Free SMLE Ethics & Preventive Medicine questions

A 51-year-old woman with COPD attends her primary care clinic. She had a painful thoracic dermatomal rash diagnosed as herpes zoster 3 years ago, which healed fully, and she is worried about a recurrence. She uses inhaled tiotropium and salbutamol only and takes no systemic corticosteroids or other immunosuppressants. She has had no shingles vaccine. What is the most appropriate advice?

A 52 year old asymptomatic man attends for a preventive health visit. He has no family history of cancer, has never smoked, and has a normal physical examination. He asks which cancers he should be routinely screened for in the absence of symptoms or specific risk factors. Which of the following cancers warrants routine screening in him?

A 45-year-old woman returns to theatre on day 3 after laparotomy for perforated appendicitis because of fever, a rigid abdomen and vomiting. Her white cell count is 27 × 10⁹/L with 95 percent neutrophils and creatinine is 87 micromol/L. A retained surgical sponge is found in the peritoneal cavity and removed. Which action by the operating surgeon is most appropriate?

A 28-year-old woman at 14 weeks of gestation attends the clinic to update her immunisations. She is well, has no allergies, and her rubella IgG is negative. She plans to travel abroad and asks which vaccines she may safely receive during this pregnancy. Which of the following vaccines is contraindicated at this time?

A 50-year-old woman with menorrhagia from a large uterine fibroid attends the clinic to complete the consent form for an elective abdominal hysterectomy. The surgeon explains the indication, the alternatives, the operative risks and the expected recovery, and the patient asks appropriate questions and agrees. Which of the following is the most important remaining step in the consent process?

A 27-year-old woman attends a primary care clinic with multiple bruises at different stages of healing on her arms and trunk. She says she fell down stairs, but the explanation does not match the pattern of injury. She has been married four years. Which of the following factors most strongly predicts intimate partner violence in a relationship?

A 27-year-old soldier will deploy for three months to the southern border region of Saudi Arabia, working outdoors in intense sunlight. He takes fluoxetine for depression, which is well controlled, and has no other medical problems or drug allergies. He attends the travel clinic for advice on preventing malaria. Which of the following is the best chemoprophylaxis regimen?

A 34 year old man plans a six week business trip to rural Nigeria, an area with intense year round Plasmodium falciparum transmission. He has no chronic illness and takes no medications. He asks the travel clinic what single measure will best protect him against malaria during the trip. Which of the following is the most appropriate recommendation?

Over one week, a family physician at a primary health care centre in a small town sees a 22-year-old man with urethral discharge and a positive Chlamydia trachomatis NAAT, a 25-year-old woman with bacterial vaginosis, an 18-year-old man with infectious mononucleosis, and a 70-year-old man with community-acquired pneumonia without an identified organism. Which condition must be notified to the Ministry of Health?

A 48-year-old woman has four months of progressive dysphagia to solids and liquids with 8 kg weight loss and mild anaemia. Upper gastrointestinal endoscopy is recommended, but she refuses because a relative died shortly after a colonoscopy. She is fully alert and competent. Which is the most appropriate next action by the physician?

A 47-year-old male public-health physician is revising a regional prostate cancer early-detection programme. An audit shows that many men with raised prostate-specific antigen had benign prostatic hyperplasia or indolent tumours, and several underwent biopsies and radical treatment with incontinence or erectile dysfunction. Which of the following strategies best addresses this problem while preserving the benefit of testing?

A 24-year-old woman attends a sexual health clinic after being treated for chlamydia. She has several male partners, uses a levonorgestrel intrauterine system for contraception, and states that she does not intend to stop having multiple partners. Today her HIV, syphilis and hepatitis B tests are negative. She asks which single measure would best reduce her risk of acquiring further sexually transmitted infections. What is the best advice?

A 60 year old man has smoked one pack daily since age 20. During counselling he asks how his risk of lung cancer compares with that of a lifelong nonsmoker of the same age. His chest radiograph is clear and he has no respiratory symptoms. Approximately how many times higher is his lung cancer risk?

A 34-year-old Saudi man living in Abha plans to perform Hajj and will travel to Makkah in 4 weeks. He has never received a meningococcal vaccine. He is well, has no chronic illness and has had no contact with anyone with meningitis. He asks what he needs to protect himself against meningococcal disease. What is the most appropriate preventive measure?