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Question 1 of 130
1. Question
A 21 year old female has recently found out that she is pregnant at 17 weeks gestation. She feels she would not be able to cope as a young single mother and has decided that she would want an abortion. She attends the GP surgery for advice on her abortion. What is the SINGLE most appropriate action?
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Question 2 of 130
2. Question
You are a junior doctor in the urology ward. Jane, one of the patients on the ward, is 2 weeks post total nephrectomy. Your colleague James has also been looking after Jane and has become well acquainted with Jane and her family. James tells you that he has added Jane on Facebook and sent her a message asking her if she wanted to meet up with him and his friends this weekend at the comedy club, as they are both fans of the comedian performing. He mentions that she is beautiful and would like to see her outside a hospital setting. What is the most appropriate initial step?
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Question 3 of 130
3. Question
A 35 year old mother attends the GP surgery with law moods. She attends the clinic appointment with her clase uncle. She has 3 young girls at home aged 4, 7 and 9 years old. She has been feeling low for the past 6 months since she split up with her partner. Her children live with her. She is asked during the consultation if she takes any recreational drugs. She admits to snorting cocaine for a week in the spring of last year. She has not used cocaine since then. She says that she would like that piece of information about cocaine use to be excluded in the clinical notes. What is the SINGLE most appropriate action?
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Question 4 of 130
4. Question
A 55 year old with a history pancreatic cancer had a cardiac arrest and died on the operating table while undergoing a pancreaticoduodenectomy. The surgeons said that he bled unexpectedly. Which is the SINGLE most appropriate authority or person to inform about his death?
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Question 5 of 130
5. Question
A 48 year old woman attends the GP requesting for sleeping tablets as she has had difficulty in falling asleep at night over the past 2 weeks. Her neighbours play loud music and throw frequent parties which disturbs her sleep. She works as a secretary and finds her work impaired because of the lack of sleep. She is unable to focus at work. She has tried ear plugs but still can hear the noise. She has told them to keep it down but they continue to play loud music at night. What is the SINGLE most appropriate action?
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Question 6 of 130
6. Question
A 79 year old man with COPD is seen in at home by his GP as he has developed a cough and fever. He feels short of breath, dizzy, and lethargic. His symptoms have gradually worsened over the past 12 hours. He is an active man and would usually cook and clean for himself. He lives alone and has no family. He tells the GP that he does not want to be resuscitated should he undergo a cardiac arrest. He had a DNR form filled 4 years ago during his admission to the medical ward for a stroke. He has a temperature of 38.7°C, heart rate of 120 beats/minute, blood pressure of 100/59 mmHg, respiratory rate of 30 breaths/minute and an oxygen saturation of 82% What is the SINGLE most appropriate action for the GP?
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Question 7 of 130
7. Question
An armed robber is injured during an exchange of gunfire with the police and comes to the Emergency Department. He requests your silence. What is the SINGLE most appropriate action?
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Question 8 of 130
8. Question
A healthy 19 year old female, gestational age of 27 weeks, presents to Obstetrics and Gynecology clinic requesting a termination. She says her boyfriend has just left her and that she would not want the baby to remind her of him. The boyfriend, who is currently in jail, has reportedly been assaulting her during their stormy 2 year relationship. What is the SINGLE most appropriate action?
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Question 9 of 130
9. Question
A 33 year old man is seen in the clinic as he has been recently diagnosed with hepatitis B. He is sexually active with his wife. They plan to start a family soon. What is the SINGLE most appropriate action for the clinician?
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Question 10 of 130
10. Question
14 year old girl presents to the clinic asking for contraception. She is sexually active. When asked about her partner, she initially did not want to reveal him but eventually, she tells you that her partner is a teacher in her school. She was previously given the advice to inform her parents which she has refused to do so. She has clearly stated that she would not want anyone to know about her relationship with the teacher. What is the SINGLE most appropriate action?
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Question 11 of 130
11. Question
Joan is an 82 year old female with advanced dementia. She was admitted a few days ago due to a chest infection. Today, Joan looks a lot better but although still not recovered, is insisting on leaving the hospital. She is not cooperative with her medication. Her daughter thinks discharge would be unsafe for her as she lives alone. What is the SINGLE most appropriate action to take in this situation?
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Question 12 of 130
12. Question
You are a healthcare professional working in the NHS. You suspect one of your colleagues to be under the influence of recreational drugs. What is the SINGLE most appropriate action to be taken?
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Question 13 of 130
13. Question
A 15 year old girl comes in with her 15 year old boyfriend requesting for oral contraceptive pills (OCP). They are sexually active. They could not be persuaded to inform their parents about their sexual relationship or that contraceptive advice was being sought. What is the SINGLE most appropriate action?
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Question 14 of 130
14. Question
A 88 year old woman with metastatic breast cancer is an inpatient in the hospice due to uncontrollable pain. She requires full support with her activities of daily living. She is on a syringe driver with morphine, haloperidol, and midazolam. Her palliative consultant titrates up her background morphine and increases her breakthrough pain relief to help reduce her pain. A few minutes later, she dies. What ethical principle is seen here?
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Question 15 of 130
15. Question
You are eating with a few friends in a restaurant. On leaving the restaurant, you notice an empty table with a patient’s hospital medical notes. The table has been unattended for a while. What is the SINGLE most appropriate action?
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Question 16 of 130
16. Question
Last night, you noticed that one of your fellow junior doctors in the same department and team as yourself had posted a status on a popular social media platform about an elderly lady with Lewy body dementia who thought she was inside Buckingham Palace. The past had gained a significant amount of attention by the time you rechecked social media this morning. The patient’s name, age and presenting features were all made public via this post, and the hospital had been tagged as the location. Which of the following is the most appropriate action to take?
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Question 17 of 130
17. Question
You see a foundation year 2 doctor taking a picture of a chest X-ray of one of the patients in the ward. He was using his phone and it captured the patient’s details including the patient’s name and hospital number. He would like to use the image with the patient’s clinical details for a lecture he is giving later today for the medical students. What is the SINGLE most appropriate action?
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Question 18 of 130
18. Question
A 15 year old girl presents to the GP surgery requesting contraception. She states that she is deeply in love with her classmate and they intend to soon consummate their relationship, with or without contraception. She says under no circumstance will she inform her parents because they do not approve of the relationship. She is a top student in her class and understands the risks of contraception and being sexually active. Who must you inform, if any, about this girl’s case?
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Question 19 of 130
19. Question
A mother brings her 12 year old son to you requesting surgery for his sticking out ears. She says that he is constantly teased in school because of his ears and wants him to undergo cosmetic surgery for it. The boy says he does not want surgery. What is the SINGLE most appropriate action?
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Question 20 of 130
20. Question
A 74 year old woman is brought by her son to the GP surgery with concerns about her memory and financial abuse. She was diagnosed with dementia a year ago. The son says that while going through her bank statements, he noticed a large sum of money sent to an unknown account from her bank a month ago. He is worried about financial abuse. His mother cannot remember having sent that money to anyone. What is the SINGLE most appropriate action?
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Question 21 of 130
21. Question
Parents of a 16 year old attend then GP surgery requesting for information about their daughter. They have heard from her friends that she is pregnant and they want to confirm this. The computer medical records show that she is currently 14 weeks gestation. She attended the GP surgery a few weeks ago for symptoms of a urinary tract infection. What is the SINGLE most appropriate action?
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Question 22 of 130
22. Question
An 85 year old woman has recently had a fall several hours ago while climbing up the stairs. An X-ray reveals a fracture neck of the left femur. The surgical team has agreed that surgery would improve her overall outcome. She lives in sheltered accommodation where carers visit her once a day to help her get dressed and make her meals. She is not oriented to time and place. She is unable to retain the information given to her in regards to the surgery. Her understanding is poor. She has no family members to contact. She has had no previous psychiatric or neurological conditions. She does not have any advance decisions made about her treatments. A lasting power of attorney has not been appointed to make healthcare decisions on her behalf. Her blood tests done in the department are normal. What is the SINGLE most appropriate action?
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Question 23 of 130
23. Question
A 15 year old girl is requesting for oral contraceptive pills (OCP) as she is sexually active. She refuses to tell her parents about her sexual activity and mentions that her partner is a 38 year old man. What is the SINGLE most appropriate action?
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Question 24 of 130
24. Question
A 44 year old woman has been admitted to the hospital because of shortness of breath and chest pain. She is wheezing and gasping for air. She has a background of stage 5 chronic kidney disease and is on haemodialysis. She has refused to attend the last few haemodialysis appointments. She is anuric. She has ankle oedema and pulmonary crackles on auscultation. Her blood pressure is 120/79 mmHg. Her ECG shows tall tented T waves. Her blood tests show the following:
Haemoglobin 132 g/L (130-180)
Potassium 7.0 mmol/L (3.5-5)
Urea 41 mmol/L (2.0-7)
Creatinine 710 μmol/L (70-150)
eGFR 10/min (>90 mL)
She is now refusing all medical interventions. What is the SINGLE most appropriate management?
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Question 25 of 130
25. Question
Sara is an 82 year old woman with advanced dementia. She was admitted 3 days ago due to a lower respiratory tract infection. She has not completely recovered but has attempted to abscond the hospital several times without informing the nurse on the ward. She is confused and does not know where she is. She has become non-cooperative with her medications including her antibiotics. She normally lives in a care home. What is the SINGLE most appropriate action in this situation?
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Question 26 of 130
26. Question
A 14 year old girl attends the GP surgery for contraceptive advice as she would like to start oral contraception. She informs the clinician that she is having sexual intercourse with a 23 year old man. Her parents are not aware of her sexual relationship and she does not want them to know. What is the SINGLE most appropriate action?
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Question 27 of 130
27. Question
A 35 year old man is seen in the clinic as he has been recently diagnosed with hepatitis B. He is sexually active with his wife and does not use any barrier methods. He cannot be persuaded to tell his wife about his diagnosis. What is the SINGLE most appropriate action for the clinician?
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Question 28 of 130
28. Question
On a visit to a nursing home a patient is being yelled at by a carer. The language used is inappropriate and even includes a threat to lock up the elderly patient. After the incident the patient states they do not feel safe in this nursing home and would like help. What is the most appropriate action?
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Question 29 of 130
29. Question
A 77 year old man with Alzheimer’s disease who lives in the nursing home has been gradually deteriorating and becoming increasingly confused over the past 3 weeks. He has been bed-bound for the past few weeks and unable to chew or swallow. The nurses believe that he has a chest infection as he has been having a productive cough and fever. He signed an advance directive 2 years ago which states that he would not want to be placed on artificial nutrition and would not like to be admitted to the hospital if he deteriorated. He nominated his son to be his lasting power of attorney for health 3 years ago. His son thinks that it is best that he received nutrition through a nasogastric tube in the hospital. His daughter who is the next of kin disagrees and believes that it is in her father’s interest not to be placed on artificial nutrition, nonetheless, she would like him to be treated in the hospital. The nurses have assessed the patient and found him not to have mental capacity to make that decision. Which is the SINGLE most appropriate action?
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Question 30 of 130
30. Question
An 80 year old woman attends the GP clinic. She wishes to change her will out of concern that people are after her wealth and requests you to act as a witness. She has a history of hypertension and Alzheimer’s disease and is on medication for bath conditions. Which of the following is the SINGLE most appropriate course of action?
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Question 31 of 130
31. Question
A 34 year old woman requests for sterilization. Her last born child has cerebral palsy. Her husband strongly objects to the procedure. She has considered all other modes of contraception but has decided on sterilization. What is the SINGLE most appropriate action?
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Question 32 of 130
32. Question
A 33 year old man is brought into the Emergency Department having been involved in a fight outside a local pub. During the fight, he was hit on the head by a metal chair. On examination, there is a open laceration on his head and he has sustained cuts and bruises on his arms and legs. He also smells of alcohol. He was initially uncooperative before lasing consciousness. What is the SINGLE most appropriate action?
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Question 33 of 130
33. Question
A 37 year old woman who was recently diagnosed with multiple sclerosis took 100 tricyclic antidepressant tablets. She was brought into the Emergency Department by her boyfriend. She is now refusing all treatment. What is the SINGLE most appropriate action?
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Question 34 of 130
34. Question
A 45 year old man is found to be HIV positive in a Genitourinary Medicine clinic. He is not sexually active. He does not want his GP informed about his diagnosis as he has witnessed a friend who suffered discrimination following accidental disclosure of his HIV status. What is the SINGLE most appropriate action?
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Question 35 of 130
35. Question
A 23 year old man has been in the intensive care unit for the past 10 days after being involved in a serious road traffic accident. He has not been conscious since the accident and is on a mechanical ventilator. The intensive care team believes that he will not be a good candidate for cardiopulmonary resuscitation and if resuscitated would be living a very poor quality of life. His family would like him to be resuscitated and treatment continued. What is the most appropriate action?
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Question 36 of 130
36. Question
An 85 year old woman with Alzheimer’s disease attends her GP surgery with her daughter for her annual medication review. During the consultation, the patient tells you that she is planning on changing her will. Her granddaughter is refusing as she says that her grandmother does not know what she is saying since she is suffering from dementia. What is the SINGLE most appropriate action to take?
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Question 37 of 130
37. Question
A 78 year old man is seen by the colorectal surgeon to discuss the results of his biopsy. He has had a colorectal biopsy in which histology shows a poorly differentiated high- grade adenocarcinoma associated with poor patient survival. He is unaware of his diagnosis. He lives independently and has plans to travel to South America in a few weeks. His wife who attend the appointment has asked the surgeon not to inform the husband if the diagnosis is terminal. What is the most appropriate next step in this case of breaking bad news?
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Question 38 of 130
38. Question
A 71 year old grandmother attends the GP surgery for a medication review with her grandson. During the consultation, the grandson mentions that he is worried as his grandmother still continues to drive despite family members telling her that she should not drive. She has Alzheimer’s disease and she has refused to inform any authority that she continues to drive. What is the SINGLE most appropriate action?
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Question 39 of 130
39. Question
A 38 year old man with a history of schizophrenia attends the clinic for a psychiatric follow-up. He still finds it difficult to keep track of his thoughts. During the consultation, he opens up and says that he is hearing voices telling him to hurt his ex-wife. He knows the voices are not real but occasionally he feels like he needs to act on them. His ex-wife lives on the next street to where he lives. He leaves before the consultation is finished.
What is the SINGLE most appropriate action?
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Question 40 of 130
40. Question
Josephine, an elderly woman living with Alzheimer’s disease has been trying to leave the residential care home in the evenings with the intention of buying a pack of her favourite chips that she used to eat when she was young. She suffers with short-term memory. She is to be accompanied if she would go out. A few days ago, Josephine was agitated and confused so one of the staff members locked her inside her bedroom to avoid her from attempting to go out. The GP learns about this event from one of the nurses. What is the most appropriate action for the GP?
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Question 41 of 130
41. Question
A mother of a 14 year old girl attends your clinic to ask for advice on which type of contraception would be best suited for her 14 year old daughter whom she says suffers from dysmenorrhoea. She would like to obtain a prescription for her daughter as her daughter was not able to make the appointment due to school activities. What is the SINGLE most appropriate next step to take?
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Question 42 of 130
42. Question
A 48 year old man attends the urology clinic for an abnormal lump on his right testicle which his GP has referred as urgent. He is seen by a male doctor who offers him a chaperone for the examination of his testicles but the patient declines and says he does not want a chaperone. His wife and brother are in the waiting room. What is the SINGLE most appropriate action?
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Question 43 of 130
43. Question
A 15 year old girl presents with her boyfriend to the Paediatric Accidents & Emergency with lower abdominal pain. On routine history taking, she mentions that she is sexually active with her boyfriend who is a 23 year old college student. Her parents have no knowledge of her sexual activity. Her boyfriend is aware of her actual age. After a full examination, she is deemed medically fit for discharge. What is the SINGLE most appropriate step to perform prior to discharging the patient?
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Question 44 of 130
44. Question
A 15 year old girl was involved in a road traffic accident. She has lost blood following a splenic rupture. She is in the emergency theatre and the surgeons believe that a blood transfusion could be life-saving. She and her family are Jehovah’s witnesses. Prior to the surgery, she consented to a blood transfusion if it would be life-saving. Her parents do not wish for her to have a blood transfusion at any cost. What is the most appropriate action?
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Question 45 of 130
45. Question
A 3 month old baby is seen in A&E with his mom with a bruise on the head. She says the baby had rolled over and fallen off the bed and hit his head on the floor. The mom put her in a supine position on her bed. On examination, there is a 2.5 cm bruise seen on the child’s left head. The infant has dropped two centiles on his weight chart.
What is the SINGLE most appropriate management?
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Question 46 of 130
46. Question
A 32 year old woman is brought in unconscious by the ambulance after receiving the news that she has terminal breast cancer earlier in the day. She is suspected of having taken an overdose of benzodiazepines. She was found by her boyfriend with an empty battle of tablets beside her with a note declaring that she wishes to end her life. The note specifically says that she does not want any treatment. What is the SINGLE most appropriate action?
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Question 47 of 130
47. Question
You are treating a general surgeon for Hepatitis B. You ask him to inform the NHS trust where he is currently working and he refuses. What is the SINGLE most appropriate action?
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Question 48 of 130
48. Question
A 30 year old female is brought into the Emergency Department by her husband drifting in and out of consciousness following a road traffic accident. A FAST scan reveals a large collection of free fluid in the peritoneal cavity. She is in shock and requires immediate blood transfusion. Her husband objects saying they are devout Jehovah’s Witnesses and are against blood transfusion. Her condition is deteriorating. What is the SINGLE most appropriate action?
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Question 49 of 130
49. Question
You are was tasked with carrying out an audit to assess the current standard of care on the paediatric ward. The criteria of the audit was for all paediatric patients admitted to the ward to have a weight documented on their chart. He collected the data over three months which included 65 patients and presented his findings and action plans in the clinical safety meeting. What is the next MOST appropriate step in the audit cycle?
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Question 50 of 130
50. Question
Martha is a 68 year old female who was recently diagnosed with ovarian cancer. A senior nurse approaches Martha and asks her permission to include her in a clinical trial and Martha agrees, however, her daughter Emily disagrees. Martha’s daughter feels that her mother is not fit to make such a decision because she has mild dementia. The nurse and Emily approach her GP together for a solution. Martha’s son, John, has been appointed her lasting power of attorney for health and welfare. What is the SINGLE most appropriate action to take in this situation?
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Question 51 of 130
51. Question
You are one of the junior doctors on the gynaecology ward. Your friend, Tim, who is a doctor working in the wards, has posted a recent Facebook photo of a drunken date. You recognise the girl as a 21 year old patient who was an inpatient 3 weeks ago. You remember that she was under the care of Tim while she was an inpatient. You confront Tim and tell him that this is inappropriate. He defends himself saying she made the first move by sending him flowers and also a friend request on Facebook. He mentions that she is really attractive and he would like to see her outside of a hospital setting on weekends. Since she is no longer his patient, he does not find this to be improper. What is the most appropriate step?
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Question 52 of 130
52. Question
A 14 year old girl presents to the clinic requesting oral contraceptives. She is sexually active with her 15 year old partner. What is the SINGLE most appropriate action?
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Question 53 of 130
53. Question
A 34 year old Jehovah’s witness has a severe postpartum haemorrhage after a normal vaginal delivery. Her estimated blood loss is 2 litres and she is still having ongoing bleeding. She has an advance directive form stating she is not to receive blood products even if it is to save her life. She has a pulse rate of 90 beats/minute and a blood pressure of 105/60 mmHg. She is semi-conscious and is not speaking. Her husband is extremely distress and would like something done. What is the SINGLE most appropriate action?
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Question 54 of 130
54. Question
Alan who is an elderly man with dementia who lives in a care home has been stressed lately as his son has been taking money from his bank account and he cannot remember the passwords to login to his bank accounts. He has informed the carers about this. What is the SINGLE most appropriate action to be taken by the carers?
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Question 55 of 130
55. Question
A 92 year old woman with a history of terminal breast cancer and multiple bone metastases is in severe pain. She takes regular morphine for her pain. She has been bed bound for the past year and feels very depressed. She has been told by the oncologist that realistically she has roughly a few months to live. She fears that the pain would worsen in the last few days of her life. She has discussed ending her life quicker with her daughter, and the daughter agrees with her decision. The patient would like to take a “lethal medication” to end her suffering and has expressed her wishes to the doctors. She is compos mentis. What is the SINGLE most appropriate action?
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Question 56 of 130
56. Question
A 34 year old man with multiple sclerosis has taken an overdose of more than 50 tablets of paracetamol with the intent to end his life. He has been brought to the emergency department by his wife. He is refusing all interventions. What is the SINGLE most appropriate action?
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Question 57 of 130
57. Question
A 42 year old male patient has just been rushed into Accident & Emergency following a road traffic accident. He has broken his right clavicle and suffered some cuts and bruises, but is conscious, alert and oriented to place, person and time. His wife arrives at the hospital and comes to you at the waiting area, frantic, enquiring about the condition of her husband. What is the SINGLE most appropriate action?
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Question 58 of 130
58. Question
A 15 year old girl attends the Emergency Department with mild vaginal bleeding. A pregnancy test is positive. She does not want her parents to know about her pregnancy and she refuses to disclose too much information regarding her sexual partner to the healthcare professionals. She has stated that her sexual partner is a student at her school and is around her age. Her last menstrual period is 7 weeks ago. What is the SINGLE most appropriate management?
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Question 59 of 130
59. Question
A 31 year old woman who was found unconscious is brought by ambulance to the Emergency Department. The paramedics state that she was seen next to empty packets of paracetamol. Serum paracetamol levels were requested and the results were platted above the treatment line. Her blood pressure is 120/80 mmHg. She has a pulse of 80 beats/minute and a respiratory rate of 18 breaths/minute. A venous blood gas was performed which shows a pH of 7.38. She remains unconscious but reacts to pain. What is the SINGLE most appropriate next step?
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Question 60 of 130
60. Question
An 85 year old woman with a background history of long standing dementia is admitted to ICU for pneumonia. She has had several refractory seizures over the past 6 months. She has been admitted three times in ICU over the past year. The anaesthetic team believe that it would be futile to resuscitate her or to intubate her. She is currently an intravenous antibiotics and fluids. Her family would like her to be resuscitated at all cost. There is no advanced notice or living will in her notes which states her decision for resuscitation. What is the SINGLE most appropriate action?
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Question 61 of 130
61. Question
The daughter of a 72 year old man receiving end of life care is concerned about his resuscitation status. Her father has heart failure and end-stage renal failure and is currently an inpatient in the intensive care unit. He was placed on a mechanical ventilator. He has been unconscious for the past 24 hours. The anaesthetic team has the opinion that it would not be in his best interest to attempt CPR should he have a cardiac arrest. The daughter believes that he should be resuscitated. What is the SINGLE most appropriate action for the health care professionals in relation to a decision to resuscitate?
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Question 62 of 130
62. Question
A 61 year old woman develops an ischaemic stroke a few hours after having her right hip arthroplasty while in recovery. She was on regular clopidogrel for a previous ischaemic stroke 2 years ago but was told by the surgeon to stop clopidogrel 7 days before the elective surgery. She has had no other medical problems in the past. With great distress, the husband would like to know if there was any potential cause of the stroke. What is the SINGLE most appropriate action for the surgeon?
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Question 63 of 130
63. Question
You are working as a junior doctor in one of the medical wards. During your handover to one of your colleagues, you notice that he smells of alcohol. You suspect that he is under the influence of alcohol. You have not noticed this before. What is the SINGLE most appropriate action?
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Question 64 of 130
64. Question
A 46 year old man has been seen by you in the oncology outpatient department a number of times. He has completed his treatment and you inform him that his follow up imaging is disease-free. He is extremely grateful and gives you an envelope containing £50. What is the SINGLE most appropriate action?
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Question 65 of 130
65. Question
Josie, who is a 76 year old woman with dementia is brought to the NHS GP surgery by her daughter Sarah who is seeking a written confirmation for Josie’s mental capacity. Her solicitor has asked her to speak to the GP for a mental capacity assessment as Sarah would like to be Josie’s lasting power of attorney for property and financial affairs. Sarah would like her mother to transfer £5000 to her for the purpose of a down payment for a new car. Sarah has asked her mother for money before which Josie has agreed. Josie seems disoriented during the conversation. What is the SINGLE most appropriate action for the GP?
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Question 66 of 130
66. Question
A 13 year old girl with a history of ovarian cyst attends an outpatient gynaecology appointment with her mother complaining of ongoing intermittent right-sided abdominal pain which is exacerbated when playing sports. She is an active person who is training to become a tennis player. On examination, palpation of the right adnexa elicits moderate pain. An ultrasound shows a large cyst of approximately 88 mm in diameter. Against her mother’s wishes, the child wants to undergo elective surgery to remove the cyst. Her mother thinks she is too young to have surgery and wants her to wait until she is older to make the decision. The patient understands the risks and complications of such surgery and provides mature reasons for wanting to go ahead with the surgery. What is the SINGLE most appropriate course of action?
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Question 67 of 130
67. Question
An 82 year old woman with a background history of long standing dementia comes to the hospital with symptoms of pneumonia. She rapidly deteriorates after a few days. The medical team has deemed that resuscitation would not be in the patients best interest as it would lead to poor quality of life. There is no advanced notice or living will in her notes which states her decision for resuscitation. Her daughter tells you that she think she should be resuscitated. What is the SINGLE most appropriate action in regards to a Do Not Resuscitate (DNR) order?
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Question 68 of 130
68. Question
A 44 year old man has been brought in with an overdose of paracetamol. His blood reports show a paracetamol level above the cutoff to start N-acetylcysteine infusion. However, he is refusing treatment as he is adamant that he wants to die. What is the SINGLE most appropriate course of action?
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Question 69 of 130
69. Question
A 33 year old man is extremely thankful for your service and for assisting in his laparoscopic appendectomy. He offers you a valuable clock as a gift. What is the SINGLE most appropriate action for you to take?
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Question 70 of 130
70. Question
A 17 year old boy is brought into the Emergency Department unconscious following a road traffic accident. What is the SINGLE most appropriate action?
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Question 71 of 130
71. Question
A 48 year old woman is seen in the outpatient orthopaedic clinic for planned elective surgery following a fall causing injury to her knee. She has a severe learning disability that was diagnosed when she was young. She is looked after by a full-time carer who is present at the appointment. She is non-verbal. The surgeon has explained the procedure and the risk and benefits to the patient and the carer. The patient does not show any signs of disagreement with the procedure but she cannot communicate her decision to the carer or the doctor. Which of the following likely explains the reason that she lacks mental capacity?
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Question 72 of 130
72. Question
A junior doctor had a needle stick injury from the needle used to draw blood from an unconscious patient in the intensive care unit. The unconscious patient is deemed to be a low risk of having blood-borne infections although he has not been tested for any blood-borne infections in the past. The junior doctor is worried about a blood-borne infection. What is the SINGLE most appropriate action?
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Question 73 of 130
73. Question
A 34 year old man attends the Emergency Department with a knife wound on his arm. He tells you that he obtained it during a fight in the local pub. An hour later, the police arrive asking staff members for details as there was a murder at the pub and they are investigating it. What is the SINGLE most appropriate action?
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Question 74 of 130
74. Question
A 26 year old foundation year two (FY2) doctor, Adrian, has just rotated into Accident & Emergency (A&E). His colleagues approach you during a break and tell you that Adrian has been taking cannabis. The nurses also approach you and complain that Adrian does not complete his tasks in a timely fashion as he looks drowsy and has difficulty in concentrating. He has been seen to be experiencing mild hallucinations. He acts paranoid and anxious. When you confront Adrian about this, he admits to using cannabis. He rejects any advice that he needs to stop cannabis. What is the SINGLE best approach to take in this situation?
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Question 75 of 130
75. Question
A mother of a 15 year old girl has a telephone appointment with the GP and has asked about the conversation that her daughter had with the GP a week ago. She is upset that the GP had prescribed her contraception without her knowledge. The clinical notes revealed that her daughter has the maturity and intelligence to understand the implications of contraception and could not be persuaded to tell her parents. The contraception that was prescribed was given in her daughters best interest as she was likely to continue sexual intercourse with or without contraceptive treatment. What is the SINGLE most appropriate next step for the GP to take?
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Question 76 of 130
76. Question
A 76 year old frail man with severe heart failure is seen in the care home by his GP as he has been having a fever, shortness of breath and a cough for the past 12 days. He was prescribed oral amoxicillin 7 days ago and finished the course, however, his symptoms have been worsening. His last echocardiogram 6 months ago shows a poor ejection fraction. His blood pressure is 80/50 mmHg. He has a temperature of 38.1°C and a respiratory rate of 30 breaths/minute. He usually mobilises with a walking frame but for the past 24 hours, he has been unable to get out of bed. He tells the GP he does not want to be resuscitated if he should undergo a cardiac arrest. He has a medical history of a myocardial infarction and type 2 diabetes mellitus. The GP also believes that CPR for this man is unlikely to be successful and if successful, it would lead to poor quality of life. What is the SINGLE most appropriate initial action for the GP?
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Question 77 of 130
77. Question
A 30 year old man is found to be HIV positive and is against condom use. After discussing with him, he is still refusing to accept the need to tell his wife of his diagnosis. What is the SINGLE most appropriate action?
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Question 78 of 130
78. Question
A 49 year old diabetic man with severe peripheral arterial disease has been advised by his surgeon to undergo an amputation of his left leg. He has a medical background of schizophrenia which has been well controlled over the past 5 years with antipsychotics. He regularly sees his psychiatrist for follow up. The surgeon requires the consent form to be discussed and signed. What is the SINGLE most appropriate initial action for the surgeon?
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Question 79 of 130
79. Question
You are the SHO in psychiatry. Your consultant is having a sexual relationship with a widowed patient that is currently being treated for depression. The lady’s condition is much improved and is awaiting discharge next week. What is the SINGLE most appropriate action?
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Question 80 of 130
80. Question
A 22 year old man with severe learning disabilities is seen in the GP surgery for his annual medication review. He is an epileptic who was prescribed lamotrigine by his neurologist, however, he admits he has not been taking the medications because he dislikes taking any form of medications. As a result of non-compliance, he has been having one to two seizures a month. The patient lacks capacity. What is the SINGLE most appropriate action?
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Question 81 of 130
81. Question
A 77 year old palliative patient diagnosed with terminal pancreatic cancer has requested a lethal dose of morphine. She is experiencing significant pain and has been suffering for a few weeks. What is the SINGLE most appropriate management?
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Question 82 of 130
82. Question
A 36 year old woman attends the gynaecology clinic with a requests for a laparoscopic sterilisation. She has two children and has completed her family. She does not want to use any other form of contraception and she understands the risk of a laparoscopic sterilisation. Her husband is unhappy with this decision and would like a further child. What is the SINGLE most appropriate action?
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Question 83 of 130
83. Question
Tracy, who is an FY2 doctor, has seen a 39 year old man in A&E for an ongoing cough for the past 6 weeks. He also suffers with heartburn over the past 2 months. Tracy reviewed his chest X-ray and considered it to be normal. She discharged him with proton pump inhibitors and informed him that his chronic cough is likely due to his gastro- cesophageal reflux disease. The following day, his chest X-ray was reported by the consultant radiologist which states that there are patchy reticular opacities seen in the perihilar lung. The A&E consultant receives the report, informs the patient, starts the patient on antibiotics and documents his actions on the clinical notes. What is the most appropriate action for Tracy?
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Question 84 of 130
84. Question
A 34 year old pregnant woman was involved in a road traffic accident and presents to the hospital with with circulatory collapse. She is a Jehovah’s Witness and carrying a witnessed written directive refusing blood and all blood products. She is taken to the operating table where the surgical team is finding it difficult to stop the bleeding. Her haemoglobin is 40 g/L. She urgently requires blood transfusion. What is the SINGLE most appropriate action?
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Question 85 of 130
85. Question
You are working on a shift in the Emergency Department. During your lunch break in a nearby cafe, you overheard an FY2 doctor who you work with discussing an argument she had with a patient earlier that day with her friends. She disclosed the patient’s medical background and the issues in relation to the argument she had with the patient. She did not mention any patient identifiable details but she was very upset as the patient did not trust her judgement. What is the SINGLE most appropriate action?
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Question 86 of 130
86. Question
A 55 year old woman has recently been diagnosed with multiple sclerosis and has been started on oral steroids. She is brought to the hospital after having ingested more than 40 tablets of paracetamol 3 hours ago. She is refusing all medical treatment as she wants to end her life. What is the SINGLE most appropriate action?
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Question 87 of 130
87. Question
A 24 year old girl presents to the Emergency Department with her partner, mother and sister. The patient reports a one day history of lower abdominal pain. She has been amenorrhoeic for 10 weeks. A pregnancy test is positive. A speculum examination reveals an opened cervical as with active heavy bleeding. She was resuscitated with normal saline and given tranexamic acid however she remained hypotensive. It is clear that she needs to be taken to theatre for an evacuation of retained products of conception however she is semi-conscious, confused and unable to speak. What is the SINGLE most appropriate action?
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Question 88 of 130
88. Question
A 33 year old woman who is 34 weeks pregnant is involved in a major road traffic accident and is brought into the Emergency Department by ambulance. She has lost significant blood and is offered a blood transfusion. She is still conscious and refuses a blood transfusion and all blood components because she is a Jehovah’s witness. She understands the implications which include death if a blood transfusion is not given. Her husband believes that she should have a blood transfusion. What is the SINGLE most appropriate action?
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Question 89 of 130
89. Question
A 69 year old man who was diagnosed with dementia 2 months ago had a car accident yesterday. He presents to the GP accompanied by his son with an injured arm. He hit the pale near his driveway while driving 20 miles/hour. He has no head injuries from the accident. He does not remember how the incident occurred. His son says he lives at home with him but he manages his day to day activities on his own. What is the SINGLE most appropriate action?
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Question 90 of 130
90. Question
A 33 year old woman who is 39 weeks pregnant is in the labour ward with her husband. She is in early labour. The midwife presses the emergency alarm as she notices the umbilical cord prolapse out of the uterus before the presenting part. The senior obstetrician is informed and a decision for an emergency caesarean section is made and she is rushed into the theater. Unfortunately, she is unable to sign the consent form as she is illiterate. What is the SINGLE most appropriate course of action?
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Question 91 of 130
91. Question
You are taking a hard-earned break in the doctors’ lounge during a busy shift when you notice your colleague, browsing what appears to be photographs of X-rays on his smartphone. When you confront him, he tells you that he frequently takes photographs of patients’ X-rays. He tells you that it is for his personal study since he is aspiring to be a consultant radiologist one day. He assures you that he will not share or send the photographs to anyone. What is the SINGLE most appropriate action that you should take in this situation?
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Question 92 of 130
92. Question
A 71 year old man is seen in the care home by his GP as he has been very tearful. The carers report that he has had low moods for the past 14 months following the death of his wife. He has Alzheimer’s disease. On most days, he is confused and wakes up in the middle of the night crying. He has lost interest in pleasurable activities he used to enjoy. He has difficulty sleeping. The GP believes that antidepressants may provide some benefit but the patient does not have the capacity to understand the treatment benefit of antidepressants. His daughter who is his next of kin does not want her father to take any medications. This was expressed during a meeting between health care professionals and herself. What is the SINGLE most appropriate action for the GP to take?
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Question 93 of 130
93. Question
A 48 year old man recently had a transient ischaemic attack. He has recovered well from it. What advice on car driving would you give him?
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Question 94 of 130
94. Question
A junior radiologist reports a CT scan of a 48 year old woman in the wards with acute shortness of breath of which the medical team are suspecting pulmonary embolism. She reports it as a normal CT scan. The consultant radiologist who later reviews the scans notices that the CT scan reveals a mass in the left breast. What is the most appropriate action for the consultant radiologist?
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Question 95 of 130
95. Question
A 15 year old girl is brought to the hospital by her parents with mild lower abdominal pain. An ultrasound scan reveals a large ovarian cyst. The decision for a laparoscopic ovarian cystectomy has been made but she refuses treatment. She understands the consequences of not having the surgery and is deemed competent. Her parents ask if they can override her decision and sign the consent form on her behalf. What is the SINGLE most appropriate action?
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Question 96 of 130
96. Question
A 34 year old woman who is fully dilated in the labour ward has an abnormal CTG. A decision for an emergency caesarean section is made however she refuses to sign the consent form as she has a fear of surgical interventions. She understands the risk for her unborn child and it is clear that she has a mental capacity to make a decision. What is the SINGLE most appropriate action?
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Question 97 of 130
97. Question
A 13 year old girl presents to the clinic requesting morning pills. She says the condom she used with her 13 year old boyfriend split into two while having intercourse. What is the SINGLE most appropriate action?
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Question 98 of 130
98. Question
You are an FY1 In the medical ward. The nurses are speaking about the behaviour of another FY1 doctor. They state that he has been acting unprofessionally and has been heard shouting at numerous patients. After confronting this offending doctor, he states that he has been having financial difficulties and personal problems lately. What is the most appropriate action?
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Question 99 of 130
99. Question
A man with dementia has an ulcerative lesion on his forehead. He wants it removed so it can help improve his memory. His wife says he is not fit to give consent. What is the SINGLE most appropriate action?
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Question 100 of 130
100. Question
You are a foundation year 2 doctor treating a 35 year old man who presents to the Emergency Department after sustaining a superficial knife wound on his forearm. He was in a heated argument with his wife when his wife drew a knife and cut him. The wound was stitched and he is medically fit for discharge. He tells you that he does not want the police to be involved. Involving the police is likely going to upset his wife and cause more harm. They live alone without any children. What is the SINGLE most appropriate action?
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Question 101 of 130
101. Question
A 45 year old man with epilepsy was mistakenly prescribed 300 mg of sodium valproate three times a day instead of 300 mg twice a day by his GP. This was on his repeat prescription and he had taken 300 mg three times a day for the past 3 months unknowingly. The mistake was spotted by his GP when he attended a medication review and the neurology clinic letter was reviewed. His GP has apologised to him for the mistake. What is the SINGLE most appropriate follow-up action for the GP?
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Question 102 of 130
102. Question
A 31 year old woman comes to Accidents and Emergency for a worsening cough and rigors. During the consultation, her husband translates for her as she speaks no English at all. On auscultating her chest, you notice multiple old and new bruises on her chest. Her husband says that they were from a fall a week ago. What is the SINGLE most appropriate immediate action?
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Question 103 of 130
103. Question
Mary, who is a close friend of Alice attends the GP surgery with concerns about the way Alice’s daughter cares for her mother. Alice has been living with dementia for the past 3 years. Mary mentions that when Alice’s daughter goes out, she locks her mother in the house to avoid Alice from wandering outside. Alice’s daughter is the sole carer for her. What is the most appropriate plan to be actioned by the GP?
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Question 104 of 130
104. Question
A 71 year old man had a recent stroke involving his right occipital lobe 2 months ago. Since the stroke, he has been suffering from left homonymous hemianopsia. He has not had any car accidents before and would still like to continue driving. What is the SINGLE most appropriate action?
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Question 105 of 130
105. Question
A 15 year old boy in London is brought to the hospital by his parents complaining of lower abdominal pains for the past three days. A clinical suspicion of appendicitis and the decision to admit was made. The young boy refuses to be admitted as he has plans to go out with his friends tonight. He is unable to understand the serious nature of an untreated appendicitis. His parents would like to overrule his wishes and to admit him. What is the SINGLE most appropriate course of action?
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Question 106 of 130
106. Question
A 44 year old man has been put under general anaesthesia in the anaesthetic room for an elective elbow surgery. On reading the consent in the theatre, it was discovered that the surgery on the theatre list differs from the surgery written on the consent form. The consent was signed 2 weeks ago during the pre-assessment clinic. The patient had called the consultant surgeon a day before to discuss his surgery and change the type of surgery. This change was reflected on the theatre list but not on the consent form. What is the SINGLE most appropriate action?
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Question 107 of 130
107. Question
A 66 year old man has been admitted to the intensive care unit for severe pneumonia. His diastolic pressure is 50 mmHg and his urea is 15 mmol/L. He is saturating 88% on oxygen. He is confused and does not know where he is. A chest X-ray shows multilobar shadowing. He is started on mechanical ventilation. He has a background of stage 4 lung cancer. The anaesthetic team have the opinion that it is not in his best interest to attempt CPR should he have a cardiac arrest. He does not have any family with him. He does not have an advance directive. What is the SINGLE most appropriate action?
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Question 108 of 130
108. Question
A mother of a 13 year old boy presents to the GP surgery. She would like to know if her child can undergo a pinnaplasty. She says that his ears are sticking out too much and her extended family makes fun of him. The young boy is not bothered by his prominent ears and does not want any surgery. He understands the reasons that his mother wants him to have a pinnaplasty but he has expressed his wishes not to have it done. What is the SINGLE most appropriate action?
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Question 109 of 130
109. Question
A 65 year old man presents to the accident and emergency department with an ambulance after being involved in a road traffic accident in front of his house. His left thigh appears to be swollen, and the leg is externally rotated. The man is confused, drowsy and disoriented. CT head was done and was reported as normal. An X-ray shows a mid-shaft fracture of the left femur. His blood pressure is 103/65 mmHg, pulse is 89 beats/minute, temperature is 36.9, and respiratory rate is 15 breaths/minute. His haemoglobin level is 105 g/L (130-180). He was accompanied by his neighbour who reports that his son lives in France. What is the most appropriate action?
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Question 110 of 130
110. Question
One of the nurses at the end of her shift, accidentally puts a copy of a list containing handover details of all the patients in the ward into handheld notes of a patient. The patient unknowingly takes the list home and calls the ward the following day informing you of the incident. What is the SINGLE most appropriate action?
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Question 111 of 130
111. Question
A 76 year old man with terminal Hodgkin’s lymphoma is seen in the care home by his GP for a palliative review. He has increasing difficulty with mobility but he still manages to walk around and communicate with the carers in the home. He is happy with his pain medications and his nausea is tolerable. He tells the GP he does not want to be resuscitated if he should undergo a cardiac arrest. The GP also believes that CPR for this man is unlikely to be successful and if successful, it would lead to poor quality of life. He has two separate appointments with his oncology team and palliative care nurse in the next few days. What is the SINGLE most appropriate action for the GP?
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Question 112 of 130
112. Question
A 33 year old man was recently diagnosed with HIV in the sexual health clinic. He would like to keep this information about the diagnosis from his wife. He promises to use condoms to prevent HIV transmission. What is the most appropriate action?
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Question 113 of 130
113. Question
A 77 year old man has had recent investigations which confirm that he has an inoperable glioblastoma multiforme. His family have informed the GP that if he were to know his diagnosis, it would make him too distressed. They have asked not to disclose the diagnosis and prognosis to the patient. What is the SINGLE most appropriate action?
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Question 114 of 130
114. Question
You are a foundation year 2 doctor. A nephrectomy is about to take place. You notice that the site marked for nephrectomy on the patient is the left but the consent form says “right nephrectomy”. The surgical notes of the consultant that has seen the patient in the morning state it is a left nephrectomy. Her nephrectomy has been cancelled and postponed twice because of sickness and COVID-19. The patient is already under general anaesthesia. What is the SINGLE most appropriate action?
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Question 115 of 130
115. Question
A 40 year old woman attends the GP surgery with her husband and sisters with complaints of fatigue and daytime sleepiness for the past 2 months. Her husband states that she snores loudly at night and occasionally there are brief episodes where she does not brief. She feels tired most of the time. She finds it hard to keep awake when she drives the car. She has a BMI of 36 kg/m2. What is the most appropriate next step in the management of this patient?
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Question 116 of 130
116. Question
A 15 year old girl attends the surgery for contraception advice. She is mentally competent and understands the implications of her sexual relationship. What is the SINGLE most appropriate action?
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Question 117 of 130
117. Question
A 33 year old man is in the anaesthetic room preparing for his elective herniorrhaphy. Shortly after being given his pre-anaesthetic medication, he changes his mind and does not want to proceed with this surgery. The consent form has already been signed earlier in the day. What is the SINGLE most appropriate action?
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Question 118 of 130
118. Question
A FY2 colleague of yours working in A&E has been having a sore throat and cough for the past 7 days. He clearly shows you evidence of exudates on his tonsils. He has asked to write a private prescription for antibiotics for him. What is the SINGLE most appropriate action to take?
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Question 119 of 130
119. Question
An 18 year old Muslim girl diagnosed with a brain tumour underwent surgery to remove the tumour. Her last CT scan shows evidence of brain herniation. She never regained consciousness after the surgery due to a suspected increase in intracranial pressure. The surgeon told the family that there was nothing else that could be done at present and they have managed her in the best way possible. The girl died 4 days later in the hospital. The family wants to bury her body as soon as possible in accordance with their religious principles. What is the most appropriate action?
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Question 120 of 130
120. Question
The son of a 78 year old gentleman with dementia, advanced pancreatic cancer and severe pneumonia has requested a best interests meeting with the ward team. He is aware that a DNACPR order has been instated for his father but would like to overrule this. The DNACPR was completed by his father as part of an advanced decision to refuse treatment and was valid at the time. The son believes that his father did not have capacity to make this decision and as he has lasting power of attorney the decision rests with him. What is the most appropriate action to take?
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Question 121 of 130
121. Question
A 33 year old pregnant woman is in labour at 40 weeks gestation. The emergency bell was rung by the midwife in the labour room as the cardiotocograph shows fetal bradycardia for the past 5 minutes that has not recovered. A quick decision to go for an emergency C-section is made however she is unable to consent as she speaks only Tigrinya and cannot understand English. Her partner is not in the hospital with her. Attempts have been made to contact the language line but at present they are unable to obtain a Tigrinya translator. What is the SINGLE most appropriate action?
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Question 122 of 130
122. Question
A 36 year old man with severe learning disabilities is seen in the hospital under the general surgeons where an elective herniorrhaphy is thought to be beneficial for the patient. Unfortunately, the patient does not have the mental capacity to sign the consent form. His surgical team have discussed the case amongst themselves and have come to the conclusion that he would benefit from surgery. He has carers attend to him for his care needs. He does not have family members or a next of kin. What is the SINGLE most appropriate action?
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Question 123 of 130
123. Question
You suspect that your colleague has been under the influence of illicit drugs however he denies the allegation after you have confronted him. You are still not convince that he is telling the truth. What is the SINGLE most appropriate action?
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Question 124 of 130
124. Question
A 16 year old boy has lower abdominal pain. A clinical suspicion of acute appendicitis was made and the surgical team has decided to go ahead with an appendectomy. The patient is happy to go ahead with the surgery but his parents refuse to sign the consent form as they are opposed to any form of surgery. The procedure has been explained clearly to the patient and his parents and they understand the risk of not going for surgery. What is the SINGLE most appropriate action?
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Question 125 of 130
125. Question
A 25 year old foundation year two (FY2) doctor, Jack, has just rotated into Accident & Emergency (A&E). His colleagues approach you during a break and tell you that Jack is not mentally stable. They tell you that Jack is often observed to be talking to himself and seeing and hearing things that others around him do not see or hear. The nurses also approach you and complain that Jack does not complete his ward tasks in a timely fashion. When you confront Jack about this, he admits to using cannabis. What is the SINGLE best approach to take in this situation?
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Question 126 of 130
126. Question
A 39 week pregnant, 28 year old woman in labour is in the maternity unit in a second stage of labour. The cardiotocography (CTG) shows late decelerations in over 50% of contractions for more than 30 minutes which suggest foetal distress. You have explained the situation to her and made it clear that an emergency caesarean-section is required and have informed her of the risk. She considers the consent but after a long discussion with her husband and weighing out the risk, she decides that she still wants a vaginal delivery. A mental capacity assessment is carried out and she is deemed to have capacity. What is the SINGLE most appropriate course of action?
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Question 127 of 130
127. Question
A 19 year old girl was caught shoplifting by two police officers. Shortly after she was accused of shoplifting, she took out a knife and cut her own wrist in an attempt to take her own life. Paramedics were called by the police officers and she was taken into the hospital for further management. A few hours later, the police officers went to the hospital. They would like to know what happened to the young girl and asked to see her medical notes. They would also like to know her name and her address. What is the SINGLE most appropriate action?
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Question 128 of 130
128. Question
An 89 year old woman with a background history of chronic myeloid leukaemia has a fever and cough for the past 7 days. She has been seen by her GP 3 days ago and has had a long discussion about her wishes and plans. She has an advance directive in place which states that she does not want to go to the hospital should she became unwell. She also has a do not resuscitate form signed by the GP that has been left in her house. Kerry, her daughter, has been concerned about her recent deterioration over the past 24 hours. Kerry would like her to be managed in the hospital and resuscitated if her heart stops. What is the SINGLE most appropriate action?
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Question 129 of 130
129. Question
A 31 year old Jehovah’s Witness was in a car accident and brought into the Emergency Department. He has lost a massive amount of blood. In the Emergency Department, he is given intravenous fluids. He is in critical condition and blood products are needed but he refuses any form of blood products due to his religious beliefs. What is the SINGLE most appropriate next step?
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Question 130 of 130
130. Question
A 44 year old man with learning difficulties presents to the Emergency Department with vomiting blood earlier in the day. On admission, his bloods show:
Haemoglobin 99 g/L
He is clinically stable but continues to vomit and requires an endoscopy to investigate the bleeding. Unfortunately, he is unable to understand the procedure or make an informed decision. What is the SINGLE most appropriate action?
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