SMLE 2019

ETHICS

Corrected By: Glory team

 SMLE 2019
Glory team
All Ethics questions

N.B: yellow highlights = Correct answers.

N.B: green highlights = Not sure.
1. dr ask you to prepare the RT kidney for op but u are sure it was the LT
one what should u do:
a- tell the surgeon
b- tell chief intern
c- review imaging scan
d- ethical committee

2. dr prescripe medication to the pt but the pharmacist thinks that the pt is

allergic to it what should u do :
a- Ask doctor to sign it
b- refuse to give medication

3- gyn explain to the pt that HRT will not help her menpousal symptom at
this stage but the pt insist to have it what should he do:
a- Dont give it to her
b- give her
c- refer her
note: humbly decline is better
You as a part of the medical system. You should refuse anything that might
cause harm to the patient in a direct or indirect way.
In this situation, you should tell your supervisor. If he did not accept, you
should tell the attending. If still no response, you should report immediately
to the dean of medicine. Patient care and safety always come first. No
matter what is the position of the person who is asking you to do so.
Never prescribe any drug that might be harmful for the patient.

4. pt were inappropriate clothes and speeks inappropritaly to the dr what

should he do:
Get nurse speak same language .

5- 6 months old infant his parent brought him for one complaints and through
PEx u notice some signs of child abuse:
a- Call social service
b- call child protection
6- Mother with appeared with some mental retardation Parents want to
take hime back home:
a- Called child protection
b- contact ethics

7- coupls with infertility ask about serogate pregnancy u are not sure wither
allowed in saudi or not:
a- Warn them might not be allowed
b- appointment to check yourself
If you have information A
No information give appointment

8.elderly with endstage cancer in unbearable pain his family ask u to give him
stronger pain killer :
Give him stronger analgesic

9. pt doesn’t want to know the details, u r the surgeon appreciated that , but
the anesthsic dr insist:
Tell the pt the decision of th dr

10- 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
Explanation:-
Certain infectious diseases with important public health significance are
reportable immediately to the appropriate local health department.
And she should be reported to the spouse if the partner refused to tell
them.
Encouraging the conversation between them is usually the best action to be
done before the physician tells the spouse.

11.dr after explain to pt what is next mx and explor there emotion went
through the main points again.What did he do is:
Summarisation

12- 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

12. 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.
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

13.DNR pt in respiratory distress surgeon thinks depulking surgery might be

helpful but might be fatal:
Dont do it respect patient wish .
Take high risk consent

14.u were late pt start to shout and angry:

Acknowledge his anger

15. female pt wants female to examine her:

Respect

16 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 comitt

17.not immunised child:

Explain the binfit to the family

18.consent in case of IUD to be taken consent from:

A- wife
B- husband
C- mutual from both

20. pt. Wants u to do his surgery forcefully and threatens you

A- do his surgery
B- refuse for surgery
C- call the admin

21.a doc on round prescribed some medicine for pt. That is not good
according to the pharmacist but doctor insisted to prescribe that and tells
the intern to write down orders:
a- write it down and get it signed from the consultant
b- refuse to do anything

22. a doc preparing to operate rt kidney but intern has some doubts that left
kidney needs to be operated :
inform about his concern to the consultant

23.a surgeon mistakenly left something inside the abdomen of the pt

during operation:
a- explain to the pt ,apologize and remove that thing
b- report to consultant
c- ethical com

24. 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
B. Do the surgery without consent
C. Refuse to do it as no one to sign
If emergency B
Not Emergency A

25. 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 veiw
c. Apologize to him and start with close ended questions
If she was talking about unrelated thing > C
But since she is talking about her diagnosis > let her finish

26.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 partient what anaesthesia doctor want
D.let the anesthesia doctor deal woth the patient

27.Male smoker go to clinic asking that he want to quiet how to start this step
is:
a. Preparation

28. Best way to stop smoking in pregnant is :

a. Behavioral way
b. bupropion
c. Electronic smoking
d. Alternative to smoke

29. 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
b. Increase iv fluid intake
c. Daily reveiw for the need of foly catheter
d. Change foly catheter before discharge .

30. 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 .

31. For newly hired female employee the sexual harrasment mostly include :
a. Client
b. Supervisore
c. Colleges
D. Co worker.

32.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

33. 12y old attitude toward parent illness :

a. Cant comprehensive the concept of disease treatment prognosis
b. Depression withdrawal response
c. Forget
‫السؤال كان وش تتوقع ردة فعل منه تجاه مرض امه وابوه عىل عمره‬
 A. ‫االول مايفهم مبدأ المرض‬

B. ‫الثان انه يكابر ويوضح القوه‬

‫ي‬

C. ‫الثالث انه ينام بدري وتبان اعراض الحزن‬

D. ‫الرابع انه يمثل اعراضهم ب دم‬

34. Post truma patient hah right side fractures in ribs fron rib 2 to 5 Patient had
respiratory distress cxr show wide mediastinum . U want to transfer the patient
to other advanced center most important step :
a. intubation
b. call the other center and talk to the senior surgeon there tell him details about
case

35. 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

36. Patient admitted to icu asked to not be resusitated before and sign form for
this he had arrested no resuscitstion done And die his son came complain why
not resusciting hus father :
a. Tell him that you respect his father wish
b. Father has terminal illness
c. No resuscitation in brain death cases

37. 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
38.case u admitted dx with ebola want to leave the hospital what to do :
a. Call security
b. Refer to infectiouse department
c. Sign form of leave against medical advice
Ebola highly contagious + life threatening

39. Copd elderly admitted exerberation at night became aggresive disoreinted

what the nurse should do first:
a. Call the duty dr for lorazepsm iv
b. Restrain her
c. Call family sit beside her
d. Elevate head of bed put nasal oxygen try to oreinted her about place and time

40. Couple want to do surogacy came to you and you dont know if allowed what
to do :
Warn them not allowed in KSA

41. Surgeon diagnosed a pt with appendicitis then he decided to do surgical

appendectomy. Intraoperatively he found appendix normal. Then doctor
removed the appendix. What is the most Appropriate action with regards to this
decision?
A- Tell the patient that Dr found appendix normal and removed it
according to guidelines
B- Don't tell patient
C- Call another Surgeon to tell him
D- Inform the ethical communication in Hospital

42. 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 the medication compliance
B. call the police
C. involve the parents and the child in the medical plan
D.refer them to the Ethics Committee

43. 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 evacuation as post partum care
C.Search for cause of abortion

44. 75 years old has terminal lung cancer , he can’t breathe , he can’t make
decision very well, the doctor want 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
Pt canot make a decision so C

45. Postmenopausal women come to take HRT. You said she didn't need it. She
insisted to take it. What to do?
A. Prescribe HRT to her
B. Don't give it
C. Consult Hospital authority
D. Refer to another Gynecologist

46. Child brought by his parents With meningitis. You need to do

emergency LP. What to do?
A-Do Lp without consent
B-Take consent from parents
C-Take consent from parents and child
D-Abstent from child, consent from parents
E-Abstent from parents, consent from child
Summary for pediatric consent
If age below 7 years : take consent from parents
If age between 7 to 17 years : assent the child and consent from the parents
If age 18 and more years : he is adult so take consent from him only

47. While you are doing a surgery, you made a surgical mistake then
you corrected it. What to do?
A-Tell patient
B-Don't tell patient
C-Write report on the case

48. Infant abandoned by his mother after delivery, pediatric surgen reviewed
the case and it was 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
Please don’t do anything without consent
Except for life-saving or limb-saving
Even if it was critical diagnosis
If emergency it will be C

49. Surgeon was doing lab cholecyctectomy and faced difficult anatomy there
was an injury to a structure. Then bleeding occurred and Surgeon repaired the
problem. After surgery what would you do?
A-Tell the patient what happened
B-Tell the patient lawyer to prepare for lawsuit
C-Tell hospital administrators to take action against you
D-Don't tell anybody

50. 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 best answer is explain to the mother then give him
B. Ignore

51. Pregant wants to quote smoking best way

A. CBT
B. Nicotine replacement
C. Buprine

52. 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

53. If patient is HIV ve+, tell him only and tell him to till his wife but doctor
should tell the authorites. 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

54. 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 for surgery with another anesthesia doctor
B- take high risk consent
C- involvement of family in decision
D- involve Hospital committe

55. 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

56. 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

57. Doctor asked the resident to give antibiotic to the patient but resident think
that the patient had sensitivity to it. What to do as a resident?
A-Ask doctor to sign the order.
B-Give the patient the antibiotic.
C-Neglect the doctor order.

58. Family think vaccine harm son. What to do?

A-Counseling and Explain to family the advantages and importance of vaccines.

59. Increase domestic violence in ?

A- pregnancy
60. 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

61. 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

62. a pt with IUFD

A- tell the pt
B- tell her husband
C- tell her relatives

63. consent in case of IUFD to b taken from

A- husband
B- wife
C- relatives
Intrauterine fetal device = taking from both

64. a pt with IUFD

A- console the couple and ask them for follow up visit after few days
B- let the mother spend some time with her dead child
65. pt newly dx with HTN and doctor tell him about disease and complication
and medicationt what doctor did?
A-give informational case
B-build bonding with pt

66. 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
C-autonomy
D-confidenenality

67. parent 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

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

A-employee
B-co-worker
C- supervisor

69. child presented with BA exacerbation , father heavy smoker and u warn him
many times before but he is careless what should u do
A- Not interfer anymore
B- Called child protection agency

70. U were late and pt start to shout and angry. What to do?
A- Explain to him why u r late
B- Acknowledge his feelings.

71. pt refuse suregeryand u explain :

a-Respect her decision

72. pt came to sign consent for hystrectoy

a-Give her detals about surgery
b-Make documentation clear

73. normal bereavement case?

Sadness , 2-3 months .. not exceeding 12 months
74. 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

75. elderly not compliant to medications. What to do?

A. worry him about carelessness
B. tell family to carry of him

76. 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

77. 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
78. 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

79. Pt with charcot leg the treating doctor decide to do amutation but pt refue
what to do ?
A. Refer to another doctor
B. Respect his wishes
C. Sign for discharge
- IF SIGN DAMA , chose it –

80. 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.

81. 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

82. Want to stop smoking, went to hospital and asked for treatment::
a. action
83. A doctor is giving a lecture about hypertension and its medication, A drug
company
representative came to you: what will you do?
Physicians ought to refuse to visit with representatives as a matter of both
professional integrity and sensible time management.

84. You got invited in diabetes campaign, and they offered you to advertise
about a drug, what to do:
A-Avoid any inform about drug…

85. 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.

86. 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

87. 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.
88. A man newly diagnosed with type 2 diabetes 2 weeks ago, he came for
follow up with you at the clinic. You were busy in the ward. His appointment is
supposed to be at 10:00 and now it is 11:15, the patient is very angry. What
should you do?
A) explore the reason of his anger
B) explain why you are late
C) show empathy to his newly diagnosed condition.

89. 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!!!
B-Inform hospital police!!!
C- Don't do surgery!!!
D- explain to the mother
-If she refused let her sign Discharge Against Medical Advice (DAMA)-

90. 21 yrs female came to ER with sign and symptoms of Appendicitis ,

Appendectomy was done after few days pt complain of same symptoms ,
surgeon deiced reopening he shocked. when knowing they left gaze inside ,
what surgeon should be do ?
a- Complain the assistant to legal committee
b- Ask help from another surgeon
c- Tell pt what happened with empathy
d- Tell his lawyer and ask to defend

91. 2- 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

92. Asthmatic child ( 7 year ) always came to ER and father was smoker and
every time the doctor advice him to quit smoking but he not listening and
careless , child right now complain severe attack , what you will do ?
a- Talk the father about that habit
b- Tell hospital committee
c- Treat the child and forget that situation

93. Male doctor want to examine his female patient, what he suppose to do?
Call for a nurse
Expose area that needed only

94. Couple come by infertility after investigation done show bilateral fallopian
tube obstruction what will do?
Tell wife
Tell husband
Tell couple

95. Pt with hx of hernia , he came now complaining of pain and he want to make
a complain against u bexuz u dont want to do the surgery, what should u do?
- do the surg
- cal the security
- referral to another surgeon
96. How to inform the society about poisons dangerous ?
- through media
- u will do camp and talk about it
- tell fathers and mothers about it
- do awareness campaigns and explain the danger of it

97.patient has intra operative common bile duct injury but controlled :
- tell the patient and reassure him
- Reassure him but dot tell him about what happen

98. asthmatic patient his father is smoker

- stick to child management
- send the parents educational material about effect of smoking on their
child asthma
- Encourage parents to quit smoking

99. 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)
- assess understanding
- Setting Agenda
- Setting ....
- Probing

100. physician was examining patient in front of his students and forgot to
cover part of patient body after he finished which of the following has been
broken :
- patient dignity
- Patient privacy
- Patient confidentiality

101. Child came to ER cyanotic , his mother saying he is crying for

1h ?
Calm him down and reassurance
- send to surgical intervention

102. 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

103. 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

104. 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
105. 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

106. 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 n console the couples emotions

107. Old pt diagnose with TB doctor start anti TB medication then pt have liver
failure and son angry
a. explain this could be happen
b. Doctor give him right medication
c. This incident will be investigated

108. Women go for CS her husband refuse who should sign

a. Father
b. Doctor
c. Wife
d. Husband

109. Mother her baby die what you will do

a. give him follow up
b. Ask father to sign something
c. Let the mother take some time with her baby

110. DNR and family refuse doctor arrogance meeting with family to :
A. Justify
B. inform

111. 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

112. 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?
- don’t tell him what happens
- Tell him and reassure him now that is no complication
- Tell Hospital ethics ...

113. Most important step in managing asthma child to insure compliance to

treatment?
A. Listen to child and answer his concerns
B. Write a plan
C. Send nurse to check compliance
114. 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

115. 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

116. 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
N.B: Call security then immediate isolation of the patient. There is
another question similar with Isolation in choices so true.

117. IUFD, what to do?

A- IOL
B- CS
C- Wait for SVD or D&E
D- Ask Pt opinion

117. 42yrs old female came to your clinic with heavy uterine bleeding
on us there uterine hyperplasia, biopsy should taken what you should
do?!
A- Verbal consent
B- Call the anaesthesia
C- Prepare the pt for immediate biopsy

118. Newborn need incubation but the parents refuse because of

death of 2brothers for the same condition before what you should do?
A- Ignore them and do intubation
B- Call the hospital committee
C- Call the security
D- Respect their wishes

119. child refuse to walk with his mother.. Always thriw his toys. The way to
deal with him
A- Time out
B- Verbal warning and shout at him
C- Sparkling
D- Scodling