222 CHAPTER 14 Practice test
20. A patient is readmitted to the A&E for the fifth time in three
months with recurrent leg pains. The patient has been reviewed
extensively by numerous medical doctors, emergency doctors, and the
patient’s GP, but the patient remains anxious about these intermittent
attacks. You complete a full work-up and establish no new findings, and
in the context of his previous admissions accept that there is nothing
more you are able to offer. Your registrar is insistent that you review
your patients more expeditiously.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Explore the patient’s psychological and social well-being despite pro-
longing your assessment of the patient.
B Explore whether the patient wishes to consider alternative/comple-
mentary therapies.
C Refer the patient to another colleague in the A&E.
D Explain to the patient that you have only a limited time to spend with
each patient and that you cannot offer him anything else.
E Refer the patient to a pain specialist.
21. Steven is a 40-year-old paranoid schizophrenic who has
returned to your ward with a severe chest infection. You
attempt to recommence intravenous antibiotics as decided by the
medical team, but the patient refuses. Steven’s mother is distressed at
the delay in treatment, stating that ‘this happens every time’ and gives
you permission as his mother to begin treatment.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Defer the decision to a senior colleague.
B Administer the intravenous antibiotics irrespective of Steven’s wishes.
C Ask the mother to help establish whether Steven has capacity to
decide for himself.
D Attempt to establish whether Steven lacks capacity by reading through
the medical notes.
E Assess Steven’s capacity for refusing this treatment.
QUESTIONS 223
22. Your consultant asks you to make a patient referral to the
drugs and alcohol liaison service in order to arrange metha-
done replacement for an intravenous drugs user, during the afternoon
ward round. The patient already appears to be suffering with withdrawal
symptoms. The registrar later informs you that you might spend an hour
trying to locate the correct office and arranging the referral, and you
should instead defer the referral until tomorrow as there are plenty of
more important patients and problems to deal with.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Ask the shadowing student doctor to attempt to locate the office
and make the referral, even though referrals are exclusively made by
doctors.
B Complete the jobs that your registrar has asked you to do, before
attempting to refer the patient to the drug and alcohol service at the
end of the day.
C Follow the registrar’s instructions and make the referral first thing in
the morning.
D Explain the importance of treating withdrawal and suggest that your
tasks be reprioritized.
E Issue a formal complaint to your consultant that the registrar is
neglecting this patient.
23. A patient appears more confused than you previously recall
during your ward round, and you feel this is not in keeping with
his previously diagnosed condition.
Choose the THREE most appropriate actions to take in this situation
A Quickly examine the patient, with a view to performing a more
detailed review tomorrow.
B Explain to the patient that you will return to review him in more detail
after the ward round.
C Consider requesting appropriate investigations.
D Document in the notes that the patient appears more confused, and
continue with the ward round.
E Establish his Abbreviated Mental Test Score (AMTS).
F Suggest that the patient be transferred to the psychiatric ward for
further assessment of his mental function.
G Perform a full history and examination at a risk of delaying the entire
ward round.
H Move on quickly so that you can continue the ward round.
224 CHAPTER 14 Practice test
24. A patient attending your GP informs you that he has recently
been diagnosed with alcohol-related seizures, and has been
asked by the hospital doctors to discuss the matter with you in terms of
his work. He is a self-employed taxi driver and is the sole provider for
his wife and family of three children, and refuses to inform the DVLA.
Choose the THREE most appropriate actions to take in this situation
A Document the advice you have given to the patient.
B Explain the reasonable possibility of another seizure.
C Call the taxi licence issuer to have his taxi licence revoked.
D Agree that he is probably not a danger but that he should inform the
DVLA nonetheless.
E Call the DVLA anonymously but keep this from the patient to main-
tain his trust.
F Tell the patient that you must inform the taxi licence issuer and call
them even if he refuses consent.
G Inform the patient that you will need to inform the DVLA if he refuses.
H Ask the patient’s wife to bring in his driving licence to the practice so
it can be destroyed.
25. A physiotherapist informs you that she has seen a nurse take
money from the wallet of a demented patient.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Ask the physiotherapist to establish some more details first by speak-
ing to the patient before making her claim.
B Establish exactly what the physiotherapist saw before informing the
Ward Sister.
C Report the incident to your Clinical Supervisor.
D Confront the nurse and ask her to empty her pockets.
E Make a non-urgent phone call to your local police station.
QUESTIONS 225
26. Morning handover from night SHOs to junior doctors working
during the day appears to be increasingly rushed, and you have
noted on several occasions blood tests and investigations not effectively
handed over. You feel this may be related to the speed with which the
handover takes place, although the registrars and consultants appear to
be happy with the pace of the morning handover.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Highlight your concerns if you identify another urgent task that is
not handed over, but otherwise do not mention it for fear of causing
difficulties.
B Speak with your Clinical Supervisor to explain that handover is
inadequate.
C Register formal complaints for those colleagues whom you feel might
be responsible for information not being handed over in the past.
D Ensure that your own handover is effective.
E Organize a meeting with the other junior doctors to explain your con-
cerns regarding the efficacy of your handover.
27. Your SHO colleague is going through a separation with his wife
and is scheduled to attend numerous civil court hearings over
the coming weeks. His performance does not seem to be affected but
you think that he does seem more despondent than usual.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Email your consultant immediately, as you are obliged to ensure
patient safety.
B Explore how your colleague is feeling and what kind of support they
feel they need.
C Advise your colleague to see a counsellor.
D Continue to observe your colleague’s performance at work, but do
not mention this matter to anyone else for the moment.
E Advise your colleague to speak to their Educational Supervisor.
