Test TOM - Ordre des Médecins Practice Questions - Test Préalable à l'Inscription au Tableau de l'Ordre des Médecins (Test TOM, DR Congo) Exam - Test TOM - Ordre des Médecins Practice Questions - Test Préalable à l'Inscription au Tableau de l'Ordre des Médecins (Test TOM, DR Congo) Exam

Question 1

A 28-year-old man presents to the emergency ward in Kinshasa with high fever (39.8°C), chills, severe headache, and vomiting. A rapid diagnostic test (RDT) and thick blood smear confirm Plasmodium falciparum infection with 8% parasitemia. He is conscious but prostrated and unable to retain oral medications. According to the DRC National Malaria Control Programme (PNLP) guidelines, what is the first-line treatment of choice?

Oral Artemether-Lumefantrine (AL) crushed in water with an antiemetic Intravenous Artesunate at 2.4 mg/kg at 0, 12, and 24 hours, then once daily until oral therapy can be tolerated Intravenous Quinine infusion at a loading dose of 20 mg/kg in 5% Dextrose over 4 hours, without monitoring blood glucose Intramuscular Chloroquine at 10 mg/kg every 12 hours for 3 days

Correct Answer:

Intravenous Artesunate at 2.4 mg/kg at 0, 12, and 24 hours, then once daily until oral therapy can be tolerated

Question 2

A 34-year-old HIV-positive patient on antiretroviral therapy presents with a 3-week history of productive cough, evening fever, drenching night sweats, and a 5 kg weight loss. Sputum GeneXpert MTB/RIF reveals Mycobacterium tuberculosis detected with no rifampicin resistance. What is the standard first-line antituberculosis treatment regimen recommended by the DRC National Tuberculosis Programme (PNLT) for this newly diagnosed drug-susceptible pulmonary tuberculosis case?

2 months of Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol (2RHZE) followed by 4 months of Isoniazid and Rifampicin (4RH) 2 months of Streptomycin, Isoniazid, Rifampicin, and Pyrazinamide (2SHRZ) followed by 6 months of Isoniazid and Ethambutol (6HE) 6 months of daily Levofloxacin, Bedaquiline, Linezolid, and Clofazimine 9 months of Isoniazid and Rifampicin monotherapy (9RH) with pyridoxine

Correct Answer:

2 months of Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol (2RHZE) followed by 4 months of Isoniazid and Rifampicin (4RH)

Question 3

A 42-year-old male with newly diagnosed advanced HIV infection (CD4 count 45 cells/uL) presents with subacute headache, fever, neck stiffness, and photophobia. Lumbar puncture reveals clear cerebrospinal fluid (CSF) with elevated opening pressure (280 mm H2O), lymphocytic pleocytosis, low glucose, and India ink preparation showing encapsulated budding yeasts. Cryptococcal antigen (CrAg) lateral flow assay is positive. What is the optimal induction management and timing of Antiretroviral Therapy (ART) initiation?

Immediate initiation of TDF + 3TC + DTG on day 1 alongside oral fluconazole 200 mg daily Induction with IV Amphotericin B deoxycholate plus oral Flucytosine (or high-dose Fluconazole 1200 mg/day), therapeutic lumbar punctures for intracranial hypertension, and deferring ART by 4 to 6 weeks from the start of antifungal treatment Immediate high-dose intravenous Dexamethasone for 4 weeks combined with immediate ART initiation to prevent neurological deficit Single-dose intrathecal Methotrexate followed by maintenance Co-trimoxazole prophylaxis

Correct Answer:

Induction with IV Amphotericin B deoxycholate plus oral Flucytosine (or high-dose Fluconazole 1200 mg/day), therapeutic lumbar punctures for intracranial hypertension, and deferring ART by 4 to 6 weeks from the start of antifungal treatment

Question 4

A 38-year-old HIV-infected woman (CD4 count 85 cells/uL) presents with a 2-week history of worsening dry non-productive cough, progressive exertional dyspnea, and low-grade fever. Arterial blood gas on room air shows PaO2 of 58 mmHg (pulse oximetry 88%). Chest radiograph reveals bilateral symmetrical perihilar interstitial ground-glass infiltrates. What is the most appropriate definitive therapeutic regimen?

Intravenous Ciprofloxacin 400 mg twice daily alone for 7 days High-dose oral or intravenous Trimethoprim-Sulfamethoxazole (TMP-SMX, 15–20 mg/kg/day of TMP) for 21 days PLUS adjunctive systemic Prednisone tapered over 21 days Inhaled Pentamidine 300 mg once monthly as primary monotherapy without oral steroids Amoxicillin-Clavulanate 1g three times daily plus Clarithromycin for 10 days

Correct Answer:

High-dose oral or intravenous Trimethoprim-Sulfamethoxazole (TMP-SMX, 15–20 mg/kg/day of TMP) for 21 days PLUS adjunctive systemic Prednisone tapered over 21 days

Question 5

During a cholera outbreak along Lake Tanganyika in eastern DRC, an adult woman arrives at the Cholera Treatment Center (CTC) with profuse watery 'rice-water' diarrhea, undetectable radial pulses, sunken eyes, skin pinch retracting very slowly (> 2 seconds), and profound lethargy. According to WHO/DRC cholera treatment protocols (Plan C), how should intravenous rehydration be initiated?

Infuse 1000 mL of 5% Dextrose over 12 hours with oral rehydration salts Administer Ringer's Lactate at 100 mL/kg total: give 30 mL/kg rapidly within the first 30 minutes, then 70 mL/kg over the next 2.5 hours Administer 0.9% Normal Saline at 10 mL/kg over 6 hours combined with intravenous furosemide Give oral loperamide 4 mg immediately and withhold all intravenous fluids until vomiting ceases

Correct Answer:

Administer Ringer's Lactate at 100 mL/kg total: give 30 mL/kg rapidly within the first 30 minutes, then 70 mL/kg over the next 2.5 hours

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Test TOM - Ordre des Médecins Practice Questions - Test Préalable à l'Inscription au Tableau de l'Ordre des Médecins (Test TOM, DR Congo) Exam

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