Which of the following factors registers a score of 3 in the Well's Score for diagnosis of pulmonary embolism (PE)?

Correct Answer: A

Rationale: The correct answer is A: A heart rate >100 beats/minute. In the Well's Score for PE, a heart rate >100 indicates a score of 3, reflecting the increased risk of PE. This is because tachycardia can be a sign of the body compensating for decreased oxygen levels due to a PE. Choices B, C, and D are incorrect because they do not register a score of 3 in the Well's Score. Immobilization or surgery within 6 weeks and presence of cancer each score 1 point, while symptoms of haemoptysis score 1 point as well. These factors are important in the overall assessment of PE risk but do not specifically correspond to a score of 3 in the Well's Score system.

Correct Answer: A

Rationale: Rationale: 1. Fasting plasma glucose >=7.0 mmol/l is a diagnostic criteria for diabetes. 2. It indicates sustained hyperglycaemia without food intake influencing the result. 3. Choice B tests glucose response to a glucose challenge and may not reflect fasting levels. 4. HbA1c measures average glucose levels over 2-3 months, not immediate status. 5. Choice D lacks specificity as random glucose levels can fluctuate.

Correct Answer: B

Rationale: The correct answer is B. Lowering blood pressure and urgent CT angiogram are crucial in suspected aortic dissection. High BP with variability between arms and tearing chest pain are classic signs. T-wave inversions in inferior leads may occur but are not specific to aortic dissection. Choice A is incorrect as antibiotics are not indicated unless infective endocarditis is confirmed. Choice C is incorrect as antiplatelet therapy and heparin are not first-line treatments for aortic dissection. Choice D is incorrect as NSAIDs can worsen aortic dissection, and echocardiogram is not the initial imaging modality of choice for this condition.

Correct Answer: D

Rationale: The correct answer is D: Measure gastric acid secretion. In a suspected case of gastrinoma, elevated serum gastrin levels can lead to increased gastric acid secretion. Measuring gastric acid secretion can help confirm the diagnosis of gastrinoma by assessing for increased acid production. This can be done with tests like the gastric acid stimulation test or the secretin stimulation test. Option A is incorrect as an exploratory laparotomy is an invasive procedure and should not be the first step in the diagnostic process. Option B, measuring serum gastrin in response to secretin infusion, may be helpful in confirming the diagnosis but measuring gastric acid secretion is more directly related to the pathophysiology of gastrinoma. Option C, treating for H. pylori, is not indicated in this case as the patient's symptoms are more suggestive of gastrinoma rather than H. pylori infection.

Correct Answer: B

Rationale: The correct answer is B: Endoscopic balloon dilatation. This patient likely has achalasia based on the symptoms of regurgitation, chest pain, dysphagia, weight loss, and the CXR findings of a dilated esophagus and absent gastric air bubble. Endoscopic balloon dilatation is the initial treatment of choice for achalasia to disrupt the lower esophageal sphincter muscle fibers and improve esophageal emptying. Proton-pump inhibitors (Choice A) are not effective for achalasia. Sucralfate (Choice C) is used for mucosal protection but does not treat achalasia. Esophageal resection (Choice D) is a last resort for refractory cases.