Paper 2 Flashcards
You are attending to Harry, an 89 year old long-term patient requiring palliative care. It has been recorded in Harry’s medical notes that he will be transferred from the hospital to a nursing home within the next few days and he has agreed to this management plan. Later on the day, Harry informs you that he has changed his mind and no longer wants to move to the nursing home.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Explain to Harry that a nursing home is better suited to his needs
B. Ask Harry why he has changed his mind
C. Explain to Harry that the nurses are too busy to meet his needs in the busy hospital environment
D. Inform your consultant that Harry is unsure about going to a nursing home
E. Ask Harry’s relatives to come in and discuss his options with him
BDEAC
B - Patient focus
D - Consultant is in charge of pt and discharge agreed between them
E - Relative can be discussed but no indication they were involved so consultant first
A - This could be done later but not now
C - Not relevant to situation
Mrs Jenson has arthritis and works in the pharmaceutical industry. She appears very well informed about her arthritis medication. She tells you that she can show you evidence that using double the recommended dose of her current medication will be safe for her and will allow her to return to her job more quickly. She asks you to prescribe to her double the recommended dose.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Advise Mrs Jenson that if she chooses to self administer the double dose she is going against medical advice
B. Tell Mrs Jenson that you cannot prescribe more than the recommended dose without senior consultation
C. Ask your consultant to speak with Mrs Jenson
D. Ask Mrs Jenson to show you the evidence that she cites
E. Seek advice from the ward pharmacist
BECDA
B - F1 don’t make those decisions
E - advice from pharmacist and direct [its your prescription here not consultant as in other qs]
C - less direct route
D - may be interesting but won’t change your response
A - Allowing this is unsafe
You and an FY1 doctor, Lorraine, are on your first rotation at the hospital. Since beginning this rotation three weeks ago, you have noticed that Lorraine is always eager to undertake additional ward tasks that are delegated by the consultant. As a result of completing too many tasks, Lorraine is staying several hours after her shift should finish every day. Lorraine often appears to be tired, and you have noticed a decrease in the quality of her work. When you sensitively raise this with Lorraine, she informs you that you must be mistaken and appears to be offended. The quality of her work has not improved since your last conversation and you must decide whether you will discuss the matter with her again.
Rank in order the importance of the following considerations in the management of this situation (1= Most important; 5= Least important).
A. The likelihood of effectively improving Lorraine’s quality of work by speaking to her for a second time
B. Maintaining the quality of patient care
C. The timely completion of all ward tasks
D. The way Lorraine reacted when you have raised the issue with her last time
E. The extent that Lorraine understands that her tiredness could be affecting patient safety
BAECD
B - Care most important
A - help to improve her quality of work
E - She may not know it is affecting and so should be discussed
C - Completion of tasks is good but SAFTEY is priority
D - previous convo should not be a deterrent to addressing again
Your FY1 colleague, Amirah, has been working alongside you during a busy night shift. You have both been on-call for the last seven hours without a break or meal. Amirah has complained about feeling dizzy throughout the shift. Amirah tells you that she needs to go and lie down but suddenly she faints in the middle of the ward. She regains consciousness two minutes later.
Rank the order in which the following tasks should be undertaken (1= Do first; 5= Do last).
A. Discuss with Amirah whether she will be able to undertake her remaining tasks for the day
B. Ask a nurse to help you transfer Amirah onto an available bed
C. Alert your specialty trainee* of the incident
D. Speak to the patients on the ward and reassure them that they will be seen to soon
E. Give Amirah a blanket and a cup of water
BECDA
B - get her stable and safe first
E - then address causes for fall eg dehydration
C - after this should inform senior
D - Pts likely seen and should be re assured
A - after they have recovered should find out if she can continue with work
You are working on a busy ward, completing some administrative tasks for your consultant, Dr Findlay. She has asked you to complete some discharge letters which should have been sent out a week ago. A new patient is admitted to the ward and the senior nurse asks you to assess him, as your colleagues are all busy completing other tasks. When you explain that you are currently completing the discharge letters for Dr Findlay, the nurse suggests that you ask the fourth year medical student on the ward to assess the patient instead.
Rank in order the importance of the following considerations in the management of this situation (1= Most important; 5= Least important).
A. The medical student’s confidence to assess the patient independently
B. The medical student’s level of clinical competence to assess the patient effectively
C. The discharge letters should have been completed a week ago
D. The urgency for the patient to be assessed is not yet clear
E. The possible time delay before the senior nurse is able to find another available colleague to assess the patient
BAECD
[Prioritisation]
B - this would impact safety if they don’t know how
A - confidence is secondary to competence
E - Risks clinical delay
C - Not an urgent priority
D - urgency of assessment only determined by initial assessment
[bullshit]
You are observing your specialty trainee*, Allan, in an operating theatre, working with a large team on a complex procedure. The patient begins to deteriorate unexpectedly and the team is under pressure to resolve the situation quickly. As all members of the team are working, Allan begins to use some extremely bad language while talking to another team member. The team member appears to be shocked by Allan’s remarks but does not respond to it and continues to focus on the procedure. You must decide whether to speak up about Allan’s behaviour immediately.
Rank in order the importance of the following considerations in the management of this situation (1= Most important; 5= Least important).
A. Allan’s likely intention to be offensive given that he is under pressure to resolve the situation quickly
B. The team members’ reason for not responding to Allan’s remarks
C. The disruption that your interjection may cause to the procedure
D. All healthcare professionals are entitled to work in a respectful environment at all times
E. The impact on other team members if Allan continues to use similar language during the rest of the procedure
DECBA
D - Colleges should work in respectful environments
E - If rest of team are uncomfortable it could impact on procedure
C - Impact of interjecting is important and should be done at a good time - ie. during a break
[wording insinuates you aren’t gonna interject]
B - Reason for not responding less important than broader issues of respectful workplace
A - this is partial justification and so least likely to influence management of situation
You are browsing your social media page in the evening and notice that your FY1 doctor colleague and good friend, Neal, has written a post. Neal writes that he has had a very long day in theatre today, with a patient who had a big bleed. Although there are no direct patient details in Neal’s post, you are aware that it would be possible to identify the patient from the details regarding her bleed, and the fact that the surgery occurred earlier today. The patient is still currently on the ward. As Neal’s social media page is set for public viewing, individuals who are not direct contacts are able to read Neal’s post.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Contact Neal, advising him to remove the social media post
B. When you next see Neal, suggest that he removes the social media post
C. Tell Neal that posting about a patient on social media is unprofessional
D. Inform your on-call consultant of Neal’s social media post
E. Advise Neal to change his social media settings to private so that only his contacts are able to read his posts
ACBDE
A - Needs to be removed - deals with immediate situation
C - Should also tell him this is unprofessional
B - less time efficient
D - on call consultant is not likely to be helpful (clinical supervisor may be)
E - this could be seen as condoning it happening
Your fellow FY1 doctor, Katrina, regularly arrives at work late and, consequently, often misses morning ward rounds. During these ward rounds, the consultant provides direction to the team regarding the tasks to be completed for the day. You and members of the healthcare team make notes and discuss the allocation of the tasks based on the consultant’s direction. Katrina asks you for an update on the allocation of ward tasks when she arrives at work late. This causes significant delays to the completion of the tasks that have been assigned to you.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Ask the consultant to delay the ward round until Katrina arrives
B. Make separate notes for Katrina to refer to when she arrives, regarding the tasks assigned to her
C. Discuss with Katrina methods that may help to improve her punctuality
D. Suggest to Katrina that she should ask another member of the healthcare team to provide her with ward round updates
E. Discuss Katrina’s repeated lateness with a senior colleague
CEBDA
C - directly deal
E - can escalate with seniors
B - this increases your workload and doesn’t deal with the problem but better than shifting onto another member (D)
A - fails to deal and makes whole team late
You have been completing an audit with another FY1 doctor, Zara. You are near the end of your rotation and have only collected half of the data; there are two wards remaining to collect data from. You and Zara have both observed that a general trend has emerged in the data that you have collected so far. One morning, Zara informs you that she has fabricated the rest of the data, based on the trend that had emerged in the existing data, and that she has submitted the report to your joint clinical supervisor*, Dr Hadi. The following week, Dr Hadi informs you that she is very pleased with the audit and wants both you and Zara to attend an international conference to present the findings.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Inform Dr Hadi that the data was fabricated by Zara
B. Tell Dr Hadi that you did not have any input into the audit so Zara should attend the conference alone
C. Tell Dr Hadi that there was a mistake with the data, so you and Zara will need to collect some more before presenting at the conference
D. Attend the conference with Zara, but refuse to present any of the findings
E. Suggest to Zara that she admits to Dr Hadi that she fabricated the data
EACBD
E - she should explain her self
A - if she wont you should tell him
C - makes sure you arent involved in fraudulent data but doesn’t solve issue
B - Not involved but lets bad data out
D - clearly implicates you in delivery of fraudulent data
You are working on a surgical ward and are due to assist your consultant in theatre with a gallbladder removal. The consultant is currently fasting for religious reasons and he has completed seven hours of a shift without eating or drinking anything. During a conversation with him shortly before the surgery, you notice that he appears to be having difficulty concentrating on what you are saying and that his hands are shaking slightly. You are aware that there may be implications for patient safety if the consultant carries out the surgery when he is not able to perform to the best of his ability.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Explain your concerns to the consultant
B. Raise your concerns in the surgical team’s pre-operative discussion
C. Continue with the surgery and discuss the incident with your clinical supervisor* afterwards
D. Bleep* the on-call consultant, explaining the situation and asking for advice on what to do
E. Suggest to the consultant that another doctor carries out the surgery
ADEBC
A - Directly deals with issue
D - ensures senior supportive input
E - addresses safety but DOESNT EXPLAIN your concerns
B - more indirect but still deals with safety
C - does not address safety
In your hospital, if members of staff make more than three errors when labelling blood bottles they are required to attend training to learn how to do this correctly. Your FY1 doctor colleague, Declan, has been required to attend this training three times as he has made repeated labelling errors. Despite this, Declan says to you, “It shouldn’t be my job to label blood bottles anyway, so I don’t pay attention”.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Inform Declan that incorrectly labelling blood bottles could have an adverse impact on patients
B. Offer to label blood bottles for Declan in future
C. Tell Declan’s clinical supervisor* about his comment
D. Advise Declan to speak to his clinical supervisor about his repeated labelling errors
E. Tell Declan that he should be more careful when labelling blood bottles
ADECB
A - SAFETY KEY
D - allows him to address issue
E - should remind him but could be done more tactfuly
C - if not -> can tell his supervisor
B - avoids issue and reinforces behaviour
You are the only doctor on a ward. A patient, who is talking to one of the nurses, starts to raise his voice. He tells the nurse that he is hungry, as he has not eaten for two days due to his surgery being delayed. He is being very loud and beginning to disturb the other patients on the ward. You do not know the history of this patient, other than the fact that his surgery has been delayed. You do not know why it has been delayed.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Suggest to the nurse that she should attempt to calm the patient as he is disturbing other patients
B. Explain to the patient that you are sorry that he is hungry but he cannot eat as he is due to have surgery
C. Explain to the patient that he should calm down as he is disturbing the other patients on the ward
D. Explain to the patient that you are sorry that he has had to wait for two days and you will try and find out when his surgery will be
E. Reassure the patient that he will have his surgery soon and that he will be able to eat in the next few hours
DBACE
D - DIRECTLY addresses concerns
B - only a partial response to the issues
A -
C -
[Both kinda need to happen but doesnt explain why thats the order] - perhaps because nurse knows the pt so better than you do it
E - obvs stupid
One of your patients, Roisin, who you have been looking after on the Cardiology ward, invites you to attend her birthday party at her home next weekend. You have been on the medical team that has been looking after Roisin for the past two months, and she is due to be discharged tomorrow. You do not have any plans for next weekend; however, you are aware that it is inappropriate to see a patient socially outside of work.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Thank Roisin for the invitation but explain that it would not be appropriate for you to attend
B. Invite other individuals from the medical team that has looked after Roisin to attend the party with you
C. Politely decline Roisin’s invitation, saying that you cannot attend
D. Ask another doctor on the ward to manage Roisin’s care until she is discharged
E. Explain that you are unable to attend, but buy Roisin a small gift
ACDEB
A - good maintain boundaries
C - also good but better to explain
D - doesn’t deal with invitation and may cause her to ask again
E - buying a gift could be seen as inappropriate
B - boundaries have been breached
Your specialty trainee, Kimberley, informs you that at the weekend she was issued with a speeding ticket by the police. You were on-call at the weekend and Kimberley was not working. She states that in order to avoid having to pay the speeding fine, she informed the police that she was working on-call and was caught speeding while driving to the hospital to deal with an emergency. Kimberley asks you to corroborate her story and inform the hospital rota coordinator that she was working at the weekend.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Advise Kimberley to tell the police the truth about the situation
B. Inform your clinical supervisor* of Kimberley’s request, without naming her, seeking his advice on how to proceed
C. Inform the police that Kimberley was not working on-call at the weekend
D. Decline Kimberley’s request
E. Explain to Kimberley why her request is inappropriate
ADBEC
[serious issues - get them to come clean first ]
A - deals with dishonesty and situation
D - does not implicate you but also doesn’t deal with situation
B - advice always good
E - you havent actually said no here
C - Clearly not
You are on a ward round with your consultant and the surgical specialty trainee*. Mr Ahmadi is due to have an elective resection of a colonic tumour. Your consultant confirms tomorrow’s theatre list, placing Mr Ahmadi first, as he wants to be present for the case. After your consultant has left for the day you realise that he did not notice Mr Ahmadi is taking warfarin for atrial fibrillation, which will increase the risk of haemorrhage during the procedure. The surgical specialty trainee is still on shift, as is the anaesthetist, who is due to do the theatre list.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Raise the problem at the consultant pre-operative ward round
B. Inform the surgical specialty trainee of the problem
C. Inform theatre that Mr Ahmadi’s case needs to be cancelled
D. Discuss the situation with the anaesthetist who is doing the list with your consultant
E. Contact your consultant on his mobile telephone to inform him of the situation
BDEAC
B - trainee is doing the case
D - then anaesthetist
E - Don’t need to discuss with consultant out of hours at home so other two better
A - Too much time delay - may compromise care
C - you don’t know if it will be cancelled and so shouldn’t make the decision
You are completing a ward round in the Acute Admissions Unit* (AAU). During the ward round your consultant repeatedly questions the patient management plans of the specialty trainee, Craig. At the end of the ward round you hear the consultant telling Craig that he is not suitable to work in acute medicine. The consultant is then called away to attend to an emergency. Craig appears to be upset and leaves the ward. You are unable to contact Craig on his hospital bleep. There are unwell patients arriving, on whom you need to seek his advice.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Leave the ward to attempt to locate Craig, and ask that he returns to the ward
B. Report Craig to the medical director for leaving the AAU
C. Seek advice regarding the new patients from another specialty trainee working on the AAU
D. Telephone the consultant, explaining the situation to her and request that she attends the AAU as soon as possible to assist with the new patients
E. Discuss how best to deal with the new patients with the other FY1 doctors on the AAU
CDEAB
C - Another trainee would be good to help now
D - if you cant maintain safety - Consultant is good
E - advice good but need senior support for unwell pts
A - leaving ward means even less staff
B - doesn’t resolve safety and raised way too high
Your consultant has asked you to take an urgent blood sample from a 65 year old female patient. Five of the patient’s adult children are visiting her and start complaining to you about the care that their mother is receiving and criticising the hospital. Although the relatives are not aggressive, they are being loud and rude and their behaviour is delaying you in taking the patient’s blood sample.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Ask the relatives to be quiet whilst you take the blood sample
B. Ignore the relatives’ comments whilst you take the blood sample
C. Ask a nurse to take the blood sample whilst you talk to the relatives elsewhere
D. Ask the relatives to leave whilst you take the blood sample and offer to speak to them afterwards
E. Wait for the relatives to leave, then take the blood sample
DCABE
D - urgent care delivered in good time [Saying you’ll talk after seems to be good here when care is urgent]
C - Also good time but involves more staff
A - delivers safe care but doesn’t diffuse
B - exacerbates situation further
E - delays urgent care and doesnt address relatives
Whilst working in the Medical Assessment Unit, you treated a patient for an asthma attack. The patient made a good recovery and was discharged from hospital last week. Today, you receive a short complimentary message from the patient through social media, thanking you for your care. The patient also sends you a friend request on social media.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Ignore the message and friend request on social media
B. Print an anonymised copy of the complimentary message for your development portfolio
C. Respond through social media, asking how the patient’s asthma has been since discharge
D. Talk to your educational supervisor* to reflect on the situation
E. Decline the friend request, politely explain via social media that any further contact would be inappropriate
EADBC
[Boundaries]
E - Deals with issue and isn’t rude
A - this is ok but doesn’t explain and so could happen again
D - if you don’t know what to do ask a senior
B - good to have in portfolio but other things are more important here
C - wrong
This is your first post on a busy surgical rotation, and you are struggling with your workload. You have been assigned a combined clinical and educational supervisor*, Mr Jones, for your placement. So far you have emailed Mr Jones twice, with no response, and your initial induction meeting was due two months ago.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Refrain from attempting to make contact with Mr Jones, waiting for him to contact you
B. Report to the Foundation Programme Director* the lack of response from Mr Jones
C. Contact Mr Jones’ secretary, in order to find Mr Jones and discuss your induction meeting
D. Ask the Foundation Programme Director to assign you a new educational supervisor*
E. Ask the hospital switchboard to transfer your call to Mr Jones’ mobile telephone number
CBEDA
C - Best way to contact is through secretary
B - Director will be good to support you in getting a response and they should be aware
E - less good way of getting in touch
D - final resort if director cant help
A - no good - need to have a tutor and it may never occur if you don’t do something
You recently attended a training session, which highlighted the importance of keeping accurate patient records for medical care and legal purposes. Your specialty trainee* with whom you regularly work also emphasises this frequently. While working with a consultant you notice that he is writing patient records but is not recording the time and date on the records at the time of creation. He is subsequently revisiting some of the records and estimating the times and dates before submitting them to the archive.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Explain to the consultant that his record keeping is inadequate
B. Search the archive for those records that the consultant has not fully completed, to show to a senior colleague
C. Speak to the consultant about the recent training session highlighting the importance of completing accurate records
D. Discuss the consultant’s behaviour with your specialty trainee, asking what form of action he would advise
E. Return to the notes to record the correct time that the consultant wrote his notes
CDABE
C - Good as direct and involves as few members as possible
D - Good to get advice
A - true but a little blunt and may cause offence
B - lots of time and effort and not needed to raise concerns
E - this could be a probity issue and doesn’t deal with issue (poor note keeping)
You have been called by a general medical ward consultant, Dr Patrick, to help cover the ward, which is extremely busy. The FY2 doctor, Chantelle, gives you a list of three patients on the ward who require blood tests urgently. Their samples need to be processed in the next hour and the results will be used to inform a management plan. While you are taking blood from one patient, a senior nurse, Reuben, informs you that you need to examine another patient immediately as she is a relative of one of the surgical consultants. When you read this patient’s notes, there is no clinical urgency to examine the patient.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Tell Reuben that, at the moment, you must prioritise taking the blood samples
B. Ask Chantelle whether you should continue taking blood samples or examine the patient
C. Tell Reuben that you will examine the patient once you have taken all the blood samples
D. Ask Dr Patrick to examine the patient next, explaining that she is a relative of the surgical consultant
E. Examine the patient, as Reuben requested
CABDE
C - these bloods are urgent and examining is not - also saying you will do it when you can
A - still prioritises blood but doesn’t address rubens request
B - advice is good but it is clear the bloods are priority here
D - the ward is busy and this is a non urgent task
E - not completing urgent tasks to do less urgent
You are working on a surgical ward with a specialty trainee* and two other FY1 colleagues. You get on well with your specialty trainee, but have noticed that he often gives you most of the jobs to do rather than delegating the tasks evenly between you and your FY1 colleagues. As a result, you regularly have to work past the end of your shift to complete all the tasks.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Discuss your concerns with the specialty trainee
B. Continue to complete the jobs to the best of your ability
C. Talk to the specialty trainee if the situation has not improved after a month
D. Inform your educational supervisor* of the difficulties you are experiencing with your workload
E. Delegate some of your tasks to your FY1 colleagues
AEDCB
A - Deals with issue timely
E - addresses issue of workload but not deal with problem
D - may take some time to deal with
C - Doesn’t address issue timely
B - doesn’t address
You are attending a social gathering at your fellow FY1 doctor, Susanna’s, home when you notice a patient task handover sheet on the kitchen table, with Susanna’s name on it. The document has specific confidential patient information on it.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Inform Susanna that this is a breach of patient confidentiality
B. Advise Susanna to destroy the handover list
C. Report the incident to your consultant the following day
D. Destroy the handover list
E. Advise Susanna to discuss the breach of patient confidentiality with her educational supervisor*
ABEDC
A - she may be unaware so tell her
B - good to destroy but without explaining may happen again
E - good but doesn’t deal with issue now
D - destroying and not telling may mean she doesn’t know what happened to the document
C - your consultant may have no contact with suzanna- it is more for her and her consultant
Mrs Davies is a patient on the ward. You are informed by a ward nurse that one of her relatives has commented on your attitude towards Mrs Davies. Apparently she has claimed that you were dismissive of Mrs Davies’ concerns about her treatment and did not spend enough time listening to her. You do not remember the particular incident and it is the first time that you have received any complaints about your attitude.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Approach Mrs Davies and talk to her about any concerns that she has
B. With Mrs Davies’ permission, arrange to meet her relative to discuss her concerns
C. Inform your clinical supervisor* about the situation
D. Seek advice from your Medical Defence Organisation* about how to respond
E. Thank the nurse and inform her that you will reflect upon your communication with patients in the future
ABCED
A - good to confirm any reported concerns as could be misinterpretation along way
B - Less direct and responsibility is to pt
C - after this could escalate to supervisor
E - this is nice but doesn’t deal with issue
D - doesn’t address issue and you should have done ABC before
You and an FY1 colleague, Liam, are working a day shift on a ward together. Your senior consultant, Mr Parry, approaches both of you and asks you to assist with a hip replacement operation. You agree to assist and, near the end of the operation, Mr Parry asks you to suture the wound. This is something that you have not done before and you are unsure whether you are competent enough to do it.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Ask Mr Parry to provide instructions and supervise you as you suture the wound
B. Explain to Mr Parry that you do not feel comfortable suturing the patient’s wound
C. Ask Mr Parry whether he will suture the wound so that you can observe
D. Suture the wound to the best of your ability
E. Ask Liam whether he would feel more comfortable to suture the wound instead
BACED
B - Always inform if you are not comfortable
A - Asking for assistance is good but should inform first
C - this is good but you wont get to practice BASIC skill
E - This takes away from your learning opportunity
D - never do things you ain’t competent in
You are called to help Simon, your specialty trainee*, review a sick patient. When you arrive, the nurse takes you to one side and she tells you that Simon smells of alcohol. You confirm that this is the case. The review is urgent and Simon is needed as you are unable to conduct the review by yourself.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Suggest to the nurse that she asks Simon whether he has been drinking
B. Explain to Simon that he should not conduct the review if he is under the influence of alcohol
C. Contact the consultant immediately to explain the situation
D. Ask a specialty trainee from another ward to review the patient with you
E. Continue with the review, but explain to Simon afterwards that he smells of alcohol
BDCAE
B - SAFETY
D - Get assistance to minimise time delay conducting URGENT review
C - inform after prioritising pt needs
A - shouldn’t delegate to nurse unless she is senior and has good working relationship with simon
E - NOT SAFE
It is 18:00 and you have just been informed by a nurse that a patient, Jane, who has been treated for a chest infection, is ready to be discharged. Jane was ready to go home earlier that day; however, you are aware that there was a delay caused by a lack of hospital transport. Hospital transport is now available and you inform Jane that she can go home. However, Jane refuses, saying that it is too late for her to go home now and that she would prefer to be discharged in the morning. There are no medical reasons why Jane should stay in hospital overnight, and a nurse has just informed you that she has already allocated Jane’s bed to another patient.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Go through Jane’s patient notes to check that there are no outstanding medical issues
B. Ask Jane if she would like a next of kin to accompany her to be discharged
C. Ask the bed manager if they could arrange for Jane to stay for another night in the hospital
D. Explain to Jane that she must be discharged this evening to free up her bed
E. Ask Jane if there is a reason why she does not want to go home this evening
EBCAD
E - get more info
B - this is good and supportive
C - find out if a bed for the night is possible
A - medical notes should just confirm what you already know
D - this may make jane think discharge is on resource grounds rather than clinical - Don’t need to discuss other pt needs here
You are working on-call on the Trauma and Orthopaedics ward. You receive a referral from a GP* for her daughter to be admitted to the ward. The GP explains to you that her daughter has sustained a rotator cuff injury to her shoulder through playing sport. You explain to her that she should take her daughter to see their own GP, however, she insists that you accept the referral.
Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
A. Seek advice from the on-call consultant about whether to accept the GP’s daughter as a referral
B. Re-emphasise to the GP that it is inappropriate for her to refer her own daughter
C. Suggest that the GP take her daughter to the Emergency Department if she needs to be seen urgently
D. Complete a critical incident form* relating to the GP’s inappropriate request
E. Tell the GP that you will accept her daughter’s referral on this occasion only
BCAED
B - GMC gidance
C - advises correct route if urgent
A - good if you require support but should do B
E - against GMC guidance
D - Doesn’t help with emergency care and doesn’t resolve
