Good luck...
Ranking Question 1
You are working in the emergency department when you review a 25 year old lady who is para 1+0 with RIF pain and a positive home pregnancy test. You notice that she has a young daughter who appears to be covered in bruises and is dressed in torn, muddy clothes.
Rank in order the following actions in response to this situation (1= Most appropriate; 5= Least appropriate)
A. Call the patient's GP to let them know the situation and ask if there are any child protection concerns
B. Do nothing as the child is not your patient
C. Confront the mother immediately regarding the appearance of her daughter
D. Discuss the case immediately with your department's assigned child protection consultant
E. Ask the admitting ward's doctors to investigate this situation further
Answer: DACEB
Rationale: This question assesses issues surrounding child protection. Although the child is not your patient, you have a responsibility to act on any child protection concerns you might have. Hence (B) is the least favourable option here. After ensuring that the mother is safe, you would involve your department's nominated consultant for child protection (D). This would be your first step as an FY1. Speaking to the GP (A) will allow any required follow up to be put in place and allow your observations to be documented for further consultations in primary care, in addition to finding out vital information about the patient's background and potential previous child protection issues. Confronting the mother (C) is a rather antagonistic approach, but is safer than the other options left to choose from. (E) would lead to possible delays, in addition to the potential for this falling through the net.
Ranking Question 2
You are an F1 in medicine. You are asked by your registrar to take blood from a patient with terminal cancer as the potassium on their last sample was high. The patient refuses.
Rank in order the following actions in response to this situation (1= Most appropriate; 5= Least appropriate)
A Inform the patient why it is important that you need to take their blood and ask why they do not want you to take it
B Ask the patient if you can come back and take it later
C Give the patient a sedative and take the blood from them
D Return the venepuncture equipment and carry on with your other jobs
E Tell the registrar that the patient has refused
Answer: AEBDC
Rationale: This question deals with your understanding of capacity and a patient's right to refuse treatment. The question does not suggest that the patient lacks capacity, therefore they can refuse treatment or procedures, whatever your thoughts on the issue. The best option here is to tell the patient why you are taking their blood (A) and explore why they do not want you to. In this case the patient has terminal cancer, but they may not be aware that a high potassium can cause life-threatening arrhythmias, although it is treatable. The next best option is to inform your registrar, as they may then wish to speak to the patient, or may offer a different solution (E). The worst option is (C), as touching a patient without their consent is battery. Simply carrying on with your jobs (D) is not safe, as the patient is at risk. Taking the blood later (B) is not ideal, but is preferable to (C) and (D).
Multiple Choice Question 1
You are an F1 on the medical assessment unit. You assess a patient who you feel is septic, with their chest as the source. You are unsure which antibiotics to prescribe.
Choose the THREE most appropriate actions to take in this situation
A Phone the microbiology consultant on call
B Ask the microbiology lab technician
C Phone the pharmacist
D Ask the nurse on the drug round
E Have a guess
F Ask the registrar on the MAU
G Check the trust guidelines on antibiotic prescribing
H Ask the SHO on the MAU
Answer: FGH
Rationale: This question tests your ability to prescribe safely. Most trusts now have guidance on antibiotics (G), but if you are not sure where these are then your senior colleagues will most likely be able to inform you (F, H). Having a guess is completely inappropriate and unsafe (E). The nurse, lab technician and pharmacist cannot advise you (B,C,D). Phoning the microbiology consultant should be reserved for difficult decisions regarding antibiotic prescription, not first-line drugs (A).
Multiple Choice Question 2
You are having lunch with another FY1 when she begins to cry and tells you she is struggling with her workload. As a result, she says, the nursing staff have been very difficult.
Choose the THREE most appropriate actions to take in this situation
A Speak to her about the problem
B Suggest she discusses the issues with the registrar
C Suggest she takes some annual leave
D Encourage her to seek counseling
E Offer to go with her to talk to her consultant
F Inform her educational supervisor that she is finding work difficult
G Ask other members of the team to be supportive as she is having difficulties coping
H Offer to perform some of her work for her
Answer: ABE
Rationale: This question assesses your ability to help colleagues when they are struggling. Talking through the problem may help (A), though she is more likely to benefit from experience senior advice (B) and (E). Taking annual leave won't solve the problem, and counseling may not be appropriate. Speaking to others is a breach of trust (F) and (G). Doing her work for her may compromise the care of your own patients (H).
You are working in the emergency department when you review a 25 year old lady who is para 1+0 with RIF pain and a positive home pregnancy test. You notice that she has a young daughter who appears to be covered in bruises and is dressed in torn, muddy clothes.
Rank in order the following actions in response to this situation (1= Most appropriate; 5= Least appropriate)
A. Call the patient's GP to let them know the situation and ask if there are any child protection concerns
B. Do nothing as the child is not your patient
C. Confront the mother immediately regarding the appearance of her daughter
D. Discuss the case immediately with your department's assigned child protection consultant
E. Ask the admitting ward's doctors to investigate this situation further
Answer: DACEB
Rationale: This question assesses issues surrounding child protection. Although the child is not your patient, you have a responsibility to act on any child protection concerns you might have. Hence (B) is the least favourable option here. After ensuring that the mother is safe, you would involve your department's nominated consultant for child protection (D). This would be your first step as an FY1. Speaking to the GP (A) will allow any required follow up to be put in place and allow your observations to be documented for further consultations in primary care, in addition to finding out vital information about the patient's background and potential previous child protection issues. Confronting the mother (C) is a rather antagonistic approach, but is safer than the other options left to choose from. (E) would lead to possible delays, in addition to the potential for this falling through the net.
Ranking Question 2
You are an F1 in medicine. You are asked by your registrar to take blood from a patient with terminal cancer as the potassium on their last sample was high. The patient refuses.
Rank in order the following actions in response to this situation (1= Most appropriate; 5= Least appropriate)
A Inform the patient why it is important that you need to take their blood and ask why they do not want you to take it
B Ask the patient if you can come back and take it later
C Give the patient a sedative and take the blood from them
D Return the venepuncture equipment and carry on with your other jobs
E Tell the registrar that the patient has refused
Answer: AEBDC
Rationale: This question deals with your understanding of capacity and a patient's right to refuse treatment. The question does not suggest that the patient lacks capacity, therefore they can refuse treatment or procedures, whatever your thoughts on the issue. The best option here is to tell the patient why you are taking their blood (A) and explore why they do not want you to. In this case the patient has terminal cancer, but they may not be aware that a high potassium can cause life-threatening arrhythmias, although it is treatable. The next best option is to inform your registrar, as they may then wish to speak to the patient, or may offer a different solution (E). The worst option is (C), as touching a patient without their consent is battery. Simply carrying on with your jobs (D) is not safe, as the patient is at risk. Taking the blood later (B) is not ideal, but is preferable to (C) and (D).
Multiple Choice Question 1
You are an F1 on the medical assessment unit. You assess a patient who you feel is septic, with their chest as the source. You are unsure which antibiotics to prescribe.
Choose the THREE most appropriate actions to take in this situation
A Phone the microbiology consultant on call
B Ask the microbiology lab technician
C Phone the pharmacist
D Ask the nurse on the drug round
E Have a guess
F Ask the registrar on the MAU
G Check the trust guidelines on antibiotic prescribing
H Ask the SHO on the MAU
Answer: FGH
Rationale: This question tests your ability to prescribe safely. Most trusts now have guidance on antibiotics (G), but if you are not sure where these are then your senior colleagues will most likely be able to inform you (F, H). Having a guess is completely inappropriate and unsafe (E). The nurse, lab technician and pharmacist cannot advise you (B,C,D). Phoning the microbiology consultant should be reserved for difficult decisions regarding antibiotic prescription, not first-line drugs (A).
Multiple Choice Question 2
You are having lunch with another FY1 when she begins to cry and tells you she is struggling with her workload. As a result, she says, the nursing staff have been very difficult.
Choose the THREE most appropriate actions to take in this situation
A Speak to her about the problem
B Suggest she discusses the issues with the registrar
C Suggest she takes some annual leave
D Encourage her to seek counseling
E Offer to go with her to talk to her consultant
F Inform her educational supervisor that she is finding work difficult
G Ask other members of the team to be supportive as she is having difficulties coping
H Offer to perform some of her work for her
Answer: ABE
Rationale: This question assesses your ability to help colleagues when they are struggling. Talking through the problem may help (A), though she is more likely to benefit from experience senior advice (B) and (E). Taking annual leave won't solve the problem, and counseling may not be appropriate. Speaking to others is a breach of trust (F) and (G). Doing her work for her may compromise the care of your own patients (H).