Jagiellonian University Medicine Entrance Exam Practice Paper with Answers (2027)

Answer: B

DNA ligase seals the nick between adjacent Okazaki fragments by forming a phosphodiester bond, once DNA polymerase has replaced the RNA primers with DNA. Primase lays down those RNA primers, helicase unwinds the double helix at the fork and topoisomerase relieves the supercoiling ahead of it; telomerase extends chromosome ends. None of them joins fragments.

Answer: D

By complementary base pairing A = T and G = C. Adenine is 18%, so thymine is also 18%, together 36%. The remaining 64% is G + C in equal amounts, so guanine is 32%. 36% is A + T, and 64% is G + C together: both answer a different question.

Answer: A

Joining a pre-mRNA's exons in different combinations gives different mature mRNAs, and so different proteins, from one gene. Splicing happens in the nucleus before export; the 5′ cap is a modified guanine nucleotide (the adenine chain is the 3′ poly(A) tail); the codon is on the mRNA and the anticodon on the tRNA; and rRNA is not translated: it is a structural and catalytic part of the ribosome itself.

Answer: E

UAA is a stop codon, so this is a nonsense mutation: the ribosome releases the chain at that point and the protein is cut short. A single base substitution does not shift the reading frame, it does not code for another amino acid (so it is not a missense mutation), and it cannot be silent because the codon no longer codes for tyrosine.

Answer: C

Transferases move a functional group from one molecule to another; kinases move a phosphate group from ATP. Ligases also use ATP, but to join two molecules with a new bond, which is the tempting confusion. Hydrolases split bonds with water, isomerases rearrange a molecule and oxidoreductases transfer electrons.

Answer: C

A competitive inhibitor binds the active site and competes with the substrate. Enough substrate outcompetes it, so the same Vmax can still be reached, but more substrate is needed to reach half of it: the apparent Km rises. A lower Vmax with the same Km describes non-competitive inhibition, and a fall in both describes uncompetitive inhibition.

Answer: A

N-linked glycosylation starts in the lumen of the rough endoplasmic reticulum, while the protein is still being made on the ribosomes attached to it. The Golgi apparatus then modifies and sorts those sugar chains, which makes it the tempting answer, but it is not where the process begins. Lysosomes degrade, the smooth ER makes lipids and the nucleolus assembles ribosomes.

Answer: E

Cortisol is a steroid: it is lipid-soluble, crosses the plasma membrane and binds a receptor in the cytoplasm, which then acts in the nucleus as a transcription factor. Adrenaline and glucagon act through G-protein-coupled receptors, insulin through a receptor tyrosine kinase and acetylcholine through a ligand-gated ion channel, all in the plasma membrane, because none of them can cross it.

Answer: B

The pump moves three sodium ions out and two potassium ions in per ATP. Because more positive charge leaves than enters, it is electrogenic and contributes slightly to the negative resting potential. Option A reverses the numbers, and C reverses the directions: sodium is kept low inside the cell and potassium high.

Answer: D

Gs stimulates adenylyl cyclase, which makes cAMP from ATP; cAMP activates protein kinase A, which phosphorylates target proteins. The phospholipase C and IP₃ pathway belongs to Gq, the fall in cAMP to Gi, cGMP to guanylyl cyclase (for example the nitric oxide pathway), and tyrosine autophosphorylation to receptor tyrosine kinases, which are not G-protein-coupled.

Answer: D

Glycolysis, glucose to two pyruvate, runs in the cytosol and needs no oxygen. Pyruvate then enters the mitochondrial matrix, where the link reaction and the Krebs cycle take place, and the respiratory chain sits in the inner mitochondrial membrane: those are later stages of respiration, not glycolysis.

Answer: B

Glycolysis reduces NAD⁺ to NADH. Without oxygen the respiratory chain cannot reoxidise NADH, so lactate dehydrogenase does it by reducing pyruvate to lactate, and glycolysis can go on making its 2 ATP per glucose. The step makes no ATP itself and releases no CO₂; lactate is turned back into glucose in the liver (the Cori cycle), not in the muscle.

Answer: E

An uncoupler lets protons flow back into the matrix without passing through ATP synthase, so electron transport and oxygen consumption continue (the energy is released as heat) but less ATP is made. Oxygen is reduced at complex IV, which is also the site cyanide blocks; ATP synthase makes ATP as protons flow into the matrix through it; and the gradient is across the inner membrane.

Answer: A

Crossing over happens in prophase I, when homologous chromosomes pair as bivalents and exchange segments at chiasmata. In metaphase I the bivalents line up, and in meiosis II the homologues have already separated, so there are no partners left to exchange with.

Answer: C

A son receives his Y chromosome from his father and one of his mother's two X chromosomes, each with probability 1/2; he is affected if he receives the X with the allele. 1/4 is the chance that any child, of either sex, is an affected son, which answers a different question. Daughters receive their father's normal X and are not affected.

Answer: A

Proto-oncogenes are normal genes (for example those encoding growth-factor receptors or Ras) that drive growth; a gain-of-function mutation, amplification or translocation makes them oncogenes, and one mutated copy can be enough. Genes such as TP53 that cause cancer when both copies are lost are tumour suppressor genes; mismatch-repair genes are caretaker genes of that kind; and a chemical that causes cancer is a carcinogen, not a gene.

Answer: C

The cross Aa × Aa gives AA : Aa : aa in the ratio 1 : 2 : 1. The child is known to be unaffected, so aa is excluded, leaving three equally likely outcomes, two of which are Aa: the probability is 2/3. 1/2 is the chance of a carrier before anything is known about the child; 1/3 is the chance that the unaffected child is AA.

Answer: D

Most bacteria have a cell wall made of peptidoglycan (murein), which human cells lack: that is why antibiotics that target it, such as penicillin, spare our cells. Both cell types have ribosomes (70S in bacteria, 80S in the human cytoplasm), a plasma membrane, DNA and cytoplasm.

Answer: E

Penicillin, a β-lactam, inhibits the transpeptidases (penicillin-binding proteins) that cross-link peptidoglycan. Growing bacteria are left with a weak wall and burst under osmotic pressure. The 30S subunit is the target of the tetracyclines and aminoglycosides, DNA gyrase of the quinolones and folate synthesis of the sulfonamides.

Answer: B

Reverse transcriptase is an RNA-dependent DNA polymerase: it makes DNA on the viral RNA template, reversing the usual flow of genetic information. Integrase acts next, inserting that DNA into the host genome, so it is the tempting distractor. RNA replicase copies RNA into RNA (as in many RNA viruses), and a DNA-dependent RNA polymerase is the host's transcription enzyme.

Answer: E

MCV = haematocrit ÷ red cell count = 0.36 L/L ÷ (4.0 × 10¹² /L) = 0.09 × 10⁻¹² L = 9 × 10⁻¹⁴ L = 90 × 10⁻¹⁵ L = 90 fL, inside the 80–100 fL range. 0.09 and 9 fL come from slipping a power of ten in the conversion; 11 fL comes from dividing the count by the haematocrit the wrong way round.

Answer: C

MCH = haemoglobin ÷ red cell count = 108 g/L ÷ (4.0 × 10¹² /L) = 27 × 10⁻¹² g = 27 pg, at the lower limit of the 27–33 pg range. 30 pg is what you get with 120 g/L of haemoglobin, a value that is not in the report; 0.27, 2.7 and 270 pg are powers-of-ten slips.

Answer: B

MCHC = haemoglobin ÷ haematocrit = 108 g/L ÷ 0.36 = 300 g/L, below the 320–360 g/L range, so the cells are hypochromic. Their size is normal: the MCV is 90 fL (previous question), so they are normocytic, not microcytic. 333 g/L would follow from 120 g/L of haemoglobin, a value that is not in the report.

Answer: A

The left ventricle pumps oxygenated blood through the aortic valve into the aorta and the systemic circulation, which is why its wall is the thickest. The right ventricle pumps deoxygenated blood into the pulmonary trunk; the atria only fill the ventricles. Both ventricles eject the same volume per beat, but into different vessels.

Answer: D

In neurulation, the ectoderm above the notochord thickens into the neural plate, which folds into the neural tube: it forms the brain and spinal cord, and the neural crest forms much of the peripheral nervous system. The notochord that induces this is mesodermal, which makes mesoderm tempting; the endoderm lines the gut and its glands; the trophoblast and hypoblast are extra-embryonic.

Answer: C

Sixteen electrons fill 1s (2), 2s (2), 2p (6) and 3s (2), leaving 4 for 3p: 1s² 2s² 2p⁶ 3s² 3p⁴. 3p⁶ would be 18 electrons, the configuration of the sulfide ion S²⁻ (or argon); 3p² is silicon. Leaving 3s empty or half-filled breaks the filling order, since 3s is lower in energy than 3p.

Answer: A

Ammonia is trigonal pyramidal: the lone pair on nitrogen makes the three N–H bond dipoles add up to a net dipole. CO₂ is linear, BF₃ trigonal planar and CCl₄ and CH₄ tetrahedral with identical substituents, so in each the bond dipoles (polar in CO₂, BF₃ and CCl₄) cancel by symmetry and the molecule is non-polar.

Answer: E

0.50 mol of H₂O is 0.50 × 6.02 × 10²³ = 3.01 × 10²³ molecules, and each molecule has 3 atoms, so there are 9.03 × 10²³ atoms. 3.01 × 10²³ counts molecules, not atoms; 1.81 × 10²⁴ is the number of atoms in a whole mole of water.

Answer: B

In 100 g: C 40.0/12 = 3.33 mol, H 6.7/1 = 6.7 mol, O 53.3/16 = 3.33 mol, a ratio of 1 : 2 : 1, so the empirical formula is CH₂O (30 g mol⁻¹). 180/30 = 6, so the molecular formula is C₆H₁₂O₆. CH₂O is only the empirical formula; C₂H₄O₂ (60) and C₃H₆O₃ (90) have the right ratio but the wrong molar mass; C₆H₆O₆ has the wrong ratio.

Answer: D

n = c × V = 0.20 mol L⁻¹ × 0.250 L = 0.050 mol, and m = n × M = 0.050 × 40 = 2.0 g. 8.0 g uses one litre instead of 250 mL; 20 g is ten times too much (it would make 2.5 L); 0.050 is the amount in moles, not the mass in grams.

Answer: A

p = nRT/V = (2.0 × 8.31 × 300) / (24.93 × 10⁻³ m³) = 4986 J / 0.02493 m³ = 2.0 × 10⁵ Pa = 200 kPa. The volume must be in m³ (1 dm³ = 10⁻³ m³); leaving it in dm³ gives 200 Pa, and 100 kPa is the answer for 1.0 mol. 400 kPa is double the correct value, as if 4.0 mol were present.

Answer: D

HCl is a strong acid and dissociates completely, so [H₃O⁺] = 0.010 = 10⁻² mol L⁻¹ and pH = −log 10⁻² = 2. A pH of 12 is that of 0.010 mol L⁻¹ NaOH; 0.01 confuses the concentration with the pH; 1 would need 0.10 mol L⁻¹.

Answer: B

For a weak acid that is only slightly dissociated, [H₃O⁺] ≈ √(Ka × c) = √(1.0 × 10⁻⁵ × 0.10) = √(10⁻⁶) = 10⁻³ mol L⁻¹, so pH ≈ 3. A pH of 1 treats the acid as strong; 5 is simply pKa; 6 forgets the square root.

Answer: E

CaF₂ ⇌ Ca²⁺ + 2F⁻, so if s mol L⁻¹ dissolves, [Ca²⁺] = s and [F⁻] = 2s, and Ksp = s(2s)² = 4s³. Then s³ = 3.2 × 10⁻¹¹ / 4 = 8.0 × 10⁻¹², and s = 2.0 × 10⁻⁴ mol L⁻¹. 5.7 × 10⁻⁶ treats the salt as 1 : 1 (s = √Ksp); 4.0 × 10⁻⁴ is the fluoride concentration, not the solubility; 3.2 × 10⁻⁴ takes the cube root without the factor 4.

Answer: C

Manganese goes from +7 in MnO₄⁻ to +2 in MnCl₂: it gains electrons, so it is reduced and KMnO₄ is the oxidising agent. Some chlorine goes from −1 in HCl to 0 in Cl₂, which is oxidation, so HCl is the reducing agent. Oxygen stays at −2 throughout, ending in water.

Answer: E

Two electrons are transferred, so n = 2. Q = 0.010/1.0 = 10⁻², log Q = −2, and E = 1.10 − (0.059/2)(−2) = 1.10 + 0.059 = 1.16 V. Lowering the product ion concentration pushes the cell reaction forward and raises the potential. 1.04 V gets the sign of log Q wrong; 1.22 V forgets to divide by n = 2.

Answer: C

By Hess's law, take the first equation as written and reverse the second (CO₂ → CO + ½O₂, ΔH = +283 kJ mol⁻¹). Adding them gives C + ½O₂ → CO with ΔH = −394 + 283 = −111 kJ mol⁻¹. −677 adds the two values without reversing the second; +111 reverses the wrong equation.

Answer: A

The reaction is spontaneous when ΔG = ΔH − TΔS < 0, i.e. when T > ΔH/ΔS = 40 000 J mol⁻¹ / 100 J K⁻¹ mol⁻¹ = 400 K. Below 400 K the unfavourable enthalpy wins; above it the entropy term does. 0.4 K comes from leaving ΔH in kJ while ΔS is in J. With ΔH > 0 and ΔS > 0 the answer cannot be 'always' or 'never'.

Answer: D

The two carbons joined by the double bond each form three σ bonds and one π bond, so they are sp² hybridised; the methyl carbon has four single bonds and is sp³. sp would need a triple bond (or two double bonds) on the carbon, as in propyne.

Answer: B

–OH on a saturated carbon is a hydroxyl (alcohol) group and –NH₂ on a carbon is a primary amino group. An amide needs a nitrogen attached to a C=O; an ether is C–O–C; neither a carbonyl nor a carboxyl group is present, since no carbon carries a double-bonded oxygen.

Answer: B

In propan-2-ol, CH₃–CH(OH)–CH₃, the carbon bearing –OH is bonded to two other carbons, which makes it secondary. Propan-1-ol and ethanol are primary (one carbon neighbour), methanol has none, and 2-methylpropan-2-ol is tertiary (three carbon neighbours).

Answer: E

Fructose has its carbonyl group at C-2, a ketone, so it is a ketohexose. Glucose and galactose (hexoses), ribose (a pentose) and glyceraldehyde (a triose) all carry an aldehyde group at C-1 and are aldoses.

Answer: D

A soap is the sodium or potassium salt of a long-chain carboxylic (fatty) acid, made by the alkaline hydrolysis of a fat (saponification). Esters of glycerol are the fats themselves, and acid hydrolysis gives free fatty acids, not their salts. In a micelle the hydrocarbon tails point inwards and the ionic heads face the water. Waxes are esters of a fatty acid with a long-chain alcohol, not of glycerol.

Answer: A

The longest chain containing the carbon bearing –OH has four carbons (butanol), numbered from the end nearer the –OH, which takes locant 1; the methyl branch then sits on C-3: 3-methylbutan-1-ol. Numbering from the other end gives the higher locant 4 to the principal group (2-methylbutan-4-ol), which the rules forbid. The compound has five carbons in all but only four in the main chain, so it is not pentan-1-ol.

Answer: C

The carboxylic acid is the principal group, so the chain of five carbons is named pentanoic acid with the COOH carbon as C-1. Counting along, the ketone C=O is on C-3, and as a substituent a ketone oxygen is called 'oxo': 3-oxopentanoic acid. 4-Oxopentanoic acid would be CH₃–CO–CH₂–CH₂–COOH; 'hydroxy' would mean an –OH, not a C=O.

Answer: D

Geometric isomerism needs each carbon of the double bond to carry two different groups. In but-2-ene, CH₃–CH=CH–CH₃, each carbon has a CH₃ and an H, so cis and trans forms exist. In the other four, at least one carbon of the double bond carries two identical groups (two H atoms, or two CH₃ groups in 2-methylpropene).

Answer: B

The molecule has two stereocentres, so the 2ⁿ rule suggests 4. But the two centres carry identical sets of substituents, so the (R,S) and (S,R) forms are the same compound: an achiral meso form with an internal plane of symmetry. That leaves 3 stereoisomers: the two enantiomers (R,R) and (S,S), and the meso form.

Answer: C

The D/L label refers to the chiral carbon farthest from the carbonyl group: in a D-sugar its –OH points to the right in the Fischer projection, as in D-glyceraldehyde; in an L-sugar it points to the left. The other –OH groups vary between sugars, but that one does not, by definition. In a Fischer projection the vertical bonds are the ones pointing away from the viewer, so substituents are drawn left or right.

Answer: E

Butan-2-ol is a secondary alcohol, and a secondary alcohol is oxidised to a ketone: butanone, CH₃–CO–CH₂–CH₃. An aldehyde (butanal) and then a carboxylic acid (butanoic acid) come from a primary alcohol, butan-1-ol. 'No reaction' is true of tertiary alcohols; but-2-ene would come from dehydration, not oxidation.

Answer: A

UV light splits Cl₂ homolytically into two chlorine radicals (initiation); Cl· then takes an H from CH₄ to give ·CH₃ and HCl, and ·CH₃ reacts with Cl₂ to give CH₃Cl and a new Cl· (propagation): radical substitution. Methane has no double bond to add to, the chain carriers are radicals, not ions, and further substitution gives CH₂Cl₂, CHCl₃ and CCl₄ as well, so chloromethane is not the only product.

Answer: A

Each term is double the one before plus 1: 3 × 2 + 1 = 7, 7 × 2 + 1 = 15, 15 × 2 + 1 = 31, 31 × 2 + 1 = 63, so the next is 63 × 2 + 1 = 127. The differences confirm it: 4, 8, 16, 32, then 64. 126 doubles without adding 1, 95 adds the last difference (32) again instead of doubling it, and 125 and 131 fit neither rule.

Answer: B

The first differences are 2, 5, 8 and 11: they rise by 3 each time, so the next difference is 14 and the next term is 30 + 14 = 44. 41 repeats the last difference (11), and 42, 43 and 45 come from adding 12, 13 or 15, none of which continues the step of 3.

Answer: C

Two series are interleaved. The terms in odd positions are 1, 3, 9, 27, each three times the last; the terms in even positions are 20, 17, 14, each 3 less than the last. The next term is in an even position, so it continues 20, 17, 14 with 14 − 3 = 11. 81 is the next odd-position term (27 × 3), the trap of reading the series as one; 30 adds 3 to 27, and 10 and 12 misjudge the step.

Answer: D

Successive percentage changes multiply rather than add. A 50% rise multiplies the count by 1.5 and a 40% fall by 0.6, so the overall factor is 1.5 × 0.6 = 0.9: the culture ends at 90% of where it started, a 10% decrease. Adding the percentages (+50 − 40) gives the tempting but wrong 10% increase. A 90% decrease confuses the final level (90%) with the change.

Answer: E

The antivirals lie entirely inside the prescription drugs, and the prescription drugs lie entirely outside the over-the-counter drugs, so the antivirals lie outside them too: no antiviral in the cabinet is sold over the counter. The first and third options reverse the inclusion (all antivirals are prescription drugs, not the other way round); the second contradicts the conclusion; the fourth contradicts the first premise.

Answer: A

A conditional "if P then Q" is equivalent only to its contrapositive, "if not Q then not P": a normal marker rules condition X out. The second option is the converse and the third the inverse; both can be false while the original is true, since other conditions may also raise M. "M is raised only if X" says the same as the converse, and "if and only if" claims both directions at once.

Answer: B

A necessary condition must hold for everyone who reaches the outcome: if passing is necessary for admission, nobody is admitted without passing, so every admitted candidate passed. The first and last options treat passing as sufficient, which the statement does not say. The third contradicts it outright. The fourth may well happen (there may be more passes than places), but nothing in the statement makes it certain.

Answer: C

There is at least one nurse who is a vegetarian, and every vegetarian avoids gelatine, so that nurse avoids gelatine: some of the nurses do. Nothing is said of the nurses who are not vegetarians, so neither "all the nurses" nor "no nurse eats meat" follows. The fourth option may be true but need not be (the vegetarians could all be nurses), and the fifth reverses "all vegetarians avoid gelatine".

Answer: D

Facing north, a right turn of 90° leaves him facing east; turning through 180° from east leaves him facing west; and a left turn of 90° from west leaves him facing south. Ending north would mean the two quarter-turns cancel, which forgets the half-turn in between; east and west are the positions after the first and second turns.

Answer: E

Turning right from north takes her east, so her two legs are at right angles and the straight-line distance is the hypotenuse of a right-angled triangle with sides 6 km and 8 km: √(6² + 8²) = √(36 + 64) = √100 = 10 km. 14 km is the distance walked, not the distance from the start, and 2 km would be right only if she had turned back on herself.

Answer: A

B cannot be in seat 2 or 4, which are both next to C in seat 3, and seat 1 is E's, so B is in seat 5. A and D take seats 2 and 4; D may not sit next to E, who is in seat 1, so D is in seat 4 and A in seat 2. The arrangement is E, A, C, D, B, and the student between C (seat 3) and B (seat 5) is D. A is between E and C instead.

Answer: B

Number the seats 0 to 5 clockwise and put P in seat 0. Then Q is opposite, in seat 3; R is one place clockwise from P, in seat 1; and S is opposite R, in seat 4. That leaves seats 2 and 5 for T and U. Seat 2 is next to Q (seat 3), so T, who is not next to Q, takes seat 5, and U takes seat 2. The person one place clockwise from R (seat 1) is in seat 2: U. The arrangement is fixed by the clues, so "cannot be determined" is wrong.

Answer: C

Work with rates: the first pump fills 1/6 of the tank an hour and the second 1/3, so together they fill 1/6 + 1/3 = 1/6 + 2/6 = 1/2 of the tank an hour, and the whole tank takes 2 hours. 4.5 hours averages the two times, and 9 hours adds them; together the pumps must be faster than the faster pump alone, so anything of 3 hours or more is impossible.

Answer: D

Let x be the volume of 10% solution. The glucose in the mixture is 0.10x + 0.05 × 300 = 0.10x + 15, and it must equal 8% of the total volume, 0.08(x + 300) = 0.08x + 24. So 0.02x = 9 and x = 450 mL. Check: 45 + 15 = 60 g of glucose in 750 mL is 8%. 300 mL would give the average of 10% and 5%, 7.5%; to pull the mixture to 8%, nearer to 10% than to 5%, more of the 10% solution is needed.

Answer: E

Write the numbers as n and n + 2: n(n + 2) = 143, so n² + 2n − 143 = 0, which factorises as (n + 13)(n − 11) = 0. The positive solution is n = 11, the numbers are 11 and 13 (11 × 13 = 143), and their sum is 24. 22 and 26 are double one of the two numbers, and 23 and 25 are odd, which the sum of two odd numbers can never be.

Answer: A

The chemistry book can stand at either end (2 ways), and the other three books then fill the remaining three places in 3! = 3 × 2 × 1 = 6 ways, so there are 2 × 6 = 12 arrangements. 24 = 4! counts every arrangement with no condition; 6 counts only one of the two ends; 48 doubles the unrestricted count.

Answer: B

The first kit works with probability 4/6. Once a working kit has been removed, 3 of the remaining 5 work, so the second works with probability 3/5. Both work with probability 4/6 × 3/5 = 12/30 = 2/5. 4/9 = (4/6)² would be right only if the first kit were put back; 3/5 is the probability that at least one is faulty; 1/15 is the probability that both are faulty.

Answer: C

Every rectangle is fixed by choosing two of the grid's horizontal lines and two of its vertical lines. A grid of 2 rows has 3 horizontal lines and one of 3 columns has 4 vertical lines, so there are C(3, 2) × C(4, 2) = 3 × 6 = 18 rectangles. Counting them by size gives the same: six 1×1, four 1×2, two 1×3, three 2×1, two 2×2 and one 2×3, total 18. 6 counts only the unit squares.

Answer: D

The newspaper moves from a difference between two groups of workers to a prediction about what handing out vitamin D would do. That move works only if the supplement itself produced the difference; if supplement-takers simply differ in other ways (as the second paragraph says they tend to), giving everyone vitamin D need not change anything. The conclusion is about respiratory sick days alone, so it needs no claim about other illnesses or about the share of all absence; it needs no claim about how many workers are deficient; and the link between exercise and infection is an objection to the conclusion, not a premise of it.

Answer: E

If workers taking an unrelated supplement show the same 30% advantage, the advantage belongs to the kind of person who takes supplements, not to vitamin D, and the newspaper's causal claim collapses. A mild winter affects both groups alike; sunlight and free fruit do not bear on the comparison; and a slight age difference between the groups could cut either way, so it neither clearly weakens nor clearly strengthens the case.

Answer: A

The passage gives two reasons the survey cannot settle the question (the groups differ in other ways, and the counts rest on memory) and says randomised trials avoid them, so the survey on its own cannot show cause and effect. "No effect" goes too far, since the trials found a small benefit; the 30% figure is the newspaper's claim, which the passage undermines; memory is called a weakness, not always wrong; and the benefit was concentrated in people with low levels, not high ones.

Answer: B

The survey found that the two went together (a correlation), but it did not assign the supplement by chance, and the passage names confounders (exercise, smoking, income) that could produce the same pattern. That makes it an association, not an established cause. There is a relationship, so "none" is wrong; nothing in the passage shows illness causing people to stop taking supplements; and random assignment is what the survey lacked, as the third paragraph points out.

Answer: C

80 of the 200 patients on drug B were pain-free: 80/200 = 0.40, or 40%. 35% is drug A's figure (84/240), 15% is the placebo's (24/160), and 25% is the share of drug B's patients who reported nausea (50/200).

Answer: D

Drug A: 84/240 = 35% pain-free. Placebo: 24/160 = 15%. The difference is 35 − 15 = 20 percentage points. 60 subtracts the raw counts (84 − 24), which ignores the groups' different sizes; 133 is the relative increase, (35 − 15)/15 ≈ 133%, a percentage rather than a difference in percentage points; 35 and 15 are the two proportions themselves.

Answer: E

The nausea rates are 36/240 = 15% on drug A, 50/200 = 25% on drug B and 16/160 = 10% on placebo, so drug B's is the highest. Sixteen placebo patients did report nausea. Drug A had more pain-free patients in number (84 against 80) but from a larger group, and its rate, 35%, is lower than drug B's 40%, so the count misleads. 15% is one and a half times 10%, not three times.

Answer: C

Respect for autonomy is the duty to respect a competent person's own informed decisions about their body and treatment, even where the doctor would have chosen differently. Beneficence (acting for the patient's good) is what the recommendation itself expressed, and following it would not have required the patient's choice. Non-maleficence is about avoiding harm and justice about fair distribution; neither describes deferring to the patient. Loyalty to the institution is not one of the four principles at all.

Answer: A

Non-maleficence ('first, do no harm') forbids exposing a patient to the risks of a treatment that offers no compensating benefit, which is exactly the case here. Respect for autonomy gives a patient the right to refuse treatment, not a right to demand an ineffective one, so it does not oblige the doctor to prescribe. Justice (fair use of resources, including the wider harm of antibiotic resistance) is relevant but secondary to the risk to this patient. Veracity and confidentiality are not in play: the doctor is honest and nothing is disclosed.

Answer: E

This is the doctrine of double effect: an action with a good effect (relief of suffering) and a foreseen but unintended bad effect (possible shortening of life) can be justified when the intention is the good effect, the bad effect is not the means to it, and the good is proportionate to the risk. The option naming those conditions is correct. A dying patient can still be harmed, so the first option is false. The family's wishes do not justify it, an inevitable death does not permit any action, and a request alone does not make deliberately shortening life acceptable; none of these is the reasoning behind palliative dosing.

Answer: B

The doctor's wish to save his life (beneficence) conflicts with his informed refusal (respect for autonomy). In medical ethics a competent adult's informed refusal of treatment is respected even when the refusal may lead to death: treating him against his will would be a serious violation of his bodily integrity. The option saying beneficence prevails because life is at stake describes the paternalism that modern medical ethics rejects for competent adults. Justice, confidentiality and veracity are not the principles in tension here.

Answer: D

Justice in this framework is distributive: benefits, burdens and costs should be shared fairly, and patients with relevantly similar needs should be treated alike. Giving everyone what they ask for ignores both need and scarcity. The majority view of colleagues is not a principle of justice. Taking 'wrongdoing' into account in care turns medicine into punishment, which justice in this sense excludes. Budgets matter to fair allocation, but balancing them is not what the principle requires of each decision.

Answer: B

Valid consent has three core elements: it is informed (nature, purpose, significant risks and alternatives explained), voluntary and given by a person with capacity. A signature is evidence that consent was sought, not what makes it valid: much everyday care rests on verbal or implied consent, and a signed form does not cure consent that was uninformed or coerced. The other four options are genuine requirements.

Answer: D

Capacity is decision-specific and time-specific: a person may be able to decide about one matter but not another, and capacity can fluctuate, so it is judged for the particular decision when it needs to be made, by asking whether the person can understand, retain and weigh the relevant information and communicate a choice. A diagnosis such as dementia does not by itself remove capacity. Disagreeing with the doctor is not evidence of incapacity. Assessment is normally done by the clinician proposing the treatment; a psychiatrist helps in difficult cases but is not required.

Answer: A

Case A shows each element of capacity for this decision: Mr D restates the information in his own words (understanding), still holds it a day and a week later (retention), balances the benefit against his fear of a long admission (weighing) and states a clear, consistent choice (communication). A diagnosis of early Alzheimer's does not remove capacity, and a choice against advice is not evidence of incapacity. The daughter's agreement plays no part in assessing capacity, and capacity is judged decision by decision, not split into 'daily' and 'medical' categories.

Answer: E

Mr D has capacity for this decision, so only he can consent to or refuse the operation; a relative, even the next of kin, cannot consent on behalf of an adult who can decide for himself, and the team's view of his interests does not override his refusal. The kindest course is to explain this to the daughter, with his agreement since her father's care is his own information, and to acknowledge her worry. Making the decision wait for the two of them to agree would hand her a veto she does not have.

Answer: C

A capacitous patient may make a decision that others think unwise; the reason is his own and is understandable given his wife's death. Good practice is to explore the fear behind the refusal and offer information that might address it, such as the expected length of stay or rehabilitation support, without pressure, and to respect the outcome. Repeating the risks until he gives in is coercion. An unwise reason is not, on its own, grounds to doubt capacity, and treating him anyway would override a valid refusal. Discharging him abandons a patient who still needs pain relief and who may change his mind.

Answer: E

Confidentiality may be breached without consent only in narrow circumstances, chiefly where disclosure is needed to prevent a serious and specific risk of harm to an identifiable person (or where the law requires it). A credible threat against a named person is the classic case. Public curiosity about a famous patient, an employer's or neighbour's wish to know, and a doctor's wish to talk about an interesting case are not justifications at all.

Answer: C

An adult patient's information belongs to him: relatives have no automatic right to it, and confirming his date of birth only shows that she knows him, not that he agrees. The right course is to ask the patient what he wishes and meanwhile offer to pass on a message. Hinting that the diagnosis is 'too serious' itself discloses information. Ending the call abruptly is unnecessarily unkind when the nurse can help without breaching confidence.

Answer: B

Even a justified breach must be proportionate: the minimum necessary information should go only to the person or body who can act to prevent the harm. Handing over the whole record or announcing it publicly discloses far more than the purpose requires, and the family is not the relevant recipient. A justified disclosure should be documented, with the reasons, so that it can be accounted for; hiding it is the opposite of good practice.

Answer: D

Disclosure to a third party for a purpose other than the patient's care, such as an insurance claim, requires the patient's explicit consent to that particular disclosure, ideally after the patient has had the chance to see what will be sent. Insurers have no automatic entitlement, a manager's approval or a fee cannot substitute for the patient's consent, and keeping the patient unaware would defeat the point of asking.

Answer: A

Removing direct identifiers is not enough when the remaining details (a very rare condition in a small community) can still identify the patient; the safe and respectful course is the patient's consent to publication. The scientific value of a report does not override confidentiality. Changing clinically relevant facts such as sex or age would make the report inaccurate, which is itself a problem of scientific honesty. The family cannot consent in place of a capacitous patient.

Answer: D

A competent patient who asks directly is entitled to an honest answer; deceiving him at the family's request would breach truthfulness and his autonomy, and would undermine trust in his care. Good practice is to find out what he already understands and how much he wants to know, then share the truth at his pace. Lying, sending him to his family and evading the question all fail him. Forcing every detail on a patient who has not asked for it is not required by honesty and can itself be harmful.

Answer: B

Honesty about mistakes is a basic professional duty: the patient should be told what happened, receive an apology and an explanation of what is being done, and the error should be reported so that the system can learn from it. Staying silent because there was no lasting harm, waiting to be asked, or reporting internally while keeping the patient in the dark all deny the patient information about his own care. Falsifying the record is dishonest and dangerous.

Answer: E

Doctors should not accept gifts or hospitality that could influence their judgement, or could reasonably be seen to, because patients must be able to trust that prescribing serves them and not a commercial interest. A lavish weekend with a token talk is exactly such a gift. Promising oneself not to be influenced does not remove the conflict or how it looks, the 'educational' label does not change its substance, and bringing family or declaring it only on request makes things worse.

Answer: A

Patient safety comes first: a doctor who believes a colleague is unfit to practise must act promptly, which here means raising it immediately with the person who can stop the operation (the senior clinician or manager responsible) before any patient is put at risk. Seniority does not excuse silence, and waiting until after the list leaves patients exposed. A social-media post is unprofessional and does not protect anyone in time. Asking the patient to decide shifts a professional responsibility onto someone who cannot assess it.

Answer: C

Doctors must not pursue personal or sexual relationships with current patients: the imbalance of power and the trust involved in care make such relationships an abuse of the professional role. The right response is a polite refusal that keeps the relationship professional. Being adults, transferring care afterwards or the treatment nearly being over do not remove the problem. Dropping the patient without explanation abandons someone who still needs care.

Answer: A

Triage allocates scarce care by clinical need and the expected benefit of treatment, so that those who can be helped most by prompt treatment get it first. Arrival order ignores need and can cost lives. Social standing and insurance status are judgements of worth or ability to pay, which justice in medicine excludes. Blame for the accident is not a clinical criterion: care is not a reward or a punishment.

Answer: E

Ranking patients by profession or 'contribution to society' values some lives above others according to their social role, which fair allocation rejects. Compatibility, urgency and expected benefit are clinical criteria that bear on whether and how much the organ will help. Time on the waiting list is a procedural criterion that treats candidates who are otherwise equal fairly; it does not judge their worth.

Answer: C

The case says the drug works when started within three days and helps little later, so prioritising high-risk patients inside that window combines need (risk of severe disease or death) with expected benefit, the two main clinical criteria for fair allocation of a scarce treatment. The draft is not based on admission order or cost. With 40 courses for more than 150 patients, it cannot guarantee that everyone is treated, and good allocation keeps criteria open to discussion rather than closing it.

Answer: D

Once the clinical criteria have been applied, the remaining patients have equal claims; a random draw respects that equality and prevents the choice from being made on irrelevant or biased grounds such as status, likeability or connections. It does not replace clinical assessment (it applies only after it) and cannot pick out who will benefit most, since by assumption they are equal. The committee remains responsible for the criteria and the process. Favouring the 'more deserving' is exactly what the lottery is designed to exclude.

Answer: B

Reserving scarce drugs for well-connected people who are not ill gives them priority on the basis of status, not need, which fair allocation forbids; the same applies if they become ill later, since they should then be assessed by the same criteria as everyone else. Fair procedures are also transparent: publishing the criteria and applying them consistently lets the public see that the decisions are reasonable and accountable. Secrecy, whether to hide a favour or to avoid complaints, undermines trust. A promise of funding is a bargain for priority, not a justification for it.