Approved Ethics file for SMLE V.

This file was collected, organized and corrected by:

Dr.Hadeel Gazal and Dr.Qasem Almulihi
This file was double checked and approved by:
Dr. Qasem Almulihi
Dr. Rouda H.
Dr. Wasan Alqurashi
Dr. Jumana Homsi
Dr. Aymen Alamri
Dr. Basel Alharbi
Dr. Laila Mohsen
Dr. Lamis Wayyani
Dr. Ather Albradi
Dr. Shahad Alqahtani
References: 2 books which are recommended by Saudi
Commission for Health Specialties
You ask about history and the pts want to express his feeling and concerns:
A. politely interrupt and ask close ended qs
B. let him express
Answer: B
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patient has cancer you told him he responded this mistake. what is this:
A. Barging
B. denial
Answer: B
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consent for CS the pt refuse to do CS, what will you do?
A. referral
B. take permission from husband
C. call hospital admin
D. force pt to do it
Answer: respect her wish or C

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Child came to ER because of asthma attack and when you talk to father about not smoking in the
home he seems not interested, what to do:
A. inform child protection
B. ignore the father and focus on treating the child
Answer: A
Another same case but first attack of asthma and father smoking what to do
A. cauenclling the father about risk of smoking on child
Answer: A
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Parents came with their son who was recently diagnosed with lung problem, dr informed
the parent that now he will explain the case to them, go through management and then he
will answer their questions, what is this called ?
A. probing
B. agenda setting
Answer is: B
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Patient got pulmonary TB and treated accordingly, got liver failure from the
treatment and admitted to ICU. Son is angry and want to suit the doctor. What is
your response?
A. Tell him that can happen to anybody.
B. Help him to suit the doctor.
C. Calm him and tell him the case will be investigated.
Answer is C
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child with abdominal pain during school days, what to do?
A. -strict rules.
B. -spanking.
The answer is: Positive reinforcement
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couple came in the fertility clinic, husband found to have HIV.
A. -tell the husband
B. -tell wife
C. -tell a close relative.
no tell the couples in the choices
The answer is: A

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Couple came to the infertility clinic wife found to have blocked tubes, what will
you do?
A. -tell wife
B. -tell husband
C. -ethics committee
D. -tell couple
The answer is: D
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Child immunocompromise mother refuse intubation because her previous child
dead in the same way:
A. ignore and intubate
The answer is: A
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female asking HRT:
A. refuse
The answer is: A
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couple asking about surogacy and you are not sure :
A. give another appointment and read about.
The answer is: A
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Pt threatened u for complaining if you don’t do the surgery
A. consult physician
B. call social worker
C. do it
D. ethical committee
The answer is: Refer the patient or B

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Patient primigravida was trying to get pregnant for 10 years and she finally got pregnant
reached 10 weeks. Then developed complete abortion. She and her husband are so
emotional and sad. The doctor try to bring togetherthe reason the management and tried to
address their emotions to bring them together. What communication skills did the doctor
practice here?
A. Summarisation
B. Reflection
C. Paraphrasing
D. Mirroring
The answer is: B
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Pt come to do cardiac catherzation but pt have concerns what to do ?
A. Explain to her and tell her the complication
B. explain to her and tell her the complication with alternative
The answer is: B
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Consultant prescribed drug for pt and the pharmacist tells you that pt has allergy from drug
, but the doctor insists to give, what to do?
A. write it and let the doctor sign it
B. refuse gently
The answer is: B
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12 y old female, acne , menorrhea , and 29 BMI , Agitated, not cooperative in examination
You have considered:
A. Mood
B. Behavior
C. Substance use
D. Anxiety
Answer is: B
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Child with multiple congenital Anomaly came needing intubation
A. respect the mother wish
B. Contact hospital ethics committee
C. Ignore the mother request and intubate
Answer is: It depends on the age

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Infant 2 months found dead his mother denied any fever NO sign for fracture or skin bruise
Which part of hx will to complete and help in reach dx ?
A. social Hx
B. allergic Hx
C. blood transfusions Hx
D. medication Mather takes in pregnancy
Answer is: A
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25-Mother refused to sign for abortion ( 22 weeks):?
A. husband sign
B. respect her
Answer is: B
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26-Patient was diagnosed with TB treated which lead to liver failure, son wants to report
what to tell him?
A. it happens with a lot of people, it a known complication
B. clam him down and say you will investigate the problem
Answer is: B
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Doctor decided CS for a pregnant lady due to fetal distress but , mother refused.. asking:
who should sign the informed consent?
A. husband
B. doctor
C. mother
Answer is: C or ethical committee
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Parents came with their son who was recently diagnosed with lung problem, dr informed
the parent that now he will explain the case to them, go through management and then he
will answer their questions ,what is this called ?
A. probing
B. agenda setting
Answer is: B
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A young man has been admitted after being diagnosed with Ebola, and he is threatening to
leave the hospital if you do not discharge him.
A. Call committee
B. Security
C. DAMA
Answer is B
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Surgeon forget after appendectomy a gauze and foreign body showed in image , What
should a surgeon do ??
A. tell the patient
B. tell hospital committee
C. not tell anyone
Answer is:A
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You can get helpful information from the patient , as a consultant what you will
do ??
A. ask open questions
B. tell the patient waiting outside
C. you are busy don’t have time
Answer is:A
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Angry man came to your clinic with her son who want goo with school team but
her mom refused and told you her wife asked me to tell you refuse and write my
son not fit for sport, As consultant what you will do ??
A. tell me what happened??
B. what you will do if you are a doctor
Answer is:A
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Female pregnant smoking,, abortion ,As doctor on consultation,,
A. ask her to stop smoking
B. smoking increase 10 times IUFD
Answer is:A
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Patient refuse CS , consent from who ??
A. patient
B. husband
C. ethical committee
Answer is:A
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90 yrs male with severe symptoms of respiratory symptoms and thoracic surgeon decide to
a surgery to improve his symptoms but with high risk?
A. explain to the patient and signed high risk consent
Answer is:A
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Patient has incomplete abortion and refused D&C, her husband ask if he can sign instead
of her , who has the right :
A. Patient
B. Husband
C. Hospital committee
Answer is:A

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Child came to ER because of asthma attack and when you talk to father about not smoking
in home he seems not interested, what to do:
A. Inform Child protection
B. Ignore the father and focus on treating the child
Answer is:A

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Women pregnant with ovarian cyst torsion refuse emergency laparotomy from whom to
take consent:
A. Respect wife
B. husband consent
Answer is:A

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43- Pt underwent tonsillectomy and the procedure take long time due to bleeding and
patient recover will after the operation but concern why it took long time :
A. Reassure and tell the pt what happen
Answer is:A
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44- Child came to the ED with gastroenteritis, U discharge him home after telling him to eat
healthy food and come to the hospital if there is warning symptom. The doctor doing??
A – safety Netting
B- mirroring
Answer is A
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Pregnant with fetal distress and refused to do CS: -
A- allow vaginal delivery
B- her husband decision
C- ethical committee
D- Do CS force
Answer is A

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Patient came to u buz she is afraid from developed cancer diagnosed with endometriosis.
what is the appropriate counseling to tell this pt in this situation:-
A- not related to cancer.
B- protect against cancer.
C- associated with ovarian cancer
Answer: C
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Child with asthma and his mother also she had poor technique for inhaler use the child
have extirpation despite the treatment what is the cause:
A- no compliance
B- poor technic
Answer is: B
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An ethical scenario in which parents brought their child for a health check. Child has
not had any vaccinations because px's don't believe in it. What should you do?*
A-Accept their decision
B-Refer them to social services,
C-Refer them to another Physician
D-Counsel them about the benefits of immunization and correct their misconceptions
Answer is: D
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A pregnant woman in labour with fetal distress. You counselled her for surgery but she
is refusing bluntly. What is the appropriate action?
A-Refer to another hospital,
B-Inform the hospital ethics committee,
C-Get consent from husband,
D- Allow vaginal delivery based on her wishes
Answer is: D

‫ اﻟﻌﻼج واﻟﺗدﺧل اﻟطﺑﻲ ﯾﺧص اﻟﻣرﯾض وﺣده وﻋﻠﻲ اﻟطﺑﯾب‬،‫ﻓﻘط ﯾرﺳل اﻟﻣرﯾض ﻟﻘﺳم اﻷﺧﻼﻗﯾﺎت إذا ﻛﺎن ﻏﯾر ﻣدرك ﻋﻠﻰ اﺗﺧﺎذ اﻟﻘرار‬
‫إﯾﺟﺎد اﻟﺑداﺋل‬
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A woman came for routine ANC and smokes about half a pack of cigarettes daily. She
had 2 normal children previously and doesn't believe smoking is harmful in pregnancy.
How do you manage?
A- Accept her beliefs,
B- Refer her to mental health services,
C- Counsel that her child is at risk of intrauterine growth restriction,
D- Counsel about nicotine replacement in pregnancy
Answer is: C
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7 years old child brought to the ER with DKA. What is the best to do after ER treatment
to make pt more compliance for ttt??
A- Listen to his concerns about DKA and its management
B- Supply child and family with a written plan of care
C- Send the Child to special care services
Answer is: B
‫ ﻟذﻟك دور اﻟواﻟدﯾن ﻟﮫ دور ﻓﻌﺎل ﻓﻲ ﻧﺟﺎح اﻟﻌﻼج‬, ‫اﻟطﻔل ﻓﻲ ھذا اﻟﻌﻣر ﻏﯾر ﻣدرك ﻟﺗﻔﺎﺻﯾل اﻷﻣراض اﻟطﺑﯾﺔ وﻣﺿﺎﻋﻔﺗﮭﺎ وإن ﺗم ﺗﺑﺳﯾطﮭﺎ‬
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Mother of baby with Fetal congenital anomaly ask u don’t Resuscitation , what to do ?
A- Honor her wish
B- ethical committee
C- Resuscitation
Answer is: Same as above question
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A pt with IUFD , what is the best thing tell pt at this moment :-
A- console the couple for early follow up visit after a few days
B- let the mother spend some time with her dead child
C- give medication during her think to induce termination
D- u can’t let her go home to think
Answer is: B
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Cause of domestic violence
A. Martia distasfied
B. Smoking
Answer is A

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A mother had IUFD and blames herself for smoking 5 cigarettes a day as a cause of the
death of her baby. What will you tell her?
A. Smoking is not associated with fetal demise
B. Tell her to stop smoking for future pregnancies
C. Tell her that further investigation needs to be done to know the cause
D. Tell her that smoking 5 cigarettes a day increases the risk by 10 folds
Answer is B
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Mom is complaining she can’t leave the house because her son is using a nublizer
which needs electricity, what do you suggest?
A. stop nubilzer and give inhaler?
B. suggest portable nubelizer
C. someone stays home with him
D. all family stay home cuz it’s important
Answer is: A or B (A more correct based on consultant answer )
While you have to use a nebulizer at home (or in a medical facility), you can carry an inhaler
in your pocket. Inhalers also deliver medication more quickly. After a few puffs, perhaps
taken a minute or two apart, you're done. It can take some practice to use an inhaler
correctly.
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Ashmatic child his family stat that thy can not go out becouse the nebuluzer machine need
electicity, what u wll do to help them?
A•Tell them they are right.
B•Provide them with nebulizer with battery.
C•Clearly instruct the inhaler and tell them to stop the nebulizer.
Answer is : C
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pt come to the doctor and he have Malignant Melanoma :
A. send him to other doctor
B. he can trusted you b/c you are good doctor
C. give more detail about his condition so he can trusted you
Answer is : C
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Case about man interruption the clinic and concern about his disease what do for him :
A. Tell him the clinic is full of pt and come again
B. listen to his complain with open ended complete question
Answer is : B
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Patient is worried and talking much and take from your time:
A. Politely interrupt him and ask close ended Q.
B. Tell him there is mor pt outside
Answer is: A

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Patient threaten that he Will complain if you didn't do a hernia surgery for him What should
you do:
A. Do it
B. Talk to hospital administration
Answer is :B but we need all options

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Best predictions of domestic violence:
A. Smoking
B. Second marriage
C. Personal?
D. Marital dissatisfaction
Answer is :
https://www.mecknc.gov/CommunitySupportServices/PreventionIntervention/Resources/DV/Documents/Pr
edictors%20of%20DV.pdf
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Pt admit for tonsillectomy but surgery prolonged bc bleeding, the surgery
successfully done , after pt ask why surgery prolonged?
A. reassure pt and don’t tell him about bleeding
B. tell another doctor to see him
C. ethics committee
D. reassure pt and tell him what happened
Answer is : D
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Ethic csae about serrugaty and the doctor know that it’s not allowed at his hospital but
doesn’t know about SA role?
Answer is till them that it’s not allowed at his hospital.
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You attended the surgery theater as an intern, ( some renal surgery ) and the surgeon was
preparing to do the surgery on the right side, but you knew from
the history that the diseased kidney is the left one. What should you do?
A- call the chef intern
B- tell the surgent
C - do nothing
Answer is: B
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Patient old with end stages cancer disease complining of sever pain and his children ask
you to give him stronger pain killers you respect theirs wishes but you told them that the
pain killers may fasten the death of there father question in this case what the doctor do ?
Answer is: principles of double effects
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Dr want to explain family cystic fibrosis from a to z wts call?
A. Summartion
B. Paraphrasing
Answer is A (explanation better answer than paraphrasing)
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Female has ovarian torsion, dr. explained to the patient about surgery and got consent
from the husband, but the patient refused doing surgery:
A. Do surgery
B. Tell someone of the relative
C. DAMA
D. Husband consent is enough
Answer is C
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Female pt going for breast examination but she wants female doctor to
examine her what you will do:
A. refuse
B. respect
Answer: B
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During abdominal examination the intern forget to close the curtain what he
broke:
A. principal of dignity
B. principal of privacy
Answer : B
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You want to do surgery to a 15 y old , from where take the consent ;
A. Parents alone
B. Patient alone
C. Both of them
Answer is Parents’ consent and ass the child
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Women want to take ocp and husband no want take ocp ?
A. empathy
B. follow wife
C. follow husband
D. Both
Answer is D
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A pt want to quit smoking and he saied well do it next year what this is called
A-prepration
B-precontemplation
C-contemplation
Answer is

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Patient came for surgery, after finishing it was discovered that the surgeon assistant forgot
infected sponge (or something like that) inside the patient. The patient was taken urgently
back to OR to be reported and to take out the infected sponge. Your action should be?
A-Inform the consultant
B. Inform the patient and apologies
C. Inform hospital ethics committee
Answer is B
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A patient was diagnosed with generalized anxiety disorder and has difficulty sleeping.
Which of the following is used for management? (No SSRI in options)
A. Alprazolam
B. Bupropion
C. Hallopridol
Answer is A (Note than the Best tx is CPT)
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elderly + metastatic cancer his son ask yo to not tell his father about the diagnosis:
A-Tell he patient
B-consult legal committee
B-consult ethical committee
Answer is A
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doctor give instruction to patients about symptoms if happen patient need further
medical help:
A-safety netting
Answer is A
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Pt ask strangers inappropriate questions and he is not aware and not respond when they
try to tell him?
A-flight of ideas
B- loose of associ
Answer is Perseveration
Not complete read more about it https://en.wikipedia.org/wiki/Thought_disorder
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When you screen a Rare disease in a population, what is highest positive result:
A-False positive
B-True positive
Answer is A
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• Difference between Privacy and Dignity. Self-study
• Odds ratio? Self-study
• Sensitivity Answer is for screening
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examine patient and forget close curtains?
A. privacy
B. Dignity
Answer: A
NOTES (Clothes = dignity) ( Curtain = privacy )
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Patient for surgery but has a persistent cough for 6 months and you didn't book him for
surgery, he is angry and threatened to report you if you didn't book him for surgery:
A. do the surgery to get his respect
B. Report him to hospital social worker
C. Consult a physician
D. Report him to the administration
Answer is: D
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A child with multiple bruises brought by parents. What should Dr. do?
A. Question parents about it
B. Refer the child
C. Inform child protection services
Answer is: C
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Scenario of an elderly with an advanced cancer. Anaesthetist thinks operation not
advised but surgeon wants to operate. What should you do?
A. Take a high risk consent,
B. The surgeon should operate with another anaesthetist,
C. Inform hospital ethics committee,
D. Refer patient to another facility.
Answer is: A
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Question about early identification of disease, what type of
prevention was it?
Answer is: 2ry screening
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Wife refused who got the right to decide?
Answer is: Patient.
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Old pt you diagnose her with atrophic vaginitis but didn't seem convinced she told you she
wanted another consultation
A. Tell her u r sure that us not necessary
B. Write report and refer
C. Refuse
Answer is: B

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107- Consultant told resident to write piperacillin Tazobactam and pharmacist said
px had? Penicillin allergy. What should the resident do?
A. Refused to write
B. Write then inform chief registrar.
C. Write and ask consultant to sign.
D. Refuse to write
Answer is: A “Refuse gently”
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Scenario of an elderly with an advanced cancer. Anaesthetist thinks operation not advised
but surgeon wants to operate. What should you do?
A. Take a high risk consent,
B. The surgeon should operate with another anaesthetist,
C. Inform hospital ethics committee,
D. Refer patient to another facility.
Answer is: A
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115- 15 years old for surgery from where you get consent?
A. parents
B. child
C. both
D. social
Answer is : Consent the parent Ascent the child
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118- Husband wants to sign the form for ovarian torsion for his wife, but she refused, who
has the authority to sign it?
A. patient
B. husband
C. family member
D. doctor
Answer is: A

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Married Female with case of ovarian torsion refuses to sign , From who you should take the
consent ?
A. Patient
B. Ethical
C. Husband
Answer is: A
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123- HIV positive husband what’s ur next step ;
A. inform husband
Answer is: A
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pregnant lady came to hospital with broken arm after her husband beat her, whats the most
likely time increase violence?
A. after retirement
B. after family visit
C. Holidays
D. at work
Answer is: C ( pregnancy first then if not there , go with holidays )
http://apps.who.int/iris/bitstream/10665/77432/1/WHO_RHR_12.36_eng.pdf
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Other of newly diagnosed child with DM1 she didn’t give him medication cuz she said he
will be normal
A. Denial
B. Neglect
C. anxietya
Answer is:A

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Bilateral ovarian abscess in a pregnant with 20 weeks who refused the surgery what to do?
A. Accept her decision
B. consent from husband
C. tell a relative
D. inform social or medical advisor
Answer is: A and let her sign that she refused
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Meningitis suspected pt's SON refuse iv antibiotic to be given to his father what to do?
A. Respect the son's decision.
B. Ask patient opinion
Answer is : B
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elderly with end-stage cancer in unbearable pain his family ask u to give him what to
do?
Answer is: Give him (principle of double effect)
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stronger pain killer: what type of desicegion making doctor use?
A. Decision of majority
B. Decision of children
C. Decision of benefits
Answer is: ( incomplete Question )
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pt doesn’t want to know the details, u r the surgeon appreciated that , but the anesthsic
dr insist?
A. Tell the pt the decision of the anasthesia dr.
Answer is: A
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pt were inappropriate clothes and speeks( I know language to nurse) in sudective way
to the dr what should he do?
A. Shout on her (scream).
B. Call security.
C. Get nurse who speak same language.
Answer is: C
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143- 65 years with lesion on his face ( long case ) and part of the biopsy report is dx
melanoma. He is known to be non compliance. How would you make him now a compliance
pt?
A. Tell him about the serious sign and symptoms
B. Show him how brilliant of a doctor you are
C. Talk to him slowly step by step to make him understand you
Answer is C
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Pt dx to have squamous cell cancec. How to break the news to him? A- Dont waste time
and tell him his options
A. Reassurance , tell him not to worry
B. Dont tell him at all , hide the dx
C. Tell him by small step in different times
Answer is D
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Female on 38 weeks long case confirmed fetal death in utero no cause identified. They
asked about Mother options by the dr?
A. Induce labour now immediately
B. She still have time to go home
Answer is B

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Pregnant with HIV what will you tell her?
A. She can breast feed
B. To do CS to avoid transmitting to child via vaginal
C. No need to give the child vaccine after birth
D. Tell her she is cute mother regardless HIV
Answer is B
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25 y/o pregnant 33 weeks has a ruptured ovarian cyst, it was an emergency to shift her to
OR and that was explained to her but she refused surgery. What to do?
A. accept her refusal
B. force her into the OR
C. take consent from husband
D. take consent from a relative
Answer is : A
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baby with hernia mother left him and pediatric surgeon want to do the surger now from
who you take the consent:
Answer is : ethical committee
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Wife came to with bruise bcs his husband hit her what is the most common cause of
violation against female ?
A. Socioeconomic
B. cultural
Answer is : B
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151- What determines the prevalence of a disease?
A. sensitivity
B. Specificity
C. predictive value
Answer is : C
NOTE:
☆ Using the same test in a population with higher prevalence increases positive predictive
value. Conversely, increased prevalence results in decreased negative predictive value.
☆ When considering predictive values of diagnostic or screening tests, recognize the
influence of the prevalence of disease.
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The doctor explains to the mother about vaccination and if the child did not take
it what will happen for the him , what do you call this
Answer is : counseling
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Female pt wants female to examine her:
A. Respect
Answer is : A
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Parents refuse to vaccinate their child what will u do :
A. Scocial service
B. Ethics department
C. Vaccinate him
D. Tell them about advantages of vaccines
Answer is : A

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Forget guze in abdomen of post operative patient . What to do :
A. Dont tell the patient
B. Tell the patient apologize and get it out
Answer is : B
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Case of amputation, pt refused. What to do?
A. Refer
B. discharge because he refused
Answer is: B
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87 years old boy presents with measles, he have never been vaccinated since his father
think it's bad, what to do?
A. Explain to the father
B. Call child protection services
C. Refuse to treat the patient
D. Treat the patient and let him go
Answer is A
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160- Female with incomplete abortion, her husband wants to sign for surgery, and she is
refuse.. Who should sign for a consent?
a) Husband
b) Family Patient Doctor
Answer is the Patient

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scenario during surgery you injured CBD and the pt is ok what to do ?
informs the pt
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couples Post coital ( after intercours) bleeding , they are sad ,
Answer is Acknowledge their emotions
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senario of suspicion Appendicitis and durning surgery appendix is normal , but you have
to remove it even thow its normal , what to do ?
Tell the pt
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senario of end cancer how sign DNR and after he died, his son is angery why you didn't
resuscitated his father ?
tell them you respect his wife
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while you came to the clinic late the pt is angry ?
explore the reason of being angry

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Mother with appeared with some mental retardation Parents want to take hime back
home:
a-Called child protection
b-contact ethics
The Answer Is: B

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Elderly with endstage cancer in unbearable pain his family ask u to give him stronger pain
killer?
a- Give him stronger analgesic
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pt doesn’t want to know the details, u r the surgeon appreciated that , but the anesthsic dr
insist:
a- Tell the pt the decision of th dr
b- I will tell him that the anesthesiologist wanted to tell him his opinion
answer is : B
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pt man result came back HIV +ve who came prior for infertility assessment:
a- Tell the patient first
b- tell wife #
c- tell both together
answer is : A
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dr after explaining to pt what is next mx and explore there emotion went through the main
points again.What did he do is:
a- Summarizations
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pt with complete abortion while waiting for admission were tearfulness and husband was
emoitinally distress what to do :
a- Explore and reflect to thire emotions
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A fetus was discovered to be dead at one of the antenatal visits. The mother is crying. Her
husband is upset. What is your role?
A-discuss the possibility of future fetal malformations
B-explore, identify their emotions, empathize.
C-explore, recognize their emotions, find solutions
D-empathy is sufficient
Answer is: C, B maybe also a correct answer
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DNR pt in respiratory distress surgeon thinks depulking surgery might be helpful
but might be fatal:
a- Don't do it respect patient wish
b-Take high risk consent
Answer : B
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You were late pt start to shout and angry:
Acknowledge his anger
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pt don’t belive this is the correct dx and wants another dr opinion:
a- Give her report as this is her right
B- refer #
C- ethical committee
Answer :A
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consent in case of IUD to be taken consent from:
A- wife
B- husband
C- mutual from both
Answer :C
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Case of child newborn abanded by his mother as he result from out of marriage relatioship
.Child is in the hospital he has hernia and pediatric surgeon said he need repair for his
hernia now How u will act :
A. Reveiw ethics section in hospital >> should be court or the ethical comity
B. Do the surgery without consent C. Refuse to do it as no one to sign
Answer: A
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You was talking to patient to get details on the history but the patient interrupted u and
start to talk about his point of veiw regarding his diagnosis and the reason of his disease .
How u would act :
A. Refer him to another doctor
B. Let him finish his point of view
c. Apologize to him and start with close ended questions
answer is : B

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Patient need operation dr start to tell the patient about the positive and possible
complications but patient refuse to hear that but the anesthesia doctor insiseted that
the patient should know the complications . How u will act
A. cancel the operation
B .Get another anaesthesia doctor
C tell the patient what anaesthesia doctor want
D.let the anesthesia doctor deal with the patient
Answer: C
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Male smoker go to clinic asking that he want to quiet how to start this step
is:
Preparation
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Best way to stop smoking in pregnant is :
a. Behavioral way
b. bupropion #
c. Electronic smoking
d. Alternative to smoke
Answer : A
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67y old man felt dawn complain of pain on hip and knee assessment releved no fractures
foly catheter inserted on first day as he was unable to move with analgesic after 5 days he
discharged to nursing home with unchanged foly catheter now complain of fever urine
analysis show full wbc in urine with bacteria , this could be prevented by
a. Prophylactic antibiotics
a. Prophylactic antibiotics
b. Increase iv fluid intake
c. Daily review for the need of foley catheter
d. Change foley catheter before discharge .
Answer: C
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12y old attitude toward parent illness:
a. Can't comprehensive the concept of disease treatment prognosis
b. Depression withdrawal response
c. Forget
Answer: Refractory behaviour: fussing, violences
Children may react to the imposed stressor by isolating themselves, feeling guilty and
worrying about changes in parental health.
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24 week preterm delivered, mother she is a doctor and she asked not to Resuscitate
her baby, what you will do ?
a. Ignore the mother and Resuscitate
b. Tell social services
c. respect her wishes
Answer:
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case you admitted dx with ebola want to leave the hospital what to do :
a. Call security
b. Refer to infectious department
c. Sign form of leave against medical advice
Answer: A
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internal medicine resident did diabetic foot examination but she forget to close curtains
when she expose pt abdomen what the ethical principles she is broke?
A. privacy
B. dignity
Answer is : A

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A woman brought with the police with bruises how to deal with her
condition ?
• Call a. Social service of the hospital
• Not examines her without her husband
• Enter to her with a large smile and begin examination
• tries to console her, she knows the cause of the bruising, and then begins the examination
Answer is D
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Patient admitted with stroke hemiplegia on 2nd day start to having 1st degree bed sores
the physicin verbally tell the nurse to change patient position every 1 hr to avoid bed sores
. Nurse forget to write this . 3 days later patient had fever on examination he had infected
grade 3 bed sores . Where is the defect :
A. Communication between the doctor and the nurse inadequate way
Answer is : A
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203-The mother refused the cs that is will save the baby.
A. Refer the pt
B. Repect her wish
C. Take the husband concent ( not sure)
D. Do vaginal delevary
E. Do cs against her wish
Answer is : B

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Copd elderly admitted exuberation at night became aggressive disoriented what the
nurse should do first:
a. Call the duty dr for lorazepam iv
b. Restrain her
c. Call family sit beside her
d. Elevate the head of bed put nasal oxygen try to orient her about place and time
answer D
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7 year old sick baby, not complinet to his medication your job as a doctor is to?
A. Explain to the parents the importance of medication compliance
B. call the police C. involve the parents and the child in the medical plan
D.refer them to the Ethics Committee
Answer: A
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women got pregnant after trying 10 years, now she is 10 week pregnant, she has abdomen
pain and vaginal bleed, she went to the ER , the dr said the was not fetal heart sound and
this is abortion ( they were shocked ) what the doctor should do ?
A.Sympathy
B.Admission after evacu#ation as post partum care
C.Search for cause of abortion
Answer: A
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75 years old has terminal lung cancer , he can’t breathe , he can’t make decisions very well,
the doctor wants to do debulking of cancer to help him breathing well, and the success of
this operation will improve his live , but the dr also knows that can develop the
complication of the operation and the anesthesia. What the dr should do?
A.go ahead surgery
B.informed consent pt
C.search alternative decision maker consent
Answer : C
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Reviewed the case and it was a hernia, he recommended to do surgery now, what should
you do?
A-Refuse to do surgery without consent
B-Consult ethics committee in hospital
C-Do surgery without consent
D-4th option can not remember it
Answer: If is emergency C if not A

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Child has flu brought by his mother for vaccinations and mother wants to postpone
because he is sick, on ex mild flow, child is active what to do
A. Reschedule in 2 wks
B. Ignore
Note: best answer is explain to the mother then give him
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214- Pregnant wants to quote smoking best way
A. CBT
B. Nicotine rep#lacement
C. Buprine
Answer : A
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34 years P4G3 GA 32 she is not came to ANC visit never, what the cause?
A- visit is expensive
B- Ignorance
C- scaring from visit
Answer: B
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If patient is HIV ve+, tell him and tell him to till his wife but the doctor should tell the
authorities. But If pt say plz don't tell my wife, then what you will do?
a) You shouldn't tell her
b) Tell health authority's only
Note: Tell patient first and ask him to inform the partner , otherwise she will be informed
legally
 ----------------------------------------------------------------------------------------------------------------------------------
Pregnant with rupture of membrane Elderly female discovered to have cancer. Her
sons said to you don't tell her she has cancer. What to do?
A. Tell pt
B. Don't tell pt #
C. Consult health authority
Answer: A
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cystic fibrosis or celiac pt sit with the dr to know how to deal with the disease and
its prognosis what does this session called
A- summarisation
B- verbal communication
Answer: B
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a mother knows that her child has diabetes and was giving him insulin then she suddenly
stops giving him insulin by saying his pancreas r working and he has no disease anymore?
A anxiety
B neglect
C denial
Answer : C
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a young child newly diagnosed asthmatic mother also asthmatic father is a chain
smoker
A stop smoking in the house
B give short acting beta agonist to the child
Answer : A
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pt newly dx with HTN and doctor tell him about disease and complication and
medication what doctor did?
A-give informational case
B-build bonding with p
Answer: A
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parents come with child not vaccinated because they think it is bad for him what you will
do?
A-consult child support
B-explains to parents about wrong myth and it is good for child
Answer: B
----------------------------------------------------------------------------------------------------------------------------------
women has sexual harassment at work usually from who?
A-employee
B-co-worker
C- supervisor
Answer: C
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U were late and pt start to shout and angry. What to do?
A- Explain to him why u r
B- Acknowledge his feelings.
Answer: B
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pt came to sign consent for hysterectomy
a-Give her details about surgery
b-Make documentation clear #
Answer: A
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normal bereavement case?
a- Sadness
b- 2-3 months
C- not exceeding 12 months
Answer: C

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Pt with history of asthma on SABA, need to go 2nd step but she refuse that, what
you do?
A- increase does of SABA
B- add LABA
C- tell pt how take steroid and benefit
Answer: C
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Elderly not compliant to medications. What to do?
A. worry him about carelessness
B. tell family to carry of him
Answer: B
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13 years child with bilateral legs burn and father said it is due being in hot path. On
exam you found another lesion due to carelessness. What to do according to Child
protection protocol?
A. inform documents and report
B. follow up
Answer: A
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227 Child with Cafe au late sopts , mother said that this is birth mark in her family.?
A- send for more genetic education
B- send for genetic to health education about neurofibromatosis
C- counseling on neurofibromatosis type 1
Answer: Café au lait spots are associated with some syndromes such as neurofibromatosis
type 1 and McCune–Albright syndrome so C first to confirm the Dx then educate the
patient. A and B are the same
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The physiotherapist for icu pt noticed a redness on the t back and he told the nurse
who forget to tell the resident ...what is the wrong here?
A. The nuerse
B. Change the nurse
C. Poor communication
Answer: C
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Pt with charcot leg the treating doctor decide to do amputation but pt refused what
to do ?
A. Refer to another doctor
B. Respect his wishes
C. Sign for discharge
Answer: B
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A nurse came to work with transparent uniform, and was talking to you in a seductive
way.
A.walk her out that minute n bring another.
B.report her to the Md.
C.leave the office.
Answer:B
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During heads assesment of adolescent psychiatry who should attend the session
a.parents should be present
b.with adolescent alone
c.with adolescent and his parents
Answer:B
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A type 2 DM pt has an appointment in the clinic at 11 o'clock, the doctor came at 12:30
because there was a serious case in the hospital, the pt was angry, what will you do as a
doctor ?
A-Apologize and expect that.
Answer: Explore his anger
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If patient that you treated gave an expensive watch as a gift, what will you do?
A-Accept it and tell to not do it again
B-Refuse it
C-Accept it
Answer:B
----------------------------------------------------------------------------------------------------------------------------------
A doctor is going to present in hypertension conference. Company that produced new drug
suggested to sponsor his trip. What he is supposed to do:
A-Disclose that he’s sponsored
B-Avoid mentioning the new drug at all
C-Reject the offer.
Answer: C

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mother brought her child to hospital. Surgeon discovered hernia and decided to do surgery
immediately. Mother refused. What to do?
A-Do surgery whatever mother decision!!! Here if emergency which hernia is not
B-Inform hospital police!!!
C- Don't do surgery!!!
D- explain to the mother
Answer: D

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Female came to ER with sign and symptoms of appendicitis, appendectomy was done ,
surgeon discover the appendix was normal , what surgeon should be do ?
a- Tell pt what happened and that was routine and no complication
b- Not tell the pt
c- - Write report about what happened and give it to hospital committee
Answer:A
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Pt with hx of hernia , he came now complaining of pain and he want to make a
complain against u because u dont want to do the surgery, what should u do?
a- do the surg
b- cal the security
c- referral to another surgeon
Answer: C

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How to inform the society about poisons dangerous ?
a- through media
b- u will do camp and talk about it
c- tell fathers and mothers about it
d-do awareness campaigns and explain the danger of it
Answer: D
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patient has intra operative common bile duct injury but controlled :
a- tell the patient and reassure him
b- Reassure him but dot tell him about what happen
Answer: A
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244- physician telling patient : ( I will be discussing with you the diagnosis of your child
disease and the outcomes the I will be answering your questions)
a- assess understanding
b- Setting Agenda>> the majority choose this.
c- Setting .... #
d- Probing
Answer: B

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Child came to ER cyanotic , his mother saying he is crying for 1h ?
a- Calm him down and reassurance
b-send to surgical intervention
Answer :A but it is Incomplete Q

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female g2 p1 previous c/s 37 week diagnosed as IUFD what to do?
A. Cs
B. induction of labour
C. tell pte u have enough time to decide either to wait or to deliver and send her home
Answer: C expectant megagames and patient can decide about the treatment
----------------------------------------------------------------------------------------------------------------------------------
eldery with pneumonia and doctor ask to start IV antibiotics but his son refuse what
you will do ?
A-ignore his son and start Abx
B-take the pt opinion
Answer:B

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Lady who have malnuratiod baby , with low socioeconomic status .. what to do with her ?
A. -Close end question and send to social worker.
B. psychiatry consultation
Answer:A
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249- Post menopausal have bleeding 2 month. do endometrial biopsy Thickness 15mm
and you want to do histrectomy next ?
A - call anathesia
B- Take verbal concent
c-hospital Admission
Answer:
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A case of infertility for 10years,with irregular menses n the woman came with bleeding n
after ultrasound is incomplete miscarriage. What will do after evaluation.
A.show empathy n sympathy.
B.empathy should be enough.
C.show empathy and console the couples emotions
Answer: C
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DNR and family refuse doctor arrogance meeting with family to :
A. Justify
B. inform
Answer:A
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pregnant 10 wk diagnosed with ovarian ca she need for abortion what to do :
A. inform hospital ethics committee
B. search in website of Saudi law #
C. ask your college
Answer:A

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patient underwent tonsillectomy, during the surgery surgeon faced with difficulty in control
bleeding. He toke him ....... it end without complications. Next day the patient ask why it
take this long time. What surgery should replay?
a- don’t tell him what happens
b- Tell him and reassure him now that is no complication
C- tell Hospital ethics
Answer:B
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255- Most important step in managing asthma child to ensure compliance to treatment?
A. Listen to child and answer his concerns
B. Write a plan
C. Send nurse to check compliance
Answer: B or listen to parent’s concerns
Strategies to improve adherence in children include using simplified drug regimens (e.g.,
once-daily dosing), pleasant-tasting medicines, liquid or other nonpill formulations, regular
phone contact between parents and physicians, reminders, information counseling, self-
management plans
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256- Elderly man with end stage Ca lung, intensivist label do not resuscitate, surgeon plan
a debulk surgery that may have little benefit. Ask about?
A- go ahead with surgery with another anaesthetist
B- take high risk consent
C- involve the family in decision #
D-involve hospital ethics committee
Answer: B
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Mother with IUFD counselled prior to delivery of liveless baby, postdelivery mother insisted
to stillborn should be admitted in NICU. Asked about the action?
A- Denial
B- Acting out #
C- two other options
D-Neglect
Answer: A
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Ebola want you discharge him out or he will go out. What to do?
A-sign dama
B- send him to infectious unit
C- call security
Answer is C
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42 yrs old female came to your clinic with heavy uterine bleeding on us thereuterine
hyperplasia, biopsy should taken what you should do?!
A- Verbal consent
B- Call the anaesthesia #
C- Prepare the pt for immediate biopsy
Answer:A
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261- child refuse to walk with his mother.. Always thriw his toys. The way to deal with
him
A- Time out
B- Verbal warning and s#hout at him
C- Sparkling
D-Scodlin
Answer: A
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What are the 4 principles for effective reporting in child abuse?
A-observe, document, report, self protection
B-observe, document, referrals, follow up
C- Document, confirm, report, conference parents.
Answer: A
Note: Child abuse steps are (observe, document , report , take care)
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Pt aborted (Ethics) what to do next
a- show empathy and talk about management
B- show empathy and explore emotion
Answer: B
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266 40 y.o female 24 weeks gastation had fever couple of days ago but didn't seek medical
advice, whats the most likely cause ?
a- afraid from physician
b- neglect
Answer: B
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267- Person asking random people inappropriate questions what psychiatric symptom is
this?
A-Perseveration
B-Flight of ideas
Incomplete, read about Thought disorder
https://en.wikipedia.org/wiki/Thought_disorder
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268- about alcohol addiction, which one is related assessment of addiction?
Do you feel guilty because you are alcoholic
Do you think you are alcoholic
Answer is A
https://www.mdcalc.com/cage-questions-alcohol-use
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Doctor tell nurse to move bedridden pt nurse forget to tell other
poor communication
Answer is: A
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Infertility with Tubal blockage:
A. tell wife
B. husband
C. both
Answer is C
‫ ﻓﺈن اﻟوﻟد ﺣق ﻟﻛﻼ‬،‫ ﻓﻲ ﺣﺎﻟﺔ اﻟﻌﻘم ﻓﻼﺑد ﺣﯾﻧﺋذ ﻣن إﺧﺑﺎر اﻟطرف اﻵﺧر ﺑﺎﻟﺣﺎﻟﺔ اﻟﻘﺎﺋﻣﺔ‬:‫اﻟﺟواب ﻓﻲ أﺣد ﻛﺗب اﻷﺧﻼﻗﯾﺎت اﻟطﺑﯾﺔ ﻟﻠﻣﺳﻠم‬
‫ ﻓﻼ ﯾﺟوز إﺧﻔﺎء ﻋﯾب ﯾﺧل ﺑﮭذا اﻟﻣﻘﺻد‬، ‫ وھو ﻣن أھم ﻣﻘﺎﺻد اﻟﻧﻛﺎح‬،‫اﻟزوﺟﯾن‬
Infertility is a shared information between couples
 ----------------------------------------------------------------------------------------------------------------------------------
275- When increase prevalence disease when incidence constant?
Follow up
Improve care
N.B: Not clear but loss of follow up is the closest answer

----------------------------------------------------------------------------------------------------------------------------------
Mother is s physician and wants to DNR for her child your action:
A-Respect her willing
B-Ignore and intubate
Answer is: Same as above similar Questions
----------------------------------------------------------------------------------------------------------------------------------
Baby preterm, with conventional anomalies, need resuscitation, mother is a dictator and
she refused. What to do?
A- Respect
B- Refuse and intubate
Answer: depends on the weeks more than 25 weeks , answer is B

----------------------------------------------------------------------------------------------------------------------------------
Baby preterm, with ALS needs intubation, family refused. What to do?
A- Respect
B- Ignore and intubate
Answer: Same as above
----------------------------------------------------------------------------------------------------------------------------------
Patient with irregular cycle and take OCP before marriage. After marriage the
husband wants a baby, but she refused. What’s correct?
Mutual consent on ocp
Answer: A
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7y girl appears underweight and neglected when asking the mother she complains that she
has other younger children to look after that she is busy with.......
A.Contact social worker
B.Refer mother to psychiatrist
C.Other options
Answer: A
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Best Advices to traveled man:
just eat in clean restaurant
just drink government water
avoid rice
Answer: A
----------------------------------------------------------------------------------------------------------------------------------
Female come to ER complaining from her neighbor (abuse her) and talk with him even he is
not with her in ER. Diagnosis?
Delusions and hallucinations
Answer: A
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284-Smocking decreasing life expectancy by how many years?
5 year
10 years
15 years
20 years
Answer: B
https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_m
ortality/index.htm
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285-Population screening program?
Colon
Ovary
Answer: A
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Pregnant patient with language barrier came to the ER for preterm labor or PROM (I don’t
remember) and she’s concerned as her 7 years old son was preterm. What should you do?
A. show that you understand her concern
B. Ignore her due to language barrier
Answer: A
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288. Female came with police with bruising in hand, and she looks sad. What is the
appropriate action?
A. Introduce yourself with big smile and start with CC *
B. Hx take from her in assistance or presence of family member
C. Focus on PE
Answer: poorly formulated Question
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Father angry because his daughter insists to enter gym. What is appropriate?
A. Explore why he angry
B. Agree with them
Answer: A
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Mother brought her child 8 years that looks not clean, failure to thrive and she was
anxious about taking care of her other children:
A. Refer to psychology
B. Refer to social worker
Answer: B
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291. Patient diagnosed as melanoma to ensure compliance with treatment what should
you do?
A. say it’s a serious disease and he might die
B. Explain pathophysiology and management options
Answer: B treatment compliance strategies are
----------------------------------------------------------------------------------------------------------------------------------
294. Pt took antiTb he is old he developed liver failure admitted to the ICU HES SON IS
ANGERY VERY ANGERY:
a. tell him
b. It could happen to any one Doctor did the best management
c. Calm the son and tell that you want to investigate
correct answer : C
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296. Screening tool should be :
A. Easy and fast
B. For rare disease
C. For dz unknown pathophysiology Highly specifice
D. No high sensitive in choices
Correct answer: A
Here it said TOOL , A screening tool can be a checklist or questionnaire used by
professionals, such as nurses, teachers, trained paraprofessionals and medical
professionals, in assessing patient disease
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Patient known case of SMA (spinal myotoni atrophy), develops respiratory muscle fatigue
and needs intubation , mother refuses as one of her children died of the same condition
what will you do?
A. consult ethical commitee
B. intubate her
Answer is: B

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Doctor tell nurse to move bedridden pt nurse forget to tell other
A - poor communication
Answer is: A
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Long scenario: Radiologist asked by the treating team to do Ct guided Fluid aspiration,
Who should get the informed consent?
A- Radiologist
Answer is: A
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303.Resident was in operation room with the consultant and during the operation the
consultant did unnecessary intervention but the patient was fine . What should the
residents do?
A. Tell the patient
B. Tell the administration
C. Write what happened in surgery report
D. Consider nothing happened because the patient was fine
Answer is: C
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Doctor told the nurse to give the patient a medicine that is intravenously but the nurse by
mistake gave the patient lidocaine because it was beside the wanted drug and the patient
died. What is this case?
A. the same medicine
B. mistake in prescription and administer
C. disconnection between doctor and nurse
D. unlike medicine
Answer is: C

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You want to break bad news. What should u do?
A. Tell the patient and family
B. Ask the patient if he wants his family with him
C. Tell him only with empath
Answer is: B
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Female patient needs kidney transplantation and the husband agree but the patient
refused. What should u do?
A. Husband's acceptance is enough
B. Make the patient sign on DAMA
Answer is: B
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Volunteers give lectures for public about preventive measures during eating and
drinking and cleaning. Type of prevention?
A. primary prevention -
B. premodal prevention
C. secondary prevention
D. tertiary prevention
Answer is: A
Primordial prevention> when you prevent the risk factors
ً‫ﻣﺜﻞ ﻟﻤﺎ ﻧﻤﻨﻊ اﻟﺘﺪﺧﯿﻦ واﻟﻜﺤﻮل ﺑﺎﻟﺴﻌﻮدﯾﮫ ﻣﺜﻼ‬
Primary prevention > you are trying to prevent disease.
‫ ﻧﺤﺎول ﻧﻮﻋﻲ اﻟﻨﺎس ﻋﻦ ﻣﺮض ﻣﻌﯿﻦ وﻛﯿﻒ ﯾﺘﻔﺎدوﻧﮫ‬،‫ﻣﺜﻼً ﻟﻤﺎ ﻧﺴﻮي ﺣﻤﻼت ﺗﻄﻮﻋﯿﺔ ﻋﻦ ﻋﻮاﻣﻞ اﻟﺨﻄﻮره ﻟﻸﺻﺎﺑﮫ ﺑﺎﻟﺴﻜﺮ او اﻣﺮاض اﻟﻘﻠﺐ‬
‫او اﻋﻄﻲ ﺗﻄﻌﯿﻤﺎت‬.
Secondary prevention > early detection of disease (screening tests)
Tertiary prevention > disease is already here, and we are trying to minimize complications
Quternary prevention > when we are trying to protect patient from invasive medical intervention and
offering ethically acceptable procedures.
 ----------------------------------------------------------------------------------------------------------------------------------
308.Surgeon is doing OP for patients with Hepatitis C and suddenly he was injured by an
injection. What is the percentage of getting infection?
A. 30%
B. 3%
C. 0.3%
D. 0.03%
Answer is: B from 0.2 % to 1.8%
2010 : https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm#f1
2001 : 1.8 range 0-7% https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm

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309.Screening in low prevalence community Positive result with be ?
● True +
● True-
● False +
● False -
Answer is:C
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310.Abundant baby, doctor said do inguinal repair now :
A. Do it without consent
B. Take consent from ethical committee
Answer is: B
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311.Doctor who is leader for a team is doing CPR for a patient. The doctor's role in
providing protection for the patient is:
A. Put another nurse instead of him
B. Put a resident instead of him
C. Providing more practice for the team
D. Make communication more between the team
Answer is D

‫ﻧ ﺴ ﺄ ل ﷲ ا ﻟ ﻌ ﻠ ﻲ ا ﻟ ﻘ ﺪ ﯾ ﺮ أ ن ﯾ ﺴ ﺎ ھ ﻢ ھ ﺬ ا ا ﻟ ﻤ ﻠ ﻒ ﻓ ﻲ ﺗ ﺤ ﻘ ﯿ ﻘ ﻜ ﻢ ﻟ ﺪ ر ﺟ ﺔ ﻋ ﺎ ﻟ ﯿ ﺔ ﻓ ﻲ ا ﻹ ﺧ ﺘ ﺒ ﺎر‬
‫و ﻻ ﺗ ﻨ ﺴ ﻮ ا ا ﻟ ﻘ ﺎ ﺋ ﻤ ﯿ ﻦ ﻋ ﻠ ﻰ ھ ﺬ ا ا ﻟ ﻌ ﻤ ﻞ ﻣ ﻦ ﺧ ﺎ ﻟﺺ د ﻋ ﺎ ﺋ ﻜ ﻢ ﻟ ﮭ ﻢ ﺑ ﺎ ﻟ ﺘ ﻮ ﻓ ﯿ ﻖ و ا ﻟ ﺴ ﺪ اد‬