HKMLE Part III

In a medicine long-case station, a 62-year-old man presents with exertional chest tightness. Which opening question best establishes the symptom chronology without leading the patient?

• AWhen did the chest discomfort first start, and how has it changed since then?
• BIs the pain crushing and brought on by exertion?
• CYou have angina, correct?
• DDo you want an ECG before we talk?

A patient with sudden right-sided weakness and expressive aphasia arrives within 90 minutes of onset. What is the safest immediate priority?

• ACheck capillary glucose and arrange urgent non-contrast CT brain
• BGive aspirin before imaging
• CSend the patient home if symptoms are improving
• DDelay assessment until a family member confirms the history

During examination of a patient with suspected chronic liver disease, which finding most directly supports portal hypertension?

• ACaput medusae with ascites
• BTender hepatomegaly alone
• CRight iliac fossa tenderness
• DIsolated clubbing

A 58-year-old woman with fever, productive cough, respiratory rate 32/min, and oxygen saturation 88 percent on air is assessed in an acute ward. What is the best first management step?

• AGive oxygen, assess sepsis risk, obtain cultures if appropriate, and start timely antibio…
• BArrange outpatient sputum culture and review in 1 week
• CStart oral antihistamine and discharge
• DWait for chest radiograph before giving oxygen

In a thyroid short-case station, which sign most strongly suggests Graves disease rather than simple multinodular goitre?

• ALid lag with diffuse goitre and fine tremor
• BA solitary hard nodule fixed to surrounding tissue
• CA normal pulse with a smooth non-tender goitre
• DTender thyroid after an upper respiratory infection

A diabetic patient has a plantar ulcer with surrounding cellulitis. Which examination element is most important to include before proposing management?

• APeripheral pulses, capillary refill, neuropathy testing, and probe-to-bone assessment
• BOnly the ulcer diameter
• COnly the patient's preferred dressing brand
• DOnly inspection of the other foot

A patient with acute severe asthma is unable to complete sentences and has widespread wheeze. What should be done first?

• AGive high-flow oxygen and inhaled bronchodilator treatment while assessing severity
• BAsk the patient to perform peak flow before treatment
• CGive an oral antibiotic as the first intervention
• DReassure and review after observation only

In a cardiovascular examination station, a collapsing pulse and early diastolic murmur at the left sternal edge most strongly suggest which valve lesion?

• AAortic regurgitation
• BMitral stenosis
• CPulmonary stenosis
• DTricuspid regurgitation

A man presents with a painful irreducible groin swelling, vomiting, and abdominal distension. What is the most appropriate next step?

• ATreat as possible strangulated or obstructed hernia and arrange urgent surgical assessment
• BReassure him that all groin hernias can wait for clinic repair
• CAttempt repeated forceful reduction until the lump disappears
• DPrescribe laxatives and discharge

A 23-year-old has migratory periumbilical pain to the right iliac fossa, fever, and localized guarding. Which diagnosis is most likely?

• AAcute appendicitis
• BUncomplicated gastroenteritis
• CRenal colic
• DPeptic ulcer disease

In a breast lump station, which initial clinical approach is most appropriate for a new hard breast mass in a 48-year-old woman?

• ATriple assessment with clinical examination, breast imaging, and tissue diagnosis
• BReassure because most breast lumps are benign
• CPrescribe antibiotics without examination
• DSchedule review in 1 year

A patient has a hot swollen calf after recent surgery and is short of breath. What is the best immediate reasoning?

• ASuspect venous thromboembolism and assess urgently for DVT and pulmonary embolism
• BDiagnose simple muscle strain and discharge
• CMassage the calf to relieve swelling
• DDelay assessment until the surgical wound has healed

A wrist injury shows dorsal displacement after a fall on an outstretched hand. What must be checked and documented before and after reduction?

• ADistal neurovascular status
• BThe patient's occupation only
• CThe brand of plaster used
• DWhether the patient can sign with the injured hand

In a surgical OSCE station, a patient with jaundice has pale stools, dark urine, and a palpable gallbladder. Which pattern does this most suggest?

• AObstructive jaundice, possibly malignant distal biliary obstruction
• BGilbert syndrome
• CHaemolysis only
• DUncomplicated viral pharyngitis

A patient has a painful swollen knee after trauma. Which feature most strongly suggests possible compartment syndrome in a limb injury station?

• APain out of proportion and pain on passive stretch
• BMild bruising over the patella
• CA small superficial abrasion
• DPain that settles completely with simple analgesia

A woman of reproductive age presents with lower abdominal pain and a positive pregnancy test. What diagnosis must be excluded urgently?

• AEctopic pregnancy
• BIrritable bowel syndrome
• CPrimary dysmenorrhoea only
• DUncomplicated cystitis only

A 34-week pregnant woman has headache, visual symptoms, blood pressure 170/110 mmHg, and proteinuria. What is the most appropriate initial action?

• AAdmit urgently, treat severe hypertension, assess mother and fetus, and prevent seizures
• BReassure and review after delivery only
• CAdvise salt restriction as the only treatment
• DPrescribe migraine medication and discharge

Immediately after delivery, a patient has heavy vaginal bleeding and a soft enlarged uterus. What is the most likely cause?

• AUterine atony
• BVulval varicosities
• CUrinary tract infection
• DPhysiological lochia only

A 28-year-old woman has lower abdominal pain, fever, cervical motion tenderness, and mucopurulent discharge. Which diagnosis best fits?

• APelvic inflammatory disease
• BUncomplicated vulvovaginal candidiasis
• CNormal ovulation pain
• DStress urinary incontinence

A woman in labour has sudden fetal bradycardia after rupture of membranes and a cord is felt at the introitus. What should be done immediately?

• ACall for help, relieve cord compression manually, position the mother, and expedite deliv…
• BAsk the mother to walk around
• CWait for the next routine cervical assessment
• DGive oral fluids and observe

A woman requests contraception and is breastfeeding 4 weeks postpartum. Which counselling principle is most appropriate?

• AAssess medical eligibility, breastfeeding status, preferences, and need for STI protectio…
• BTell her all hormonal contraception is absolutely contraindicated while breastfeeding
• COffer only emergency contraception
• DAvoid discussing condoms because she is married

A 4-year-old has fever for 6 days, bilateral non-purulent conjunctivitis, cracked lips, rash, and swollen hands. What is the most likely diagnosis?

• AKawasaki disease
• BSimple viral coryza
• CScabies
• DIron deficiency anaemia

A 10-month-old with diarrhoea has dry mucous membranes, sunken eyes, and reduced urine output but is alert. What is the best initial management?

• AAssess dehydration severity and give oral rehydration if no shock or contraindication
• BGive antidiarrhoeal medication as first-line treatment
• CWithhold all fluids for 12 hours
• DStart broad chemotherapy

A wheezy 7-year-old uses accessory muscles and has oxygen saturation 90 percent on air. What is the most appropriate immediate action?

• AGive oxygen and inhaled bronchodilator promptly while assessing severity
• BAsk the child to run to demonstrate exercise tolerance
• CDelay treatment until spirometry is available
• DGive cough syrup and discharge

A 2-month-old has fever and appears mottled with poor feeding. What is the safest disposition?

• AUrgent paediatric assessment for possible serious bacterial infection or sepsis
• BHome observation only because fever is common
• CGive paracetamol and defer review for 1 week
• DTreat as teething

A newborn in Hong Kong is being discharged from a maternity unit. Under the Hong Kong Childhood Immunisation Programme, which vaccines are scheduled at birth?

• ABCG and first dose hepatitis B vaccine
• BMMR and varicella
• CHPV vaccine
• DDTaP-IPV booster only

A parent brings a child with multiple bruises of different ages and an explanation that does not fit the injuries. What should the candidate do?

• AEnsure immediate safety, examine carefully, document objectively, and escalate safeguardi…
• BIgnore the bruises if the parent seems pleasant
• CAccuse the parent of abuse in front of the child
• DDischarge without documentation to avoid conflict

In a Hong Kong clinical station, the patient speaks Cantonese and the candidate selected English on the application form. What is the most professional approach if communication is not adequate?

• AUse the arranged interpreter or request appropriate language support and speak directly t…
• BAsk a nearby child relative to translate sensitive details
• CContinue in English even when the patient does not understand
• DAvoid history taking and rely only on examination

A patient is anxious about an intimate examination. According to MCHK professional expectations, what is the best response?

• AExplain the reason, obtain consent, offer a chaperone, and document the discussion
• BProceed quickly without explanation
• CRefuse all intimate examinations
• DAsk the patient to sign a blank consent form

A patient asks for a sick leave certificate for dates before you first assessed them. What professional principle should guide the response?

• ACertify only what you have personally verified or can properly support from records
• BWrite any dates requested to preserve rapport
• CAsk the patient to fill in the diagnosis later
• DIssue the certificate without documenting the consultation

A 68-year-old with exertional dyspnoea has bibasal crackles, raised JVP, ankle oedema, and an S3 gallop. Which investigation best confirms cardiac systolic or diastolic dysfunction?

• AEchocardiography
• BPlain abdominal radiograph
• CUrine dipstick only
• DSkin prick testing

A patient with chronic cough, weight loss, night sweats, and upper-zone changes on chest radiograph is seen in Hong Kong. What public-health action is required if tuberculosis is suspected or confirmed?

• ANotify the Centre for Health Protection through the statutory notification pathway
• BWait until treatment is completed before notifying
• CNotify only if the patient consents
• DNo notification is needed for pulmonary disease

A 45-year-old with epigastric pain has haematemesis and postural dizziness. What is the best initial management sequence?

• AAssess airway and circulation, obtain IV access, resuscitate, crossmatch blood, and arran…
• BGive oral antacid and discharge
• CPerform elective outpatient endoscopy in several months
• DEncourage oral fluids before checking observations

A patient with atrial fibrillation has acute palpitations but is hypotensive, confused, and has chest discomfort. What is the most appropriate management?

• AUrgent synchronized electrical cardioversion with resuscitation support
• BRoutine outpatient Holter monitoring
• COral rate control and discharge
• DValsalva manoeuvre only

A patient has fever, dysuria, flank pain, vomiting, and tachycardia. Which management plan is most appropriate?

• ATreat as acute pyelonephritis with sepsis assessment, cultures, IV fluids, and empiric an…
• BDiagnose uncomplicated cystitis and give only urinary alkalinizer
• CDelay treatment until a routine outpatient ultrasound
• DAdvise no fluids until fever resolves

A man with known COPD is drowsy, cyanosed, and has oxygen saturation 82 percent on air. What is the safest immediate approach?

• AGive controlled oxygen, obtain arterial blood gas promptly, and escalate ventilatory supp…
• BWithhold all oxygen because COPD patients retain carbon dioxide
• CGive high-dose sedative to reduce respiratory distress
• DDischarge if wheeze improves after one nebulizer

A patient with long-standing hypertension has sudden tearing chest pain radiating to the back and unequal arm blood pressures. Which investigation is most appropriate if stable?

• ACT aortogram
• BExercise treadmill test
• CBarium swallow
• DPlain wrist radiograph

A confused diabetic patient is sweating and capillary glucose is very low. What should be done first?

• ATreat hypoglycaemia immediately and reassess consciousness
• BWait for laboratory glucose confirmation
• CGive rapid-acting insulin
• DSend for CT brain before treatment

A patient has fever, neck stiffness, photophobia, and a non-blanching rash. What is the best immediate management?

• ATreat as suspected meningococcal sepsis or meningitis with urgent antibiotics and resusci…
• BWait for outpatient lumbar puncture
• CGive oral antihistamine for the rash
• DDischarge with advice to rest

In a neurology short case, a patient has spastic weakness, brisk reflexes, and an extensor plantar response. What lesion pattern is most likely?

• AUpper motor neuron lesion
• BLower motor neuron lesion
• CNeuromuscular junction disorder only
• DFunctional visual loss

A febrile traveller returning to Hong Kong from Southeast Asia has severe headache, retro-orbital pain, myalgia, rash, and thrombocytopenia. What is an important local public-health step if dengue is suspected?

• ANotify the Centre for Health Protection because suspected or confirmed notifiable infecti…
• BAvoid notification unless mosquito breeding is seen at home
• CStart aspirin for pain relief
• DTell the patient dengue spreads directly person to person

A patient with rheumatoid arthritis has painful swollen small joints, morning stiffness lasting more than an hour, and reduced grip. What is the best management principle?

• ARefer early for disease-modifying treatment while controlling pain and preserving function
• BUse only long-term oral steroids without review
• CAdvise complete bed rest for several months
• DIgnore joint swelling if X-rays are initially normal

A frail older patient develops acute confusion after admission. Which approach is best?

• ALook for reversible causes, review medications, optimize hydration, pain, sleep, vision,…
• BDiagnose dementia without further assessment
• CUse physical restraints as first-line treatment
• DGive benzodiazepines routinely to all delirious patients

A patient has sudden painless monocular visual loss described as a curtain descending. What is the most appropriate next step?

• AUrgent ophthalmology assessment for possible retinal detachment
• BRoutine optometry review in 6 months
• CTreat as conjunctivitis
• DGive only migraine advice

A patient with suspected sepsis has hypotension after initial fluid resuscitation and rising lactate. What should the candidate do?

• AEscalate urgently for senior and critical-care input while continuing source control and…
• BWait until morning ward round
• CStop monitoring once antibiotics are prescribed
• DAvoid documenting observations

In a non-interactive surgical station, an abdominal CT shows free intraperitoneal air under the diaphragm in a patient with severe epigastric pain. What is the best diagnosis and action?

• APerforated viscus requiring resuscitation and urgent surgical review
• BSimple constipation suitable for laxatives
• CRenal colic requiring only hydration
• DUncomplicated gastritis for outpatient antacid