SJT Mock 1 Flashcards
Pharmacist says the drug your consultant asks for is contraindicated. Is it better to ask your reg to review the situation or say that the consultant requested the antibiotic and it would be best to speak to him
say that the consultant requested the antibiotic and it would be best to speak to him
Patient is scared of upcoming discharge, who do you send to speak to them?
Occupational Therapist > Reg
What matters more: patient safety, your own health?
As a doctor, the care of the patient is your main concern
Most important consideration: right to finish on time at the end of shift, disappointing friends by being late, poor consultant reference
right to finish on time at the end of shift > poor consultant reference> disappointing friends by being late
You are on the way to theatre. A nurse asks you to review a patients medication which was done erroneously. A lonely patient beckons you to come talk to him.
A.Review the patient’s dose, as requested by the nurse
B.Respond to the patient’s immediate question or query
C.Attend the theatre to observe the procedure
D.Take steps to investigate the nurse’s allegations about prescription errors further
E.Spend more time with the patient if he wants someone to talk to
Answer: ABCDE
Rationale: Preventing a potential medication error and ensuing patient harm should be the absolute first priority (A). The patient beckoning you may have a very valid and important question and therefore this should be acknowledged as a priority (B). Attending theatre is a good learning opportunity which will help you deliver better patient care (C). Ensuring that the nurse’s concerns about errors are addressed is very important, but not immediate (D). Spending time with a patient is desirable but can be done by others if necessary –you will need to draw it tothe attention ofanother member of staff(E).
Who to contact if you cannot find the folder containing the pre-operative protocols? (3)
1) Reg
2) On-call microbiologist
3) BNF
The worst place to get information on pre-operative protocols?
National Guidelines
National guidelines would be the last place to get information in this situation (C). Local guidelines are based on the national ones but they will include information specific to local circumstances.
What is worse for finding out pre-operative protocols: asking a nurse or using national guidelines
using national guidelines
What to do about someone who always has sleeves down?
Monitor situation
Tell Infection control
Tell nurse in charge of ward
Tell Reg
Nurse > Reg > Monitor > Tell infection control
Key thing to do if a patient who is meant to be discharged raises concerns over leaving (or their family does)?
Seek the opinion of a senior colleague informing the patient there will be a delay as the team decides what to do
Allie, tells you that her mother has been complaining about her chest and is struggling with a cough. You review the observation chart and listen to Joan’s chest, which doesnot indicate a problem. Allie insists that her mother has a chest infection and should not be discharged.
A.Ask the ward nurse to inform the rehabilitation hospital that Joan’s condition needs assessing on arrival
B.Inform Allie that she should insist on a further review of Joan’s condition when she arrives at the rehabilitation hospital
C.Advise Allie that you will delay the transfer in order to consult with a senior member of your team
D.Advise Allie of the urgent need to discharge her mother to create space on the ward
E.Contact the rehabilitation hospital and write detailed notes outlining Joan’s symptoms and possible investigations to send with her
C.Advise Allie that you will delay the transfer in order to consult with a senior member of your team
E.Contact the rehabilitation hospital and write detailed notes outlining Joan’s symptoms and possible investigations to send with her
A.Ask the ward nurse to inform the rehabilitation hospital that Joan’s condition needs assessing on arrival
B.Inform Allie that she should insist on a further review of Joan’s condition when she arrives at the rehabilitation hospital
D.Advise Allie of the urgent need to discharge her mother to create space on the ward
First step if you feel that your contributions, decisions and confidence are being undermined by other team members? (3)
1) Discuss your concerns with all team members
2) Seek advice from senior colleague
3) Document what happens
Why is documenting a less appropriate option in many scenarios?
Not proactive
Not had many learning opportunities:
A.Take on a position of responsibility as part of the junior doctors’ committee
B.Ask the Foundation Programme Director if you can move to work at another unit
C.Ask your consultant if you can support outpatient clinics and theatre sessions
D.Offer to assist your FY1 colleagues on other busier wards
E.Inform the Foundation Programme Director that the job should be reviewed to include more learning elements
CDEBA
Taking on additional positions of responsibility, whilst admirable, is something that you should do because you want to, and can fit in around your professional life both in this, and other teams to which you will move (A)
Patient arrives without correct paperwork at the end of your shift, do you:
Ask a Nurse to chase up paperwork
Handover
Inform Reg there is no paperwork
Ring where patient came from
Ring > Handover > Nurse > Reg
A more senior doctor will be in a position to ‘chase up’ the admitting unit to complete the relevant paperwork and drug chart, but they will also have to other duties that require attention from someone at their level (E).
Lack of information handed over, what is not an early action to take?
Informing a senior, they are busy enough. Chase this up yourself
Someone refuses a handover. Is it better to:
Tell them you will leave detailed notes in their folder so they can follow it up later
Ask a nurse to find another doctor who will accept the handover (taking blood)
Tell them you will leave detailed notes in their folder so they can follow it up later
–> informing a nurse is less reliable as you have not handed over the task to a specific doctor, and the nurse does not know which doctor to contact
Patient doesn’t speak ANY english. Do you continue trying to communicate as best possible or telephone next of kin to ask about symptoms
Telephone next of kin to ask about symptoms
Simply continuing without taking any alternative action would not be good clinical care (B).
Best thing to do if a patient only speaks a certain language?
Find a doctor who speaks the language > book a translator
Better to offer patient a self discharge form or discharge them yourself as an F1
Self discharge
FY1 doctors should never discharge patients without close supervision so Option (A)is inappropriate.
Keep patient in hospital or discharge them with verbal approval of a senior over the phone
Discharge them with verbal approval of a senior over the phone
What do you tell the husband when he asks about his wife who just found out she is pregnant?
A.Tell Mr Mathews that he will need to speak to Mrs Mathews directly about her condition
B.Tell Mr Mathews that you would like to obtain Mrs Mathews’ permission to speak to him first
C.Tell Mr Mathews that you would like to discuss Mrs Mathews’ case with a senior colleague before speaking with him
D.Tell Mr Mathews that you are currently investigating Mrs Mathews’ abdominal pain
BDAC
Sharing only the information that the family member is aware of (abdominal pain) would buy you some time and you will not have divulged any confidential information with her husband hence (D)is the next option. The patient’s husband is likely to be under stress and asking him to speak directly to his wife to get information is likely to add further stress which makes option (A)less preferable. Similarly saying that you need to discuss the case with your senior (C)is evasive and doesn’t establish patient consent to discuss the results.
You suspect a dose is doubled, do you change it or assume its right?
Change it
Could be dangerous to do nothing
Should you explain the clinical need for other scans to be conducted before your patients scan
Yes, after apologising first
May help them to understand why there is a delay
Your colleague leaves your ward for theatre and directs her bleeps to you. Is it better to:
Write a list of the jobs that have arisen in their absence so that they can complete them when they return to the ward
Report them to their line manager
Write a list of the jobs that have arisen in their absence so that they can complete them when they return to the ward
–> Jobs will be ordered on clinical need and completed as such
Your colleague sees someone with epilepsy driving, what do you do?
A.Advise your FY1 colleague to speak to Haman about what she observed
B.Advise your FY1 colleague to seek advice from a senior colleague
C.Ask Haman if he has been driving after he has had a seizure
A
B
C
As your colleague saw Haman driving it is the colleague’s duty to act. They have directly witnessed the driving and therefore are in a better position to describe what they saw
Consultant requests scan that reg says is not needed, is it better to
Request Scan
Discuss with consultant radiologist
Request Scan
The consultant retains overall responsibility for the patient and so if it is not possible to discuss the reasons for different viewpoints, it is appropriate to follow the consultant’s advice (A).
Discussing the case with the radiologist is likely to be beneficial for patient management and your learning but it would be better to understand the reasons for the difference in opinion by discussing with your own team rather than involving another consultant (B)
Should you advise the patient to withdraw his consent until he has further details of the operation if he is unsure of the procedure?
Nah
It would be inappropriate for you to give this advice to the patient (B)without making an attempt to resolve the issues.
Rank these options if you are concerned a patient may be allergic to what has been prescribed?
A.Speak with the on-call pharmacist about whether you should prescribe the drug
B.Explain to the locum doctor that you are concerned about prescribing the drug
C.Ask another senior doctor whether it is appropriate to prescribe the drug to
D.Prescribe the drug as requested by the locum doctor
E.Speak about your concerns with the nurse who would administer the drug
BAECD
The nurse also has a responsibility, as they will be giving the drug to Mr Singh and needs to know about your concerns(E).You may find that experienced nurses will bring concerns regarding prescribing to your attention. Talking to another senior doctor about this would also be a reasonable course of action but not as good as speaking to the doctor concerned and introduces another opinion (C).
Who to contact if you think a patient will have an allergic reaction to a drug prescribed as he is allergic to a similar drug
The doctor who prescribed it 1st
Then the on-call pharmacist
You see photos of a colleague at a party on social media what is a better thing to do:
Ask your F1 colleague for advice
Suggest they delete the photos
Ask your F1 colleague for advice
Mrs Singh is dying and her family have requested a single room to provide her with some privacy. A nurse has advised Mr Green that he is to be moved out of the single room but he has refused as he says he feels uncomfortable being in award with other patients.
A.Mrs Singh and her family have a right to privacy
B.That another single room is unlikely to become available in the near future
C.That Mr Green’s daughter is a medico-legal solicitor
D.That Mr Green had the room first
E.Mr Green’s reasons for wanting to stay in the single room
ABEDC
Mrs Singh has a greater medical and social need and recognising her right to privacy is the most important consideration(A). If resources permit then avoiding conflict and minimising movement of patients takes precedence, but there is no time to wait for this possibility (B).
Cannot contact F1 taking over shift and you’ve forgotten to do a proper handover:
Contact an FY1 colleague working on another ward to ask her to look up the investigation results for you
Telephone the ward nursing staff and ask them to get the FY1 taking over your shift to look up the investigation results
Contact the on-call specialty trainee* and explain the situation
Contact the on-call specialty trainee* and explain the situation
Nurse > different FY1
Contacting the ward nursing staff to pass on the message to the FY1 achieves the same result but is less reliable, since you have not handed the task over to a specific doctor for a medical task, and you will have less certainty that it will be acted upon (A). Option A is however preferable to Option D, because you are passing the problem on to a colleague who has no on-going responsibility for this patient (D).
Can a post mortem be described as standard practice?
No, very inappropriate
Should you tell someone to calm down before you can speak to them?
No
May inflame the situation further (inappropriate)
Nurse’s relative is in your care and asks about her. What is the best course of action?
Explore her anxieties
Remind her about patient confidentiality
Remind her it is confidential
Pharmacist has noticed there is double dose:
Change dose to half
Explain to pharmacist you want to keep it the same as the consultant requested
Ask the patient if he knows why he is on a higher dose of the drug than normal
Ask the patient if he knows why he is on a higher dose of the drug than normal
Change dose to half
Explain to pharmacist you want to keep it the same as the consultant requested
Which is better:
A.Make a list of the patients under your care on the AAU, detailing their outstanding issues, leaving this in the doctors’ office when your shift ends and then leave at the end of your shift
B.Quickly go around each of the patients on the AAU, leaving an entry in the notes highlighting the major outstanding issues relating to each patient at the end of their bed and then leave at the end of your shift
End of the bed
Leaving a list in the general doctors’ office is least effective as your colleague is unlikely to know it is there
Tried to speak to a nurse who undermines you without success in the past and she continues her behaviour what do you do:
Speak to her in private
Inform your consultant
Inform the nurse in charge
Ask other F1s for similar experiences
Continue ignoring her
Jill is behaving unprofessionally here, and could potentially become subject to disciplinary measures via her professional body, the Nursing and Midwifery Council.
You should inform your consultant (D), or Foundation Programme Director, who would then make enquiries, leading to action if deemed appropriate.
It is worthwhile to ask other FY1s if they have had similar problems (E), as it would remind them that they, too, should not be expected to suffer such behaviour. You should advise them to discuss it with their consultant, or with the Foundation Programme Director.
Informing the nurse in charge (B) is best left to your consultant. Option (C)carries a significant risk that Jill may become antagonistic and verbally hostile; she may potentially make unfounded allegations against you, particularly if you were speaking to her with no witness present. You have already tried unsuccessfully to have an informal conversation. Continuing to ignore Jill’s comments (A)is inappropriate
