Lebanon Medical Colloquium common mistakes
Lebanon Medical Colloquium · Understand the traps and how to avoid them.
Choosing the single most 'textbook-correct' answer when the vignette describes a locally constrained setting (e.g., no CT scanner available at night, patient cannot afford a drug, blood bank has no cross-matched units), instead of choosing the answer that reflects the safest available option in that setting.
Candidates prepare from international question banks where the resource-rich answer is always correct, so they default to the gold-standard investigation or therapy even when the stem explicitly removes it. The habit is reinforced because most practice material never tests resource awareness.
What to do instead
Before answering, underline every availability constraint in the stem (time of day, facility level, listed unavailable equipment, cost, transport). Then rank options by 'safe now' rather than 'best in theory': stabilization, transfer, or a locally available alternative usually outranks a test or drug the setting cannot deliver. Practise by rewriting one standard vignette per domain into a district-hospital version and answering both.
Committing to a diagnosis after the first two or three data points and then reading the remaining stem as confirmation, so a later contradictory vital sign, drug history, or lab value is ignored.
Time pressure and pattern-recognition training reward fast closure. Once a familiar illness script activates ('fever plus neck stiffness equals meningitis'), candidates stop updating and miss the alternative that the rest of the stem was built to support.
What to do instead
Adopt a fixed two-pass routine: first pass reads the entire stem without choosing anything and lists the positive and negative findings; second pass re-reads specifically looking for the one finding that does not fit the leading diagnosis. If any finding is unexplained, the leading diagnosis is wrong or incomplete. Track this in practice by logging every question where your first impression differed from your final answer.
Treating pediatric dosing, fluid rates, and vital-sign thresholds as scaled-down adult values, or failing to recalculate weight-based doses when the child's weight must be derived from age.
Adult medicine dominates study time, so pediatric numbers are recalled approximately. Candidates also forget that normal respiratory rate and heart rate change with age and that maintenance fluid is calculated by the Holliday-Segar weight bands, not linearly.
What to do instead
Build a one-page age-banded reference (neonate, infant, toddler, school-age, adolescent) for normal heart rate, respiratory rate, blood pressure, and weight estimation, and memorize the 4-2-1 maintenance rule and the 10/20/30 mL/kg bolus bands. In every pediatric item, write the calculated dose or rate in the margin before looking at the options, then match.
Answering obstetric emergencies with the non-pregnant adult algorithm: giving a standard fluid bolus and vasopressors for hypotension in pregnancy, or ordering CT pulmonary angiography without considering fetal and maternal trade-offs, or delaying delivery to complete investigations.
The same presenting complaint (shock, breathlessness, seizure) triggers adult templates. Candidates underestimate that aortocaval compression, increased plasma volume, and normal pregnancy values (lower blood pressure, lower CO2, higher heart rate) change both the interpretation and the first maneuver.
What to do instead
For any pregnant patient, run a three-question checklist before answering: (1) Is this a resuscitate-and-deliver situation (eclampsia, hemorrhage, sepsis, abruption)? (2) Does positioning or left lateral tilt change the first step? (3) Are the reference ranges pregnancy-specific? Memorize the short list of conditions where delivery is the treatment, and answer those before any diagnostic refinement option.
Reading an imaging or laboratory item as a single abnormal finding and picking the diagnosis that fits that finding, without integrating the modality's limitations, the timing of the test, or the pre-test probability described in the stem.
Radiology and laboratory items are often skimmed because they look factual. Candidates forget that a normal scan early in a disease course does not exclude it, that sensitivity and specificity depend on prevalence, and that a positive test in a low-probability patient is more likely false positive.
What to do instead
For every test-based item, state the pre-test probability from the stem, then ask whether the result changes management. Learn the small set of timing rules (early CT in stroke, plain film before abdominal series, cultures before antibiotics, troponin kinetics) and the concept of post-test probability well enough to apply it to a numerical stem. If the stem gives prevalence, compute rather than guess.
Managing a perioperative or airway scenario by skipping the pre-induction checklist: not assessing airway predictors, not confirming fasting status, not planning for difficult mask ventilation, and moving straight to the induction drug choice.
Exam items emphasize drug selection and doses, so candidates treat anesthesia as pharmacology. The structured pre-assessment, backup plan, and equipment readiness are the parts most often assumed rather than stated, and candidates omit them under time pressure.
What to do instead
Answer perioperative items in a fixed sequence: assess (airway, aspiration risk, comorbidity, fasting), optimize, plan (primary and rescue technique, equipment, monitoring), then drug. If an option describes a rescue plan or a checklist step that the others omit, weigh it heavily. Practise by writing the pre-induction plan aloud for ten common scenarios.
Handling ethical and legal items by choosing the option that feels most compassionate or most defensive, rather than the one that follows the correct decision-making pathway: assessing capacity, obtaining valid consent, respecting confidentiality limits, or escalating through the proper channel.
Candidates answer from personal values and from fear of litigation. They conflate 'what a good doctor would feel' with 'what the law and professional guidance require', and they forget that capacity assessment precedes substituted judgment and that confidentiality has defined exceptions.
What to do instead
Use a capacity-first algorithm: does the patient have capacity (understand, retain, weigh, communicate)? If yes, the competent patient's refusal stands even if it seems unwise. If no, follow the legal hierarchy for substitute decision-makers and the best-interests standard. For confidentiality, name the specific exception (public health notification, court order, serious risk to an identifiable person) before disclosing. For errors, disclose early and honestly, then report through the incident system.
Prescribing by diagnosis alone: naming the first-line drug but missing the contraindication, interaction, renal or hepatic dose adjustment, or monitoring requirement embedded in the stem's comorbidity list.
Pharmacology revision centers on mechanisms and class effects, while exam items test the individualization step. Candidates recognize the correct drug class and stop reading, so the ACE inhibitor in bilateral renal artery stenosis or the NSAID in renal impairment slips through.
What to do instead
After selecting a drug, run a five-point safety pass: allergy, renal and hepatic function, pregnancy and lactation, interacting medications in the stem, and required monitoring (levels, ECG, electrolytes, blood counts). Eliminate any option that fails one of these before finalizing, even if it is the guideline first-line agent.
In psychiatry, labeling a presentation as a primary psychiatric disorder without first excluding the medical and substance-related causes the stem hints at, or misjudging the timeline that distinguishes delirium, acute agitation, and psychosis.
Psychiatry is studied as a separate system, so candidates apply DSM-style criteria in isolation and forget that thyroid disease, delirium, steroid use, and withdrawal states present with psychiatric symptoms. Acute disturbance of attention and fluctuating course is often read as psychosis.
What to do instead
Before any psychiatric diagnosis, run the medical screen: vitals, glucose, electrolytes, thyroid, toxicology, infection, and medication review. Use the course to separate them: fluctuating attention with altered consciousness is delirium until proven otherwise; preserved consciousness with fixed false beliefs is psychosis; abrupt onset with autonomic signs suggests substance or withdrawal. Answer the medical cause first whenever the stem offers one.
In emergency and critical care items, choosing the definitive treatment over the immediate life-saving maneuver, or ordering investigations before completing the primary survey and initiating resuscitation.
Candidates are trained to be thorough and to confirm before acting, which is correct on the ward but wrong in an unstable patient. The stem's abnormal vitals are read as data to explain rather than as an instruction to act now.
What to do instead
Apply the rule that the correct answer is the one that fixes the immediate threat: airway before imaging, hemorrhage control before cross-match results, defibrillation before drug sequencing in shockable arrest, antibiotics within the first hour in septic shock. Sort options by time-to-benefit and choose the fastest effective action; investigation options are wrong whenever a resuscitation option exists and the patient is unstable.