Bar Exam (Next Generation) Quiz: Actual Causation

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Actual CausationQuestion 1 of 18

Renata, who has advanced osteoporosis, tripped and fell in a narrow aisle at a hardware store. She caught her foot on a display ladder that an employee had left flat on the floor while stocking shelves. Renata fractured her hip in the fall and sued the store. The store concedes leaving the ladder in the aisle was negligent, but it denies that the fall caused the fracture. Renata's expert says the impact of the fall caused the hip to break. The store's expert notes that an X-ray taken two months earlier had revealed a hairline fracture in Renata's hip that had not fully healed.

Which additional fact, if true, would be most important in determining whether the store's negligence caused Renata's fractured hip?

The hairline fracture would have progressed to a complete fracture at approximately the same time even if Renata had not fallen.

Renata was looking at her phone and not watching where she was walking when she tripped.

The employee placed the ladder flat only two feet from the end of the shelf, not the three feet specified by store policy.

Renata had been diagnosed with osteoporosis two years earlier and had been advised to use a walker.

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Bar Exam (Next Generation) Quiz

Bar Exam (Next Generation) Quiz: Actual Causation

Practice Actual Causation in Bar Exam (Next Generation) with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

What this quiz covers

This quiz focuses on Actual Causation, giving you a quick way to practice the rules, question types, and explanations that matter most for Bar Exam (Next Generation).

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

All questions

Question 1

Which additional fact, if true, would be most important in determining whether the store's negligence caused Renata's fractured hip?

The hairline fracture would have progressed to a complete fracture at approximately the same time even if Renata had not fallen. (correct answer)
Renata was looking at her phone and not watching where she was walking when she tripped.
The employee placed the ladder flat only two feet from the end of the shelf, not the three feet specified by store policy.
Renata had been diagnosed with osteoporosis two years earlier and had been advised to use a walker.

Explanation: When negligence is conceded, the remaining battle is causation — specifically, whether the store's conduct was a "but-for" cause of Renata's broken hip. That means asking: would the injury have happened anyway, even without the fall? The most important fact is that the hairline fracture would have progressed to a complete fracture at approximately the same time even if Renata had not fallen. If true, the fall did not cause the hip to break; the pre-existing condition did. The store's negligence may have coincided with the injury, but it was not the cause. The fact that Renata was looking at her phone does not answer the causation question. It could support a comparative negligence defense, reducing her recovery, but the store already left the ladder negligently, and the issue is what caused the fracture — not who was careless at the moment. Similarly, the employee placing the ladder two feet instead of three feet from the shelf end may show a breach of store policy, but it does nothing to prove that the fall caused the fracture. Renata's osteoporosis and her doctor's advice to use a walker are also not exculpatory; tort law takes plaintiffs as they find them, so a pre-existing vulnerability does not break the causal chain if the fall actually triggered the break. On causation questions, separate "did the defendant act negligently?" from "did that negligence make the injury happen?" — and watch for facts showing the injury was inevitable on its own.

Question 2

A doctor negligently failed to diagnose a patient's cancer. At the time of the negligent failure, the patient had a 45% chance of survival with proper treatment. Because of the delay, her chance of survival dropped to 10%, and she died. Her estate sued the doctor under the Patient Compensation Act, which provides in relevant part:

'§4. Lost Chance of Survival. (a) In an action for medical malpractice based on a lost chance of survival, the plaintiff must prove that the defendant's negligence was a substantial factor in reducing the patient's opportunity for a better outcome. (b) The plaintiff may not recover under this section unless the opportunity for a better outcome that existed immediately before the defendant's negligence was greater than 50%. (c) If the plaintiff satisfies subsection (b), damages shall be the percentage of the opportunity lost, multiplied by the damages that would otherwise be recoverable for the patient's death.'

Under §4, which of the following is most accurate regarding the estate's claim?

The estate may recover 35% of the wrongful-death damages, representing the percentage of the opportunity for survival that the delay destroyed.
The estate may not recover under §4 because the doctor's delay did not cause the cancer, which was the actual cause of the patient's death.
The estate may recover the full amount of wrongful-death damages because the doctor's negligence was a substantial factor in the patient's death.
The estate may not recover under §4 because the patient's opportunity for a better outcome before the negligence was 45%, not greater than 50%. (correct answer)

Explanation: This question tests how a statutory "lost chance of survival" claim works. Whenever you see such a statute, check the threshold eligibility rule first: before the negligence, did the patient have a greater-than-50% opportunity for a better outcome? Only if that precondition is met do you move on to causation and percentage damages. Here, the patient had a 45% chance of survival before the doctor's negligent failure. Section 4(b) says the plaintiff may not recover unless that pre-negligence opportunity was greater than 50%. The estate therefore fails at the threshold. The later drop from 45% to 10% and the doctor's negligence being a substantial factor are relevant facts, but they cannot overcome the statute's explicit bar. The choice saying the estate may recover 35% of wrongful-death damages incorrectly applies the subsection (c) percentage formula without satisfying subsection (b). The "full amount" choice wrongly equates substantial-factor causation with full wrongful-death recovery; §4 creates a limited remedy, not a replacement for the statutory threshold. The "delay did not cause the cancer" choice misunderstands the nature of lost-chance claims—the doctor need not cause the underlying disease, only negligently reduce the patient's opportunity for a better outcome. The correct conclusion is that recovery is barred because 45% is not greater than 50%. Study tip: read statutory elements in order. A threshold like "greater than 50%" can dispose of the claim before you ever reach causation or damages—don't let sympathetic facts pull you past the statutory requirement.

Question 3

During a hunting trip, P was struck by a bullet while walking along a trail behind a deer. Two hunters, D and R, had fired at the deer at about the same time from opposite sides of the trail. P sued D. D concedes he fired toward the deer but contends R's bullet struck P. R admits he also fired at the deer.

Which additional fact, if true, would most help D show his bullet did not cause P's injury?

The bullet recovered from P was too fragmented for ballistics testing, so it could not be matched to either rifle.
R was using a rifle with a higher muzzle velocity than D's rifle.
D's rifle had a custom trigger with a lighter pull than R's rifle.
The entry wound was on P's right side, and D had been standing to P's left. (correct answer)

Explanation: When you see a multiple-shooter torts question, focus on but-for causation: would P's injury have occurred even if D had not fired? Both D and R fired, so the evidence must link the actual bullet to one shooter. The strongest fact is the wound's location. P's entry wound was on his right side, and D was standing to P's left. A bullet from D, coming from the left, would ordinarily have entered on P's left side or traveled left-to-right through the body. An entry wound on the right therefore points toward R, who was on the opposite side, and helps show D's bullet was not the cause. The fragmented bullet does not help because it creates no directional link; it simply means the projectile cannot be identified. R's higher muzzle velocity is also unhelpful—velocity alone does not tell you whose bullet hit P or where it entered. D's custom trigger with a lighter pull is worse than irrelevant: it concerns D's ease of firing, not whether his bullet caused the wound, and could even suggest D fired more readily. On causation questions, look for physical-trajectory evidence—entry wound, shooter position, bullet path—rather than weapon characteristics or inability to test. Ask: would the injury have happened anyway without D's shot? If yes, D is not a but-for cause.

Question 4

A patient with a persistent cough and unexplained weight loss visited a doctor. The doctor diagnosed a viral infection and did not order a chest X-ray. Seven months later, the patient was diagnosed with advanced lung cancer and died within a year. The patient's estate sued the doctor for negligence. The patient was a longtime smoker. Medical experts agreed that the cancer was present and growing at the time of the first visit. At that time, the patient had a 40% chance of surviving five years; by the time of the later diagnosis, the chance was 15%.

Which of the following is the most significant legal issue raised by these facts in evaluating whether the doctor's negligence caused the patient's death?

Whether the doctor's failure to order a chest X-ray was a deviation from the accepted standard of care for a patient with these symptoms.
Whether the doctor's delay caused a loss of a chance of survival, even if the patient would probably have died from the cancer anyway. (correct answer)
Whether the patient's smoking history should reduce the estate's recovery because it contributed to the risk of lung cancer.
Whether the doctor's misdiagnosis was a foreseeable cause of the patient's death under the circumstances.

Explanation: Whenever a delayed-diagnosis case gives you survival probabilities both before and after the delay, you are almost certainly looking at the loss-of-chance doctrine. In ordinary tort causation, a plaintiff must show that the negligence probably caused the death. But when a doctor's delay reduces a patient's chance of surviving an already-existing condition, many courts treat that lost chance itself as a compensable injury. Here, the cancer was present and growing at the first visit, and the five-year survival chance dropped from 40% at that time to 15% by later diagnosis. That drop frames the critical causation question: did the doctor's delay cause a loss of a chance of survival, even though death may have been more likely than not anyway? This is exactly the correct choice. The question about whether failing to order a chest X-ray deviated from the accepted standard of care addresses breach, not causation; it matters for liability generally, but it does not resolve the unique causal problem presented by these probabilities. The smoking-history choice might seem relevant to the patient's baseline risk or comparative fault, but it does not answer whether the delay destroyed a meaningful chance; smoking is already baked into the 40% and 15% figures. The foreseeability choice invokes general proximate-cause language, but the more specific issue is not whether death was foreseeable; it is whether the lost chance itself is legally actionable. So when you see survival probabilities before and after a negligent delay, focus on loss of chance — not breach, not smoking apportionment, and not ordinary foreseeability.

Question 5

Section 22 of the Model Civil Justice Act provides:

(a) A defendant's tortious conduct is a factual cause of harm if it hastens or exacerbates an injury or condition that would otherwise have occurred or become disabling at a later time.

(b) But-for causation is satisfied if the harm would not have occurred at the time it did absent the defendant's conduct; the fact that an identical harm would have occurred later from natural causes does not defeat actual causation.

(c) The defendant is liable only for the additional harm caused by the acceleration or exacerbation, not for harm that would have occurred in any event.

Victor, who had a terminal illness with an expected remaining lifespan of about 12 months, was severely injured when Lena negligently ran a stop sign and struck his car. Emergency physicians testified that the collision did not cause Victor's underlying illness but caused internal bleeding that killed him within 24 hours. Absent the collision, he would have died from the illness in about 12 months. Lena concedes negligence. Under Section 22, which statement best describes Lena's liability, if any, for Victor's death?

Lena is not liable, because Victor would have died within a year even absent the collision; his death was caused by his terminal illness, not by Lena's negligence.
Lena is not liable, because her negligence did not cause the terminal illness; a defendant is not a factual cause of harm that would have occurred anyway from natural causes.
Lena is liable for the full value of the life Victor would have had absent both the illness and the collision, because the collision caused Victor's death at the time it occurred.
Lena is liable only for the additional harm caused by the acceleration, because the collision hastened Victor's death; she is not liable for the harm that would have occurred later in any event. (correct answer)

Explanation: This question tests "hastened harm" causation under a statute that treats acceleration as factual cause but limits damages. When you see a plaintiff who was already dying or injured before the defendant acted, remember: causation can still exist if the defendant made the harm occur sooner, but the defendant owes only for the lost time or worsened condition, not the underlying loss. Here, Victor's terminal illness is not a defense. Section 22(b) says but-for causation is satisfied if the harm would not have occurred at the time it did. Without Lena's collision, Victor would have died in about 12 months; with it, he died within 24 hours. That makes her negligence a factual cause of his death at that earlier time. However, Section 22(c) limits liability to the "additional harm" from acceleration. Lena must compensate for the value of the roughly 12 months of life Victor lost, not for a death that was inevitable. The wrong answers reflect two main traps. "Lena is not liable, because Victor would have died within a year even absent the collision" ignores the statute's explicit rule that later natural death does not defeat actual causation. Similarly, "her negligence did not cause the terminal illness" misses the point: the negligence caused the internal bleeding that killed him immediately; it need not cause the preexisting condition. Finally, "liable for the full value of the life Victor would have had absent both the illness and the collision" overstates liability by ignoring the limitation in §22(c) and by treating Victor as if he had a healthy lifespan. On exam day, when a defendant "merely" accelerates an inevitable harm, choose liability for the acceleration only—not full damages, and no liability at all.

Question 6

Rosa worked for 15 years at a plant where she was exposed to a solvent manufactured by ChemCo. She developed leukemia and sued ChemCo, claiming the solvent caused her disease. At trial, her expert testified that the solvent is a recognized cause of leukemia and that Rosa's exposure increased her risk of developing leukemia by 25%. The expert also testified that Rosa had smoked cigarettes for 25 years, which increased her risk of leukemia 12-fold, and that he could not determine which exposure actually caused Rosa's leukemia.

In Ingram v. ChemPro Industries, the state supreme court held: 'General causation — that a substance is capable of causing a disease — and proof of exposure do not establish factual causation. The plaintiff must prove specific causation: that the defendant's product, more likely than not, caused this plaintiff's disease. Where the plaintiff has been exposed to other risk factors that are independently capable of causing the disease, evidence that the defendant's product increased the plaintiff's risk, without evidence permitting the inference that the product was a substantial factor in the disease, is insufficient.'

Under Ingram, which of the following is most accurate regarding whether Rosa has established that ChemCo's solvent was a factual cause of her leukemia?

Rosa has established factual causation because the solvent is a recognized cause of leukemia and her exposure to it increased her risk of the disease.
Rosa has established factual causation because the solvent's contribution to her risk combined with the contribution from her smoking, and a defendant need not be the sole cause of the plaintiff's disease.
Rosa has not established factual causation because the evidence shows only that the solvent increased her risk, without evidence permitting the inference that the solvent was a substantial factor in her leukemia. (correct answer)
Rosa has established factual causation because her exposure to the solvent was a but-for cause of her increased risk of leukemia, even if the solvent was not the cause of the leukemia itself.

Explanation: Whenever you see a toxic tort question involving multiple risk factors, immediately separate general causation (can it cause?) from specific causation (did it cause this plaintiff's disease?). Ingram explicitly rejects using increased risk alone to prove specific causation. The correct answer is the choice stating Rosa has not established factual causation because the evidence shows only increased risk without a substantial factor inference. Rosa's expert testified the solvent increased her risk by 25% but admitted he could not determine which exposure caused her leukemia. Given her 25-year smoking history (a 12-fold risk increase), the evidence does not permit a jury to infer the solvent was a substantial factor in her disease. This directly satisfies Ingram's requirement. The choice stating Rosa has established factual causation because the solvent is a recognized cause and increased her risk is wrong because it relies on general causation alone, which Ingram holds is insufficient. The choice arguing the solvent's contribution combined with smoking and that a defendant need not be the sole cause is a tempting trap. While a defendant need not be the sole cause, the plaintiff still bears the burden of proving this defendant's product was a substantial factor. Since the expert explicitly could not determine the actual cause, combining the risk percentages does not provide the necessary evidence of specific causation. The choice claiming but-for causation of the increased risk is wrong because it conflates causing a statistical risk with causing the disease itself. Factual causation requires proof the solvent caused the leukemia, not merely the elevation of risk. Study tip: Whenever you see "increased risk" or "recognized cause," ask yourself: does this prove a substantial factor in this patient's specific injury, or does it merely establish statistical possibility? If the expert cannot rule out other independent causes, specific causation fails.

Question 7

Section 7 of the Model Civil Justice Act provides:

(a) A person's tortious conduct is a factual cause of harm if the harm would not have occurred absent that conduct.

(b) If two or more tortious acts each would have been sufficient, standing alone, to cause an indivisible harm, each is a factual cause, provided each act occurred before the harm was complete and the acts operated concurrently.

Piper, a commercial nursery owner, sued Ajax Chemical and Bass Transport after her irrigation well became unusable. Ajax negligently spilled solvent into groundwater on June 1; tests showed that by June 5 the Ajax solvent alone had already made the well unusable. On June 10, Bass negligently spilled an identical solvent into the same aquifer; that solvent would also have made the well unusable by itself, and it reached Piper's well on June 12. The well remained unusable thereafter. Neither Ajax nor Bass contests that its spill was tortious. Under Section 7, which defendant or defendants are factual causes of Piper's harm?

Neither Ajax nor Bass, because Piper's well became unusable even without Bass's spill and Ajax's spill was sufficient by itself to render the well unusable.
Ajax only, because Ajax's spill occurred before the harm was complete; Bass's spill occurred after the harm was complete and did not hasten or worsen the harm. (correct answer)
Bass only, because Bass's later spill would independently have rendered the well unusable, whereas Ajax's earlier spill had already spent its force and could not be a continuing cause.
Ajax and Bass, because each spill alone would have been sufficient to render the well unusable, and each spill was tortious.

Explanation: This question tests factual causation under Section 7, specifically how timing affects otherwise sufficient causes. The key move is to separate "could have caused the harm" from "actually caused the harm that already occurred." Ajax's spill is a clear factual cause: by June 5, the Ajax solvent alone had already made the well unusable, so the harm occurred absent? No—rather, the harm occurred because of Ajax's conduct, and it was complete by June 5. Bass's spill on June 10 came after that harm was complete, and although it would independently have made the well unusable, the statute says an act after the harm is complete that neither hastens nor worsens the harm is not a factual cause. Section 7(b) does not save Bass because it requires the acts to have operated concurrently and before the harm was complete. Therefore Ajax only. The choice saying "Neither Ajax nor Bass" is wrong because Ajax's spill actually did cause the harm; the absence of Bass's spill would not undo Ajax's causation. "Bass only" is wrong because Ajax did not cease being a cause merely because its force had already produced the harm. "Ajax and Bass" is the tempting answer because each spill alone was sufficient, but it ignores the explicit statutory timing requirement: concurrent sufficient causes must each occur before the harm is complete. On causation questions, always check the timeline: when was the harm complete, and did each defendant's act occur before that moment? A later independent cause that could have caused the same harm is not a factual cause if it neither hastens nor worsens the already-completed injury.

Question 8

Section 18 of the Model Civil Justice Act provides:

(a) When a plaintiff demonstrates that two or more defendants each owed and breached a duty to the plaintiff, one of the defendants caused the plaintiff's harm, the plaintiff cannot identify which defendant caused it, and all persons who may have caused the harm are before the court, each defendant has the burden of proving noncausation.

(b) A defendant satisfies that burden only by proving that another person's tortious conduct was the factual cause of the harm; proof that another person was negligent, without more, is insufficient.

(c) If a defendant proves noncausation, that defendant is exonerated; if no defendant proves noncausation, every defendant is jointly and severally liable.

Nina was struck by a bullet at a shooting range. Omar and Pete, standing nearby, each negligently fired a handgun in Nina's direction at roughly the same time. One bullet struck Nina. The bullet recovered from Nina was a .22-caliber round. Omar's handgun was a .38-caliber revolver, which cannot fire .22 ammunition; Pete's handgun was a .22-caliber pistol, which could fire that round. No other shooter was present, and both Omar and Pete are before the court. Under Section 18, which defendant or defendants are liable for Nina's injury?

Neither Omar nor Pete, because Nina cannot prove which defendant's shot was the but-for cause of her injury, and the recovered bullet does not identify who fired it.
Both Omar and Pete, because each negligently fired in Nina's direction; one bullet caused the harm; and, under the burden-shifting rule, neither has conclusively proven noncausation.
Omar only, because Pete's .22-caliber pistol could not have caused a wound of the severity suffered by Nina; the recovered .22 bullet must have come from Omar's .38 revolver despite its caliber.
Pete only, because Omar's .38 revolver could not have fired the recovered .22-caliber bullet, while Pete's .22 pistol could have; Pete has not proven noncausation. (correct answer)

Explanation: Whenever you see a burden-shifting rule like Section 18, remember its purpose: the plaintiff need not identify which defendant caused the harm if all possible tortfeasors are in court and each was negligent. The burden then falls on each defendant to prove noncausation. Nina satisfies the threshold: both Omar and Pete negligently fired toward her, one bullet struck her, and both are before the court. Omar can meet his burden because his .38 revolver cannot fire a .22-caliber bullet; he is physically incapable of having caused Nina's injury. That leaves Pete's .22 pistol as the only possible source, so Pete has not proved noncausation and is solely liable. The choice saying "neither Omar nor Pete" misunderstands the statute: Nina does not have to prove which bullet hit her, and the recovered .22-caliber bullet actually excludes Omar. The "both Omar and Pete" choice is wrong because Omar has affirmatively shown noncausation through the caliber mismatch. The "Omar only" choice is illogical: a .38 cannot fire a .22, and the wound-severity theory is unsupported speculation. So Pete only is correct. Study tip: in alternative-liability questions, identify which defendants are eliminated by physical impossibility; if only one possible cause remains, that defendant carries the burden and loses if they cannot prove noncausation.

Question 9

Section 12 of the Model Civil Justice Act provides:

(a) If a defendant's tortious conduct deprives a patient of a chance to achieve a better medical outcome, the patient may establish factual causation by proving that, at the time of the tortious conduct, the chance was greater than 10% and that the defendant's conduct reduced that chance.

(b) Damages for loss of chance are measured by multiplying the total damages for the patient's physical harm by the percentage-point reduction in the chance.

Dr. Gray negligently failed to report a suspicious mass shown on a June 1 CT scan until August 1. By then, Patient's cancer had spread. At trial, an oncologist testified that with proper treatment beginning June 1, Patient would have had a 22% chance of surviving five years; with treatment beginning August 1, her chance was 6%. Patient died four months after the delayed diagnosis. Her estate sued Dr. Gray for wrongful death. Under Section 12, can the estate establish factual causation, and if so, what damages may it recover?

No, because the estate cannot prove that prompt diagnosis would have saved Patient; her chance of survival was below 50% at all times, so but-for causation fails.
Yes, because the delay reduced her chance of survival from 22% to 6%; the estate may recover 16% of the total damages for her physical harm. (correct answer)
Yes, because the delay deprived Patient of the 22% chance she had; the estate may recover 22% of the total damages for her physical harm.
Yes, because the delay, by depriving Patient of any meaningful chance, was a substantial factor; the estate may recover the entire total damages for her death.

Explanation: This is a statutory loss-of-chance question under Section 12, so the key is applying the statute's specific threshold and damages formula, not ordinary but-for causation rules. Section 12 allows factual causation when a defendant's conduct reduces a chance that was greater than 10% at the time of the tortious conduct. It does not require proof that the patient would have survived under a more-likely-than-not standard. Here, Patient's chance with June treatment was 22%, and with August treatment it fell to 6%. Because 22% exceeds 10%, the delay satisfies Section 12(a); the chance was reduced by 16 percentage points. Under Section 12(b), damages are measured by multiplying the total damages for Patient's physical harm—here, the wrongful-death damages—by that 16% reduction. So the estate may recover 16% of those damages. The answer claiming "No, because the chance of survival was below 50%" misses the statute's purpose: loss of chance is recoverable even when the lost chance was less than 50%, as long as it exceeded 10%. The answer saying the estate "may recover 22%" confuses the original chance she had with the percentage-point reduction actually caused by the delay; the statute measures the loss, not the starting chance. And the answer saying the estate may recover "the entire total damages" ignores Section 12(b)'s explicit proportionate formula and overstates causation—Patient retained a 6% chance even with the delay, so her estate may recover only the value of the 16-point chance lost, not full wrongful-death damages. For Section 12 questions, always identify the starting chance, the later chance, and whether the starting chance exceeds 10%. Then apply the formula: reduce total damages by the percentage-point reduction, not by the original chance.

Question 10

Victor owns a furniture warehouse. An employee of the roofing company, while repairing Victor's roof, dropped a welding torch into a storage area, and the torch ignited cardboard boxes. At nearly the same time, lightning struck a transformer on a pole beside the warehouse, causing the building's wiring to ignite. The two fires spread and merged, and the warehouse was destroyed. Fire investigators agree that either fire, by itself, would have destroyed the warehouse before firefighters could arrive. Victor sues the roofing company for negligence. The roofing company admits that its employee negligently dropped the torch but claims the warehouse would have burned anyway because of the lightning.

Which of the following questions is most important in determining whether the roofing company is liable for the destruction of the warehouse?

Whether the roofing company's employee should have obtained a fire permit before using a welding torch on Victor's roof.
Whether the lightning strike was a superseding cause that relieves the roofing company of responsibility for the fire.
Whether the torch fire contributed to the destruction of the warehouse even though the lightning fire alone would also have destroyed it. (correct answer)
Whether Victor's failure to install an automatic sprinkler system makes him partly responsible for the damage to the warehouse.

Explanation: This question tests causation in negligence, specifically the problem of concurrent independent causes. When two fires would each independently have destroyed the warehouse, the usual "but-for" test fails: Victor's loss would have occurred even without the roofing company's negligence. So courts ask whether the negligent fire was a substantial factor incorrectly causing the harm. The most important question is therefore whether the torch fire contributed to the destruction of the warehouse even though the lightning fire alone would also have destroyed it–contributorily. If yes, the negligence is a cause; if no, it is not. The wrong answers are traps. The fire-permit question goes to whetherthel roofing company breacheda duty, but negligence is already admitted, so the remaining issue is causation, not standard of care. The lightning-as-superseding-cause argument misreads the doctrine: lightning was not an unforeseeable intervening act occurring after the defendant's negligence; it was an independent concurrent cause operating at nearly the same time, so it does not automatically relieve liability. And Victor's failure to install a sprinkler system concerns comparative fault or failure to mitigate damages, which might reduce his recovery but does not answer whetherthe roofing company caused the loss in the first place. Strategy tip: When you see two sufficient causes, don't anchor on but-for causation. Ask whether the defendant's negligence was a substantial factor in the harm — concurrent natural causes do not erase liability.

Question 11

Marco went to an emergency room with severe abdominal pain. The emergency physician diagnosed acid reflux, prescribed antacids, and sent him home. Twelve hours later, Marco collapsed and died from a ruptured abdominal aortic aneurysm. His estate sued the physician, claiming that a timely CT scan would have revealed the aneurysm and allowed surgical repair. The physician concedes that failing to order a CT scan fell below the standard of care.

Which additional fact, if true, would most undermine the estate's claim that the physician's failure caused Marco's death?

The emergency physician had been on duty for eighteen hours and was required to take a break after seeing Marco.
The aneurysm could not have been detected on a CT scan at the time Marco was in the emergency room. (correct answer)
The CT scanner required a radiology technician who would have taken twenty minutes to arrive.
Marco had not seen a doctor for five years before this emergency room visit.

Explanation: Whenever you see a causation question in a malpractice case, separate the two required links: the doctor's breach and the patient's harm. The estate must show that if the CT scan had been ordered, Marco likely would have survived. The fact that the aneurysm could not have been detected on a CT scan at the time he was in the ER severs that link completely. If the scan would have shown nothing, then ordering it would not have changed the treatment, so the physician's failure did not cause the death. The other choices miss this causal link. The physician being on duty for eighteen hours and required to take a break after seeing Marco goes to physician fatigue or hospital policy, not to whether the missed scan caused death. The CT technician taking twenty minutes to arrive is likewise about delay, but if the aneurysm was undetectable, timing does not matter. Marco not having seen a doctor for five years might suggest preexisting health neglect, but it does not explain how the physician's specific failure to order a CT caused the fatal outcome. On causation questions, ask: "Even if the defendant had done the right thing, would the harm still have occurred?" If yes, there is no but-for causation. Here, the undetectable aneurysm is the strongest answer because it makes the alleged breach harmless. On exam day, watch for facts that attack causation rather than duty or breach—they are often hidden in answer choices that sound like negligence but do not actually connect the doctor's error to the injury.

Question 12

Petra bought an over-the-counter sleep aid manufactured by PharmaCo. The label said 'do not drive or operate machinery after taking this product,' but it did not warn that alcohol could increase the sedative effect. Petra took the recommended dose, drank one glass of wine, and then drove to a store. She fell asleep at the wheel and struck a tree, suffering serious injuries. PharmaCo concedes that the combination of the drug and alcohol caused Petra to fall asleep and that the label should have warned against combining the drug with alcohol. Petra testified in her deposition that she often drank wine after taking sleep aids and that she probably would not have changed her behavior even if the label had contained the alcohol warning.

Which issue is most important in determining whether the inadequate warning caused Petra's injuries?

Whether Petra's blood alcohol concentration was above the legal limit for driving at the time of the accident and would therefore support a comparative-fault defense.
Whether an adequate warning against combining the drug with alcohol would have caused Petra to avoid drinking or driving after taking the drug on the night of the accident. (correct answer)
Whether PharmaCo knew or should have known at the time of sale that users commonly combined this sleep aid with alcohol and that the combination could impair driving.
Whether Petra's decision to drive after drinking was an unforeseeable superseding cause that broke the causal connection between the label and her injuries.

Explanation: When a product-liability claim rests on an inadequate warning, the causation question is not whether the drug caused the harm, but whether the missing warning caused the harm. The key inquiry is "but-for": would the plaintiff have acted differently if the warning had been given? That is exactly what matters here. Petra admitted in her deposition that she often drank wine after taking sleep aids and probably would not have changed her behavior even with an alcohol warning. If true, the inadequate label did not cause her injuries—her injury would have occurred anyway—so the warning issue turns on whether an adequate warning would have made her avoid drinking or driving that night. The blood alcohol concentration choice misses the point: a legal-limit violation might support comparative fault, but it does not tell you whether the warning itself caused the accident. Similarly, whether PharmaCo knew users combined the drug with alcohol goes to duty and breach—whether the warning was inadequate—not to causation. The superseding-cause option is also off; Petra's driving after drinking was not unexpected, and the question is whether the faulty warning caused her conduct, not whether her conduct was an independent event. On the bar exam, separate causation from breach: first ask what the defendant failed to warn, then ask whether that failure changed the plaintiff's conduct. A plaintiff's own testimony that she would not have heeded the warning is often fatal to causation.

Question 13

While hunting rabbits, Paul was struck by a single bullet and seriously injured. At that moment, three hunters fired in Paul's direction: Dan, who negligently fired a .22-caliber rifle; Earl, who negligently fired a 12-gauge shotgun; and Frank, who negligently fired a .22-caliber rifle. Dan and Earl were Paul's invited guests. Frank was a trespasser; after the shooting he fled and has never been identified or located. The bullet recovered from Paul was .22 caliber. Paul sued Dan and Earl for negligence, but he cannot prove whether Dan's or Frank's bullet struck him.

In Nunez v. Trapp, the state supreme court held: 'Where a plaintiff is injured by the act of one of several defendants, all of whom acted negligently toward the plaintiff, and the plaintiff cannot identify which defendant caused the injury, the burden of proof on factual causation shifts to each defendant to show that his negligence was not the cause. The shift is available only if (1) all potential tortfeasors are before the court and (2) the defendants' negligent conduct was substantially simultaneous and of the same type.'

Under Nunez, which of the following is most accurate regarding the burden of proving factual causation in Paul's action against Dan and Earl?

The burden shifts to Dan and Earl, and each must prove that his own conduct did not cause Paul's injury, because Paul cannot identify the shooter.
The burden does not shift; Paul must prove by a preponderance of the evidence that Dan's bullet caused his injury, and Earl is not a potential tortfeasor because he did not fire a rifle. (correct answer)
The burden shifts only to Dan, because Earl's shotgun could not have fired the bullet that struck Paul, and Dan must prove that Frank's bullet, not his, struck Paul.
The burden shifts to Dan and Earl because all three hunters acted negligently toward Paul and the shots were fired at the same moment.

Explanation: Whenever you see multiple negligent actors and an unidentified cause, think about alternative liability. Under Nunez, the burden shifts only if (1) all potential tortfeasors are before the court and (2) their negligent conduct was substantially simultaneous and of the same type. Here, both requirements fail. The bullet recovered from Paul was .22 caliber, so Earl's shotgun could not have fired it; Earl is not a potential tortfeasor. The other potential tortfeasor is Frank, who also fired a .22 rifle, but Frank fled and is not before the court. Because not all potential tortfeasors are present, the burden does not shift. Paul must prove by a preponderance of the evidence that Dan's bullet caused his injury. The statement that the burden shifts to Dan and Earl because Paul cannot identify the shooter ignores Nunez's all-tortfeasors requirement and also treats Earl as a potential tortfeasor when his shotgun could not have caused a .22-caliber injury. The statement that the burden shifts only to Dan, who must prove Frank's bullet struck Paul, is similarly flawed: Frank's absence from the case prevents any shift, and Dan does not have the burden to prove Frank's identity or conduct. Finally, the statement that the burden shifts to Dan and Earl because all three hunters acted negligently and fired simultaneously repeats those errors—Frank is not before the court, Earl did not fire a rifle, and simultaneous negligence alone is insufficient. On this exam, when a burden-shifting rule appears, first list every potential tortfeasor and check whether all are before the court and whether their conduct matches the injury mechanism. If any potential actor is missing, the plaintiff keeps the burden.

Question 14

Naomi, age 45, saw Dr. Anand about a lump in her breast. Dr. Anand ordered a mammogram. The radiologist's report described the imaging as 'suspicious for malignancy' and recommended a biopsy. Dr. Anand read the report but told Naomi the finding was 'probably nothing' and did not schedule a biopsy. Eight months later, a different doctor biopsied the lump and diagnosed stage III breast cancer. Naomi later died. An expert for Naomi's estate will testify that if the biopsy had been performed when recommended, the cancer would very likely have been stage I, with a five-year survival probability of about 90 percent; by the time of the actual biopsy, the survival probability was about 25 percent. The defense expert will testify that the tumor may have metastasized before the first mammogram and would have been fatal even with prompt treatment.

Which issue is most important in determining whether Dr. Anand's failure to follow up on the biopsy recommendation caused Naomi's death?

Whether a reasonably careful primary care physician, on receiving a radiologist's report recommending a biopsy, would have scheduled the biopsy or referred Naomi to a specialist within a short time.
Whether Dr. Anand's explanation of the mammogram's limitations and the possibility of a false-negative result was sufficient to make Naomi's consent to the procedure informed.
Whether the eight-month delay allowed Naomi's cancer to progress to a stage at which death was substantially more likely, or whether the cancer would have been fatal even if the biopsy had been performed promptly. (correct answer)
Whether the estate may recover damages for Naomi's emotional distress and fear of death after she learned that the suspicious finding had not been followed up.

Explanation: When you see a malpractice question, separate the elements: duty, breach, causation, and damages. The doctor's failure may clearly be a breach, but the hardest issue is often causation: did the breach actually cause the harm? Here, both experts agree the biopsy was delayed, but they disagree over whether the delay mattered. That is exactly the causation dispute. The most important issue is therefore whether the eight-month delay allowed the cancer to progress to a stage where death was substantially more likely, or whether the cancer would have been fatal even with a prompt biopsy. If the tumor had already metastasized before the mammogram, the delay did not cause Naomi's death; if prompt biopsy would likely have changed the outcome, it did. The first choice—whether a reasonably careful primary care physician would have scheduled or referred—addresses breach, the standard-of-care element. Even if the doctor's conduct fell below the standard, Naomi's estate must still prove causation, so this is not the most important issue. The second choice about informed consent to the mammogram misses the point: Naomi's claim is about failing to act on the biopsy recommendation, not about the risks of the imaging itself. Finally, the choice about emotional distress damages concerns a different category of harm; while fear and distress might be recoverable in some cases, the question specifically asks what most determines whether the failure caused Naomi's death. On exam day, when you see dueling experts on outcome, your job is to identify the causal link—not just the doctor's negligence.

Question 15

A fire destroyed Paula's home. The fire began when two separate fires merged: one started by sparks from power lines owned by Delia Power Co., which negligently failed to maintain its equipment, and one started by a lightning strike. Each fire, by itself, was sufficient to destroy the home, and the lightning fire involved no wrongful conduct. Paula sued Delia Power for negligence, alleging that its negligence caused the destruction of her home.

In Colton v. Midstate Power Co., the state supreme court held: 'To establish factual causation, a plaintiff must ordinarily prove that the harm would not have occurred absent the defendant's conduct. We recognize an exception: where two or more tortious acts, each alone sufficient to produce the same harm, operate concurrently, the plaintiff need not prove but-for causation. That exception does not apply when one of the sufficient causes is non-tortious; in such a case, the plaintiff must prove that the defendant's conduct was necessary to the harm.'

Under the rule in Colton, which of the following is most accurate regarding whether Delia's negligence was a factual cause of the destruction of Paula's home?

Delia's negligence was a factual cause because it was a substantial factor in bringing about the destruction, even though the lightning fire alone would have destroyed the home.
Delia's negligence was a factual cause because, when two independent fires each sufficient to destroy the home merge, each fire is regarded as a cause of the destruction.
Delia's negligence was not a factual cause because the exception for concurrent sufficient causes applies only when both causes are tortious, and Paula cannot show that the home would not have been destroyed absent Delia's negligence. (correct answer)
Delia's negligence was a factual cause only if Paula proves that the lightning fire did not also contribute substantially to the destruction of the home.

Explanation: Whenever you see a factual causation question, start with but-for causation: would the harm have occurred absent the defendant's conduct? The exception for concurrent sufficient causes allows liability even without but-for proof, but the court in Colton limited that exception to cases where every sufficient cause is tortious. Here, the lightning fire was a sufficient non-tortious cause, so the exception does not apply. Because the home would have been destroyed by the lightning fire alone, Paula cannot prove that Delia's negligence was necessary to the harm. Therefore, Delia was not a factual cause. The "substantial factor" choice is tempting because that test often appears in multiple-cause cases, but Colton explicitly rejects it when one sufficient cause is non-tortious. Similarly, the choice saying "two independent fires each sufficient to destroy the home merge, each fire is regarded as a cause" states the general concurrent-cause rule but ignores the court's key limitation: the exception applies only when both causes are tortious. The choice about "only if Paula proves that the lightning fire did not also contribute substantially" flips the burden and misstates the test; Paula must prove Delia's conduct was necessary, not disprove the lightning's role. The correct view is the one recognizing that the non-tortious sufficient cause blocks the exception, so but-for causation fails. Study tip: on causation questions, first ask whether a non-tortious cause alone could have produced the harm—if yes, the concurrent-cause exception may not save the plaintiff.

Question 16

Marge had a degenerative spinal condition that, her doctors testified, would have become severely painful within two years even without any accident. A car negligently driven by Ned rear-ended Marge. The accident aggravated her condition, and she began experiencing severe pain immediately — pain identical in character to what she would have experienced in two years. Marge sued Ned, claiming damages for the severe pain she has suffered since the accident.

The state Civil Liability Act provides in relevant part:

'§9. Causation: Preexisting Conditions. (a) A defendant's negligence is a factual cause of the plaintiff's harm if the harm would not have occurred at the time it did absent the defendant's negligence. (b) Where the defendant's negligence accelerates the progress of a preexisting condition, the defendant is a factual cause of the harm suffered during the period of acceleration, but is not a factual cause of the harm that would have occurred in any event. (c) If the evidence does not permit the factfinder to separate the harm caused by the defendant's negligence from the harm that would have occurred without it, the plaintiff may not recover.'

Under §9, which of the following is most accurate regarding whether Ned's negligence was a factual cause of Marge's pain?

Ned's negligence was a factual cause of Marge's pain during the period of acceleration, but not of the pain she would have suffered in any event. (correct answer)
Ned's negligence was not a factual cause because Marge would have suffered the same severe pain within two years even if the accident had never occurred.
Ned's negligence was a factual cause of all of Marge's pain because the accident triggered the severe pain, and a defendant takes the plaintiff as she finds her.
Ned's negligence was not a factual cause because Marge's pain at the time of trial was identical to the pain she would have suffered within two years, so the harm cannot be separated.

Explanation: Whenever you see a question about causation involving a preexisting condition, focus on the statutory language and the timing of the harm. Here, §9(b) directly addresses acceleration: a defendant is a factual cause of harm suffered during the period of acceleration, but not of harm that would have occurred anyway. Because Ned's negligence caused Marge's pain to begin immediately rather than in two years, the entire two-year period from accident to the natural onset is the "period of acceleration." Under §9(a), the harm (pain) would not have occurred at that earlier time absent Ned's negligence, so he is the factual cause of that accelerated pain. The pain she would have suffered after the two-year mark is not his responsibility. The choice saying "Ned's negligence was not a factual cause because Marge would have suffered the same severe pain within two years" wrongly ignores §9(b) — it treats "but-for" causation as all-or-nothing, but the statute explicitly creates liability for the acceleration period. The choice claiming Ned is a factual cause of all pain because "a defendant takes the plaintiff as she finds her" is a common torts maxim, but it does not override the statutory apportionment rule; it applies to the extent of harm, not to causation of harm that would occur anyway. Finally, the choice arguing no factual cause because the pain is identical and cannot be separated misunderstands §9(c): that section bars recovery only when the evidence does not permit separation. Here, the statute itself provides the separation — the acceleration period is determinable from the doctors' testimony about the two-year natural progression. The correct answer is the one that tracks §9(b) directly. Remember: when a statute defines causation, apply its specific rules first, not common-law generalities.

Question 17

Two wildfires converged on a ranch, destroying a barn. One fire started when a farm employee negligently left a haying machine running, causing sparks to fall into dry grass. The other started when lightning struck a neighboring field an hour earlier. The fires merged about half a mile from the barn, and the barn burned down. The ranch owner sued the farm, alleging the employee's fire caused the loss. The farm concedes negligence but contends that the lightning fire alone would have destroyed the barn.

Which additional fact, if true, would be most important in determining whether the employee's fire actually caused the destruction?

The farm had been warned twice that the haying machine was throwing sparks.
The lightning fire started first and was closer to the barn than the employee's fire.
The employee's fire was still burning when it reached the barn. (correct answer)
The barn was insured against wildfire damage, and the insurer had already paid the owner.

Explanation: When two fires merge and destroy a single piece of property, you are dealing with concurrent causation. The legal question is whether the defendant's fire was a "substantial factor" in bringing about the harm, meaning it must have physically contributed to the destruction. The fact that the employee's fire was still burning when it reached the barn is decisive because it proves that the fire was an active, contributing force at the exact moment the barn was destroyed. It didn't merely start a fire that fizzled out; it merged with the lightning fire and played a direct physical role in the loss, satisfying the substantial-factor test. The farm having been warned twice about the sparks goes to notice and breach of duty—but since the farm already concedes negligence, that fact is irrelevant to causation. Similarly, the lightning fire starting first and being closer might suggest it would have destroyed the barn alone, but that raises only a "but-for" problem. Under the substantial-factor test, the employee's fire can still be a cause even if another fire was sufficient, provided it was actually active at the time of harm. Finally, the barn being insured and the insurer having paid is a collateral-source matter entirely unrelated to whether the employee's fire caused the damage. On the bar exam, when you see multiple causes, scan for facts showing whether the defendant's conduct was active and contributing at the moment of injury. If the act had ceased or never reached the scene, it cannot be a cause—but if it was still burning, it is a substantial factor.

Question 18

During surgery to remove a patient's kidney stone, a small metal guidewire broke. The surgeon has admitted that he pulled on the guidewire with force exceeding the standard of care. The manufacturer has admitted that the wire was sold with a latent manufacturing defect. An expert cannot determine whether the wire broke because of the surgeon's excessive force or because of the defect. The broken piece was discovered in the patient's body and required a second surgery. The patient sues both the surgeon and the manufacturer.

Which issue is most important in determining whether the patient can recover from either defendant for the broken guidewire?

Whether the guidewire broke because the surgeon pulled with excessive force or because the manufacturer supplied a defective wire. (correct answer)
Whether the surgeon was negligent in failing to inspect the guidewire for latent defects before the operation.
Whether the need for a second surgery to remove the broken wire was a foreseeable consequence of the first surgery.
Whether the patient's consent to the surgery bars a claim for injury caused by a broken surgical instrument.

Explanation: When you see two defendants and an injury that could have been caused by either one, the threshold issue is causation—specifically, which wrongful act actually broke the wire. The surgeon admitted using excessive force, and the manufacturer admitted selling a defective wire, but the expert cannot determine which caused the break. That uncertainty is the heart of the case: unless the patient can prove the surgeon's force or the manufacturer's defect actually caused the break, neither defendant is liable. In some multiple-defendant situations, if both acted tortiously and one caused the harm, the burden of proof may shift to the defendants—but that only matters if the causation question is unresolved. So the most important issue is whether the wire broke because of the surgeon's excessive force or the manufacturer's defective wire. The choice about the surgeon failing to inspect the wire is not central: surgeons generally are not expected to discover latent manufacturing defects, and even a duty to inspect would not tell us what caused the break. Foreseeability of the second surgery is a damages/proximate-cause issue, but it cannot help until the broken wire is tied to a defendant's wrongful act. And the patient's consent to surgery does not bar claims for a surgeon's negligence or a manufacturer's defective product—consent covers known risks, not excessive force or a hidden defect. Study tip: in multiple-defendant tort questions, first identify which element of a claim is truly contested. If the facts emphasize uncertainty about the cause, focus on actual causation and any burden-shifting doctrine that may apply.