Q1. A 45-year-old male presents to the outpatient clinic with a 3-month history of productive cough, night sweats, and significant weight loss. He lives in a crowded urban area in Addis Ababa. His sputum smear is positive for Acid-Fast Bacilli (AFB). Which of the following is the standard initial first-line regimen for this patient according to the national tuberculosis guidelines?
A) 2 months of Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol, followed by 4 months of Rifampicin and Isoniazid
B) 2 months of Rifampicin and Isoniazid, followed by 4 months of Pyrazinamide and Ethambutol
C) 6 months of continuous Rifampicin, Isoniazid, and Ethambutol
D) 2 months of Streptomycin, Isoniazid, and Ethambutol, followed by 4 months of Rifampicin
Correct Answer: A
Explanation: According to national and WHO guidelines, the standard short-course chemotherapy for new drug-susceptible pulmonary TB consists of a 2-month intensive phase with four drugs (2RHZE) and a 4-month continuation phase with two drugs (4RH).
Q2. A 24-year-old G1P0 woman at 38 weeks of gestation presents to the emergency department with a severe headache and blurry vision. Her blood pressure is 160/110 mmHg on two readings 4 hours apart, and a dipstick urinalysis shows 3+ proteinuria. While being evaluated, she develops a generalized tonic-clonic seizure. What is the immediate drug of choice to manage this patient’s seizures?
A) Diazepam
B) Magnesium sulfate
C) Phenytoin
D) Phenobarbital
Correct Answer: B
Explanation: Magnesium sulfate is the definitive drug of choice for the prevention and treatment of eclamptic seizures, outperforming traditional anticonvulsants like diazepam and phenytoin.
Q3. An 18-month-old child is brought to a rural health center with severe wasting, bilateral pitting pedal edema extending to the lower legs, and a “flaky paint” dermatosis. The child appears lethargic and apathetic. Based on these findings, what is the most accurate nutritional diagnosis?
A) Marasmus
B) Kwashiorkor
C) Nutritional Marasmic-Kwashiorkor
D) Severe Stunting
Correct Answer: B
Explanation: The hallmark sign of Kwashiorkor is bilateral pitting pedal edema. It is often accompanied by regular dermatological signs (“flaky paint” dermatosis), hair changes, and marked apathy due to severe acute protein malnutrition.
Q4. A 32-year-old male presents with a 2-day history of high-grade fever, chills, severe headache, and joint pain. He recently traveled to a malaria-endemic lowland region in Ethiopia. A rapid diagnostic test (RDT) is positive for Plasmodium falciparum. He is fully conscious, able to take oral medication, and shows no signs of organ dysfunction. What is the recommended first-line treatment?
A) Oral Artemether-Lumefantrine
B) Intravenous Artesunate
C) Oral Chloroquine
D) Oral Quinine
Correct Answer: A
Explanation: Oral Artemether-Lumefantrine (Coartem) is the standard first-line treatment for uncomplicated Plasmodium falciparum malaria in Ethiopia. Parenteral treatment (IV Artesunate) is reserved for severe malaria cases.
Q5. A 60-year-old female presents to the emergency department with a 6-hour history of severe, crushing substernal chest pain radiating to her left arm, accompanied by diaphoresis. An electrocardiogram (ECG) shows ST-segment elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
A) Left Anterior Descending (LAD) artery
B) Right Coronary Artery (RCA)
C) Left Circumflex (LCx) artery
D) Left Main Coronary Artery
Correct Answer: B
Explanation: ST-segment elevation in leads II, III, and aVF indicates an acute inferior wall myocardial infarction (STEMI), which is typically caused by the occlusion of the Right Coronary Artery (RCA).
Q6. A 4-year-old boy is brought to the pediatric emergency unit with a 3-day history of high fever, barking cough, and progressive difficulty breathing. On physical examination, you note inspiratory stridor at rest, subcostal chest indrawings, and mild agitation. What is the most likely diagnosis?
A) Acute Bronchiolitis
B) Foreign Body Aspiration
C) Laryngotracheobronchitis (Croup)
D) Bronchial Asthma
Correct Answer: C
Explanation: Viral laryngotracheobronchitis, or Croup, classically presents in young children with a prodrome of fever, a distinctive barking cough, and inspiratory stridor caused by upper airway edema.
Q7. A 28-year-old primigravida at 39 weeks of gestation has been in active labor for 12 hours. Her cervical dilation has remained stationary at 6 cm for the last 4 hours despite strong, regular uterine contractions (4 contractions in 10 minutes, each lasting 45 seconds). The fetal heart rate is reassuring. What is the most appropriate next step in management?
A) Augmentation with Oxytocin infusion
B) Perform an immediate Cesarean Section
C) Administer maternal sedation and re-evaluate in 2 hours
D) Perform instrumental delivery using vacuum extraction
Correct Answer: B
Explanation: This patient is experiencing active phase arrest of labor with adequate uterine contractions, which points to cephalopelviproportion (CPD) or malposition. Oxytocin is not indicated if contractions are already adequate; a Cesarean section is required.
Q8. A 55-year-old chronic cirrhotic patient presents with a tense abdomen, shifting dullness, and a fluid thrill. Paracentesis is performed, and the ascitic fluid analysis reveals a serum-ascites albumin gradient (SAAG) of 1.4 g/dL. What does this SAAG value indicate regarding the etiology of the ascites?
A) Peritoneal Carcinomatosis
B) Portal Hypertension
C) Tuberculous Peritonitis
D) Nephrotic Syndrome
Correct Answer: B
Explanation: A SAAG value of 1.1 g/dL or higher indicates that the ascites is caused by transudative pressures related to portal hypertension, highly consistent with liver cirrhosis.
Q9. A 40-year-old male is brought to the emergency department after a motor vehicle accident. He is tachycardic (HR 120 bpm), hypotensive (BP 85/50 mmHg), and has distended neck veins. On thoracic examination, there are decreased breath sounds and hyperresonance on the right hemithorax. What is the immediate life-saving intervention?
A) Obtain an urgent chest X-ray
B) Perform needle thoracocentesis in the second intercostal space at the midclavicular line
C) Perform endotracheal intubation and mechanical ventilation
D) Administer a rapid 2-liter bolus of normal saline
Correct Answer: B
Explanation: The clinical triad of hypotension, distended neck veins, and unilateral absent breath sounds with hyperresonance signifies a tension pneumothorax. Immediate needle decompression is vital to restore venous return and cardiac output before waiting for any imaging.
Q10. A 12-year-old girl presents with migratory polyarthritis affecting her knees and elbows, a new-onset cardiac murmur, and choreiform movements. She had a severe sore throat 3 weeks ago that went untreated. Which organism is responsible for initiating this disease process?
A) Staphylococcus aureus
B) Group A Beta-Hemolytic Streptococcus
C) Streptococcus pneumoniae
D) Haemophilus influenzae
Correct Answer: B
Explanation: Acute Rheumatic Fever is an autoimmune, non-suppurative inflammatory complication that occurs a few weeks following an untreated pharyngeal infection caused by Group A Beta-Hemolytic Streptococcus (Streptococcus pyogenes).
Q11. A 30-year-old pregnant woman (G2P1) at 32 weeks of gestation presents with sudden-onset, painless, bright red vaginal bleeding. She denies any trauma or abdominal pain. Her abdomen is soft and non-tender, and the fetal heart rate is normal. What is the most likely diagnosis?
A) Abruptio Placentae
B) Placenta Previa
C) Uterine Rupture
D) Vasa Previa
Correct Answer: B
Explanation: Painless, bright red third-trimester vaginal bleeding in the presence of a soft, non-tender uterus is the classic clinical presentation of placenta previa. Abruptio placentae, by contrast, is characteristically painful.
Q12. A 48-year-old diabetic male presents with severe pain, swelling, and erythema of his right lower leg. The lesion has a poorly demarcated border and is warm to the touch. There is no fluctuance or crepitus. Which layer of the skin and subcutaneous tissue is primarily involved in this condition?
A) Epidermis only
B) Dermis and subcutaneous tissue
C) Deep fascia
D) Stratum corneum
Correct Answer: B
Explanation: Cellulitis is an acute spreading infection of the deep dermis and subcutaneous fat, typically caused by Streptococcus pyogenes or Staphylococcus aureus.
Q13. During a community health assessment in a low-income sub-city, a medical student finds that the infant mortality rate is high. Which of the following components is included in the numerator when calculating the Infant Mortality Rate (IMR)?
A) Number of deaths among children under 5 years of age in a given year
B) Number of deaths among infants under 1 year of age in a given year
C) Number of fetal deaths after 28 weeks of gestation
D) Number of neonatal deaths within the first 28 days of life
Correct Answer: B
Explanation: The Infant Mortality Rate is calculated as the number of deaths of live-born children under 1 year of age in a given year, divided by the total number of live births in that same year, multiplied by 1,000.
Q14. A 9-month-old infant is brought to the clinic due to poor feeding and lethargy. The mother reports the infant has had watery diarrhea for 4 days. On exam, the child is lethargic, has deeply sunken eyes, and the skin pinch goes back very slowly (> 2 seconds). According to IMNCI guidelines, how should this child’s dehydration status be classified?
A) No Dehydration
B) Some Dehydration
C) Severe Dehydration
D) Persistent Diarrhea
Correct Answer: C
Explanation: Under the Integrated Management of Neonatal and Childhood Illness (IMNCI) guidelines, a child presenting with two or more signs among lethargy/unconsciousness, sunken eyes, and a very slow skin pinch (> 2 seconds) is classified under Severe Dehydration.
Q15. A 50-year-old chronic heavy smoker presents with progressive, painless jaundice, clay-colored stools, and dark tea-colored urine for 1 month. On examination, he has a palpable, non-tender gallbladder in the right upper quadrant. What is the most likely diagnosis?
A) Acute Cholecystitis
B) Choledocholithiasis
C) Carcinoma of the Head of the Pancreas
D) Hepatocellular Carcinoma
Correct Answer: C
Explanation: Courvoisier’s Law states that in a patient with progressive, painless jaundice, a palpably enlarged, non-tender gallbladder is highly unlikely to be caused by gallstones and instead points directly toward a malignant biliary obstruction, such as pancreatic head adenocarcinoma.
Q16. A 25-year-old male is brought to the clinic with acute-onset generalized edema, hematuria, and mild hypertension. He reports having a severe skin infection (impetigo) about 2 weeks ago. Urinalysis reveals dysmorphic red blood cells and red blood cell casts. What is the underlying pathophysiological mechanism?
A) Direct bacterial invasion of the renal parenchyma
B) Immune-complex deposition in the glomerular basement membrane
C) IgE-mediated hypersensitivity reaction
D) Autoantibodies against the glomerular basement membrane
Correct Answer: B
Explanation: Post-streptococcal glomerulonephritis (PSGN) is a classic Type III hypersensitivity reaction. Circulating antigen-antibody complexes deposit along the glomerular basement membrane, initiating an inflammatory response that manifests as acute nephritic syndrome.
Q17. A 35-year-old HIV-positive patient with a CD4 count of 80 cells/µL presents with a 2-week history of progressive headache, low-grade fever, and neck stiffness. A lumbar puncture is performed. India ink preparation of the cerebrospinal fluid (CSF) reveals encapsulated budding yeast cells. What is the induction treatment of choice?
A) High-dose oral Fluconazole alone
B) Amphotericin B combined with Flucytosine
C) Intravenous Ceftriaxone
D) Intravenous Acyclovir
Correct Answer: B
Explanation: The standard optimal induction regimen for cryptococcal meningitis in patients with advanced HIV is a combination of intravenous Amphotericin B and oral Flucytosine for 1 to 2 weeks, followed by consolidation therapy using Fluconazole.
Q18. A 23-year-old healthy woman presents for a routine prenatal checkup at 12 weeks of gestation. She asks about nutritional interventions to prevent neural tube defects (NTDs) in her baby. At what period is folic acid supplementation most effective in preventing these defects?
A) From the second trimester until delivery
B) Pre-conceptionally up to the first 12 weeks of gestation
C) Only during the active phase of labor
D) Exclusively during the third trimester
Correct Answer: B
Explanation: The neural tube closes within the first 28 days following conception, often before a woman realizes she is pregnant. Therefore, folic acid must be taken pre-conceptionally and through the first trimester to significantly reduce the risk of structural NTDs.
Q19. A 65-year-old male with a history of chronic osteoarthritis presents to the emergency room with a 4-hour history of hematemesis and epigastric burning pain. He reports taking high-dose Ibuprofen daily for the past 6 months. What is the primary mechanism of injury leading to this presentation?
A) Inhibition of Cyclooxygenase-1 (COX-1) leading to decreased prostaglandin synthesis
B) Direct chemical necrosis of the esophageal sphincters
C) Stimulation of gastrin-secreting cells in the antrum
D) Inactivation of mucosal parietal cell H+/K+ ATPase pumps
Correct Answer: A
Explanation: Non-selective NSAIDs like Ibuprofen exert systemic effects by blocking the COX-1 enzyme. This action curtails the production of cytoprotective prostaglandins (PGE
2
and PGI
2
), which downregulates mucosal blood flow, mucus production, and bicarbonate secretion, making the stomach vulnerable to acid injury and bleeding.
Q20. A 4-year-old girl is brought with a history of fever and a rash for 4 days. On examination, she has conjunctival injection, a maculopapular rash starting from the face and spreading downwards, a runny nose, and small white spots on an erythematous base inside her buccal mucosa opposite the lower molars. What is the most likely diagnosis?
A) Scarlet Fever
B) Measles (Rubeola)
C) Rubella (German Measles)
D) Varicella (Chickenpox)
Correct Answer: B
Explanation: The combination of the “3 Cs” (cough, coryza, conjunctivitis), a maculopapular rash that spreads cephalocaudally, and pathognomonic Koplik spots (white lesions on the buccal mucosa) establishes a definitive clinical diagnosis of Measles.
Q21. A 70-year-old male with a known history of benign prostatic hyperplasia (BPH) presents to the emergency room with severe lower abdominal discomfort and an inability to urinate for the past 10 hours. On palpation, a distended, tender bladder is felt up to the umbilicus. What is the most appropriate initial management step?
A) Prescribe oral Finasteride and arrange an outpatient clinic visit
B) Perform urgent transurethral resection of the prostate (TURP)
C) Insert a urethral Foley catheter to decompress the bladder
D) Administer aggressive intravenous fluid boluses
Correct Answer: C
Explanation: This patient is experiencing acute urinary retention secondary to BPH. The immediate, definitive emergency intervention required to relieve severe pain and safeguard the upper urinary tract from post-renal failure is decompression via urethral catheterization.
Q22. A 34-year-old female presents to the health center for an evaluation of a neck mass. On physical examination, a firm, non-tender 2 cm nodule is palpated in the right lobe of the thyroid gland. She has no symptoms of hyperthyroidism or hypothyroidism. What is the standard initial diagnostic investigation for this thyroid nodule?
A) Thyroid Computed Tomography (CT) scan
B) Thyroid Ultrasound followed by Fine Needle Aspiration Cytology (FNAC)
C) Empirical treatment with Levothyroxine for 3 months
D) Immediate total thyroidectomy
Correct Answer: B
Explanation: The standard baseline diagnostic algorithm for evaluating structural thyroid nodules requires a thyroid ultrasound to assess for high-risk characteristics, paired with Fine Needle Aspiration Cytology (FNAC) to establish a benign or malignant cytologic profile.
Q23. A 26-year-old G3P2 woman at 34 weeks of gestation presents with regular uterine contractions. On sterile speculum examination, fluid is seen pooling in the posterior vaginal fornix, which turns nitrazine paper blue. Ferning is visible under microscopy. There are no signs of infection or fetal distress. What is the most appropriate management strategy?
A) Immediate induction of labor with high-dose oxytocin
B) Administer prophylactic antibiotics, antenatal corticosteroids, and monitor closely for infection
C) Perform an immediate emergency Cesarean delivery
D) Discharge the patient home and advise bed rest until 40 weeks
Correct Answer: B
Explanation: For patients with preterm premature rupture of membranes (PPROM) between 24 and 34 weeks without evidence of chorioamnionitis or fetal distress, conservative expectant management is recommended. This includes administering corticosteroids for lung maturity and prophylactic antibiotics to prolong latency and reduce maternal-fetal infectious morbidity.
Q24. A 42-year-old male presents with severe pain in his right great toe that started suddenly last night. On exam, the first metatarsophalangeal joint is erythematous, swollen, and exquisitely tender. Synovial fluid analysis reveals needle-shaped, negatively birefringent crystals under polarized light. Which of the following medications is used for long-term maintenance to lower serum uric acid levels?
A) Allopurinol
B) Indomethacin
C) Colchicine
D) Hydrochlorothiazide
Correct Answer: A
Explanation: The clinical profile and crystal analysis confirm acute gouty arthritis. While NSAIDs (Indomethacin) or Colchicine treat the acute flare, Allopurinol is a xanthine oxidase inhibitor explicitly used for long-term maintenance to reduce serum uric acid production and prevent recurrent attacks.
Q25. As a medical officer leading a primary healthcare team, you are organizing a mass immunization campaign against Measles in your catchment area. Which level of disease prevention does this mass vaccination campaign represent?
A) Primordial Prevention
B) Primary Prevention
C) Secondary Prevention
D) Tertiary Prevention
Correct Answer: B
Explanation: Primary prevention aims to intercept the development of disease entirely by optimizing baseline immunity or removing pathogenic threats before an initial infection occurs. Immunization campaigns are classic examples of primary prevention.