SJT

Question 1

If patient is undergoing tests and is found to be pregnant and husband is in waiting room - what is the most important consideration you have?

Answer 1

consent

Question 2

who does the GMC recommend resolving conflicts with in the first instance?

Answer 2

the person in question

Question 3

if unsure whether patient is abusing pain meds like codeine, what is best mx plan?

Answer 3

limited 7 day supply then review if can’t be certain of abuse

Question 4

how to address colleague who isn’t pulling their weight?

Answer 4

address this with them in the first instance
then raise with clinical supervisor
then look at why it is an issue - are you too busy with your rota

Question 5

you notice a drug error (eg pt has too much warfarin tablets): what 3 things to do?

Answer 5

make sure correct dose given
raise with nurse dispensing
apologise for mistake

Question 6

why never prescribe or give a tablet to give a partner/family member you don’t know/never met?

Answer 6

allergies to meds

Question 7

accepting gifts: GMC states:

Answer 7

do not ask for or accept 
from pts, colleagues, or others 
any inducement/gift/hospitality 
that may be seen to affect the way you 
prescribe for/treat/refer/organsie care for pts

Question 8

gift limit usually:

Answer 8

£10

Question 9

GMC recommend the following when things go wrong:

Answer 9

offering an apology to the patient, putting the situation right (in this case, repeating the sample) and explaining what has happened and the short and long-term implications of the mistake.

Question 10

duty of candour (4):

Answer 10

Tell the patient when something has gone wrong
Apologise to the patient (or carer or family member where appropriate)
Offer an appropriate resolution
Explain the potential short and long-term effects of the error

Question 11

is saying sorry legal admission of liability?

Answer 11

no

Question 12

never prescribed a rare drug before: who to seek advice from? (no guideline on intranet)

Answer 12

senior medical colleague
pharmacy
BNF

Question 13

can f1s request scans and imaging out of hours?

Answer 13

not without consultant signing off, no

Question 14

maintaining trust (domain) - key points:

Answer 14

Show respect for patients
Treat patients and colleagues fairly and without discrimination
Act with honesty and integrity

Question 15

drug error: key thing to do:

Answer 15

cross it out and prescribe appropriate alternative

Question 16

yellow card forms (drugs): what are they used for?

Answer 16

to report suspected adverse drug reactions to the BNF (particularly regarding drugs new to the market). These are not used for reporting prescribing errors

Question 17

how do you cooperate with complaints procedures?

Answer 17

respond fully, promptly, and honestly to complaints.

Question 18

if late, and bottom two choices are do nothing and hope no one notices vs ask f1 colleagues to lie and say you are busy, what is worse?

Answer 18

do not ask colleagues to lie as unproffesional in 2 aspects, not just one

Question 19

GMC guidance: doctor’s health:

Answer 19

you should not rely on your own judgement of the risk posed by your health to your patients
consult your GP / occ health

Question 20

breaking bad news to family - what to do with bleep?

Answer 20

give to reg on call
keep but only respond to emergencies/arrests
keep and respond to all calls
give to staff nurse
leave at nurses station

Question 21

conidentiality: situation when you can breach it eg husband has HIV no plans to tell partner

Answer 21

remember you have to break confidentiality, so all options that have this should be prioritised

Question 22

You are a foundation year one doctor on a Care of the Elderly ward. You have noticed that Gladys, an 80-year-old lady who is recovering from a hip fracture, has not been eating her meals. She has severe dementia and has not been able to understand and retain other information during her admission.

Answer 22

senior nurses first
consultant review
dietician review (after consultant review)
then suggest to her to eat more
do nothing

Question 23

with safeguarding issues - what is key things to do:

Answer 23

contact child protection officer/safeguarding lead first
as best to not be only person who knows what’s going on
good practice to inform the parent what you are going to do
better to tell senior than tell nobody

Question 24

with procedures eg LP you havent done before ->

Answer 24

PATIENT SAFETY first
willingness to learn
honesty, candour - admit to consultant and pt before you haven’t done one
get someone who has done one to do it before you

Question 25

havent eaten in ages - light headed - what is worst scenario -

Answer 25

keeping on working - pt safety!!!!

Question 26

can discahrge safely?

Answer 26

not without some sort of experienced senior review

Question 27

?NAI in child - first thing to do -

Answer 27

admit child for proper assessment and potential skeletal survey

Question 28

if you can deal with situation, what shouldn’t you do?

Answer 28

delegate

Question 29

if pt is doing something harmless to others but illegal eg importing alcohol - what is question testing?

Answer 29

boundaries of dr - not your place to comment/act on illegalities

Question 30

who can you contact if in ED and suspected nai?

Answer 30

senior dr or nurse in department
admit to paeds
get paeds on call team involved

Question 31

colleague doesn’t have code for abg machine and abg needs doing urgently - what don’t you do?

Answer 31

give them your code - do not put yourself at risk

Question 32

You are a foundation year 2 (FY2) doctor currently on a placement in general practice. A patient, Ian, 36, brings his child, Charlie, 4, to see you with a burn on his hand, due to him touching a hot radiator. On examination the burn appears mild, however on general inspection you notice Charlie looks very thin, malnourished and has dirty clothing on. On further questioning, Ian reveals he was asleep following binging on alcohol at home. Ian and Charlie live together alone, as Charlie’s mother died last year. Ian reveals that since her death he has struggled at home and has started consuming considerably more alcohol, but he is planning on reducing his consumption. ??

Answer 32

contact snr GP
contact social services
find out how much alcohol he takes
call police
give leaflets on AA

Question 33

You are a F2 working in the Respiratory Unit. You insert a cannula in a patient for IV antibiotics and you flush it with 10mls of 0.9% saline given to you by a nurse. Whilst you are disposing of the equipment, you realise that the saline is out of date and expired in July 2015. What do you immediately do? (3)

Answer 33

check for adverse fx
apologise
clinical incident form

Question 34

who transfuses the actual blood?

Answer 34

nurses

Question 35

You are an F1 on call for medicine. A nurse asks you take a sample for a cross match from a patient who needs a transfusion and is difficult to bleed. The patient has a haematological malignancy and has become anaemic but is stable and well.

You take the blood and send it to the laboratory. You then realise that you labelled the sample with the wrong patient’s details.

Answer 35

B. Phone the laboratory to inform them of the mistake
D. Inform the nurses on the ward of the mistake
C. Document the mistake in both patient’s notes
E. Send another cross match
A. Do nothing as the patient has a previous correct cross match on the system

Question 36

which act MHA or MCA can patients be forced to take medicine for physical illness?

Answer 36

MCA

Question 37

consultant is rude to you - consistently making life harder, don’t want to come in - who do you go to?
cons also your clinical supervisor

Answer 37

1st - reg - can reconcile without escalating hopefully
2nd - ed supervisor
3rd - FP school - report
4th - nothing
5th - gossip

Question 38

GMC: effective communication 4 principles

Answer 38

Listen to patients and answer any questions honestly
Ensure that information is delivered in a manner that can be understood. Identify and apply practical measures to overcome any communication and language barriers
Provide support and information to patients’ relatives or carers in a considerate manner
Doctors on duty need to be easily reachable by their patients and colleagues for any advice or support

Question 39

GMC partnership with patients 4 principles:

Answer 39

Empower patients with the information required for patients to make decisions with regards to their care. This includes information on the clinical conditions, treatment options and the relevant risks and uncertainties
Ensure that patients are aware of the progress of their care
The roles and responsibilities of each member of the team need to be made clear to the patients
Patient confidentiality needs to be maintained, even after the patient is deceased

Question 40

off licence prescribing:

Answer 40

refuse
discuss current NICE EVIDENCE
review current tx

Question 41

when complaint made against you - who are most important people to contact?

Answer 41

consultant and defence union