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SJT QuestionS
Multiple Choice Question
You are an F1 on plastic surgery. A patient is admitted with a large psoas abscess from injecting drugs. He absconds from the ward, but returns later on behaving strangely. You catch him in the toilet about to inject something into his cannula. He starts to become aggressive. He is due for theatre shortly.
Choose the THREE most appropriate actions to take in this situation.
A Call security
B Attempt to take the drugs off him
C Ask the nursing staff to help you restrain him
D Inform the consultant of what you have seen
E Write him up for some sedation
F Lock him in the bathroom
G Leave and let someone else deal with him
H Try to calm the patient while the nursing staff call security
Answer A, D, H
Rationale
This scenario assesses your ability to deal with aggressive, potentially violent patients. In this patient's case he has taken drugs so his behaviour may be unpredictable. The most important aspects of this case are your safety and the safety of those around you (hence it is a good idea to call security – A,H). You must inform the consultant, as this patient could be very sick but now they may not be able to take him to theatre as planned (D).Trying to take his drugs or restraining him (B,C) are both very dangerous tactics, and locking him in the bathroom is potentially an inflammatory act (F). Sedation is no use as you will not be able to administer it (E) and also you cannot be sure which drugs he has taken. Leaving to let someone else deal with the situation is not helpful in the slightest (G).
Ranking Question
You are an F1 on medicine. Your consultant asks you to discuss a DNAR with a patient. He has been handed over the patient from MAU, but the patient was sleeping when he was on the ward round. When you go to see the patient, you realise they have dementia with an AMT of 0/10.
Rank in order the following actions in response to this situation (1 = Most appropriate, 5 = Least appropriate)
A Take the form to the consultant and inform him that the patient has dementia
B Ask the family to come in to discuss the DNAR
C Phone the consultant and inform him that the patient has dementia and ask his advice
D Sign the DNAR
E Phone the family to discuss the DNAR
Answer ACBED
Rationale
This question tests your knowledge of competence and legality of decision-making for those without capacity. The worst thing you can do in this situation is to go ahead and sign the form (D), as you are too junior to make this decision. The best answer is to take the form to the consultant and ask what he wishes to do (A). This is preferable to(C), as he may wish to sign the form given this new piece of information (depending on the patient's condition). Talking to the family (B) and (E) shows initiative, but it is better to check with your senior before doing so. Discussing difficult issues such as DNAR is often better face-to-face if possible (B) and offers you the option of having support from other medical staff. Talking on the phone (E) is less desirable, as often it can be difficult to convey a message effectively.
You are an F1 on plastic surgery. A patient is admitted with a large psoas abscess from injecting drugs. He absconds from the ward, but returns later on behaving strangely. You catch him in the toilet about to inject something into his cannula. He starts to become aggressive. He is due for theatre shortly.
Choose the THREE most appropriate actions to take in this situation.
A Call security
B Attempt to take the drugs off him
C Ask the nursing staff to help you restrain him
D Inform the consultant of what you have seen
E Write him up for some sedation
F Lock him in the bathroom
G Leave and let someone else deal with him
H Try to calm the patient while the nursing staff call security
Answer A, D, H
Rationale
This scenario assesses your ability to deal with aggressive, potentially violent patients. In this patient's case he has taken drugs so his behaviour may be unpredictable. The most important aspects of this case are your safety and the safety of those around you (hence it is a good idea to call security – A,H). You must inform the consultant, as this patient could be very sick but now they may not be able to take him to theatre as planned (D).Trying to take his drugs or restraining him (B,C) are both very dangerous tactics, and locking him in the bathroom is potentially an inflammatory act (F). Sedation is no use as you will not be able to administer it (E) and also you cannot be sure which drugs he has taken. Leaving to let someone else deal with the situation is not helpful in the slightest (G).
Ranking Question
You are an F1 on medicine. Your consultant asks you to discuss a DNAR with a patient. He has been handed over the patient from MAU, but the patient was sleeping when he was on the ward round. When you go to see the patient, you realise they have dementia with an AMT of 0/10.
Rank in order the following actions in response to this situation (1 = Most appropriate, 5 = Least appropriate)
A Take the form to the consultant and inform him that the patient has dementia
B Ask the family to come in to discuss the DNAR
C Phone the consultant and inform him that the patient has dementia and ask his advice
D Sign the DNAR
E Phone the family to discuss the DNAR
Answer ACBED
Rationale
This question tests your knowledge of competence and legality of decision-making for those without capacity. The worst thing you can do in this situation is to go ahead and sign the form (D), as you are too junior to make this decision. The best answer is to take the form to the consultant and ask what he wishes to do (A). This is preferable to(C), as he may wish to sign the form given this new piece of information (depending on the patient's condition). Talking to the family (B) and (E) shows initiative, but it is better to check with your senior before doing so. Discussing difficult issues such as DNAR is often better face-to-face if possible (B) and offers you the option of having support from other medical staff. Talking on the phone (E) is less desirable, as often it can be difficult to convey a message effectively.