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 ETHICS

FOUR MAJOR PRINCIPLE OF ETHICS

#Autonomy

1. elderly 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 is: B

2. elderly + metastatic cancer his son ask you to not tell his father about the diagnosis: in other
recall Pt 70 years diagnosed with cancer, family asked you not to tell him what you should
do?
A. Tell the patient
B. consult legal committee
C. consult ethical committee
Answer is A

3. 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

4. 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

5.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 empathy
Answer is: B

pg. 1
 6.90years old k/c of inoperable bronchogenic carcinoma was admitted to ICU because he
developed deterioration and pneumothorax and he have DNR the thoracic surgeon wants to
do a type of surgery that will let him breathe better but not sure if he will survive it What is
next choice?
A. Tell the patient about high risk operation and let him sign it
B. Do not tell the patient because he have DNR and can not survive
C. Tell the Intinsivist to sign for the patient
D. Tell the surgeon to tell the patient
Answer is: A

7.A 40 y/o man comes to the counseling clinic after diagnosis of bronchogenic cancer, and you tell
him that he needs to stop smoking. He is ignorant and completely refuses. What will you tell
him?
A. We need to speak to your family about this
B. We will do everything to help you stop smoking
C. We will stop seeing you if you don’t quit
D. Smoking is harmful and you’ll die.
Answer is B

8.Patient Chronic smoker not willing to quit ?

A. Set time for quitting
B. Send him classes
C. Personalized ,something discussion with him
Answer is: C, by exclusion

9.Female pt going for breast examination but she wants female doctor to examine her what you
will do:
A. refuse
B. Respect
Answer: B

10.Old pt you diagnose her with atrophic vaginitis but didn't seem convinced she told you she
wanted another consultation in other recall pt don’t belive this is the correct dx and wants
another dr opinion:
A. Tell her u r sure that us not necessary
B. Write report and refer
C. Refuse
Answer is: B

pg. 2
11.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. call the security
C. referral to another surgeon
Answer: C

12.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

13.Elderly 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 is: B

14.A woman admitted for pneumonia and she is confused, her son is the
next kin and he refused to give her antibiotics because he thinks it will
harm her. What should you do
A. don't give as he is the next kin
B. consult him in front of the consultant
C. ask the patient
Answer is: C

15.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

16.Elderly patient has cancer ask for DNR, after death, his son complain, what is your action
A. Tell the son that you respect his father’s wish.
Answer is: A

pg. 3
 17.patient diagnosed with IUFD, had previous cs?
A. direct her to do cs.
B. direct her to vaginal delivery.
C. wait for her decision
D. give her the benefits and disadvantages of cs and vaginal delivery
Answer is: D

18.Patient had IUFD diagnosis confirmed by US. What is your next step in management?
A. Tell patient
B. Tell relatives
C. Advance preparation
D. Do more investigations
Answer is : A

19.Pregnant with dead fetus 3rd trimester normal labs ,vitally stable ,what to do?
A. let her to go home to decide what to do
B. management depends on bishop score
Answer is: A

#DAMA Qs

20.A 65 y/o man presents to the ER with Charcot’s knee. After initial management he is admitted
under the surgery ward.The surgeons inform him that he needs amputation but he
refused.What is your action?
A. ask the patient to sign DAMA
B. Refer to another hospital
Answer is :A

21.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

22.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

pg. 4
 23.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

24.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

25.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

#Beneficence

26.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
answer is: B

27.90 years 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

28.18 months baby came with family, nurse inform doctor that patient never was vaccinated in the
file since birth, the parents refuse vaccines and say “ vaccines damages the baby brain)
what is the appropriate action?
A. Refer parents to psychiatry
B. Contact ethical committee
C. Explain about the vaccines and the great side of it
Answer is: C

pg. 5
29.Parents didn't vaccinate their child because it is "bad for the brain" as they believe. What should
you do?
A. Call social worker
B. explain that it is rumors and they should viccinate the child
C. Report child abuse
Answer is: B

30.7 years old child diagnosed with Measles when the father was asked about vaccination then he
said that vaccination is wrong and dangerous What is your appropriate action?
A. Explain that this is a myth and explain the benefit
B. Ignore the father's opinion and treat the child
Answer is: A

31.18 months baby came with family, nurse inform doctor that patient never was vaccinated in the
file since birth, the parents refuse vaccines and say “vaccines damage the baby brain”. What
is the appropriate action?
A. Refer parents to psychiatry
B. Contact ethical committee
C. Explain about the importance of vaccines and how safe they are
Answer is: C

32.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 if emergency case go with A

33.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

34.70 yo man, present with skin change, report revealed malignant melanoma. Who can make the
pt comply to your medical advice ?
A. this is a serious issue.
B. you are professional so he trusted you
C. explain to the pt by medical term.
D. take time to tell him and try to gain his trust
ANSWER:

pg. 6
35.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

36.7 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

37.65 years with lesion on his face (long case) and part of the biopsy report is dx Melanoma. He is
known to be noncompliance. 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

38.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

39.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

40.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

pg. 7
 41.Pregnant with graves symptomatic and eye manifestation,she refuse ttt ?
A. Explain the importance of ttt and risk to mother and baby
B. Respect
C. Follow up after months (i think was more than 3 month)
Answer is A

42.Baby will be prepared for open heart surgery, mother is very worry about him what is the best
way to deal with her worry?
A. explain what will happen before and after the surgery
B. Inform the parents this operation so easy and every day can we do it in hospital
C. Give parent anxiety drug
D. donʼt inform parents any details for operation
Answer is: A

#non-maleficence

43.Patient old with end stages cancer disease complaining of severe 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 their father question in this case what the doctor do?
Answer is: principles of double effects

44.Elderly with endstage cancer in unbearable pain his family ask u to give him stronger pain killer?
A. Give him stronger analgesic

45.A 93 yo man has dementia and multiple sicknesses and was found to have cancer and
metastasis to liver and lung and lymph nodes how will you manage
A. Chemotherapy
B. Palliative surgery to improve his breathing
C. Watchful care
Answer is: B

46.IUFD what is , patient have previous CS what is the most appropriate management?
A. wait for patient decision
B. go for CS
C. try vaginal delivery
D. counsel the patient that CS is better than vaginal
Answer is: A

pg. 8
 INFORMED CONSENT AND DOCUMENTATION

#Child consent

47.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 ask the child

48.you want to do LP for 15 y.o child, from whom you should take the consent?
A. Parents
B. Child
C. Both
D. None
Answer is: C

49.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

50.15 years old case of meningitis LP to be done what to do?

A. Take consent form parents and assent from patient
B. take consent from parents and donʼt assent patient
C. no need for consent
D. consent patient only
Answer is: A

51.Abundant baby , doctor said do inguinal repair now?

A. Do it without consent
B. Take consent from ethical committee
Answer is: B

pg. 9
 52.Baby abounded by his mother as he’s result of out of wedlock pregnancy Pediatric surgeon
asses him he has inguinal hernia decided he need inguinal hernia repair. Pt need
consent What’s appropriate next step?
A. refer the police
B. refer to social worker
C. you do the consent for the baby
D. call the ethical committee
Answer is: D

53.Abandond infant brought to hospital, he has hernia and the surgeon must do surgery for him
now (emergent), from whom take the consent?
A. Social worker
B. Police
C. ethical committee of the hospital
D. No need bx it is emergent case
Answer is: C

#Situational consent

54.75 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

55.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 if patient competent, if not > C

pg. 10
56.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

57.Radiologist suggest something for pt case.. who should take the pt consent for radiologist
opinion?
A. radiologist
B. Head nurse
C. Medical resident
D. Any one of treatment team
Answer is A

58.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

pg. 11
 DOCTOR TO MEDICAL STAFF RELATIONSHIP

59.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

60.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

61.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

62.pt doesn’t want to know the details, u r the surgeon appreciated that , but the anesthesia dr
insist?
A. Tell the pt the decision of the anesthesia dr.
Answer is: A

63.Doctor tell nurse to move bedridden pt nurse forget to tell other

A. poor communication
Answer is: A

64.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

pg. 12
65.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

66.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

67.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? the same medicine
A. mistake in prescription and administer
B. disconnection between doctor and nurse
C. unlike medicine
Answer is: C

68.Pt is going for surgery and when the surgeon was discussing the procedure and complications
she said she do not want to know anything just do the operation, he referred her to
anesthesiologist and he want to explain everything to the pt, what u will do:
A. Tell the pt what the anesthesiologist is going to do
B. Postponed the operation and refer her to another anesthesia
C. Consult the hosp ethical committee
D. I forgot .. i think tell the anesthesia about the pt wish (can we delete this q )
Answer is : A

69.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

pg. 13
70.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

pg. 14
 DOCTOR TO OATIENT RELATIONSHIP
#Dealing with angry patient

71.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

72.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

73.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

74.Pt with swelling and chronic cough you prescribed medication 6 month ago and he did take it
and come now he said if you don't do the surgery I will Complaint against you. What to do?
A. Do surgery
B. refuse to do surgery
C. talk to hospital committee
Answer is: B

75.Father angry because his daughter insists to enter gym. What is appropriate?
A. Explore why he angry
B. Agree with them
Answer: A

pg. 15
76.26-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

77.Pt threatened u for complaining if you don’t do the surgery in other recall Patient threaten that
he Will complain if you didn't do a hernia surgery for him What should you do:
A. consult physician
B. call social worker
C. do it
D. ethical committee
Answer is: Refer the patient or B

78.Hernia patient wanted the surgery he thratened to complain the doctor:

A. Talk to administration
B. Do surgery
C. Consult physician
D. Ethical committe
Answer is : A

79.You were late pt start to shout and angry:

Answer is: Acknowledge his anger

80.Patient tells you he wants to kill his ex-girlfriend.What to do next?

A. Call police.
B. Call ex-girlfriend.
C. Give haloperidol.
Answer is: A

81.Patient threaten that he Will complain if you didn't do a hernia surgery for him What should you
do:
A. A-consult physician
B. B-call social worker
C. C- do it
D. D-Talk to hospital administration
Answer is : D

pg. 16
#Conversation aspects

82.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

83.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

84.Elderly women came to clinic frightened because of endometrial hyperplasia and want you to
book her for hysterectomy. What to do?
A. Do what she asks for
B. Refer to gyne oncology because the risk of malignancy
C. Calm her down and hear her thoughts
Answer is C

85.Patient came to a surgical clinic , you want to take the hx and the pt want to explain his
perception of the cause of his pain
A. Tell him the clinic is busy and u don’t have enough time
B. Let him explain
C. politely interrupt him and ask him close ended questions
D. refer him to other dr
Answer is B Another exam taker was asked: “A female who likes to talk a lot keeps
interrupting you and wouldn’t let you complete your history. What would be the best course
of action?” In this case, the answer is C.

pg. 17
#Dealing with flirting women

86.female came with revealing clothes u dnt understand her language:

A. Ask help from another colleague
Answer is : A

#Bad news

87.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

88.The parents that has IUFD and they are blaming their self . The mother is very anxious and sad,
the father doesn't know how to express his feeling what to do?
A. Explore and validate their emotions with empathy
B. Identify their emotions and calm them down
Answer is: A

89.Pregnant 34 weeks, diagnose with IUFD , she feels guilty because she smokes, how will deal with
her?
A. Tell her to wait for autopsy results
B. sympathize with he
Answer is A

90.Pt dx to have squamous cell cancer How to break the news to him?
A. Dont waste time and tell him his options
B. Reassurance, tell him not to worry
C. Don't tell him at all, hide the dx
D. Tell him by small step in different times
Answer is D

91.pt with complete abortion while waiting for admission were tearfulness and husband was
emotionally distress what to do :
A. Explore and reflect to their emotions

pg. 18
92.Women have abortion she was shocked what the doctor should do ?
A. sympathy
B. admission after evacuation as pp care
C. search for the cause
Answer is: A

93.question about what’s the appropriate thing to do after a child death for parents ?
A. book them for a family medicine appointment
B. let the mother stay with the child to say goodbye
C. ignore
Answer is B

94.pregnant came with abdominal pain she was anxious because she lost previous pregnancy she
speak different language what to do:
A. show her that her feelings understood
B. refer her to other colleagues
C. show her her feelings don’t matter because she have been through it before
Answer is: A

95.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

96.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: B

97.In case of death of newborn What should you do immediately for the parents?
A. Ask the father if he would like to file a complaint
B. Let the mother spend sometime with her dead baby
C. arrange a close follow up with the primary team
Answer is: B

pg. 19
 98.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 ? in other recall Pregnant after
10 years of infertility, on 8th week diagnosed with complete abortion, she is crying and her
husband is overwhelmed with emotions, how to approach?
A. Sympathy
B. Admission after evacuation as post-partum care
C. Search for cause of abortion
Answer is : A

99.What is the first response after death of baby

A. Let the mother take time with her dead baby
B. Urgent follow up with primary care
C. Tell the family to complain about hospital
Answer is: A

100.Foreign pt presented to ER for delivery she is anxious and worried about the baby?
A. Call other doctor
B. Try to understand her fears
C. Say her fears can’t be understood
Answer : B

pg. 20
 REPRODUCTIVE ISSUES AND DONATION
101.pt came to sign consent for hysterectomy
A. Give her details about surgery
B. Make documentation clear
Answer: A

102.25 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

103.pregnant 10 week 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

104.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

105.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

106.Female dr adviced to do cs coz risk of fetal death But she refused Take consent from :
A. hospital director
B. Consent from husband
C. Do vaginal deliver
D. Refer to another doctor
Answer is : ethical committee

pg. 21
107.Women take contraceptive and husband don’t want it and want to have a baby but wife refuse,
your action: in other recall Lady and her husband comes to you she wants IUD insertion but
husband wants her to get pregnant refuses insertion... What to do??
A. show empathy
B. support wife choice
C. support husband choice
D. contraceptive requires mutual consent
Answer is : D

108.Patient refuse CS , consent from who ??

A. patient
B. husband
C. ethical committee
Answer is:A

109.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

110.Consent for CS the pt refuse to do CS,what'll you do?

A. referral
B. take permission husband
C. call hospital admin
D. force pt to do it
Answer is: ETHICAL COMMITTEE

111.The mother refused the cs that is will save the baby.

A. Refer the pt
B. Respect her wish
C. Take the husband consent ( not sure)
D. Do vaginal delivery
E. Do cs against her wish
Answer is: B

pg. 22
112.couple came in the fertility clinic, husband found to have HIV.
A. tell the husband
B. tell wife
C. tell a close relative.
D. no tell the couples in the choices
Answer is: A

113.Couple came to fertility center Lady infertile:

A. Tell wife
B. Tell husband
C. Tell both
D. Tell relative
Answer is: C

114.Couple came to the infertility clinic wife found to have blocked tubes, what will you do? In other
recall Couple come by infertility after investigation done show bilateral fallopian tube
obstruction what will do?
A. tell wife
B. tell husband
C. ethics committee
D. tell couple
Answer is: D

115.Patient has incomplete abortion and refused D&C, her husband asks if he can sign instead of
her, who has the right:
A. Patient
B. Husband
C. Hospital committee
Answer is: A

116.Lady came with incomplete abortion, she is for surgery, she refused the surgery and her
husband agreed . What will you do ?
A. Respect her wishes
Answer is A

117.couples with infertility ask about surrogate pregnancy which not allowed in ur hospital and u are
not sure wither allowed in saudi or not?
A. Warn them might not be allowed in ksa.
B. appointment to check yourself and then tell them.
C. Referral to colleague who can help to do it.
Answer is: B

pg. 23
118.Patient want to take hormonal therapy, but you are sure that it is not suitable for her, and she
decided to complain against you, what is your action ? In other recall Hormonal therapy in
post-menopausal woman? In other recall gyn explain to the pt that HRT will not help her
menopausal symptom at this stage but the pt insist to have it what should doctor do?
A. Don’t give it to her (refuse)
B. give her
C. refer her
Answer: A

119.42 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

120.old pt with AUB she is worried and want to do hysterectomy what you will do ?
A. calm her down and tell her other treatment options
Answer: No answer

121.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

122.38 w with IUFD, with Hx of cs 4 y ago, what to do ?

A. Let pt decide SVD or medical IOL
B. Tell pt benefit of SVD than CS
C. do immediate CS and don’t let pt become more sad
Answer is : A

123.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

pg. 24
124.What is important to do when taking Hysterectomy consent in clinic? ON OTHER RECALL Large
ovarian tumor, dr decided elective hysterectomy, she come to complete a consent form,
what is most app initial step?
A. Clear documentation
B. Careful listening
C. Introduction for the surgery
D. Explore her feelings
Answer is : C

125.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

126.25-Mother refused to sign for abortion (22 weeks):?

A. husband sign
B. respect her
Answer is: B

127.Pregnant unbooked G3p2 came to ANC visit and she gave you report about her socioeconomical
state she cannot handle anything and she don’t want her baby due to ... long scenario U/s
report Baby well with good fetal heart rate, GA 16+4 weeks What is your plan ?
A. prepare her for abortion
B. tell her husband about it and take consent
C. refuse
D. refer her
Answer is C

128.A newborn needs rustication, he has multiple anomalies and the mother is a colleague in the
same hospital, she does not want you to resuscitate, what to do?
A. Respect
B. Resuscitate
less than 20wks >>> u don't have to resuscitate
between 20-25 wks >> it depends on case , medical team and mother can decide
more than 25 wks>> u have to resuscitate

pg. 25
129.Female patient who is in forties and pregnant wants abortion and threatens you that she will
attempt sucide if you not abort the pregnancy. What should you do?
A. Do the abortion
B. Give her herbal remedies that help in abortion
C. Admit her to psychology support to convince her
D. Get her out of your clinic
Answer is: C

pg. 26
 ABUSE
#Child abuse

130.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 Child abuse steps are (observe, document , report , take care)

131.13 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

132.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

133.Child Head trauma subarachnoid, hge, periorbital edema, bruises and LOC Father said he found
her like this, what to do?
A. Call child protection
Answer is: A

134.4 months old baby girl came by ambulance, you no is not mentally well, CT showed subdural
hematoma, retinal hemorrhage, old fractures on chest x ray. Her father said she fell. Baby
starts to cry and parents insist on signing against medical advice, what will you do?
A. Force them to stay and call social worker
B. Give them neurology follow up after 2 weeks
C. Call the police
Answer is: A or child protection (shaken baby syndrome, child abuse)

pg. 27
#Women abuse

135.Female patients come 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. Threatens the husband by police
B. Tell the police
C. Do what the patient said to you
D. Give the patient your number to tell if this happens again in future
Answer is B

136.Woman was physically abused by her husband. What is the most predicted presumption
among abusers for this behavior?
A. culture reasons
B. socioeconomic reasons
C. gender role inequality
Answer is: B

137.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

138.women has sexual harassment at work usually from who?

A. employee
B. co-worker
C. supervisor
Answer: C

139.A woman brought with the police with bruises how to deal with her condition ?
A. Call Social service of the hospital
B. Not examines her without her husband
C. Enter to her with a large smile and begin examination
D. tries to console her, she knows the cause of the bruising, and then begins the
examination
Answer is D

140.Cause of female abuse?

A. Low socioeconomic
B. Age
C. Belief in gender
Answer is : pregnancy

pg. 28
141.Female come to ER with prusis multiple area. Which indicate domestic violence?
A. Second marriage
B. Tobacco
Answer is A

142.Domestic violence most common due to

Answer is 2nry pregnancy.

143.Most common cause of violence: ?

A. second marriage
B. bankruptcies
C. marital unsatisfaction
Answer is: A

144.Female abused by her husband looks sad:

A. induce yourself with a smile and take the history
B. Try to figure out what happened and the reason of her sadness
C. Ask about the chief complaint
Answer : B

145.Pregnant lady came crying to the clinic after she punched on the face from her husband
what is the main risk factor increases the violence?
A. pregnancy duration
B. holidays
Answer: A

146.Female pregnant 30 weeks, her husband punched her in the face and abdomen then she hit
the floor. Examination all normal. What best next step?
A. A.Immediate CS
B. B.Confirm what happened
C. C.Reassure and discharge
D. D.Follow up
Answer is: B

147.Pregnant lady came to the hospital with broken arm caused by husband abuse. Which of the
following is the most likely time for increased intimate partner violence?
A. After retirement
B. During pregnancy
C. At family visits
D. Holiday
Answer is A

pg. 29
 MEDICAL ERROR

148.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

149.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

150.scenario during surgery you injured CBD and the pt is ok what to do ?

Answer is: informs the pt

151.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 Change the nurse
B. Poor communication
Answer is: C

152.Female patient was planning to do D&C and instead of taking the patient to the room she
was taken to the room of hysterectomy and hysterectomy was done by mistake. What
should you do?
A. Tell the patient

pg. 30
 OTHER ETHICAL STATIONS
153.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 is: C

#Child concerns

154.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

155.Child presenting with asthma exacerbation, father smokes in home, told many times not to
smoke but he doesn't care and doesn't want to listen. What do you do?
A. A. Call child care services.
B. B. Explain why its important not to smoke at home.
C. C. Call medical ethical committee of the hospital
Answer is: A

156.A child with worsening asthma father won’t quit smoking what should u do?
A. consult ethics
B. refer to another doctor
C. report it
Answer is: C

157.a young child newly diagnosed asthmatic mother also asthmatic father is a chain smoker in
other recall first attack of asthma and father smoking what to do
A. stop smoking in the house
B. give short acting beta agonist to the child
Answer : A

pg. 31
158.Child immunocompromise mother refuse intubation because her previous child dead in the
same way:
A. ignore and intubate
Answer is: A

159.Mother with child porn premature 23 weeks and needs intubation and resuscitation but she
refused.What to do?
A. respect her wish
Answer is: A

160.Baby preterm, with conventional anomalies, need resuscitation, mother is a dictator and she
refused.What to do? In other recall Baby preterm, with ALS needs intubation, family
refused.What to do?
A. Respect
B. Refuse and intubate
Answer: depends on the weeks more than 25 weeks , answer is B

161.child with spinal muscualr dystrophy, his conidition now mandates intubations but parents
refused? in other recall 2 year muscular dystrophy,with respiratory distress, parents refuse
intubate or any thing cuz his brother die from same condition what to do?
A. intubate anyway
B. respect their wish
C. consult ethical committee
Answer is: A

162.Intern was assigned to stay with a child until they take him for operation , the child doesn't
speak the same language, he is anxious:
A. Intubate
B. Sedate
C. Ask the nurse to stay with him so u can check the child chart
D. Examine him with your stethoscope and let the child use a stethoscope to listen to his
own heart rate
Answer is: D

163.child with abdominal pain during school days, what to do?

A. strict rules.
B. spanking.
Answer is: Positive reinforcement

pg. 32
164.Asthmatic child his family stat that thy can not go out because the nebulizer machine need
electricity, what u will 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

165.Neonate with multiple congenital malformations and need resuscitation and mother one of
the hospital physicians and wish to not resuscitate? In other recall Preterm 23 week with
fatal congenital anomalies, mother doctor and advised do not resuscitate what you will do?
A. Owner her wishes
B. Hospital ethical committee
C. Ignore mother's wish and resuscitate
Answer is: A (he was 24w preterm)

166.Abandoned child u will do surgery, how to take consent:

A. Social worker
B. Ethical committee
C. Hospital administration
Answer is: B

167.7y 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

168.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

169.7 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

pg. 33
 170.During heads assessment of adolescent psychiatry who should attend the session parents
should be present
A. with adolescent alone
B. with adolescent and his parents
Answer: B

171.Mother with appeared with some mental retardation Parents want to take him back home:
A. Called child protection
B. contact ethics
The Answer Is: B

172.mothertook her child I think 6months old her concern is that he has 1 testes, presented with
the inguinal hernia, pedia surgeon advise treatment
A. Refer to police
B. Refer to social worker
C. Ask ethical comity
D. Refuse
Answer is : C

#Dignity and privacy

173.During abdominal examination the intern forget to close the curtain what he broke:
A. principal of dignity
B. principal of privacy
Answer : B

174.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

175.IM resident doe got to close the curtain while examine the patient's foot what is the ethical
principle he broke?
A. Privacy
B. Dignity
Answer is: A

176.examine patient and forget close curtains?

A. Privacy
B. Dignity
Answer: A NOTES (Clothes = dignity) ( Curtain = privacy )

pg. 34
 177. Difference between Privacy and Dignity.
A. Self-study
B. Odds ratio? Self-study
C. Sensitivity
Answer is for screening

178. During PE, resident don’t close the curtains, what he violates?
A. privacy
B. Dignity
Answer is: A

#Agenda

179.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

180.244- 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

181.Doctor explained to the patient (I will start with nature of the disease, limitation, and
treatment options and finally the prognosis. What did the doctor perform?
A. probing
B. agenda setting
C. safety netting
Answer is: B

pg. 35
#Elderly concern

182.Elderly patient not compliant to medications. Proper action?

A. Make him worry about his carelessness
B. Ask his family to care for him
Answer is: B

183.DNR and family refuse doctor arrogance meeting with family to :

A. Justify
B. inform
Answer: A

184. about old patient admitted to ICU and confused. You want to give him fluids and antibiotics
and his son refuses. What’s your management:
A. Ignore the son & give Abs
B. Respect the son point of view
C. Discuss the son in the presence of other consultants
D. Tell the patient and take his opinion
Answer is: C

185.Very old pt in ICU with carcinoma and other trouble in breath.. surgeon want to do sm
surgery to improve breathing but sure if the pt will survive during the surgery.. what to do?
A. Let the pt sign very high consent
B. No need to do it cuz the reinsure improvement
Answer is: If he is comatose or intubated so > discuss with family members neurogenic
shock

pg. 36
 Research and Epidemiology
What do sensitivity values tell you? The sensitivity of a test is also called the true positive rate (TPR) and is the proportion of samples that are
genuinely positive that give a positive result using the test in question. For example, a test that correctly identifies all positive samples in a panel
is very sensitive. Another test that only detects 60 % of the positive samples in the panel would be deemed to have lower sensitivity as it is
missing positives and giving higher a false negative rate (FNR). Also referred to as type II errors, false negatives are the failure to reject a false null
hypothesis (the null hypothesis being that the sample is negative).

What do specificity measures tell you? The specificity of a test, also referred to as the true negative rate (TNR), is the proportion of samples that
test negative using the test in question that are genuinely negative. For example, a test that identifies all healthy people as being negative for a
particular illness is very specific. Another test that incorrectly identifies 30 % of healthy people as having the condition would be deemed to be
less specific, having a higher false positive rate (FPR). Also referred to as type I errors, false positives are the rejection of a true null hypothesis
(the null hypothesis being that the sample is negative).

186.In choosing test for screening of cancer which is important? In other recall: What is best for screening
test?
A. Sensitivity
B. Specific
C. Cheap
D. Quick to do
Answer is: A

187.screening test should be in other recall most important factor in any screening test
A. Cheap.
B. Highly specific.
C. Highly sensitive.
D. Quick to do.
Answer is: C

188.Sensitivity:
Answer is: for screening

189.Which of these diagnostic tools is confirmatory?

A. Specific
B. Sensitive
Answer is: A

190.about the sensitivity... what is the definition?

Answer is: (true +ve) while specificity (true-ve) > check the note.

191.When you screen a Rare disease in a population, what is highest positive result:
A. False positive
B. True positive
Answer is A

pg. 37
192.Disease has low prevalence in population? What will be positive ?
A. False positive
B. False negative
C. True positive
D. True negative
Answer is A

193.Ratio of prevalence?
A. Odd ratio
B. Predictive value
Answer is: B

194.Which of the following will be affected by the prevalence of the disease?

A. sensitivity
B. specificity
C. relative value
D. predicted value
Answer is :D Predictive value more accurate, Because both sensitivity and specificity will be
affected

195.Which test is appropriate to study 5

different types of exercise given to obese
ladies over a period of time and follow their
BMI?
A. cohort
B. cross sectional
C. case control
D. clinical trial
Answer is:

196.Highest level of evidence to determine

exercise effect on quality of life:
A. cohort
B. clinical trial
C. case control
D. observational study
Answer is:

pg. 38
197.If incidence is the same, what would increase the prevalence of a disease?
A. more accurate diagnostic tests
B. better coping with the disease
C. Loss of follow up
Answer is: B
Ø A will increase both ( incidence + prevalence )
Ø B will increase prevalence only
Ø C would decrease prevalence

198.You have a population, 800 have liver disease and 800 dont have it. The test shows 200 of those with
the disease to be positive. What is the sensitivity?
A. 25%
B. 33%
C. 50%
Answer is A

199.Question about (CAGE questionnaire) for alcoholic pt :

pg. 39
 Community and Preventive Medicine
______________________________________________________________________________

by CDC: life expectancy for smoker is at least 10 years shorter than for nonsmoker, quitting smoking
before than age of 40 reduce the risk of dying from smoking related diseases by about 90%.

200.How many years of life average smoker is expected to lose?

A. 5
B. 10
C. 15
D. 20
Answer is B

201.Smocking decreasing life expectancy by how many years?

A. 5 years
B. 10 years
C. 15 years
D. 20 years
Answer is B

1. Ask - Identify and document tobacco use status for every patient at every visit. (You may wish to
develop your own vital signs sticker)
2. Advise - In a clear, strong, and personalized manner, urge every tobacco user to quit.
3. Assess - Is the tobacco user willing to make a quit attempt at this time?
4. Assist - For the patient willing to make a quit attempt, use counseling and pharmacotherapy to help
him or her quit.
5. Arrange - Schedule followup contact, in person or by telephone, preferably within the first week after
the quit date.

202.5As for smoking?

Answer is: Ask, Advise, Assess, Assist, and Arrange

203.What is the percentage of male smokers in Saudi arabia?

A. 11%
B. 37%
C. 61%
D. 25%
Answer is: D, PLEASE NO NEED TO FIGHT, CHOOSE THE PERCENTAGE YOU LIKE.

204.In cigrate many harmful chemicals, regarding nicotine what is the most important thing u r
concerned about?
A. COPD
B. Lung Ca
C. Addiction
Answer is: C Nicotine > addiction

pg. 40
205.Male smokers came for regular check up , he is doing fine and not thinking about quitting smoking.
What is the next appropriate step?
A. Set smoking cessation date
B. Provide him with nicotine replacement therapy
C. Give him information about his individual case
Answer is: C, BY EXCLUSION THE CORRECT ANSWER SHOULD BE “TO KNOW IF HE EVER TRIED TO QUIT
SMOKING OR NOT”

206.Evidence based medicine approved method for smoking cessation?

A. Acupuncture
B. Hypnosis
C. Vernicoline
Answer is: C, Bupropion as well especially when combined with behavioral interventions.

Level of prevention:
1. Primordial prevention → when prevent the risk factors.
2. Primary prevention → when trying to prevent the disease.
3. Secondary prevention → early detection of the disease by (screening test)
4. Tertiary prevention → when the disease is already happened and trying to minimize the
complications.
5. Quaternary prevention → when trying to protect the patient from invasive medical intervention
and offering ethically acceptable process.

207.Natural history stages when best to do screening ?

A. pre-disease stage
B. Pre-clinical stage
C. Pre-clinical disease stage
D. Pre-recovery, disability, death stage
Answer is A

208.primordial prevention?
Answer is Risk factors prevention like in cardiac diseases.

209.Which one of the following is a primordial prevention method?

A. Preventing risk factors of MI
B. Modifying existing risk factors of MI
C. Preventing MI complication
Answer is: A

210.screening the mother for HBs what type of prevention?

A. 1ry
B. 2ry
C. 3ry
D. Primordial
Answer is: B

pg. 41
 211.60 years old came ask for pneumococcal
vaccine what you will give?
A. PSV 23 only
B. PSV 23 and pcv B
C. Not give anything
Answer is: A

212.Eleadry pt asymptomatic, What is the order

of Pneumococcal vaccine give it to him ?
A. PCV-13 then PCV 23
B. PCV-23 then PCV13
C. PCV-23 then PCV 23
D. Don’t give him the vaccine
Answer is: B

213.Vaccination PCV13 and PPSV23 in healthy elderly patient

A. No need
B. Give both at the same time
C. PCV13 the PPSV23
Answer is C

214.Pilgrim , according to KSA what should be vaccinated for

A. Meningococcemia
B. Hemophilus influenzae
Answer is: A

215.What vaccine give for all travelers coming for Hajj

A. Meningitis
B. Yellow fever
Answer is: A

216.Pilgrims from Africa came for Hajj, vaccinated by meningococcal vaccine, what other prophylaxis on
arrival
A. Isolation 6 days
B. isolation 10 days
C. 500 mg ciprofloxacin oral
D. Od on arrival
Answer is: C

pg. 42
217.Minimal daily activity for childre? In other recall daily physical activity? In other recall during
24h? In other recall recommended exercise duration for children?
A. 30 minutes
B. 60 minutes
C. 120 minutes
D. 180 minutes
Answer is: 60 min.

218.Minimal aerobic exercise duration?

A. 10
B. 15
C. 20
D. 30
Answer is: D

219.Minimum hours of activity for a child daily?

A. 1/2 hour
B. 1 hour
C. 1.5 hours
D. 2 hours
Answer is: B

220.Minimum day for exercise?

A. 2
B. 3
C. 4
D. 5
Answer is: D/ week.

221.Minimum day of activity for adult ?

A. 2
B. 3
C. 4
D. 5
Answer is: D, Minimum activity 30 min 5 days per week

222.Minimal workout activity for adult?

A. 20 per 6 days
B. 30 per 5 days
Answer is: B

pg. 43
223.Minimal exercise min in small session:
A. 5
B. 10
C. 15
D. 20
Answer is:

224.How many times to do Strengthen muscle exercise weekly?

A. 2
B. 3
C. 4
D. 5
Answer is:

pg. 44
225. Number of hours cause obesity:
A. 5
B. 6
C. 7
D. More than 7
Answer is: A

226.How many hours of sleep are associated with weight gain?

A. < 6 hours
B. 7 hours
C. 8 hours
D. > 9 hours
Answer is: A

227.New weird question i dnt really remember a lot, What measurement is used for prevention
of obesity on dm prevalence?
A. Relative risk
B. Attributable risk
Answer is: A

pg. 45
228.about how to make a pediatric 12 years old, how to sit him safely in the car to protect him
from Airbag injury?
A. Restrain him in front seat
B. Restrain him in front seat
C. Use something chair
D. Make him set in the back seat facing backward
Answer is: D

229.Avoid air-bag injuries in children below 2 y/o?

A. Restrain in back seats
B. Restrain in front seat
C. Rear face in front of seat
D. Booster in front of seat
Answer is: A

230.How to determine if a child complaining of certain symptoms is actually sick?

A. Presence of symptoms at night
Answer is A

231.When say this pain from organ ( organic pain)?

A. Befor sleep time
B. Before awakening
C. Two choices I forgot it
Answer is: B

Best of luck

pg. 46