MSRA Practice and Application 3

Question 1

A 70-year-old patient with dementia is brought to the ED by family.
She is in pain from a fractured hip and lacks capacity.
The family insists on conservative management against medical advice.
What governs the treatment decision?

Accepted Answer

The patient's previously expressed wishes and best interests assessment

Answer

The family's decision as next of kin

Answer

The most senior clinician's preference

Answer

A court order must be obtained before any action

Question 2

You discover a drug error was made by a colleague — the wrong dose of anticoagulant was given to a patient who is currently stable. What is the most appropriate next step?

Accepted Answer

Inform the treating team immediately, complete an incident report, and be transparent with the patient

Answer

Monitor the patient and document it privately without telling the team

Answer

Advise the colleague to self-report at a later time

Answer

Only report if the patient develops complications

Question 3

A 32-year-old woman presents at 28 weeks gestation with new-onset hypertension (BP 158/102) and proteinuria. What is the most likely diagnosis?

Accepted Answer

Pre-eclampsia

Answer

Gestational hypertension

Answer

Chronic hypertension

Answer

HELLP syndrome

Question 4

A patient with a penicillin allergy label requires surgical prophylaxis. On further questioning, the reaction was a mild rash 20 years ago. What is the best approach?

Accepted Answer

Use cefazolin, as cross-reactivity risk is low with a history of mild rash

Answer

Avoid all beta-lactams regardless

Answer

Use vancomycin as the only safe option

Answer

Perform formal allergy testing before any surgery

Question 5

A 55-year-old man presents with a 2-week history of productive cough, night sweats, and weight loss. He was born in a high-prevalence TB country. What is the most appropriate initial investigation?

Accepted Answer

Chest X-ray and sputum AFB smear and culture

Answer

Start empirical antibiotics and review in one week

Answer

CT thorax with contrast

Answer

Mantoux test alone

Question 6

You are asked to countersign a prescription written by a medical student. You have not seen the patient. What should you do?

Accepted Answer

Review the patient yourself before countersigning the prescription

Answer

Sign it as the student is supervised and you trust their assessment

Answer

Ask a nurse to verify the prescription before signing

Answer

Decline to sign and ask the student to find another doctor

Question 7

A 28-year-old woman presents with right iliac fossa pain, nausea, and a positive pregnancy test. Her BP is 90/60 and HR 118. What is the most urgent priority?

Accepted Answer

Insert two large-bore IV cannulae, send bloods, and activate emergency gynecology

Answer

Arrange a pelvic ultrasound scan and review results

Answer

Administer analgesia and reassess in 30 minutes

Answer

Perform a pelvic examination before any investigations