, CHAPTER LIST
General Principles & Foundations of Endocrine, Metabolic & Neurological
Practice Medicine
Chapter 1: Diagnosis: The Art of Being a Chapter 21: Endocrinology
Doctor Chapter 22: Dermatology
Chapter 2: Human Genetics Chapter 23: Diabetes Mellitus
Chapter 3: Immunity Chapter 24: Lipid and Inherited
Chapter 4: Evidence-Based Practice Metabolic Disorders
Chapter 5: Ethical Practice Chapter 25: Liaison Psychiatry
Oncology & Critical Care Chapter 26: Neurology
Chapter 6: Malignant Disease Chapter 27: Ear, Nose and Throat, and
Chapter 7: Palliative Care and Symptom Eye Disease
Control Cardiopulmonary & Gastrointestinal
Chapter 8: Sepsis and the Treatment of Systems
Bacterial Infection Chapter 28: Respiratory Disease
Chapter 9: Water, Electrolytes and Chapter 29: Venous Thromboembolic
Acid–Base Balance Disease
Chapter 10: Critical Care Medicine Chapter 30: Cardiology
Chapter 11: Surgery Chapter 31: Hypertension
Chapter 12: Prescribing, Therapeutics Chapter 32: Gastroenterology
and Toxicology Chapter 33: Nutrition
Public & Global Health Chapter 34: Liver Disease
Chapter 13: Global Health Chapter 35: Biliary Tract and Pancreatic
Chapter 14: Public Health Disease
Chapter 15: Geriatric Medicine, Frailty Chapter 36: Kidney and Urinary Tract
and Multimorbidity Disease
Haematology & Systemic Conditions Specialized & Population Health
Chapter 16: Haematology Chapter 37: Sexually Transmitted
Chapter 17: Haematological Oncology Infections and HIV
Chapter 18: Rheumatology Chapter 38: Obstetric Medicine
Chapter 19: Bone Disease Chapter 39: Women's Health
Chapter 20: Infectious Diseases and Chapter 40: Men's Health
Tropical Medicine Chapter 41: Environmental Medicine
,Chapter 1: Diagnosis – The Art of Being a Doctor
Block 1: Single Best Answer (SBA) MCQs
Question 1
Which diagnostic reasoning strategy relies on immediate, non-analytical recognition of a clinical
presentation?
A. Bayesian probability analysis
B. Algorithmic decision-making
C. Pattern recognition
D. Hypothetico-deductive reasoning
Answer: C
Rationale: Pattern recognition (System 1 thinking) relies on non-analytical, immediate retrieval
of stored clinical exemplars from prior experience.
Question 2
Which term describes the cognitive bias of relying excessively on the initial piece of information
received when making a diagnosis?
A. Anchoring bias
B. Premature closure
C. Confirmation bias
D. Availability heuristic
Answer: A
Rationale: Anchoring bias occurs when a clinician focuses on early information or an initial
impression and fails to adjust the probability as new evidence emerges.
,Question 3
What is the primary determinant of post-test probability according to Bayes' theorem?
A. Pre-test probability and test likelihood ratio
B. Test cost and availability
C. Sample size of the validation study
D. Clinical experience of the examiner
Answer: A
Rationale: Bayes' theorem defines post-test odds as the product of pre-test odds and the
likelihood ratio of the diagnostic test.
Question 4
Which consultation model emphasizes exploring the patient's ideas, concerns, and expectations
(ICE)?
A. Paternalistic model
B. Biomedical model
C. Calgary-Cambridge framework
D. SOAP note model
Answer: C
Rationale: The Calgary-Cambridge framework structures clinical communication around both
the biomedical agenda and the patient's personal perspective (ideas, concerns, expectations).
Question 5
Which cognitive error refers to accepting a diagnosis before it has been fully verified?
A. Framing effect
B. Hindsight bias
C. Diagnostic momentum
D. Premature closure
Answer: D
,Rationale: Premature closure is the tendency to stop the diagnostic process early, accepting a
initial working diagnosis without ruling out alternatives.
Question 6
Which component of the medical interview is most crucial for establishing a differential
diagnosis in over 80% of medical cases?
A. Imaging findings
B. Physical examination
C. Laboratory blood panel
D. Clinical history
Answer: D
Rationale: A thorough clinical history provides sufficient diagnostic information to formulate the
correct differential diagnosis in 80–85% of complex medical presentations.
Question 7
Which framework is widely used in UK practice for breaking bad news to patients and relatives?
A. CURB-65 score
B. SPIKES protocol
C. NEWS2 system
D. SBAR framework
Answer: B
Rationale: The SPIKES protocol (Setting, Perception, Invitation, Knowledge, Empathy,
Strategy/Summary) is the standard structured approach for delivering difficult news.
Question 8
Which term describes the probability that a disease is present before diagnostic test results are
known?
A. Sensitivity
,B. Specificity
C. Pre-test probability
D. Negative predictive value
Answer: C
Rationale: Pre-test probability represents the baseline likelihood of a condition based on
epidemiology, clinical history, and physical examination prior to testing.
Question 9
Which type of reasoning is preferred when a clinician encounters a complex, atypical, or
unfamiliar clinical presentation?
A. Hypothetico-deductive reasoning
B. Heuristic shortcutting
C. Pattern recognition
D. Intuitive Gestalt processing
Answer: A
Rationale: Hypothetico-deductive reasoning (System 2 analytical thinking) is systematic and
explicit, making it essential for complex or unfamiliar cases.
Question 10
Which aspect of the doctor-patient relationship is fundamental to shared decision-making?
A. Absolute patient autonomy without advice
B. Unilateral clinician directive
C. Strict adherence to institutional protocol
D. Alignment of clinical evidence with patient values
Answer: D
Rationale: Shared decision-making integrates the clinician's expert appraisal of evidence with
the patient's informed preferences, goals, and values.
Block 2: Short Structured / Very Short Answer (Fill-in) Items
,Question 11
What acronym represents the patient's perspective during history taking regarding their
understanding and worries about their condition?
Answer: ICE (Ideas, Concerns, Expectations)
Rationale: ICE stands for Ideas, Concerns, and Expectations, the core patient-centred
elements of the medical history.
Question 12
Name the cognitive bias where recent vivid clinical cases disproportionately influence a
clinician's diagnostic estimate.
Answer: Availability heuristic
Rationale: The availability heuristic leads clinicians to overestimate the likelihood of a diagnosis
because a recent or memorable case easily comes to mind.
Question 13
What term describes the psychological phenomenon where a diagnosis attached to a patient by
a previous doctor is accepted without re-evaluation?
Answer: Diagnostic momentum
Rationale: Diagnostic momentum occurs when a preliminary label gathers adherence as it
passes from provider to provider without critical review.
Question 14
What diagnostic value combines sensitivity and specificity to demonstrate how much a test
result alters the disease odds?
,Answer: Likelihood ratio
Rationale: Likelihood ratios (positive and negative) quantify how much a specific test result
increases or decreases the pre-test odds of disease.
Block 3: Extended Matching Questions (EMQs)
Theme: Cognitive Biases and Errors in Clinical Reasoning
Option Condition / Cause / Feature
A Anchoring bias
B Premature closure
C Confirmation bias
D Availability heuristic
E Framing effect
F Diagnostic momentum
G Sunk cost fallacy
H Base-rate neglect
Question 15
,A physician selectively orders tests that support an initial impression of acute pancreatitis while
ignoring normal amylase levels. → Select the single most likely cognitive bias from the table
above.
Answer: C
Rationale: Confirmation bias involves searching for, interpreting, and favoring information that
confirms pre-existing beliefs while disregarding conflicting data.
Question 16
A triage nurse labels a patient as 'alcohol intoxication', leading subsequent medical staff to
attribute drowsiness to alcohol without ruling out subdural haematoma. → Select the single most
likely cognitive bias from the table above.
Answer: E
Rationale: The framing effect occurs when the presentation or initial contextual description
heavily biases subsequent clinical evaluation.
Question 17
A junior doctor diagnoses gastroenteritis in an elderly patient with abdominal pain and stops
evaluating after learning of one bout of diarrhoea, missing a bowel ischaemia. → Select the
single most likely cognitive bias from the table above.
Answer: B
Rationale: Premature closure is the uncritical acceptance of an initial diagnosis before
completing a full differential evaluation.
, Question 18
A consultant overdiagnoses pulmonary embolism in three consecutive dyspnoeic patients after
attending a coroner's inquest regarding a missed fatal PE last week. → Select the single most
likely cognitive bias from the table above.
Answer: D
Rationale: The availability heuristic causes clinicians to overestimate disease frequency due to
recent emotionally striking or memorable clinical experiences.
Block 4: Key Features / Extended Reasoning Items
Question 19
A 45-year-old man presents with vague fatigue. Initial screening bloods show mild microcytic
anaemia. What is the most appropriate next step in diagnostic reasoning before ordering
invasive investigations?
A. Discharge with reassurance that fatigue is non-specific
B. Formulate a structured differential diagnosis based on pre-test probability
C. Immediately schedule urgent colonoscopy and gastroscopy
D. Prescribe high-dose oral iron supplements without further testing
Answer: B
Rationale: A structured differential diagnosis based on patient epidemiology and pre-test
probability must precede invasive diagnostic investigations.
Question 20
A clinician uses the SPIKES framework to break news of a pancreatic malignancy. After
establishing the patient's perception, what is the next sequential step?
A. Express personal regret and end the consultation
General Principles & Foundations of Endocrine, Metabolic & Neurological
Practice Medicine
Chapter 1: Diagnosis: The Art of Being a Chapter 21: Endocrinology
Doctor Chapter 22: Dermatology
Chapter 2: Human Genetics Chapter 23: Diabetes Mellitus
Chapter 3: Immunity Chapter 24: Lipid and Inherited
Chapter 4: Evidence-Based Practice Metabolic Disorders
Chapter 5: Ethical Practice Chapter 25: Liaison Psychiatry
Oncology & Critical Care Chapter 26: Neurology
Chapter 6: Malignant Disease Chapter 27: Ear, Nose and Throat, and
Chapter 7: Palliative Care and Symptom Eye Disease
Control Cardiopulmonary & Gastrointestinal
Chapter 8: Sepsis and the Treatment of Systems
Bacterial Infection Chapter 28: Respiratory Disease
Chapter 9: Water, Electrolytes and Chapter 29: Venous Thromboembolic
Acid–Base Balance Disease
Chapter 10: Critical Care Medicine Chapter 30: Cardiology
Chapter 11: Surgery Chapter 31: Hypertension
Chapter 12: Prescribing, Therapeutics Chapter 32: Gastroenterology
and Toxicology Chapter 33: Nutrition
Public & Global Health Chapter 34: Liver Disease
Chapter 13: Global Health Chapter 35: Biliary Tract and Pancreatic
Chapter 14: Public Health Disease
Chapter 15: Geriatric Medicine, Frailty Chapter 36: Kidney and Urinary Tract
and Multimorbidity Disease
Haematology & Systemic Conditions Specialized & Population Health
Chapter 16: Haematology Chapter 37: Sexually Transmitted
Chapter 17: Haematological Oncology Infections and HIV
Chapter 18: Rheumatology Chapter 38: Obstetric Medicine
Chapter 19: Bone Disease Chapter 39: Women's Health
Chapter 20: Infectious Diseases and Chapter 40: Men's Health
Tropical Medicine Chapter 41: Environmental Medicine
,Chapter 1: Diagnosis – The Art of Being a Doctor
Block 1: Single Best Answer (SBA) MCQs
Question 1
Which diagnostic reasoning strategy relies on immediate, non-analytical recognition of a clinical
presentation?
A. Bayesian probability analysis
B. Algorithmic decision-making
C. Pattern recognition
D. Hypothetico-deductive reasoning
Answer: C
Rationale: Pattern recognition (System 1 thinking) relies on non-analytical, immediate retrieval
of stored clinical exemplars from prior experience.
Question 2
Which term describes the cognitive bias of relying excessively on the initial piece of information
received when making a diagnosis?
A. Anchoring bias
B. Premature closure
C. Confirmation bias
D. Availability heuristic
Answer: A
Rationale: Anchoring bias occurs when a clinician focuses on early information or an initial
impression and fails to adjust the probability as new evidence emerges.
,Question 3
What is the primary determinant of post-test probability according to Bayes' theorem?
A. Pre-test probability and test likelihood ratio
B. Test cost and availability
C. Sample size of the validation study
D. Clinical experience of the examiner
Answer: A
Rationale: Bayes' theorem defines post-test odds as the product of pre-test odds and the
likelihood ratio of the diagnostic test.
Question 4
Which consultation model emphasizes exploring the patient's ideas, concerns, and expectations
(ICE)?
A. Paternalistic model
B. Biomedical model
C. Calgary-Cambridge framework
D. SOAP note model
Answer: C
Rationale: The Calgary-Cambridge framework structures clinical communication around both
the biomedical agenda and the patient's personal perspective (ideas, concerns, expectations).
Question 5
Which cognitive error refers to accepting a diagnosis before it has been fully verified?
A. Framing effect
B. Hindsight bias
C. Diagnostic momentum
D. Premature closure
Answer: D
,Rationale: Premature closure is the tendency to stop the diagnostic process early, accepting a
initial working diagnosis without ruling out alternatives.
Question 6
Which component of the medical interview is most crucial for establishing a differential
diagnosis in over 80% of medical cases?
A. Imaging findings
B. Physical examination
C. Laboratory blood panel
D. Clinical history
Answer: D
Rationale: A thorough clinical history provides sufficient diagnostic information to formulate the
correct differential diagnosis in 80–85% of complex medical presentations.
Question 7
Which framework is widely used in UK practice for breaking bad news to patients and relatives?
A. CURB-65 score
B. SPIKES protocol
C. NEWS2 system
D. SBAR framework
Answer: B
Rationale: The SPIKES protocol (Setting, Perception, Invitation, Knowledge, Empathy,
Strategy/Summary) is the standard structured approach for delivering difficult news.
Question 8
Which term describes the probability that a disease is present before diagnostic test results are
known?
A. Sensitivity
,B. Specificity
C. Pre-test probability
D. Negative predictive value
Answer: C
Rationale: Pre-test probability represents the baseline likelihood of a condition based on
epidemiology, clinical history, and physical examination prior to testing.
Question 9
Which type of reasoning is preferred when a clinician encounters a complex, atypical, or
unfamiliar clinical presentation?
A. Hypothetico-deductive reasoning
B. Heuristic shortcutting
C. Pattern recognition
D. Intuitive Gestalt processing
Answer: A
Rationale: Hypothetico-deductive reasoning (System 2 analytical thinking) is systematic and
explicit, making it essential for complex or unfamiliar cases.
Question 10
Which aspect of the doctor-patient relationship is fundamental to shared decision-making?
A. Absolute patient autonomy without advice
B. Unilateral clinician directive
C. Strict adherence to institutional protocol
D. Alignment of clinical evidence with patient values
Answer: D
Rationale: Shared decision-making integrates the clinician's expert appraisal of evidence with
the patient's informed preferences, goals, and values.
Block 2: Short Structured / Very Short Answer (Fill-in) Items
,Question 11
What acronym represents the patient's perspective during history taking regarding their
understanding and worries about their condition?
Answer: ICE (Ideas, Concerns, Expectations)
Rationale: ICE stands for Ideas, Concerns, and Expectations, the core patient-centred
elements of the medical history.
Question 12
Name the cognitive bias where recent vivid clinical cases disproportionately influence a
clinician's diagnostic estimate.
Answer: Availability heuristic
Rationale: The availability heuristic leads clinicians to overestimate the likelihood of a diagnosis
because a recent or memorable case easily comes to mind.
Question 13
What term describes the psychological phenomenon where a diagnosis attached to a patient by
a previous doctor is accepted without re-evaluation?
Answer: Diagnostic momentum
Rationale: Diagnostic momentum occurs when a preliminary label gathers adherence as it
passes from provider to provider without critical review.
Question 14
What diagnostic value combines sensitivity and specificity to demonstrate how much a test
result alters the disease odds?
,Answer: Likelihood ratio
Rationale: Likelihood ratios (positive and negative) quantify how much a specific test result
increases or decreases the pre-test odds of disease.
Block 3: Extended Matching Questions (EMQs)
Theme: Cognitive Biases and Errors in Clinical Reasoning
Option Condition / Cause / Feature
A Anchoring bias
B Premature closure
C Confirmation bias
D Availability heuristic
E Framing effect
F Diagnostic momentum
G Sunk cost fallacy
H Base-rate neglect
Question 15
,A physician selectively orders tests that support an initial impression of acute pancreatitis while
ignoring normal amylase levels. → Select the single most likely cognitive bias from the table
above.
Answer: C
Rationale: Confirmation bias involves searching for, interpreting, and favoring information that
confirms pre-existing beliefs while disregarding conflicting data.
Question 16
A triage nurse labels a patient as 'alcohol intoxication', leading subsequent medical staff to
attribute drowsiness to alcohol without ruling out subdural haematoma. → Select the single most
likely cognitive bias from the table above.
Answer: E
Rationale: The framing effect occurs when the presentation or initial contextual description
heavily biases subsequent clinical evaluation.
Question 17
A junior doctor diagnoses gastroenteritis in an elderly patient with abdominal pain and stops
evaluating after learning of one bout of diarrhoea, missing a bowel ischaemia. → Select the
single most likely cognitive bias from the table above.
Answer: B
Rationale: Premature closure is the uncritical acceptance of an initial diagnosis before
completing a full differential evaluation.
, Question 18
A consultant overdiagnoses pulmonary embolism in three consecutive dyspnoeic patients after
attending a coroner's inquest regarding a missed fatal PE last week. → Select the single most
likely cognitive bias from the table above.
Answer: D
Rationale: The availability heuristic causes clinicians to overestimate disease frequency due to
recent emotionally striking or memorable clinical experiences.
Block 4: Key Features / Extended Reasoning Items
Question 19
A 45-year-old man presents with vague fatigue. Initial screening bloods show mild microcytic
anaemia. What is the most appropriate next step in diagnostic reasoning before ordering
invasive investigations?
A. Discharge with reassurance that fatigue is non-specific
B. Formulate a structured differential diagnosis based on pre-test probability
C. Immediately schedule urgent colonoscopy and gastroscopy
D. Prescribe high-dose oral iron supplements without further testing
Answer: B
Rationale: A structured differential diagnosis based on patient epidemiology and pre-test
probability must precede invasive diagnostic investigations.
Question 20
A clinician uses the SPIKES framework to break news of a pancreatic malignancy. After
establishing the patient's perception, what is the next sequential step?
A. Express personal regret and end the consultation
