MSRA Practice and Application 2

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?

Accepted Answer

Withhold warfarin and give oral vitamin K 1–2mg

Answer

Administer IV vitamin K 5mg

Answer

Give fresh frozen plasma

Answer

Continue warfarin and recheck INR in 24 hours

Question 2

During a ward round, you notice a colleague appears intoxicated while examining patients. What is the most appropriate first action?

Accepted Answer

Immediately report your concerns to a senior colleague or supervising consultant

Answer

Document the observation and report at the next morbidity meeting

Answer

Confront the colleague privately after the ward round

Answer

Do nothing as it may be a misinterpretation

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?

Accepted Answer

Explain your clinical concern about subarachnoid hemorrhage and escalate if the decision is unchanged

Answer

Accept the radiologist's decision without further discussion

Answer

Order the scan anyway using a different clinical indication

Answer

Send the patient to the emergency department to get the scan done there

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?

Accepted Answer

Assess mental capacity at this moment before proceeding

Answer

Proceed as the patient consented earlier when capacitous

Answer

Postpone the procedure indefinitely

Answer

Ask the patient's next of kin to provide consent

Question 5

A diabetic patient on metformin requires a contrast CT scan. What is the most important pre-procedure consideration?

Accepted Answer

Stop metformin 48 hours before and restart only after renal function is confirmed normal post-procedure

Answer

Double the metformin dose to prevent contrast-induced hyperglycemia

Answer

Switch the patient to insulin before the scan

Answer

No special precautions are needed with modern contrast agents

Question 6

A patient with known penicillin allergy (anaphylaxis) requires treatment for a severe community-acquired pneumonia. Which antibiotic is most appropriate?

Accepted Answer

Clarithromycin or levofloxacin

Answer

Co-amoxiclav

Answer

Ceftriaxone

Answer

Meropenem

Question 7

A foundation doctor is asked by a patient for a copy of their medical records. What is the correct response?

Accepted Answer

Explain the process for submitting a subject access request under data protection law

Answer

Provide copies immediately as patients have an absolute right to access

Answer

Decline, as notes are the property of the hospital

Answer

Provide a summary only, not the full records