A 24-year-old woman with chronic anorexia nervosa presents to the Emergency Department with diarrhea, chest pain and palpitations. She is noted to have a BMI of 13, a heart rate of 48/min, significant orthostatic hypotension and a temperature of 35.9 °C. Her electrocardiogram shows frequent premature ventricular contractions. Her blood work indicates elevated liver transaminases and evidence of acute kidney injury from dehydration. She agrees to admission for medical stabilization only if she does not receive fluids either orally or intravenously, as they will cause her to gain weight and to feel bloated. Which one of the following is the best next step?

• A. Refuse to admit her unless she agrees to full treatment
• B. Obtain a psychiatric consultation
• C. Assess her capacity to consent for medical treatment
• D. Ask her if she has a substitute decision-maker
• E. Start intravenous fluids and physically restrain if necessary

A 4-month-old girl is brought by a parent to your clinic with a history of recurrent vomiting since birth. She cries with feeding and has not gained weight in the last 2 weeks. Her hemoglobin level is 95 g/L (100-125).
The patient is currently being fed thickened hypoallergenic formula. Which one of the following is the most appropriate therapy?

• A. Omeprazole.
• B. Calcium carbonate.
• C. Bismuth sulfate.
• D. Loperamide.
• E. Metoclopramide.

A 32-year-old woman, gravida 0, comes to your office for contraception counselling, specifically about insertion of a levonorgestrel-releasing intrauterine device. She has a past history of breast cancer and is presently on tamoxifen. Which one of the following is the best advice for your patient?

• A. She will require pre-procedure antibiotics
• B. She has a high risk of irregular bleeding following insertion
• C. It may increase her risk of breast cancer recurrence
• D. After consultation with her oncologist, she may choose this option
• E. This device will increase her risk of future infertility

A 25-year-old woman who is at 8 weeks ' gestation plans to travel to rural Cambodia to care for her ill mother. Which one of the following treatments should be provided to her before the trip?

• A. Ciprofloxacin for travellers ' diarrhea
• B. Hepatitis B immunoglobulin
• C. Tetanus and diphtheria booster if last received more than 5 years ago
• D. Antimalarial chemoprophylaxis

A 45-year-old woman presents to the emergency department after being involved in a motor vehicle collision.
She reports severe right hip pain. On examination, the right hip is flexed and adducted. A radiograph shows a posterior dislocation. Which one of the following is the most appropriate management?

• A. Total hip arthroplasty.
• B. Closed reduction under sedation.
• C. Gradual reduction with skeletal traction.
• D. Open reduction under general anesthetic.