Kuwait MOH exam questions by profession

Answer: A. Check serum calcium urgently and prepare intravenous calcium gluconate

Perioral and digital paraesthesia with a positive Chvostek sign indicate hypocalcaemia from parathyroid injury or removal, which can progress to tetany and laryngospasm; urgent calcium level and IV calcium gluconate are needed. Checking for haematoma is an important post-thyroidectomy assessment, but bleeding presents with neck swelling and airway compromise, not paraesthesia and facial twitching.

Answer: D. Give fibrinolysis now and then transfer to the PCI centre

Primary PCI is preferred only when it can be delivered within 120 minutes of diagnosis; when the expected delay is longer, fibrinolysis should be given without delay to patients presenting within 12 hours, followed by transfer for angiography. Direct transfer for primary PCI is tempting but here would delay reperfusion beyond the recommended window. Troponin should never delay reperfusion in STEMI.

Answer: B. Amiodarone 300 mg IV

In shockable cardiac arrest, AHA and ERC guidance is to give amiodarone 300 mg IV after the third shock, with a further 150 mg after the fifth shock if VF persists. The 150 mg dose is the second, later bolus, not the first. Atropine is no longer recommended in cardiac arrest, and adenosine is for stable narrow-complex tachycardia.

Answer: A. Fluid restriction

Hypotonic hyponatraemia with concentrated urine, high urine sodium and euvolaemia is consistent with SIADH, and fluid restriction is first-line for mild to moderate asymptomatic cases. Isotonic saline can worsen hyponatraemia when urine osmolality is well above that of the infused fluid, because the sodium is excreted and free water retained. Hypertonic saline is reserved for severe symptoms.

Answer: C. Withhold the antipsychotic and escalate for urgent medical management

Fever, lead-pipe rigidity, altered consciousness, autonomic instability and raised CK after starting a dopamine antagonist indicate neuroleptic malignant syndrome, a medical emergency: the antipsychotic is stopped and the patient is cooled, hydrated and escalated. Serotonin syndrome is the tempting alternative, but it typically follows serotonergic drugs and presents with clonus and hyperreflexia rather than lead-pipe rigidity.

Answer: B. Immobilise the wrist and arrange further imaging, preferably MRI

Scaphoid fractures are often not visible on initial radiographs, and a missed fracture risks non-union and avascular necrosis of the proximal pole, so suspected fractures are immobilised and further imaging such as MRI is arranged. Discharging the patient as a sprain on the basis of normal radiographs is the classic error.