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Q- A 55 year-old man underwent internal fixation of fractured femur after a motorcar accident and massive bleeding 24 hours ago. He was stable after the surgery and his urine output was normal after he received intravenous fluids. Now he complains of substernal chest pain and shortness of breath. On examination, His temperature is 98.8 F, Pulse is 110/min, blood pressure is 160/100 mmHg and his respiratory rate is 24/min. There is no jugular vein distention. His extremities have established pulses bilaterally and good perfusion. Auscultation reveals harsh systolic murmur across the precordium and crackles on both lung bases. ECG shows sinus tachycardia with delayed precordial transition and no other changes. Laboratory tests including cardiac enzymes are all normal.
What is the most likely diagnosis?
A- Acute myocardial infarction
B- Left bundle branch block
C- Septic shock
D- Hypertrophic cardiomyopathy
E- Pericardial effusion


Q- A 16-year-old woman is brought to the emergency room by her mother following a seizure. She is 30 week pregnant with twins. Her mother told you that her daughter was eating lunch and when she stood up she fell on the floor and started shaking. She never had any seizures before. During last week, she complained of headache and swelling of her face. She missed her last two obstetrician's appointments.
On Examination, she is unresponsive and difficult to arouse. Her blood pressure is 210/120. There is edema of her face and both hands. Fetal heart rate is 140/min.
What is the next step of management of this patient?
A- Hospitalization and treatment with antihypertensive and epileptic drugs and wait until delivery at term
B- Hospitalization and observation until delivery at term
C- Hospitalization and induction of labor
D- Outpatient treatment and recommend regular visits to the clinic

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