Here are two representative exam-standard MCQs, written to test clinical reasoning and teach through clear rationales.

Card 1 Question (1–2 sentences): A 28-year-old at 10 weeks’ gestation has severe nausea, weight loss, and ketonuria. Which is the most appropriate first-line inpatient management step? A. Start oral ondansetron only B. IV fluids with thiamine, then dextrose as needed C. Immediate total parenteral nutrition D. Induce labor Correct answer: B Rationale (1–2 sentences): Hyperemesis with ketonuria needs IV rehydration, electrolyte correction, and thiamine before carbohydrate to reduce risk of Wernicke encephalopathy. Dextrose can be added after thiamine and initial stabilization.

Card 2 Question (1–2 sentences): A 64-year-old has sudden painless monocular vision loss with a pale retina and a cherry-red spot. What is the most likely diagnosis? A. Acute angle-closure glaucoma B. Central retinal artery occlusion C. Central retinal vein occlusion D. Optic neuritis Correct answer: B Rationale (1–2 sentences): A pale retina with a cherry-red spot is classic for central retinal artery occlusion from retinal ischemia. The key discriminator is painless, sudden onset with arterial findings rather than venous hemorrhages or inflammatory pain.