MSRA Professional Dilemmas Mock Selection

Scenario: You are a Foundation Year 1 (FY1) doctor on a busy surgical ward. A patient, Mr. Henderson, has just returned from theatre after a major abdominal surgery. He is complaining of severe pain, despite receiving his prescribed regular analgesia. The nurse tells you that he has already had a PRN (as required) dose of opioid analgesia administered an hour ago. You notice his vital signs are stable, but he appears distressed. Task: Choose the three most appropriate actions.

Scenario: You are an FY1 doctor on a ward round. The consultant asks you to document a particular discussion with a patient about their prognosis. You were not present for this specific discussion and only have a brief handover from the registrar, which doesn’t fully detail the conversation. The consultant is pressing for the notes to be completed urgently. Task: Choose the three most appropriate actions.

Scenario: You are an FY2 doctor in General Practice. A long-standing patient, Ms. Davies, who you know to have a history of depression, confides in you that she has been self-harming again and feels overwhelmed. She explicitly states, “Please don’t tell anyone; I just needed to tell someone.” You are concerned about her safety. Task: Choose the three most appropriate actions.

Scenario: You are a Core Surgical Trainee working in the emergency department. A patient presents with a laceration that requires suturing. The patient smells strongly of alcohol and is becoming increasingly agitated and verbally abusive, refusing to cooperate with the procedure. You are concerned about your ability to perform the procedure safely and effectively. Task: Choose the three most appropriate actions.

Scenario: You are an FY1 doctor on night duty. A nurse approaches you with a concern about a colleague, Dr. Sharma, who appears to be constantly tired, is making more errors than usual, and occasionally smells of alcohol. The nurse is hesitant to report this formally but is worried about patient safety. Task: Choose the three most appropriate actions.

Scenario: You are an FY2 doctor on an elderly care ward. Mrs. Khan, an 85-year-old patient, has been admitted with pneumonia. Her son, Mr. Khan, approaches you, appearing very distressed, and requests to see his mother’s medical records to understand her condition better. Mrs. Khan is mentally alert and capable of making her own decisions. Task: Choose the three most appropriate actions.

Scenario: You are an FY2 doctor on a general medical ward. A patient, Mr. Jones, who has recently been discharged from a different hospital, returns to your ward with new symptoms. He is very upset and states he believes he was a victim of medical negligence during his previous admission, alleging that a serious medical error led to his current symptoms. Task: Choose the three most appropriate actions.

Scenario: You are an FY2 doctor on a cardiology ward. Mr. Green, a patient you were looking after, sadly passed away unexpectedly. His distraught family approach you, demanding to see his medical records as they suspect medical negligence led to his death. Task: Choose the three most appropriate actions.

Scenario: You are an FY1 doctor on a busy night shift. You notice a colleague, another FY1, who seems disorientated and you think you can smell alcohol on their breath. They are currently reviewing a patient and seem to be struggling to complete basic tasks. Task: Choose the three most appropriate actions.

Scenario: You are an FY2 doctor on a surgical ward. You are aware that a patient who recently had abdominal surgery at your hospital has been readmitted with complications, and it has been discovered that a surgical swab was inadvertently left inside them. The patient’s distraught relative approaches you, expressing anger and distress about this serious incident. Task: Choose the three most appropriate actions.

Scenario: You are an FY2 doctor in General Practice. Mrs. Smith, a new mother, brings her 6-week-old baby for a routine check-up. During the consultation, she casually mentions that she occasionally has “a few glasses of wine” in the evenings and continues to breastfeed, stating she thinks it “doesn’t affect the baby much.” Task: Choose the three most appropriate actions.

Scenario: You are an FY1 doctor on a surgical ward. A patient, Mr. Davies, who is due for surgery tomorrow, approaches you appearing anxious and requests a sedative medication, stating, “I can’t sleep with all this worry about the operation. My GP usually gives me something.” Task: Choose the three most appropriate actions.

Scenario: You are an FY1 doctor on a busy ward round. As you approach a patient’s bed, a large group of the patient’s family members are present and immediately express their concerns about the patient’s slow recovery and lack of communication from the medical team. They appear distressed and are asking multiple questions. The patient is alert and aware. Task: Choose the three most appropriate actions.

Scenario: You are an FY1 doctor on a medical ward. A colleague, another FY1 from a different team, approaches you urgently and asks you to countersign a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) form for a patient you know to be unwell, but whose case you are not fully familiar with. They state they have had a brief conversation with the family, but the patient lacks capacity. Task: Choose the three most appropriate actions.

Scenario: You are an FY2 doctor on a busy medical ward. A patient’s relative approaches you, clearly upset, and complains that a particular staff nurse has been consistently rude and unhelpful, and has ignored their requests for information. You have not personally witnessed this behaviour. Task: Choose the three most appropriate actions.

Scenario: You are an FY1 doctor in a general medical clinic. You are reviewing a patient with poorly controlled type 2 diabetes and hypertension. You note that the patient has a BMI of 35, and during the consultation, they express frustration with their weight, stating, “I’ve tried everything, but nothing works.” Task: Choose the three most appropriate actions.

Scenario: You are an FY1 doctor on a surgical ward. A patient, Mr. Chang, who is scheduled for surgery tomorrow, is Nil by Mouth (NBM). You walk past his bed and notice his family members are attempting to feed him food they brought from home, despite the NBM sign displayed prominently. Task: Choose the three most appropriate actions.

Scenario: You are an FY2 doctor seeing a patient in an outpatient clinic. During the consultation, the patient mentions that while sitting in the waiting room, they overheard two doctors discussing another patient’s medical details loudly, including their name and diagnosis. The patient expresses concern about patient confidentiality. Task: Choose the three most appropriate actions.

Scenario: You are an FY1 doctor on a ward round. Your consultant asks you to prescribe oral antibiotics for Mrs. Evans, a patient under their care who has developed a chest infection. You have not personally assessed Mrs. Evans on this ward round, and you are not fully aware of her recent observations or allergies. Task: Choose the three most appropriate actions.

Scenario: You are an FY2 doctor working in palliative care. A patient under your care has recently died unexpectedly following a rapid deterioration. The patient’s family, who are very distressed, approach you and question the quality of care provided, stating they feel something went wrong. Task: Choose the three most appropriate actions.

Scenario: You are an FY2 doctor in a hospital, and you are approached by a friend, Ms. Peterson, whose sister is a patient in the same hospital under a different team. Ms. Peterson expresses concerns about her sister’s diagnosis and treatment plan and asks for your informal opinion on the case or if you can arrange a second opinion for her sister. Task: Choose the three most appropriate actions.

Scenario: You are an FY1 doctor on a medical ward. You are preparing a patient for a necessary procedure, but despite your clear explanations, the patient, who is fully alert and oriented, states they do not wish to proceed with the treatment. You believe the treatment is vital for their health. Task: Choose the three most appropriate actions.

Scenario: You are an FY2 doctor in a memory clinic. A patient with advanced dementia, Mrs. White, attends with her daughter. The daughter requests a powerful sedative for her mother to manage agitation during a planned long-haul flight to visit relatives, stating her mother becomes very distressed during travel. You are concerned about prescribing a sedative without clear indication or assessing capacity. Task: Choose the three most appropriate actions.

Scenario: You are an FY2 doctor seeing a patient in your outpatient clinic for a routine follow-up. During the consultation, the patient becomes very distressed, not about their own health, but because their close family member has recently been diagnosed with a serious, life-limiting illness and is being treated at a different hospital. The patient asks you for details about their family member’s prognosis and treatment. Task: Choose the three most appropriate actions.

Scenario: You are an FY1 doctor on a busy medical ward. You review a patient and, based on your assessment, you suspect a significant diagnostic error has been made by a more senior colleague earlier in the day, potentially leading to a delay in appropriate treatment. Task: Choose the three most appropriate actions.