SMLE Brain Ethics PDF

SMLE Brain | Ethics Version 3 January 2022 – July 2023 References: Professionalism and Ethics Handbook for Residents: A Practical guide – Saudi Commission for Health Specialties Saudi Guidelines for Informed Consent 2019 AMBOSS UpToDate Notes: We did our best to ans...

SMLE Brain | Ethics Version 3 January 2022 – July 2023 References: Professionalism and Ethics Handbook for Residents: A Practical guide – Saudi Commission for Health Specialties Saudi Guidelines for Informed Consent 2019 AMBOSS UpToDate Notes: We did our best to answer the questions as accurately as possible, there may be mistakes Please make sure to check our telegram channel for the latest version of this file: https://t.me/smlebrain https://t.me/smlebrain 1) A physician was working on a research paper. Before publishing the paper, he made some changes to some of the data and omitted other parts of his results. What is this action referred to? A) Falsification B) Fabrication C) Plagiarism D) Near miss Answer: A, to falsify data is to manipulate or change the data. On the other hand, fabricating data is basically making up data which doesn’t exist. Plagiarism is to steal someone else’s data and present it as your own. 2) Patient coming from an endemic area for malaria. Later on, he was admitted to the hospital with Heart failure. Doctor did not ask the patient about travel or medication history. Thus, he ordered the nurse to give digoxin. Who is at fault? A) Computerized drug prescription system B) Nurse failed to write drug formularies C) Pharmacist who failed to check prescription D) Patient who did not bring his medicine pack/ report his medicines Answer: A, really and truly, the doctor is the one at fault for not taking the patient’s medical history but based on these options, the failure of the computerized drug prescription system to flag the patient for using antimalarial drugs which will have interactions with digoxin is the most appropriate answer. 3) Warfarin was not stopped by patient despite of the clear instructions, the nurse in the OR noticed that the patient did not stop the drug as instructed and informed the surgeon, so the surgeon postponed the operation: A) Adverse event B) Medical negligence C) Near miss D) Principle of totality Answer: C, A near miss is an event where the patient could have been in harm but it was avoided due to chance or some other event. 4) A 15-year-old child was brought to the clinic by his parents with fever and neck stiffness. A lumbar puncture was ordered for the child. Consent for the investigation should be taken from: https://t.me/smlebrain A) Take consent from patient and assent from parents B) Take consent from patient and don’t assent parents C) No need for consent D) Consent the parents only Answer: A, Children above the age of puberty are virtually adults and should be able to make decisions for themselves. However, the age of majority is 18 in Saudi Arabia so the parents should assent the decision as well. 5) Patient came with vaginal discharge she has done CS with episiotomy 10 days ago, the obstetrician diagnosed her with UTI and prescribed Abx, but she did not improve then she went to another obstetrician, and he found infected vaginal swab, What is the medical error done by the first obstetrician? A) Let the midwife assist him and depend on her B) Doctor failed to follow the surgical safety protocol in the OR C) No communication between the second and first obstetrician D) Genuine difference assessment or diagnosis of patient case Answer: B, from what I understand, the first obstetrician forgot a swab during his operation only to be discovered incidentally by the second obstetrician later. Of course, it’s the first doctor’s fault for not following the surgical safety protocols. 6) A Patient presented to the ER with right lower abdominal pain. An appendectomy was done after taking consent. The surgeon discovered the appendix was normal but still removed the appendix and sutured the incision. Which of the following is the most appropriate action? A) Inform the Patient and tell him it's a part of the protocol B) Let another surgeon tell the patient C) Don't tell the patient D) Consult the ethics committee Answer: A, the patient has right to know that his appendix was removed despite the absence of appendicitis. 7) A 3-year-old child was brought by his mother for a regular check-up. The child behaved badly, continued to shout “NO!” and throw toys. His mother tried to stop him but he continued to ignore his mother. Which of the following would you advise this mother? A) Ignorance https://t.me/smlebrain B) Counselling C) Positive reinforcement D) Punish the child Answer: C 8) The government did a health campaign to encourage the consumption of low- fat products and a low salt intake in order to prevent hypertension and diabetes. Why type of prevention is this? A) Primordial prevention B) Primary prevention C) Secondary prevention D) Tertiary prevention Answer: B, this is a difficult question I must admit. Primordial prevention is to prevent the risk factor from occurring in the first place, but primary prevention is to stop or reduce risk factors which are already present in the population. Consumption of high salt/high fat products is already commonplace in KSA. -AMBOSS 9) An 18-month child was brought to clinic for a regular checkup. The doctor found out that the child had not taken any of his scheduled vaccines. He asked the mother why and she replied “Vaccines will make my son retarded!”. What is the appropriate action? A) Refer the mother for psychiatric assessment B) Contact child protection services C) Explain the benefits of vaccines to the mother D) Contact the hospital ethics committee Answer: C 10) A mother brought her child to the clinic with bruises. The mother was also found to have bruises on her arm. When asked about it, she said “oh this? Yes I fell down the stairs and so did my child ”. What is the most appropriate action? A) Ignore her and focus on treating the child B) Tell her to report the incident to the police C) Obtain consent from the husband to treat the child https://t.me/smlebrain D) Treat the child and report the incident to the child protection services Answer: D 11) Child presented to the ER with his first asthma exacerbation. He was placed on nebulized SABA and stabilized. The father is a smoker and when asked not to smoke at home but he seemed uninterested. Which of the following is the best next step? A) Treat the child and ignore the father B) Call child protection C) Counsel the father about the risks of smoking on the child D) Consult the ethics committee Answer: C, in this case they did not mention if this was a repeating incident or not. It is an unnecessary escalation to call child protection before giving the father proper education first. 12) Child was having severe asthma exacerbation and father won’t quit smoking despite being told multiple times about the harms of smoking on his child, what is the most appropriate action? A) Treat the child and ignore the father B) Call child protection C) Counsel the father about the risks of smoking on the child D) Consult the ethics committee Answer: B, He was told many times to stop smoking near his child but he hasn’t stopped. This is harming the child and must be reported. 13) A woman presented to the hospital with a broken arm caused by her husband who was angry she didn’t make him tea properly. Which of the following is the most common time domestic violence is increased? A) During pregnancy B) After retirement C) At family visits D) On holidays Answer: A, “rates of domestic violence are higher in pregnancy and the postpartum period” – AMBOSS https://t.me/smlebrain 14) One of the goals for Saudi Arabia in 2030 vision is to improve the health by decreasing the preventable causes of death underage of 5 years group, this will be conducted through: A) Specialized hospitals B) Education C) Immunization D) Economic development Answer: C 15) A Child came with a potentially toxic dose of paracetamol. The physician requests an “Acetaminophen level”. The lab technician calls to report results. He says: “two” stops and pauses and then says ”one, three”. The nurse mistakenly writes it as “2.13” while the real result was “213”. The patient went into irreversible liver damage, which of the following explain the error that has happened? A) Doctor did not check B) Lack of communication C) Technician didn't check if the nurse got the number correctly D) Mishandling from the nurse Answer: B, the lab technician is wrong for not double checking with the nurse and the nurse is also wrong for not double checking with the lab technician. 16) Which of the following is an example of respecting patient autonomy? A) Providing the patient with medical information B) Covering the patient’s body parts C) Treat all patients equally D) Signing a consent Answer: D 17) An elderly with end stage cancer c/o severe pain. The family asked the physician to give a stronger analgesic or to increase the dose. The doctor explains that while it might help alleviate the pain, it also might hasten their father’s death. Which of the following is this referred to? A) Principle of subsidiarity B) Principle of double effects C) Principle of totality D) Principle of informed choice https://t.me/smlebrain Answer: B, the concept of double effects is that there is no single good choice. The physician makes a choice which may have a bad effect so long as the good effect is equal or better and moral 18) A baby was left at the hospital doors without a guardian and suspected to be born out of wedlock. Upon examination it was recommended by the pediatric surgeon to do a hernia repair. Which of the following is the most appropriate action? A) Inform the case to the police B) Inform the case to the social workers C) Consult the ethics committee D) Do the surgery without consent Answer: C, under normal circumstances, consent would need to be obtained from the child’s parents. The fact that the case mentioned the baby is abandoned means it doesn’t currently have anyone to consent on its behalf. Here there is an ethical dilemma on whether to proceed with the hernia repair or not and therefore the case should be referred to the ethics committee before starting any surgical procedure. 19) A 50-year old heavy smoker presented to the clinic for a regular checkup. He showed no interest in quitting smoking at all. Which of the following is the most appropriate action? A) Offer smoking cessation classes B) Nicotine replacement therapy C) Set a deadline to quit smoking D) Offer personalized advice Answer: D, this patient has no interest in quitting smoking. It would not make sense to offer classes to someone who is not interested. Neither would addiction-quitting strategies be useful for someone who doesn’t want to quit. The best approach would be to offer advice that would convince him to quit smoking first. 20) A cohort study was carried out comparing the association of green tea and black tea with diabetes. Over 10 years, the risk ratio of green tea (exposed) was 0.85 compared with black tea (unexposed). Which of the following is the correct interpretation? A) Green tea drinkers have a lower risk of DM B) Black tea drinkers have a higher of DM C) Getting DM Amongst both groups is not related D) The results happened by chance https://t.me/smlebrain  Answer: A, If RR < 1 then protective, If RR = 1 then no association, If RR 1 < then positive association 21) A patient was admitted to the hospital with a diagnosis of Ebola. After a few hours, the patient wanted to leave to “just buy a drink and come back” you refused to let him out but he insisted. Which of the following is the most appropriate action? A) Call security B) Refer him to the infectious disease department C) Sign him DAMA D) Consult hospital administators Answer: A, Ebola is a life-threatening disease which poses a major risk to the public. He must be kept in isolation until he recovers. 22) A new test was introduced to detect liver disease. The 1st group of 800 subjects have liver disease and the 2nd group of 800 do not. The test found 200 positive results in the 1st group and 100 positive results in the 2nd group. Calculate the sensitivity? A) 86% B) 50% C) 33% D) 25% Answer: D, Sensitivity = True positive/(True positive + False negative). In other words that would be 200/(200+600) = 200/800 = 2/8 = ¼ = 25%. 23) A medical student presented to the clinic asking for a sick leave because he was with his sick mother in the hospital last night and couldn't study. Tomorrow is his final exam. Which of the following is the most appropriate action? A) Refuse politely and tell him to study earlier B) Refer him to another colleague who will accept this C) Give him a sick leave and save your future colleague D) Call the hospital and make sure he's saying the truth and his mother is sleeping there Answer: D, this is a controversial question, but I will try my best to explain my point of view. The first point is that sick leaves can be given in KSA if a person is taking care of https://t.me/smlebrain his immediate sick relative. He doesn’t have to be sick himself to receive a sick leave. This is also true in most countries. The issue that most people have with this question is that his exam is tomorrow, he attended the hospital with his mother last night, not tomorrow so how could you write him sick leave for the following day? This is why option D is the best answer, here you are not just blindly writing him a sick leave but rather you are checking if she is still sleeping there or not. This would be the most balanced answer, you are not refusing nor are you agreeing to write him the sick leave. Generally speaking, ethics questions favour the more balanced answers in the exam. Also, Is it your place to give the medical student study advise? Even if it was, is it appropriate? The student’s mother is so sick she was hospitalized for the night and may still be hospitalized, is it appropriate, considerate or even ethical to tell the student he should have studied earlier in this particular context? 24) What study design we can use to assess the burden of hypertension in Saudi Arabia? A) Ecological study B) Observational C) RCT D) Population survey Answer: B, the burden of disease requires parameters such as the prevalence of a particular disease. The prevalence of a disease is measured by a cross sectional study which in turn is an observational study. 25) Case of suspected child abuse with parents complaining of baby having pain otherwise looking and doing well X- ray showed fracture of both ulna and radius What will you do next: A) Ct brain and admission B) Call Child protection service C) Call police D) Believe parents Answer: D, there is not enough information, long bone fractures in the context of a known incident such as falling is typically not suspicious. They mentioned that the child looks well and is doing well. There is nothing which makes this case suspicious according to the information given. 26) Female on ultrasound showed lesion, she’s scheduled for CT guided drainage, from who should consent be taken from? https://t.me/smlebrain A) Radiologist B) Registered nurse C) Internal medicine resident D) Any one from the managing team Answer: A 27) A drug approved by the FDA is prescribed by a doctor who is the shareholder of the pharmaceutical company. Which of the following terms best describes this scenario? A) Confidentiality B) Conflict of interest C) Justice D) Non-maleficence Answer: B 28) A child was brought to the clinic for a regular check up. Which of the following findings is suggestive of child abuse? A) Linear bruises on the back B) Multiple bruises on lower limbs C) Head hematoma and underlying linear skull fracture D) Bruises on the elbow Answer: A, linear or ligature bruises on the back are highly suggestive of belt/whip lashes. Bruises on the lower limbs and elbows are common in children due to running and playing. 29) A researcher wants to examine the effectiveness of drug A. He does so by combining multiple research papers to reach a conclusion. What type of study is the researcher trying to make? A) Case control study B) Cohort Study C) Meta analysis D) Randomized control trial Answer: C, although we usually determine the effectiveness of a drug through randomized control trials, here they mentioned that they combine multiple research papers therefore this would be a meta-analysis. https://t.me/smlebrain  30) 11-month-old boy is not moving his right hand and when he presented to the hospital it appeared that he had right ulnar and radial fracture presented after 2days history of fall on an outstretched hand when the doctor asked the parents why they didn’t bring him earlier they said that they didn’t see any bruises. child is dressed well, well-nourished and has had regular well baby visits. A) Treat the child and inform the authorities B) Believe the parents and treat the child C) Treat the child and order head CT D) Call the police Answer: B, although there is a delayed presentation of 2 days which is suspicious, the parents’ explanation as to why they didn’t come earlier is valid and possible. Also the baby is well dressed and well nourished. They did not mention if he has any other issues such as unusual fractures, bruises or any issues with the parents (alcohol, drug abuse etc). 31) The number of new-born deaths was 4.8 per 1000 in Saudi Arabia during 2020, What was needed to calculate this figure? A) Number of women in the reproductive age B) Number of child deaths in 2020 C) Population in mid 2020 D) Number of new-borns in 2020 Answer: D 32) Whilst studying the effects of smoking, you needed to determine the number of students who are currently smoking throughout high schools in KSA. Which of the following is the most appropriate study? A) Field study B) Community study C) Cross sectional study D) Case control study Answer: C, cross sectional studies are used to determine prevalence 33) One of the female hospital staff went into labour at 23 weeks gestation. The baby had a congenital heart defect and needed intubation, but the mother refused and did not want to resuscitate the baby for “personal reasons”. What is the best next step? A) Ignore the mother and intubate the baby https://t.me/smlebrain B) Respect the mother’s wishes C) Consult the ethical committee D) Refer the case Answer: B, < 23 weeks don’t resuscitate, 23-25 weeks respect mother’s wishes, >25 weeks always resuscitate. 34) A medical intern was attending an operation and observed the surgeon preparing the right side of the patient for an incision. He knew that the diseased kidney was on the left side from studying the patient’s history. What should the intern do? A) Call the chief intern B) Tell the surgeon C) Tell the attending nurse D) Do nothing Answer: B 35) A screening test for a disease in a low prevalence area will result in an increase in? A) False negative B) False positive C) True negative D) True positive Answer: B, if the prevalence is low there are more false positive results 36) 70 years old, menopause, came seeking hormonal replacement therapy, and you explained that there is no benefit in her case, but she insisted, what you will do? A) Refer her to another gynaecologist B) Prescribe her the medication C) Refuse her the medication D) Consult the ethics department Answer: C, hormonal therapy is a prescription therapy which comes with serious adverse effects. Prescription drugs shouldn’t be given out purely at the request of the patient without any medical merit. 37) A patient presented with an infection. Which one of the following diseases is the doctor required to report to the ministry of health? https://t.me/smlebrain A) Chlamydia trichomatis B) Bacterial vaginosis C) Lobar pneumonia D) Infectious mononucleosis Answer: A, sexually transmitted diseases must be reported to the MOH for contact tracing and ensuring sexual partners are notified/tested. 38) Parents brought their child to the hospital for inability to move his arm Xray showed fracture at both distal ulna and radial bone. The child looks healthy and dressed well, and good hygiene they recall that 2 days ago the mom dropped a plate at the child arm and noticed he couldn’t move his arm they didn’t notice any bruising, so they thought it’s just a strain. Which of the following is indicative of child abuse? A) Type of fracture B) Delayed presentation C) Consistent story of the parents D) The appearance of the baby Answer: B -UpToDate 39) A 56-year-old male suffering from chronic illness was managed by a physician for the last 5 years. His hospital changed administration and a new physician was assigned. The patient was angry and demanded his previous physician. What’s the best next step? A) Assure the patient that there are many great physicians who can treat him B) Ignore the patient and continue treatment C) Send a medical report and refer the patient D) Call security Answer: C, every patient has the right to change his physician and ask for a referral https://t.me/smlebrain 40) Findings in a research report show that the incidence of a particular disease in Saudi Arabia is higher in females than in males but the prevalence is equal in both females and males. How can this be explained? A) Fatality cases are higher in females B) Fatality cases are higher in males C) Females carry the disease for longer D) Males carry the disease for longer Answer: A, Incidence measure new cases. For example, if more females are being newly infected but also die from it more than males, then the incidence is higher in females, but the prevalence may be equal. This is because in the end we may be left with the same amount of males and females with the disease. 41) A famous Saudi celebrity presented to the clinic for a follow up on her condition. After the celebrity left, another patient took pictures of her private information on the screen. It was revealed to the public this celebrity had an STD. Who is at fault? A) The nurse who didn’t check the screen after the doctor left B) The patient who took the picture C) No-one is at fault as he is a celebrity D) The doctor who did not sign out of the account Answer: D, The doctor and the patient are at fault. But the doctor made a serious mistake in failing to protect the confidentiality of the patient. It is not the public’s right to know about a person’s medical condition despite being a celebrity. 42) A couple presented to the clinic complaining of infertility for the last 3 years. They asked about the availability of a surrogate option in the hospital and whether it was legal in KSA. Which of the following is the most appropriate option? A) Tell them it is not an available option in this hospital B) Refer him to another consultant with connections to surrogacy centres C) Tell them it is illegal in Saudi Arabia D) Give them appointment and read about the topic Answer: D, as I mentioned earlier, the most balanced answer is usually the correct answer when it comes to ethics questions. Surrogacy is a controversial topic in Saudi Arabia. https://t.me/smlebrain 43) A case of pregnant for C/S. Prior to the operation she told the nurse she doesn’t like to get blood transfusion. Later when they delivered the placenta she bled profusely and started to faint. What will you do next? A) call the husband and take permission from him B) order blood and transfuse to her C) call the hospital ethics committee D) don’t transfuse to her Answer: B 44) The WHO requested health related data with regards to a particular health issue affecting the population. Which of the following should KSA share with the WHO? A) Health indicator B) Health determinant C) Risk factors D) Case fatality Answer: A, a health indicator is a measure designed to summarize information about a given priority topic in population health or health system performance. 45) A male doctor wants to examine a female patient, he called a female nurse to join him during the examination as chaperone. What ethical principle did he practice? A) Justice B) Privacy C) Non-maleficence D) Informed consent Answer: B, this is the closest answer, non-maleficence means to “do no harm”. This is an ethical principle applied when caring for patients and ensuring there is no medical negligence. It is not related to this case. 46) 37.3% fatal case due to corona what does it mean? A) 37.3% of people with COVID- 19 died B) 37.3% of people diagnosed COVID- 19 C) 37.3% of people recovered from COVID-19 D) 37.3% of people received COVID-19 vaccine Answer: A https://t.me/smlebrain 47) A pregnant woman is undergoing an operation and told the nurse she doesn’t want a blood transfusion beforehand. Now she has severe bleeding and became hypotensive. Which of the following is the most appropriate action? A) Start the blood transfusion now B) Consult the ethics committee C) Take the consent from the patient before she loses consciousness D) Take consent from the husband Answer: A, She is already in the OR, written consent was already obtained to transfuse blood if needed as with any major operation. Also this is considered life-saving treatment and consent can be ignored 48) A doctor examining a citizen returning from overseas found him positive for HIV. The patient begged the doctor to not inform his wife and said if she found out, she will leave him. What is the most appropriate action? A) Respects the patient’s wishes B) Inform the wife of the diagnosis C) Inform the boss of the diagnosis D) Report the case to the authorities Answer: D, It is the physician’s job to inform the ministry of health who will then contact- trace and inform the wife. The physician should not contact the wife directly. 49) WHO report that the Case-fatality is 37.4% for Mers Cov, what does the percentage means? A) Number of population at risk for Mers Cov infection B) Number of Infant who will catch the infection if their mother is +ve C) Number of death among infected people with Mers Cov D) Number of people diagnosed with Mers Cov Answer: C 50) A child was brought by his parents with muscular atrophy, the pediatrician decided he needs intubation, but the parents refused claiming that their previous child had the same disease and died because of hospital negligence. What is the best next step? A) Call child protection B) Ignore both parents and intubate the child C) Consult the ethics committee https://t.me/smlebrain D) Respect the parent’s request Answer: B, this is an emergency and the child needs intubation. The parent’s do not have to consent to save the child’s life. After the child is stabilized, they can request the child continues treatment at a different hospital. 51) A female underwent caesarean section and consent was obtained. Patient later developed massive bleeding that was not being controlled by medical management and hence a decision for hysterectomy was made by the two consultants. However, no consent for hysterectomy has been obtained. What will the surgeon do? A) Obtain consent from the husband B) Perform the hysterectomy without consent C) Consult the ethics committee D) Do not perform the hysterectomy Answer: B, under normal circumstances, when consent cannot be obtained by the patient because of a lack of consciousness, we can obtain consent from the patient’s family. However, the patient has massive bleeding, now this becomes an emergency and so hysterectomy must be performed to save her life. 52) Results came with bad prognosis, who should tell the patient? A) Ethics office B) Treating physician C) Administrator D) Lab technician Answer: B 53) A Patient was diagnosed with a malignancy. What is the point of a multidisciplinary team? A) Compassion B) Judgement-free discussions C) End of life care D) Patient treatment optimization Answer: D 54) A newly diagnosed diabetic patient arrived on time for his appointment. The doctor on the other hand arrived late due to a medical emergency. The patient was very angry. Which of the following is the most appropriate next step? https://t.me/smlebrain A) Explore the cause of the anger B) Acknowledge the cause of anger C) Ignore the cause of the anger D) This is normal with new diagnosed diabetic patients Answer: B, the physician arrived late so naturally he should acknowledge his late arrival. Why would he explore the reason for his anger when it’s obvious the reason is he is late. 55) An 83-year-old was brought to the clinic by his family because of weight loss for the last 2 months. The patient was diagnosed with colorectal cancer and the family requested that you do not inform the patient. What is the next best step in management? A) Consult hospital ethics committee B) Inform the patient of his diagnosis C) Do not inform the patient at the request of his family D) Consult the hospital legal team Answer: B, it is the patient’s right to know his diagnosis unless he specified that he doesn’t want to be informed. 56) The health ministry unveiled new plans to tackle diabetes in the country. Which of the following is considered a secondary prevention? A) Screening of diabetics B) Chronic management of diabetes C) Education in health and disease D) Sugar taxation measures Answer: A 57) A new screening test for diabetes has a sensitivity of 90% and specificity of 80%, which of the following is the best interpretation? A) 80% of non-diabetics had positive result B) 80% of diabetics had positive result C) The test was positive for 90% of diabetic patients D) For each 100 positive test results, 90% were diabetics Answer: C 58) Which of the following is true about perinatal mortality? https://t.me/smlebrain A) Includes all stillbirth after the 20th week of pregnancy B) Includes all neonatal deaths in the 1st 8 week of life C) Includes all stillbirths and 1st week neonatal deaths D) Specifically neonatal Deaths is usually deaths per 10,000 live births Answer: C 59) A 45-year-old smoker came to the clinic for his diabetes follow-up. During discussion, he acknowledged that smoking is not good for his health. He plans to quit this year. According to the Stages of Change Model, at what stage of change is this patient? A) Precontemplation B) Contemplation C) Preparation D) Maintenance Answer: C, precontemplation: not considering quitting, contemplation: considering quitting but not planning, preparation: planning to quit, maintenance = already quit. 60) A man requested information about the patient’s diagnosis and insisted that he knows as he is the patient’s relative. The doctor refused. Which ethical principle was applied? A) Privacy B) Confidentiality C) Dignity D) Informed consent Answer: B 61) After a new outbreak of covid in the city of Wuhan. Which entity is responsible for sounding the international alarm? A) Wuhan regional government B) Chinese government C) WHO D) Egypt Answer: C, Wuhan alerts China, China alerts the WHO and the WHO announces the pandemic. https://t.me/smlebrain 62) A pregnant lady presented to the clinic because her husband punched her face and abdomen. Investigations found the mother to be stable and the CTG was reassuring. Which of the following is the best next step? A) Admit for observation B) Discharge C) Call the hospital D) Ensure the story is correct from the husband Answer: A, This is a suspected domestic violence case and there may be a risk of a miscarriage occurring if the mother returns to her husband and is punched again. Admission then report to the police/authority. 63) Patient came to the ER with MI and needed PCI, when the cardiologist assessed his condition, he noticed the patient was depressed with low mood, the patient refused the PCI. He demonstrated a good understanding of his problem to the doctor. Next step? A) Treat the patient regardless of consent B) Refer the patient for psychiatric assessment C) Respect the patient’s choice after discussinig the reasons of refusin D) Take consent from the patient’s relative Answer: B, The case suggests the patient may have depression. This is a serious mental illness and may be the reason he is refusing treatment therefore a psychiatric evaluation is recommended before consent. Check my channel for a more comprehensive explanation. 64) A 30 year old woman and her husband present to the clinic at 9 weeks gestation with mild spotting after intercourse. She has a history of abortions. The couple are blaming themselves and show strong emotions. Which of the following is the best action? A) Identify their own emotion and calm them down B) An empathetic response is sufficient to calm them down C) Understand their own emotions without showing them D) Explore and validate their emotions with an empathetic response Answer: D, They like fancy words like "explore" and "validate" in the exam. Seems like the best option to choose. 65) A 27-year-old woman presented to the police department with bruises all over her body. Which of the following is the main predictor of domestic violence? https://t.me/smlebrain A) Tobacco use B) Second marriage C) Personal bankruptcy D) Marital dissatisfaction Answer: D 66) The National Center Screening Program is to be established based on priority and impact, which of the following cancer populations is recommended? A) Lung cancer B) Colorectal cancer C) Pancreatic cancer D) Oral cancer Answer: B, Colorectal cancer is amongst the most common cancers in KSA, also screening for lung cancer is typically indicated for smokers whereas screening for colon cancer is for anyone above 50 67) A scenario of a doctor who shared a medical report without consent. What is the justification? A) A family member requested a report B) It is a reportable disease C) The patient is mentally incompetent D) The hospital wants to share the case with the public media Answer: B, It is in the interest of public safety to report certain infectious diseases to the health authorities even without consent. 68) The doctor wanted to inform the patient that she has lung cancer, who should the doctor inform? A) The patient only B) The patient and her husband and kids C) The patient and her friends D) Whoever the patient chooses Answer: D 69) A case of suspected MER-COV, the patient asked you not to report it as he is afraid he may lose his job. An infection control senior is waiting for results so that he can send it to the ministry of health. What is the most appropriate action? https://t.me/smlebrain A) Confirm the case then report B) Report the case as a suspected case within 24 hours C) Treat the patient then report D) Respect the patient’s wishes and do not report Answer: B, "MERS-CoV is a category I reportable infectious disease (within 24 hrs). All healthcare facilities must report suspected cases through Health Electronic Surveillance Network (HESN)." -MOH guidelines 70) A female patient presented to the doctor's office with signs of abuse. She told you the abuse was from her husband and told you not to tell her husband. What should you do? A) Threaten the husband with a police report B) Inform the police C) Respect the patient’s wishes D) Consult the ethics committee Answer: B, Domestic violence must be reported in order to protect the patient 71) You have to tell a 30 year-old male about diagnosis of cancer in a meeting in a quite room what should be done? A) Decrease the severity of the situation B) Use advanced medical terminology C) Be straightforward and convey the information directly in a sensitive way D) Inform the patient’s family first Answer: C, When breaking bad news, you should be clear but also empathetic. Decreasing the severity of the situation is not a part of SPIKES. 72) A patient is scheduled for surgery and when you explain the complications he said “I don’t want to listen to the complications, just proceed with the surgery”. Which of the following is the most appropriate action? A) Proceed with the surgery B) Do not proceed with the surgery C) Involve a close relative in the discussion D) Inform hospital management Answer: C, The patient can opt to have a close relative make decisions on his behalf. This would be the most appropriate action if it were an elective/non-urgent surgery. https://t.me/smlebrain 73) A woman presented to your clinic wearing very revealing clothes and talks to you in a way which is unprofessional and seductive. Which of the following is the most appropriate action? A) Report her to the hospital administration B) Shout at her C) Report her to the authorities D) Ask a female nurse to talk with her Answer: D 74) A patient is in need of urgent surgery but is not competent to make decisions, the attendant refuses to sign the consent. What is the most appropriate action? A) Do the surgery B) Don’t do the surgery C) Change the attendant D) Ask the patient Answer: It depends on the scenario. If it is a life-threatening condition and the surgery will save his life then the attendant’s consent is not considered and the answer is A. Refer to Saudi guidelines for informed consent 2019 page 11 75) The most common error in medicines/drugs is due to? A) Doctors B) Nurses C) Pharmacists D) Look-a-like/Sound-a-like drugs E) Medication delivery system Answer: E, Medication dispensing errors can occur for a number of reasons: dosing strength, dosing form, miscalculated dose, failing to identify drug interactions and contraindications and outdated patient info. 76) A doctor discharged a patient without giving him a discharge summary or instructions. What is this act called? A) Abandonment B) Battery C) Misfeasance D) Principle of totality https://t.me/smlebrain Answer: A, The doctor discharged the patient prematurely. This would count as a "negligent termination" of the physician-patient relationship which is the definition of Abandonment. 77) A Female patient was brought to the ER unconscious. Her genitalia needed to be examined. Which of the following is the most appropriate action? A) Take permission from her relative B) Take permission from the consultant C) No permission needed to examine her D) Shout in a loud voice “I will examine the patient” Answer: C, The patient was brought to the ER unconscious so its safe to assume her life is in danger. A gaurdian's consent is not considered in this case. Refer to Saudi guidelines for informed consent page 11 78) A Penicillin-allergic child was given doxycycline and now has developed a skin rash. Which of the following has occurred? A) Medication error B) Prescription error C) Avoidable adverse effect D) Unavoidable adverse effect Answer: D, Penicillin allergic patients can be safely given tetracycline so giving doxycycline would NOT be an error. Rather this is a typical known unavoidable adverse effect when taking tetracyclines 79) Which study design is most appropriate to study 5 different types of exercises given to obese ladies over a period of time to assess changes to their BMI? A) Cohort study design B) Cross sectional study design C) Case control study design D) Clinical trials Answer: D 80) A pregnant woman presented to the clinic and after an ultrasound checkup, you confirm the fetus is dead. What is your immediate action? A) Inform the patient B) Inform her relative C) Do further testing https://t.me/smlebrain D) Advance for preparation Answer: A, This recall is vague, preparing for any procedure shouldn't be done before informing the patient, the patient has a right to be informed, no need to do further testing if fetal death is confirmed. 81) What is the highest level of evidence to determine exercise effect on quality of life? A) Cohort study design B) Clinical trial C) Case control study design D) Observational study design Answer: B 82) A hypertensive patient was prescribed Hydralazine 25mg by his physician. Instead he took Hydroxyzine 25mg. Which of the following is the likely type of error? A) Look-a-alike error B) Sound-a-alike error C) Illegal prescription D) Handwriting error Answer: A, These two drugs have many letters shared between them, and similar dosage strength. Likely there was no handwriting done as prescriptions are done over a computer. They do not sound a like. 83) An intellectually disabled pregnant woman with an IQ of 80 presents to the clinic with her mother. The mother wants the patient to have an abortion, but the patient wants to continue her pregnancy. Which of the following actions is appropriate? A) Refuse to perform the abortion B) Perform the abortion as the patient is not competent C) Call child protective services D) Obtain a court order to perform an abortion Answer: D, She is mentally incapacitated and unable to make sound decisions or raise the child. However a medical committee must be consulted to assess how this may affect her health mentally and physically. https://t.me/smlebrain 84) A multiparous patient who had delivered 6 babies previously all of which through CS now wants to deliver her 7th baby by CS. The doctors recommended tube ligation to prevent serious complications with future pregnancies. What is the best action? A) Take consent from her or her representative B) Take consent from her husband C) Take consent from her and tell her to inform her husband D) Consult ethics committee Answer: C, The ideal answer is to take consent from her AND her husband as she will be sterile after this procedure and marriage gives the husband a right to children therefore he has to consent as well. 85) You receive a call from another physician about a former female patient, the patient recently moved to another city and you referred her to the physician who is calling you now. The physician needs to immunize the patient for trip overseas and requests that your office sends a copy of the patient’s immunization records; however, the patient never formally authorized you to release her information, what is the most appropriate course of action? A) Send the patient’s immunization records to her new physician without her formal consent B) Consults the ethics committee of the state medical board about the appropriate course of action C) Have the patient sign a consent form allowing the release of her medical information to her new physician D) Refuses to send the patient’s immunization records to her new physician without the patient’s formal consent Answer: A, Physicians may disclose health information between each other in the interest of patient care without explicit consent from the patient. 86) A 7-year-old boy injured his foot after stepping on a nail, the wound is deep and contaminated with soil. The child is not immunized against tetanus and his parents refuse immunization because of religious beliefs. What is the most appropriate action? A) Consult child protective services and/or obtain a court order B) Respect the patient’s religious preferences, clean and irrigate the wound C) Immunize the child and disregard his patient’s wishes D) Refuse to treat the patient https://t.me/smlebrain Answer: A, Although you can give life-saving treatment to a child without consent, in this case, Life-altering consequences will not necessarily occur immediately, there is a window of about 1-2 days after which the tetanus vaccine/immunoglobulin may become ineffective. A more appropriate approach is to try to convince the parents and if not, call child protection services. 87) A 29-year-old primigravida at 36 weeks gestation comes to the clinic with her husband for a routine prenatal visit, her pregnancy has been uncomplicated and she had no chronic medical condition, her only medication is daily prenatal vitamin, vital signs are normal. Fundal height is 36cm and fetal heart sounds are 150/min on Doppler ultrasound, the patient says she has created a detailed birth plan and would like to have a natural delivery, she says a vaginal birth is necessary for her to feel fully connected to her baby, and she is not interested in receiving any medication to decrease the pain. The patient’s wishes are acknowledged and documented in the chart; however the physician states that unexpected events can occur during labor and delivery that require a cesarean delivery. The patient replies “A Cesarean delivery is not part of my birth plan and I don’t want to have one”. Which of the following is the most appropriate response? A) “I would only recommend a Cesarean delivery if it were absolutely necessary, let’s talk about what the indication would be” B) “Birth plans are good for uncomplicated deliveries, but in an emergency, you can trust that my recommendation is the safest option” C) “If you do not want a cesarean delivery, I will not perform one, I will make sure to document this in your chart” D) “My priority is to take care of you and your baby, so if the baby is in distress labor, I will need to do a cesarean delivery” Answer: A 88) A patient had a previous DNR and now he is going to have surgery. Which of the following is the most appropriate? A) Keep DNR during surgery B) Put DNR on hold and continue after surgery C) Put DNR off even after surgery Answer: B, I need a better recall with the 4th option. The best approach for these patients is a policy of "required reconsideration" of the existing DNR orders. Should be discussed with patient before surgery. 89) A 66-year-old woman presents with stage 1 small cell carcinoma of the right lung. The cancer is operable, but she expresses her desire to forgo the https://t.me/smlebrain  operation and explore natural methods of treating her cancer. She shows no signs of mental incompetence and understands her disease and treatment options well. What is the most appropriate next course of action? A) Research natural methods of cancer treatment to help the patient navigate her desired treatment options B) Consult a psychiatrist to assess the patient's medical decision-making capability C) Convince the patient to go to the operating room for another indication and remove the carcinoma while she is sedated D) Inform the patient that she is making a disastrous mistake and convince her that refusing the surgery will lead to her death Answer: A, Lets exclude: ⁃ C is definitely wrong, you can’t lie to your patient about a surgical procedure or any medical matter! ⁃ D is wrong, using the word ‘Disaster’ and ‘Lead to your death’ is not professional and compassionate conduct.⁃ B is wrong as the case mentions she does not display any mental incompetence and has good knowledge of her disease and treatment options. There was no mention of mental illnesses such as depression. ⁃ A is the most appropriate answer because of the last part, ‘help the patient navigate her desired treatment options’. The patient is refusing surgery despite having good knowledge on her disease and is competent. Your best option as a physician is to guide her through her treatment options and inform her on natural methods, if any, through your research. 90) A woman tells her physician that her husband of has been abusing her. He has began abusing their 3-year-old daughter. She plans on killing her husband when he comes home. She has already purchased a gun and plans on using it tonight. What to do? A) Call the authorities to report abuse by the husband and the wife's threat B) Call the husband to warn him about his wife's threat C) Call the authorities to report the wife's threat D) Call the authorities to report abuse and arrange for the patient to be place in a woman's shelter Answer: A 91) A pregnant woman presented to the clinic. She is a high gravida and has done previous cesarean sections. She has metastatic cancer and her doctor advised for the termination of the pregnancy but her husband is refusing. What is the appropiate action? https://t.me/smlebrain A) You need both consent from her and husband B) Only need her consent C) Only need her consent and she should inform her husband D) Obtain consent from a representative Answer: C, Usually consent is required from both parents for an abortion. But in this case there is a medical risk to the mother's wellbeing. 92) Primigravida at 18 weeks gestation comes to the clinic for a routine prenatal visit and an anatomy ultrasound. The patient feels well and has no concerns, she is accompanied by her mother as her husband was unable to get off work, and the patient has no chronic medical conditions and her only daily medications is a prenatal vitamin, ultrasound shows a cephalic singleton fetus measuring at less than 10th percentile consistent with severe growth restriction, there are bilateral choroid plexus cysts, clenched fists and a large ventricular septal defect, amniotic fluid level is normal, the placenta is posterior and fundal, which of the following is the most appropriate initial statement by the physician? A) “There are some things about your ultrasounds that I need to discuss with you, is it okay to do that now?” B) “Would it be okay if your mother stepped out of the room so we can talk about your results?” C) “Let’s schedule a follow up visit to discuss the results when your husband can be there here with you” D) “Could I speak to you in private about my concerns with your ultrasound findings?” Answer: A 93) A woman at 10 weeks gestation comes to the office for an initial prenatal visit, the patient has no chronic medical conditions and no prior surgeries, while discussing what to expect during the pregnancy and delivery, the patient states that she would like a primary cesarean delivery performed, the patient’s mother has struggled for years with urinary and fecal incontinence after having 3 vaginal deliveries and the patient does not want the same complications, the physician discusses the complications associated with cesarean delivery. Including the increased risk of complications in future pregnancies, based on the lack of medical and Obstetric indications, the physician is uncomfortable agreeing to perform the procedure, however the patient states that she understands the risk and still wants a cesarean delivery, which of the following is the most appropriate management of this patient? A) Refer the patient to another obstetrician-gynecologist https://t.me/smlebrain  B) Perform a caesarean delivery on maternal request C) Tell the patient the procedure will not be covered by her insurance D) Wait and discuss further when the patient is in active labor Answer: D, The patient is only 10 weeks pregnant, she still has many more antenatal visits and around 7 months left if she goes through a normal pregnancy. In this time she may change her mind and go through with the recommendation of the physician and have a vaginal delivery. If she reaches active labor and still wants a CS then go for CS, easy. 94) A senior physician has asked you to prescribe piperacillin tazobactam for a patient with a known penicillin allergy. Which of the following is the most appropriate action? A) Order the prescription and ask the consultant to sign it B) Gently refuse to order it C) Order the prescription and sign it D) Consult the ethics committee Answer: B 95) A woman got abused by her husband, she refuses to call the police. What is the most appropriate action? A) Respect her wishes B) Educate her about violence C) Talk to her husband D) Ignore her and report the case to the police Answer: B, I couldn’t find any Saudi guidelines on the subject of domestic violence but according to western guidelines, you cannot report domestic violence to the police without the patient’s consent. However, child abuse must be reported regardless of the mother’s wish. The answer is either A or B, but if educating her about violence means providing useful information on how to report domestic violence and where to find support, then B is the correct answer. 96) A patient had colorectal cancer and does not wish to do the surgery. His wife and son do not agree with him. The patient went on to have a decreased level of consciousness and his family requested to do the surgery. What is the most appropriate management? A) Do the surgery if there is written consent B) Refuse the surgery as the patient wishes C) Do the surgery if there is benefit for life https://t.me/smlebrain D) Consult the ethics committee Answer: A, Unless the patient provided explicit written refusal of surgery, the family are now the decision makers as he has become mentally incompetent 97) A neonate was coded blue. “Do not resuscitate” was discussed with the parents but the discussion was not completed. What is the most appropriate action? A) Do not resuscitate the neonate B) CPR then complete the discussion C) Complete the discussion then do CPR D) Do CPR immediately Answer: B, As long as the discussion was not completed and there are no written consents/documents signed on behalf of the neonate, you should follow usual protocol and resuscitate first, then discuss. 98) A man visits his family physician where he states he was diagnosed with Hepatitis B. You check his medical records which confirm he does have Hepatitis B. The man does not want his wife to know despite explaining the risk of infecting her. What to do? A) Call the local health department and report the patient's Hepatitis B status B) Call the patient's wife and warn her that she is at risk for Hepatitis B C) Listen to the patient and maintain confidentiality D) Encourage your patient to receive marriage counselling Answer: A, You can not maintain confidentiality in cases where there is a health risk to others. You also shouldn't directly contact his wife. Report to relevant health authorities that will contact his wife. 99) A 12 year old boy is terminally ill with osteosarcoma. He asks you how long he is likely to survive. His parents asked you in the past to avoid discouraging their son by withholding the true severity of his condition. What is the best course of action? A) Discuss the patient's condition honestly without providing an estimated survival time B) Explain that a positive attitude will improve life expectancy and he shouldn't worry about longevity C) Provide an estimate of survival time based on a literature review D) Refer this question to the patient's parents https://t.me/smlebrain Answer: A, Providing an estimate of survival time based on a literature review may not be appropriate as it could create false expectations or unnecessary distress. 100) A child with muscle atrophy disease and recurrent chest infections requires resuscitation. However, the mother informs the medical team that the child has a "Do Not Resuscitate" (DNR) order in place. How should this situation be handled? A) Take the DNR order from the mother B) Seek consent for DNR from the hospital C) Take the order by hospital physician to carry out resuscitation D) Consult hospital administration Answer: C, Likely the DNR in place is for his muscle atrophy disease and operations related to his condition, this means resuscitation due any other reason such as infection is warranted. 101) Patient came for surgery, and during operation, doctor requested the nurse to administer a unit of blood. However, the nurse informed the doctor that the patient had already received a unit of blood as per a previous order. What is this situation called? A) Closed loop communication B) Order assessment C) Hand off D) Cut off Answer: A, The recall was much worse than this, I tried to reconstruct the case to best of my ability. 102) A child is admitted to the PICU with a subdural hematoma. The father reports the child fell from his bed. On physical examination, the child has ecchymosis on the buttocks and back and bilateral femoral fractures. What's the most likely diagnosis? A) Hematoma B) Pathological fracture C) Battered child syndrome D) Accidental injury Answer: C https://t.me/smlebrain 103) A female who recently got married has been taking oral contraceptive pills (OCPs) even before her marriage. She wishes to continue taking OCPs, but her husband wants her to stop. What is the most appropriate approach? A) Patient consent is enough B) Both the patient and her husband should be consented C) The patient's consent should be taken after discussion with her husband D) Husband's consent is enough Answer: B, "Decisions on contraception must be based on mutual consent between husband and wife" page 206, Ethics and professionalism Saudi handbook 104) A patient has recently stopped smoking and has started using nicotine replacement patches. The patient is motivated to quit smoking and is actively taking steps towards achieving that goal. Which stage of smoking cessation is the patient currently in? A) Action B) Preparation C) Contemplation D) Precontemplation Answer: A, The patient has already taken the step of stopping smoking and is actively using nicotine replacement patches. This indicates that the patient is in the Action stage. 105) A 27-year-old woman at 39 weeks of gestation experiences a complicated delivery due to shoulder dystocia. As a result, the infant develops brachial plexus palsy. What is the best approach to reduce complication rates for shoulder dystocia? A) Schedule simulation drills with the entire clinical team at regular intervals B) Conduct a debriefing for team members after each adverse event C) Perform a root cause analysis after every adverse event D) Use a checklist that categorizes shoulder dystocia risk in every patient chart Answer: A, Continuous training and practice enhance the team's skills and preparedness, ultimately leading to improved outcomes for both the mother and the infant. 106) An 89-year-old man with a history of metastatic cancer asks you to prescribe medications that will end his life. While you personally have reservations about assisted suicide, you are in a state where its legal. What is the appropriate course of action? https://t.me/smlebrain A) Inquire about the patient's reasons for wanting assisted suicide B) Comply with the patient's wishes and agree to help perform assisted suicide C) Encourage the patient not to pursue assisted suicide D) Refer the patient to a qualified medical provider who assists with performing assisted suicides Answer: A, It is important to have an open and compassionate conversation with the patient to understand their reasons for considering assisted suicide. 107) A 10-year-old child with a severe neurological progressive condition is under the care of a pediatrician. The parents ask about the duration of a DNR order for their child. How should the DNR order be managed in this case? A) DNR is valid for life B) DNR is reviewed annually C) DNR is reviewed every 3 months D) DNR is reviewed every 6 months Answer: B, Orders must be reviewed - at most every 6 months for inpatients. For outpatients, the most recent DNR (up to 1 year) order is in effect in any emergency situation. -Saudi guidelines on DNR 108) A study was conducted on 1320 cases to investigate the effects of a new drug. In order to ensure a successful study, which of the following factors must be avoided? A) Plagiarism B) Explain the study to the cases C) Unknown identity of the cases D) Consent of the cases Answer: A 109) A critically ill patient is admitted to the intensive care unit (ICU). The medical team is considering a Do Not Resuscitate (DNR) order for the patient. Which of the following statements is true about DNR orders? A) DNR orders should be taken by 3 worthy doctors B) DNR orders should be discussed with the patient C) DNR orders should be discussed with the patient's family D) DR orders should be discussed with hospital administrators https://t.me/smlebrain Answer: A, DNR order initiation: The DNR order to be recommended by THREE doctors. ONE is the attending physician as a consultant and the other TWO doctors not less than specialists -DNR Saudi guidelines 110) An 8-year-old girl has sustained a painful open fracture-dislocation that needs immediate treatment following a car accident. Her parents are out of town, and the babysitter is in a different hospital. Which of the following is the best course of action? A) Reduce the fracture and complete a thorough evaluation B) Do not treat the patient until given verbal consent over the phone by her parents C) Obtain verbal consent from the babysitter over the phone D) Obtain a court order to treat the patient Answer: A 111) A patient is experiencing hemiplegia and weakness after a stroke. The patient is currently undergoing physiotherapy. What form of disease prevention is this? A) Tertiary B) Secondary C) Primary D) Rehabilitation without prevention Answer: A, Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting effects. This is done by helping people manage long-term, often- complex health problems and injuries. 112) A father of one of your patients, approaches you and asks you to prescribe an oral hypoglycaemic medication for his daughter's treatment. However, the daughter is currently uninsured. He requests that you put the prescription in his name. What is correct? A) Write a prescription in the father's name but inform daughter's PCP physician about her treatment B) Write prescription in father's name to prevent complications and suggest daughter gets medical help C) Do not write a prescription to his insurance company for intention to commit fraud D) Write a prescription for the daughter for a different and less expensive medication Answer: C https://t.me/smlebrain 113) A man with liver problems and a history of alcoholism visits the clinic. After he leaves, his wife approaches you and requests an alcohol lab test because she suspects that his drinking is causing his illness. What is the correct action to be taken? A) Do not perform a test for alcohol without the patient's permission B) Send the specimen for testing for alcohol but only inform the patient of the result C) Tell the patient about his wife's request and ask him about alcohol use D) Ask the wife for more information before deciding whether to send the specimen for alcohol testing Answer: B, "even when substance abuse is suspected and the patient is able to provide consent, clinicians often order drug testing without the patient's knowledge and consent."-American journal of medicine 114) The doctor checks on the labor of his patient on Friday evening. he's leaving for vacation in a few hours, but an on-call obstetrician will be available for deliveries. The physician recommends a CS. Which of the following principles is demonstrated? A) Conflict of interest B) Beneficence C) Directive counseling D) Justice Answer: A, It is in the interest of the physician to finish early and go on vacation by doing a CS though it may not be best for the patient. therefore there is a conflict of interest. 115) A 57-year-old patient presents with hematemesis, mild varicosity of the distal esophagus, and a bleeding site that was recognized and cauterized. The patient has been a heavy drinker for the past 10 years and asks what caused this. How should you respond? A) It's probably a consequence of alcohol consumption causing oesophageal varices B) I'm not sure C) This happened because you are an alcoholic D) Let's get you better first, and then we can discuss your disease in greater detail Answer: A, Considering the patient seems stable and bleeding was managed. The patient is well enough to ask about his disease. I do not see a reason why you should withhold information relevant to his disease. https://t.me/smlebrain 116) A woman you performed a tubal ligation on reports well and says shes ready to go home. You suspect that you left a surgical towel in the patient’s abdomen. Closer examination of post-surgery imaging confirms your suspicion. What is the appropriate action? A) Contact the hospital's legal team before taking further action B) Convince the patient to return to OR for another procedure and remove the towel after she is sedated C) Do not inform the patient and allow her to return home to avoid the risk of a second operation D) Inform the patient that you forgot to remove a towel and perform a second operation to remove it Answer: D 117) A 92-year-old woman with likely osteomyelitis and sepsis, she was diagnosed with metastatic squamous cell lung cancer a month prior to admission. The patient will probably require intubation to survive, but she has a living will dated 3 weeks ago that states she does not want any extraordinary measure taken to prolong life. Her daughter just arrived and requests to have everything done for the patient. What is the most appropriate course of action? A) Meet with the patient’s daughter and any other family members to discuss their rationale for ignoring her wishes about terminal care B) Transfer the patient back to the nursing home C) Inform the patient’s daughter that her mother has a living will and that you will not intubate her to prolong her life D) Intubate the patient and transfer to ICU Answer: C, Respect patient autonomy 118) A patient with a "Do Not Resuscitate" (DNR) order was transferred to another hospital. What is the most accurate statement? A) DNR from another institution is valid for 6 months B) DNR from another institution is valid for 24 hours C) DNR from another institution is not valid D) DNR from another institution is valid Answer: B, Upon or during transferring or receiving a patient to/from other national or international health institutes, signed orders of DNR from other facilities are valid for 24 hours -DNR saudi guidelines https://t.me/smlebrain 119) A case of an 8-year-old child who is a known case of recurrent DKA. The health educator explained the symptoms of DKA by saying “The child will need to urinate more, have a fruity smell, have tummy pain and vomit”. What technique did the educator use? A) Teach back B) Plain language C) Critical language D) Collaborative communication Answer: B, Hint: use of the word "tummy" shows the the language being used is not medical, rather simple plain english so that the patient/patient family can understand. 120) A female patient with a strong family history of breast cancer undergoes BRCA screening. Her employer requests the results, as a physician, what do you do? A) Tell the patient to send a request to the ethics committee B) Refuse C) Tell the patient to give it to the employer if it's positive D) Tell the employer to contact the ethics committee Answer: B, The patient has a right to confidentiality. If found to have breast cancer, this does not pose a risk for people around her. Therefore there is no justification for informing her employer. 121) A woman with no background of hypertension (HTN) has been diagnosed with it. What is the best way to educate her about the risk factors? A) Health promotion model B) Health belief model C) Theory of reasoned action D) Diffusion of innovation Answer: B, The Health Belief Model proposes that people are most Ilkely to take preventative action if they perceive the threat of a health risk to be serious and if they feel they are personally susceptible. 122) A doctor agreed that the patient needs to abort the child due to chromosomal anomalies, but the father refused. What is the appropriate course of action in this situation? A) Doctor's consent is enough B) Mother's consent prevails https://t.me/smlebrain C) Father's consent prevails D) Consult ethics committee Answer: C, "If the reason for abortion is life threatening fetal abnormalities, the consent of both the mother and the father is required" -Saudi Guidelines for Informed Consent 123) A lady whose husband died and wants to use her husband's sperm from a sperm bank to get pregnant. Which option is most appropriate? A) She can use it with his family's approval B) She cannot use it C) She can use it with the approval of 3 consultants D) She can use it if there is previous consent of the couple Answer: B, "It is prohibited to fertilize a wife's egg with the husband's sperm after divorce or death..." - Saudi Law of Fertilization,UteroFetal and Infertility Treatment Units 124) Research for a group of cardiac patients: half will receive a new drug, and half will receive a placebo. Which of the following is correct for the patients? A) Withdrawal at any time B) Explaining and knowing the research instruments C) Explaining the results of the procedure D) Knowing if they receive the drug or the placebo Answer: A, 125) A child presents in the emergency room with diabetic ketoacidosis (DKA), but the physician only provided hydration and discharged the patient. The patient's condition worsened afterward. What type of medical error is this? A) Error of omission B) Error of commission C) Error of documentation D) Error of interpretation Answer: A, Commission is doing something wrong. Omission is failing to do something right, in this case he did not give the patient insulin after hydration. there was an omission. 126) Company want to study subgroup of people for prevalence of Alzheimer's disease , what method used by the IRB to check the ethical point? A) Utilitarianism https://t.me/smlebrain B) Skeptic ethics C) Deontology Answer: C, This recall is missing a 4th option and important information in the case scenario. I think the 3rd option is “deontology”, and likely is the answer but we definitely need a better recall 127) You treat an elderly female patient, and her relative gives you a gift of a traditional meal. What is the most appropriate action? A) Accept the gift B) Inform the facility administration C) Politely refuse the gift D) Accept the gift and tell her not to do it again Answer: A, Inexpensive items can be accepted such as a pen or a meal. Any expensive item worth like a watch cannot be accepted. 128) A nurse informs you about a patient in the ICU. The nurse provides information about the patient's history, recent changes, and recommends you to come see him. What is this part of communication? A) Situation B) Background C) Assessment D) Recommendation Answer: B 129) A new study was conducted to investigate the effect of HIV on mortality. The target group was recruited from hospitals and followed for 10 years to compare mortality between negative and positive HIV patients. What does ethics impose on this research? A) A considerable profit B) Frequent appearances on social media C) To have in its center the rights of the target group D) To have in its center the achievement of the hypothesis Answer: C 130) A 50-year-old female with a history of severe multiple sclerosis was recently diagnosed ESRD. The patient is alert and has expressed a wish for "Do Not Resuscitate" (DNR). A recent lab result shows a potassium level of 6. What is the appropriate action? https://t.me/smlebrain A) Dialysis is possible after reversal of DNR B) Dialysis cannot be done because of DNR C) Ignore the patient's wishes and proceed with dialysis D) Take consent from her family Answer: C, The wording is a little bit strange, if the patient explicitly rejected dialysis treatment then you have to comply and respect the patient’s right to consent. However the patient asked for a DNR which is different. A DNR order does not mean "do not treat." Rather, it means only that CPR will not be attempted. Other treatments (for example, antibiotic therapy, transfusions, dialysis, or use of a ventilator) that may prolong life can still be provided. – MDS Manuals "The DNR order shall have no effect on other medical/ nursing care...Care will be provided...and may include but are not limited to sedation, analgesia, fluid..." - Saudi DNR guidelines 131) A pregnant woman at 42 weeks gestation is admitted to delivery, and her pregnancy has been uncomplicated. Fetal heart rate monitoring shows a baseline of 130/min with absent variability. The patient is informed of the need for an emergency cesarean delivery due to significant risk for fetal asphyxia and death. However she refuses to undergo cesarean delivery stating that she fully understands the risks but continues to insist on vaginal delivery. What is the most appropriate next step? A. Respect the patient's decision and proceed with vaginal delivery B. Proceed with emergency cesarean delivery because the fetal rights are more important than the patient's autonomy C. Proceed with emergency cesarean delivery because there is evidence of fetal distress D. Seek a court order forcing the mother to undergo emergency cesarean delivery Answer: A, It is not allowed to force a patient or his relatives to give informed consent if the patient has refused with full capacity. This is deemed as a violation of the properly informed consent regulations. - Saudi guidelines for informed consent page 15 132) A girl with depression symptoms and suicidal attempts is advised by her doctor to be admitted, but she becomes very angry about the suggestion. What ethical principle supports the doctor's decision to want to admit the patient? A) Justice B) Beneficence C) Privacy D) Non-maleficence https://t.me/smlebrain Answer: B, Beneficence refers to the duty of healthcare providers to act in the best interest of the patient and promote their well-being. 133) During a surgical preparation, a nurse noticed that something was not properly sterilized. The nurse immediately said, "Stop now; it was not properly sterilized." What type of communication was used? A) Check back B) Call out C) Critical language D) Closed loop communication Answer: C, Critical language refers to an agreed upon phrase by a team that can be used to "stop the line" or halt activity if someone feels safety is a concern. 134) A 12-year-old boy diagnosed with end-stage cancer, with metastases to the femur and backbone. The doctor has accepted a "do not resuscitate" (DNR) order. What is your management to help at this stage? A) Inotropic support B) Mechanical ventilation support C) Morphine D) Nothing to do Answer: C, As previously mentioned, DNR doesn’t mean you cannot give analgesics, fluids, dialysis and other supportive measures that do not resuscitate the patient. 135) A 45-year-old female patient requires a CABG operation after unsuccessful thrombolytic therapy and PCI. She is currently unconscious, and her husband is out of the city. What is the most appropriate course of action regarding obtaining consent? A) Wait for the husband to return B) Take consent by phone from the husband C) Let him choose a local guardian until he arrives D) Obtain court order to treat patient Answer: B, Consent can be taken over the phone. In this case if you were unable to reach the guardian, then you can proceed with treatment if 2 specialists assess the need for treatment. https://t.me/smlebrain  136) Patient with ectopic pregnancy presented with abdominal pain, the nurse called the doctor but he was busy and asked her to give medication to the patient. What is the most appropriate action? A) Ask another nurse to approve B) Give methotrexate C) Give paracetamol D) Doctor cant prescribe over phone Answer: D, This recall is deficient, I see no issue why you cannot give paracetamol without a prescription but also there is no way you can give methotrexate without any prescription. Send us a better recall! 137) A researcher wants to apply for a research grant but the ethics authority might have a concern and reject it. He will collect data on patients who will undergo cervical cancer screening. He will not tell them the results and it will be blind. What is the thing that he can do to get his research grant accepted? A) Nothing, it will be accepted B) Hand reports over the phone to the patients C) Tell the negative cases about their results D) Tell the positive cases about their results and instruct them where to go after that Answer: A, by exclusion, all other options are incorrect ‫دعواتكم لنا بالتوفيق‬ Try Our New SMLE Brain App! The SMLE Brain app provides an efficient way to study for you exams. Revolutionize the way you prepare! 2000+ questions — SMLE-style questions that are well written. Filter questions — By month, specialty and subspecialty. Add notes — Which you can review later if you come across the question again. Bookmark — With 4 different colours, and make a custom quiz with only bookmarks so that you can review difficult questions. Change answers — You may not agree with the answer we provided, after all there are a few debatable questions! This is why we give you the ability to change the answer and save it while maintaining our answer in a different color for reference! https://apps.apple.com/sa/app/smle-brain/id6449404760 https://play.google.com/store/apps/details?id=com.ahmeddilli.smlebrain https://t.me/smlebrain