Mongolia Feldsher Licensing Exam common mistakes
Mongolia Feldsher Licensing Exam · Understand the traps and how to avoid them.
When a case describes a patient with fever, productive cough and weight loss, the candidate jumps straight to a tuberculosis diagnosis and skips naming the alternative common conditions (community-acquired pneumonia, chronic bronchitis, bronchial asthma, lung cancer) that the question is asking them to differentiate before confirming TB.
In Mongolia TB is genuinely common, so candidates pattern-match the word 'fever + cough + weight loss' to TB and stop reasoning. The exam deliberately tests differential diagnosis and the specific case-definition steps (sputum smear, GeneXpert, chest X-ray, contact history) rather than the final label.
What to do instead
Practise writing a two-line differential for every respiratory case before choosing an answer: list at least two alternatives and the single finding that rules each in or out (e.g. acute onset with focal crackles and leukocytosis favours pneumonia; chronicity over 2-3 weeks with night sweats and upper-lobe infiltrate favours TB). Then check that the chosen answer names the confirmatory test, not just the diagnosis.
The candidate labels a patient as having 'shock' or 'dehydration' and proceeds to treatment without first stating the triage category and the ABCDE priority order, or orders fluids before assessing airway and breathing in a trauma scenario.
Textbook knowledge of shock types is well memorised, but exam scenarios are written so that the first correct action is almost always an ABCDE step or a triage colour, not a drug or a fluid bolus. Candidates read the diagnosis first and the sequence second.
What to do instead
For every emergency or trauma item, write the ABCDE letters at the top of your scratch paper and assign the patient to a triage category (red/yellow/green) before reading the answer options. Eliminate any option that skips a prior step (e.g. giving IV fluids before controlling external haemorrhage or securing the airway).
In paediatric cases the candidate calculates a drug dose or IV fluid rate using adult figures, or forgets to weight-base the dose (mg/kg) and to state the maximum ceiling dose.
Adult internal-medicine revision dominates study time, and paediatric dosing formulas are revised less often. Under time pressure the candidate recalls the drug name and adult dose but not the per-kilogram figure or the maximum cap.
What to do instead
Memorise and drill a short paediatric dosing table (paracetamol 10-15 mg/kg/dose, amoxicillin 40-50 mg/kg/day divided, ORS 75 mL/kg over 4 hours for some dehydration, maintenance 4-2-1 rule) and always write the calculation out: weight x mg/kg, then compare against the adult maximum. If the question gives a weight, the answer almost always requires a calculation.
The candidate answers a question about notifiable disease reporting by naming the treatment or isolation measure but omits the reporting obligation itself - who reports, to whom (the soum hospital / district health authority / National Center for Communicable Diseases), and within what timeframe.
Clinical management feels like the 'real' answer, and reporting feels administrative. Candidates also confuse the legal reporting duty with clinical discretion, so they select 'report if the patient consents' or 'report after confirmation'.
What to do instead
For every infectious-disease item, ask yourself 'is this notifiable, and what is the reporting chain and deadline?' Learn the principle that suspected cases of plague, anthrax, measles, polio and similar are reported immediately by telephone and then in writing, and that TB and most other notifiable diseases are reported by the treating facility without waiting for patient consent. Practise stating the chain explicitly: feldsher/family doctor -> soum hospital -> aimag/ district health department -> national level.
In obstetric scenarios the candidate treats antepartum or postpartum haemorrhage as a single 'give fluids and refer' answer, missing the specific first-line uterotonic, the bimanual uterine massage step, and the fact that referral must be arranged in parallel with resuscitation rather than after it.
Rural practice experience emphasises referral, so candidates default to 'transfer to aimag hospital' as the complete answer. The exam expects simultaneous stabilisation and transfer, with named drugs and doses.
What to do instead
Build a fixed postpartum haemorrhage sequence: call for help, uterine massage and bimanual compression, oxytocin 10 IU IM, IV access with two large-bore lines, tranexamic acid 1 g IV, then transfer with ongoing oxytocin infusion. For any obstetric emergency, check that the chosen answer includes both immediate life-saving action and arranged referral.
The candidate selects an antibiotic or analgesic without checking the contraindication or interaction stated in the vignette - for example prescribing an NSAID to a patient with peptic ulcer or renal impairment, or a tetracycline/fluoroquinolone in pregnancy or to a child under 8.
Candidates focus on the indication ('this is the drug for pneumonia') and skim past the co-morbidity or pregnancy line in the stem, which is precisely the detail the item was written to test.
What to do instead
Before selecting any drug answer, re-read the stem for four flags: pregnancy/lactation, age under 8 or over 65, renal or hepatic impairment, and allergy or current medication. Write the four flags in the margin and eliminate any option that conflicts with one of them, even if the drug is otherwise the correct choice for the diagnosis.
The candidate describes a procedure (wound suturing, abscess drainage, catheterisation, injection) without stating the aseptic and infection-control steps, or answers an infection-control question by naming hand hygiene alone and omitting instrument processing, waste segregation and sharps handling.
Procedural steps are learned as a surgical sequence, with sterility treated as assumed background rather than an examinable step. Candidates also underestimate how often infection-control items are scored on the full chain rather than the single most familiar element.
What to do instead
For every procedure, rehearse a fixed preamble: hand hygiene, gloves, skin antisepsis with the correct agent and contact time, sterile field, sharps disposal in a puncture-proof container, and waste segregation by colour category. For infection-control items, check whether the answer covers the whole chain (hand hygiene, PPE, sterilisation by autoclave versus disinfection, waste, sharps) before choosing.
The candidate answers a medical-documentation or ethics item by choosing what is clinically best for the patient while ignoring the legal requirement - for example disclosing a diagnosis to a relative without the patient's consent, or completing a record retrospectively without noting the late entry.
Clinical reasoning is over-trained relative to legislation and record-keeping rules, so the candidate applies 'beneficence' and forgets confidentiality, informed consent and the requirement for contemporaneous, signed, dated records with corrections made by a single line and initialled.
What to do instead
Learn the small set of legal rules that generate most ethics items: confidentiality yields only with patient consent or a specific legal duty (notifiable disease, court order); informed consent requires capacity, information and voluntariness; records must be contemporaneous, legible, signed and dated, and late entries must be marked as such. When an ethics option sounds clinically kind but bypasses consent, eliminate it.
In internal-medicine items the candidate gives the correct diagnosis but chooses a management option that skips the primary-care level of care - for example ordering a CT scan or specialist referral as the first step for uncomplicated hypertension or type 2 diabetes in a soum setting, instead of lifestyle advice plus a first-line thiazide or metformin with a follow-up plan.
Candidates study hospital-level guidelines and answer as if they were in a tertiary centre, ignoring the exam's family-medicine framing and the resource level implied by the question.
What to do instead
For each chronic-disease item, apply the primary-care ladder: confirm diagnosis, give lifestyle counselling with specific targets, start the first-line drug available at soum level, set a follow-up interval, and state the referral trigger (e.g. hypertensive emergency, pregnancy, treatment failure). Choose the least resource-intensive correct option unless the stem describes red flags.
The candidate memorises the routine immunisation schedule as a list of ages but cannot state, for a given child, which vaccines are due now, which are contraindicated (live vaccines in immunocompromise or pregnancy), and what to do about a missed dose or a mild illness on the day of vaccination.
The schedule is revised as a rote table without the decision rules around it, so items about catch-up schedules, true versus false contraindications, and the correct response to a minor febrile illness are answered by guesswork.
What to do instead
Learn the schedule together with three rules: (1) catch-up vaccination starts from where the child left off and does not restart the series; (2) mild illness with or without low-grade fever is not a contraindication; (3) live vaccines are avoided in pregnancy and significant immunocompromise. For each item, write the child's age, list the vaccines due at that age, then cross-check against the three rules before answering.