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Mock 2
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- Question 1 of 70
1. Question
During your rotation as an SHO in a prominent urban hospital, you encounter a patient in the ICU demonstrating signs of a severe respiratory distress. While you have managed mild respiratory cases, the intensity of this situation seems beyond your current level of expertise. What steps would you take?
Rank the following actions in order of appropriateness (1= Most appropriate; 5= Least appropriate
- A. Persist in addressing the patient's symptoms independently, believing that asking for assistance might affect your reputation.
- D. Quickly gather all pertinent patient details and administer first-line treatments based on your existing knowledge to stabilize the patient.
- C. Begin the process to document the event using a clinical incident report, detailing your initial actions for future evaluation.
- B. Immediately contact a senior pulmonologist or seasoned physician for assistance and guidance.
- E. Treat this situation as a chance for learning and attempt to handle the case by yourself, hoping to better prepare for future similar events.
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CorrectIncorrect - Question 2 of 70
2. Question
While working as an SHO in a large metropolitan hospital, a patient urgently brings to your attention that their premium mobile phone and wallet seem to be missing. How should you address this situation?
Rank the following actions in order of appropriateness (1= Most appropriate; 5= Least appropriate
- E. Draft an official report capturing the claimed theft.
- A. Console the patient who might have been a victim of theft and meticulously document the specifics about the missing mobile phone and its disappearance.
- C. After understanding the circumstances surrounding the alleged theft, consult the senior nurse and deliberate on the possibility of contacting the police.
- B. Display notices across the ward, alerting everyone about the theft, advising all staff, patients, and visitors to safeguard their belongings, and to be vigilant for any suspicious activities.
- D. Question the neighbouring patients in the same section if they have witnessed the mobile phone or wallet and look into their bedside drawers.
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CorrectIncorrect - Question 3 of 70
3. Question
You are an intern working in a busy hospital ED. One of your colleagues has called in sick, causing a significant increase in your workload due to the lack of staff. The next day, you see photos on social media showing that the same colleague was at an amusement park with their family. What do you do?
Rank the following actions in order of appropriateness (1= Most appropriate; 5= Least appropriate
- A. Inform the ED Consultant about your colleague's actions.
- E. Address the issue during the next departmental meeting.
- D. Contact the IMC and report your colleague for potential misconduct.
- B. Discuss the situation with your colleague first, explaining the strain their absence placed on the department.
- C. Ignore the situation, as no immediate harm was caused to the patients.
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CorrectIncorrect - Question 4 of 70
4. Question
You are an intern working in the surgical department in a busy hospital. During your shift, you observe that the surgical locum registrar is not attending to patients who appear to be in serious conditions. You’re concerned that these patients are being neglected or overlooked. 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:
- E. Decide to end your shift early as you feel it's unsafe to work with the locum registrar, fearing you might also be held responsible for any oversight or mistakes.
- B. Contact the on-call surgical consultant immediately and voice your concerns.
- D. Directly confront the locum registrar in a professional manner, inquiring about the status of the patients in question and helping if necessary.
- C. Inform the hospital administration about the registrar's negligence and ask for an immediate replacement.
- A. Assume the registrar knows best and do nothing, thinking that maybe the patients' conditions aren't as serious as they seem.
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CorrectIncorrect - Question 5 of 70
5. Question
You are an intern in a busy medical ward. You’ve observed that your co-intern consistently leaves about an hour earlier than the scheduled end of their shift. Given the high patient load and the need for proper patient handovers, this concerns you.
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:
- C. Casually chat with some of the ward's nurses and staff to understand if there might be valid reasons for your colleague’s early departures.
- A. Ignore the situation, reasoning that perhaps your colleague has personal reasons or has finished their tasks efficiently.
- D. Directly confront your colleague, warning them that their behaviour is unacceptable and that you may escalate the issue to the senior staff.
- B. Immediately report your colleague's behaviour to the Consultant without discussing it with them.
- E. Approach your colleague in a non-confrontational manner, seeking to understand their reasons for leaving early, and expressing your concerns about patient safety and workload distribution.
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CorrectIncorrect - Question 6 of 70
6. Question
You have just finished your shift in medical ward and on your way to attend important family event, you remember that you forgot to note down a patient’s penicillin allergy in their chart. You try reaching out to the on-call intern, but their phone goes unanswered.
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:
- C. Try contacting the SHO to inform them of your mistake and ask if they can rectify the error since you're unable to get through to the intern.
- A. Assume the nursing staff will notice the omission and address it.
- E. Let it slide and decide to correct it the next day when you're back at the hospital.
- B. Return to the hospital immediately and correct the oversight, even if it means being late for your personal commitments.
- D. Phone the ward directly and inform the senior nurse about your oversight, asking them to notify the on-call doctor.
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CorrectIncorrect - Question 7 of 70
7. Question
You are an intern working in the Emergency Department. One of your patients comes in with recurrent abdominal pain that has been extensively investigated before, with no conclusive cause found. You have a suspicion that the underlying issue might be psychosocial, but the patient is insistent that a surgical review is necessary.
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:
- A. Immediately refer the patient to the on-call surgical team, even though you believe the abdominal pain is not surgically related.
- E. Consult with a senior colleague in the Emergency Department to discuss the case and seek guidance.
- D. Recommend a follow-up in the outpatient department, suggesting they ask their GP to refer them for further evaluation.
- C. Discuss the previous investigations with them, trying to reassure them about the thoroughness of past evaluations and the low likelihood of a surgical cause.
- B. Request a psychiatric consultation, considering the potential psychosocial cause underlying their symptoms.
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CorrectIncorrect - Question 8 of 70
8. Question
You are an SHO doctor at the city hospital. One of your patients, a well-to-do elderly gentleman, visits you following a successful cataract surgery that restored his vision. He mentions that he’s thrilled to drive his luxury sports car again and offers to gift it to you as a token of his gratitude for referring him to a specialist in time. 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.
- D. Gratefully accept the luxury car; after all, you played a pivotal role in his treatment, but advise him to discuss it with his family.
- A. Refuse the car but suggest he could donate to the hospital's charity or patient care fund.
- B. Happily accept the car, asking him not to inform anyone to avoid any potential misunderstandings.
- C. Politely decline the offer, emphasizing that it's against professional regulations set by the IMC.
- E. Suggest he should consider gifting the car to the ophthalmologist who performed the surgery, not yourself.
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CorrectIncorrect - Question 9 of 70
9. Question
You are an intern working in a busy hospital department. During a hectic morning, you realize you forgot to take your Levothyroxine, which you require daily for your hypothyroid condition. You’re concerned as you usually take it at the same time every morning. 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
- B. Call a family member or friend to see if they can bring your medication to the hospital for you.
- D. Call your GP to see if they can issue a prescription and fax it to a nearby pharmacy, which you can pick up during your break.
- E. Write a prescription for yourself, and during your lunch break, head to an outside pharmacy.
- A. Book into the A&E department to get a prescription for the Levothyroxine.
- C. Ask a nurse if she can provide Levothyroxine for you from the medicine cupboard.
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CorrectIncorrect - Question 10 of 70
10. Question
You are an SHO in the internal medicine department of a hospital. Recently, there has been a spike in upper respiratory tract infections in the community. A patient comes to you requesting a prescription for antibiotics, as she believes it will prevent her from catching an infection. However, her vitals and blood tests are completely normal. She’s insistent because she’s read about it online. 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.
- D. Sit the patient down and provide a thorough explanation about the misuse of antibiotics and their implications.
- E. Advise her to seek a second opinion from another doctor in the practice.
- C. Tell the patient you'll write the prescription this time but advise her to come back if she feel unwell.
- A. Explain to the patient why antibiotics aren't needed and end the consultation without giving her any written information.
- B. Hand the patient a leaflet on antibiotic misuse without further discussion.
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CorrectIncorrect - Question 11 of 70
11. Question
You are an SHO at a downtown hospital. A patient under your care has recently been diagnosed with recurrent syncope and frequent blackout episodes, experiencing several incidents over the past months. You’ve explicitly informed him of the risks associated with driving and emphasized his obligation to report his condition to the NDLS. Despite your warnings, he has driven several times and has candidly expressed his intention to continue doing so. What would be your subsequent steps?
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.
- B. Attempt to persuade him not to drive and, with his consent, discuss the matter with his spouse or family.
- A. Discuss in-depth the reasons he's choosing to ignore your advice about not driving. Offer him the opportunity to get a second opinion from another doctor, but also emphasize he should not drive until then.
- E. Advise him that you'll inform his spouse about his decision to continue driving, emphasizing that it poses a significant safety risk for him and the public.
- D. Inform him directly that you have no other choice but to notify the NDLS because he is disregarding your medical advice and continuing to drive.
- C. Without discussing further with the patient, directly contact the NDLS after the patient leaves.
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CorrectIncorrect - Question 12 of 70
12. Question
You are in GP practice. It’s a busy Friday evening, and you encounter a 15-year-old girl who appears mature and shows Gillick competence. She comes to you seeking contraceptive pills. Upon discussing further, you understand her concerns about her sexual health. However, she emphatically mentions that she does not want her parents to know about her request. How do you respond?
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.
- B. Assure her that, in line with IMC guidelines, her consultation will be treated confidentially, and her parents won’t be informed without her consent, unless there's a significant risk to her well-being.
- D. Without any further consultation, refuse to prescribe the contraceptive pills.
- A. Discuss with her the potential risks and benefits of contraceptive pills, emphasizing the importance of proper usage and understanding.
- C. Bypass her wishes as she is underage and contact her parents directly to discuss the situation since you believe they should be informed.
- E. Encourage her to consider discussing the matter with her parents, explaining that while her privacy is respected, parental support can sometimes be beneficial in these situations.
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CorrectIncorrect - Question 13 of 70
13. Question
You are an intern working in the radiology department of a city hospital. A patient, Mrs. Smith, approaches you visibly upset. She explains that she was taken for an X-ray of her knee, which she never required. On checking her notes, you realize that the X-ray had been booked for another patient with the same surname. The X-ray, being an unnecessary exposure to radiation for Mrs. Smith, concerns her. Now, Mrs. Smith and her daughter want to know how such a mistake could have occurred.
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.
- A. Apologise to Mrs. Smith and her daughter for the oversight and ensure them that such mistakes are very rare.
- C. Reassure Mrs. Smith and her daughter that the department will investigate the error to prevent similar incidents in the future.
- D. Explain to Mrs. Smith and her daughter that errors can occasionally occur, but the level of radiation in a single X-ray is minimal and unlikely to cause harm.
- B. Offer to arrange a discussion with the radiology department head if Mrs. Smith would like more detailed information.
- E. Tell Mrs. Smith and her daughter that you are not in charge of the bookings, and they should raise the concern with the reception desk.
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CorrectIncorrect - Question 14 of 70
14. Question
You are working as an SHO in the Emergency Department. Mrs. Farrell, a 65-year-old patient, has been brought in with severe abdominal pain and recurrent episodes of vomiting. You suspect Mrs. Farrell might have an intestinal obstruction. In accordance with your hospital’s guidelines, you call the surgical intern, Dr. O’Reilly, to evaluate her. However, he declines, stating he is busy with other patients at the moment.
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.
- C. Continue to manage Mrs. Farrell's condition yourself, adhering to hospital guidelines for suspected intestinal obstructions.
- B. Reach out to Dr. O'Reilly once more, emphasizing the critical nature of Mrs. Farrell's symptoms and the need for an immediate evaluation.
- E. Contact the senior surgeon on duty, explaining Mrs. Farrell's situation and Dr. O'Reilly's unavailability.
- D. Document Dr. O'Reilly's refusal to evaluate Mrs. Farrell in her medical records.
- A. Consult with a senior colleague from the Emergency Department for guidance on how to proceed.
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CorrectIncorrect - Question 15 of 70
15. Question
You are an SHO working in the Emergency Department. Lately, you have been feeling overwhelmed and burnt out. To address this, you apply for a week of annual leave to recharge. However, your consultant, Dr. Matthews, states that due to the department being short-staffed, they cannot grant your leave request. Dr. Matthews adds, “In this profession, sometimes you have to push through even when you’re feeling low. I am working as well without any leave.” How would you respond?
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.
- C. "I appreciate that you also work long hours and push through, but I believe taking my leave would be best for my well-being and ultimately the patients."
- D. "Can we perhaps find a compromise, like a shorter leave, so I can get some rest, but the department won't be too strained?"
- A. "Dr. Matthews, I understand the department is under-staffed, but my well-being is crucial for effective patient care. I genuinely need this break."
- B. "If I continue without taking a break, it might affect the quality of care I provide. It’s essential for both me and the patients that I take this leave."
- E. "It seems like taking breaks or leaves is frowned upon here. Is that the culture of this department?"
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CorrectIncorrect - Question 16 of 70
16. Question
You are an intern in the Orthopaedics Department. Today, while working with a Senior House Officer (SHO) named Dr. Martin, you were tasked with applying a cast to a patient with a fractured arm. After completing the procedure, Dr. Martin remarks, “You took quite a while to apply that cast, didn’t you? Speed is crucial in situations like these.” You are taken aback by this, as you believe you’ve been diligently following the standard procedure for applying casts and were focused on ensuring the patient’s comfort.
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.
- B. Discuss Dr. Martin’s comment with your clinical supervisor to gain clarity and advice.
- A. Seek feedback from other doctors in the Orthopaedics Department about your performance when applying casts.
- D. Strive to hasten your subsequent procedures, attempting to finish them more quickly.
- E. Review the number of cast applications you’ve done in comparison to other interns in the department to gauge your speed.
- C. Arrange a time to speak with Dr. Martin to understand his perspective and discuss his feedback further.
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CorrectIncorrect - Question 17 of 70
17. Question
You are caring for a patient, Maeve, on the Nephrology ward when she invites you to attend her daughter’s wedding next week. You’ve been part of the medical team that has overseen Maeve’s treatment for the last two months, and she is due to be discharged in a few days. You are free next week, but you understand the importance of maintaining professional boundaries between a doctor and their patient outside the clinical environment.
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.
- E. Request a different doctor on the ward to oversee Maeve's care until her discharge.
- C. Gratefully acknowledge Maeve's invitation but clarify that it would not be professional for you to attend.
- A. Politely decline Maeve's invitation without offering a specific reason.
- B. Mention that attending is not feasible but consider sending a modest congratulatory card to Maeve's daughter.
- D. Propose that other members of the medical team who cared for Maeve come to the wedding with you.
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CorrectIncorrect - Question 18 of 70
18. Question
You are working on a busy ward in the hospital. You have made three unsuccessful attempts to insert a Foley’s catheter into a patient who requires it due to urinary retention. You’re beginning to doubt your ability to successfully insert the catheter with a fourth attempt. The patient is becoming agitated and anxious with every unsuccessful try. You call an SHO for assistance, but he tersely informs you that someone of your level should be able to do this, and he is too busy with other matters to help.
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.
- B. Document the difficulty in the evening handover and hope a colleague will address it.
- A. Make another attempt to insert the Foley's catheter.
- E. Seek advice from a fellow intern on how to proceed.
- C. Call the SHO again and urge him to reconsider his stance.
- D. Approach another colleague on the ward to assist you.
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CorrectIncorrect - Question 19 of 70
19. Question
You have been conducting a clinical audit with another intern, Rahul, on the effectiveness of a new postoperative protocol in the surgical department. The audit is almost complete, but you have yet to finalize your findings. As part of the audit, you had planned to present your results at a local meeting for the hospital’s clinical teams. One morning, Rahul informs you that he has adjusted some of the figures in the audit to make the new protocol appear more favourable, believing it would guarantee the presentation’s approval. Later, your SHO, Dr. Sullivan, commends both of you on the excellent work and mentions that the department has decided to present the audit’s findings at the next hospital-wide meeting.
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.
- D. Attend the meeting but refuse to present or discuss the findings due to concerns.
- C. Let Dr. Sullivan know about the adjusted data yourself.
- B. Explain to Dr. Sullivan that the findings need further verification before they can be presented.
- E. Advise Rahul to reconsider the presentation since the data is not genuine.
- A. Speak with Rahul and suggest he informs Dr. Sullivan about the adjusted data.
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CorrectIncorrect - Question 20 of 70
20. Question
You are an intern working in the orthopedic ward of a busy hospital. Mr. Smith, a 60-year-old patient with chronic back pain due to arthritis, approaches you with a request. He’s done extensive research and believes that doubling the dose of his current medication will expedite his recovery and enable him to resume work sooner. He’s confident in the safety of this regimen and requests that you prescribe the increased dosage.
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.
- A. Inform Mr. Smith that self-administering a double dose is against medical advice.
- D. Ask Mr. Smith to present the research he’s referring to.
- C. Request a senior SHO or consultant to discuss the dosage with Mr. Smith.
- E. Consult the hospital pharmacist for advice on the matter.
- B. Explain to Mr. Smith that prescribing above the recommended dose requires senior consultation.
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CorrectIncorrect - Question 21 of 70
21. Question
You are SHO at a regional hospital. One of your patients is a six-year-old boy, Alex, who has been admitted multiple times due to severe asthma attacks. During your evaluation, you learn that his parents smoke heavily at home. You gently inform them that this could be exacerbating Alex’s asthma. Later, the parents approach you, clearly upset, and inform you that they plan to file an official complaint, feeling accused and blamed for their son’s health issues.
Choose the THREE most appropriate responses, assuming they are all expressed in a respectful and polite manner.
CorrectIncorrect - Question 22 of 70
22. Question
You have been in your new surgical rotation for a few weeks and noticed that an intern colleague, James, has been consistently late for morning handovers for the past 4-5 days. This tardiness often leads to delays in the ward’s workflow, and the team often ends up finishing their tasks later than scheduled.
Choose the THREE most appropriate actions to take in this situation:
CorrectIncorrect - Question 23 of 70
23. Question
During your evening shift on the surgical ward, you’re preoccupied assisting a nurse in the care of a post-cholecystectomy patient. When you rejoin the team, you discover that the consultant surgeon and the specialty trainee have been called away urgently due to another patient suspected of developing peritonitis. Before leaving, the consultant asks you to ensure Mr. Jackson, who was discussed at the beginning of the round, undergoes further explorative surgery. As you approach Mr. Jackson to explain the upcoming surgery, he voices his frustration over the numerous procedures he has had recently.
Choose the THREE most appropriate actions to take in this situation:
CorrectIncorrect - Question 24 of 70
24. Question
You are an intern working a night shift at the hospital. You are alerted about a patient who is exhibiting signs of acute delirium and had previously been physically aggressive towards a nurse. The patient is attempting to self-discharge even though he’s not medically cleared to do so. The senior nurse on the ward is concerned that the current setting isn’t appropriate for the patient’s needs.
Choose the THREE most appropriate actions to take in this situation.
CorrectIncorrect - Question 25 of 70
25. Question
There have been a large number of weekend admissions. During the ward round at the start of the week, your consultant has decided to discharge a number of these patients. You return to the ward to complete the discharge paperwork for an elderly patient who had been admitted following a fall. You strongly feel she would need a social package to be implemented before discharge can be considered.
Choose the THREE most appropriate actions to take in this situation.
CorrectIncorrect - Question 26 of 70
26. Question
You are an intern in an obstetrics and gynecology ward at the hospital. A 17-year-old girl, 8 weeks into her pregnancy, approaches you requesting an abortion and emphasizes that her parents should not be made aware of either her pregnancy or her visit to the hospital.
Choose the THREE most appropriate actions to take in this situation.
CorrectIncorrect - Question 27 of 70
27. Question
You are an SHO on a trauma and orthopedics ward at the hospital. A patient is urgently in need of a blood transfusion following a significant loss of blood from a severe accident. The medical team feels this is the only option to save the patient’s life. The patient, while conscious, is adamant about not receiving a blood transfusion due to his personal beliefs.
Choose the THREE most appropriate actions to take in this situation.
CorrectIncorrect - Question 28 of 70
28. Question
You are an intern in a gastroenterology ward in the hospital. One of your patients requires a colonoscopy due to symptoms suggesting a possible bowel condition. On the morning of the procedure, you discover that the patient wasn’t administered the necessary bowel prep the previous night. The scheduled gastroenterologist is understandably upset by the oversight, believing the patient isn’t adequately prepared for the procedure, and declines to conduct the colonoscopy.
Choose the THREE most appropriate actions to take in this situation.
CorrectIncorrect - Question 29 of 70
29. Question
You are an intern in a busy city hospital. The next patient you attend to is a lady from Poland, who speaks limited English. On examination, her blood pressure is found to be 170/100. She mentions she’s never been diagnosed with hypertension before.
Choose the THREE most appropriate actions to take in this situation.
CorrectIncorrect - Question 30 of 70
30. Question
You are an intern in a busy regional hospital. During your rounds, you encounter a foreign doctor who displays symptoms of cellulitis. He strongly advocates for a particular antibiotic treatment that isn’t in line with the hospital’s standard procedure. He explains that this specific antibiotic combination is standard practice in his native country and has previously been effective for his condition.
Choose the THREE most appropriate actions to take in this situation:
CorrectIncorrect - Question 31 of 70
31. Question
Your registrar in a regional hospital informs you about the audit presentation you’re scheduled to present at the upcoming grand round. You are not prepared yet and plan to stay awake overnight to complete the presentation.
Choose the THREE most appropriate actions to take in this situation:
CorrectIncorrect - Question 32 of 70
32. Question
You are an SHO at a regional hospital. A concerned mother brings her 1-year-old son to you, mentioning that he has been unusually fussy and has been pulling at his ear frequently. She has spoken to some friends and read online that antibiotics can quickly resolve ear infections and is keen on getting a prescription for her son. Upon examination, you determine that the child’s symptoms are indicative of a mild viral ear infection, not a bacterial one that would require antibiotics.
Choose the THREE most appropriate actions to take in this situation.
CorrectIncorrect - Question 33 of 70
33. Question
You are an SHO in a surgical hospital. A patient is post-operative following a conversion of laparoscopic to open cholecystectomy. During your ward round, you assess the patient’s pain and decide to prescribe strong analgesia. The nurse attending the patient expresses concerns and is hesitant to administer the prescribed medication.
Choose the THREE most appropriate actions to take in this situation.
CorrectIncorrect - Question 34 of 70
34. Question
You are an SHO in a surgical hospital. A 34-year-old patient under your care has just been diagnosed with bowel cancer. A staging CT scan reveals the potential for curative treatment through surgery. However, the patient expresses a desire to pursue alternative medicine instead of the recommended surgical procedure.
Choose the THREE most appropriate actions to take in this situation:
CorrectIncorrect - Question 35 of 70
35. Question
You are a GP-Trainee in a hospital setting. During a ward round, the on-call consultant criticizes your approach to a particular case, doing so in a manner that felt disrespectful and belittling, especially given it was in front of patients.
Choose the THREE most appropriate actions to take in this situation.
CorrectIncorrect - Question 36 of 70
36. Question
You’re an SHO working a night shift in a hospital. An alarm goes off, indicating a cardiac arrest situation. Rushing to the scene, you find a nurse from the emergency department already performing CPR on the patient. As you quickly review the patient’s notes, you discover a valid Do Not Attempt Resuscitation (DNAR) form.
Choose the THREE most appropriate actions to take in this situation.
CorrectIncorrect - Question 37 of 70
37. Question
You are an SHO on a gastroenterology hospital team. A patient, who underwent a colonoscopy with biopsies due to persistent changes in bowel habit and abdominal pain, returns to see you for the results. The patient only speaks Gaelic, and all previous communications have been facilitated through his daughter. The daughter informs you at the beginning of the consultation not to reveal to her father if the results indicate he has cancer.
Choose the THREE most appropriate actions to take in this situation:
CorrectIncorrect - Question 38 of 70
38. Question
You are an SHO on a neurology firm at the hospital. During your clinic rounds, a patient, recently diagnosed with multiple sclerosis, asks about the causes of the disease. You realize that while you have a basic understanding, you might not have the most recent or comprehensive information to provide. The patient appears anxious, and you want to ensure they have accurate and complete information.
Choose the THREE most appropriate actions to take in this situation.
CorrectIncorrect - Question 39 of 70
39. Question
A group of six medical students is assigned to your team. You have been spending a considerable amount of time with one of the students, and you feel that a mutual romantic interest is emerging.
Choose the THREE most appropriate actions to take in this situation:
CorrectIncorrect - Question 40 of 70
40. Question
You have just finished your evening shift as an on-call emergency medicine FY1 doctor and decide to stop by a local café. While there, you notice a group of nursing students who were recently on your ward. They seem to be heavily intoxicated and are causing a disturbance, yelling obscenities at other customers. The students are eventually confronted by a security guard and asked to leave the premises.
Choose the THREE most appropriate actions to take in this situation:
CorrectIncorrect - Question 41 of 70
41. Question
A 58-year-old woman with a history of untreated hypertension suddenly presents to the emergency department with severe, tearing chest pain radiating to her back between the scapulae. She describes the onset as sudden while she was lifting a heavy box. On examination, she appears diaphoretic with a blood pressure of 190/100 mmHg in her right arm and 160/90 mmHg in her left arm. Heart rate is 110 bpm. On auscultation, you appreciate a faint early diastolic murmur. Given her presentation, you suspect aortic dissection.
Which of the following investigations would be most appropriate to confirm the diagnosis?
CorrectIncorrect - Question 42 of 70
42. Question
A 35-year-old female presents to her primary care physician with a 2-month history of persistent dry cough, fatigue, and joint pains. She denies any fevers, night sweats, or weight loss. On examination, she has slightly enlarged, non-tender lymph nodes in the cervical and axillary regions. A chest examination reveals bilateral inspiratory crackles at the lung bases. A skin examination reveals a few erythematous nodules on the shins, which are tender to touch.
Which of the following is the MOST definitive investigation to confirm the diagnosis of in this patient?
CorrectIncorrect - Question 43 of 70
43. Question
A 52-year-old male executive with a history of hypertension and smoking is brought to the emergency department with intense, crushing chest pain radiating to his left arm and jaw. The episode started approximately one hour ago during a corporate meeting. He is sweating profusely, anxious, and nauseated. His BP is 145/90 mmHg, HR is 110 bpm, and he is in evident distress. An ECG is performed immediately, showing ST-segment elevations in leads II, III, and aVF.
The initial management included aspirin, nitroglycerin, oxygen, and morphine, but the pain has not completely resolved. The nearest facility with catheterization laboratory is 2 and half hour away.
You consider the most appropriate next step in the management.
CorrectIncorrect - Question 44 of 70
44. Question
A 32-year-old woman presents to the dermatology clinic with a recurring rash. She reports intense itching, especially at night, leading to disrupted sleep. The woman states the rash comes and goes but has been more persistent over the past month. On examination, the dermatologist notes erythematous patches with ill-defined borders on her neck, antecubital fossae, and backs of the knees. There are areas of lichenification, crusting, and some excoriations due to persistent scratching.
Which of the following diagnoses aligns most with the patient’s clinical presentation?
CorrectIncorrect - Question 45 of 70
45. Question
A 60-year-old woman presents to the emergency department with a sudden onset of severe pain in her right eye that began 2 hours ago. She describes the pain as intense and throbbing and associates it with blurred vision and halos around lights. She has also felt nauseous and vomited twice. On examination, the right eye is noticeably red, the cornea appears cloudy, and the pupil is mid-dilated and reacts poorly to light. Intraocular pressure (IOP) measurement reveals a pressure of 50 mm Hg in the right eye.
Which of the following is the best immediate management step for this patient’s condition?
CorrectIncorrect - Question 46 of 70
46. Question
A 48-year-old female presents to the emergency room with a sudden onset of pleuritic chest pain and shortness of breath. She recently underwent a knee replacement surgery 10 days ago and had been largely immobile since the procedure. On examination, she appears anxious, her heart rate is 105 bpm, respiratory rate 22 breaths/minute, and oxygen saturation is 94% on room air. On auscultation, her lungs are clear, and there are no murmurs, rubs, or gallops heard on cardiac examination. Given her clinical presentation and background, you suspect pulmonary embolism (PE).
Which of the following investigations would be the most appropriate initial step to confirm the diagnosis?
CorrectIncorrect - Question 47 of 70
47. Question
A 45-year-old construction worker presents to the outpatient clinic complaining of a 3-week history of severe, sharp pain radiating down the back of his right leg, sometimes reaching his calf. He recalls lifting heavy equipment at work when he first noticed the pain. On examination, straight leg raising test on the right side exacerbates his leg pain, and there is some weakness during great toe extension.
Which of the following is the most appropriate initial investigation for this patient’s condition?
CorrectIncorrect - Question 48 of 70
48. Question
A 59-year-old woman visits the emergency department complaining of excessive thirst, frequent urination, and a generalized weakness that has worsened over the past two weeks. She also mentions experiencing some nausea, constipation, and confusion. She has a history of breast cancer treated with surgery and radiation three years ago and is currently in remission. She takes no medications and has no other medical conditions. On examination, her blood pressure is 110/70 mmHg, heart rate is 88 beats per minute, and her physical examination is largely unremarkable except for mild dehydration. Lab results reveal raised serum calcium levels.
Which of the following is the most likely cause of her hypercalcemia?
CorrectIncorrect - Question 49 of 70
49. Question
A 29-year-old woman presents to the outpatient department with a 3-week history of painful, red lumps on her lower legs. She says they have been growing in size and number, causing significant discomfort, especially when touched. She has no history of any similar episodes in the past. She mentions an associated low-grade fever and joint pain. She denies any recent illness, travel, or changes in medications. The patient has a 10-year history of oral contraceptive use and no known allergies. Her family history is unremarkable, and she has no known exposure to tuberculosis.
On examination, erythematous, tender nodules are present over the anterior aspect of both lower legs. The joints, especially the ankles, are mildly swollen but without any significant redness. There is no evidence of pharyngitis or cough. Preliminary blood work reveals an elevated ESR.
Which of the following is the most likely diagnosis?
CorrectIncorrect - Question 50 of 70
50. Question
A 32-year-old woman presents to her primary care physician complaining of unexplained weight loss over the past two months, despite an increased appetite. She also reports intermittent palpitations, tremors in her hands, excessive sweating, and difficulty sleeping. She denies any difficulty swallowing or a sensation of a lump in her throat. Physical examination reveals a fine tremor of her outstretched fingers, warm and moist skin, and a visible but non-tender thyroid gland that moves with swallowing. There’s also a noticeable lid lag when she’s asked to follow a moving object with her eyes. Blood tests show decreased TSH and elevated free T4 levels.
Which of the following is the most appropriate next step in the management of this patient?
CorrectIncorrect - Question 51 of 70
51. Question
A 35-year-old woman presents to the emergency department with a 48-hour history of progressively worsening right lower quadrant abdominal pain. Initially, the pain was diffuse and crampy but has now localized and become sharp. She has had bouts of nausea, two episodes of vomiting, and noticed a low-grade fever at home. On examination, she’s febrile, her heart rate is elevated, and there’s significant tenderness and rebound in the right lower quadrant. An upright chest X-ray shows free air under the diaphragm.
Which of the following is the most appropriate next step in the management of this patient?
CorrectIncorrect - Question 52 of 70
52. Question
A 19-year-old college student presents to the urgent care clinic complaining of severe sore throat for the past 3 days. She describes the pain as sharp, constant, and exacerbated by swallowing. She also reports a high-grade fever, chills, and fatigue but denies cough or nasal congestion. On examination, her tonsils appear enlarged, erythematous, and covered with a thick, white exudate. Anterior cervical lymph nodes are tender and palpably enlarged. Her voice has a muffled quality, and she exhibits difficulty in opening her mouth fully.
Based on the described clinical presentation, which of the following is the most likely diagnosis?
CorrectIncorrect - Question 53 of 70
53. Question
A 68-year-old woman presents to the emergency department after a fall on her outstretched hand while walking her dog. She complains of immediate pain and swelling in her right wrist. On examination, the wrist appears dorsally angulated, and there’s notable tenderness over the distal radius. Radiographic studies confirm a transverse fracture of the distal radius with dorsal angulation and displacement.
What is the most appropriate initial management for this patient’s condition?
CorrectIncorrect - Question 54 of 70
54. Question
A 75-year-old male patient with a history of COPD and recent hospitalization for pneumonia (treated with IV antibiotics) is admitted to the hospital complaining of watery diarrhea for the past 3 days. He mentions having abdominal cramps, and low-grade fever and has noticed the presence of a foul smell. The patient reports experiencing six episodes of bowel movements a day, and the stools are loose and watery. There is no visible blood in the stool. On examination, the patient is mildly dehydrated, abdominal examination reveals mild distension and diffuse tenderness without rebound or guarding.
Which of the following is the most appropriate initial management for this patient?
CorrectIncorrect - Question 55 of 70
55. Question
An 8-year-old boy is brought to the pediatric clinic by his mother, who is concerned about his bed-wetting episodes. She shares that the child has never been dry at night for a continuous period longer than six months. He has no daytime symptoms, and there are no reports of urgency, frequency, or dysuria. The child has a regular bedtime routine and doesn’t consume an excessive amount of liquids in the evening. The family history is significant for the mother having similar issues until she was about 9 years old. On physical examination, the child is of average height and weight for his age, with no signs of spinal or neurological abnormalities. His external genitalia and perineal area appear normal, with no rashes or signs of irritation. A focused neurological exam is non-contributory.
Given the findings, which of the following is the most appropriate next step in management?
CorrectIncorrect - Question 56 of 70
56. Question
A 5-year-old girl is brought to the paediatric clinic by her mother who is concerned about a rapidly evolving rash. The mother explains that the child had mild fever and fatigue two days prior, and since yesterday, she noticed a rash starting behind the child’s ears, then spreading to her trunk. The rash started as small red bumps, but she noticed that some of them have transformed into fluid-filled blisters. The child is scratching incessantly, despite the mother’s efforts to prevent it. On physical examination, you note macules, papules, and vesicular lesions present simultaneously in different areas. The child is afebrile, with no other notable symptoms. You suspect chickenpox.
Which of the following is the most appropriate management step?
CorrectIncorrect - Question 57 of 70
57. Question
A 7-year-old boy is brought to the clinic by his mother who reports that he has been having recurrent and prolonged nosebleeds, more than his peers. She also noticed large bluish bruises on his legs and arms that appear even with minor bumps. The boy’s teacher also mentioned that he seems to complain of joint pain after playing sports at school. The family history is notable for similar symptoms in his maternal uncle who died at a young age after a minor surgical procedure. Based on the presentation and family history, which of the following is the most likely diagnosis?
CorrectIncorrect - Question 58 of 70
58. Question
A 37-year-old woman is brought into the emergency department following a car accident. On examination, the patient opens her eyes when spoken to, is confused and disoriented but able to answer questions, and she obeys commands to move her limbs.
Using the Glasgow Coma Scale (GCS), what is her score?
CorrectIncorrect - Question 59 of 70
59. Question
A 34-year-old woman presents to her primary care physician’s office complaining of some new symptoms she’s been experiencing over the past few weeks. She was started on citalopram for her newly diagnosed depression a month ago. She’s been adherent to her medication, but she’s noticed persistent nausea, tremors in her hands, and difficulty sleeping at night. Furthermore, she reports episodes of excessive sweating even in a cool environment. On examination, you note a slightly increased heart rate and dilated pupils.
Which of the following is a recognized side effect of citalopram?
CorrectIncorrect - Question 60 of 70
60. Question
A 68-year-old man with atrial fibrillation is started on warfarin as anticoagulation therapy. He is curious about how the medication works and asks the physician about its mechanism of action. The physician decides to test the knowledge of the medical student shadowing him.
Which of the following best describes the mechanism of action of warfarin?
CorrectIncorrect - Question 61 of 70
61. Question
A 68-year-old man comes to his primary care physician complaining of difficulty urinating for the past 4 months. He mentions that he often feels the urge to urinate, especially at night, but when he tries, the flow is weak and interrupted. Sometimes he feels that he hasn’t emptied his bladder completely. Recently, he also noticed a delay in the initiation of urination. He denies any haematuria, pain, or discharge. He has no history of fever or flank pain. His medical history is significant for hypertension controlled with medication.
Which of the following is the most probable diagnosis for his condition?
CorrectIncorrect - Question 62 of 70
62. Question
A 58-year-old woman visits her primary care physician, complaining of a sudden, strong urge to urinate that she often cannot control in time to get to the bathroom. She shares that these episodes have resulted in several embarrassing situations over the past month. She has had to change her clothes multiple times throughout the day and is now reluctant to venture too far from home. She denies any burning sensation during urination or fever. She also denies any pain in the pelvic area. She mentions having a few episodes of nocturia. Her medical history reveals that she is post-menopausal and is on antihypertensive medications. She doesn’t consume excessive caffeine or alcohol.
Based on her symptoms, which of the following is the most likely clinical feature of her condition?
CorrectIncorrect - Question 63 of 70
63. Question
A 57-year-old female presents with a flushed face and generalized pruritus, which worsens after hot showers. She reports increasing fatigue and has recently noticed early satiety with a mild, dull pain in her left upper quadrant. Her full blood count reveals a raised haemoglobin of 18.5 g/dL, haematocrit of 54%, and elevated platelet and white blood cell counts. The JAK2 V617F mutation test comes back positive. The patient is diagnosed with polycythaemia rubra vera (PRV).
In order to prevent thrombosis and reduce her haematocrit, which of the following would be the most appropriate first-line management?
CorrectIncorrect - Question 64 of 70
64. Question
A 45-year-old man is dining at a local restaurant when he suddenly stands up, clutching his throat with both hands. He appears panicked and is unable to speak or cough effectively. His face starts to turn blue, indicating severe hypoxia. A bystander, realizing the situation, asks for help. You approach the patient and must decide on the next appropriate action.
What is the best immediate intervention?
CorrectIncorrect - Question 65 of 70
65. Question
A 67-year-old female presents to her primary care physician with complaints of persistent fatigue, unexplained weight loss over the past few months, and intermittent episodes of bone pain, especially in her back and ribs. She also mentions that she’s been feeling increasingly thirsty and urinating more frequently than usual. On examination, the physician notices mild pallor. A routine blood test reveals an elevated protein level, especially the gamma globulin fraction. A subsequent urine test detects Bence-Jones proteins. Radiological studies of her spine show “punched-out” lytic lesions.
Given these clinical findings and investigations, what is the most likely diagnosis for this patient?
CorrectIncorrect - Question 66 of 70
66. Question
A 45-year-old female patient is admitted to the burn unit following a kitchen accident where she sustained burns from boiling water. The burns cover her entire left arm and extend onto the left side of her chest. After assessing the extent and depth of the burns, you estimate that she has second-degree burns over approximately 18% of her total body surface area. She weighs about 60kg. Given the extent of her burns, fluid resuscitation is a primary concern to prevent complications.
Which fluid resuscitation strategy is most appropriate for this patient as per the Parkland formula?
CorrectIncorrect - Question 67 of 70
67. Question
A 38-year-old male presents to the neurology clinic with severe unilateral headaches that have been recurring for the past three weeks. He describes the pain as sharp and stabbing, located around his right eye. Each episode lasts about 2 hours and often wakes him from sleep. He also reports associated tearing of the right eye and nasal congestion during these episodes. The patient notes that he gets about 2-3 of these headaches daily and then they seem to disappear for months. Physical examination is unremarkable. Given his clinical presentation, what is the most appropriate acute management for his condition?
CorrectIncorrect - Question 68 of 70
68. Question
A 54-year-old male presents to the emergency room with a sudden onset of severe chest pain described as “tearing” that radiated to the back. The pain began abruptly 2 hours ago while he was watching television. The patient has a history of untreated hypertension. On examination, his blood pressure is found to be 175/105 mmHg in the right arm and 150/95 mmHg in the left arm. There is a slight delay in the femoral pulse compared to the radial pulse. His heart sounds are normal, but there is a diastolic murmur heard over the aortic area. Based on the presentation and the findings, aortic dissection is suspected.
Which of the following is the best initial investigation to confirm the diagnosis?
CorrectIncorrect - Question 69 of 70
69. Question
A 58-year-old male is brought to the emergency department following a high-speed motor vehicle accident. On initial assessment, he presents with severe chest pain, increased work of breathing, and paradoxical movement of a section of his rib cage during respiration. Palpation reveals multiple fractures on the left lateral chest wall. Breath sounds are diminished on the left side, and he is becoming increasingly anxious and hypoxic. An X-ray confirms the presence of a flail chest involving four consecutive ribs.
Which of the following is the most appropriate next step in managing this patient?
CorrectIncorrect - Question 70 of 70
70. Question
A concerned mother brings her 2-year-old daughter to the emergency department in the late evening. She reports that her daughter developed a low-grade fever and a runny nose two days ago. Earlier tonight, the child started to have a barking cough, became increasingly hoarse, and seemed to struggle slightly with her breathing. The mother also noticed a high-pitched, whistling sound when the child breathed in. There’s no drooling, and the child can swallow without difficulty. On examination, the child appears anxious with mild intercostal and subcostal retractions. There’s no stridor at rest, but it’s noticeable when the child becomes agitated. Based on the clinical presentation, you suspect a common paediatric condition.
Which of the following clinical features is most consistent with the child’s presentation?
CorrectIncorrect