SJT

Question 1

2. A patient on your ward is HIV positive. He is from a minority
   community which he feels might react negatively if they knew of
   his diagnosis. As a result, he is very anxious that no one (including his
   close family) should be told.
   Rank in order the following actions in response to this situation (1 = Most
   appropriate; 5 = Least appropriate)
   A Eliminate all mention of HIV from his notes.
   B Amend your patient list so this detail is missing or obscured (e.g. ‘ret
   roviral illness’).
   C Ensure the safety of other doctors and phlebotomists by writing
   ‘HIV+’ on blood requests.
   D Tell the patient that he should talk to his family as you cannot guaran
   tee complete confi dentiality.
   E Continue as you would for any other patient under your care.

Answer 1

2 E, B, D, C, A

Question 2

3. You are sitting in the pub opposite your hospital after work.
   A group of doctors and nurses from another department is
   talking loudly and joking about patients on their ward. These patients
   could easily be identifi ed from the conversations you are overhearing.
   Rank in order the following actions in response to this situation (1 = Most
   appropriate; 5 = Least appropriate)
   A Speak to the person who is speaking loudest so he is aware that his
   behaviour is inappropriate.
   B Call hospital security and ask them to intervene.
   C Challenge the whole group so that they are aware that their behav
   iour is inappropriate.
   D Contact a manager in their department the following day to alert
   them to this breach.
   E Ignore the situation, as they should know better and you do not want
   to cause a scene.

Answer 2

3. A, C, D, E, B

Question 3

8. Your consultant knows that you are interested in his specialty and
   suggests that you attend a one-day course in another city the fol
   lowing week. You recognize that this would be a good opportunity for
   professional development. Unfortunately you have no remaining annual
   leave days and are not entitled to study leave. The rota administrator says
   that you cannot have time off to attend.
   Rank in order the following actions in response to this situation (1 = Most
   appropriate; 5 = Least appropriate)
   A Ask your SHO if she will look after the ward in your absence and go
   if she agrees.
   B Speak to your Educational Supervisor and, with their support, ask the
   service manager for special permission.
   C Accept that you cannot attend the course.
   D Add up the number of days that you worked late the week before and
   attend the course as you are owed enough hours in lieu.
   E Attend the course as you already have your consultant’s permission.

Answer 3

8
.
B, C, A, D, E

Question 4

11. You are concerned that patients on your ward are rarely seen
    by a senior doctor. They are reviewed weekly by a registrar
    but almost never by consultants, who seem to be working at a pri
    vate hospital most of the time. You are uncertain whether to raise the
    issue or how you would do this as both your Clinical and Educational
    Supervisors are consultants within this department. You are deciding
    whom to contact for advice.
    Choose the THREE most appropriate actions to take in this situation
    A The consultant who seems most absent from the department and is
    known to have the biggest private practice.
    B Your partner.
    C Your medical defence organization.
    D A friend from school whose judgement you trust and is now a solicitor.
    E An employer liaison offi cer at the General Medical Council.
    F A consultant in another department who is known for his fi erce oppo
    sition to private practice.
    G An SHO who spends his weekends at the private hospital assisting in
    theatre.
    H A senior non-clinical colleague (e.g. a manager).

Answer 4

11. C, E, H

Question 5

19. A group of fi ve medical students is attached to your fi rm. You
    have been spending a lot of time with one of the students and
    feel that a mutual attraction is developing.
    Choose the THREE most appropriate actions to take in this situation
    A Try to avoid the student for the rest of the rotation.
    B Meet with the student socially so that any romance can develop away
    from the workplace.
    C Try to ensure that your attention is equally distributed between all
    students on the fi rm.
    D Avoid any romance developing while the student is attached to
    your fi rm.
    E Tell the student that you are attracted to them but that you should
    remain professional.
    F Ask one of the others whether this particular student is attracted
    to you.
    G Try to avoid unprofessional feelings developing in future.
    H Continue with any developing relationship, as you are not directly
    responsible for supervising medical students.

Answer 5

19. C, D, G

Question 6

25. You are completing an orthopaedics audit during one of
    your FY1 rotations. The consultant surgeon has asked you to
    review the complication rates for total knee replacements performed
    at this hospital and compare them with the average across the Trust.
    Your analysis shows slightly worse postoperative outcomes at this
    hospital, and the average appears to be signifi cantly skewed by the high
    complication rates of your consultant.
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Report the consultant surgeon to the Care Quality Commission, as
    this is an issue of patient safety.
    B Ask all the orthopaedic consultants for advice about the data at the
    following week’s departmental meeting.
    C Speak with your consultant orthopaedic surgeon privately about the
    f
    i ndings.
    D Omit your consultant’s data, and submit a report without further
    discussion.
    E Obtain further data on preoperative parameters for the cases.

Answer 6

25. C, E, B, A, D

Question 7

31. A group of medical students ask if you can help them prepare
    for their forthcoming end-of-module examination on the res
    piratory system. You agree to teach them at the end of the week, pro
    vided that they stay and assist you with some ward jobs that evening,
    which they agree to do. You are reminded about your teaching commit
    ment the day before the students’ examination, but unfortunately you
    have forgotten to prepare a relevant lesson plan.
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Inform the students that they should have reminded you earlier in the
    week, and now you are unable to teach them.
    B Defer the teaching until they want to prepare for their next
    end-of-module examination.
    C Attempt to teach the students, even if your knowledge is insuffi cient,
    but fi nish the teaching early if it does not prove helpful.
    D Teach the students about haematology, with which you are more
    comfortable.
    E Adopt a style of teaching that only utilizes questioning the students,
    and refl ect every question asked back towards the group.

Answer 7

31. C, E, D, B, A

Question 8

35. Your hospital is at the centre of a news story regarding a leaked
    audit which shows a recent rise in mortality following heart
    valve replacements. As an FY1 doctor on the cardiothoracic ward, you
    feel strongly about the negative portrayal of your senior surgical col
    leagues’ abilities, believing the results to be due to the use of a new
    prosthesis. A news reporter approaches you as you are leaving the ward
    and asks if you would like to comment.
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Share with the reporter your honest opinions of the competence of
    your senior colleagues and the possibility of a fault with the new pros
    thetic valves.
    B Ask for the contact details of the reporter and agree to an interview
    once you have obtained permission from your local Trust.
    C Politely decline to comment.
    D Discuss in general terms the diffi culty that surgical innovators face
    when introducing novel technologies, without going into specifi c
    details about your department.
    E Explain your frustration with the ignorance demonstrated by the
    media and the general public in relation to health matters.

Answer 8

35. C, B, D, E, A

Question 9

7. An FY1 doctor with whom you work closely says she is concerned
   that you seem ‘down’ and have been so for a few weeks. You have
   noticed that your mood is lower than normal but put this down to stress
   and tiredness. You do not think that you are clinically depressed and are
   embarrassed by your colleague raising the possibility.
   Rank in order the following actions in response to this situation (1 = Most
   appropriate; 5 = Least appropriate)
   A Clarify the nature and reasons for your colleague’s concern.
   B See your Educational Supervisor at the next possible opportunity to
   discuss your mental health.
   C Make a routine appointment with your GP.
   D Ask other FY1 colleagues whether they think you are depressed.
   E Use a depression screening tool to determine whether you require
   drug treatment.

Answer 9

7
.
A, C, B, D, E

Question 10

10. Your consultant asks you to meet her in her office. She tells
    you that she is concerned about your performance; specifi cally
    that you sometimes arrive late for her ward rounds and that your level
    of clinical knowledge is below her expectations of a doctor at your level.
    You disagree with this assessment, as you have only been late twice and
    do not think that there are any particular gaps in your knowledge.
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Explain why you feel that her assessment is unfair, and ask her to
    provide specifi c examples to illustrate her concerns.
    B Ask the foundation school about the possibility of changing consult
    ants as there has been a relationship breakdown.
    C Ask the consultant for advice about how you can act on her concerns
    and improve your performance.
    D Using your e-portfolio, conduct a Team Assessment of Behaviour
    (TAB) round looking for evidence of concern about your performance
    from other colleagues.
    E Tell the consultant that you believe your knowledge to be no worse
    than that of other FY1 doctors, and that you won several prizes at
    medical school.

Answer 10

10. C, A, D, E, B

Question 11

18. Your registrar suggests one morning before the ward round
    that your appearance is inappropriate. In particular, he says that
    you are showing too much of your chest and are wearing a watch.
    Choose the THREE most appropriate actions to take in this situation
    A Remove the watch immediately as it confl icts with Trust policy.
    B Explain that you had not realized that your dress was inappropriate
    and will consider this before coming to work the next day.
    C Point out that your consultant also wears a watch.
    D Wear more revealing clothes the following day to show you are free
    to interpret the Trust dress code yourself.
    E Tell your registrar that he should be more interested in your clinical
    ability than your choice of clothes.
    F Decline to participate in the ward round because you have been
    insulted by the registrar.
    G Tell your consultant that your registrar was insulting and bullying
    before the ward round.
    H Seek feedback from other colleagues if you are uncertain whether
    your clothes really are inappropriate.

Answer 11

18. A, B, H

Question 12

20. You know that you do not always communicate well when feel
    ing stressed and want to avoid this impacting on your relation
    ship with colleagues.
    Choose the THREE most appropriate actions to take in this situation
    A Use Team Assessment of Behaviour (TAB) rounds and informal feed
    back from colleagues to gauge your success at managing stress.
    B Tell other team members early on that they should avoid making you
    stressed.
    C Ask other FY1 doctors on your team to be responsible for shared
    tasks to minimize your workload.
    D Make sure that you always go home at fi ve o’clock.
    E Try to streamline your work eff ectively so that you are not left with
    lots of tasks to complete at the end of the day.
    F Talk to senior colleagues early if you think that the workload is getting
    on top of you.
    G Drink alcohol in the evenings to ‘loosen up’.
    H Ask Human Resources (HR) for time each week to attend yoga and
    relaxation classes.

Answer 12

20. A, E, F

Question 13

29. You are clerking patients in the Emergency Department. Your
    current patient is in police custody and, at the point of dis
    charge, the accompanying offi cers ask you for a copy of the discharge
    summary. The patient asks you not to provide them with any details but
    the offi cers insist that you must cooperate with their request.
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Politely explain to the police offi cers that you cannot provide informa
    tion without your patient’s consent.
    B Discuss with a consultant if the offi cers insist.
    C Give a discharge summary to the patient, knowing that it might be
    confi scated later on.
    D Give the offi cers a discharge summary, as helping the police is in the
    public interest.
    E Tell the offi cers that there are no circumstances under which you
    would betray your patient’s confi dence.

Answer 13

29. A, B, E, C, D

Question 14

2. You are a respiratory FY1 doctor and have inserted a number of
   chest drains before and have been asked to do so for a patient on
   your ward. Previous consents have always been obtained by diff erent
   doctors. You intend to obtain consent for this patient but recall that this
   can be found to be invalid afterwards unless the patient is warned about
   important complications.
   Rank in order the following actions in response to this situation (1 = Most
   appropriate; 5 = Least appropriate)
   A Obtain verbal consent and document that the patient has been
   consented in the notes.
   B Obtain legal advice before consenting.
   C Obtain verbal consent with a nurse as a witness.
   D Complete a formal written consent form.
   E Refuse to complete the procedure as only SHO grade or above
   should consent.

Answer 14

2
.
D, A, C, E, B

Question 15

3. You are working as an FY1 doctor at night in the surgical assess
   ment unit, when you are asked to clerk an elderly patient who is
   profoundly deaf and unable to write.
   Rank in order the following actions in response to this situation (1 = Most
   appropriate; 5 = Least appropriate)
   A Attempt a brief verbal history.
   B Skip the history, and focus your management on the examination and
   investigations.
   C Do not attempt to clerk the patient without an interpreter present.
   D Complete your detailed history via handwritten questions.
   E Extrapolate a history based on the limited fi ndings of the ambulance
   crew on their initial assessment sheet.

Answer 15

3
.
D, E, B, A, C

Question 16

9. You are an FY1 doctor in rheumatology looking after a patient who
   is about to be discharged this afternoon. During his stay a CTPA
   was completed for chest pain which was negative but showed a lung
   mass of unknown signifi cance with a suggestion for interval scanning.
   Rank in order the following actions in response to this situation (1 = Most
   appropriate; 5 = Least appropriate)
   A Use capital letters in the discharge letter to highlight the incidental
   f
   i nding and requirement for an interval CT scan.
   B Phone the GP to inform them of this fi nding.
   C Explain the problem to the patient and ensure he sees his GP to
   arrange an interval CT scan.
   D Inform the ward clerk to relay the report fi ndings to the patient.
   E Advise that the patient returns to the rheumatology clinic to see your
   consultant for further review of the mass.

Answer 16

9
.
B, C, A, E, D

Question 17

13. You are looking after several unwell patients as the medical FY1
    doctor covering wards at the weekend when a Sister asks you
    for an urgent discharge summary to help relieve a bed crisis in the hospi
    tal. She sympathizes with your workload but insists that a discharge letter
    must be written immediately.
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Acknowledge the severity of the bed crisis, but refer her to your reg
    istrar, explaining that you have more urgent matters to attend to.
    B Phone the registrar and ask if there are any spare junior doctors who
    can assist with your tasks.
    C O ff er to write the discharge letter once you have stabilized your
    patients.
    D Ask the Ward Sister to complete the discharge letter but sign a blank
    copy in advance to expedite the discharge.
    E Take two minutes to write a brief discharge letter before returning to
    the care of your patients.

Answer 17

13. C, A, B, E, D

Question 18

17. You are preparing to fi nish your ward shift and must leave on
    time to catch a fl ight to the test centre, where you are due to
    sit an important examination. There are still two patients left to see as
    part of your ward round. Both are stable and awaiting input from social
    services, but your visit is likely to be prolonged by family members who
    are currently visiting.
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Perform a quick examination of each patient without speaking to
    them or their families.
    B See the patients but explain that you cannot spend much time with
    their relatives today, and that someone will be available to answer
    questions tomorrow.
    C Ask the nurses to remove the families before briefl y reviewing each
    patient.
    D Assess the patients as usual and answer any questions the family
    members may have, even if this results in missing your fl ight.
    E Explain to the nurses that the patients will be seen on tomorrow’s
    ward round, and catch your fl ight.

Answer 18

17. B, A, D, C, E

Question 19

24. While you are working in A&E, a nurse informs you that a 33-week
    pregnant woman is being brought by helicopter into resuscitation
    following a road traffi c collision. She asks you to prepare for her arrival in
    approximately fi ve minutes. Your registrar has already been informed, and
    he asks you to call for assistance while he bleeps the obstetric team.
    Choose the THREE most appropriate actions to take in this situation
    A Inform the neonatal registrar.
    B Call the orthopaedic consultant at home.
    C Fast bleep the haematology registrar.
    D Summon the cardiac arrest team.
    E Request a phototherapy light.
    F Call the switchboard and ask them to put out a trauma call.
    G Ask a nurse to fi nd a neonatal incubator and bring it to resuscitation.
    H Ensure that there are medical students present, to maximize the
    learning opportunity.

Answer 19

24. A, F, G

Question 20

25. While working on call, you are asked to cannulate a large patient
    who requires intravenous antibiotics for a suspected diarrhoeal
    infection. Your bleep sounds for a third time during your fourth can
    nulation attempt when you fi nally believe that you have obtained access.
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Stop your attempt immediately and answer your bleep.
    B Secure and fl ush the cannula before answering your bleep.
    C Try to get the attention of the Ward Sister so that she can answer
    your bleep.
    D Answer your bleep after securing and fl ushing the cannula, cleaning
    the work area, and saying goodbye to the patient.
    E Ignore the bleep as they will call again if it is important.

Answer 20

25. B, C, D, E, A

Question 21

26. A patient on your ward is diagnosed with anal cancer. He tells
    you that his community would react very negatively if they
    knew of his diagnosis. As a result, he is very anxious that no one fi nds
    out, including his family.
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Promise to remove any mention of anal cancer from his notes.
    B Tell the patient that you will remove any mention of his diagnosis from
    patient lists.
    C Tell the patient that his family are bound to fi nd out at some point and
    it would be better if he told them.
    D Let the nursing staff know that his family are not aware of the
    diagnosis.
    E Treat him as any other patient under your care.

Answer 21

26. B, D, E, C, A

Question 22

40. You have clerked Mr Smith, a 56-year-old man with abdominal
    pain, who was also reviewed by Dr Mayer, the duty consultant.
    The following day, the new duty consultant reads your clerking and pro
    poses a completely diff erent management plan. He has no new informa
    tion to hand and did not examine the patient, and you are unhappy with
    his suggestions.
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Politely decline to follow the second consultant’s management plan
    until he sees the patient.
    B Clarify with the second consultant to whom you are ultimately
    responsible.
    C Highlight the diff erences in management between the two consultants.
    D Accept the plan instigated by the second consultant.
    E Ask the registrar to see the patient afterwards for a ‘tie-breaker’
    opinion.

Answer 22

40. C, D, E, B, A

Question 23

4. Your next patient at the gynaecology clinic arrives with her
   brother-in-law, who explains that she is unable to speak any English.
   As you begin the interview you start to suspect that her brother-in-law
   is only communicating some of the information.
   Rank in order the following actions in response to this situation (1 = Most
   appropriate; 5 = Least appropriate)
   A Reiterate to the brother-in-law that you need him to translate word for word.
   B Try to establish whether the patient is happy with her brother-in-law
   acting as interpreter.
   C Schedule another appointment with a formal interpreter.
   D Invite the clinic receptionist into the consultation as she claims to
   speak a similar language to the patient’s.
   E Ask the brother-in-law to leave and complete the consultation with
   out any interpreter.

Answer 23

4 C, A, B, D, E

Question 24

21. You are clerking a young child in A&E who has been admitted
    with suspected bronchiolitis. Physical examination is unremark
    able except for a moderate wheeze, although you note that the parents
    appear somewhat unkempt, with dirty hands and clothes. You consider
    what to document as part of your fi ndings in the medical notes.
    Rank in order the following in response to this situation (1 = Most appropri
    ate; 5 = Least appropriate)
    A Your opinion of the parents’ treatment of the child, based on their
    appearance.
    B Detailed physical examination and objective clinical assessment of
    the child.
    C A brief summary of your clinical assessment.
    D Complete your notes after they have been confi rmed by a senior.
    E Complete your notes later on after getting through a few more
    patients, to keep the clinic moving.

Answer 24

21. B, C, E, D, A

Question 25

While you are working in A&E, a nurse informs you that a 33-week
pregnant woman is being brought by helicopter into resuscitation
following a road traffi c collision. She asks you to prepare for her arrival in
approximately fi ve minutes. Your registrar has already been informed, and
he asks you to call for assistance while he bleeps the obstetric team.
Choose the THREE most appropriate actions to take in this situation
A Inform the neonatal registrar.
B Call the orthopaedic consultant at home.
C Fast bleep the haematology registrar.
D Summon the cardiac arrest team.
E Request a phototherapy light.
F Call the switchboard and ask them to put out a trauma call.
G Ask a nurse to fi nd a neonatal incubator and bring it to resuscitation.
H Ensure that there are medical students present, to maximize the
learning opportunity.

Answer 25

24. A, F, G

Question 26

25. While working on call, you are asked to cannulate a large patient
    who requires intravenous antibiotics for a suspected diarrhoeal
    infection. Your bleep sounds for a third time during your fourth can
    nulation attempt when you fi nally believe that you have obtained access.
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Stop your attempt immediately and answer your bleep.
    B Secure and fl ush the cannula before answering your bleep.
    C Try to get the attention of the Ward Sister so that she can answer
    your bleep.
    D Answer your bleep after securing and fl ushing the cannula, cleaning
    the work area, and saying goodbye to the patient.
    E Ignore the bleep as they will call again if it is important.

Answer 26

25. B, C, D, E, A

Question 27

13. During your fi rst month working on the neurosurgery ward,
    you have become increasingly troubled by your registrar’s abil
    ity. You have seen him misinterpret basic clinical signs. On one occa
    sion you tried to share your concerns with the consultant in charge
    but he discounted them, highlighting the registrar’s natural ability in the
    operating room.
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Ask your consultant again to consider the registrar’s overall
    performance.
    B Inform your Educational Supervisor.
    C Approach the registrar and ask him whether he would be willing to
    receive teaching from you after work.
    D Inform the Clinical Director.
    E Share your thoughts with another FY1 colleague.

Answer 27

13. A, B, D, C, E

Question 28

24. You are on a fast-paced surgical ward round. Your consultant tells
    a patient that she will need a ‘Hartmann’s procedure which will
    leave a colostomy’ and she signs a consent form. You can tell from her body
    language that she wants to ask questions but does not feel able to do so.
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Explain that you will come back after the ward round in case she
    wants to ask any more questions.
    B Insist that the consultant stays until he has answered her questions.
    C Tell the patient that your consultant will come back later to answer
    questions.
    D Let the ward round continue but remain behind to draw a picture for
    the patient illustrating Hartmann’s procedure.
    E Continue with the ward round but return later to answer questions.

Answer 28

24. A, E, D, B, C

Question 29

25. As you are sitting at the nurses’ station completing a discharge
    summary, you see a 55-year-old patient walking away from you
    with his gown fl apping open at the back.
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Shout to the patient by name so that he can be alerted to his state of
    undress.
    B Catch up with the patient and let him know that he is partially
    undressed.
    C Help him tie up the gown correctly.
    D Find a nurse and let them know the patient needs assistance.
    E Catch up with the patient and tell him that he should be more careful
    in case he embarrasses other patients or visitors.

Answer 29

25. B, C, D, E, A

Question 30

27. A patient admitted to your ward with pneumonia is shown to
    have tuberculosis (TB). He is asked to wear a face mask when he
    leaves his side room and told that the case must be reported to the Health
    Protection Agency. He refuses to allow information about his illness to be
    sent externally and is often seen outside his side room without a mask.
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Explore the reasons for this patient’s non-compliance.
    B Explain that TB is potentially dangerous and very easily spread to oth
    ers in the hospital.
    C Explain that you will not send his details externally but that his GP
    must be informed.
    D Explain to the patient but submit his details to the Health Protection
    Agency (HPA), regardless of whether he gives consent.
    E Discharge the patient from hospital without further treatment as he is
    a danger to other patients.

Answer 30

27. B, D, A, C, E

Question 31

28. Ron is an elderly man with bowel obstruction. He is delirious
    and keeps pulling out intravenous cannulas as well as occasion
    ally tugging on his nasogastric tube. Reinserting cannulas is becoming
    increasingly time-consuming and he is running out of suitable veins.
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Resite cannulas in areas less likely to be disrupted (e.g. feet).
    B Prescribe gloves/mittens according to hospital policy.
    C Try taping and bandaging tubes for additional security.
    D Ask whether a ‘special’ nurse can be assigned for one-to-one care.
    E Tape incontinence pads around Ron’s hands to stop him pulling
    out lines.

Answer 31

28. C, A, D, B, E

Question 32

29. Ivy has dementia and often screams out all night. Her clinical
    condition has recently improved and she has become mobile
    by ‘furniture walking’ around the ward. She is violent and abusive when
    stopped by members of staff .
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Try to reason with Ivy, explaining as far as possible that it is unsafe for
    her to move around the ward.
    B Suggest distracting interventions, such as playing music.
    C Prescribe ‘as required’ (PRN) sedation.
    D Ask whether a ‘special’ nurse can be assigned for one-to-one care.
    E Prescribe sedation when Ivy becomes particularly agitated and endan
    gers herself or others.

Answer 32

29. A, B, D, E, C

Question 33

38. A staff nurse approaches you with concerns about Mark, a
    young man with a recently repaired femoral fracture. He insists
    on wearing his own clothes and will not change into a hospital gown.
    Friends also bring food in for him (e.g. take-away curries), which upsets
    other patients.
    Choose the THREE most appropriate actions to take in this situation
    A Ask Mark to change into a gown because otherwise he is diffi cult to
    examine.
    B Tell the nurse that there is no good reason why Mark shouldn’t wear
    his own clothes.
    C Explain to the nurse that Mark should be able to eat food from out
    side if he prefers.
    D Tell Mark that if he is well enough to eat curry then he is well enough
    to be discharged.
    E Tell the nurse that the other patients should ask their friends/relatives
    to bring in food if that’s what they want.
    F Ask Mark to consider other patients having to eat hospital food
    before choosing food for his friends to bring.
    G Suggest that Mark be swapped with another patient who is currently
    in a side room with diarrhoea and vomiting.
    H Tell the nurse that Sister controls the ward and that she should speak
    to Mark if there is a problem.

Answer 33

38. B, C, F

Question 34

11. Frances, an FY1 colleague, confi des in you that she was
    recently diagnosed with thyroid cancer. She does not appear
    to be symptomatic and is scheduled to undergo a biopsy and surgical
    treatment at another hospital in a month’s time. Although she is not as
    spritely as usual, you have not noticed any change in her performance.
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Suggest that she refers herself for counselling via Occupational Health.
    B Advise Frances to inform her Educational Supervisor.
    C Inform your consultant immediately.
    D Gently explore how she is feeling about the diagnosis.
    E Keep an eye on Frances at work but do not say anything to anyone else.

Answer 34

11. D, B, E, A, C

Question 35

15. Each time you phone radiology, you receive a barrage of criti
    cism from a particularly discourteous radiology registrar. Your
    colleagues now try to make fewer requests whenever this particular reg
    istrar is on duty. He once criticized your ‘incoherent’ radiology requests
    and, when you asked how your requests could be improved, he hung up
    the phone.
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Arrange a meeting between the radiology registrar and the Mess
    President.
    B Raise the issue with your Clinical Supervisor.
    C Ask for a slot at the monthly radiology meeting to discuss communi
    cation between junior doctors and duty registrars.
    D Contact the Clinical Director for Radiology to explain your diffi culty.
    E Avoid making radiology requests when this registrar is on duty unless
    they are absolutely necessary.

Answer 35

15. B, D, C, A, E

Question 36

20. Your registrar suff ers from refl ux disease and is experiencing
    very bad heartburn after lunch. His symptoms stop him from
    carrying out the ward round. He informs a nurse he forgot to take his
    usual proton pump inhibitor (PPI) that morning and is given omeprazole
    from the drug cabinet.
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Report the registrar for taking patient medication.
    B Suggest that he obtains the medication from A&E by admitting himself
    as a patient and having the medicine formally prescribed.
    C O ff er to prescribe omeprazole for your registrar on a discharge sum
    mary prescription.
    D Reprimand the nurse who has given him the PPI.
    E Do nothing.

Answer 36

20. B, C, D, A, E

Question 37

25. Annabelle, the Ward Sister, has bleeped you and asks you
    to prescribe atenolol to a patient who is hypertensive. After
    reviewing the patient, you disagree and feel that antihypertensives are
    not clinically indicated. Annabelle is not convinced by your explanation,
    saying that in her ‘extensive experience’ they are needed.
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Explain how and why you arrived at your decision not to prescribe
    antihypertensives.
    B Insist on your management plan as you are responsible for signing the
    prescription.
    C Agree to prescribe antihypertensives, but ask the patient’s GP to stop
    them on discharge.
    D Inform Annabelle that you will discuss the issue with a senior col
    league, but that she should not give any medication for the time being.
    E Agree that she should give the medication but do not sign the
    prescription chart.

Answer 37

25. D, A, B, C, E

Question 38

27. There is a cardiac arrest call in the outpatients clinic at the other
    side of the hospital. You arrive to fi nd a nurse performing chest
    compressions being watched by a domestic assistant and a fi nal-year
    medical student.
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Instruct the medical student to take over chest compressions.
    B Encourage the medical student to lead the crash call to develop his
    leadership skills.
    C Instruct the domestic assistant to bring the crash trolley.
    D Instruct the medical student to bring the crash trolley, while you take
    over chest compressions.
    E Wait for instructions from the nurse doing compressions.

Answer 38

27. D, A, C, E, B

Question 39

35. You are coming to the end of your fi rst FY1 rotation in endo
    crinology. The job was challenging and you felt inadequately
    prepared for many of the responsibilities during induction. You consider
    how you might go about helping your successor.
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Feed back your thoughts on the induction to your Clinical Supervisor
    during your fi nal meeting.
    B Write a list of useful tips for your successor.
    C Take a week off your next rotation to help support your successor
    during their fi rst week.
    D Leave your mobile phone number for your successor to contact you
    if they encounter diffi culties.
    E Leave the induction process to the Foundation Programme
    management team.

Answer 39

35. A, B, D, E, C

Question 40

You are on your way to add a patient to an emergency theatre list urgently, when a nurse stops you to say they are concerned about one of your patients, Mr Connor. Mr Connor’s catheter is showing a very low urine output following his surgery earlier that morning. You checked on him 2 hours ago during ward rounds, at which point his urine output was adequate given his body size.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

d. Ask the nurse to record Mr Connor’s vital signs and tell her that you will head straight back to the ward once you have added your patient to the emergency theatre list
c. Explain that you need to add a patient to the emergency theatre list, and tell her to find another member of the team to review Mr Connor
e. Ask the nurse whether Mr Connor’s urine output has changed since the ward round this morning
a. Reassure the nurse that you reviewed Mr Connor’s urine output on the ward round earlier that morning
b. Go straight to the ward and review Mr Connor

Answer 40

Answer: EDBCA

Question 41

It is 8am and you are beginning a New Year’s Day shift. A fellow FY1 colleague has called in sick for the same shift, stating that she has food poisoning. The following day you learn that this colleague has posted pictures on social media from a New Year’s Eve party.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

d. Ask your colleague to explain why she called in sick the day after a party
c. Seek advice from your FY2 colleague on the ward
e. Ask your consultant to have a look at the photos on the social networking site
a. Tell all of your other junior doctors colleagues to have a look at the social media photos
b. Advise your FY1 colleague to remove the photos from the social networking site
d. Ask your colleague to explain why she called in sick the day after a party
c. Seek advice from your FY2 colleague on the ward
b. Advise your FY1 colleague to remove the photos from the social networking site
e. Ask your consultant to have a look at the photos on the social networking site
a. Tell all of your other junior doctors colleagues to have a look at the social media photos

Answer 41

Answer: DCBEA

Rationale: This question assesses your ability to work effectively in a team and act in a professional manner, respecting your colleagues

(D) Your first action should be to ask her why she called in sick to establish whether she actually has food poisoning or not. This allows you to establish the facts rather than make assumptions about your colleague (such as she may have a hangover)

(C) Seeking advice from the ward FY2 doctor about professional life is a sensible second choice

(B) It is appropriate to suggest that the colleague removes the photos, as a doctor must ensure photos posted on social media do not bring into question their fitness to practice i.e. a doctor posting photos intoxicated the night before a shift may cause the public to question their fitness to practice medicine

(E) You should report the photos to a senior colleague only if your colleague has no explanation, or shows no remorse

(A) It is least appropriate to tell other colleagues about the photos as it serves no purpose other than embarrassing the colleague

Question 42

After a prolonged period of antibiotic treatment, a patient with a complex medical history dies on the geriatric ward. Despite having enough information to complete the death certificate, your consultant is keen to arrange a post-mortem to find out more. He gains consent from the patient’s family, however, the family approach you a short time later and tell you that they felt coerced to agree to it, and that they are upset about the request.

Rank in order the appropriateness of the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).

d. Discuss the family’s concerns with them
e. Reassure the family that post-mortems are standard practice in these types of situations
c. Ask another senior colleague to meet with the family to discuss their concerns
a. Refer the family’s request back to your consultant and ask him to speak to them again
b. Ask your consultant why he is requesting the post-mortem
d. Discuss the family’s concerns with them
a. Refer the family’s request back to your consultant and ask him to speak to them again
c. Ask another senior colleague to meet with the family to discuss their concerns
b. Ask your consultant why he is requesting the post-mortem
e. Reassure the family that post-mortems are standard practice in these types of situations

Answer 42

Answer: DACBE

Question 43

1. You are working as an FY1 doctor in the Medical Assessment Unit,
   seeing Marcin who is a 35-year-old Polish man with very limited
   English language skills.
   Rank in order the following actions in response to this situation (1 = Most
   appropriate; 5 = Least appropriate)
   A Attempt a brief history using hand gestures and diagrams.
   B Try to contact a member of Marcin’s family to act as an interpreter
   over the phone.
   C Do not attempt a history without a translator present.
   D Skip the history, and focus your management on the examination and
   investigations.
   E Extrapolate a history based on the limited fi ndings of the ambulance
   crew on their initial assessment sheet.

Answer 43

1. B, E, D, A, C

Question 44

15. You are working as the orthopaedic FY1 doctor when you
    are called by the orthopaedic registrar on your mobile about
    a patient who will be arriving on the private ward. He asks you to clerk,
    cannulate, and initiate intravenous fl uids, as the patient will be undergo
    ing elective surgery the following morning.
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Prioritize the preoperative clerking and fl uid administration alongside
    your other tasks.
    B Contact a responsible person (e.g. duty manager) to ask about the
    appropriateness of doing jobs on the private ward.
    C Suggest that the registrar comes in to complete the clerking if he has
    agreed to see the consultant’s private patient.
    D Help if possible, but inform the registrar that this is not a long-term
    solution for managing private patients.
    E Agree to complete the tasks for a reasonable fee.

Answer 44

15. A, D, B, E, C

Question 45

22. Six hours ago you prescribed intravenous antibiotics for a surgi
    cal patient for a suspected pelvic abscess. During your after
    noon ward round you fi nd that the antibiotics have still not been given
    by the nurse.
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Contact the pharmacy and seek advice about how to prepare the
    infusion yourself.
    B Inform the Ward Sister that the antibiotics have been dangerously
    delayed.
    C Ensure that the nurse understands the importance of giving antibiotics
    promptly.
    D Approach the nurse on her break and insist that she prepares the
    intravenous antibiotics immediately.
    E Allow the nurse to complete her jobs without further instruction—
    she will administer the infusion when she has time.

Answer 45

22. C, B, D, A, E

Question 46

29. You have just completed your assessment of a patient who is
    hypotensive and asked the nurses to administer intravenous
    f
    l uids. You are bleeped by another ward to say that a patient is pyrex
    ial. While you are taking this call, your crash bleep summons you to a
    third ward.
    Rank in order the following actions in response to this situation (1 = Most
    appropriate; 5 = Least appropriate)
    A Many doctors carry crash bleeps and you should prioritize the patient
    you are currently treating.
    B Attend the crash call but return later to document your assessment
    retrospectively.
    C Document your current assessment of the patient who is hypotensive
    and then attend the crash call.
    D See the febrile patient after the crash call and then return to docu
    ment your approach to the hypotensive patient.
    E Don’t document anything as the unwell patients are a priority.

Answer 46

29. B, D, E, C, A

Question 47

You are a medical F2 on call for ward cover. You are stabilising Mrs Green who has acute pulmonary oedema which may be due to a heart problem. You are bleeped by one of the nurses on another ward requesting an urgent review of Mr Fray who has chest pain.

Rank in order the following actions in response to this situation (1 = Most appropriate; 5 = Least appropriate)

A - Immediately go and review Mr Fray’s chest pain in person
B - Ask the nurse to wait, stabilise Mrs Green, leaving clear instructions for her continuing care and then go to see Mr Fray
C - Inform the nurse that you are with an acutely unwell patient and ask them to seek a review from another doctor
D - Stabilise Mrs Green and ask the nurses to perform an ECG and basic observations on Mr Fray and give him oxygen until you arrive
E - Ask Mrs Green’s nurse to find another doctor to finish up with Mrs Green and attend to Mr Fray

Answer 47

The preferred answers are: DCBEA

1. D - Stabilise Mrs Green and ask the nurses to perform an ECG and basic observations on Mr Fray and give him oxygen until you arrive
   This option gives some instructions to the nurses for Mr Fray’s immediate care and will gather more information about Mr Fray’s condition while you attend to Mrs Green
2. C - Inform the nurse that you are with an acutely unwell patient and ask them to seek a review from another doctor
   This option is worse than option D as it does not attend to Mr Fray in any way but is better than option B as it leaves the nurses attending Mr Fray with instructions to continue seeking help.
3. B - Ask the nurse to wait, stabilise Mrs Green, leaving clear instructions for her continuing care and then go to see Mr Fray
   This option is worse than options D and C as it leaves the nurses attending to Mr Fray waiting without any further instructions for an unspecified amount of time. This option is better than options E and A as it at least provides effective care for Mrs Green.
4. E - Ask Mrs Greens nurse to find another doctor to finish up with Mrs Green and attend to Mr Fray
   This option is worse than options B, C and D as it leaves Mrs Green without care, you are the doctor on call and are already attending Mrs Green. Even if her nurses are able to find another doctor to see her it is likely that work that you have done will need to be repeated by another doctor in order to form an effective management plan. This option is better than option A as you are at least informing someone that you are leaving Mrs Green.
5. A - Immediately go and review Mr Fray’s chest pain in person
   This option is the worst as it effectively abandons Mrs Green who the scenario describes as acutely unwell.

Question 48

As an ENT F2, Mike is asked to see a 46 year old woman with otitis externa. The ear needs to be cleaned with microsuction but the patient is very anxious and had a painful experience last time. There are 3 other patients in the waiting room. Should Mike:

Rank in order the following actions in response to this situation (1 = Most appropriate; 5 = Least appropriate)

A - Discuss at length the issues she had after the last episode of microsuction and reassure her
B - Start microsuctioning without further delay
C - Explain to her the reasons for the microsuction, discuss the procedure and proceed only if she is happy.
D - Suggest that she come back to see you the next day when she may be less anxious
E - Book her in the see another doctor later in the week

Answer 48

The preferred answers are: CADBE

1. C - Explain to her the reasons for the microsuction, discuss the procedure and proceed only if she is happy.
   Taking some time to discuss the procedure acknowledges her distress and performing the micro-suction attends to her clinical need. The scenario states clearly that the ear needs to be cleaned and it may well be that part of her distress is caused by her ear problem. This option is the best because it addresses both her clinical and emotional needs.
2. A - Discuss at length the issues she had after the last episode of microsuction and reassure her
   It is kind to reassure this patient and take time to explore her previous experience. This option mentions no plan to undertake the microsuction procedure but it does attempt to alleviate her anxiety making a successful procedure more likely at a later time. However - not addressing the clinical need makes this a worse option than C.
3. D - Suggest that she come back to see you the next day when she may be less anxious
   This option is not as good as Options A and C which resolve either the clinical or emotional need in this appointment. However - it is patient centred and may make the patient feel more in control of the process and therefore less anxious. The delay of only one day is minor.
4. B - Start microsuctioning without further delay
   This option does meet her clinical need but ignores her emotional need and overall wellbeing. It may cause her additional pain and distress during this procedure and make her less likely to seek medical help in the future having had two difficult experiences. This option is worse than options C, A and D as it prioritises the clinical to the exclusion of the emotional needs of the patient whereas options A and D tried to meet her emotional needs first so that the clinical need could be met later.
5. E - Book her in the see another doctor later in the week
   This option is worse than option D as it includes a larger delay and also passes the work on to another doctor. It is worse than option B as it doesn’t meet her clinical need. None of the patient’s needs are addressed. The patient has now seen two doctors - neither of whom gave her the care she needed. She may simply not attend again. There is nothing in the scenario that suggests that this patient cannot be handled by Mike

Question 49

You are an F2 doctor in A&E. A lady has just returned from x-ray to discover that her wedding ring can not be located. The nurse who was dealing with the patient is currently on a tea-break and your shift is about to end. You decide to:

Rank in order the following actions in response to this situation (1 = Most appropriate; 5 = Least appropriate)
B - Delay the end of your shift and enquire with the nurse when she returns from her tea-break
E - Refer the matter to a nurse in the immediate area
D - Enquire with colleagues in the immediate area
C - Search for the nurse concerned
A - Advise the patient to enquire with the next attending nurse

Answer 49

The preferred answers are: EADBC

Question 50

You are an Endocrinology F2 and asked to see a haemodialysis patient on a renal medical ward. The nephrologists have asked you to see their patient as he has been found to have deranged TFTs (Thyroid Function Tests) on a routine blood test. When you arrive on the ward the patient’s notes and drug chart are missing.

Rank in order the following actions in response to this situation (1 = Most appropriate; 5 = Least appropriate)
A - Refuse to see the patient until the notes are found.
B - See patient but make no decisions or notes.
C - See the patient without notes, writing on a separate continuation sheet your impressions and recommendations for drug prescription and possible tests, hand this to a nurse.
D - Spend a little time looking for the notes on the ward before seeing the patient
E - See patient, prescribe drugs on a new chart and order tests and plan to make notes when they are found later.

Answer 50

The preferred answers are: DCABE

1. D - Spend a little time looking for the notes on the ward before seeing the patient
   This is the best option as the notes are likely to be on the ward and the drug chart will definitely be located or re-written by the next drug round. A quick look may result in you finding them and will furnish you with the information you need to make good clinical decisions.
2. C - See the patient without notes, writing on a separate continuation sheet your impressions and recommendations for drug prescription and possible tests, hand to nurse.
   While not ideal this is a good second best, fulfilling your commitment to see the patient and making recommendations for their care. By handing your notes to the nurse you ensure that the patient’s confidentiality is not compromised.
3. A - Refuse to see the patient until the notes are found.
   While this isn’t best practice, it is a reasonable course of action, given that you require the notes to make decisions about the the patient’s care.
4. B - See patient but make no decisions or notes.
   This option doesn’t seem a good use of your time, additional to the fact that any consultation with a patient must be written up.*
5. E - See patient, prescribe drugs on a new chart and order tests and plan to make notes when they are found later.
   This course of action may be indicated in an emergency but not for a routine non-urgent referral. You run the risk of causing Adverse Drug Reactions . The GMC states that prescribers must …’Be in possession of, or take, an adequate history from the patient, including: any previous adverse reactions to medicines; current medical conditions; and concurrent or recent use of medicines, including non-prescription medicines’*. Without first seeing the notes you may duplicate tests or decisions already made thereby wasting time and resources.

Question 51

You are a new F2 on a Renal Ward. You are on a night shift and have been asked to assist the Registrar with a Vascular Catheter insertion for a hyperkalemic patient needing emergency dialysis. The patient needs to be consented but has no family with them and speaks very little English. An HCA on another ward is found and asked to translate, as she speaks a similar dialect. As you observe you feel uneasy, the translator seems to be saying many of the key words in English and seems quite dismissive of the patient saying he understands. The Registrar is keen to proceed.

Rank in order the following actions in response to this situation (1 = Most appropriate; 5 = Least appropriate)
A - Assist as it is an emergency and it is in the best interests of the patient to have the dialysis.
B - Refuse to assist stating that consent has not been properly gained.
C - Immediately phone the Trust’s language and translation service and consent the patient yourself.
D - Phone the Renal Consultant for advice.
E - Share your concerns with the Registrar and see if he is satisfied that the patient has been consented.

Answer 51

The preferred answers are: EBDCA

Question 52

You are an F2 caring for a 32 year old male who has just had an emergency appendectomy. It has become clear since his admission that he is an overseas visitor. The Overseas Visitor Team has just spoken to the patient alerting him to the fact that he may not be eligible for free NHS treatment potentially liable for the total cost of his treatment. Your patient’s brother comes to you very concerned and tells you that they won’t be able to afford the bill and begs you not to prescribe any further treatment.

Rank in order the following actions in response to this situation (1 = Most appropriate; 5 = Least appropriate)
A - Seek advice from the Overseas Visitors Team
B - Alert the brother to the importance of your patient’s current treatment, giving a clear and full explanation of the prescriptions in place.
C - Tell the brother you must focus on the patient’s prescribing as that is your prime concern.
D - Speak to the patient.
E - Research cheaper treatment options and reduce costs where you can by prescribing cheaper pain relief and antibiotics.

Answer 52

The preferred answers are: DAECB

1. D - Speak to the patient. This is the best option as you need to understand the patient’s wishes, if he wishes to be discharged or will refuse further treatment for fear of additional costs you need to know. At present the information has been relayed to you by a relative and it is not clear how much you have consent to share with the brother.
2. A - Seek advice from the Overseas Visitor Team. This is a good option, these are the experts in this unusual situation and will give you more information and advice and may be able to clarify whether this patient will be paying for his treatment or not. The scenario says the Overseas Visitor Team has alerted him to the fact that he “may not be eligible” and is “potentially liable” so there is no definite liability established.
3. E - Research cheaper treatment options and reduce costs where you can by prescribing cheaper pain relief and antibiotics.
   This option is worse than Options A and E as it assumes that there is a liability to pay for treatment and the word “Research” implies you do not currently know of the cheaper options and will need to look into them which will probably take some time. If these alternatives are not in standard use they may not be immediately available in the hospital pharmacy. This research may be unnecessary if the patient proves eligible.
4. C - Tell the brother you must focus on the patient’s prescribing as that is your prime concern.

This option is better than option B as it avoids sharing information with the brother where you do not have clear consent to do so. A patient is more than a collection of prescriptions and his concerns or stress about the cost of treatment could affect his recovery and well being. You should not dismiss the family’s concerns (which the patient may share) out of hand.

5. B - Alert the brother to the importance of your patient’s current treatment, giving a clear and full explanation of the prescriptions in place.
   This option is the worst as it is not clear that you have any permission to discuss the treatment with this relative.

Question 53

You are an FY2 on the surgical ward. One of the healthcare assistants on the ward asks his advice. She has been suffering from night sweats for the last 2 months and has noticed painless lumps in her neck. These are symptoms which may suggest Hodgkin’s Lymphona.

Rank in order the following actions in response to this situation (1 = Most appropriate; 5 = Least appropriate)
A - Gently explain that she should not seek your advice as you are colleagues
B - Suggest she make an appointment to see her GP urgently
C - Take a full history, perform an examination and suggest a diagnosis based on this
D - Suggest she goes to A&E for an assessment after her shift today
E - Be careful not to make a diagnosis but reassure her that she has nothing to worry about

Answer 53

The preferred answers are: BDCAE

Question 54

It is the day before all FY1s and FY2s move onto their next placement. Your colleagues on the ward have all taken annual leave and you were the only junior present during the day today. Your working hours are 08.00-17.00. It has been a very busy day and it is now 19.30. You have stayed late to try and finish all your jobs. You are now beginning to feel very tired however you still have some jobs left to do.

Rank in order the following actions in response to this situation (1 = Most appropriate; 5 = Least appropriate)
A - Handover all urgent jobs to the on-call FY1 and write routine jobs on the team handover sheet
B - Stay and complete all your urgent jobs as best you can and then gather your things and leave
C - Gather your personal belongings and go home without doing any further work today
D - Complete the urgent jobs and write the outstanding routine jobs on the team handover sheet
E - Leave and email medical staffing in the morning about the situation today

Answer 54

The preferred answers are: ADBEC

1. A - Handover all urgent jobs to the on-call FY1 and write routine jobs on the team handover sheet
   As you are now feeling very tired it would not be appropriate to try and do any more jobs yourself. The most appropriate option would be to handover urgent jobs to the on-call FY1 and handover routine jobs to the new team.
2. D - Complete the urgent jobs and write the outstanding routine jobs on the team handover sheet
   This is the next most appropriate option as urgent jobs still get done and routine jobs are again handed over to the new team.
3. B - Stay and complete all your urgent jobs as best you can and then gather your things and leave
   This is less appropriate than option D as there is no handover of routine jobs.
4. E - Leave and email medical staffing in the morning about the situation today
   This is not a good option as there is no handover of any jobs. It is better than option C as you are informing medical staffing of the staffing issue on this particular day which may result in changes or better planning in future.
5. C - Gather your personal belongings and go home without doing any further work today
   This is the least appropriate option as jobs are not handed over or completed and you do not do anything to alert medical staffing of the problems you have had as you do with option E.

Question 55

You are an FY2 in Psychiatry. You are asked to see a mother on the postnatal ward. She admits to you in confidence that she took heroin during her pregnancy. She is concerned that her baby is very irritable and she thinks he may be having withdrawal symptoms. She does not want her partner to know about her heroin use. She agrees to let you tell the midwives and the paediatricians so they can look after the baby.

A - Encourage her to tell her partner about her drug use and update the team caring for the baby
B - Explain that you need her to inform her partner about her drug use before you can update the team caring for the baby
C - Inform her partner about her drug use in pregnancy when you next see him so he can support her recovery, update the team caring for the baby
D - Advise her partner to keep an extra close eye on the baby but don’t mention the drug use, update the team caring for the baby
E - Inform her you will tell her partner about the drug use if she does not and update the team caring for the baby

Answer 55

The preferred answers are: ADECB

Question 56

Communication: 15. You are admitting a patient who does not speak fluent English for an elective operation. He
does not have a translator or a relative present. You know from his notes that the patient
speaks Urdu. It is apparent that his pain has worsened since his clinic appointment. You
ask the patient how long he has been suffering from this pain. The patient appears to
understand what you are saying but cannot reply. He is clinically stable.
Rank in order the appropriateness of the following actions in response to this situation (1=
Most appropriate; 5= Least appropriate).
A. Ask a doctor who speaks Urdu to attempt to communicate with the patient
B. Continue trying to communicate with the patient to ask about his symptoms
C. Telephone the NHS language services to obtain a translator
D. Ask a senior doctor for advice on how to proceed
E. Telephone the patient’s next of kin to ask about the patient’s medical history and symptoms

Answer 56

Answer: ACDEB

Rationale: There are clear NHS guidelines about communicating with patients whose first
language is not English; you should always consult these (e.g. on your hospital’s intranet) as an
FY1.
If an Urdu-speaking doctor was available, asking for assistance would be most appropriate
as she/he would be communicating directly and fluently with the patient (A).

The second most
appropriate action is to telephone (or arrange in advance where known) to obtain a qualified
translator (C) although this can take longer than Option (A).
This patient’s clinical care is
potentially being compromised because of the communication difficulties, particularly if these
cannot be addressed, so consulting a senior doctor is appropriate (D).
There are potential
concerns about involving a patient’s next of kin including confidentiality and also gender or age
differences depending on the nature of the patient’s clinical problem (E).
Simply continuing without
taking any alternative action would not be good clinical care (B).

Question 57

Communication:
You are an orthopaedic FY2 and review a 35 year old Indian lady in clinic. She has broken her wrist and requires an operation. She does not speak good English and is accompanied by her 14 year old son who speaks fluent English and Hindi and offers to translate. You ascertain from her son that he is the only one in the family who speaks good English.

Choose the three most appropriate actions to take in this situation
A. Arrange to see the lady with a professional interpreter as soon as possible
B. Ask the lady if she will allow her son to interpret
C. Ask her son to translate as you go through a consent form
D. Apologise for not being able to do anything further today
E. Ask her son to sign the consent form to confirm he has interpreted correctly
F. Ask her son if he is willing to act as interpreter and ensure he understands the importance of the task
G. Ask her son to explain to her that she will need to come back to clinic when a professional interpreter has been arranged
H. Explain the procedure in as simple English as you can and ask the patient to sign to consent form

Answer 57

ADG

In this situation the best option would be to explain to the lady that she will need to come back to clinic with a professional interpreter and apologise for the delay (options D and G) and arrange to see the patient with a professional interpreter as soon as possible (Option A). Although the patient and her son may be willing to have her son translate and he may well be competent enough to do so it is less appropriate than arranging for a professional interpreter. There is nothing in the scenario that suggests that the patient has an urgent need for the operation in question making B, C, E and F not ideal. As the patient doesn’t speak good English is would be unwise to assume that even a simple explanation would gain valid consent (option H). Another option not in the list would be to see if any of your orthopaedic colleagues speak fluent Hindi and would be able to translate.

Question 58

You are working in A&E and a 16 year old girl comes to see you with her mother. She states that she has abdominal pain but you sense she feels awkward answering your questions in front of her mother. There is a female nurse with you.

Choose the three most appropriate actions to take in this situation
A. Ask the mother if she might wait in the waiting room
B. Explain to them both that you need to ask some in depth questions
C. Request a urine sample
D. Do a pregnancy test before saying anything further
E. Explain that you’ll be testing for various things without mentioning pregnancy
F. Explain that pregnancy will be among the tests
G. Take a history avoiding sexual history questions
H. Ask the patient if she’d prefer to be seen alone

Answer 58

The preferred answers are: HCF

H. Ask the patient if she’d prefer to be seen alone
C. Request a urine sample
F. Explain that pregnancy will be among the tests

Option H gives the patient the choice and control rather than the mother (Option A). Option C and F go together - a pregnancy test needs to be done and it is better to be honest about your intentions.
Option B may not elicit good answers if the patient is not forthcoming because her mother is present and option E is deliberately misleading as pregnancy will need to be tested for. Option G will elicit an incomplete and possibly useless history. Option D is unsuitable as you need consent for investigations as well as procedures.

Question 59

Michael is an F2 in General Practice. His next patient is a 16 year old girl who he has not met before. She comes in on her own and starts to describe some vague symptoms. Suddenly, she bursts into tears. What should Michael do?

Choose the three most appropriate actions to take in this situation
A. Leave the room to give the patient some space
B. Ask why she is crying
C. Offer the patient a tissue
D. Allow the patient to cry if she needs to
E. Give the patient a gentle hug
F. Ask the patient to elaborate on why she came today
G. Call reception and ask if a female chaperone can come in
H. Ignore the crying to avoid embarrassing the patient

Answer 59

The preferred answers are: BFD

Question 60

You are working on your fourth long shift in A&E this week. It is 9pm and you were supposed to finish at 7pm. You have worked at least 2 extra hours every day over the last four days due staff shortages. You are feeling very tired and flustered and the unit is still very busy and remains short staffed. You are already late for your mother’s 50th birthday party and you know she’ll be very upset if you don’t make it. You would like to finish dealing with the patients you have seen today and you are not on the rota for tomorrow.

Choose the three most appropriate actions to take in this situation
A. Ask if you can leave now but come in tomorrow
B. Call your mum and say you are on the way
C. Drink coffee to keep you alert until you finish your tasks
D. Go straight home and go to sleep
E. Leave now due to your tiredness
F. Speak with your supervisor about the staffing issue
G. Stay until your current patients have been dealt with
H. Text your mum to apologise that you won’t make her party

Answer 60

The preferred answers are: BEF

B - Call your mum to say you are on the way
E - Leave now due to your tiredness
F - Speak with your supervisor about the staffing issue