Primary Care Organization
Primary care organization questions test understanding of the gatekeeping role, continuity of care, and the structure of the delivery system. Candidates must know the principles of the general practice model: first contact, comprehensiveness, coordination, and longitudinality. Understand referral pathways, documentation standards, and the difference between planned and urgent referral. Know how preventive services, chronic disease registers, and home visits fit into practice organization. Understand quality indicators and the logic of clinical guidelines.
Traps: referring before completing an appropriate primary care assessment; failing to document the reasoning behind a decision; confusing the roles of primary, secondary, and tertiary care; ignoring continuity when a patient sees multiple providers.
Worked example: a patient requests a referral to a specialist for a problem that can be managed in primary care. The correct response is to assess, explain the management plan, and refer only if criteria for referral are met, documenting the discussion. This preserves access and continuity.
Rule of thumb: primary care manages undifferentiated problems and coordinates care; it refers when the problem exceeds its scope or requires specialist intervention. Documentation should make the reasoning clear to any colleague.
Key concepts: gatekeeping, continuity, referral criteria, documentation, and quality measurement.
Medical Rehabilitation
Rehabilitation questions test functional assessment and goal setting. Candidates must understand the rehabilitation team, the International Classification of Functioning framework (impairment, activity limitation, participation restriction), and the difference between restorative and compensatory strategies. Know the principles of early mobilization, prevention of complications of immobility (pressure injury, thrombosis, contracture, deconditioning), and the role of assistive devices. Understand rehabilitation after stroke, myocardial infarction, and major surgery, and the importance of measuring function rather than only disease markers.
Traps: prescribing bed rest when early mobilization is indicated; focusing on the impairment while ignoring the patient's functional goals; missing depression or cognitive impairment that limits rehabilitation; failing to assess fall risk.
Worked example: a patient after stroke has weakness on one side. The rehabilitation plan addresses impairment (strength and tone), activity (walking and self-care), and participation (return to work and social roles), with measurable goals and a team approach. Progress is judged by function, not by imaging.
Rule of thumb: rehabilitation begins on day one of illness or injury, not after acute care ends. Set goals with the patient, and measure what the patient needs to do.
Key concepts: functional assessment, goal setting, immobility complications, and team-based rehabilitation.
Clinical Pharmacology
Clinical pharmacology questions test prescribing principles: pharmacokinetics (absorption, distribution, metabolism, excretion), pharmacodynamics, and individual variation. Candidates must understand half-life and steady state, first-pass metabolism, hepatic enzyme induction and inhibition, and renal dose adjustment. Know the major drug interactions and the drugs requiring therapeutic drug monitoring. Understand adverse drug reactions, including type A (dose-dependent) and type B (idiosyncratic), and the principles of rational polypharmacy.
Traps: ignoring renal function when dosing; forgetting that enzyme inducers take time to act while inhibitors act quickly; missing interactions between anticoagulants and antibiotics; attributing a new symptom to disease when it is an adverse drug reaction.
Worked example: a patient on warfarin is started on an antibiotic and the INR rises. The antibiotic inhibits warfarin metabolism, increasing bleeding risk. The correct action is to monitor the INR more frequently and adjust the dose, not to stop anticoagulation abruptly.
Rule of thumb: for every new drug, ask four questions: does the patient's organ function change the dose, does it interact with current drugs, does it need monitoring, and what is the plan to stop it if ineffective?
Key concepts: pharmacokinetics, interactions, dose adjustment, therapeutic monitoring, and adverse reaction classification.
Diagnostics
Diagnostics questions test the interpretation and appropriate use of laboratory and imaging tests. Candidates must understand sensitivity, specificity, likelihood ratios, and pretest probability, and how they combine in clinical decision-making. Know the meaning of reference ranges, the difference between screening and confirmatory tests, and the causes of false-positive and false-negative results. Understand when imaging is indicated, which modality answers the question, and the risks of radiation and contrast. Know how to interpret common laboratory panels and blood gases.
Traps: ordering tests without a question in mind; treating a laboratory value instead of a patient; ignoring pretest probability when interpreting results; forgetting that reference ranges vary by laboratory and population; misinterpreting a normal result as excluding disease when sensitivity is imperfect.
Worked example: a patient has a moderate pretest probability of disease and a test with a likelihood ratio near 1. The result does not meaningfully change probability. The right response is to choose a better test or reassess clinically, not to treat on the basis of a nondiscriminatory result.
Rule of thumb: every test should change management. If the result will not alter what you do, do not order it.
Key concepts: pretest probability, likelihood ratios, test limitations, imaging indications, and laboratory interpretation.
Medical Ethics and Legal Aspects
Ethics and legal questions test the principles of autonomy, beneficence, non-maleficence, and justice, and their application to consent, confidentiality, and end-of-life care. Candidates must understand informed consent (capacity, information, voluntariness), the assessment of decision-making capacity, and the role of surrogate decision-makers. Know the rules on confidentiality and its exceptions, mandatory reporting, and documentation standards. Understand the legal framework for medical error disclosure and the patient's right to access information.
Traps: equating refusal of treatment with incapacity; disclosing information to family without consent; assuming a signed form equals valid consent; failing to document a capacity assessment; confusing confidentiality exceptions with routine practice.
Worked example: a competent adult refuses a recommended treatment. Capacity is presumed unless there is evidence otherwise. The correct response is to ensure the patient understands the consequences, document the discussion, and respect the refusal. Refusal by a capable patient is legally and ethically binding.
Rule of thumb: capacity is decision-specific and presumed. Assess understanding, appreciation, reasoning, and expression of choice; then respect the decision.
Key concepts: informed consent, capacity assessment, confidentiality, mandatory reporting, and documentation.