Diplomat Board of Family Medicine 2024-B

A 52-year-old woman present with new onset central compressing chest pain along with nausea and vomiting. Pain is continuous from last 30 minutes. Her BP is 110/70 and pulse 90/minute. ECG shows QRS complexes in V1 and V 6 as follows. One of her ECG done one month ago does not show these changes. What will be your action plan?

You visit a 72-year-old woman comes to you with severe central chest pain radiating into her left arm for the past two hours. She has a history of hypertension and hypercholesterolemia. Her regular medications are amlodipine and simvastatin. Her BP is 169/93 mmHg, and her heart rate is 118 bpm. Her ECG shows ST segment elevation in lead I, aVL and V5, V6. You give her 300mg of aspirin and decide to call an ambulance. Which of the following medicines will you add next?

A 58-year-old man returns to your surgery for a consultation with the results of his recent ambulatory blood pressure monitoring (ABPM). His average reading was 152/96. What is the best treatment for this patient?

A 49-year-old man presented with high grade dyspnea, pounding of heart and chest pain since last six month. His pulse is irregular and 140 per minute. Long lead II on ECG show What will be your plan regarding heart rate?

A 12-year-old girl presents to the surgery. She reports being unwell for the past 2 weeks. Initially she had a sore throat, but she is now experiencing joint pains intermittently in her knees, hips and ankles. On examination there are some pink, ring-shaped lesions on the trunk and occasional jerking movements of the face and hands. What is the most likely diagnosis?

A 52-year-old woman known diabetic and has been diagnosed to have stable angina previously. Her chest pain was well managed on oral medication. Now she presents sudden shortness of breath and orthopnea for the last two months. She does not complain of chest pain. Fine crackles are audible in both lungs’ basis. What will be most specific test to make the diagnosis of heart failure?

A 47-year-old man presents with palpitations. He had been drinking heavily over the past few nights. His heart rate is about 150 beats per minute and his rhythm is irregularly irregular. What is the most likely diagnosis?

A 26-year-old man was diagnosed to have type 1 diabetes mellitus at age of 12 years. He is worried about getting heart attack and requests you to start Lipid lowering drug. How many years after diagnosis of type 1 diabetes mellitus should Statins be started?

A 39-year-old man present with newly onset continuous central chest pain which started 30 minutes ago. Pain is compressing in nature along with nausea and sweating. ECG show ST elevation in chest leads. Which medicine will you offer in GP clinic before referring to emergency?

A 70-year-old hypertensive patient presents to your clinic for a follow up. He is taking Amlodipine 10 mg daily, and his BP is still 160/100mm Hg. According to NICE guidelines, which is the most appropriate antihypertensive drug to be added to his prescription?

A 40-year-old woman came to you with complaints of body aches, weight loss, weakness and dizziness when getting up from a sitting position. She also reported gradual darkening of her skin complexion over one year. Her BP is 90/60 mmHg and there are black patches inside the mouth. Rest of examination is unremarkable. What is the most likely diagnosis for this patient?

A 70-year-old female presents with complaints of increasing low mood, lethargy, weight gain, and constipation for the last six months. Her TSH level is: 20.8 mU/l (0.45 and 4.5 mU/l) & Free T4 is: 4.2 pmol/l (FT4: 12.0 - 22.0 pmol/L). According to NICE guidelines, what would be the most appropriate initial dose of levothyroxine therapy for this patient?

A 27-year-old girl present with TSH was 22 mIU/L (0.27 --- 4.2 mu/L) which was done as part of medical check-up for a new job. She has no symptoms. Her anti thyroid peroxidase antibodies are positive. What is the single most likely diagnosis?

A 40-year-old woman presented with body aches, weight loss, postural hypotension, and dark pigmentation on her skin. Her short Synacthen test shows (Synthetic ACTH)- < 400 nmol/L (normal values- > 600 nmol/L) How do you manage this patient on a long-term basis?

A 35-year-old woman presented with tiredness, weight gain, body aches, easy bruising and menstrual disturbances for the last six months. Her BMI is 32 kg/m2, and her blood pressure is 170/100 mm Hg. Her face is round and hairy, and she has purplish linear marks on her abdomen. Her Fasting blood sugar is 120 mg/dl. What would be the most likely diagnosis in this case?

A 52-year-old man presents to your clinic, concerned about having diabetes. He reports body aches and increased urination. His labs show FBG at 130 mg/dL and RBG at 210 mg/dL. According to NICE guidelines, what would be the target of HbA1c for this patient?

A 55-year-old diabetic man presents with persistently elevated blood glucose levels despite lifestyle modification measures for the past three months. His fasting blood sugar (FBS) is 140 mg/dL, and his HbA1c is 7.1%. His BMI is 25 kg/m2 What is the most appropriate first-line drug treatment for him?

A 38-year-old diabetic and hypertensive man comes to you for follow-up. He is taking Metformin 1g BD, Lisinopril 10mg daily. He has blood glucose fasting of 130mg/dl, random blood glucose of 280mg/dl and HbA1c of 7.8%. His brother had a myocardial infarction at the age of 42 years. According to NICE guidelines, which is the most appropriate oral hypoglycemic medication to reduce cardiovascular risk?

A 55-year-old man with type 2 diabetes mellitus is reviewed in your clinic. He has been taking optimal doses Metformin and Sitagliptin. His fasting blood glucose is 160 mg/dl and HbA1c is 8%. His BMI is 35 Kg/M2. He has difficulty in brisk walking due to knee pain. What will be the most appropriate drug to be added to his prescription?

A 62-year-old woman with type 2 diabetes comes for a follow-up. Despite taking optimal Metformin, Sitagliptin and Empagliflozin, her latest HbA1c is 9.2%, She is compliant with her medication and following a healthy lifestyle. Which of the following would be the most appropriate initial insulin treatment for her?

A 29-year-old man known cases of asthma presents with severe cough and wheezing for the last three weeks and wakes up two times a week due to his symptoms. His symptoms are uncontrolled on short-acting beta-2 agonist on as required basis. What is the single most appropriate medicine to be added to his prescription?

A 54-year-old obese woman presents with shortness of breath. She lives in a village and has been cooking food for family on woodfire. Chest auscultation is unremarkable. Spirometry shows an obstructive pattern with no reversibility to bronchodilators. What would be the most likely diagnosis in this patient?

A 45-year-old obese woman presents with a sudden onset of shortness of breath which started while sitting in the waiting area for three hours. Her BP is 100/70 mm Hg, Heart rate is 120 bpm, RR is 24 /min and chest examination is normal. Her chest X-ray is reported normal. What is the single most likely diagnosis?

A 20-year-old boy presents with episodic cough and shortness of breath for the last two years. His cough is more in the early morning and during exercise. He does not have fever or weight loss. What is the single most appropriate diagnostic test at this stage?

A 45-year-old woman presents to the clinic with complaints of eye pain, joint pain, weight loss, fatigue, persistent dry cough, and shortness of breath for the last three months. Upon examination, she has tender red nodules on her shins and enlarged lymph nodes in her neck. A chest X-ray reveals bilateral hilar lymphadenopathy. What would be the most likely diagnosis?

A 19-year-old boy has been brought by his father to your clinic for evaluation. The boy complains of cough and shortness of breath off and on since 6 months. His father wants you to confirm the diagnosis of asthma as many of his cousins are also suffering from asthma. You advised spirometry which shows: FEV1 = ↓↓ FVC = ↓ FEV1/FVC = 0.3 (0.75 to 0.80) What is the most appropriate interpretation of this PFT?

A 50-year-old man presented to you with productive cough, hemoptysis and progressive weight loss for the last 6 months. He smokes 30 cigarettes every day. CXR shows widened mediastinum. What is the most likely diagnosis of this patient?

A 51-year-old diabetic and hypertensive man presents with shortness of breath, hemoptysis & progressive weight loss for the last 6 months. He smokes 30 cigarettes every day & his diet has not been as adequate as before. CT scan shows lymph node involvement & multiple apical lung lesions suggestive of malignancy. Which of the following is the primary risk factor for lung cancer?

A 25-year-old schoolteacher presents with nausea, vomiting, anorexia, aversion to her usual 2 packs a day tobacco habit, and right upper quadrant pain. She has been sick for the past 3 days. Two of the students in her class have come down with similar symptoms. She looks acutely ill. Her pulse is 100/min, BP 110/70, respirations 18, temperature 101⁰F. Her sclera is icteric, her liver edge is tender. What is the most likely diagnosis in this patient based on epidemiological situation of Pakistan?

24-year-old patient presents with constipation, abdominal pain, bloating & feeling of incomplete evacuation for last 2 year. Symptoms increased during her exams. Examination & investigations are insignificant. What is the single most appropriate choice for her constipation in this condition?

A 17-year-old boy presents with a 10-month history of diarrhea, abdominal distension and flatulence. He denies Malena, rectal bleeding and fever. He has lost 4 kg in weight unintentionally over the past 10 months. His symptoms are worse on eating wheat products and better on taking rice. His abdomen and rectal examinations are normal. What is definitive investigation to confirm this diagnosis?

A 25-year-old patient presents to your clinic complaining of 4-6 loose stool containing blood for the last six months. She also has painful red swelling on her shin. What is the most likely diagnosis?

A 40-year-old man presents with diarrhea since last 4 weeks. He had returned from a trek in Nepal 5 weeks ago. He had been drinking spring water and cooking foods up hills. He has also experienced abdominal cramping, bloating and excessive flatulence. He denies fever and blood in the stools. His stool examination shows Giardia Lamblia. What is the most appropriate drug for his condition?

You treated a 70-year-old man develops severe diarrhea and abdominal cramps after taking Co-Amoxiclav for his respiratory infection. His pulse is 100 BPM, BP is 110/80 mm Hg, and abdomen has mild generalized tenderness without guarding. Which is the most appropriate treatment for his diarrhoea?

A 45-year-old woman presents with a 3-month history of upper abdominal discomfort after meals, occasional nausea, and no alarm features (e.g., weight loss, dysphagia). She takes ibuprofen occasionally for knee pain. Examination is unremarkable. What is the next most appropriate step in management?

A 30-year-old man who is diagnosed case on anxiety disorder get his complete hepatitis B profile checked after surfing it from internet. One of his Lab results is positive. He came to you in panic as he thinks he has some hepatitis. His lab reports are as follows: Hep B c Ig G Negative Hep B e Ag Negative Hep B s Ab Positive Hep B s Ag Negative What is the best interpretation of his lab reports?

A 45-year-old man presents with heart burn, bloating on and off for the past few months. He denies any symptoms of bleeding, dysphagia, or weight loss. He does not consume alcohol, eats a balanced diet, and is not on any regular medication. Physical examination is unremarkable. What is the single most appropriate initial step in management?

A 40-year-old obese woman presents with constant dull pain in right-side of abdomen for past few hours. Pain increases on eating fatty foods and each episode lasts for less than 6 hours. There is mild tenderness in the right hypochondrium, and the pain radiates to back as well. Which one of the following is the best modality for initial evaluation?

A 52-year-old woman presents with fever, chills, dysuria, increased urinary frequency, and sharp pain in the right flank for the past 3 days. She appears pale, drowsy and disoriented, and has a positive right renal punch tenderness. Her blood pressure is 160/90 mmHg. What is the most appropriate step in management?

A 34-year-old man arrives at your clinic with a 2-hour history of intense right flank pain radiating toward his groin. He appears visibly distressed, clutching his side and shifting uncomfortably. His blood pressure 146/92 mmHg, heart rate 98 bpm, and temperature 37.2°C. Which analgesic will you give as first line in general practice?

A 45-year-old woman presents with swelling in her ankles, legs, eyes, and hands for the past 2 weeks. She reports that the swelling has progressively worsened, and she has also noticed foamy urine. Her blood pressure is 130/85 mmHg. Laboratory results show Albumin-creatinine ratio of 225mg/mmol, and urine dipstick positive for 3+ protein. What is the most likely diagnosis?

A 54-year-old man presents for an annual check-up. Routine urinalysis reveals 2+ blood on the dipstick test, which is confirmed by a urinalysis a week later. He denies urinary symptoms, abdominal pain, or history of trauma. His father died of bladder cancer 15 years ago. What is the appropriate initial diagnosis test?

A 12-year-old boy presents to your clinic with complaints of dark-colored urine that started a week ago. His mother reports that he recently recovered from a sore throat infection two weeks ago. On examination, his blood pressure is elevated to 150/92 mmHg. Urine exam shows RBC +++, protein +1, red cell casts and normal WBC. What is the most likely diagnosis?

A 27-year-old man attends a follow-up appointment after passing a kidney stone. Analysis of the stone reveals that it is composed of calcium oxalate. He reports drinking more than 3 liters of fluids daily and has a history of recurrent calcium oxalate stones. Which of the following is the most appropriate recommendation to help prevent further stone formation?

A 57-year-old diabetic man comes to you for review. He is taking Metformin 1 gram twice a day and Sitagliptin100mg once a day. You ordered an eGFR test to assess his renal function. At what level of eGFR level will you stop metformin altogether?

A 5-year-old child presents with blood report shows Hb = 8.5 g/dL, MCV = 70 fL (80 - 100 femtoliters), MCHC 25 pg/c (27 - 31 picograms/cell). What is the most appropriate treatment?

A 25-year-old woman presents with weakness and lethargy since last one year. She denies any other symptoms. Her nails are soft and flat and her conjunctiva are pale. Her laboratory tests reveal a hemoglobin of 10g/dL, MCV 70fL, MCV = 65 fL (80 - 100 femtoliters), MCHC 24 pg/c (27 - 31 picograms/cell). What is the most appropriate test to confirm the cause of anemia in this patient?

A 60-year-old male presents with pallor, shortness of breath, sore mouth, and numbness of the feet. He takes a lot of fresh fruits and vegetables. His neurological examination reveals a decreased sensation in his lower extremities. He underwent stomach surgery 5 years ago and avoids meet in any form. His lab results indicate Hb 9.5 g/dl, MCV 110 fL (80 - 100 femtoliters). Which one is the most appropriate supplement for him?

A 32-year-old woman presents to the clinic with complaints of fatigue, dizziness, and shortness of breath on exertion for the past two months. She also reports feeling cold and has brittle nails. On physical examination, conjunctival pallor and koilonychia (spoon-shaped nails) are noted. Her laboratory results are as follows: Hemoglobin: 9.8 g/dL (Normal: 12.0–15.5 g/dL) Mean Corpuscular Volume (MCV): 68 fL (Normal: 80–100 fL) Serum Ferritin: 8 ng/mL (Normal: 20–200 ng/mL) What is the most likely diagnosis?

A 25-year-old male, who is asymptomatic brings his blood report showing Hb = 9g/dl with microcytic, hypochromic red blood cells (RBCs). He has been taking ferrous sulfate tablets for the last 3 months. His diet includes an adequate intake of iron-rich foods, and there is no significant history of blood loss. What is the most likely reason for his anemia?

A 45-year-old woman presents to the emergency department with sudden onset of pleuritic chest pain, shortness of breath, and hemoptysis. She recently underwent surgery for a fractured hip 2 weeks ago. On examination, her heart rate is 110 beats per minute, respiratory rate is 22 breaths per minute, and oxygen saturation is 91% on room air. A chest X-ray is unremarkable. What is the most likely diagnosis?

A 45-year-old man presents with a 10-year history of recurrent small bump at right side of the anal canal that periodically becomes swollen with pain and discharges pus. After discharging pus, the swelling settles leaving a small punctum. What is the most likely diagnosis of this condition?

A mother seeks advice for her 6-year-old daughter, who has been experiencing diarrhea and abdominal distention for the past two years. The symptoms improve when she consumes rice and worsens when she consumes bread and bakery items. The child appears pale and also has angular stomatitis. What is the single most appropriate initial non-invasive test?

A 65-year-old male presents with fever, diarrhea and pain in the left side of his abdomen for the past two day. He has a chronic history of constipation and straining. On examination, there is tenderness in the left iliac fossa. He also has a fever of 102°F. What is the most likely diagnosis?

A 55-year-old man presents with a painless swelling in the right groin area since last 15 years. The swelling becomes more prominent when he stands and disappears on lying down. The swelling extends into the scrotum. What is the most likely diagnosis?

A 38-year-old woman, G4P2A1, presents for her monthly check-up at 25 weeks of gestation. She denies any symptoms. What is the single most appropriate diagnostic test for her condition?

A 2-year-old girl has been brought to your clinic with 3-day history of fever, runny nose, watery eyes and cough. Overnight, she developed a harsh barking cough. On examination, her temperature is 38°C and chest auscultation reveals conducted sounds. What is the most likely diagnosis?

A 2-year-old girl has been brought to your clinic with 3-day history of fever, runny nose, watery eyes and cough. Overnight, she developed a harsh barking cough. On examination, her temperature is 38°C and chest auscultation reveals conducted sounds. What is the single most effective treatment for this condition?

A mother brought her child to your clinic for a follow up. At what age would the average child acquire the ability to sit without support?

A 30-year-old woman attends her antenatal checkup at 24 weeks of pregnancy. You advise an OGTT, which reveals a fasting plasma glucose level of 126 mg/dL and a 2-hour plasma glucose level of 162 mg/dL. According to NICE guidelines, what is the most appropriate next step in management?

A 12-week pregnant presents as she came into contact with a child who has vesicular rash one week ago. She presents to your clinic with fever and vesicular rash all over her body since one day. What is the most appropriate management at this stage?

A 28-year-old woman comes in for her antenatal checkup at 24 weeks of pregnancy. She was diagnosed with mild gestational diabetes. You prescribe metformin, but she declines due to experiencing diarrhea as a side effect. According to NICE guidelines, what is the most appropriate next step in management?

A 55-year-old man presents in with fever, severe body aches, periorbital pain, bleeding gums and melena since last two days. His laboratory results reveal a Hemoglobin 8.5 g/dL (Male: 13.0 - 16.0 g/dL) WBC count 2,500/µL (5,000 - 10,000/mm³) Platelet count 20,000/µL (150,000 - 400,000/mm³) What is the most likely diagnosis?

A 31-year-old man thinks that his wife wants to kill him by poisoning his food. He has no evidence to support his thoughts, but he is 100% convinced about this. What is the single most appropriate term to explain his thought process?

A 6-year-old child complains of intermittent leg pain, mostly in the evening after playing soccer. The child has no pain in the morning, no limp, and no limitations in physical activity. The child is systemically well, with normal physical exam and motor milestones. What is the most likely diagnosis?

A 40-year-old male presents with dry mouth, polyuria and polydipsia. He is using some medicine from quite some time prescribed by psychiatrist. Which drug is responsible for his symptoms?

A 34-year-old female who has recently had a routine cervical smear, presents to your clinic to discuss her report. Her recent pap smear shows dysplasia. Her previous pap smear 5 years ago was normal. What is the most appropriate management?

A 16-year-old girl presents for evaluation of primary amenorrhea. She denies cyclic abdominal pain. Her review of systems and past medical history are unremarkable. On examination: She has no axillary or pubic hair and no breasts development. What is the most appropriate initial investigation for her amenorrhea?

A 38-year-old man presents with episodes of sudden onset severe pain around left eye, tearing of left eye and runny nose which last one hour. His vision is normal. He usually has episodes of such pain for a week or so and then he remains fine for couple of months. He noticed that the pain starts 1 ½ hours after he uses alcohol. What is the single most appropriate diagnosis?

A mother brings her 2 years old child with recurrent chest infections. His anterior fontanel is 2 cm and his wrist appear broad. His reports show reduced Calcium & Phosphate and increased Alkaline Phosphatase. What would be the diagnosis?

A 24-year-old woman presents with facial asymmetry since last three days. Her face is pulled towards right side and there is drooling of saliva from left side. She is unable to close left eye. There are no wrinkles on her right side if forehead but wrinkles on her left side of forehead are persistent. She can partially move her left side of forehead. What is the site of lesion of 7th cranial nerve in this case?

A 38-year-old man comes with severe pain around left eye, tearing of left eye, runny nose for the last 30 minutes. The pain is severe and unbearable. He noticed pain specifically starts 1 ½ hours when he uses alcohol. His family reports that his left eye becomes smaller than right eye during he pain. What immediate treatment you will advise to relieve his pain?

A 53-year-old overweight woman has been experiencing progressively worsening pain in both knees over the past couple of years. The pain gets worse towards the end of the day. What is the most likely diagnosis?

A 26-year-old single man presents to your office complaining of a painless ulcer on his penis since last 3 days. He reports having casual unprotected sexual contact with an unknown sexual partner one week ago. What is the single most like diagnosis?

A 24 years old sexually active man presents with urethral discharge. He reports having an unprotected sexual activity five days ago. He received an injection of Ceftriaxone 250 mg IM one day ago. Which other medicine will you add to his prescription according to WHO guidelines?

A patient on 4 drug regimen anti tuberculous treatment for the last four weeks comes to you with complaint of jaundice and vomiting. Examination shows jaundice. His labs show: • Serum bilirubin 5.8 mg/dL (0.1 – 1.2mg/dl) • Direct bilirubin 3.2 mg/dl • Indirect bilirubin 2.6 mg/dl • ALT (SGPT) 220 U/L (7-55 U/L) • AIk PO4 280 (45-115 U/L) What is the single most appropriate next step in management?

A 32-year-old male presents to you with complains of intermittent high-grade fever with chills & rigors since last one week. In between episodes of fever the patient remains fine except having mild weakness. He looks pale on examination. His blood smear shows trophozoites of Plasmodium falciparum. What is the single most appropriate treatment for this condition?

A 21-year-old man has been suffering from recurrent sore “mouth” off and on especially at the time of meals for the last three years. There are superficial, round, 3-4 mm erosions on lateral side of tongue and hard palate. The erosion keep on changing places in every recurrence. What is the single most effective treatment for “healing” of lesions?

A 19-year-old boy is present with one week history of malaise, low grade fever, dry cough, sore throat and abdominal pain. There are exudates on tonsils. There are bilateral anterior cervical lymph node chains palpable. What is the most likely diagnosis?

A 30-year-old diabetic patient presents with pain and swelling in his right knee for the last 2 days. His right knee is swollen and red. He has a fever of 1020 F. He is unable to move his left knee joint. Which of the following is the most likely diagnosis in this patient?

A 30-year-old female presents with painful swelling of both hands particularly proximal interphalangeal joints for last 1 month. These symptoms, especially stiffness, are worse in the early morning and last for 2 hours. What would be the most likely diagnosis?

A 37-year-old woman presents for review. She is 26 weeks pregnant and has had no problems with her pregnancy to date. Blood pressure is 144/92 mmHg, a rise from her booking reading of 110/80 mmHg. Urine dipstick reveals the following: Protein negative Leucocytes negative Blood negative What is the most appropriate description of her condition?

A 1-year-old child has been brought with a high-grade fever, maculopapular rash on the body, rash inside the mouth, red eyes and cough. There is no lymphadenopathy noted on examination. What is the most likely diagnosis?

A 4-year-old girl presents with fever, sore throat and maculopapular rash on truck for the last two days. Her tongue has prominent papillae and is hyperemic. Her tonsils are inflamed and enlarged. What is the single most appropriate therapy for this child?

A 39-year-old female asthmatic patient is taking oral steroids daily for last 4 months. She is worried about osteoporosis. What would be the most appropriate diagnostic test for her bone status?

A 63-year-old woman presents to your clinic with complains of backpain, reduced height, stooped posture since last one year. Her pains worsened after she received one week course of Prednisolone for facial palsy. What is the most appropriate first line drug for this condition?

A 73-year-old chronic hypertensive woman presents with several months’ history of tiredness, weakness, and breathlessness on exertion. She prefers to sit than to lie down in bed. There is ankle edema and bilateral basal crepitus. What is the most likely reason for her shortness of breath?

A 38-year-old woman with a 2-day history of high-grade fever, rigors, headache, neck pain, confusion and drowsiness. She is febrile (40°C) with neck stiffness. What is the single most appropriate antibiotic according to WHO guidelines before referring to this patient?

A 62-year-old woman presents with a 3-month history of episodes of severe facial pain affecting the right side. The pain is described as sharp and electric shock-like, triggered by activities such as eating or talking. Her physical examination is normal. Which of the following is the most appropriate first line drug for this condition?

A married man presents to your clinic with primary infertility for three years. This is his first marriage. He denies any history of trauma or infection of the testes in the past. What is the most appropriate initial diagnostic step?

A mother brings 9 years old son with deterioration in school performance. You interviewed the child alone and found sexual abuse at school. He asks you not to tell his parents. Who will be the first person to be informed about sexual abuse?

A 25-year-old pregnant woman in first trimester comes with fever, sore throat, painful swallowing. She denies coughing. There are exudates on the tonsils. Jugulodigastric lymph nodes are enlarged and tender. Which one is the most appropriate first line antibiotic for her?

A doctor in his practice conscientiously and judiciously applies the results of randomized controlled trials in the management of his patients. What is the most appropriate term for such type of practice

A 17-year-old boy comes to you with complaints of evening fever, cough & dyspnea for the last one month. During examination you noticed that his tongue is dry coated & there are crepitation in right upper lung zone. What would be the most likely diagnosis?

A mother brings her 2 years old son for vaccination. He received BCG and first doses of Polio, DPT, Hib and Hepatitis B. She discontinued the vaccination of her child due to domestic issues. How would you manage this case according to EPI?

30 years old obese man comes for advice about weight loss. Which one of the following is the best indicator of obesity in his case?

You have been asked to see a mother whose son died in an accident this morning. The family thinks that she is not her normal self and is unusually calm and detached in this moment of grief. What is the most likely diagnosis?

A mother of a 16-year-old student comes for some advice regarding a very strange behavior in her daughter, who steps back and forth a number of times while passing through any door. She also spends a lot of time in bathroom washing her hands again and again. She has been otherwise a much disciplined, organized individual, very particular about her cleanliness. What is the most likely diagnosis?

A 25-year-old married woman presents with foul smelling offensive greyish vaginal discharge. Smear shows clue cells. What is the most appropriate drug for this condition?

Son of 85-year-old man complain his father hearing has decreased, and it has become difficult to communicate with him. What is the single most likely diagnosis of his hearing loss?

A 78-year-old woman with a history of ischemic heart disease presents with shortness of breath on exertion and a history of waking at night 'gasping for air'. His chest X-ray shows prominent hila, small bilateral pleural effusions and upper lobe diversion. What is the most likely diagnosis?

A 70-year-old male patient with prostate carcinoma has been experiencing severe back pain due to metastatic deposits, along with weight loss over the past three months. He is currently taking Diclofenac and Paracetamol, but his pain remains unrelieved. What is the most appropriate next medicine to be added for his bone pains according to WHO pain ladder?

A 65-year-old male patient with multiple myeloma complains of severe body pain. He has been taking Ibuprofen, but it has not provided relief. Which is the single most appropriate drug for his bone pain?

A 31-year-old female come to you with a history of epilepsy on sodium valproate consults you following an uneventful pregnancy. Her epilepsy are well controlled on Valproate. She wants to continue breast feeding. What would be the most appropriate advice regarding Vlaproate for this patient?

A 31-year-old woman presents with headache for the last one year. Her headache is better in the morning and increases as the day passes by. She feels like having a constricting band around her head. She admits financial and disturbed sleep. What prophylactic medicine will you prescribe her to prevent headache?

A 60-year-old patient has a severe headache, shoulder stiffness, fever, jaw pain during chewing and scalp tenderness while combing for the last 2 weeks. She reports stiffness of shoulder and hips in the morning. What is the single most appropriate initial test to diagnose this condition?

A 46-year-old man returns to your clinic for a consultation with the results of his recent ambulatory blood pressure monitoring (ABPM). His average reading was 15/90 mmHg. What is best treatment option?

A 47-year-old male is brought to the ER with complains of severe headache, drowsiness, disorientation, nausea and vomiting since last 2 hours. He was sitting with his family and suddenly started shouting because of sudden onset of severe pain and then became drowsy. On examination, his neck is stiff, but he is afebrile. There is no loss of power in limbs. What is the most likely diagnosis?

A 45-year-old male presents to the office with a 24-hour history of weakness of right side of the face including forehead. On examination, the patient is found to have complete right sided facial paralysis, and he is unable to close his right eye and raise his right eyebrow. The right ear appears normal. What is the single most appropriate medicine for this condition?

A 19-year-old girl present with episodic bi-temporal headache since last one year. The headache occurs once or twice a month and lasts for 4-5 hours. It is throbbing n nature, and she feels nausea at the time of headache. Her mother also has similar headache. What is the single most effective medicine to stop an episode of this type of headache?

While playing a soccer match a player twisted his right knee. He felt sudden severe pain in his knee. He was unable to continue his match. After 8 hours he was brought in emergency with severe pain & effusion on right knee with flexed knee position. His knee Xray is normal. What would be the next appropriate definitive test for confirmation of diagnosis?

A mother brings her 5-year-old daughter complaining that she becomes stiff, immobile and starts starring for about a minute. During such episodes she neither listens nor talks. After a minutes, she starts moving and talking again. What is the single most appropriate drug for her in primary care setting?

A 28-year-old married woman presents with weakness, tiredness, low mood, crying, loss of interest in daily activities, anhedonia and poor sleep. She denies thoughts of self-harm. Her condition started after giving birth to her baby three months ago. She is breastfeeding her baby. Her physician examination is normal. What is the most appropriate drug for her condition?

A 20-year-old boy comes to you with complaints of fever, which is increasing with time, rigors, chills, body aches, abdominal pain, nausea and diarrhea for the last week. During the examination, you noticed that his tongue is dry and coated and there is a mild tenderness all over the abdomen. What investigation you would choose to confirm the diagnosis of typhoid in this patient?

A 30-year-old male comes with fever, vomiting, and lethargy for 48 hours. He has headaches and stiffness in his neck. His pulse is 120/min, BP= 90/60mm Hg, temp=103 F°. There is non-blanching rash on his body. Which of the following is the most likely causative organism in this case?

A 12-year-old child presents with high-grade fever for 4 days, severe headache, retro-orbital pain, muscle and joint aches, and a rash. On examination, there is no localized infection. Laboratory findings reveal thrombocytopenia and elevated hematocrit. What is the most appropriate earliest blood test to diagnose this condition in primary care setup?

A 17-year-old boy presents with complaints of progressively increasing high fever, body aches, abdominal pain, and diarrhea for the past 9 days. Upon examination, you observe that his tongue is dry and coated, and there is mild tenderness all over the abdomen. What is the single most likely diagnosis in this case?

An 8-year-old boy was brought in by his mother with complaints of fever and sore throat for 2 days. On examination, jugulodigastric lymph nodes are palpable and tender and tonsils are hyperemic. He is known to have allergy to Penicillin. What would be the most appropriate alternate antibiotic for this patient according to WHO guidelines?

A 6-year-old boy presented with a generalized vesicular eruption and fever for the past four days following contact with a child who had vesicular rash. Examination reveals vesicles on an erythematous base scattered across the body, with particularly severe involvement on the face and trunk. The child is otherwise healthy. What would be the most appropriate initial management in primary care setting?

A 34-year-old lady complains of episodic vertigo, ringing in both ears, feeling of ear fullness, nausea and vomiting for one year. Patient explains dizziness as world is spinning around her. She also reports progressive hearing loss with these episodes. What is the single most likely diagnosis?

A 32-year-old pregnant woman presents with intermittent fever. Her blood film shows Vivax malaria. The patient is otherwise stable. Her LMP was 2 months ago. What is the single most appropriate initial drug for her?

A 10-year-old child presents with a 5-day history of fever, chills, and sweats. The fever pattern appears cyclic, occurring every 48 hours. The child recently returned from a trip to a village. Physical examination reveals mild pallor.

A 12-year-old boy presented to your clinic with a history of intermittent fever, rigors, body aches, and headache. Suspecting vivax malaria, you prescribed Chloroquine and Primaquine. Two days later, he returned with jaundice and weakness. His laboratory results were as follows: • Total bilirubin: 8.2 mg/dL (high) • Conjugated bilirubin: 1.0 mg/dL (normal) • Unconjugated bilirubin: 5.2 mg/dL (high) • SGPT: 36 U/L (normal) • Alkaline phosphatase: 170 U/L (normal) What is the most likely interpretation of LFTs?

A 26-year-old woman was started on anti-tuberculous treatment (ATT) one week back for pulmonary tuberculosis. She returns back to the clinic complaining of red urine. Which of the following drugs is responsible for redness of urine?

A 46-year-old man presents to your clinic for poor sleep, anxiety, headache, fear of dying for the last week. He has become irritable, restless, and is unable to concentrate on his work. Last week his close friend died of a heart attack while sitting in his office. What is the single most appropriate diagnosis for his mental condition?

A 22-year-old college student has come to you complaining of a lack of confidence. He says he has difficulty talking to people. He gets short of words and starts babbling whenever he confronts girls, and he tries to avoid them. He is now worried because he is going to get married in six months and he has no experience in talking to ladies. What is the single most appropriate diagnosis?

A 38-year-old woman presents with persistent worrying about multiple issues in her life. She has been feeling over the edge for the past eight months since she lost her job. She also complains of irritability, difficulty concentrating, and muscle tension. Her sleep is normal. What is the most important first-line drug for her?

A 45-year-old man presents for follow-up of his Major Depressive Disorder. He has been on an SSRI for the past 3 months. Although he is improving but he has developed erectile dysfunction, anorgasmia and anhedonia. What is the recommended alternative medicine for his depression?

A 50-year-old woman presents with a 3-month history of low mood, poor appetite, fatigue, and difficulty concentrating. She feels like crying. She is otherwise functioning well in her family and her office. What is the single best initial psychotherapy for this patient?

A 25-year-old newly married man presents to your clinic complaining of ejaculation within one minutes of sexual intercourse. He is worried as he cannot satisfy his wife. He has no other significant comorbidities and takes no medications. Which of the following medications is best for his problem?

A 32-year-old divorced woman single mother complains of constant tiredness, body aches, numbness of hands and feet, mild headache, dyspepsia, non-refreshing sleeping, mood swings, and palpitations for more than two years. Her tests are normal. She has to do a job for her living and also take care of daily chores and her two kids. She frequently visits the same doctor with new complaints. What is the most likely diagnosis of her mental condition?

A 27-year-old man has been visiting several clinics, emergencies and hospital with left sided chest pain. He is convinced that he has a heart problem and will die of a heart attack. He has repeatedly done ECG, Echo, cardiac enzymes but all his lab results are normal. What is the most likely diagnosis of his mental condition?

A 20-year-old male medical student presents with social withdrawal, poor appetite, and disturbed sleep for the past month. He recently moved to a hostel after his family relocated to another country. This is the first time he has lived away from family. He could not concentrate and failed the recent college assessment. He denies any prior psychiatric history. What is the diagnosis for this student’s current condition?

A 15-year-old girl presents to the clinic with a two-month history of feeling sad most of the time. She reports difficulty concentrating in school, loss of interest in activities she previously enjoyed, and changes in sleep patterns, including trouble falling asleep. She denies any significant medical history, and her physical examination is unremarkable. She does not report substance use or any psychotic symptoms. What is the most likely diagnosis?

A 27-year-old woman presents with concerns about her nose. She is preoccupation with belief that her nose is ugly. Despite reassurances from others, she is not convinced. She spends several hours each day in front of the mirror, comparing her nose to others. This behavior is interfering with her daily life. What is the most likely diagnosis?

A 35-year-old man presents with excessive worry about various aspects of his life, feeling on edge for the past 9 months following a relationship breakup. He reports irritability, difficulty concentrating, and muscle tension. He has difficulty falling asleep. He fears that something bad will happen to him. This condition is present on most days of the week. What is the most likely diagnosis?

A 22-year-old man has been brought by family members complaining that they have seen him talking to himself, seeing fairies in his room, believing that his mother is trying to poison him. What is the single most appropriate diagnosis?

A 78-year-old woman with a history of dementia is brought to the emergency department by her family, who report a sudden change in her behavior over the past two days. The patient is confused, disoriented, and has difficulty recognizing her surroundings. She is alternately drowsy and agitated, accusing family members of taking her belongings. Her memory is impaired, and she is unable to recall events from the past few hours. The most likely diagnosis is:

A 17-year-old girl presents to with concerns about her weight. She reports restricting her food intake, exercising excessively, and feeling extremely anxious about gaining weight, despite her BMI being 14.5 kg/m². She has the habit of counting her ribs. She denies vomiting. Her systemic review shows amenorrhea for the last 6 months. What is the most likely diagnosis?

A 65-year-old woman presents with progressive memory loss, difficulty recalling recent events, and trouble with decision-making over the past year. Her family reports that she often repeats questions and forgets familiar names. Her mother also had a similar cognitive decline in her 70s. The patient’s symptoms are most consistent with:

A 45-year-old woman with major depressive disorder has been taking sertraline (an SSRI) for 8 weeks but reports no improvement in her symptoms. Currently she is on Sertraline 150 mg daily. What is the most appropriate next step in management?

A 45-year-old male presents with a 3-day history of fever, lower abdominal pain, and difficulty urinating. He reports urinary urgency, frequency, a burning sensation during urination, and perineal discomfort. Additionally, he describes a dull ache in the perineal and rectal areas. His prostate is tender and boggy on digital rectal examination. Which one of the following is the most likely diagnosis?

A 70-year-old man presents with frequent urination and difficulty starting his urine stream, along with a feeling of incomplete bladder emptying over the past few months. Ultrasound show enlarged prostate and post void urine of 100 ml. Urine and PSA test are normal. What is the most appropriate initial treatment to relieve his symptoms?

A 33-year-old man presents with primary infertility for the past 2 years. His semen analysis results are as follows: pH: 7.8 Volume: 3 cc (normal range: 2-6 cc) Semen count: 10 million/ml (Normal 39 million or more) Activity: Motile: 20% (Normal 40% or more) Sluggish: 50% Non-motile: 30% Shape: Normal: 80% (Normal 4% or more with normal forms) Abnormal: 20% WBC: 0-1 RBC: 0-1

A 6-month-old baby has been brought to your clinic with fever and pain in right ear for 2 days. The child is febrile, irritable and the tympanic membrane is red and dull. What is the single most appropriate initial treatment at primary care set up?

A 36-year-old man presents with excessive sneezing, runny nose and intermittent blocked of nose whenever he is exposed to dust from carpets. His condition lasts for one to two days. In between he remains fine. What is the single most appropriate initial medicine?

A 42-year-old man present with 102o fever, runny nose, right sided severe facial pain which is more on bending forwards since last 4 days. His right maxillary bone is tender. What is the single most appropriate drug for him according to WHO guidelines?

A 30-year-old man presented with dizziness for last 6 months which occurs when he looks upward or raises his head. Episode lasts 10 to 30 seconds. He denies hearing loss or tinnitus. On Examination Nystagmus was elicited when he quickly looks up and down. The rest of the examination is normal. What is the most likely diagnosis?

A 7-year-old child is brought to the clinic by their parents because he has started responding late to their calls as if he is not hearing properly. On examination the tympanic membranes are dull, showing clear fluid with air bubbles inside the middle ear. There is no redness on the tympanic membrane. The child is interacting normally, and he is scoring well in his school. What is the most appropriate step in management?

A 5 years old boy has been brought by mother complaining of mild pain in right ear since last 2 days. She also reports symptoms of common cold since last 5 days. The child is otherwise active, playful and eats well. On examination the right tympanic membrane is dull, mildly hyperemic, and he has 101o F fever. What is the most appropriate management step at this stage?

A 7-year-old girl has been brought by mother after recovery from recent sore throat in which she was given antibiotics. She has missed school ten times in the last two years due to severe sore throats needing antibiotics. Her weight is 21 kg. Her tonsils are enlarged bilaterally. What is the most appropriate definitive step for her condition?

A 65-year-old man comes to your clinic for routine eye check-up. He complains about spots of blindness in his vision. His eyeballs feel hard on digital palpation and there is loss of peripheral visual field. What is the single most likely diagnosis?

A 30-year-old man comes to your clinic complaining of pain, blurred vision and redness of left eye. Fluorescence staining shows branching ulceration. What is the most appropriate treatment?

A 47-year-old female presents with bilateral red eyes, runny nose and malaise since last 2 days. She feels irritation in her eyes. Her vision is normal. Her pre-auricular lymph nodes are palpable. Her 15 years old sone also had similar redness of eye few days ago. What is the most likely diagnosis?

A 58-year-old woman comes to your clinic with progressive blurring of vision for the last two years. She has had diabetes for the last 8 years. Her pupils are white. You are unable to see the fundus of the right eye. What is the single most probable diagnosis?

A 65-year-old man complains that he has not able to see passing cars on both sides while he is driving since the last few months. His frontal vision is fine. He has had minor accidents during this period. He also reports changes in his face and size of hands. What is the most appropriate definitive diagnostic test for his condition?

A new born baby has been brought by mother for routine check-up. Red reflex is absent bilaterally and there are cardiac murmurs on auscultation. She gives a history of fever and rash during pregnancy. Which one of the following is the cause of his eye manifestation?

A 10-year-old girl presents with a small painful, red swelling on the edge of her right upper eyelid. On examination, a localized lump with surrounding redness is seen at the eyelid margin at the base of an eyelash. There is no systemic illness or fever. What is the most likely diagnosis?

A 20-year-old male presents with backache and stiffness for the last 6 months. These symptoms are more in the morning. Flexion of back is restricted and there is a loss of lumber lordosis. What is the most appropriate initial diagnostic investigation?

A 20-year-old person had a road traffic accident in his car 3 days ago. His car was hit from behind. At that time, he was normal except for a little bit of pain in his neck. Now he suddenly develops severe neck pain more on the extension in his neck. What would be the most likely diagnosis?

A 55-year-old man presents with a 6-month history of gradually worsening pain and stiffness in his right shoulder. He reports difficulty with activities such as combing his hair and reaching behind his back. On examination, both active and passive range of motion are significantly reduced in all directions, especially external rotation. There is no history of trauma, and he denies systemic symptoms. What is the most likely diagnosis?

A 30-year-old patient presents pain and brief stiffness of hands, shoulder and wrists after playing tennis after a gap of many years. There is no fever. He denies any previous history of joint disease. He cannot close his fist properly due to swelling. What is the single most appropriate initial drug for his pain?

A 60-year-old man presents with low back pain for the last 2 weeks. He also reports numbness of right leg, peri-anal region and medial side of thighs. What is the most appropriate step in management?

A 75-year-old person complains of severe backache for the last three weeks. He has used many medicines like Diclofenac, and Ibuprofen but no relief. He denies any trauma. He wakes up from sleep because of back pain. What would be the next appropriate initial investigation?

A 38-year-old bodybuilder had back pain after lifting heavy weigh in the gym two days ago. He now complains of increasing numbness & tingling in both legs & loss of control over his bladder & bowel. Which of the following should be your first step in his management?

An 85-year-old nursing home resident is complaining of body aches. Her posture is stooped. Her BMD shows T score of -2.8. She is taking Calcium & Vitamin D regularly. What would be the most appropriate first line treatment for her bone condition?

A 43-year-old woman presents with difficulty in rising form a sitting position & general bone pain. She also has difficulty climbing stairs. She often gets cramps in calf muscles and hands. Her reports show reduced Calcium & Phosphate and increased Alkaline Phosphatase. What is the single most appropriate treatment for this condition?

A 60-year-old man presents to your clinic with sudden onset of pain, redness and swelling of the base of big toe of right foot. Pain is severe and he cannot put weight on his right foot. He is fond of barbeque. His weight is 100 Kg. The first tarsometatarsal joint is swollen, warm, tender and red. What is the most appropriate initial medication to manage his acute condition?

A 66-year-old woman presents to her GP with pain at the radial side of right wrist. The pain started after using gardening scissors after a long time. The pain is worse on the flexion of the thumb. On examination, there is localized tenderness at distal part of radius just proximal the base of thumb which increases by passive flexion of the thumb. carpometacarpal joint of her left hand. What is the single most appropriate diagnosis?

A 35-year-old woman presents with painful swelling of both wrists, metacarpophalangeal (MCP) joints and proximal interphalangeal joints since last two months. She reports joint stiffness, particularly in the mornings, which gradually improves after about an hour. What is the most appropriate specific diagnostic test?

A 41-year-old man presents with a three-month history of intermittent pain, swelling, and stiffness in his wrists and proximal interphalangeal (PIP) joints, particularly in the mornings. Laboratory tests show a positive rheumatoid factor, and X-rays reveal joint space narrowing and soft tissue swelling. You started her on oral Prednisolone. What is the most appropriate initial drug to control disease progression in a primary care setting?

A 50-year-old man presents with heel pain for the last three weeks which is most intense when he takes his first steps in the morning or after prolonged periods of sitting, but it tends to improve with walking and activity. He denies any recent trauma or changes in physical activity levels. There is localized tenderness over the medial aspect of the heel on the plantar surface. What is the most likely diagnosis?

A 35-year-old hypertensive obese patient presents with menorrhagia due to Dysfunctional Uterine Bleeding. Her complete blood count shows mild anemia. Rest of investigations including pap smear, ultrasound pelvis, and TSH are normal. She is Para 4+0. She does not desire any more children. What is the most appropriate contraceptive for her at this stage?

A 37-year-old woman presents with swelling around the nail of left big toe since last two weeks as shown in picture. She works at a laundry shop and wash clothes. There is no history of trauma. What is the most likely diagnosis?

36-year-old man presents with a painless lesion on the penis, weight loss, and generalized lymphadenopathy. What is most likely diagnosis?

A 30-year-old mother brings her healthy 2-week-old baby to the clinic for a routine check-up. She mentions that she is exclusively breastfeeding and is wondering if her baby needs any vitamin supplements Which of the following vitamin supplements would you advise at this age?

A 6-month-old infant is brought to the clinic for a routine examination. During the physical exam, you notice that the child’s right testis is not palpable in the scrotum. The rest of the examination findings are normal. What is the most appropriate step in management at this stage?

A mother brings her 6-year-old son to your clinic with scratches on his legs after he fell from bicycle on the road 3 hours ago. He has received his primary vaccination and a booster of DPT at the age of 4 years. What is the most appropriate action regarding his tetanus immunication?

A 4-day-old baby has been brought by his parents to your clinic with complaints of yellow discoloration of eyes and skin. He is taking feed normally and passing 4-5 semi solid yellow stools. His weight is 3.5 Kg and systemic examination is normal. What is the single most likely cause of his jaundice?

A 14-month-old boy presents with straining during stools, crying in pain, and pulling his knees to his chest every 15-20 minutes. There was a small amount of blood in his diaper this morning. On examination, he is irritable and lethargic. Abdominal examination shows a small mass in the right iliac fossa. What is the most likely diagnosis?

A 25-year-old female presents with pains in knees, ankles, elbows and hands, fever, headache, hair loss, cough, light purple colored rash on both cheeks and nose for the last 1 month. What is the single most likely diagnosis?

A 25 years old female presents with pain in knee, elbow, wrist joint, hair loss, urticaria and photosensitivity for last 2 months. Lab reports show Hb 8.5 g/dl platelets 110000 – (150000 – 450000) & protein urea, BP 160/100 and splenomegaly. What would be the most confirmative diagnostic test?

A 29-year-old married woman presents to your clinic for contraceptive advice as she had an unprotected intercourse with her husband last light. What is the single most appropriate contraceptive step for her at this stage?

A mother brings her 2 years old son with complaints of diarrhea for one day. The baby has passed 5-6 watery stools. There is no blood or fever. The baby is thirsty, has a reduced appetite and has slightly sunken eyes. He is not playing but smiling to funny gestures. He passed urine three hours ago. What is the single most appropriate step in management?

A 28-year-old female presents to the clinic due to four fleshy, protuberant lesions on her vulva which are slightly pigmented since last 2 weeks. She has recently started a relationship with a new partner. What is the most appropriate initial management?

A 2-year-old girl presents with intense itching, especially at night. Family members are experiencing similar symptoms. Lesions are present on whole body but more on the finger webs, wrists and lower legs. What is the most appropriate treatment?

A 27-yer-old man presents numerous small hyperpigmented scaly patches on the trunk for the last few months. What is the single most appropriate initial treatment?

A 42 yrs old male presents with two patches of hair loss on scalp and beard for one year. The skin of lesions is smooth, slightly depressed and shiny. There are exclamation mark like hair around the patches of hair loss. What is the most appropriate step in management?

A mother brings a 7-year-old girl to your clinic with itching on scalp for 15 days. There are nits, eggs and live lice in scalp hair. What is the most effective treatment option for her lice?

A 35-year-old woman presents with fever, left eye pain, and bulging of the right eyeball, reduced vision and diplopia for one day. She has a chronic history of frontal headache which increased on bending, sneezing, and a blocked nose. What is the single most appropriate diagnosis?

A 7-year-old uncircumcised boy presents with severe pain and noticeable swelling of the foreskin of penis, which cannot be retracted back over the glans. The glans penis is visible, but the foreskin is trapped behind it and cannot be reduced manually, causing increasing discomfort. There is no discharge from penis. What is the most likely diagnosis?

A 35-year-old woman presents with chronic redness and irritation in her eyes along with crusting around her eyelashes, eyebrows, and scalp hair. Examination reveals erythema around the eyelids with mild scaling at the lash line. What is the most appropriate initial management for her condition in primary care setting?

A 28-year-old woman presents with a two-month history of her ring finger frequently catching and locking in a bent position while typing. She often needs to manually straighten it. Physical examination reveals a tender nodule at the base of the affected finger and restricted motion during extension. What is the most likely diagnosis?

A 6-month-old girl was brought by her parents due to a swelling in the umbilical region present since birth. The swelling occasionally disappears. On examination, a 3 x 3 cm soft, round, and smooth swelling was observed in the umbilical region. What is the most appropriate step at this stage?

A 55-year-old man with a 35-year smoking history presents with a chronic productive cough, nighttime breathlessness, and fatigue. Mild pedal oedema is observed, and adventitious breath sounds are noted in all lung lobes. His chest X-ray show According to NICE guidelines, what is the most appropriate diagnosis for this case?

A 45-year-old chronic smoker presents to your clinic with an acute onset of cough, shortness of breath, inability to talk and restlessness. On examination, he is cyanosed, the right side of chest is bulging and there is no air entry and chest movement on the right side. The trachea is shifted towards the left. The right chest is hyper-resonant. His face is cyanosed. His chest X-ray shows: What is the most likely diagnosis?

A mother brings her 2 years old son with complaints of diarrhea for one day. The baby has passed 5-6 watery stools. There is no blood or fever. The baby is thirsty, has a reduced appetite and has slightly sunken eyes. He is not playing but smiling to funny gestures. He passed urine three hours ago. What is the single most appropriate step in management?

A 29-year-old married woman presents to your clinic for contraceptive advice as she had an unprotected intercourse with her husband last light. What is the single most appropriate contraceptive step for her at this stage?

A 25 years old female presents with pain in knee, elbow, wrist joint, hair loss, urticaria and photosensitivity for last 2 months. Lab reports show Hb 8.5 g/dl platelets 110000 – (150000 – 450000) & protein urea, BP 160/100 and splenomegaly. What would be the most confirmative diagnostic test?