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

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:

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:

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

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.

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:

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.

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

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.

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:

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 SHO, 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.

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

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.

You are working on a busy ward in the hospital as an intern. 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.

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.

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.

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.

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.

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.

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.

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:

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:

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.

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.

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.

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.

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.

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.

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:

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:

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:

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:

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.

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.

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.

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.

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.

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.

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:

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:

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?

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?

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.

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?

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?

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?

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?

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?

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 history of inflammatory bowel disease. Her family history is unremarkable, and she has no known exposure to tuberculosis.

Which of the following is the most likely diagnosis?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

A 30-year-old woman is brought in by her partner, who reports that over the last few days, she has been exceptionally energetic, speaking rapidly, and has barely slept, yet doesn’t seem tired. She has been working on several projects simultaneously, has taken up a new hobby, and seems excessively confident in her abilities. Despite being more talkative and impulsive, she has not displayed any signs of delusions or hallucinations and continues to function well at her job and in social settings. She denies any recent depressive episodes.

What is the most likely diagnosis?

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?

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?

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?

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?

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?

A 10-year-old boy is brought to the clinic by his parents due to concerns about his behaviour at home and school. His teachers have reported that he is frequently distracted, struggles to complete assignments, and often forgets to bring his books and materials. At home, he is described as being constantly on the move, interrupting conversations, and unable to sit through family meals or activities. His parents also mention that he talks excessively and is impatient when waiting for his turn during games. Despite these behaviours, he is described as bright and intelligent but unable to stay focused on tasks, especially those requiring sustained attention.

What is the most likely diagnosis, and what would be the first-line management approach?

A 35-year-old woman presents to her GP with symptoms of low mood, lack of interest in daily activities, insomnia, and significant weight loss over the past 2 months. She reports feeling fatigued, finds it hard to concentrate, and has lost interest in hobbies she once enjoyed. She denies suicidal ideation but feels hopeless and unable to cope with her job and responsibilities at home. This is her first episode of depression, and she has no prior history of mental health issues.

What is the most appropriate first step in managing her condition?

A 32-year-old woman with a history of schizophrenia is brought in by her family due to worsening symptoms over the past month. She has stopped taking her medication and is now hearing voices telling her that her neighbours are spying on her. She is becoming increasingly paranoid, avoiding meals because she believes her food is poisoned. She has also been neglecting personal hygiene and is no longer engaging in daily activities. Her psychiatrist wants to start her on treatment again.

What is the most appropriate first-line management option?

A 72-year-old male who recently suffered an ischemic stroke is admitted to the critical care unit. Due to his inability to swallow, a nasogastric tube (NGT) is inserted for enteral feeding. Before starting the feeding, the healthcare team needs to confirm the correct placement of the NGT.

What is the most accurate method to ensure the NGT is in the correct position?

A 65-year-old woman with a history of poorly controlled type 2 diabetes mellitus was brought to the hospital in an unresponsive state and later pronounced dead. She had recently been admitted for a foot ulcer that had been progressively worsening despite treatment. The autopsy revealed severe septicaemia with multiple organ involvement, and the direct cause of death was attributed to sepsis originating from the infected foot ulcer.

What is the most appropriate underlying cause or contributing condition to list in Part 1b of the death certificate?

A 22-year-old female presents to the clinic complaining of frequent episodes of binge eating followed by feelings of guilt. She admits to self-induced vomiting multiple times a week over the past six months to “get rid of the calories.” She has noticed swelling around her jaw and some discomfort in her teeth. Her BMI is 20. On examination, you observe parotid gland swelling and calluses on her knuckles. Blood tests reveal normal electrolytes.

What is the most appropriate initial management for this patient?

A 32-year-old woman with a history of depression presents to the emergency department 3 hours after ingesting approximately 25 tablets of paracetamol (500 mg each) in a suicide attempt. She appears alert but is visibly anxious. On examination, her vital signs are stable, and there are no signs of jaundice or hepatic tenderness. Blood tests, including liver function tests and coagulation profile, are unremarkable. A serum paracetamol level will be taken at 4 hours post-ingestion.

What is the most appropriate immediate management step for this patient?

A 6-year-old boy is brought to the clinic by his parents due to chronic coughing, recurrent chest infections, and poor weight gain despite a good appetite. His mother mentions that his stools are often bulky, greasy, and have a foul odour. On examination, the child appears thin with clubbing of the fingers. The parents also note that his skin tastes salty when they kiss him. There is no significant family history, but the parents are concerned about his frequent respiratory issues.

What is the most likely diagnosis?

A 30-year-old pregnant woman at 18 weeks’ gestation is concerned about her baby’s development and wants to ensure there are no abnormalities. She hasn’t experienced any symptoms but wants to know the best test to evaluate her baby’s anatomy and any possible birth defects.

Which test is most appropriate for her at this stage?

An 88-year-old woman was admitted with a catheter-related urinary tract infection (UTI) and has now been treated. She is medically fit for discharge, but her daughter is concerned about her safety at home as the patient is frail and has mobility issues.
What is the most appropriate next step in discharge planning?

A 45-year-old patient with a known penicillin allergy presents with symptoms of septic arthritis in the knee. The diagnosis has been confirmed via synovial fluid analysis. An appropriate antibiotic regimen needs to be initiated.

What is the best initial treatment option for this penicillin-allergic patient?

A 32-year-old patient presents to hospital complaining of sudden onset redness, pain, and photophobia in the left eye since the morning. The patient denies any recent trauma or contact lens use but mentions a history of psoriasis. On examination, you notice circumcorneal redness and a small pupil. Slit-lamp examination by ophthalmologist reveals cells in the anterior chamber. There is no discharge or lesion on the cornea that suggests an infection.

What is the appropriate step in management ?

A 52-year-old woman visits her gynaecologist for a routine check-up. She has a BMI of 35, has never been pregnant, and reports that her mother was diagnosed with breast cancer at age 47. She has been experiencing irregular, heavy menstrual periods for the past six months. She is concerned about her risk of developing endometrial cancer and seeks advice on her risk factors and possible preventive measures.

What is the most significant risk factor for endometrial cancer in this patient?

A 45-year-old man with a 10-year history of Bipolar Affective Disorder presents to the emergency department with new-onset tremors, vomiting, and confusion. He mentions that he has been on lithium therapy for mood stabilization. Recently, he travelled a long distance and has also been taking ibuprofen for knee pain. His family reports that he has not been drinking enough water during the journey.

What is the most appropriate test to perform?

A 60-year-old female patient with a history of osteoporosis has been prescribed bisphosphonates by her endocrinologist to improve bone density and reduce the risk of fractures. She is keen to understand the best way to take this medication to maximize its effectiveness and minimize side effects.

She consults with you to clarify the best method of administration.

An 18-year-old woman visits your clinic with complaints of vaginal discharge, post-coital bleeding, and inflammation of the vulva and cervix. She mentions recently beginning a sexual relationship with a new partner. On examination, you find her pelvis is tender, but her abdomen is not.

You suspect chlamydial cervicitis based on the symptoms and sexual history.

A 68-year-old patient with advanced pancreatic cancer is receiving palliative care at home. In recent days, the patient has begun experiencing frequent episodes of nausea and vomiting, which have not responded to oral medications. The patient’s palliative care team decides to administer anticipatory medications to manage these symptoms subcutaneously.

The patient’s family requests information on the best options for immediate relief.

A 58-year-old woman presents to the emergency department complaining of sudden onset severe eye pain, blurred vision, and seeing halos around lights. Her medical history is notable for Diabetes, HTN and depression. Please note, She is hypothyroid as well.

Which medication most likely contributed to her symptoms.

Maria, a 45-year-old woman with type 2 diabetes, visits her endocrinologist for her annual diabetes management review. She mentions that she hasn’t attended a diabetic retina screening for few years, primarily due to her busy schedule and uncertainty about the need and frequency of screening given her stable diabetic condition.

Maria asks her endocrinologist for advice on how often she should undergo diabetic retina screening.