Q- A patient comes to a rural hospital one hour after he experienced excruciating chest pain. After workup, you diagnose his case as a myocardial infarction. The nearest hospital is 2 hours away. What is the best next step??
A- Administer thrombolytic now
B- Consult a cardiologist
C- Transfer to the nearest hospital
A- Administer thrombolytic now- In a confirmed myocardial infarction where PCI cannot be performed within 120 minutes, the best immediate treatment is thrombolytic therapy. Since the nearest hospital is 2 hours away and time-to-reperfusion is critical, giving thrombolytics immediately offers the greatest survival benefit.
Q- Which one of the following can be found in the blood sample of a patient diagnosed with sickle cell disease?
A- Bite cells
B- Howell-Jolly bodies
C- Schistocytes
D- Spherocytes
B- Howell-Jolly bodies- Patients with sickle cell disease develop functional asplenia due to repeated splenic infarctions. Without a functioning spleen, they cannot remove nuclear remnants from red blood cells, leading to the presence of Howell-Jolly bodies on a blood smear. Bite cells occur in G6PD deficiency, schistocytes in microangiopathic hemolysis, and spherocytes in hereditary spherocytosis or autoimmune hemolytic anemia.
Q- Which of the following is the most appropriate next step in the management of a patient complaining of symptoms of GERD?
A- Barium swallow
B- Endoscopy
C- Omeprazole
D- Ranitidine
C- Omeprazole- For typical GERD symptoms without alarm features, the best initial management is a trial of a proton pump inhibitor such as omeprazole. Endoscopy and barium studies are not first-line unless there are concerning symptoms. Ranitidine is no longer recommended due to safety concerns and is less effective than PPIs.
