One of your patients presents to your clinic for a consultation regarding their recurrent hemoptysis. On review of their chart, you realize that although you had ordered chest radiography 2 months ago, the result cannot be found in the chart. You call the radiology department and are relieved to find that the chest radiography was done and that it did not reveal any pathology. After informing the patient of this lapse in reporting, which one of the following is the best next step?

• A. Remind the patient that they are responsible for calling for outstanding test results.
• B. Send a letter of complaint to the radiology department for not sending a report.
• C. Reassure the patient that this is a rare occurrence in your clinic.
• D. Review your clinic ' s filing procedures and make any needed improvements.

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A 56-year-old man is admitted to hospital with pyelonephritis and started on intravenous antibiotics. On day 2 of his hospitalization, he continues to report right flank pain, but he is able to walk. His vital signs are as follows:
Temperature: 38.5°C
Blood pressure: 90/60 mm Hg
Heart rate: 105/min
The patient is mentating well but is concerned about his dog that is home alone due to his unexpected hospitalization. He requests to be released from hospital as he needs to make arrangements for his dog. Which one of the following is the best next step?

• A. Offer to stop by his apartment on your way home, if he is agreeable to it and gives you the key.
• B. Change him to oral antibiotics, and finish his treatment as an outpatient.
• C. Explain that his health is a priority and insist that he stay.
• D. Ensure he understands the risk and accept his decision to leave for a few hours while you hold his bed.
• E. Discharge the patient, but ensure he signs an " Against Medical Advice " form.

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A 62-year-old man (wealthy philanthropist) with emphysema from smoking and a 21-year-old woman (elementary teacher) with cystic fibrosis are both compatible matches for a lung transplant. Which criterion determines organ allocation?

• A. The date the patient was placed on the waiting list.
• B. The patient has family members who rely on them for income.
• C. Whether the underlying condition is due to self-induced illness.
• D. The clinical severity of the patient's pulmonary disease.
• E. The patient's value and contributions to society.

You are meeting an otherwise healthy 10-year-old boy in your office for the first time. His BMI is at the 80th percentile. He has no symptoms and his physical examination is normal. Which one of the following is the best next step?

• A. Hemoglobin A1c
• B. Morning serum cortisol
• C. No investigations
• D. Thyroid function testing
• E. Fasting lipid profile

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A 42-year-old man comes to your family practice. He has started seeing a reflexologist to help manage his chronic back pain. He presents to you a letter from the reflexologist outlining the weekly necessary treatments, each costing $300, and a list of blood tests for the patient to have done. The patient asks you to order the laboratory testing and send the results to his "other doctor." Which one of the following is the best next step?

• A. Report the reflexologist to the medical regulatory authority.
• B. Order the tests and arrange to send them to the reflexologist.
• C. Decline to order the tests but inquire further about his back pain.
• D. Report the reflexologist to the regulatory authority for alternative and complementary practitioners.
• E. Tell your patient to stop seeing this practitioner.

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