. Which drug class improves mortality in heart failure with reduced ejection fraction?
  82. A patient has hyperkalaemia of 7.2 mmol/L with peaked T waves. What is the first intervention?
  83. Which electrolyte disturbance causes a prolonged QT interval and torsades de pointes when severe?
  84. A patient has severe hyponatraemia (110 mmol/L) with seizures. What is the initial treatment?
  85. What is the most likely diagnosis in a young woman with weight loss, tremor, heat intolerance and a diffuse goitre with exophthalmos?
  86. Which drug is used to treat hyperthyroidism in Graves disease and can cause agranulocytosis?
  87. What is first-line pharmacological treatment for type 2 diabetes in most adults without contraindications?
  88. Which finding would stop metformin therapy?
  89. Which HbA1c result is diagnostic of diabetes mellitus according to standard criteria?
  90. Which sign suggests adrenal crisis?
  91. A 25-year-old presents with sudden painless loss of vision in one eye and a cherry-red spot at the macula. What is the diagnosis?
  92. Which feature distinguishes ischaemic stroke from haemorrhagic stroke on first imaging?
  93. Within what time window can intravenous alteplase be given for an acute ischaemic stroke in standard guidelines?
  94. What is the most common cause of bacterial meningitis in adults?
  95. What is the first step when meningitis with meningococcal rash is suspected in primary care?
  96. What antibiotic is first-line for uncomplicated cystitis in a non-pregnant woman?
  97. A patient with iron deficiency anaemia and no obvious cause is 62 years old. What is the key investigation?
  98. Which vitamin deficiency causes megaloblastic anaemia with neurological symptoms such as subacute combined degeneration?
  99. Which drug is the first-line treatment of hypertension in a black patient under 55 according to many guidelines?
  100. Which class of antihypertensive is contraindicated in pregnancy?

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