MSRA Practice and Application 5

Question 1

A 22-year-old student presents after a paracetamol overdose taken 4 hours ago. She is asymptomatic. What is the most important initial step?

Accepted Answer

Measure serum paracetamol level and plot on the treatment nomogram

Answer

Reassure and discharge as she is asymptomatic

Answer

Start N-acetylcysteine immediately without waiting for levels

Answer

Perform liver function tests and discharge if normal

Question 2

You are writing a discharge letter and realize you are unsure about a clinical detail. The patient has already left the ward. What is the most appropriate action?

Accepted Answer

Review the patient's notes, contact the ward team if needed, and complete an accurate letter before sending

Answer

Complete the letter with your best estimate of the information

Answer

Leave the detail blank and send the letter

Answer

Ask the patient to call in to provide the missing information

Question 3

A 58-year-old woman presents with sudden painless visual loss in the right eye described as a 'curtain coming down.' What is the most likely diagnosis?

Accepted Answer

Retinal detachment

Answer

Central retinal vein occlusion

Answer

Anterior ischemic optic neuropathy

Answer

Vitreous hemorrhage

Question 4

A patient with schizophrenia refuses antipsychotic medication. He has capacity and is not currently posing a risk to himself or others. What is the most appropriate response?

Accepted Answer

Respect his decision, document it, and arrange close follow-up

Answer

Administer the medication covertly in food or drink

Answer

Apply for a community treatment order immediately

Answer

Contact his family to persuade him to take the medication

Question 5

You are performing a venepuncture and accidentally sustain a needlestick injury from a patient with known HIV on antiretroviral therapy with an undetectable viral load. What is the most appropriate immediate action?

Accepted Answer

Wash the wound, report immediately, and seek urgent occupational health assessment for post-exposure prophylaxis

Answer

Reassure yourself as undetectable viral load means no transmission risk and take no further action

Answer

Start post-exposure prophylaxis yourself without formal assessment

Answer

Test yourself for HIV in 3 months and take no immediate action

Question 6

A 65-year-old man with known ischemic heart disease develops severe central chest pain radiating to the jaw. His ECG shows ST elevation in leads II, III, and aVF. What is the most appropriate immediate management?

Accepted Answer

Aspirin 300mg, oxygen only if SpO2 <94%, activate PPCI pathway

Answer

Aspirin 75mg and admit for monitoring

Answer

Thrombolysis immediately without further investigation

Answer

IV GTN infusion and reassess in one hour

Question 7

A medical student asks you to sign off a clinical procedure they have not yet been observed performing. They explain they 'definitely know how to do it.' What should you do?

Accepted Answer

Explain that sign-off requires direct observation of competent performance and arrange a supervised opportunity

Answer

Sign off the procedure as the student seems confident

Answer

Ask the student to find another supervisor

Answer

Sign off provisionally and review in a month