National Health Regulatory Authority Licensure Examination (NHRA Bahrain) · Clinical Medicine And Surgery

Internal Medicine, Cardiology and Pulmonology

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

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Random questions from this topic, one at a time. You see the answer and the explanation straight after each one.

All 31 questions

  1. A 58-year-old male presents with crushing substernal chest pain radiating to his left jaw for 45 minutes. His ECG reveals 3 mm ST-segment elevations in leads II, III, and aVF. Which coronary artery is…
  2. A 64-year-old female with long-standing hypertension presents with sudden dyspnea and orthopnea. Examination reveals bilateral basilar crackles, an S3 gallop, and jugular venous distention. What is th…
  3. A 42-year-old female presents with fatigue, cold intolerance, weight gain, and constipation. Laboratory evaluation reveals an elevated TSH of 14.2 mIU/L and a low free T4. What is the most appropriate…
  4. A 68-year-old male with a 40 pack-year smoking history presents with progressive dyspnea and chronic morning cough. Spirometry demonstrates an FEV1/FVC ratio of 0.58 post-bronchodilator. What diagnost…
  5. A 32-year-old male presents with acute severe headache, neck stiffness, and fever of 39.1 degrees C. Physical examination demonstrates a positive Kernig sign. Lumbar puncture reveals cloudy CSF with o…
  6. A 52-year-old male with type 2 diabetes presents for routine follow-up. Blood pressure is 148/92 mmHg on two separate visits. Urinalysis demonstrates microalbuminuria (albumin-to-creatinine ratio 180…
  7. A 72-year-old female presents with sudden onset of right-sided hemiparesis and expressive aphasia that started 75 minutes ago. Her non-contrast head CT shows no hemorrhage or acute demarcation. Blood…
  8. A 45-year-old male presents with recurrent episodes of severe epigastric burning pain that awakens him at night and improves temporarily after eating. Stool antigen test confirms Helicobacter pylori i…
  9. A 30-year-old female with Graves' disease presents with fever, tachycardia of 145 bpm, profuse diaphoresis, delirium, and nausea after an untreated dental infection. What endocrine emergency does this…
  10. A 60-year-old male with cirrhosis and ascites presents with diffuse abdominal pain, fever, and mild confusion. Paracentesis demonstrates cloudy fluid with an absolute neutrophil count of 380 cells/mm^…
  11. A 50-year-old male with chronic alcoholism presents with tremor, agitation, visual hallucinations, diaphoresis, and hypertension 48 hours after his last drink. What is the first-line medication class…
  12. A 24-year-old female presents with malar rash, photosensitivity, arthralgias in both wrists, and painless oral ulcers. Laboratory tests show ANA positive at 1:640 (speckled) and anti-double-stranded D…
  13. A 65-year-old male presents with painless gross hematuria. He has a 35 pack-year smoking history. Physical examination is unremarkable. What is the most appropriate next diagnostic evaluation?
  14. A 35-year-old male presents with recurrent episodes of palpitations, episodic headaches, and profuse perspiration. Blood pressure during the episode is 210/115 mmHg. Twenty-four-hour urine testing rev…
  15. A 70-year-old male smoker presents with hemoptysis, cough, and anorexia. Chest CT reveals a central hilar mass, and laboratory studies show serum sodium 118 mmol/L with low serum osmolality and high u…
  16. A 28-year-old male with human immunodeficiency virus (HIV) and a CD4 count of 85 cells/microL presents with progressive exertional dyspnea, nonproductive cough, and fever. Chest radiography reveals bi…
  17. A 48-year-old female presents with jaundice, pruritus, and dark urine. Serum alkaline phosphatase and GGT are markedly elevated. Antimitochondrial antibodies (AMA) are positive at 1:160. What chronic…
  18. A 55-year-old male with chronic kidney disease stage 4 develops weakness. ECG reveals tall, peaked T waves with a narrow base in the precordial leads and PR prolongation. Serum potassium is 6.9 mmol/L…
  19. A 62-year-old female presents with acute pain, redness, and swelling of the first metatarsophalangeal (MTP) joint. Arthrocentesis demonstrates cloudy synovial fluid with negatively birefringent needle…
  20. A 38-year-old female presents with tingling in her hands and feet, muscle cramps, and a positive Chvostek sign following total thyroidectomy. What electrolyte disturbance is responsible?
  21. A 50-year-old male with heavy alcohol consumption presents with severe epigastric pain radiating to his back, accompanied by persistent vomiting. Serum lipase is 1,450 U/L (reference < 60 U/L). What i…
  22. A 63-year-old male with persistent atrial fibrillation has a CHA2DS2-VASc score of 4 (hypertension, age 65, diabetes). What is the recommended long-term antithrombotic management?
  23. A 40-year-old male presents with recurrent nephrolithiasis. Serum calcium is elevated at 2.85 mmol/L (11.4 mg/dL), serum phosphorus is low at 0.65 mmol/L, and intact PTH is elevated at 110 pg/mL. What…
  24. A 34-year-old female presents with double vision and eyelid drooping worsening toward the evening. Repetitive nerve stimulation shows a decremental response, and anti-acetylcholine receptor (AChR) ant…
  25. A 29-year-old male with chronic intermittent bloody diarrhea and tenesmus undergoes colonoscopy. Examination demonstrates continuous mucosal inflammation, erythema, and superficial ulcerations extendi…
  26. A 67-year-old male with type 2 diabetes and hypertension presents with macrocytic anemia (hemoglobin 8.8 g/dL, MCV 112 fL). Peripheral smear reveals hypersegmented neutrophils. Neurological examinatio…
  27. A 56-year-old male presents with acute crushing chest pain, dyspnea, and diaphoresis. ECG demonstrates 2.5 mm ST-segment elevation in leads V1 through V4. Vital signs: BP 86/50 mmHg, HR 118 bpm. Bilat…
  28. A 68-year-old female presents with 3 hours of acute right-sided hemiplegia and expressive aphasia. Blood pressure is 178/98 mmHg. Non-contrast head CT rules out intracranial hemorrhage and shows early…
  29. A 45-year-old male with decompensated alcoholic cirrhosis presents with massive upper GI bleeding. After airway protection and crystalloid resuscitation, what is the standard initial pharmacotherapy p…
  30. A 32-year-old female presents with progressive muscle weakness, diplopia, and ptosis that worsens toward the evening and improves after rest. Repetitive nerve stimulation testing reveals decremental m…
  31. A 50-year-old male presents with recurrent nephrolithiasis, generalized bone pain, and fatigue. Serum calcium is 11.8 mg/dL, serum phosphate is 2.1 mg/dL, and intact parathyroid hormone (iPTH) is 145…

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