DHA Clinical Practice & Guidelines 3

Question 1

A 72-year-old diabetic patient presents with a non-healing foot ulcer with exposed tendon and surrounding cellulitis. His wound probe-to-bone test is positive. What does this finding most likely indicate?

Accepted Answer

Osteomyelitis

Answer

A positive probe-to-bone test (metal probe contacts bone through the wound) has a high positive predictive value for osteomyelitis in diabetic foot ulcers. This finding, combined with exposed tendon and cellulitis, strongly suggests bone infection.

Question 2

Which finding on fundoscopy is pathognomonic of hypertensive retinopathy grade IV (malignant hypertension)?

Accepted Answer

Papilledema

Answer

Papilledema (optic disc swelling) is the hallmark of grade IV (malignant) hypertensive retinopathy. It indicates severely elevated ICP secondary to malignant hypertension and represents a hypertensive emergency requiring urgent BP reduction.

Question 3

A patient with chronic kidney disease stage 3B has eGFR of 32 mL/min/1.73m². Which medication requires dose adjustment or should be avoided?

Accepted Answer

Metformin

Answer

Metformin should be used with caution when eGFR is 30–45 mL/min/1.73m² and is contraindicated when eGFR <30. It increases risk of lactic acidosis in renal impairment. DHA guidelines follow international standards for CKD drug dosing.

Question 4

A 45-year-old woman presents with fatigue, weight gain, constipation, and cold intolerance. TSH is 12 mIU/L and free T4 is low. What is the most appropriate treatment?

Accepted Answer

Levothyroxine (T4) replacement

Answer

Primary hypothyroidism (high TSH, low free T4) is treated with levothyroxine (synthetic T4). T4 is converted to active T3 peripherally. Levothyroxine has a long half-life (~7 days) allowing once-daily dosing.

Question 5

Which of the following best describes the appropriate management of a first unprovoked seizure in an adult with a normal MRI and EEG?

Accepted Answer

Defer AED treatment; counsel on seizure precautions and driving restrictions

Answer

After a single unprovoked seizure with normal investigations, immediate AED therapy is not mandatory. Current guidelines recommend shared decision-making, with AEDs offered if recurrence risk is high. Patients must be counseled on driving restrictions and safety precautions.

DHA - Dubai Health Authority Practice Test

DHA - Dubai Health Authority Practice Test

DHA Clinical Practice & Guidelines 3