Microsoft word - example questions stage 2 assessment.doc

NATIONAL RECRUITMENT OFFICE FOR GENERAL PRACTICE TRAINING STAGE 2 ASSESSMENT

PROFESSIONAL DILEMMA QUESTIONS:
Ranking Questions
With this type of question you will be presented with scenarios followed by a number of possible
options. Unless the scenario says otherwise, consider yourself a second year Foundation Doctor
(F2 or FY2) working a rotation.
Rank each option in order from the most appropriate (1) to the least appropriate (5) given the
circumstances described in the scenario. There are no tied ranks. You will be shown how to
make your selection before the test begins.

Example A

You are a second year foundation doctor (F2 or FY2) working in general practice. At the baby clinical the
nurse gives you a syringe with fluid already drawn up, an immunisation (MMR) to give to a baby. After the
parent and child have gone home you realise that the syringe contained only diluent; the ampoule of active
powder is intact.
Rank in order the following actions in response to this situation.
A
Contact the parent immediately and explain what has happened Inform the practice manager of the nurse’s mistake Send a further appointment without delay Discussion of Example A: A is the best answer. The parents should be informed of the mistake immediately so that they are aware the baby has not received the immunisation and can make appropriate arrangements. D is the next best answer. The need to repeat the immunisation is addressed, however this does not share with the parents what has happened or the reason for the appointment and so is not such a good answer. It is good to fill in a critical incident form so that the causes of the error are investigated but this does not address the need to repeat the immunisation so C is the next best answer. B is not a good response because it does not address the baby’s need and it would be better to discuss the error directly with the nurse to find out what had happened. E is not a good response because you are the only person who knows the baby has not received the immunisation and if you take no action this will not be redressed. NATIONAL RECRUITMENT OFFICE FOR GENERAL PRACTICE TRAINING
Example B
A 55 year old woman with ischaemic heart disease has smoked 20 cigarettes per day for 40 years. She
requests nicotine replacement patches. She has had these previously but has been inconsistent in their
use and has often continued to smoke while using the patches.
Rank in order the following actions in response to this situation
A
Emphasise the dangers of smoking but do not prescribe Enquire about the difficulties she has with sopping smoking and any previous problems with patches Insist on a period of abstinence before prescribing any further patches Prescribe another supply of patches and explain how they should be used Suggest that nicotine replacement therapy is not suitable for her but explore alternative therapies Discussion of Example B B is the best response to this situation. The patient clearly wishes to stop smoking but is experiencing difficulties in doing so. A discussion about the problems she aces may help her to make her next attempt more successful. E is also a good response but it assumes the nicotine replacement therapy is not suitable for her, whereas it may be the right approach and she may need more help in using effectively. D is a possible approach but given her previous failures with the patches it may need more than this for her to succeed. A is unlikely to help her. She clearly already wants to stop smoking or she would not be making repeated attempts with the patches and this option does not include any alternative approach to stopping. C is a very poor response. If she is unable to stop smoking with the patches, she is unlikely to do very well without. Here are some more examples of ranking questions for you to try (Answers are NOT available) A good friend, whose father has been admitted to the hospital you are working in, asks you to find details of his illness as the hospital will not tell her anything over the telephone. She is on holiday abroad and needs to know whether to return home early. Rank in order the following actions in response to this situation A Decline politely, explaining that this would be a breach of hospital rules. Ask you friend to confirm in writing that you have her permission to ask for information Ask you consultant for advice on what is the best option Tell you friend that you will ask her father whether he will discuss his case with you Tell your friend that you will discuss her situation with her fathers consultant. You are reviewing a routine drug chart for a patient with rheumatoid arthritis during an overnight shift. You notice that your consultant has inappropriately prescribed methotrexate 7.5mg daily instead of weekly. Rank in order the following immediate actions in response to this situation A Ask the nurse if the consultant has made any other drug errors recently. Correct the prescription to 7.5mg weekly Leave the prescription unchanged until the consultant ward round the following morning Phone the consultant at home to ask about changing the prescription NATIONAL RECRUITMENT OFFICE FOR GENERAL PRACTICE TRAINING One evening when you are just coming to the end of your shift, you receive a message from Dr Spencer, a consultant on another ward. She wants to discuss aspects of the care you provided to one of her patients when you were covering the medical wards a couple of days ago. Rank in order the following actions in response to this situation. A Ring Dr Spencer’s extension to see if she is still at work Check whether your own consultant is aware of any issues Ring Dr Spencer’s ward to see if the nurse in charge is aware of any issues Leave a message for Dr Spencer acknowledging that you have received her request You are working in a minor injuries unit. There is currently no more senior help on site. You have seen a patient who has limped in. After examination and X-ray you have identified a fracture of a small foot bone. You have told the patient that a plaster cast will be required. You have instructed the senior nurse to do this. She refuses on the grounds that this is not clinically necessary. Rank in order the following actions in response to this situation. A Tell the patient that after advise from an experienced nurse you no longer feel that the plaster is necessary. Ask the nurse to arrange to apply the plaster just this time but promise to review the management with a senior colleague next day. Explain to the patient that there is a difference of opinion and let the patient choose between the options. Contact senior nurse management and explain that the nurse has refused your reasonable instruction. You are one of a group of Foundation doctors who have been asked to present a case at a symposium. You know one of the other doctors has a reputation for being lazy and letting others cover her work. Rank in order the following actions in response to this situation. A Initiate a team discussion to set down ground rules, divide the work and agree everyone’s individual contribution. Work with the other members of the team and accept her non-engagement in the task. Make sure she has work to complete towards the task and keep checking progress with her. Discuss your concerns with the other members of the team and ask for their help in getting her involved. NATIONAL RECRUITMENT OFFICE FOR GENERAL PRACTICE TRAINING
PROFESSIONAL DILEMMA QUESTIONS:

Multiple Best Answer
In these questions you will be presented with scenarios followed by a number of possible options.
For each scenario select the options which together are the most appropriate response to the
situation given the circumstances described.
You will be asked to choose two or three options. You will be shown how to make your selection
before the test begins.
Example C

You are looking after Mrs Sandra Jones, who is being investigated in hospital. You are asked by her family
not to inform Mrs Jones if the results confirm cancer.
Choose the THREE most appropriate actions to take in this situation.
A
Explain to the family that it is Mrs Jones’ decision Ask Mrs Jones whether she wishes to know the test results Ask Mrs Jones whether she wishes you to inform the family Inform Mrs Jones that her family to not wish her to have the results Give the results to the next of kin first
Suggested responses for Example C
As Mrs Jones is the patient it is her decision whether she should hear her results, not the family’s. Indeed,
it is Mrs Jones choice whether the family should be informed of the results at all. This should be explained
to the family. Therefore the correct responses are C, D and E. Together these actions are the most
appropriate response to the situation.
Here are some more examples of multiple best answer questions for you to try. (Answers are
NOT available)
A woman due for discharge after surgery for an ectopic pregnancy asks to speak to a doctor about her
future fertility.
Choose the TWO most appropriate actions to take in this situation
A
Tell her she is at increased risk of an ectopic pregnancy and requires early assessment in future pregnancies Reassure her that her future fertility might not be affected Give a gynaecology follow up appointment for 12 months if she does not get pregnant Reassure her that one of your friends had an ectopic pregnancy but subsequently had a normal pregnancy within a few months NATIONAL RECRUITMENT OFFICE FOR GENERAL PRACTICE TRAINING
A patient has a history of drug abuse and has been in and out of prison over the past 3 years. He has been
trying to obtain a prescription for diazepam. You are a Foundation Year 2 (FY2) doctor in general practice
and he has been booked into your surgery as an extra patient. He is a large man with many tattoos.
Choose the THREE most appropriate actions to take in this situation.
A
Give the patient a prescription for a small amount of diazepam See the patient and explain that you are not allowed to prescribe the diazepam as it is against the practice prescribing policy See the patient and explain that he needs to provide a urine specimen for a toxicology screen before you can prescribe diazepam Provide a prescription for the same dose and quantity that the last doctor provided Tell the reception staff that you will not see this patient as an extra Tell the reception staff that you will only see this patient as an extra if you have a chaperone. Arrange for the patient to be reviewed in a day or two by a partner*
* Senior Colleague

You are asked by the nurse in charge to assess an agoraphobic patient who wants to self-discharge. He is
on the ward, part-way thorough investigations for lung cancer. He is extremely agitated and anxious, to the
point of aggression. Nursing staff are starting to feel a little threatened.
Choose the THREE most appropriate actions to take in this situation
A
Explain it is normal to be anxious and upset about a possible diagnosis of lung cancer Explain how important it is that the tests are completed Explain that if he leaves he could be putting himself at risk
You feel very upset after a performance assessment (mini CEX) with your clinical supervisor on the ward.
You feel that your supervisor was rude and undermined you in front of the patient.
Choose the THREE most appropriate actions to take in the situation.
A
Speak to your clinical supervisor about how you feel Apologise to the patient for the behaviour of your supervisor Wait until you are calmer to take any action Speak to you programme director as soon as possible Reflect on whether you can learn from the feedback Discuss your supervisor’s behaviour with your colleagues Behave normally so that your supervisor does not realise that you are upset. NATIONAL RECRUITMENT OFFICE FOR GENERAL PRACTICE TRAINING
CLINICAL PROBLEM SOLVING
Clinical Problem Solving questions will be drawn from the following topic areas:
• Infectious disease / Haematology / Immunology / Allergies / Genetics NATIONAL RECRUITMENT OFFICE FOR GENERAL PRACTICE TRAINING
CLINICAL PROBLEM SOLVING QUESTIONS:

The example questions that follow illustrate two of the question formats that may be used. Other
question formats may also be used when appropriate. You will be shown how to make your
selection before the test begins. Answers for these example questions are NOT available.

Q1. A 25 year old woman has a muco-purulent discharge, pelvic pain, cervicitis and urethritis. Which is the
SINGLE most likely cause of her symptoms? Choose ONE option only.

Q2. A 55 year old, obese mn ws recently diagnosed with type 2 diabetes mellitus. He has been treated with
a 3 month trial of lifestyle modification of diet, exercise and smoking cessation. At 3 months his HbA1c
remains greater than 7% and he has not lost weight. Select the SINGLE most appropriate management
option form the list below. Choose ONE option only.
Reduced Vision

For each patient below, what is the most likely diagnosis? Select ONE option only from the list above.
Each option may be selected once, more than once or not at all.

Q3. A 75 year old man, who is a heavy smoker, with a blood pressure of 170/105, complains of floaters in
the left eye for many months and flashing lights in bright sunlight. He has now noticed a “curtain” across his
vision.

Q4. A 60 year old woman complains of shadows that sometimes obscure her vision for a few minutes. She
has felt unwell recently with loss of weight and face pain when chewing food.

Q5. A 45 year old woman, who is a heavy smoker, with blood pressure of 170/110 complains of impaired
vision in the right eye. She has difficulty discriminating colours and has noticed that her eye aches when
looking to the side.
NATIONAL RECRUITMENT OFFICE FOR GENERAL PRACTICE TRAINING Joint Pain

For each patient below, what is the most likely diagnosis? Select ONE option only from the list above.
Each option may be selected once, more than once or not at all.

Q6. A 50 year old woman has dry eyes and widespread joint pain. She has a positive rheumatoid factor.

Q7. A 35 year old man has an acutely painful, hot, swollen knee. He is afebrile with a normal blood count.

Source: http://www.gprecruitment.org.uk/downloads/Example%20questions%20Stage%202%20assessment%202011.pdf