Free DHA practice questions

Correct answer: A

• A. Give repeated inhaled salbutamol plus ipratropium, controlled oxygen, and systemic corticosteroids

  This is the appropriate immediate treatment for a severe acute asthma exacerbation. Short-acting bronchodilators, controlled oxygen, and early systemic corticosteroids should be started promptly.

• B. Administer a sedative and observe the patient for spontaneous improvement

  Sedatives can depress respiratory drive and may worsen respiratory failure. Observation without immediate bronchodilator and corticosteroid therapy is unsafe.

• C. Give oral antihistamine alone and reassess peak expiratory flow after one hour

  Antihistamines do not adequately reverse acute bronchospasm and should not be used alone for a severe asthma exacerbation.

• D. Give intravenous antibiotics and defer bronchodilator therapy until chest radiography is completed

  There are no features suggesting bacterial pneumonia, and imaging should not delay urgent bronchodilator and corticosteroid treatment in a severe asthma attack.

Global Initiative for Asthma (GINA), Global Strategy for Asthma Management and Prevention, 2025 · Management of exacerbations in primary or acute care (checked 9 August 2026)

Correct answer: D

• A. Start metformin alone and reassess the HbA1c in 3 months

  Metformin monotherapy is inadequate initially because the patient has symptomatic, marked hyperglycaemia and an HbA1c above 10%, circumstances in which insulin should be considered promptly.

• B. Start an SGLT2 inhibitor alone and reassess the HbA1c in 3 months

  An SGLT2 inhibitor may provide cardiovascular or renal benefits in selected patients, but monotherapy is not the appropriate initial response to this degree of symptomatic hyperglycaemia.

• C. Start a GLP-1 receptor agonist alone and defer insulin therapy

  A GLP-1 receptor agonist can be useful in type 2 diabetes, particularly with obesity, but it should not replace prompt insulin initiation in this patient with symptomatic severe hyperglycaemia.

• D. Start basal insulin and metformin, with glucose monitoring and education

  This is correct because marked hyperglycaemia with HbA1c above 10% and symptomatic hyperglycaemia warrants prompt initiation of insulin. Metformin may be used concurrently because there is no evidence of renal dysfunction or acute metabolic decompensation.

American Diabetes Association Standards of Care in Diabetes 2026 · Section 9: Pharmacologic Approaches to Glycemic Treatment (checked 9 August 2026)

Correct answer: C

• A. Nontuberculous mycobacterial pulmonary disease

  Nontuberculous mycobacteria generally do not produce a positive tuberculosis-specific interferon-gamma release assay, and this patient has no radiographic or clinical evidence of pulmonary disease.

• B. Bacille Calmette–Guérin vaccine reaction

  BCG vaccination can cause a false-positive tuberculin skin test, but it does not cause a positive interferon-gamma release assay. Therefore, the vaccination scar does not explain this result.

• C. Latent tuberculosis infection

  This is the best diagnosis. A positive interferon-gamma release assay indicates Mycobacterium tuberculosis infection, while the absence of symptoms and normal chest radiography support latent rather than active tuberculosis.

• D. Active pulmonary tuberculosis

  Active pulmonary tuberculosis is unlikely because the patient has no constitutional or respiratory symptoms and has a normal chest radiograph. An IGRA cannot by itself distinguish active from latent infection, so the clinical assessment is essential.

CDC/NTCA Clinical Practice Guidelines for the Diagnosis of Tuberculosis in Adults and Children · Testing for TB infection with an IGRA or TST (checked 9 August 2026)

Correct answer: A

• A. Administer routine antenatal anti-D immunoglobulin

  This is correct. An unsensitized RhD-negative pregnant woman should receive routine antenatal anti-D prophylaxis at around 28 weeks to prevent maternal alloimmunization.

• B. Administer magnesium sulfate for fetal neuroprotection

  Magnesium sulfate for fetal neuroprotection is considered when imminent preterm birth is expected, not during an uncomplicated 28-week pregnancy.

• C. Start low-dose aspirin prophylaxis

  Low-dose aspirin is used for selected women at increased risk of pre-eclampsia; RhD negativity is not an indication for aspirin.

• D. Administer intramuscular iron therapy

  Iron therapy is indicated for confirmed iron-deficiency anemia, not solely because the patient is RhD-negative with a negative antibody screen.

National Institute for Health and Care Excellence (NICE), Antenatal care, Guideline NG126, 2021 · Routine antenatal anti-D prophylaxis (checked 9 August 2026)

Correct answer: D

• A. Administer antenatal corticosteroids and defer delivery for 48 hours

  Antenatal corticosteroids may be considered when delivery is anticipated before 34 weeks, but delivery should not be delayed in a patient at or beyond 34 weeks with severe features or persistent neurological symptoms.

• B. Administer magnesium sulfate and observe without antihypertensive therapy or delivery

  Magnesium sulfate provides seizure prophylaxis but does not control severe hypertension or treat the underlying placental disease. It should not replace urgent blood-pressure treatment and delivery in this setting.

• C. Continue the pregnancy to 37 weeks with inpatient maternal and fetal surveillance

  This is inappropriate because she has preeclampsia with severe features, including severe hypertension, persistent neurological symptoms, thrombocytopenia, and elevated liver enzymes. At 34 weeks or later, delivery is recommended after maternal stabilization.

• D. Stabilize the mother with urgent antihypertensive therapy and magnesium sulfate, then initiate delivery

  This is the best approach. Severe hypertension requires prompt treatment, magnesium sulfate prevents eclamptic seizures, and preeclampsia with severe features at 34 weeks or later requires delivery after maternal stabilization. The route of delivery depends on obstetric circumstances.

American College of Obstetricians and Gynecologists, Practice Bulletin No. 222: Gestational Hypertension and Preeclampsia, 2020 · Management of Preeclampsia With Severe Features; Timing of Delivery (checked 9 August 2026)

Correct answer: B

• A. Rectal misoprostol

  Misoprostol may be considered when oxytocin is unavailable or ineffective, but it is less effective and has more frequent fever, shivering, nausea, and diarrhoea than oxytocin.

• B. Intravenous oxytocin

  Oxytocin is the recommended first-line uterotonic for postpartum haemorrhage caused by uterine atony, together with uterine massage and resuscitation.

• C. Intramuscular methylergonovine

  Methylergonovine is not the preferred first-line agent and is contraindicated in hypertension because it can cause severe vasoconstriction and hypertension.

• D. Intramuscular carboprost

  Carboprost is a second-line uterotonic when bleeding persists despite oxytocin; it should also be avoided or used cautiously in patients with asthma.

World Health Organization, Recommendations for the prevention and treatment of postpartum haemorrhage, 2017 · Treatment of postpartum haemorrhage due to uterine atony; uterotonics (checked 9 August 2026)

Correct answer: A

• A. Measles

  Correct. High fever, cough, coryza, conjunctivitis, Koplik spots, and a cephalocaudal maculopapular rash are classic for measles.

• B. Varicella

  Varicella produces an intensely pruritic vesicular rash in different stages of evolution, rather than a cephalocaudal maculopapular rash with Koplik spots.

• C. Rubella

  Rubella usually causes a milder illness, with posterior auricular or suboccipital lymphadenopathy; Koplik spots and prominent cough, coryza, and conjunctivitis favor measles.

• D. Roseola infantum

  Roseola typically affects infants, with a rash appearing as the fever resolves; it does not cause Koplik spots or the characteristic respiratory prodrome.

American Academy of Pediatrics, Red Book: 2024–2027 Report of the Committee on Infectious Diseases · Measles (Rubeola) (checked 9 August 2026)

Correct answer: B

• A. Administer intravenous naloxone

  Naloxone is not part of the initial management of neonatal bradycardia or apnea during resuscitation. Effective ventilation and, when indicated, chest compressions and epinephrine are required.

• B. Administer intravenous epinephrine at 0.01–0.03 mg/kg

  This is correct because the heart rate remains below 60/min despite effective ventilation and 60 seconds of coordinated chest compressions. Intravenous epinephrine through umbilical venous access is indicated.

• C. Administer an intravenous isotonic saline bolus of 10 mL/kg

  Volume expansion is considered when there is suspected blood loss or evidence of hypovolemia, such as pallor, weak pulses, and poor response despite resuscitation. It is not the routine next intervention here without evidence of hypovolemia.

• D. Administer intravenous sodium bicarbonate

  Sodium bicarbonate is not recommended during initial neonatal resuscitation because it has no established routine role and may be harmful. Ventilation, compressions, and epinephrine take priority.

Textbook of Neonatal Resuscitation, 8th edition, American Academy of Pediatrics and American Heart Association · Medications: Epinephrine (checked 9 August 2026)

Correct answer: C

• A. Begin intravenous antibiotics and observe for clinical improvement

  Epididymitis is less likely because the onset is sudden, nausea is present, and the cremasteric reflex is absent. Antibiotics and observation would risk irreversible ischemic injury.

• B. Arrange urgent Doppler ultrasonography before obtaining surgical review

  Doppler ultrasonography can help when the diagnosis is uncertain, but in this patient the classic findings make torsion highly likely. Imaging must not delay urgent surgical exploration.

• C. Perform immediate scrotal exploration with detorsion and bilateral orchiopexy

  This is the appropriate management for suspected testicular torsion because the clinical findings are highly suggestive and testicular viability declines with time. Surgical exploration should not be delayed for imaging.

• D. Attempt manual detorsion and schedule outpatient orchiopexy

  Manual detorsion may occasionally be used as a temporary measure while preparing for surgery, but it is not definitive treatment and should not be followed by delayed outpatient fixation.

European Association of Urology Guidelines on Paediatric Urology · Acute scrotum and testicular torsion (checked 9 August 2026)

Correct answer: B

• A. Insert a posterior nasal pack under sedation

  Posterior packing is reserved for suspected or confirmed posterior epistaxis or bleeding that cannot be controlled by anterior measures. This patient has an uncomplicated anterior bleed.

• B. Apply firm pressure to the soft nose while leaning forward

  This is the recommended first-line treatment for uncomplicated anterior epistaxis. Pressure should be continuous for about 10–15 minutes while the patient leans forward.

• C. Perform immediate chemical cautery of the bleeding vessel

  Cautery is appropriate when a bleeding point remains visible after adequate pressure, but it is not the initial step before compression.

• D. Arrange urgent computed tomography of the paranasal sinuses

  Imaging is not required for a straightforward, traumatic anterior nosebleed with a visible source and no features suggesting a mass, foreign body, or significant facial injury.

American Academy of Otolaryngology–Head and Neck Surgery Foundation, Clinical Practice Guideline: Nosebleed (Epistaxis), 2020 · Initial Management (checked 9 August 2026)