MSRA Professional Dilemmas Mock EMQ

Dr. Anya Sharma, an FY1 doctor on a busy medical ward, is reviewing Ms. Evelyn Hayes, a 68-year-old patient admitted with community-acquired pneumonia. During your evening rounds, you notice Ms. Hayes has become acutely short of breath, is coughing profusely, and her oxygen saturation has dropped significantly despite receiving supplemental oxygen. Her early warning score (EWS) is escalating rapidly, and you suspect she is developing acute respiratory distress syndrome. You attempt to contact the medical registrar, Dr. Ben Carter, but he informs you he is currently managing a cardiac arrest on another ward and will be delayed by at least 20-30 minutes.

Question: Rank the following actions in order of appropriateness, from 1 (Most appropriate) to 5 (Least appropriate).

Dr. Samuel Davies, a core surgical trainee (CT1), is off-duty. While Browse a popular social media platform, he comes across a post from a former patient, Ms. Clara Jones, whom he treated for an appendectomy two months ago. The post, visible to the public, contains explicit details about her recent recovery, including complications she experienced, and names Dr. Davies and the hospital department in a negative light. She has also posted a photograph of her discharge summary, clearly showing her personal identifiable information and hospital numbers. Dr. Davies feels embarrassed and concerned about the accuracy of some of her claims.

Question: Rank the following actions in order of appropriateness, from 1 (Most appropriate) to 5 (Least appropriate).

Dr. Olivia Rodriguez, a surgical FY2, is supervising Dr. Daniel Kim, an FY1, in the insertion of a peripheral intravenous cannula in a patient awaiting surgery. Despite multiple attempts, Dr. Kim is struggling to successfully insert the cannula, causing the patient increasing discomfort and distress. Dr. Rodriguez observes that Dr. Kim’s technique is hesitant, and he appears visibly flustered, muttering “”I can’t do this”” after each failed attempt. The patient is starting to express anxiety about the procedure.

Question: Rank the following actions in order of appropriateness, from 1 (Most appropriate) to 5 (Least appropriate).

Dr. Emily Chen, an FY1 doctor, is asked to obtain consent for a non-urgent elective tonsillectomy from Mr. Henry Wilson, a 22-year-old patient. Dr. Chen explains the procedure, risks, and benefits. Mr. Wilson initially seems to understand and signs the consent form. However, a few hours later, his mother approaches Dr. Chen, expressing strong reservations. She states, “”He’s always been a bit naive, and he was quite anxious earlier. I’m worried he didn’t truly understand what he was signing. Also, I don’t think he really needs this operation.”” The surgery is scheduled for the following morning.

Question: Rank the following actions in order of appropriateness, from 1 (Most appropriate) to 5 (Least appropriate.

Dr. Chloe Roberts, an FY2 doctor, is covering a ward during a busy on-call shift. She notices that a significant portion of the ward work (e.g., chasing scans, ordering specific blood tests, coordinating discharge plans) for the patients under one of her consultant’s care consistently falls to her, even when other FY2s on the team are less busy. This consultant’s patients also seem to have more complex and demanding tasks. Dr. Roberts feels overwhelmed and believes the workload is unfairly distributed amongst the junior doctors, leading to stress and potentially impacting patient care.

Question: Rank the following actions in order of appropriateness, from 1 (Most appropriate) to 5 (Least appropriate).

Dr. Chloe Green, an FY1 doctor, is on the ward when she receives a phone call from Mr. George Davies, the son of her patient, Mrs. Eleanor Davies (85 years old), who is currently recovering from a stroke. Mr. Davies states that he is very concerned about his mother’s recent memory problems and insists that she should not be allowed to make any decisions about her care. He demands that Dr. Green only speak with him about his mother’s treatment plan and not directly with Mrs. Davies, claiming she lacks capacity. Mrs. Davies herself, though occasionally forgetful, has been able to express clear preferences regarding her diet and daily routine.

Question: Rank the following actions in order of appropriateness, from 1 (Most appropriate) to 5 (Least appropriate).

Dr. Daniel Wong, an FY2 doctor, is reviewing a patient, Mr. John White, who has been admitted with severe abdominal pain. Mr. White is known to have a history of chronic pain, and nurses on the ward have commented that he frequently requests increasing doses of opioid analgesia. During your assessment, Mr. White expresses extreme pain and asks for a higher dose of opioid medication, stating the current dose is ineffective. You feel uncomfortable prescribing an additional higher dose without further investigation, but Mr. White is becoming visibly agitated.

Question: Rank the following actions in order of appropriateness, from 1 (Most appropriate) to 5 (Least appropriate).

Dr. Isabella Chen, a Foundation Year 1 doctor, is on call for the surgical wards. She receives a call from the nursing staff reporting that a patient, Mr. Robert Evans, who underwent an elective hernia repair this morning, is refusing to take his prescribed oral analgesia due to severe nausea and vomiting. The nurses are concerned about his increasing pain and discomfort, and they have tried non-pharmacological measures without success. Mr. Evans is becoming distressed.

Question: Rank the following actions in order of appropriateness, from 1 (Most appropriate) to 5 (Least appropriate).

Dr. Michael Lee, an FY2 doctor, is asked by his consultant, Professor Anya Sharma, to write a discharge summary for Ms. Sarah Chen, a patient who was admitted for an acute exacerbation of COPD. Professor Sharma states, “”Just pull up her previous summary, update the dates, and sign it off; I’m too busy to review it.”” Dr. Lee has not been directly involved in Ms. Chen’s care during this admission and has limited knowledge of her current clinical status or all the details of her hospitalization. He feels uncomfortable signing off a document for a patient he hasn’t directly overseen.

Question: Rank the following actions in order of appropriateness, from 1 (Most appropriate) to 5 (Least appropriate).

Dr. Sophia Khan, a GP trainee, is conducting a home visit for Mrs. Evelyn Hayes, an elderly patient with multiple comorbidities who lives alone. During the visit, Mrs. Hayes confides in Dr. Khan that she has decided to stop taking several of her prescribed medications because they make her feel tired and she “”prefers to enjoy the time she has left.”” She explicitly states, “”Please don’t tell my children; they’ll only worry and try to force me to take them.”” Mrs. Hayes appears to understand the implications of her decision, though Dr. Khan is concerned about the potential negative health consequences.

Question: Rank the following actions in order of appropriateness, from 1 (Most appropriate) to 5 (Least appropriate).       

Dr. Ben Carter, a medical FY1, is working on a general medical ward. During a busy afternoon, he observes a ward sister, Ms. Fiona Clark, shouting aggressively at a newly qualified healthcare assistant (HCA) for what appears to be a minor procedural error. The HCA looks visibly distressed and is close to tears. Ms. Clark’s tone and manner are highly unprofessional and are overheard by other staff and a patient’s visitor nearby. This is not the first time Dr. Carter has witnessed Ms. Clark speaking harshly to junior staff.

Question: Rank the following actions in order of appropriateness, from 1 (Most appropriate) to 5 (Least appropriate).       

Dr. Sophie Miller, a medical registrar, is supervising an FY1 doctor, Dr. Liam O’Connell, who is preparing to insert a central venous catheter (CVC) in a critically ill patient. Dr. Miller notices that Dr. O’Connell is skipping some steps in the strict sterile protocol, such as not fully covering his hair, and appears to be rushing. When Dr. Miller gently reminds him about the protocol, Dr. O’Connell sighs loudly and mutters, “”I’ve done loads of these, it’ll be fine. We don’t have all day.””

Question: Rank the following actions in order of appropriateness, from 1 (Most appropriate) to 5 (Least appropriate).

Dr. Laura Davies, a newly appointed consultant in Geriatric Medicine, is attending a multidisciplinary team (MDT) meeting. During the discussion about a complex patient, Mr. Arthur Green, the lead physiotherapist, Mr. Tom Evans, expresses strong disagreement with the proposed discharge plan, stating he believes Mr. Green is not safe to return home due to his mobility issues and a lack of adequate home support. Dr. Davies feels Mr. Evans is being overly cautious and that the discharge plan is reasonable. The meeting is becoming tense.

Question: Rank the following actions in order of appropriateness, from 1 (Most appropriate) to 5 (Least appropriate).

Dr. Chloe Roberts, an FY2 doctor, is asked by her supervising consultant, Dr. David Miller, to perform a routine ward procedure, a lumbar puncture, on a patient. Dr. Roberts has limited experience with lumbar punctures, having only observed one during her training. She feels anxious and uncertain about her ability to perform the procedure safely and effectively without direct supervision, but Dr. Miller is busy in clinic and expects her to proceed independently.

Question: Rank the following actions in order of appropriateness, from 1 (Most appropriate) to 5 (Least appropriate).

Dr. Emily Davis, an FY1 doctor, is working in a busy emergency department. She is asked to review a patient, Mr. Steven Patel, who presented with symptoms suggestive of a urinary tract infection (UTI). Dr. Davis performs an initial assessment and orders a urine sample for analysis. Later, she receives the lab results which show significant pyuria and nitrites, confirming a UTI. However, Mr. Patel’s allergy history states “”Penicillin: Anaphylaxis,”” and the standard first-line antibiotic prescribed on the departmental protocol for UTIs is amoxicillin (a penicillin derivative). Dr. Davis feels unsure about the appropriate alternative antibiotic to prescribe.

Question: Rank the following actions in order of appropriateness, from 1 (Most appropriate) to 5 (Least appropriate).

Dr. Chloe Roberts, an FY1 doctor, is on duty during a busy Saturday evening shift in the Emergency Department. A patient, Mr. Liam White, presents with a painful, swollen ankle following a fall. After examining him and reviewing an X-ray, Dr. Roberts confirms a simple ankle sprain with no fracture. She advises conservative management, including rest, ice, compression, and elevation (RICE), and offers pain relief. Mr. White, however, insists on being referred for an MRI scan immediately, stating he has private medical insurance and “”wants the best possible care”” to ensure he can play football next week. He becomes agitated when Dr. Roberts explains it’s not clinically indicated at this stage.

Question: Rank the following actions in order of appropriateness, from 1 (Most appropriate) to 5 (Least appropriate).

Dr. Daniel Kim, an FY1 doctor, is preparing for his next rotation and is reviewing his e-portfolio. He notices that a mandatory supervisor meeting with his clinical supervisor, Dr. Emma Harrison, was due last week and has not yet occurred. Dr. Kim knows Dr. Harrison is very busy and has a reputation for occasionally missing or delaying supervision meetings. Dr. Kim is keen to ensure his e-portfolio is up-to-date and that he receives the necessary feedback and sign-offs for his learning outcomes.

Question: Rank the following actions in order of appropriateness, from 1 (Most appropriate) to 5 (Least appropriate).

Dr. Olivia Rodriguez, an FY2 doctor, is covering a ward and receives a phone call from Ms. Maria Sanchez, a patient’s daughter. Ms. Sanchez sounds distressed and says, “”I just saw an update on my mother’s Facebook page that was posted by ‘Dr. Hospital Life.’ It mentions her being admitted with a rare condition and includes details that only someone involved in her care would know. I think it’s a doctor from this hospital, and it’s making my mother very upset.”” Dr. Rodriguez recalls seeing a doctor from her hospital posting about their day-to-day experiences on a public social media platform, often using a pseudonym.

Question: Rank the following actions in order of appropriateness, from 1 (Most appropriate) to 5 (Least appropriate).

Dr. Samuel Davies, a core surgical trainee, is operating with a consultant surgeon. During a complex procedure, the consultant makes an error that, while not immediately obvious, could potentially lead to a significant complication for the patient in the long term. Dr. Davies notices the error but the consultant continues without acknowledging it. Dr. Davies is concerned but also intimidated by the consultant’s seniority and reputation for being resistant to challenge.

Question: Rank the following actions in order of appropriateness, from 1 (Most appropriate) to 5 (Least appropriate).

Dr. Noah Thompson, a medical FY1, is working late on the ward. He has just administered a new, high-dose antibiotic intravenously to Mr. Peter Jones, a patient with severe sepsis, as prescribed by the consultant. Shortly after, he realizes he miscalculated the dosage and administered twice the prescribed amount. Mr. Jones is currently stable, but Dr. Thompson is aware that this antibiotic in high doses can cause significant renal impairment. He is the only doctor on the ward, and the registrar is in theatre and unreachable.

Question: Rank the following actions in order of appropriateness, from 1 (Most appropriate) to 5 (Least appropriate).

Dr. Ben Miller, an FY1 doctor, is attending a ward round where the consultant, Dr. Clara Williams, is discussing the care of Mr. Thomas Green, a patient with advanced dementia. During the discussion, Dr. Williams mentions that Mr. Green’s “”Do Not Attempt Cardiopulmonary Resuscitation”” (DNACPR) order was put in place last week after a discussion with his son, Mr. Alex Green. Dr. Miller recalls from her previous review of Mr. Green’s notes that there was no documented evidence of Mr. Green’s capacity being formally assessed at that time, nor any evidence of Mr. Green’s wishes being explored, despite him occasionally appearing able to engage in simple conversations.

Question: Rank the following actions in order of appropriateness, from 1 (Most appropriate) to 5 (Least appropriate).

Dr. Sarah Jones, an FY2 doctor, is on a night shift. She is called to review Ms. Priya Sharma, a 35-year-old patient who has just been admitted with severe community-acquired pneumonia. Ms. Sharma is coughing frequently and appears to be struggling with shortness of breath. The oxygen saturation on her observations chart is 88% on air. Dr. Jones checks the patient’s notes and sees that the admitting FY1 doctor has prescribed antibiotics but has not prescribed any oxygen therapy or provided clear instructions on respiratory support. The FY1 doctor is off-site and unreachable.

Question: Rank the following actions in order of appropriateness, from 1 (Most appropriate) to 5 (Least appropriate).

Dr. Alex Campbell, an FY1 doctor, is approached by a pharmaceutical sales representative during his lunch break in the hospital canteen. The representative offers Dr. Campbell a free ticket to a major sporting event, stating it’s “”just a small thank you”” for doctors who might consider their new drug in the future. Dr. Campbell feels uncomfortable accepting the offer, as he understands there are strict rules around gifts from pharmaceutical companies.

Question: Rank the following actions in order of appropriateness, from 1 (Most appropriate) to 5 (Least appropriate).

Dr. Liam O’Connell, a medical FY2, is feeling overwhelmed with his workload on the ward. He has several patients to review, discharge summaries to write, and an urgent task to chase a critical blood result for a deteriorating patient. He knows he won’t be able to complete everything before the end of his shift. A junior colleague, Dr. Sophie Chen (also an FY2, but less experienced), approaches him asking for help with a complex patient query.

Question: Rank the following actions in order of appropriateness, from 1 (Most appropriate) to 5 (Least appropriate).

Dr. Eva Hansen, a GP registrar, is reviewing a new patient, Mr. John Williams, a 45-year-old man. During the consultation, Mr. Williams states that he requires a “”sick note”” (Statement of Fitness for Work) for his employer because he “”doesn’t feel like going to work”” for the next two weeks. He admits he has no specific illness or symptoms that would genuinely prevent him from working. Dr. Hansen feels pressured as Mr. Williams is very insistent and hints that his previous doctor was always “”understanding”” about such requests.

Question: Rank the following actions in order of appropriateness, from 1 (Most appropriate) to 5 (Least appropriate).