MSRA Practice and Application 2 — Questions and Answers
Question 1: A 45-year-old patient on warfarin presents with an INR of 6.2 and minor gum bleeding. Which is the most appropriate immediate management?
- Administer IV vitamin K 5mg
- Withhold warfarin and give oral vitamin K 1–2mg (Correct answer)
- Give fresh frozen plasma
- Continue warfarin and recheck INR in 24 hours
Correct answer: Withhold warfarin and give oral vitamin K 1–2mg
For supratherapeutic INR with minor bleeding, withholding warfarin and giving low-dose oral vitamin K is first-line management.
Question 2: During a ward round, you notice a colleague appears intoxicated while examining patients. What is the most appropriate first action?
- Document the observation and report at the next morbidity meeting
- Immediately report your concerns to a senior colleague or supervising consultant (Correct answer)
- Confront the colleague privately after the ward round
- Do nothing as it may be a misinterpretation
Correct answer: Immediately report your concerns to a senior colleague or supervising consultant
Patient safety takes priority; immediate escalation to a senior is required when a colleague may be impaired during clinical duties.
Question 3: A GP requests an urgent CT head for a patient with sudden-onset severe headache. The radiologist declines, stating it is not clinically indicated. How should you proceed?
- Accept the radiologist's decision without further discussion
- Explain your clinical concern about subarachnoid hemorrhage and escalate if the decision is unchanged (Correct answer)
- Order the scan anyway using a different clinical indication
- Send the patient to the emergency department to get the scan done there
Correct answer: Explain your clinical concern about subarachnoid hemorrhage and escalate if the decision is unchanged
Clinicians must advocate for patient safety by clearly communicating clinical concerns and escalating through appropriate channels if the disagreement persists.
Question 4: You are about to perform a lumbar puncture on a patient who previously consented but now seems confused and cannot re-confirm consent. What should you do?
- Proceed as the patient consented earlier when capacitous
- Assess mental capacity at this moment before proceeding (Correct answer)
- Postpone the procedure indefinitely
- Ask the patient's next of kin to provide consent
Correct answer: Assess mental capacity at this moment before proceeding
Capacity must be assessed at the time of the procedure; prior consent does not override the need for current capacity assessment.
Question 5: A diabetic patient on metformin requires a contrast CT scan. What is the most important pre-procedure consideration?
- Stop metformin 48 hours before and restart only after renal function is confirmed normal post-procedure (Correct answer)
- Double the metformin dose to prevent contrast-induced hyperglycemia
- Switch the patient to insulin before the scan
- No special precautions are needed with modern contrast agents
Correct answer: Stop metformin 48 hours before and restart only after renal function is confirmed normal post-procedure
Metformin should be withheld around contrast administration to prevent lactic acidosis if contrast-induced nephropathy occurs.
Question 6: A patient with known penicillin allergy (anaphylaxis) requires treatment for a severe community-acquired pneumonia. Which antibiotic is most appropriate?
- Co-amoxiclav
- Ceftriaxone
- Clarithromycin or levofloxacin (Correct answer)
- Meropenem
Correct answer: Clarithromycin or levofloxacin
In true penicillin anaphylaxis, beta-lactams including cephalosporins carry cross-reactivity risk; macrolides or fluoroquinolones are preferred alternatives.
Question 7: A foundation doctor is asked by a patient for a copy of their medical records. What is the correct response?
- Provide copies immediately as patients have an absolute right to access
- Explain the process for submitting a subject access request under data protection law (Correct answer)
- Decline, as notes are the property of the hospital
- Provide a summary only, not the full records
Correct answer: Explain the process for submitting a subject access request under data protection law
Patients have the right to access their records under GDPR/data protection law via a formal subject access request, which should be directed to the appropriate team.
MSRA Practice and Application 2
A 45-year-old patient on warfarin presents with an INR of 6.2 and minor gum bleeding.
Which is the most appropriate immediate management?