You are a doctor responding to a crisis call from a distressed individual named Melati. Melati has just experienced a sudden, traumatic event and is overwhelmed by intense emotions and anxiety. She is struggling to cope with the immediate aftermath of the incident and has difficulty functioning. Your primary goal is to provide immediate assistance. What is the primary focus of crisis intervention in this scenario?

Addressing the immediate emotional and practical needs of Emily.

Suggesting medication to manage her acute distress

Assessing her childhood experiences and attachment patterns.

Exploring the long-term historical factors contributing to her crisis.

Offering long-term psychotherapy to address deep-rooted emotional issues.

Aan, a 34-year-old male with a history of schizophrenia, is brought to the emergency department by his family members. He has been agitated, pacing, and shouting for several hours, not responding to verbal de-escalation techniques. What should the ER doctor consider as the further intervention?

Administer a short-acting antipsychotic IM

Educate mindfulness and deep breathing

Administer a short-acting benzodiazepine IV

Initiate electroconvulsive therapy (ECT)

Administer a long-acting antipsychotic IM

A 40-year-old woman presented with subacute onset of quadriparesis of 3 months' duration, associated with electric shock like pains radiating along the outer aspect of the right arm. On examination, she had spastic grade 4/5 quadriparesis, the right biceps jerk was absent, and the other tendon jerks were brisk with extensor planter responses. What is the most likely diagnosis?

Cervical cord compression at C5 level

Nerve root compression at C3 level

Subacute combined degeneration of the cord

Patient came to emergency room due to profuse vaginal bleeding since yesterday. She claimed that she is pregnant for 3 months. She has just passed some tissues prior to consult and after that the bleeding diminished. She is on stable vital signs. On physical examination, the abdomen was soft and non-tender. The cervix was soft and closed, with minimal bleeding from vagina. Ultrasound has been done and the result is an empty uterus and both adnexas within normal limits. What do you think happen in this patient and what is the treatment?

Complete abortion and observation

Missed abortion and observation

Complete abortion and curettage

Incomplete abortion and curettage

Incomplete abortion and observation

A 20-year-old woman at 30 week gestation presents to the emergency room with malaise, headache, and nausea. On physical exam, she is alert and oriented. She is noted to have bilateral lower extremity edema. A urine dipstick shows 2+ proteinuria and her blood pressure is 150/96 mmHg. Her other laboratory values are within normal limits. She is discharged home. The next day, she returns with a worsening headache and found with elevated blood pressure again at 163/100 mmHg. What is the best management for this patient?

Lung maturation and induce labor

Oral magnesium sulfate for prophylaxis

Continuous anti-hypertension therapy until term pregnancy

Admission to hospital and observation until term pregnancy

Andi, 11 years old, was brought to the ER with pain at his right testicle since 2 days ago. The pain is so intense that often makes him cry. There was no history of nausea, vomiting and dysuria. On physical examination, patient's vital signs are stable. Scrotal examination revealed blue dot sign and tenderness at upper pole of his right testicle. Which one of this option is the most appropriate management for this patient?

Single dose of Ceftriaxone IM and Levofloxacine oral for 10 days

There is no need of medication because it is a self-limiting disease

A five years-old girl developed a high fever, of 40C, and increasing difficulty breathing within a 10-hour period. She refused to drink or eat, and she cried only minimally despite her ill-looking appearance. Her vital status: disoriented, HR 140x/m, RR 48x/m, temp 40C, O2 sat 80%. There is some drooling of saliva down her chin, and a soft inspiratory stridor is heard. She had no preceding coryzal symptoms. What is the most appropriate next step of management?

Take a throat swab for culture and sensitivity

Give nebulized adrenaline to the patient

During a treatment of an overdose case in emergency, breathing begins to slow down and patient become apneic. The patient become unconscious fall into a coma for more than 5 minutes. After the doctor realized it he/she is trying to give patient treatments. Despite all of the treatments, the patient still unconscious for the rest of his life (vegetative state). Why do you think this happened?

Prolong hypoxyoxgenation causing permanent brain damage

Brain damage accompanied with liver failure

Multiple organ dysfunction due to drug overdose

Brain injury caused by multiple treatments given during hypoxemia

Severe sepsis causing permanent brain damage

A 38-year-old female was diagnosed with Diffuse peritonitis due to perforated ileum due to abdominal typhoid infection. The surgeon has done laparotomy and ileostomy to her 2 days ago. She recovered well in the ICU for 2 days and now she is admitted to general ward today. You are doctor at duty tonight in the general ward. The patient was admitted to general ward at 1 PM and she is alert, stabile vital signs and no complaint except for tolerable pain at his abdominal wound. The ileostomy is vital, no signs of necrotic, with productive enteric content and gas, about ¼ of its full capacity. At 11 PM, you are alerted by the nurse that the patient seems in confusion GCS E3M4V2=9, HR 110x/m, RR 24x/m, T 90/palpation. Temp 37.20 C. Her abdomen is not distended, no bowel sound is heard. No muscular rigidity. Her abdominal wound is within normal limit, the ileostomy is still vital, no signs of necrotic, with full capacity of the stoma bag. The family said the nurse in the morning shift have empty the stoma bag 3 times as it is full of enteric content and gas. You proceed to check her pulse, her pulse is weak and her extremities are cool, clammy. Without hesitation, you proceed to

Rehydrate the patient with massive crystalloid infusion

Call the surgeon to inform the patient's condition and prepare for emergency re-laparotomy

Send the patient to ICU again for severe sepsis campaign

Give IV antibiotics to reduce the abdominal infection

Mr. Hendry, 34 years old male, got a motor vehicle accident. He was not using helmet when the accident happened. When he fell, his head hit the road. He become unconscious after that and never again regain his consciousness until now. When ambulance came, his blood pressure is 120/80 mmHg, pulse 88 x/minutes, respiratory rate was 12 x/ minutes. What do you think the cause of his unconsciousness?

The concussion effect to the brain stem

He was drunk before the accident

Big hematoma compressing his scalp

Broken bone at his head causing infection

Other medical problem such as heart attack, hyperglycemia, etc.

A 70 y.o female is admitted to ER at 11 PM with chief complain diffuse/whole severe abdominal. At first the pain was only in her epigastric area for 4 days and then it spread to whole abdomen for the last 2 days. She also have continuous progressive fever since this morning, with very minimal oral intake since this morning also. Since 3 days ago she has melena, without diarrhea, with normal stool volume and frequency. She also has decreased mictrition. No history of abdominal trauma, no history of previous episode like this. She has history of chronic gastritis and chronic knee arthritis. She routinely consumed painkiller for her knee arthritis, bought by the patient herself (self-medication) for more than 10 years. She now looks sleepy and lethargic with GCS E3M6V5 BP 100/60 mmHg, HR 120x/m, RR 20x/m, Temp 38C. Skin is dry with decreased turgor. Extremity is cool, clammy with normal capillary refill. Abdomen is distended, negative liver dullness, decreased bowel sound, muscular rigidity is present with tenderness and rebound tenderness at palpation. Digital Rectal Examination/DRE shows that she has decreased sphincter tone, smooth mucosa, rectal vault is normal with tenderness all direction. The punctum maximum of pain is at the epigastric region. At your gloves after DRE you found black bloody stool with foully smelling. You need to stabilize the patient, what do you do? (prioritize your action)

Non per oral, Give oxygen and IV Fluids, abdominal decompression, IV antibiotics and analgetic

Give fluid and blood to the patient, antibiotics and analgetics

Intubate and send the patient to the ICU

Lab check and abdominal xray, abdominal CT if needed

Emergency consult to surgeon for emergency exploratory laparotomy

A male, 34 years old came to Emergency Department (ED) with knive stabbing wound in his right upper abdomen. Pasien remain concious, complaining about pain on his right upper abdomen. Vitals signs are Blood pressure 100/70 mmHg, Pulse 109 x/mnt, RR: 22 x/mnt, t: 36.4; VAS 6-7. Which one is not an indication for Exploration Laparotomy for this case:

Penetrating injury just only to remove Corpus alienum without signs of organ injury

Penetrating abdominal injury with unstable hemodynamic

Penetrating injury with Signs of Free air and peritonitis

Penetratring injury with signs of bleeding in Gastrointestinal Tract

Penetrating injury proved to penetrating large vessels

A 25-year-old woman arrives in the emergency room following an automobile accident. She is acutely dyspneic,cannot even spoke a word, with a respiratory rate of 60 breaths/min. Her trachea is shifted to the left side.Breath sounds are markedly diminished on the right side. The first step in managing the patient should be to

Decompress the right pleural space

Draw arterial blood for blood gas determination

A 30-year-old man is struck by a car traveling at 80 km/hour. He has obvious fractures of the left tibia near the knee, pain in the pelvic area, and severe dyspnea. His heart rate is 180 beats per minute, and his respiratory rate is 48 breaths per minute with no breath sounds heard in the left chest. A tension pneumothorax is relieved by immediate needle decompression and tube thoracostomy. Subsequently, his heart rate decreases to 140 beats per minute, his respiratory rate decreases to 36 breaths per minute, and his blood pressure is 80/50 mmHg. Warmed Ringer's lactate is administered intravenously. The next priority should be to:

Perform external fixation of the pelvis

Full blood examination, including Lactate and Blood gas analysis

Obtain abdominal and pelvic CT scans

Call family to give emergency blood transfusion for the patient

Consult a surgeon for emergency operation

Bob, a 22-year-old male, begins treatment with haloperidol. Three weeks after the initiation of therapy, physical examination shows mask-like facies, drooling, tremors, pill-rolling motion, cogwheel rigidity, and shuffling gait. Which of the following is the most likely pathophysiology of these symptoms?

Decreased dopamine levels in the nigrostriatal pathway

Decreased dopamine levels in the tuberoinfundibular pathway

Decreased dopaminergic activity in the mesolimbic pathway

Increased dopaminergic activity in the mesolimbic pathway

Decreased dopaminergic activity in the mesocortical pathway

A 72 year old man, came to ER with chief complaint of severe whole abdominal pain since 2 days ago, with pain score 9 from 10. The most severe pain is felt in left lower quadrant, at first it was intermittent, but not it is continuous. The pain is progressive and worsened with patients’ movement. 2 days ago the pain score is 7 from 10 when he moved, now it is 9 from 10 even when he is not moving. The pain is accompanied with inability to pass gas and defecate since 1 week ago. He also complained of distended abdomen and severe vomiting. His physical examination: he looks in grave condition, in severe pain. BP is 110/70 mm Hg, RR 32x/m, HR 120x/m, Temp 39.20C. O2 Saturation 96%. His skin turgor is decreased. His abdomen is very distended, bowel sound is increased with metallic sound (+). When you performed abdominal percussion, you noticed there is hipertympanic sound in all quadrant. You also noticed tenderness and rebound tenderness in left lower quadrant, without any muscular rigidity. You couldn’t palpate any mass in his left lower quadrant because his abdomen is very distended. What is another required physical examination should you check for this patient?

Digital rectal examination to check whether the rectal ampulla is collapsed

Percussion in Traube space to check spleen, because the pain is in the left side

Deep palpation to check liver and spleen

Ascites examination: fluid shift and fluid wave

A woman who had a normal vaginal delivery with 2nd-degree perineal lacerations develops postpartum hemorrhage. The third stage was managed actively and the placenta and membranes were expelled completely soon after delivery of the baby. What is the first step in the management?

Insert two large IV cannulas and give fluid

Call the anesthesiologist and prepare for operation

Place a condom catheter intrauterine for tamponade

A 23-year-old man is brought immediately to the emergency department from the hospital parking lot where he was shot in the lower abdomen. Examination reveals a single bullet wound. He is breathing shakily and has a thready pulse. He is unconscious and has no detectable blood pressure. Optimal immediate management is to

Initiate primary survey and transfer the patient to the operating room

Initiate transfusion of Fresh Frozen Plasma and whole blood

Perform an emergency abdominal and pelvic CT scan

Give oxygen and insert a urinary catheter

A teenage bicycle rider is hit by a truck at a high rate of speed. In the emergency department, she is actively bleeding from open fractures of her legs and has abrasions on her chest and abdominal wall. Her blood pressure is 80/50 mm Hg, heart rate is 140 beats per minute, respiratory rate is 8 breaths per minute, and GCS score is 6. The first step in managing this patient is to

Perform endotracheal intubation and ventilation

Obtain a lateral cervical spine x-ray

Administer 2 liters of crystalloid solution

Insert a central venous pressure line

Apply the PASG and inflate the leg compartments

A 47 year old male was brought to emergency due to history of brief unconsciousness. The family told that the patient was suffering from edema in his both leg since a week ago, and he was prescribed Furosemide for his problem. Physical examination showed normal heart sound and normal vesicular sound on both lungs. What do you suggest causing the brief unconscious in this patient?

Drug induced orthostatic hypotension

Stimulation to trigeminal nerve

Hyperactivity of vasovagal reflex

A 45-year-old man is brought to the emergency department after collapsing and having convulsions. He began seizing about 15 minutes ago and has not regained consciousness during this time. His coworkers report that he fell to the ground and started shaking uncontrollably, with frothy saliva visible around his mouth. His coworkers have no idea about his previous health history. Upon arrival, the patient is still actively convulsing with rhythmic jerking of all four limbs, but his airway patency is preserved. His vital signs show a heart rate of 120 bpm, blood pressure of 150/90 mmHg, and oxygen saturation of 98% on nasal cannula. Blood glucose is measured at 85 mg/dL. On physical examination, his pupils are equal and reactive. Which of the following is the next best step in the management of this patient?

Administer intravenous diazepam

Intubate and administer propofol

Administer oral phenobarbital per NGT

Administer intravenous phenytoin

A 78 years old male is admitted to ER with chief complaint severe whole abdominal pain, starting since 3 days ago. At first he complained of colicky severe abdominal pain, accompanied with nausea and vomiting, and cannot passage gas, also distended abdomen since 6 days ago. He denies any fever, but his micturition is decreased since 3 days ago. Previously he had alteration of his bowel habit since 6 months ago, the stool caliber is decreased and accompanied with fresh blood, mixed in his feces. No history of chronic diarrhea. Decreased of weight also noticed by the patient and the family but they don't know about the number. His physical exam: He is lethargic, anemic, look cachexic. BP 110/60 mmHg, HR 100x/m, weak but regular. RR 28x/m, Temp 38.6 C. Body weight 60 kg, Height 170 cm. urine output 30 cc/hour. His abdomen: distended, no bowel sound, percussion: pain at whole abdomen, palpation: tenderness and rebound tenderness at whole abdomen, muscular rigidity at whole abdomen. What has happened to this patient?

It is an obstructed bowel case that lead to strangulated ileus and peritonitis in the end

It is an obstructed bowel because he has no passage of the stool for 6 days

It is a peritonitis because the patient has distended abdomen

It is a paralytic ileus because the patient has no bowel sound

It is an acute abdomen with shock

MCQ ICM2

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MULTIPLE CHOICE QUESTION

30 sec • 1 pt

You are a doctor in the emergency department, currently working with a patient, Anto, who is experiencing a recent crisis related to the sudden loss of his job. Anto is struggling with feelings of hopelessness, anxiety, and has reported suicidal ideation. Which of the following best describes the primary focus of crisis intervention compared to psychotherapy in this context?

Crisis intervention aims to provide long-term emotional support and insight, while psychotherapy is focused on immediate stabilization.

Crisis intervention and psychotherapy have identical goals and approaches when dealing with individuals in crisis.

Crisis intervention emphasizes addressing the immediate crisis situation and safety, while psychotherapy is oriented towards exploring and resolving deeper emotional issues.

Crisis intervention prioritizes assessing the underlying causes of the crisis, while psychotherapy is focused on short-term symptom relief.

Crisis intervention is exclusively focused on medical management, whereas supportive psychotherapy emphasizes psychological support.

MULTIPLE CHOICE QUESTION

30 sec • 1 pt

A 37-year-old man falls 4 meters off of a roof and fractures his cervical spine, causing damage at the C4 level. He is initially a flaccid quadriplegic with areflexia. This areflexia and flaccidity evolve into hyperreflexia and spasticity within 2 weeks later. What is the cause of this phenomenon?

Spinal cord laceration

Spinal cord hypoxic

Spinal cord compression

Spinal shock

Spinal cord contusion

MULTIPLE CHOICE QUESTION

30 sec • 1 pt

A 89-year-old male has intermittent colicky pain in his abdomen, localized in his left lower quadrant and radiating to the whole abdominal region since 2 days ago. The pain is progressively worsened, with earlier pain scale is 4/10 and now it is 10/10. He also complained of obstipation, his last defecation is 5 days ago, with decreased in stool calibre and fresh blood in his faeces. He also complained of nausea and vomiting, and distended abdomen. He looks severely malnourished, he has decreased of weight, 10 kg in last month. His vital signs: BP 110/70 mmHg, HR 120×/m RR 40×/m, Temp 36.8 degree Celsius. He looks anaemic, his skin turgor is decreased. His abdomen is distended, increased bowel sound and metallic sound is observed, without muscular rigidity. What would you do next for the early management?

Refer him to ICU

Rehydrate the patient

Consult him to the surgeon

Prepare him for blood transfusion

Give him albumin transfusion

MULTIPLE CHOICE QUESTION

30 sec • 1 pt

Anton, 24 years old, came to the ER with pain at his right testicle since 4 days ago. It was accompanied with fever and scrotal swelling. The patient admitted that he has multiple sexual partners and rarely use condom. On physical examination, temperature shows 38,5C. Scrotal examination revealed a swollen, red and warm scrotum. The patient stated that the pain was relieved with elevation of the scrotum. Color doppler ultrasonography revealed increase of epididymal size and intratesticular blood flow. What is the most appropriate management for this patient?

Single dose of Ceftriaxone IM and Doxycycline oral for 10 days

NSAID administration and physical activity restriction

Refer the patient for immediate surgery

Ciprofloxacin oral 2x500 mg for 7 days

Single dose of Ceftriaxone IM and Levofloxacin oral for 10 days

MULTIPLE CHOICE QUESTION

30 sec • 1 pt

You are working with a patient who has a history of suicidal thoughts and a previous suicide attempt. He has recently expressed feeling overwhelmed by stress and isolation. You decide to create a safety plan to help him manage moments of crisis and suicidal ideation. What is a crucial component to include in the safety plan to enhance his suicide prevention strategy?

Identifying cognitive distortions and exploring alternative thoughts

Encouraging him to develop a personalized list of coping strategies and distractions

Giving him adequate space to express his childhood trauma

Examining transference within the doctor-patient relationship

Investigating the underlying causes of his suicidal thoughts

MULTIPLE CHOICE QUESTION

30 sec • 1 pt

A 62-year-old man come to Emergency Department with chief complaint a sudden severe chest pain 4 hours ago. The substernal chest pain start suddenly while he was watching his favourite football match on TV. The pain lasted for about 30 minutes, radiated to his jaw and left arm while he sweated a lot. His wife force him to go seek medical attention although now he does not feel the pain anymore. He has a history of abnormal fasting glucose test but not take any medicine regularly. What is the most appropriate diagnosis now?

Acute pericarditis

Acute coronary syndrome

Aortic regurgitation

Psychological chest pain

Mitral Stenosis

MULTIPLE CHOICE QUESTION

30 sec • 1 pt

A male, 70 year old, came to emeegency department with shortness of breath and pink frothy sputum. On physical examination: RR 36x/m, BP 170/100, HR 130x/m, SpO2 100%. The chest X ray showed CTR 70%. What is the most probably pathomechanism of the disease?

Imbalance oxidant-antioxidant

Decrease oncotic pressure

Ventilation impairment

Increased hydrostatic pressure

Perfusion Impairment

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MCQ ICM2

A 37-year-old man falls 4 meters off of a roof and fractures his cervical spine, causing damage at the C4 level. He is initially a flaccid quadriplegic with areflexia. This areflexia and flaccidity evolve into hyperreflexia and spasticity within 2 weeks later. What is the cause of this phenomenon?

A male, 70 year old, came to emeegency department with shortness of breath and pink frothy sputum. On physical examination: RR 36x/m, BP 170/100, HR 130x/m, SpO2 100%. The chest X ray showed CTR 70%. What is the most probably pathomechanism of the disease?

A male, 70 year old, came to emergency department with shortness of breath and pink frothy sputum. On physical examination: RR 36x/m BP 170/100, HR 130x/m, SpO2 100%. The chest X ray showed CTR 70%. What is the pathognomonic sound on auscultation?

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