While serving your rotation as an SHO in a large city hospital, you feel that your Senior Registrar consistently assigns last-minute tasks only to you. You haven’t noticed this behavior towards any other interns or SHOs. How should you address this situation?

Rank the following actions in order of appropriateness (1= Most appropriate; 5= Least appropriate)

You are an intern in a hospital’s emergency department. A patient presents with severe pain, and you prescribe a painkiller. As you log the medication details, you realize you’ve prescribed a drug to which the patient has a documented allergy. What do you do next?

Rank the following actions in order of appropriateness (1= Most appropriate; 5= Least appropriate

You are an SHO in the emergency department. A 24-year-old woman presents with bruises on her arms and initially mentions that she bumped into some furniture. On further probing, she reveals that her ex-partner, inflicted the injuries during a heated argument. She is adamant about not wanting any legal actions or other interventions. How would you proceed?

Rank in order from 1 to 5 the following actions in response to this situation. Where 1 is the most appropriate action and 5 is the least appropriate action:

You are an intern in a city hospital. During your regular rounds, you overhear one of the Registrars conversing with a patient in a manner that suggests a potential intimate relationship. The tone and content of the conversation alarm you, and you are unsure how to proceed, especially since relationships of this nature are against the IMC’s guidelines.

Rank in order from 1 to 5 the following actions in response to this situation. Where 1 is the most appropriate action and 5 is the least appropriate action.

Upon beginning your rotation as an intern in a multidisciplinary team at a hospital, you suspect that a senior Health Care Assistant (HCA) within the team is illicitly obtaining prescription medications and might be using them. On closer inspection, you indeed observe the HCA discreetly taking the medications from the cabinet at the start of their shift, prior to commencing their duties on the ward.

Rank the following actions in order of appropriateness (1= Most appropriate; 5= Least appropriate

You have been working on a particularly busy ward with another SHO colleague. Recently, you’ve noticed that during times when the ward is less busy, your colleague frequently watches Netflix on his personal device. While everyone needs a break occasionally, you feel that this is happening more often than what would be deemed appropriate and that it might impact patient care or other tasks that need attention.

Rank in order from 1 to 5 the following actions in response to this situation. Where 1 is the most appropriate action and 5 is the least appropriate action:

You’re an SHO in the Paediatrics Department of a busy hospital. As you’re about to take a short break after several hours of non-stop work, a visibly exasperated parent approach you. The parent says, “I’ve been waiting with my son for hours! This is unacceptable. He’s uncomfortable, and I have other responsibilities. Can’t you do something to speed this up? This hospital’s service is terrible!” The child, though uncomfortable, does not have a life-threatening condition and is queued appropriately based on the severity of his condition.

Rank in order from 1 to 5 the following actions in response to this situation. Where 1 is the most appropriate action and 5 is the least appropriate action.

You are an intern working in a busy surgical unit. As you are finishing your rounds, you overhear a colleague, a Senior House Officer (SHO), loudly berating and verbally abusing a nurse in the corridor. This behaviour appears unprofessional and could harm the morale of the team. What do you do?

Rank in order from 1 to 5 the following actions in response to this situation. Where 1 is the most appropriate action and 5 is the least appropriate action:

You are an SHO doctor on a medical ward. You are called during your night shift at 5 am to attend to a demented patient who is wandering the ward and refuses to stay in bed. Upon your arrival, you observe the patient walking quietly, with all other patients still sound asleep and undisturbed. The head nurse requests you to sedate the patient, as they feel overwhelmed.

Rank in order from 1 to 5 the following actions in response to this situation. Where 1 is the most appropriate action and 5 is the least appropriate action.

You are an SHO working in a busy department when you come across a concerning situation. Your colleague, Dr. Alex, is talking animatedly in the break room about an offer he received from a patient. The patient, grateful for the care provided, has invited Dr. Alex to join him for a vacation on his yacht. You express your reservations to Dr. Alex regarding the ethics of accepting such an offer. Dr. Alex, however, seems to think it’s just a kind gesture and dismisses your concerns, suggesting it’s “none of your concern.”

Rank in order from 1 to 5 the following actions in response to this situation. Where 1 is the most appropriate action and 5 is the least appropriate action.

You’re an intern at a large metropolitan hospital. During your rotation in the internal medicine department, you’ve noticed that on multiple occasions, your consultant has not been wearing a mask while interacting with COVID-19 patients. This is against the infection control guidelines laid down by the IMC and hospital policy. What steps do you take in this situation?

Rank in order from 1 to 5 the following actions in response to this situation. Where 1 is the most appropriate action and 5 is the least appropriate action.

You are an intern working in a large hospital’s Emergency Department. While on duty, a nurse informs you that a patient’s family is upset because their relative, who was supposed to have an MRI today, did not get the scan. You are unfamiliar with this patient, having never attended to them before, and are unaware of the specifics regarding their scheduled MRI. What do you do?

Rank the following actions in order of appropriateness (1= Most appropriate; 5= Least appropriate

You are an intern in a hospital. A distressed mother presents with her 2-year-old child who has a suspicious fracture. Upon questioning, she confides that her partner caused the injury to the child. The mother is visibly afraid and pleads with you not to involve TUSLA (The Child and Family Agency) as she does not want her partner to get into trouble. She emphasizes that she will ensure the safety of her child but is adamant about not getting authorities involved.

Rank in order from 1 to 5 the following actions in response to this situation. Where 1 is the most appropriate action and 5 is the least appropriate action.

You are working in the cardiology department as an SHO. Your supervising consultant, Dr. O’Sullivan, has a reputation for making swift decisions, often leaving you slightly overwhelmed with the pace of his diagnostic process. One day, after Dr. O’Sullivan has discussed some tests with a patient named Ronan and left the room, Ronan turns to you and says, “I couldn’t follow a word of what Dr. O’Sullivan said. It seemed like you were a bit lost too!” You are clear on the immediate tasks Dr. O’Sullivan has set out for Ronan’s care, but you’re uncertain about the rationale behind some of his decisions. How will you deal the situation?

Rank in order from 1 to 5 the following actions in response to this situation. Where 1 is the most appropriate action and 5 is the least appropriate action.

You are an SHO in the Emergency Department. A 30-year-old patient, Ms. Fisher, comes in with complaints of a sudden, severe headache, which she describes as the “worst she’s ever felt.” From the history and your examination, you are concerned about a potential subarachnoid hemorrhage and think that urgent imaging and possibly a lumbar puncture are required. As you are explaining the potential risks and benefits of the procedures to Ms. Fisher, her older brother, who accompanied her, constantly interjects and speaks on her behalf. Every time Ms. Fisher tries to voice her concerns or ask a question, he interrupts, seemingly trying to make decisions for her.

Rank in order from 1 to 5 the following actions in response to this situation. Where 1 is the most appropriate action and 5 is the least appropriate action.

You are an intern at a hospital. Late one evening, Rajesh, the nurse in charge of the Intensive Care Unit (ICU), approaches you regarding a pressing matter. An ICU bed is urgently needed for a critically ill patient being transferred from the emergency department. However, all beds are currently occupied. One of the ICU patients, Sophia, is stable and can be safely transferred to a general ward. Rajesh requests that you communicate this to Sophia, who has been enjoying the intensive care and attention she receives in the ICU. Upon informing Sophia of the imminent move, she appears distressed, asking, “Why can’t I stay here? I feel so well taken care of in the ICU.”

Rank in order from 1 to 5 the following actions in response to this situation. Where 1 is the most appropriate action and 5 is the least appropriate action.

You are an SHO on your way to your A&E night shift at City Hospital, but you’re running late due to a traffic jam. You’ve already alerted your team that you’d be delayed by about ten minutes. Amid the traffic, you encounter a recent road traffic accident. The police are on site, but there’s no ambulance in sight. How do you act?

Rank in order from 1 to 5 the following actions in response to this situation. Where 1 is the most appropriate action and 5 is the least appropriate action.

Tonight, you are on-call as an intern in general surgery, which includes covering the Paediatric ward. A nurse informs you that the SHO has requested you to insert an NG-tube for a 12-year-old patient while he is in theatre with another patient. You’ve never been trained on how to insert an NG-tube in children.

Rank in order from 1 to 5 the following actions in response to this situation. Where 1 is the most appropriate action and 5 is the least appropriate action.

You are working in the hospital’s Diabetic Clinic and have just examined a patient with a foot ulcer that appears to be infected and needs surgical debridement. You attempt to contact the surgical SHO several times, but when he responds, he is very dismissive and states, “It seems like all the other interns are incapable of making sound clinical judgments.” You’ve never interacted with him before, but your intern colleagues have mentioned that he can be quite abrasive.

Rank in order from 1 to 5 the following actions in response to this situation. Where 1 is the most appropriate action and 5 is the least appropriate action.

You are working in the medical ward and are in charge of the care of Mr. James, a 70-year-old patient who was admitted for the management of a chronic lung condition. His treatment is now complete and according to the medical assessments, he is fit to be discharged. However, when you inform Mr. James of the plan to discharge him back to his home, he seems reluctant. He expresses his desire to stay in the hospital for a longer period because he feels that he isn’t fully fit yet.

Rank in order from 1 to 5 the following actions in response to this situation. Where 1 is the most appropriate action and 5 is the least appropriate action.

You are an intern working in the Emergency Department. Mr. Thompson, a 45-year-old man, has been brought in after a road traffic accident. He is displaying signs of intoxication and is verbally aggressive towards the staff, making it difficult to attend to his injuries. You approach him, but he loudly states he does not wish to be seen by you.

Choose 3 appropriate responses out of 8 options.

Mr. Richardson, a 55-year-old male patient, arrives at the hospital with severe abdominal pain. He’s accompanied by a 22-year-old female, Miss Taylor. When you assume Miss Taylor to be Mr. Richardson’s daughter and ask if she’ll be supporting him post-treatment, he corrects you irritably, stating she’s his partner and asks for a different doctor.

Choose the THREE most appropriate actions to take in this situation:

While working as an intern on the orthopedic ward, a distressed elderly patient, Mr. Turner, who has previously been diagnosed with early-stage Alzheimer’s, approaches you claiming that his mobile phone has gone missing from his bedside table. He is convinced one of the healthcare assistants took it.

Choose the THREE most appropriate actions to take in this situation.

You are an SHO on an obstetrics and gynaecology ward at the hospital. A young woman, known to have a history of alcohol abuse, informs you that she is in a troubled marriage and has faced domestic violence from her husband. She seeks your advice but is hesitant about taking any steps that might reveal her situation to her spouse.

Choose the THREE most appropriate actions to take in this situation.

You are a senior house officer in a busy hospital. During your ward rounds, you come across a 65-year-old gentleman who presents with a pulsatile abdominal mass. Upon examination, you suspect an abdominal aortic aneurysm (AAA). Your registrar is currently engaged in resuscitation with another patient.

Choose the THREE most appropriate actions to take in this situation.

You’re beginning a night shift in the Emergency Department. During handover, Sarah, the intern who worked during the day, assures you that there’s nothing significant to pass on. Later in the evening, a senior nurse approached you, stating that she had contacted Sarah multiple times regarding a 75-year-old patient with acute abdominal pain and persistent vomiting. Upon reviewing, you provide the necessary care for the patient. The next morning, when you discuss the incident with Sarah, she vehemently denies having been informed about the patient, accusing the nurse of providing false information.

Choose the THREE most appropriate actions to take in this situation.

You are an SHO in a paediatric ward at the hospital. A young child in your care has tragically passed away under unforeseen circumstances. The devastated family is trying to grapple with the loss. While discussing the further course of action, you highlight the necessity of a post-mortem examination to pinpoint the cause of death. The distraught father objects, emphasizing that due to their religious beliefs, they must bury their child within the next 24 hours.

Choose the THREE most appropriate actions to take in this situation.

You are a GP-Trainee in a GP practice, and a patient arrives for ear syringing. You have observed the procedure a few times but have never conducted it yourself. The Senior GP, who usually supervises these procedures, has been called to attend an urgent case. The patient is already in the consulting room, expecting the procedure to be done.

Choose the THREE most appropriate actions to take in this situation.

You are an SHO in a hospital. During a break, your fellow SHO confides in you, mentioning that he’s thinking about switching jobs due to the toxic environment created by a certain registrar. He is, however, hesitant to take any step, fearing potential consequences.

Choose the THREE most appropriate actions to take in this situation.

You are an intern on a surgical rotation and you’re tasked with updating a patient’s medication list. While reviewing, you notice he has been given double the recommended dose of painkillers for the past three days due to a prescription mistake.

Choose the THREE most appropriate actions to take in this situation:

You are an SHO in a busy regional hospital. One of your colleagues, an intern, approaches you, expressing anxiety about an upcoming medical exam. He requests additional time off for preparation, even though he’s already utilized most of his allocated leave. Granting this request would mean you’d have to shoulder his responsibilities alongside your own.

Choose the THREE most appropriate actions to take in this situation:

You are an SHO on a surgical team in a bustling hospital. A post-operative patient approaches you, mentioning that they have been feeling nauseous since their surgery and have asked the attending nurse multiple times for anti-sickness medication. However, the nurse hasn’t provided any relief yet. The patient is visibly distressed and hints at wanting to file a complaint about this neglect. The drug chart does indicate that you had prescribed anti-sickness medication, but it seems it hasn’t been administered yet.

Choose the THREE most appropriate actions to take in this situation:

You are an SHO on a surgical hospital team. A consultant from a different team approaches you, indicating that one of the interns attached to your team is wearing acrylic nails, which goes against hospital policy due to infection control reasons. They request that you address the issue with the intern.

Choose the THREE most appropriate actions to take in this situation.

You are an intern on a surgical team. Your registrar is preparing a presentation for an international medical conference and asks you to handle her bleep for the day. She mentions that the continuous bleep interruptions are hampering her preparations but assures you she will remain within the hospital vicinity.

Choose the THREE most appropriate actions to take in this situation.

You are an SHO in a surgical hospital. A patient is admitted to your ward with an intestinal obstruction. On the morning ward round, after reviewing the CT abdomen/pelvis results, your registrar questions the decision made by the admitting team regarding their management. When the patient asks the registrar about his decisions, he reveals that the admitting team was ‘ignorant’.

Choose the THREE most appropriate actions to take in this situation

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You are an SHO in a hospital. You administer an antibiotic to a 34-year-old patient who is showing signs of sepsis. Subsequently, you discover that the antibiotic you administered had expired a few months ago. The nurse, upon learning about this, blames you for not checking the drug’s expiry date and hints at reporting the incident.

Choose the THREE most appropriate actions to take in this situation.

You’re an SHO in a bustling medical hospital department. Due to many doctors being on various leaves, the team often feels short-staffed. While managing, the consultant swiftly goes through patient assessments on your ward and moves on, leaving you with a list of tasks. This has resulted in extended work hours and limited learning experiences compared to other SHOs in different departments.

Choose the THREE most appropriate actions to take in this situation.

You are an SHO in the Emergency Department (ED). A patient who came to the ED with abdominal pain has had all investigations, which have turned out to be normal. As the patient prepares to leave, he requests a sick note for yesterday, today, and tomorrow.

Choose the THREE most appropriate actions to take in this situation:

You are an SHO working in neurology. During a weekly meeting, an intern is tasked by the consultant to audit the number of patients diagnosed with multiple sclerosis in the past year to evaluate the efficacy of a new diagnostic criterion that the hospital had adopted. As the intern presents their audit plan during a subsequent meeting, you realize that the methodology and topic seem very familiar. After searching through your records, you discover that you had presented a very similar audit just two years ago during your tenure as an intern in another hospital. The results of your previous audit had led to significant changes in diagnostic practices.

Choose the THREE most appropriate actions to take in this situation.

You are an SHO working in the orthopaedics department of a large hospital. You overhear a conversation where a fellow trainee admits to having his e-Portfolio filled out with the help of a consultant, who is a close family friend. You’ve personally observed this trainee struggle with some of the tasks he’s supposedly been certified competent in. At the same time, you find it challenging to get similar signoffs for your e-Portfolio, despite genuinely displaying competence.

Choose the THREE most appropriate actions to take in this situation:

A 57-year-old female professor, who is an avid hiker, presents to the cardiology clinic after noticing progressive exercise intolerance over the past six months. While she used to lead her hiking group, she now finds herself lagging and often needs to rest. Additionally, she has begun to wake up breathless at night and has started using two pillows to sleep. On auscultation, you note a high-pitched, pan systolic murmur best heard at the apex, radiating to the axilla.

Based on the clinical picture, which of the following is the most likely diagnosis?

A 45-year-old female presents to the emergency department with a 4-day history of sharp, pleuritic chest pain that’s relieved by sitting up and leaning forward. She had a mild upper respiratory tract infection 2 weeks ago. On examination, her blood pressure is 115/70 mmHg, heart rate is 90 bpm, and temperature is 98.7°F. Auscultation of the heart reveals a pericardial friction rub. An ECG shows widespread upwardly concave ST-segment elevations and PR-segment depressions. The diagnosis of acute pericarditis is made.

Considering her presentation and prior medical history, which of the following is the most appropriate initial treatment for her condition?

A 68-year-old man with a 45-year pack smoking history presents to his primary care physician complaining of increasing breathlessness over the past year. He mentions that he now gets winded after walking just one block, whereas he used to be able to walk a mile without any trouble. He also reports a chronic cough that produces a moderate amount of white sputum, especially in the mornings. He has had two respiratory infections requiring antibiotics in the past six months. On examination, you observe the patient using accessory muscles to breathe. His chest appears barrel shaped. On auscultation, you hear decreased breath sounds and expiratory wheezing.

Based on these findings, which clinical feature is most indicative of his likely diagnosis?

A 26-year-old male with a known history of asthma presents to the emergency department with increasing breathlessness, wheezing, and chest tightness over the past 6 hours. He states he caught a cold a few days ago and his symptoms have been progressively worsening since. He uses a salbutamol inhaler, which usually helps, but today he’s needed to use it every 20 minutes with little relief. On examination, he is using his accessory muscles to breathe, and his respiratory rate is 28 breaths/minute. You can hear widespread wheezing throughout both lung fields, and his oxygen saturation is 92% on room air. Peak expiratory flow rate is 40% of his predicted best.

Which of the following interventions is the MOST appropriate initial management step for this patient?

A 6-year-old boy is brought to the clinic by his mother, who reports that her son has developed a rapidly spreading rash around his mouth and nose over the past 5 days. On examination, the boy has multiple honey-coloured crusted lesions, some of which have burst to reveal red, raw skin underneath. There are no bullae. The rest of the physical examination is unremarkable. His older sibling recently had a similar rash which was self-limited. The boy is otherwise healthy, with no known drug allergies. The mother is eager for treatment to prevent further spread and complications.

Which of the following is the most appropriate initial treatment?

A 68-year-old woman with type 2 diabetes mellitus presents with a complaint of soreness and a burning sensation in her mouth for the past two weeks. She mentions that she’s recently been on a prolonged course of antibiotics for a respiratory tract infection. On examination, you observe creamy white patches on her tongue and buccal mucosa which, when scraped off, leave a reddened, bleeding surface underneath. She denies difficulty swallowing but admits her mouth feels very dry lately. Given the clinical picture, you suspect oral candidiasis.

Which of the following is the most appropriate first-line treatment for this patient’s condition?

A 28-year-old male presents to the otolaryngology clinic complaining of right ear discomfort for the past week. He mentions he has recently started swimming lessons and since then has noticed pain in his ear. On further questioning, he reports a sensation of fullness in the affected ear, itching, and decreased hearing. There is no associated fever, nasal congestion, or throat pain. On otoscopic examination, the physician notices a swollen, erythematous external auditory canal with some white exudate. There is no perforation of the tympanic membrane or fluid behind it.

Which of the following diagnoses aligns most with the patient’s clinical presentation?

A 35-year-old school teacher presents to the outpatient clinic with a 4-day history of redness, itching, and a watery discharge from her left eye. The symptoms began suddenly when she woke up in the morning, initially mistaking it for “sleep” in her eye. By afternoon, the redness had intensified, and she began to feel a mild burning sensation. She denies any trauma to the eye, vision changes, or pain. She reports that a couple of her students had similar symptoms last week. On examination, her left eye reveals diffuse conjunctival redness with a clear, watery discharge. The cornea is clear, and there is no significant lymph node enlargement near the ear.

Which of the following is the most suitable initial management approach for this patient’s presentation?

A 52-year-old secretary presents to her GP with a 6-month history of nocturnal tingling and numbness affecting her thumb, index, and middle fingers. She often wakes up at night needing to “shake out” her hand. Lately, she’s also noticed similar symptoms during the day, especially when holding her phone or a book. She denies any weakness but mentions dropping items more frequently. On examination, Tinel’s sign and Phalen’s test are positive on the right hand.

What would be the most appropriate initial management for this patient’s condition?

A 67-year-old postmenopausal woman presents to the emergency room after slipping on the kitchen floor and landing on her right side. She reports excruciating pain in her right hip and is unable to bear weight on it. She mentions a history of back pain for the past year and recalls having lost about two inches in height. She had menopause at age 52 and has a history of smoking. She’s never been on hormone replacement therapy and doesn’t participate in weight-bearing exercises. Her mother had a hip fracture at the age of 70.

Which of the following is the most likely diagnosis for this patient’s condition?

A 34-year-old woman presents to her primary care physician with complaints of generalized fatigue, muscle weakness, and a recent weight loss of 15 pounds over the past three months. She also reports increased craving for salt and notes that even minor cuts and bruises take longer to heal. On examination, the physician notes hyperpigmentation of her skin, especially noticeable in the creases of her palms. Her blood pressure is 90/60 mmHg, and it drops further when she stands up. Given her symptoms and findings, the physician is suspecting a certain endocrine disorder.

Which of the following is the most likely diagnosis for this patient’s condition?

A 42-year-old male presents to the clinic with episodic headaches, palpitations, and excessive sweating for the past 6 months. These episodes are often triggered by physical exertion and can last anywhere from a few minutes to several hours. On one occasion, he was taken to the emergency room due to a sudden episode of very high blood pressure. His past medical history is unremarkable, and he takes no medications. On examination, his blood pressure is found to be 180/100 mmHg with a heart rate of 110 bpm. Further lab investigations reveal elevated urinary metanephrines.

Which of the following is the most appropriate step in management?

A 29-year-old woman presents to the gastroenterology clinic with a 6-month history of recurrent bloody diarrhoea, lower abdominal cramping, and unintentional weight loss of approximately 10 pounds. She mentions having around six bowel movements daily, often accompanied by an urgency to defecate. She denies any joint pain, eye problems, or skin rashes but has been feeling fatigued lately. On examination, she appears pale. Abdominal examination reveals mild tenderness in the lower abdomen without guarding or rebound. Laboratory investigations show iron-deficiency anaemia and an elevated CRP. A sigmoidoscopy reveals continuous inflammation of the rectum and sigmoid colon with loss of vascular pattern and multiple superficial ulcers.

Which of the following is the most appropriate next step in the management of this patient?

A 56-year-old man presents to the gastroenterology clinic with a 10-year history of gastroesophageal reflux disease (GERD) symptoms. Despite proton pump inhibitor therapy, he still experiences weekly heartburn. He denies dysphagia, weight loss, or anaemia but mentions a recent sensation of food sticking briefly in his lower chest. Given the chronicity of his GERD and his new symptom, there’s a concern about potential complications.

Which of the following is the most appropriate investigating to confirm the diagnosis in this patient’s condition?

A 9-year-old boy presents to the emergency department with a 5-day history of a palpable purpuric rash on his legs and buttocks. The mother mentions that two weeks ago, he had a mild upper respiratory infection, which resolved on its own. Over the past three days, he started complaining of intermittent abdominal pain and had two episodes of dark-coloured urine. On physical examination, the boy appears uncomfortable but not toxic. His vital signs are stable. Palpable purpura is seen predominantly on the lower extremities and buttocks, sparing the trunk and upper extremities. The abdomen is slightly distended, with mild tenderness to palpation in the right lower quadrant without guarding or rebound. There’s no joint swelling, but he winces when moving his ankles.

Based on the clinical findings, which of the following is the most likely diagnosis?

A 2-week-old exclusively breastfed infant is brought to the paediatric clinic by her concerned mother. The infant appears well-fed, active, and without any signs of distress. The mother reports that the baby’s skin and eyes have been progressively turning yellow since day 5 of life. She also mentions that the baby is feeding well, has an adequate number of wet and soiled diapers daily, and hasn’t shown any signs of dehydration or lethargy. The baby had a normal birth history, and the initial new-born screen was unremarkable. On physical examination, the infant is alert, with yellowish discoloration of the skin and sclerae. There is no hepatosplenomegaly. Laboratory studies show an unconjugated hyperbilirubinemia, with all other liver function tests within normal limits.

Given the findings, which of the following is the most probable diagnosis for this infant?

A 4-year-old boy is brought into the emergency department by his panicked parents. They report a sudden onset of high fever, drooling, and difficulty breathing over the past few hours. The child appears anxious, sits in an upright position, leaning forward, and refuses to lie down. He speaks in a soft voice and seems to be trying to swallow. On examination, you note stridor, but there is no cough or wheezing. The parents mention that he was recently in contact with an older cousin who had a throat infection. Based on the clinical presentation, you are highly suspicious of acute epiglottitis.

Which of the following is the most appropriate immediate management step?

A 68-year-old man with a history of congestive heart failure comes to his cardiologist’s office for a routine follow-up. He has been taking furosemide, a loop diuretic, for the last six months to manage his fluid overload. Recently, he’s been feeling fatigued and reports frequent muscle cramps, especially in his calves. He also mentions increased thirst and more frequent night-time trips to the bathroom. On examination, you note a slightly irregular heartbeat. You suspect that these symptoms might be related to the side effects or complications of his medication.

Which of the following is a recognized side effect or complication of furosemide?

A 62-year-old male with advanced prostate cancer is seen in the oncology clinic. He was diagnosed 18 months ago and has been on hormonal therapy. However, he has developed increasing bone pain in his pelvis and lumbar spine over the last few months, which is refractory to opioids and NSAIDs. A bone scan reveals multiple bony metastases in the mentioned areas. His performance status is relatively good, but the pain is limiting his activities of daily living and affecting his quality of life.

Given the refractoriness of his pain to medical management, which of the following would be the most appropriate next step in managing his bone pain?

A 25-year-old woman is brought into the emergency department with sudden onset of shortness of breath, generalized hives, and swelling of her lips and tongue. She mentions she was at a picnic and ate a sandwich, unaware that it contained traces of peanuts, to which she has a known allergy. Within minutes of consumption, she started feeling dizzy, her throat felt tight, and she developed a diffuse rash. On examination, she is agitated, with widespread wheezing on auscultation, a swollen face, and a blood pressure of 85/50 mmHg.

What is the most appropriate management for this patient?

A 35-year-old woman presents to the emergency department with severe, colicky pain in the right lower quadrant of her abdomen. The pain began suddenly a few hours ago and has been fluctuating in intensity since then. She also reports nausea and has vomited twice. She denies fever, changes in bowel movements, or urinary symptoms. Physical examination reveals significant tenderness in the right lower quadrant. Her vital signs are within normal limits.

Which of the following is the most likely diagnosis?

A 45-year-old male is brought to the emergency department after being found unconscious and lying on the floor for an unknown duration following a fall. His medical history is notable for statin medication due to high cholesterol levels. Physical examination reveals muscular weakness and swellings indicative of muscle breakdown. The urine is noted to be tea-coloured, and blood tests reveal elevated levels of creatine kinase, confirming muscle necrosis, and signs of acute kidney injury.

An urgent ECG is performed due to his risk factors and clinical presentation, which reveals tall T waves, suggesting the presence of hyperkalaemia.

What is next best step in terms of management?

A 65-year-old male patient presents to the clinic complaining of visible blood in his urine for the past two weeks. He reports no pain during urination, no increased urgency or frequency of urination, and no abdominal or flank pain. He has a 30-year history of smoking a pack of cigarettes daily but quit smoking 5 years ago. He has no history of urinary stones or recurrent urinary tract infections. He denies any recent fever, chills, or other signs of infection. On physical examination, his vitals are stable, and there are no obvious abnormalities noted in the abdominal and rectal examination. He has no family history of cancers.

What is your diagnosis?

A 58-year-old woman with a history of gastric bypass surgery 10 years ago presents to the clinic with complaints of fatigue, weakness, and difficulty concentrating. Recently, she also noticed some numbness in her hands and feet. On examination, she has pallor and mild glossitis. Neurological examination reveals impaired vibration sense in the feet. Blood tests show a macrocytic anaemia, and a peripheral smear indicates hypersegmented neutrophils. The serum vitamin B12 level is found to be low.

Considering her clinical presentation and history, what is the most appropriate next step in the management of her vitamin B12 deficiency?

A 5-year-old boy is brought to the clinic by his parents who are concerned about his behaviour. They report that he has difficulty interacting with other children, often plays alone, and doesn’t respond when called by name. He seems more interested in lining up his toy cars than engaging in pretend play. His language development is delayed, and he tends to repeat certain phrases over and over. His parents also noticed that he becomes extremely distressed with any change in his daily routine.

What is the most likely diagnosis?

A 52-year-old woman presents to the emergency department with a 2-day history of fever, malaise, and sore throat. She recently completed her third cycle of chemotherapy for breast cancer 7 days ago. On examination, her temperature is 38.9°C, heart rate is 110 bpm, and blood pressure is 90/60 mmHg. Her oral mucosa shows ulcerations, and she appears fatigued. Lab results reveal a white blood cell count of 1.2 x 10^9/L with an absolute neutrophil count of 0.4 x 10^9/L.

Based on her presentation, what is the most appropriate next step in the management of this patient?

A 25-year-old male presents to the emergency department with a sudden onset of sharp left upper quadrant abdominal pain radiating to the left shoulder. The pain started after he was tackled during a rugby game 2 hours ago. On examination, his blood pressure is 90/60 mmHg, heart rate 110 bpm, and he appears pale. His abdomen is tender to palpation in the left upper quadrant with signs of peritoneal irritation. Bedside FAST (Focused Assessment with Sonography for Trauma) ultrasound reveals free fluid in the abdomen.

Given the patient’s presentation and the findings on examination, what is the most appropriate step in management?

A 70-year-old female patient is brought into the emergency department by her family. She’s had a fever for the past 3 days and has been less responsive since the morning. On examination, she’s febrile at 38.9°C, her blood pressure is 85/50 mmHg, heart rate is 110 bpm, and her respiratory rate is 24 breaths/min. She appears disoriented, and her skin feels cold and clammy. Blood tests show a raised white blood cell count. The physician is concerned about sepsis and wants to implement the “Sepsis 6” bundle within the hour.

Which of the following best represents the initial steps for the “Sepsis 6” bundle?

A 35-year-old man is brought into the emergency department following a head injury at a construction site. He was wearing a helmet when a small piece of debris fell from a height, striking his head. He did not lose consciousness and has no amnesia. He’s complaining of a mild headache but has no vomiting or other neurological symptoms. On examination, his GCS is 15, there is no visible external injury, pupils are equal and reactive, and he has no focal neurological deficit. However, he is extremely anxious and insists on having a brain scan.

Which of the following is the most appropriate course of action based on the NICE guidelines for CT scans post-head injury?

A 4-year-old boy is brought to the paediatric outpatient department by his mother. She’s concerned because he’s had a fever for the past 6 days, and she’s noticed changes in his skin and eyes. On examination, the child appears irritable with bilateral non-exudative conjunctivitis. His lips are cracked, and there’s a red appearance to his tongue. On further inspection, you notice swelling in his hands and feet, and there’s a non-blanching rash on his trunk. His cervical lymph nodes are also enlarged.

Which of the following best describes the child’s condition?

A 67-year-old male patient presents to the emergency department with acute onset of symptoms. His wife reports that while having breakfast, he suddenly stopped talking mid-sentence and seemed confused. On examination, the patient has difficulty understanding spoken language and is unable to form coherent sentences. Additionally, he has weakness on the right side of his face and is unable to lift his right arm. He does not complain of a headache, and there’s no seizure activity noted. His vitals are stable, and there’s no neck stiffness or rash.

Which of the following is the most likely diagnosis?

A 28-year-old man presents with a history of alternating episodes of extreme sadness, loss of interest, and low energy, interspersed with periods of elevated mood, increased energy, reduced need for sleep, and excessive spending. These mood changes have been ongoing for over two years. During the elevated periods, he feels overly confident, but there are no hallucinations or delusions. He is now seeking help because his depressive episodes are becoming more frequent and impairing his ability to work.

What is the most appropriate first-line medical treatment?

A 27-year-old man is brought to the emergency department by his family due to strange behaviour. Over the past two weeks, he has been talking to himself, stating that he hears voices commenting on his actions, such as “He is brushing his teeth now.” He claims that others can read his thoughts and control his body movements. He has also become increasingly withdrawn, spending most of his time staring blankly at the wall. On examination, he appears disheveled and has limited eye contact.

What is the most likely diagnosis?

A 28-year-old male is brought to the emergency department following a road traffic accident. He complains of severe pain in the left side of his abdomen and chest, radiating to his left shoulder. On examination, his blood pressure is 90/60 mmHg, and his heart rate is 120 beats per minute. He appears pale and diaphoretic. An abdominal ultrasound (FAST) shows free fluid in the peritoneal cavity.

What is the most likely diagnosis and appropriate next step in management?

A 72-year-old man was found unresponsive at home and declared dead upon arrival at the hospital. He had a known history of hypertension, type 2 diabetes mellitus, and chronic kidney disease. His family mentioned that he had been complaining of sudden, severe chest pain that radiated to his left arm a few hours before his death. An autopsy revealed a complete occlusion of the left anterior descending coronary artery, along with evidence of a large area of myocardial necrosis involving the left ventricle.

What is the most appropriate cause of death to list in Part 1a of the death certificate?

A 45-year-old man presents to the emergency department with sudden onset severe chest pain radiating to his back. He describes the pain as “tearing” and is visibly distressed. On examination, his blood pressure is 180/110 mmHg in the right arm and 150/90 mmHg in the left arm. His past medical history includes hypertension, but he has not been taking his medications regularly. A chest X-ray reveals a widened mediastinum.

What is the most likely diagnosis?

A 19-year-old female presents to your clinic accompanied by her mother. She has experienced significant weight loss over the past six months and is now very thin. Her mother mentions that she often avoids meals, exercises excessively, and has recently started inducing vomiting after eating. On examination, you notice calluses on the back of her hands and her BMI is 16. Her heart rate is 48 beats per minute, and she appears dehydrated. When asked, she insists she still needs to lose more weight. Laboratory tests reveal hypokalaemia and low blood glucose levels.

What is the most appropriate immediate management for this patient?

A 30-year-old woman presents to the emergency department 6 hours after ingesting 20 tablets of paracetamol (500 mg each) in a suicide attempt. She denies any symptoms like nausea, vomiting, or abdominal pain. On examination, she is alert with stable vital signs. There are no signs of liver tenderness or jaundice. Blood tests, including liver function tests and INR, are pending. A serum paracetamol level will be measured soon.

What is the most appropriate next step in management?

A couple comes to a genetic counselling clinic because they have a 2-year-old son who has been recently diagnosed with cystic fibrosis. Both parents are healthy with no history of cystic fibrosis in their families. They are concerned about the chances of having another child with the disease and want to understand the genetics involved. Genetic testing confirms that both parents are carriers of the CFTR gene mutation.
What is the most likely inheritance pattern of cystic fibrosis for their future children?

A 35-year-old woman at 17 weeks’ gestation has just received a high-risk result from her screening test for Down syndrome. She is concerned about the accuracy and wants a definitive diagnosis of her baby’s chromosomal status.
Which is the most appropriate diagnostic test to confirm her baby’s condition?

A 78-year-old man with multiple chronic conditions, including diabetes and hypertension, frequently forgets to take his medications correctly. His daughter reports that he sometimes takes the wrong dosage or misses doses entirely. After a recent hospital visit for poor medication adherence, the pharmacist suggests a solution.

What is the most appropriate step to ensure he takes his medication correctly?

A 55-year-old woman undergoing chemotherapy for breast cancer reports severe nausea and vomiting following her treatment sessions. She has no known allergies and no history of heart problems. The oncology team seeks to prescribe the most effective antiemetic to manage her symptoms.

Which antiemetic is most appropriate for managing chemotherapy-induced nausea and vomiting?

A 67-year-old female patient with a diagnosis of Giant Cell Arteritis (GCA) is being evaluated for long-term management options. She has been on high-dose prednisolone for the initial phase of treatment and has shown a good response. The healthcare team is considering additional long-term medications to manage her condition and minimize side effects.

What is the most appropriate long-term medication to add to her regimen?

A 58-year-old man with newly diagnosed hypertension has been started on an ACE inhibitor. His doctor wants to ensure that the medication is not adversely affecting his kidney function or electrolyte levels.

Which test should be scheduled 2 weeks after starting the ACE inhibitor to monitor its effects?

A 9-year-old girl is brought to your clinic by her parents, who are concerned about her behaviour both at home and in school. Her teachers report that she often has difficulty staying focused on tasks and is frequently distracted during lessons. She struggles to complete her assignments and is often forgetful, losing her school supplies. At home, her parents describe her as constantly restless, always talking, interrupting conversations, and frequently leaving her seat during family meals. They also mention that she has trouble waiting her turn when playing games with her siblings.

What is the most likely diagnosis based on her symptoms?

A 55-year-old female patient with a history of hypertension and chronic stable angina is scheduled for an elective laparoscopic cholecystectomy. She is currently on metoprolol for angina, lisinopril for hypertension, and ibuprofen for osteoarthritis pain.

Which of the following medications should be continued or discontinued on the day of surgery?

Dr. Anna, a 35-year-old physician, has recently been diagnosed with bipolar disorder. Her psychiatrist recommends starting sodium valproate for its mood-stabilizing properties. Dr. Anna is currently single but is considering starting a family in the next few years. She seeks advice on contraception while taking sodium valproate, given its known teratogenic risks.

What is the contraception option for Dr. Anna ?

A 6-year-old child, previously healthy, presents to the emergency department with a high fever, sore throat, muffled voice, and a barking cough that started earlier in the day. The mother reports that the child appears very anxious, is drooling, and has difficulty breathing. The symptoms started suddenly and have progressively worsened over the past few hours. Upon examination, the child is sitting upright, leaning forward, and appears very distressed with inspiratory stridor.

What is the first line management.

A 58-year-old female patient with a history of hypertension and chronic gastritis presents with a three-month history of tremors, bradykinesia, and rigidity. She reports no family history of Parkinson’s disease. Recently, her symptoms have worsened, impacting her daily activities. She is currently taking multiple medications, including antihypertensives and antiemetics.

Considering her medication history and symptoms, which drug is most likely contributing to her parkinsonian symptoms?

A 7-year-old boy is brought to the paediatric clinic by his parents for a routine check-up. During the examination, it is noted that his right testis is not palpable in the scrotum. The parents report that this has been the case since birth, but they were unsure whether it required medical attention. The boy has no urinary symptoms or pain, and his development has been normal.

Given the finding of an undescended right testis, which of the following is the most significant risk associated with this condition?