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Sample questions
Original questions in the exam's style. Choose an answer, then check it.
A 58-year-old man who takes diclofenac for knee pain has sudden severe epigastric pain that began an hour ago. He lies still, with a rigid board-like abdomen, heart rate 112/min and blood pressure 108/66 mmHg. Bowel sounds are absent. Which is the most appropriate initial investigation in the emergency department?
Answer: C. NSAID use with sudden severe epigastric pain and generalised rigidity suggests a perforated peptic ulcer. An erect chest radiograph rapidly shows free gas under the diaphragm and supports the need for surgery after resuscitation. Endoscopy is dangerous with a perforation because insufflation worsens contamination, and amylase or ultrasound will not answer the key question. Based on: WSES Guidelines on perforated peptic ulcer (2020)
A 19-year-old football player collapsed during a match and recovered quickly. His father died suddenly aged 36. Examination reveals a harsh ejection systolic murmur at the left sternal edge, and the ECG shows left ventricular hypertrophy with deep T-wave inversion. Echocardiography confirms asymmetric septal hypertrophy. Which manoeuvre will decrease the intensity of his murmur?
Answer: A. In hypertrophic cardiomyopathy the dynamic outflow obstruction worsens when left ventricular volume falls (Valsalva, standing, vasodilators such as amyl nitrite) and improves when volume or afterload rises, as with squatting or handgrip. Squatting therefore softens the murmur, in contrast to aortic stenosis, where it typically does not. Based on: ESC Guidelines for the management of cardiomyopathies (2023)
A surgeon is about to start a knee arthroscopy on a patient who is already anaesthetised. The theatre nurse notes that the operative site mark is on the opposite knee from the consent form. Which element of the international patient safety goals applies?
Answer: C. The JCI goal for safe surgery requires correct-site, correct-procedure and correct-patient verification, including a time-out in which any team member can stop the procedure. A discrepancy between consent and marking must be resolved with verified documents before incision. Based on: Joint Commission International: IPSG.4; WHO Surgical Safety Checklist (2009)
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Original questions, an explanation for every option, and a mock exam built to the blueprint. One exam per pass, from BHD 11.3.