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

For an incapacitated adult, treatment decisions are based on best interests and any previously expressed wishes, not family authority alone.

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

Patient safety, open disclosure, and duty of candour require immediate communication with the treating team and completion of a formal incident report.

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

New hypertension after 20 weeks gestation with proteinuria is diagnostic of pre-eclampsia.

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

A distant history of mild rash has a very low risk of true penicillin allergy; cephalosporins like cefazolin are generally safe and preferred for surgical prophylaxis.

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

Chest X-ray and sputum AFB smear/culture are the initial investigations for suspected pulmonary tuberculosis.

(MSRA) Multi-Specialty Recruitment Assessment Practice Test

(MSRA) Multi-Specialty Recruitment Assessment Practice Test

MSRA Practice and Application 3