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Clinical medical question bank

Practise every clinical specialty with explained SBAs.

Recall Engine's clinical question bank has 18,000+ single best answer questions across 1,000+ topics in 15 specialties. The largest are Internal medicine, Surgery, and Paediatrics. Every question explains each option.

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Clinical specialties

Clinical has 15 specialties and 1,000+ topics. Each one below shows its questions and opens its own page with every topic.

Clinical sample questions

These 5 are published clinical questions shown exactly as students see them. Open an answer to see why it is right and why every other option is wrong.

Question 1 · Surgery, Clinical

A 74-year-old man taking aspirin has had 8 hours of sudden epigastric pain and now has generalised tenderness with guarding. Pulse is 104 per minute, temperature 37.6 C, white cell count 15 x 10^9/L, and lipase is normal. An erect chest radiograph shows no gas under either hemidiaphragm. What is the most appropriate next investigation?

  1. A. Abdominal ultrasound of the upper abdomen
  2. B. Observation with repeat examination in 6 hours
  3. C. CT of the abdomen and pelvis with IV contrast
  4. D. Barium meal and follow-through study
  5. E. Urgent upper gastrointestinal endoscopy
Show the answer and explanation

Answer: C. CT of the abdomen and pelvis with IV contrast

Sudden pain with generalised guarding and leucocytosis in an aspirin user makes perforation likely, and the erect film does not change that: plain films show free gas in only about 30 to 85 percent of perforations, so a negative film never excludes it. CT is the preferred test because it shows small amounts of free gas and fluid and often the site; water-soluble oral contrast can be added if doubt remains. Normal lipase makes pancreatitis less likely.

Why the other options are wrong

  • A. Abdominal ultrasound of the upper abdomen: Ultrasound is limited by bowel gas and operator skill and is poor at showing small volumes of free gas, so it would not reliably confirm or exclude perforation here.
  • B. Observation with repeat examination in 6 hours: Observation accepts a false negative film; generalised guarding with leucocytosis after sudden pain needs a diagnosis now, and delay worsens outcome after perforation.
  • D. Barium meal and follow-through study: Barium leaking through a perforation causes a severe barium peritonitis, so it is avoided whenever perforation is suspected, as it is in this man with peritonism.
  • E. Urgent upper gastrointestinal endoscopy: Endoscopy needs air insufflation, which can enlarge a perforation and does not show free gas or fluid; it does not answer the question raised by his peritonism.

Key point: When perforation is suspected but the erect film shows no free gas, proceed to CT of the abdomen, adding water-soluble contrast if needed; never use barium and never accept a negative plain film as exclusion.

References

Question 2 · Obstetrics and gynaecology, Clinical

A person with suspected endometriosis has used an appropriate trial of paracetamol and an NSAID but still has pain limiting daily activities. There is no new acute complication. Which care step follows NG73?

  1. A. Use surveillance of an asymptomatic incidental ovarian lesion
  2. B. Consider other pain management and referral for further assessment
  3. C. Use a first short analgesic trial with planned review
  4. D. Arrange acute operative care for suspected torsion
  5. E. Use a fertility-focused assessment as the principal escalation
Show the answer and explanation

Answer: B. Consider other pain management and referral for further assessment

Inadequate relief after the initial analgesic trial supports further pain-management options and assessment. Disabling symptoms also meet the gynaecology referral criteria.

Why the other options are wrong

  • A. Use surveillance of an asymptomatic incidental ovarian lesion: This person has persistent disabling pain rather than an asymptomatic incidental finding.
  • C. Use a first short analgesic trial with planned review: That step has already been completed without adequate benefit.
  • D. Arrange acute operative care for suspected torsion: No sudden acute torsion syndrome is present.
  • E. Use a fertility-focused assessment as the principal escalation: No current conception or subfertility priority is supplied.

Key point: Escalate pain assessment and consider referral after inadequate initial endometriosis analgesia.

Question 3 · Internal medicine, Clinical

A patient has confirmed antithyroid-drug agranulocytosis. After recovery, what principle fits NICE?

  1. A. Restart the same antithyroid drug
  2. B. Switch to another thionamide
  3. C. Use levothyroxine replacement
  4. D. Monitor clinical thyrotoxicosis symptoms
  5. E. Do not restart an antithyroid drug; arrange specialist alternative treatment
Show the answer and explanation

Answer: E. Do not restart an antithyroid drug; arrange specialist alternative treatment

NICE advises stopping and not restarting an antithyroid drug after agranulocytosis, with specialist selection of an alternative strategy.

Why the other options are wrong

  • A. Restart the same antithyroid drug: NICE advises not restarting an antithyroid drug after confirmed agranulocytosis.
  • B. Switch to another thionamide: NICE's no-restart recommendation applies to any antithyroid drug after agranulocytosis, rather than allowing a routine thionamide switch.
  • C. Use levothyroxine replacement: The case does not establish a hypothyroid replacement requirement; replacement does not suppress continuing hormone overproduction.
  • D. Monitor clinical thyrotoxicosis symptoms: Symptom review remains useful but does not state the required no-restart and specialist alternative-treatment principle.

Key point: NICE advises stopping and not restarting an antithyroid drug after agranulocytosis, with specialist selection of an alternative strategy.

Question 4 · Family and community medicine, Clinical

A mother compares two imported breakfast cereals whose older-style labels show total sugars but no added sugars line. Both list 12 g total sugars per 40 g serving. Cereal one lists: whole wheat, sugar, glucose syrup, honey, salt. Cereal two lists: whole oats, raisins, dried apple, salt. Which conclusion about cereal one is best supported?

  1. A. Most of its sugar is added, since sweeteners lead its ingredients
  2. B. Its sugar is natural, because the first ingredient is whole wheat
  3. C. Both cereals carry equal added sugar, since total sugars match
  4. D. Honey is natural, so only the sugar line counts as added
  5. E. The order says nothing, because ingredients follow alphabetical order
Show the answer and explanation

Answer: A. Most of its sugar is added, since sweeteners lead its ingredients

Ingredients are listed by weight in descending order. In cereal one, three sweeteners (sugar, glucose syrup, and honey) sit among the first four ingredients, so most of its 12 g of sugars are added. Cereal two's sugars come from dried fruit. WHO counts honey and syrups as free sugars and advises keeping free sugars under 10% of energy. The current US label shows added sugars directly, but older or imported labels may not.

Why the other options are wrong

  • B. Its sugar is natural, because the first ingredient is whole wheat: A whole grain first does not make the sugars natural; three sweeteners (sugar, glucose syrup, and honey) fill the next places, so most sugar is added.
  • C. Both cereals carry equal added sugar, since total sugars match: Equal total sugars do not mean equal added sugars; cereal two's sugar comes from raisins and dried apple, while cereal one's comes from added sweeteners.
  • D. Honey is natural, so only the sugar line counts as added: Honey and glucose syrup are both added sugars when put into a product, so all three sweeteners count as added.
  • E. The order says nothing, because ingredients follow alphabetical order: Ingredients are listed by weight, largest first, not alphabetically, which is why sweeteners near the top signal a large share of added sugar.

Key point: Ingredient lists run by weight, largest first; several sweeteners near the top, including honey and syrups, mean most of a product's sugar is added.

References

Question 5 · Dermatology, Clinical

A man with chronic hepatitis C has erosions inside his mouth. Which skin disease is particularly associated with this oral disease?

  1. A. Erythema multiforme
  2. B. Urticaria
  3. C. Livedo reticularis
  4. D. Small vessel vasculitis
  5. E. Lichen planus
Show the answer and explanation

Answer: E. Lichen planus

Hepatitis B and C are associated with lichen planus, particularly erosive oral disease, and it is seen more with hepatitis C than hepatitis B. Urticaria, pruritus and erythema multiforme occur with both viruses.

Why the other options are wrong

  • A. Erythema multiforme: Erythema multiforme is associated with hepatitis B and hepatitis C.
  • B. Urticaria: Urticaria and pruritus are associated with hepatitis B and hepatitis C.
  • C. Livedo reticularis: Livedo reticularis is associated with hepatitis B and C along with small vessel vasculitis, polyarteritis nodosa and cryoglobulinaemia.
  • D. Small vessel vasculitis: Small vessel vasculitis is associated with hepatitis B and C along with polyarteritis nodosa and cryoglobulinaemia.

Key point: Lichen planus, especially erosive oral disease, is linked to hepatitis C more than to hepatitis B.

More of the question bank

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