Master Specialist Internal Medicine (INT5921)
for DHA Speciality

A 58-year-old man with type 2 diabetes and hypertension presents with 3 days of progressive dyspnoea, orthopnoea, and bilateral leg swelling. He reports no chest pain. Vital signs: BP 168/96 mmHg, HR 112/min, RR 26/min, SpO2 89% on room air, temperature 36.8?C. Examination reveals bibasal crackles, elevated JVP, and S3 gallop. ECG shows sinus tachycardia with no ST changes. Troponin I is 0.04 ng/mL (normal

A 34-year-old woman at 32 weeks gestation presents with 2 days of right upper quadrant pain, nausea, and malaise. She has no prior liver disease. Vital signs: BP 148/92 mmHg, HR 98/min, temperature 37.2?C. Laboratory: ALT 210 U/L, AST 185 U/L, platelets 88 x 109/L, LDH 620 U/L, bilirubin 1.8 mg/dL, creatinine 1.1 mg/dL. Urine protein is 2+ on dipstick. Peripheral blood smear shows schistocytes. What is the most likely diagnosis?

A 72-year-old man with COPD (FEV1 45% predicted) presents with 4 days of increased sputum purulence, cough, and dyspnoea. He has no fever or chest pain. Vital signs: RR 24/min, HR 92/min, SpO2 88% on room air (baseline 92%). Chest X-ray shows hyperinflation without consolidation. He has received amoxicillin for 3 days without improvement. What is the most appropriate antibiotic?

A 45-year-old woman presents with 6 weeks of fatigue, arthralgias, and a malar rash. She has no oral ulcers or photosensitivity. Vital signs: BP 138/84 mmHg, HR 78/min, temperature 37.0?C. Laboratory: ANA 1:640, anti-dsDNA positive, C3 low, C4 low, urine protein 3.5 g/24h, creatinine 1.0 mg/dL, platelets 210 x 109/L. She has no hematuria or red cell casts. What is the most appropriate next step?

A 68-year-old man with atrial fibrillation on warfarin presents with sudden onset of right arm weakness and aphasia. Last known well was 2 hours ago. Vital signs: BP 178/94 mmHg, HR 110/min irregular, glucose 142 mg/dL. Non-contrast CT head shows no hemorrhage. INR is 2.8. What is the most appropriate management?