100 Dilemma Question Msra

GPST STAGE 2
Professional Dilemmas
Dilemmas
FOR GPST/GPVTS ENTRY
4th Edition
Olivier Picard (CiSCMEDICAL

Gail Allsopp Interview Skills Consulting
Published by ISC Medical
97 Judd Street, London WC1H 9JG
www.iscmedical.co.uk - Tel: 0845 226 9487
4th edition: ISBN13: 978-1-905812-22-6

A catalogue record for this book is available from the British Library.
1st Edition: December 2006

2nd Edition: October 2007
3rd Edition: June 2008
This Edition: November 2011
© Interview Skills Consulting Limited 2006-2011. All rights reserved.

No part of this publication may be reproduced, stored in a retrieval
system, or transmitted in any form or by any means, electronic,
mechanical, photocopying, recording or otherwise, without prior
permission of the publishers.
Printed in the United Kingdom by:

Purbrooks Ltd, Gresham Way, Wimbledon Park, London SW19 8ED
The authors have, as far as possible, taken care to ensure that the
information given in this text is accurate and up to date. However,
readers are strongly advised to confirm that the information with
regards to specific patient management complies with current
legislation, guidelines and local protocols.
The information within this text is intended as a study aid for the
purpose of the GPST/GPVTS selection examinations. It is not
intended, nor should it be used as a medical reference for the direct
management of patients or their conditions.
2
CONTENTS
A Introduction 6
B Worked Examples 9
C Practice Scenarios 13
Scenario 1 – Late colleague 13

Scenario 2 – Petty theft on the ward 14
Scenario 3 – Sick colleague 15
Scenario 4 – Drug error 16
Scenario 5 – Delayed colleague 17
Scenario 6 – Epileptic taxi driver 18
Scenario 7 – Work/Life interference 19
Scenario 8 – Colleague and drugs 20
Scenario 9 – Drunk consultant 21
Scenario 10 – Prescribing for a friend 22
Scenario 11 – Late colleague 23
Scenario 12 – Work/Life interference 24
Scenario 13 – Emergency during meeting 25
Scenario 14 – Colleague and drugs 26
Scenario 15 – Patient confidentiality 27
Scenario 16 – Gift from patient 28
Scenario 17 – Patient confidentiality 29
Scenario 18 – Inappropriate patient/doctor contact 30
Scenario 19 – Racist patient 31
Scenario 20 – Emergency in busy setting 32
Scenario 21 – Difficult nurse 33
Scenario 22 – Non-English-speaking patient 34
Scenario 23 – Gift from patient 35
Scenario 24 – Inappropriate patient/doctor contact 36
Scenario 25 – Sick colleague 37
Scenario 26 – Sexual harassment 38
Scenario 27 – Drug error 39
Scenario 28 – Colleague burning out 40
Scenario 29 – New patient on methadone 41
Scenario 30 – Colleague caught in a lie 42
Scenario 31 – Doctor watching child pornography 43
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Scenario 32 – Doctor watching adult pornography 44
Scenario 33 – Nurse flirting at Christmas party 45
Scenario 34 – Nurse taking antibiotics for personal use 46
Scenario 35 – Colleague leaving shift early 47
Scenario 36 – Tramp outside A&E 48
Scenario 37 – consultant in poorly-led arrest call 49
Scenario 38 – Public humiliation by consultant 50
Scenario 39 – Colleague taking a sip of alcohol 51
Scenario 40 – Misfiled DNR order 52
Scenario 41 – 17-year-old patient with bruises 53
Scenario 42 – Often unreachable registrar 54
Scenario 43 – Demanding patient 55
Scenario 44 – Call from the press 56
Scenario 45 – Using patient notes for audit 57
Scenario 46 – Colleague with bad body odour 58
Scenario 47 – Receptionist in improper conversation 59
Scenario 48 – Inappropriate demand from consultant 60
Scenario 49 – consultant asking for backdating of notes 61
Scenario 50 – Patient confidentiality on ward 62
Scenario 51 – Patient confidentiality with partner 63
Scenario 52 – Personal integrity 64
Scenario 53 – CCU emergency 65
Scenario 54 – Alternative medicine 66
Scenario 55 – Interpreter 67
Scenario 56 – Breaking bad news 68
Scenario 57 – Certification of death 69
Scenario 58 – Repeat prescribing 70
Scenario 59 – Victim of crime 71
Scenario 60 – Capacity 72
Scenario 61 – Consent 73
Scenario 62 – Pre-operative assessment 74
Scenario 63 – Consent 75
Scenario 64 – Euthanasia 76
Scenario 65 – Antibiotics 77
Scenario 66 – GP refusing antibiotics 78
Scenario 67 – ECG review 79
Scenario 68 – Anaemia 80
Scenario 69 – Toothache 81
Scenario 70 – Trainer problem 82
Scenario 71 – Anaphylaxis 83
Scenario 72 – Back pain 84
Scenario 73 – Surgery refusal 85
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Scenario 74 – Child neglect 86
Scenario 75 – Unexpected diagnosis 87
Scenario 76 – Wrong procedure 88
Scenario 77 – Prolonged prescribing 89
Scenario 78 – Chest pain 90
Scenario 79 – Missed diagnosis 91
Scenario 80 – Basic life support 92
Scenario 81 – Child protection 93
Scenario 82 – Diabetic patient 94
Scenario 83 – Termination of pregnancy 95
Scenario 84 – DNA 96
Scenario 85 – Hypertension 97
Scenario 86 – High INR 98
Scenario 87 – Rapid discharge 99
Scenario 88 – Admission refused 100
Scenario 89 – Change of medication 101
Scenario 90 – Screening 102
Scenario 91 – New cancer diagnosis 103
Scenario 92 – Child protection 104
Scenario 93 – Possible wrong CT scan 105
Scenario 94 – Recurrent admission 106
Scenario 95 – GP referral 107
Scenario 96 – Home visit 108
Scenario 97 – Violent patient 109
Scenario 98 – Testicular lump 110
Scenario 99 – Threatened suicide 111
Scenario 100 – Vaccination refusal 112
Scenario 101 – Prescribing for family / friends 113
Scenario 102 – Delayed referral 114
D Suggested Answers 115
5
A Introduction
Purpose of the Professional Dilemma paper

The Professional Dilemma paper (also sometimes called Situational
Judgement Test or SJT) forms part of Stage 2 of the GPST recruitment
process. It is used to assess your ability to use your judgement in resolving
problems in a work-related situation. It is designed to test generic
competencies as opposed to clinical or technical skills and therefore a good
dose of common sense is required instead of strong clinical knowledge (which
is tested in the first Stage 2 paper: Clinical Problem Solving, through MCQs
and EMQs).
The competencies tested are all those listed in the National Person
Specification for the GP selection process, but with a specific emphasis on the
following:
 Empathy & Sensitivity

Your ability to take on board other people’s perspectives and to handle
other people, whether patients or colleagues, with care, attention and
understanding.
 Coping with Pressure

Your ability to recognise your own limitations and deal with pressure and
stress by developing appropriate coping mechanisms.
 Professional Integrity
Your willingness to take responsibility for your own actions and to respect
others.
The full National Person Specification can be found on the national GP

recruitment website at http://www.gprecruitment.org.uk.
6
Two styles of Professional Dilemma / SJT questions
Professional Dilemma questions usually come in two distinct formats, both of
which are used in the GPST selection paper.
 Type 1: Ranking possible actions

You are given a scenario which highlights a particular problem or dilemma.
The question sets out five or more possible actions that you may envisage
taking. Your task is to rank these options from the most suitable to the
least suitable.
 Type 2: Selecting multiple appropriate actions

You are given a scenario which highlights a particular problem or dilemma.
The question sets out a large number of options (typically seven). Out of
the list, you must pick the one, two or three actions that you deem most
suitable. There is no need to rank them in any particular order.
See Section B for worked examples of each type of SJT question.
Answering the questions

All questions must be answered from the perspective of a junior trainee doctor.
Typically the professional dilemma paper will contain 50 to 60 questions that
you will need to answer in 110 minutes. This makes it an average of 2 minutes
per question. Although this seems a lot at first glance, in reality many people
run out of time, not least because the scenarios and possible options take
some time to read, but also because each question requires a degree of
analysis which may take you well beyond the average allocated time. In many
ways, Professional Dilemma / SJT questions are testing your instinctive
reactions and therefore favour those candidates who naturally match the
desired criteria for entry into General Practice – after all, this is the primary aim
the examiners are seeking to reach. Nevertheless, with a little practice,
everyone can gain an understanding of how the questions are structured and
the level of answer required.
Marking Scheme
Unlike MCQs or EMQs, where there is a clear correct answer that you must
find in order to score, the marking of professional dilemma questions is done
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in relation to the distance between your answer and the “benchmark” answer
specified by the examiners through consensus.
In simple terms, all exam questions are attempted by several GPs/examiners,

their answers (which may vary from one examiner to the next) are carefully
recorded and a consensus agreed between them on what constitutes the
“correct” answer for each of the questions. For each question, your answer is
then compared to the “consensus” answer. If it matches, then you score the
maximum possible mark. If it doesn’t match, then you either score “nil” or
partial marks if your answer is close enough to the consensus answer or not.
So, for example, the ideal answer may be ABCDE, but the panel may have
concluded that an answer such as ACBDE could also work, but would attract a
slightly lower score.
This marking system reflects the fact that, although there is an ideal answer, in
many cases it would not be totally wrong to take a slightly different approach.
It therefore offers more flexibility and helps distinguish between the candidates
who got it totally wrong and those who are not far away from the desired final
answer. In any case, your aim should be to match the benchmark answer
exactly in order to maximise your personal score.
Such marking scheme means that, in some cases, you may feel that you have
given an appropriate answer (and indeed it would also be considered
appropriate by many doctors) but could end up scoring low simply because
your answer does not quite match what most other doctors would do in the
situation set out in the question. For that reason, it is important that you
understand exactly the principles which are underlying each answer, and not
just treat the exercise as a true or false question and answer session.
To assist you in this task, in this book you will find:
 2 worked examples (one for each type of scenario)

 Over 100 practice scenarios dealing with a wide range of dilemmas
 Fully explained answers for all scenarios.
Good luck with your preparation.
Olivier Picard & Gail Allsopp
8
B Worked Examples
Worked Example 1
You have just finished a long 12-hour medical take and you are feeling
washed out. You need to send an application form for your next post by
tomorrow and you realise far too late that it will take you a good 5 hours
to complete it. It is already midnight and you have a busy shift tomorrow
which starts at 8 am. What do you do?
Rank in order the following actions in response to this situation

(1= Most appropriate; 5= Least appropriate):
A. Forget the application form. There is nothing that you can do about it.
B. Call your registrar first thing in the morning to see if you can get some
time off to finish the form. You can then go to work in the afternoon.
C. Complete the form until 5am and then go to work at 8am.
D. Copy the answers from a form that your friend did last year and which got
him through.
E. Call in sick the next morning and do the form properly.
Suggested answer: 1:B – 2:A – 3:E – 4:C – 5:D
How to approach this question

Option A seems a sensible approach but then you will lose out (admittedly by
your own fault, but there may be a way around it).
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Option B seems sensible too. You are involving your senior. You are taking a
gamble because he might refuse but if he does then you will be no worse off
than under option A anyway. At least you will have tried to find a solution by
using the appropriate channels. This shows good insight and also a good
approach to team work.
Option C would only give you 3 hours’ sleep and would be unsafe.
Option D is plagiarism.
Option E would be lying and is therefore dishonest.
From this you can deduce the following:
 A and B are the two most sensible options with B being better than A
because it may achieve the desired result in the most acceptable manner.
A is just giving up when there may be an alternative which would satisfy
most people.
 There is a grey area with C and E. Staying up late when you are already
tired and then going in with little sleep could be potentially dangerous for
patients. On the other hand, lying is also unacceptable. Faced with two
bad options you must think about the consequences of both. Going to
work whilst tired may be fatal for a patient. In addition, your team will be
relying on you to be fully performing when you may not be. On the other
hand, lying may look bad but at least you are not compromising patient
safety. Also, if you call in sick, you are giving your team an opportunity to
organise itself around your absence and to optimise patient care. In
conclusion, neither C nor E are really acceptable but E must be better than
C purely on the grounds of patient safety. You might be forgiven for lying
to your team but you risk being struck off for placing a patient in danger.
We have now identified that B and A are the top two options in that order and
that E and C are two of the bottom options in that order. This gives us the
sequence B – A – E – C. The only outstanding issue is where D should fit.
Option D is a grave offence which would potentially be punished by being

struck off the Register. No excuse that you could give would justify your
behaviour. Option C as discussed earlier is potentially unsafe, with the
emphasis being on the word “potentially”: provided you remain alert and
recognise a situation when you have become unsafe, then it may just about be
acceptable (and you still retain the option to go home later if you are too tired).
Therefore D must be worse than C.
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Worked Example 2
During a very busy shift, the relatives of a recently deceased patient
want to see you to discuss “things”. What do you do?
Choose the THREE most appropriate actions to take in this situation:
A. Ask the nurse to talk to the relatives to get an understanding of the type of
“things” that they want to discuss so that you can be fully prepared when
you see them.
B. Tell the nurse to let the relatives know that you are aware they are
waiting, that you are busy right now but that if they go home you will call
them as soon as you are free.
C. Ask one of your juniors to talk to the relatives, to let them know that you
cannot see them because you are busy, and to deal with any queries.
D. Tell the nurse that you will only grant the relatives 5 minutes and no more
as you are busy.
E. Inform your registrar that you need to see the relatives and ask him
whether he can cover for you.
F. Tell the nurse to send the relatives to PALS as your involvement with the
patient is over.
G. Tell the nurse to find an excuse to send the relatives home as the patient
is dead and the matter is therefore less important than the patients that
you are currently dealing with.
Suggested answer and approach

Here are some issues that should cross your mind when reading this scenario:
A – You are using another team member appropriately; the nurse is already
with the relatives and it makes sense that you may want to know more about
the relatives’ request in order to ensure that you can have the relevant
information ready when you do meet with them eventually.
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B – This may be a little inconvenient for the relatives as they would obviously
prefer to get answers straight away. But you are being honest with them and
there is a feeling that you want to get their queries resolved even if it is only on
the phone.
C – This is potentially placing your junior in a difficult situation and it also looks
a little like you are trying to pass the buck. But this is a possibility.
D – This places the nurse in a difficult position. It is also a fairly aggressive

stance.
E – Talking to your registrar may help you identify a good way around the
problem. Also, if you need to go and see the relatives, then this option will
make the registrar aware of the situation and the team will be able to deal with
your temporary absence.
F – PALS won’t be able to deal with the relatives’ queries. They will only
encourage the relatives to contact you so it will defer the problem. It may
sound like a good tactic in the short term but it is really unhelpful. In any case,
you should consider it part of your duty to deal with the relatives, particularly if
you have been dealing with the patient before his death.
G – This is rude both to the relatives and to the nurse, whom you will place in
a difficult position.
There are therefore four possible candidates for the most appropriate actions:
A, B, C and E. We need to eliminate one: it will be C because of the potential
difficulty to which you will be exposing your junior colleague.
The answer is therefore A, B and E. (Note that these do not need to be

ranked.)
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C Practice Scenarios
Scenario 1
A patient has complained to you that a small amount of cash has
disappeared from his bedside table.
What do you do?

A. Organise a team meeting and ask the culprit to replace the money as soon
as possible.
B. Call the police. Theft is a criminal offence.
C. Ask the patient for details about the alleged theft, reassure him that you
will do what you can to deal with the issue, and notify a senior nurse of the
problem.
D. Send an email to all your colleagues notifying them of the incident and
asking them to warn their patients to be careful about personal
possessions.
E. Remind the patient that he should have been more careful about his
possessions and tell him that you will see what you can do.
13
Scenario 2
You are working on a busy ward, having to deal with many admissions
every morning.
You share the workload with another junior colleague who has been
constantly late by 20 minutes for the past week.
What do you do?
A. You call your colleague’s wife to see whether your colleague has personal
problems which may explain his delay.
B. You arrange a discussion with your colleague, express your discontent

and tell him to make sure that he comes on time as his delay is slowing
you down.
C. You arrange a discussion with your colleague to enquire about the

reasons behind the delay.
D. You work harder to compensate for his absence, in the knowledge that his
delay is likely to be short term.
E. You discuss your concerns with a group of nurses from your ward to gain
insight into his behaviour at work.
F. You mention the delay to your registrar and ask him whether he can deal
with it.
G. In order to avoid confrontation with the colleague you do nothing for the
time being, knowing senior colleagues will soon notice his behaviour.
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Scenario 3
After a long day, the SHO who was meant to take over from you has
called in sick 10 minutes before the end of your shift, just as you were
supposed to hand over to him.
You had arranged to go out with friends that evening and they are
expecting you in 2 hours’ time.
What do you do?

A. Do your colleague’s shift for him. He can then take on one of your shifts
when he gets back.
B. Stay for two hours and hand over to the registrar on call afterwards.
C. Contact the registrar on call to hand over to him and go home to prepare
for your evening.
D. Contact the registrar on call to hand over to him, offer to stay behind for a
couple of hours and join your friends later.
E. Explain to your colleague that this places you in a difficult position, offer to
stay for an hour and ask him to come in an hour’s time to take over as you
cannot stay any longer.
15
Scenario 4
During a ward round, your consultant prescribes penicillin on a drug
chart whose allergy box has been left blank by the admitting doctor. The
patient’s hospital notes clearly state a penicillin allergy.
Having spotted the discrepancy, the nurse brings you the chart a short
while later to cross off the penicillin and prescribe an alternative.
What would you do subsequently?
A. You contact a senior nurse and express concerns at the fact that the
allergy was not mentioned on the drug chart.
B. You discuss the incident with your consultant and complete a critical
incident form.
C. You inform the patient that you have correctly identified he is allergic and
that you will get back to the consultant to discuss how the
misunderstanding took place.
D. You organise a meeting with your consultant to discuss the reasons

behind his decision to prescribe penicillin when the notes clearly showed
that the patient was allergic.
E. You organise a team meeting to discuss the problem and to give the
person responsible a chance to explain why the incident happened.
F. You bring the issue up at the next junior doctors’ meeting without
mentioning the name of the offending doctor.
G. You report the admitting doctor to a senior pharmacist for possible

escalation of the matter and retraining.
16
Scenario 5
After a 13-hour day, you are waiting for the arrival of your colleague so
that you can hand over to him. You are exhausted because you have just
switched over from a week of nights and you are starting to feel sleepy.
Your colleague is already 15 minutes late and has not called to say that
he is ill.
What do you do?
Rank in order the following actions in response to this situation (1= Most
appropriate; 5= Least appropriate):
A. Inform your registrar that you are too tired to stay and that you need to
leave immediately because you cannot function effectively.
B. Go and see your consultant and let him know that, because you are in
breach of the 13-hour limit imposed by the European Working Time
Directive, you will hand over to him before leaving.
C. Patiently wait for your colleague and cover his shift until he arrives.
D. Hand over to a nurse and leave the hospital.
E. Contact your colleague to see what the matter is and how long the delay
is likely to last.
17
Scenario 6
One of your patients, a taxi driver, has recently been diagnosed with
epilepsy. Before discharge, you made him aware of his duty to inform
the DVLA. You have also made it clear to him that he should not be
driving at this current time.
On a shopping trip to town, you see him at the wheel picking up a

passenger.
What do you do?

A. Report the matter to his boss
B. Call the patient to express your concerns and organise a meeting with him
to discuss the incident.
C. Call the patient’s wife to express your concerns and enlist her help to stop
the patient from driving.
D. Report the matter to the DVLA.
E. Send a letter to the patient warning him that you will report him to the
DVLA next time you see him pick up a customer.
18
Scenario 7
You have arranged to go out for dinner with your partner tonight.
Just before leaving your shift you have been informed that a junior
doctors’ teaching session that was meant to take place tomorrow
morning has now been brought forward and starts in 10 minutes.
What do you do?

A. Tell another junior doctor to apologise to the group for your absence.
B. Find out what the meeting is about and discuss with the person running
the meeting whether your attendance is strictly necessary as you have
organised a dinner with your partner.
C. Slip away unnoticed.
D. Tell a nurse to let the organiser know that you cannot make it.
E. Call your partner and inform him/her that you cannot make the dinner as
you must attend an important teaching session.
19
Scenario 8
During a discussion with a fellow junior doctor in the mess, you notice
that a bag of marijuana has fallen out of his bag.
What do you do?
Choose the THREE most appropriate immediate actions to take in this

situation:
A. Inform the GMC as it is not appropriate for any doctor to take drugs since
it can endanger patients.
B. Call the police as marijuana is an illegal substance.
C. Recommend that your colleague considers professional help.
D. Have a discussion with your colleague about the incident to understand

what the situation is.
E. Seek his reassurance that he is not using the drug, and tell him that you
will keep quiet about the incident if he flushes it down the toilet.
F. Discuss the incident with your registrar.
G. Report the incident to the Clinical Director.
20
Scenario 9
One of your consultants came in this morning obviously drunk.
You have advised him to go home but he has dismissed you and is
about to start his regular clinic.
What do you do?
A. Call the GMC to warn them of the problem.
B. Discuss cancelling the clinic session with the outpatients administrator /

clinic manager.
C. See another consultant to discuss the situation.
D. Let the consultant run the clinic and ask him to contact you if at any point
he feels unable to continue running the clinic so that someone else can
take over.
E. Insist that the consultant should only see patients with a chaperone.
F. Sit in the clinic with the consultant yourself to ensure that patients are
safe.
G. Complete a critical incident form.
21
Scenario 10
One of your friends, who is asthmatic and works as an engineer, is
going on holiday to Europe tomorrow. He has forgotten to order a repeat
prescription for his inhaler.
He is asking you whether you can help in any way.
What do you do?

A. Tell him to go to his nearest A&E.
B. Get an inhaler from A&E yourself.
C. Get an inhaler from the ward.
D. Ask him to contact his GP.
E. Write a prescription for him.
22
Scenario 11
One of your colleagues arrives consistently late for his shifts.
What do you do?

A. Tell their senior about the delays.
B. Discuss the problem with other junior doctors.
C. Approach your late colleague, tell him that his lateness is causing
problems and that he must be on time.
D. Ask your colleague if there is a reason for being late and whether there is
anything you can do to help.
E. Make a record of the lateness and watch and wait.
23
Scenario 12
A colleague asks you to review one of his patients as he is busy on the
ward.
This means that you will have to stay late but it is already 5pm and you
are about to go out with your family, who have come to collect you.
What do you do?

A. Agree to see the patient and tell your family to go home.
B. See the patient quickly and ask your family to stay in the waiting room.
C. Ask your colleague to hand over the job to the SHO on call.
D. Contact the SHO on call yourself and hand over the job
E. Tell your consultant to see the patient.
24
Scenario 13
You are about to give a case presentation to your department when a
nurse bleeps you for an emergency on the ward.
What do you do?

A. Go straight away without telling anybody.
B. Tell the nurse that you cannot attend the patient but that you will go after
the meeting.
C. Ask a colleague to attend the ward.
D. Cancel the teaching session and attend the emergency.
E. Apologise to the team at the meeting and ask a colleague to fill in while
you find out more information and see if you need to attend at once.
25
Scenario 14
One of your colleagues confides in you that he has a cocaine addiction
problem.
He is asking you to keep the information to yourself as he needs your

support and no aggravation.
What do you do?

A. Tell your colleague that you have no option but to report the matter to a
senior straight away.
B. Reassure your colleague that you will support him but tell him that he
needs to address the matter with his seniors, otherwise you will have no
option but to tell them yourself.
C. Report the matter to a consultant without telling your colleague that you
have done so.
D. Agree with your colleague and keep quiet about it.
E. Investigate whether your colleague has performance problems and report

the matter to the consultant if he has any.
26
Scenario 15
A patient has revealed to you that they have a history of taking illegal
substances.
They are begging you to delete any mention of drug-taking from the
notes as it could compromise their medical insurance if the information
ever came to light.
What do you do?
A. Reassure the patient that you are bound by a duty of confidentiality and
you simply cannot divulge any information about them to a third party
without their consent.
B. Tell the patient that you cannot guarantee his confidentiality but that you
will inform him first if you need to breach it.
C. Tell the patient that you simply cannot delete any information from the
notes.
D. Delete the information from the notes.
E. Delete the information from the notes if it has no relevance to the patient’s
current health problems.
F. Tell the patient that you will have to reveal the information if asked by the
insurance company.
G. Contact the insurance company naming the patient, inform them of the
issue and ask for advice.
27
Scenario 16
A young patient, whom you have been treating on your ward for the first
time, offers you a £100 book voucher to thank you for your help in their
recovery on your ward.
During their short admission your only contact with the patient was with
the team during ward rounds. You do not expect the patient to come
back for another stay on your ward.
What do you do?

A. Tell the patient that you cannot accept the gift because it would not be
ethical.
B. Accept the gift and give it to your wife/husband/partner.
C. Accept the gift and put it towards ward funds.
D. Politely refuse the gift because their recovery is the best recompense for
you.
E. Accept the gift but tell the patient not to let any of the team know as you
do not want any trouble.
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Scenario 17
You are dealing with a ward patient whose wife’s best friend works on
your ward as a nurse.
The patient has asked you specifically to ensure that no information

about his health should be given to the nurse in question so that his wife
cannot gain information about his health.
What do you do?

A. Inform the patient that there is nothing that you can do about it and that
they will need to put up with the situation as it stands.
B. Have a word with the rest of the team to ensure that the patient’s
confidentiality is maintained.
C. Tell the nurse that she must take some time off whilst the patient is in the
ward so as not to compromise his right to confidentiality.
D. Have a word with the patient to understand the reasons behind his
request and see if there is a possible compromise that can be reached.
E. Transfer the patient to another part of the ward where the nurse does not
work.
29
Scenario 18
During a clinic run by your consultant, you walk into the room and find
the consultant with his arms around the patient’s shoulder.
What do you do?

A. Assume that there must be a reasonable explanation for the situation and
ignore the issue.
B. Ask the patient to leave the room so that you can have a word with the
consultant.
C. Report the matter to the Clinical Director.
D. Have a word with the consultant after the patient has left and ask him
about the circumstances.
E. Seek advice from the registrar who is running the clinic next door.
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Scenario 19
During a late-running clinic, one of your colleagues is reduced to tears
after receiving racist remarks from one of the patients in anger at the
delay he is experiencing.
Your colleague is distressed and has told you that she does not want to
see that patient.
What do you do?

A. Tell the patient to go home and to book another appointment with another
doctor once he has calmed down.
B. Agree to see the patient and explain to the patient at the start of the
consultation that what he did was unacceptable.
C. Tell the patient that he will be seen but by a different doctor and that he
will need to wait until one of them is free. If he does not like this, he has
the opportunity to rebook another appointment.
D. See him yourself and make sure that his appointments are scheduled
early on the list in future.
E. Tell your colleague to see the patient, as she should learn to handle such
situations by herself.
31
Scenario 20
You work in a GP practice and you require an ECG urgently for a patient
who is experiencing chest pains.
There is one ECG machine in the practice but it is new and you simply
have not had time to learn how to use it. Only one of the nurses knows
how to operate the machine and she appears to be busy with a patient at
present.
What do you do?

A. Search for the instructions in the supply cupboard.
B. Interrupt the nurse and ask if she is able to carry out the ECG straight
away.
C. Using your experience of previous models, perform the ECG yourself.
D. Call an ambulance and send the patient to A&E.
E. Send the patient home and ask him to call you if the pain gets worse.
32
Scenario 21
You work in a GP practice and you require an ECG urgently for a patient.
There is one ECG machine in the practice but it is new and you simply
have not had time to learn how to use it. Only one of the nurses knows
how to operate the machine.
When you asked the nurse to carry out the ECG, she replied in an angry
tone that she was too busy when, in reality, she was simply doing some
filing. With no other alternative, you sent the patient to A&E.
What do you do next?
A. Inform the nurse that she compromised the safety of the patient, ask for
an explanation and explain that you will need to inform the head of the
practice next time such an incident takes place.
B. Bring this up at the next management meeting to see if anyone else has
experienced that problem and whether any personnel matters should be
attended to.
C. Organise for training for yourself and the rest of the team on the ECG
machine.
D. Organise a discussion with the nurse to understand the basis of her

behaviour.
E. Report the incident to the head of the PCT.
F. Write to the patient informing him that he can make a complaint if he

wants to.
G. Send an email to all your colleagues asking them to watch out for that
nurse as she may cause problems.
33
Scenario 22
A 25-year-old pregnant Indian woman who cannot speak English
presents to your GP surgery accompanied by her father.
The father tells you that his daughter would like to have a termination of
pregnancy.
What do you do?

A. Ask the father to interpret for his daughter.
B. Obtain an interpreter and discuss the situation with the patient and her
father.
C. Obtain an interpreter and ask the father to leave the room so that you can
talk to the patient alone.
D. Ask the father if someone else from the family could interpret for the
daughter.
E. Attempt to talk to the daughter through the use of diagrams and other
non-verbal means.
34
Scenario 23
Mrs Smith is a 70-year-old lady who has been your patient for over 30
years and whom you see regularly throughout the year.
She gives you a standard bottle of your favourite drink for your birthday.
What do you do?

A. Refuse the gift because it is against regulations.
B. Graciously accept the gift, telling the patient that it is kind of her.
C. Accept the gift but make sure that the practice manager is aware of it.
D. Accept the gift but tell the patient that it has to be the last time.
E. Refuse the gift but double-check with your defence union afterwards.
35
Scenario 24
In a clinic, a female patient mentions that, during her previous
consultation, one of your colleagues examined her breasts. This seems
odd to you as there is nothing mentioned in the notes.
What do you do?

A. Ask the patient about the circumstances surrounding the examination and,
after the consultation, ask your colleague for further details on the issue.
B. Tell the patient that this might constitute an assault and explain the
complaint procedure to her.
C. Say nothing to the patient and report the incident to the Clinical Director.
D. Seek advice from a trusted senior colleague.
E. Contact the GMC.
36
Scenario 25
Another junior doctor on your team confides in you that he has
contracted Hepatitis C during his previous job and needs your advice.
He would appreciate that you keep the matter confidential.
What do you do?
A. Inform the Personnel/Medical Staffing department.
B. Refer your colleague to Occupational Health to be vaccinated.
C. Discuss the matter with a senior colleague.
D. Discuss the situation with a senior colleague if you see that your
colleague performs risky procedures.
E. Ask a senior sister to alert you if he is doing any exposure-prone

procedure.
F. Recommend to your colleague that he should get advice from his defence
union.
G. Recommend to your colleague that he should discuss the matter with his
seniors.
37
Scenario 26
You have noticed that one of the consultants on your team is often
making remarks of a sexual nature to one of the secretaries. On the
surface she does not seem to be affected by this.
What do you do?
A. Encourage the secretary to check the staff manual to determine what

action she should take.
B. Let the secretary know that you have observed the consultant harass her
and that she should raise the issue with her seniors.
C. Arrange a discussion with the consultant in question to let him know that
such behaviour must stop.
D. Approach a senior colleague that you can trust to discuss the matter.
E. Contact the GMC, who will handle the situation from then on.
F. Inform the HR or personnel department.
G. Wait until the next incident to mention something to the consultant about
how inappropriate his remark was.
38
Scenario 27
In the past few minutes, you have flushed an intravenous cannula with
lidocaine instead of saline. The patient does not seem to be
experiencing any adverse reaction.
What do you do?
A. Tell the patient that you have made a mistake, apologise and offer the
means to make a complaint if he so wishes.
B. Bleep your registrar for information and further advice.
C. Wait 5 more minutes and if the patient is fine then do not take any further
action.
D. Write the mistake in the notes but do not notify the patient as there was no
adverse reaction.
E. Tell the patient that you have injected a bit of local anaesthetic (which is a
procedure that is sometimes carried out) so as to be open but not to worry
him.
F. Explain to the patient that you have made a mistake caused by wrong
labelling, which is the nurse’s responsibility. Give the patient the means to
make a complaint against the nurse if he so wishes.
39
Scenario 28
Your registrar looks permanently tired. You know that he has been
working very hard over the past few months.
He seems to be burning himself out and makes simple mistakes every

day, though none have actually had any adverse effect on patients so
far.
What do you do?
A. Approach the registrar and express your concerns about his health and
the simple mistakes that he has been making.
B. Inform the registrar that all mistakes, even small, are a danger to patients
and that you will have no choice but to talk to the consultant if the situation
does not improve.
C. Discuss with your registrar the possibility to take on some of his work.
D. Encourage the registrar to raise the issue with his consultant to find a
workable solution to the situation.
E. Contact Medical Staffing to see if they can get a locum to relieve the
pressure on the registrar.
F. Inform Occupational Health and encourage them to contact the registrar

before it is too late.
G. Complete a critical incident form the next time a mistake occurs.
40
Scenario 29
You are a GP and you are seeing a newly registered patient, a 30-year-
old heroin addict who is asking for methadone. The patient’s notes have
not arrived from his previous practice.
What do you do?

A. Ask the patient which dose he normally takes and prescribe one dose
only.
B. Send the patient to A&E.
C. Tell the patient that you cannot prescribe any controlled drugs until his
notes have arrived.
D. Call his previous GP, check the normal dose previously prescribed and
prescribe one dose to the patient.
E. Prescribe the patient one week’s worth of an average dose of methadone

and call his GP to ensure that his notes reach you within one week.
41
Scenario 30
One Friday morning, one of your colleagues calls the ward from his
home and says that he will not be coming in as he is feeling unwell.
Subsequently, you find out that in fact he spent a long weekend abroad
with his family and was never ill in the first place.
What do you do?

A. Do nothing.
B. Tell your consultant as soon as you find out about the lie.
C. Ask the colleague in question about the situation and warn him that you
will have no option but to mention something to the consultant if this
reoccurs.
D. Discuss the matter with your fellow junior doctors.
E. Ask the colleague about the situation at the next team meeting.
42
Scenario 31
You walk into the doctors’ mess and see one of your registrars watching
child pornography on his laptop.
What do you do?

A. Nothing. He is watching the images on his private computer and therefore

it is his own business.
B. Call the police. Child pornography is illegal.
C. Send an anonymous note to your colleague saying that you spotted him
watching the images and that the consultant will be warned next time it
happens.
D. Approach a senior colleague that you can trust and let them handle the
matter.
E. Notify the HR department.
43
Scenario 32
You walk into the doctors’ mess and see one of your registrars watching
standard adult pornography on a hospital computer.
What do you do?
A. Notify Personnel as this is clearly an abuse of NHS property.
B. Tell your colleague that it is not really appropriate to watch these kinds of
images on hospital property and that he should be careful as some people
may find it offensive.
C. Discuss the situation with other junior colleagues and confront him as a
group so as to have maximum impact and make him stop.
D. Have a word with your consultant if this occurs too often.
E. Have a word with your consultant if the registrar’s performance is affected

by his activities.
F. Contact the IT department so that they can monitor the computer’s

activities.
G. Notify the police.
44
Scenario 33
One of the nurses you used to work with on another ward tells you that
one her colleagues was very drunk during the Christmas party and was
heavily flirting with one of the paramedics. Her seniors were not present
at the party.
What do you do?

A. Do nothing.
B. Approach the nurse and tell her that by making a fool of herself, she acted
unprofessionally.
C. Have a word with one of her seniors.
D. Ask your consultant to have a word with one of her seniors.
E. Contact the Director of Nursing about the issue.
45
Scenario 34
You see a nurse pick antibiotics out of a drug trolley and place them in
her handbag for personal use.
What do you do?

A. Approach the nurse in question and explain that it is not best practice.
B. Report the matter to your consultant.
C. Report the matter to a senior nurse.
D. Report the matter to the Director of Nursing.
E. Write a critical incident form.
46
Scenario 35
You work with only one other junior colleague on the ward. It is 3pm and
all ward jobs have been completed.
The shift normally ends at 5pm but your colleague says that he is going
out for a birthday meal and would like to leave straight away so that he
has time to go home, get ready and drive to the restaurant.
What do you do?
A. Make sure that he has agreed it with the registrar before he leaves.
B. Let him slip away without a word so that no fuss is made.
C. Take his bleep from him.
D. Insist that he stays.
E. Tell him to clear it with Medical Staffing.
F. Make him double-check that there is nothing left to be done before he

leaves.
G. Ask him to redirect his bleep to the doctor on call for the evening.
47
Scenario 36
You leave the hospital and see a tramp on a bus stop bench just outside
A&E. He is holding an empty bottle of wine and is vomiting on the
pavement.
What do you do?

A. Walk past him and ignore him.
B. Go up to the tramp and see if he is okay.
C. Take him to A&E.
D. Go to A&E yourself and ask a member of the team to take charge of the
tramp.
E. Call 999.
48
Scenario 37
During a ward round with your consultant (your registrar is away today),
a patient goes into cardiac arrest. The arrest call has been put out and
the team has yet to arrive.
Having completed your ALS course a month ago and led several arrests
since, you are best placed to assume the role of team leader. Your
consultant has not recertified his ALS for many years but is now giving
orders that you know are inappropriate.
What do you do?

A. Ensure that only basic life support is being given while you are waiting for
the arrest team to arrive.
B. Let the consultant take over the handling of the arrest and discuss with
him later how it may be better to let colleagues more experienced with
cardiac arrest lead such situations in future.
C. Let the consultant give orders but signal to the nurses to do differently
when you feel his orders are not appropriate.
D. Reassure the consultant that you are the most experienced and up-to-
date person on the team. Then take over the leadership of the team.
E. Ask a nurse to call another consultant with cardiac arrest experience from
the adjacent ward. Let your consultant lead the arrest while waiting for the
other consultant to arrive.
49
Scenario 38
During a bedside teaching session, your consultant asks you a range of
questions, some of which you struggle to answer.
Towards the end of the session, you are left with the feeling that the
consultant is rude and has embarrassed you in front of the patient.
What do you do?
A. Contact the Human Resources department to complain about the incident.
B. Complain about the incident to a senior nurse.
C. Take some time out to think about the incident and how you might want to
react to it.
D. Argue with the consultant at the bedside so that he knows straight away
that he is being harsh on you.
E. Once the session is over, apologise to the patient about the consultant’s
behaviour.
F. Arrange a meeting with the consultant to discuss the incident.
H. Discuss the incident with your educational supervisor.
50
Scenario 39
You walk into the mess and find one of your colleagues taking a sip at a
bottle of whisky, whilst you know that his shift does not end for another
3 hours.
What do you do?

A. Let your colleague know that his behaviour makes him unsafe towards
patients and that, as a result, you will need to inform his educational
supervisor.
B. As your colleague does not appear drunk, let the matter drop without
addressing the issue with him in case he becomes embarrassed.
C. As your colleague does not appear drunk, let the matter drop but let him
know that you will need to talk to senior colleagues if you catch him again.
D. Discuss the situation with your colleague to determine the reasons for his
drinking and offer to help him out. Encourage your colleague to discuss
the situation with his seniors.
E. At the end of your colleague’s shift, organise a meeting with other junior
doctors to discuss how you can best proceed.
51
Scenario 40
You are bleeped to attend a crash call for Mr Smith who is arresting. On
reading the notes, you do not find any DNR order and proceed with CPR,
unsuccessfully.
A little while later, whilst reading another patient’s notes, you notice a
DNR order for Mr Smith, which had evidently been misfiled. The relatives
have witnessed the arrest. They are upset and are still with the patient.
What do you do?
A. Contact your consultant and complete a critical incident form.
B. Contact your consultant but complete a critical incident form only later on
when/if such misfiling happens again.
C. Let the resuscitation team know about the recently discovered DNR form.
D. Nothing, since the patient has died.
E. Talk to the relatives in a separate room.
F. Wait until your consultant comes back to talk to the relatives.
G. Inform senior managers at Trust level.
52
Scenario 41
A 17-year-old female patient presents to your surgery covered with
severe bruises. She explains that she lives with a criminal who
sometimes beats her up when he is high on drugs.
When you offer to help her out, she refuses to allow you to tell anyone
about it.
What do you do?

A. Maintain your patient’s confidentiality and do nothing.
B. Tell the patient that, unless she cooperates, you will have no alternative
but to contact social services or the police.
C. Seek advice from one of your senior colleagues about how you should
proceed.
D. Ask the girl if she would be prepared to discuss the issue with someone
from social services. If she refuses, do it anyway but without her
knowledge.
E. Contact her partner to discuss the situation with him.
53
Scenario 42
During your on calls you work with a registrar who is often unobtainable.
For the fifth time in a week, you bleeped him to review a very sick patient
urgently and he has failed to turn up.
Whenever you ask him where he has been, his only excuse is that his
bleep functions erratically and that he wasn’t aware that you had
bleeped him.
What do you do?
A. Contact your consultant to inform him about the problem.
B. Ignore the problem but make sure that whenever you require help on a
patient-related matter you seek advice from another suitable registrar.
C. Ignore the problem but make sure that whenever you require help on a
patient-related matter you seek advice from another junior doctor at your
level.
D. Initiate a meeting with your registrar to get to the bottom of the problem.
E. Ask some of the nurses whether they have heard the registrar’s bleep go
off so as to check whether he is telling the truth.
F. Complete a critical incident form.
G. Complain to a senior nurse about the problem.
54
Scenario 43
A patient presents to A&E. He is very impatient and insists on the best
possible care. You diagnose folliculitis and recommend salt water
bathing and a no-shave period.
The patient does not want to take your advice and demands to be
referred to a dermatologist for a second opinion.
What do you do?

A. Tell the patient that he will need to go back to his GP in order to be

referred to a dermatologist.
B. Reassure the patient that you are confident about the diagnosis and that
he should trust you.
C. Ask another doctor from A&E to review the patient to confirm the
diagnosis as a second opinion.
D. Tell the patient that you can refer him privately if he wants a referral to a
dermatologist.
E. Ask the patient to come back on another day to see a different A&E
doctor.
55
Scenario 44
Your hospital has recently been in the news because of an adverse
event and a phone call from a journalist is being transferred to you in the
very busy A&E department where you work.
What do you do?

A. Tell the journalist that you are confident that the hospital is doing a very
good job and that you know that everything is being done to remedy
difficult situations quickly and efficiently.
B. Tell the journalist that you cannot speak with him and put the phone down.
C. Tell the journalist that, if he gives you his contact details, you will pass
them on to the relevant person.
D. Tell the journalist to contact the Trust’s Press Officer.
E. Tell the journalist that you will call them back at the end of your shift when
you have more time to speak.
56
Scenario 45
You are doing an audit for your practice. It is Friday lunchtime and you
must present your preliminary results on Monday morning to your
supervisor. To finish the current phase of the audit you still need to
enter data from the notes of 20 patients into a database that resides on
your own laptop.
In view of your workload, you may not be able to collect all the
remaining data before the end of the day. The practice will be closed
during the weekend and you do not have the keys.
What do you do?

A. Take the patients’ notes home with you to continue the data input at home
over the weekend.
B. Make photocopies of the relevant pages of the patient notes, removing

any patient-identifiable information, and take these photocopies back
home with you to work on over the weekend.
C. Draw a quick plan of the data required on a piece of paper and quickly
collect the data needed before the practice shuts for the day.
D. Look at the average profile of the patients that you have already entered
into your database and create new patient data matching the average
profile in order to reach the number of patients discussed with your
supervisor.
E. Ask your supervisor to defer the meeting to another day, once you have
had time to complete your input.
57
Scenario 46
One of the nurses on your ward is complaining about the bad body
odour of one of your colleagues and is asking you if you could have a
word with him.
What do you do?
A. Tell the nurse that this is really an issue for the consultant to deal with and
that she should go and talk to him.
B. Go and talk to the consultant about it yourself.
C. Ask a few other colleagues whether they agree with the nurse’s view
before going to see the consultant yourself.
D. Raise the issue at a team meeting when the colleague in question is

present.
E. Raise the issue at a team meeting in the absence of the colleague in

question.
F. Raise the issue in confidence with the colleague in question.
G. Send the colleague an anonymous note asking him to sort the issue out.
58
Scenario 47
You overhear a receptionist talking to one of the regular patients in front
of other patients. She is making fun of an ugly patient who came in
earlier.
What do you do?

A. Firmly tell the receptionist to stop the discussion there and then.
B. Do nothing for the time being but raise the problem with the clinic
manager at the next occurrence.
C. Contact the clinic manager immediately, alerting them to the situation.
D. Have a private word with the receptionist once the patient has left.
E. Apologise to the other patients present and reassure them that it will not
happen again.
59
Scenario 48
You have written a case report for publication and your consultant has
recently reviewed your final draft. When he gives you his comments
back, you notice that he has added two names to the list of authors.
On enquiring, he tells you that they are his wife and his ex-registrar who
are both currently unemployed and need publications on their CV to
enhance their chances of employment. Neither were involved with the
case discussed in your paper.
What do you do?
A. Tell the consultant that you cannot publish the case reports with their
names on and that you will submit it with your name only.
B. Discuss the situation in confidence with the Clinical Director and envisage
contacting the GMC about the two other doctors.
C. Agree to add the two names to the publication as it is only a case report
and not a research paper.
D. Check with other colleagues whether something similar has happened to

them and contact the GMC about your consultant if it has.
E. Discuss the matter with the consultant in a private meeting.
F. Report your consultant to the GMC.
G. Contact the paper where the case report is due to be published to tell
them about the situation.
60
Scenario 49
Your consultant asks you to make a backdated alteration to the notes in
order to cover up for a past mistake made by the team.
What do you do?
A. Make the change requested by the consultant as you are worried that he
may give you a bad reference.
B. Refuse to make the entry.
C. Make a note of the conversation that you have had with the consultant
and contact your defence union.
D. Report the matter to the Clinical Director at the earliest opportunity.
E. Inform the patient of the consultant’s request and of the mistake made.
F. Inform the GMC.
G. Inform the police as there are potentially legal implications.
61
Scenario 50
You work as the SHO on a general surgical ward. A 20-year-old girl was
brought in earlier to A&E by her father after collapsing in the street.
She subsequently developed abdominal pains and has been accepted by

your team. She is now clinically stable and preliminary tests are
unremarkable.
Her father is on the phone to you, asking for information about his
daughter’s admission. What do you do?

A. Tell the father that you simply cannot communicate with him on any
matter relating to his daughter as this would be breaching her
confidentiality.
B. Reassure the father that his daughter is fine but that you cannot give any
further details without talking to his daughter first.
C. Explain to the father that his daughter has developed abdominal pains but
that you cannot give any further details without talking to his daughter first.
D. Explain to the father that you will need to determine whether his daughter
is competent before deciding whether you are able to release any further
details to him.
E. Hand the phone over to the registrar and ask him to handle the call.
62
Scenario 51
A woman presents to your surgery and explains that she has caught a
sexually-transmitted infection (STI). The infection must have come from
her husband since she is “faithful”.
The patient thinks that her husband came to see you recently and she
suspects that it was about an STI. In fact, he came to see you last week
and told you that he was “100% faithful” and that he might have caught
an infection from his wife.
What do you do?

A. Tell her that you got a completely different story from her husband as he
felt that he had caught his infection from her.
B. Seek advice from a colleague about how to handle the matter.
C. Tell her that the husband indeed came to see you but that you are not at
liberty to divulge the matters discussed during the consultation.
D. Tell her that you cannot discuss any issues relating to other patients,
including whether or not they have attended your surgery recently.
E. Tell her that you are facing a potential conflict of interest and that she
should register with another GP.
63
Scenario 52
You have been charged with providing a series of lectures to final year
medical students on a range of topics with which you are very familiar.
One of the students whom you know well has somehow managed to get
hold of a photocopy of the forthcoming exam papers and asks you to
make sure that you address all the relevant issues at your teaching
sessions.
What do you do?

A. Confiscate the papers and report the matter straight away to the deanery,
naming the student involved.
B. Confiscate the papers and report the matter straight away to the deanery,
withholding the student’s name.
C. Advise him to throw away the papers without looking at them.
D. Ignore the matter.
E. Inform the student that in order to maintain a fair process he will need to
make sure that all other students also have a copy of the exam papers.
64
Scenario 53
You are an F1 doctor on call covering the general medical wards.
You already have a list of things to do and receive a further call from
CCU regarding a conscious hypotensive patient. The nurses insist that
you attend immediately.
What do you do?

A. Drop everything and run to CCU to assess the patient.
B. Tell the nurses they will have to wait as you have a list of things to do.
C. Ask the nurses to call someone else as you are busy, giving them the
bleep number of the doctor who will help them.
D. Ask for more information about the patient including their diagnosis and
other vital signs.
E. Put out a crash call as you are unable to attend immediately.
65
Scenario 54
Judy, one of your patients in General Practice, is 35 years old and has
recently been diagnosed with an underactive thyroid (hypothyroidism).
The endocrine team have commenced her on Thyroxine.
She comes to see you and tells you that she is not taking the Thyroxine
as she uses homeopathic remedies for her hypothyroidism and is
feeling much better as a result.
What do you do?

A. Ask her what she understands about her illness and if she will come back
to see you for a blood test in 3 months’ time.
B. Tell her she should take the thyroxine and refer her back to the
endocrinologists.
C. Tell her that she is being unreasonable, that homeopathy doesn’t work
and that she should take the thyroxine.
D. Do nothing now but offer her the option of coming back to see you. After
all it’s her choice.
E. Ask her if there were any problems with the thyroxine, if she understands
why she should take it and what will happen if she doesn’t take it. Explain
anything she doesn’t understand but offer her the choice of what to do,
with a follow up appointment.
66
Scenario 55
You are an F2 doctor in General Practice. An elderly Turkish patient, who
cannot speak or understand English, comes to see you. A 6-year old girl
is present; the girl tells you that she will interpret for her grandmother.
What do you do?

A. Refuse to see the patient at all. Tell the receptionist to get them to rebook
their appointment.
B. See the patient but refuse to use the 6 year old as an interpreter. It’s
inappropriate.
C. See the patient; ask what the problem is and if it is something simple that
you feel a 6 year old could explain to her grandmother then continue with
the consultation, ensuring at the end of the consultation that the
grandmother knows she should try not to use the child again.
D. See the patient but explain through the 6 year old that it is not advisable to
use a child as an interpreter asking if there is anyone else with her to help.
E. See the patient and explain to them via the child that you will call
language line (telephone interpreting service) and use that instead of the
child
67
Scenario 56
You are an F2 doctor in A&E and have just been present at an arrest
situation where the patient did not survive.
You were team leader at the arrest and need to inform the relatives of the
patient’s death. Your shift ends in 10 minutes.
What do you do?

A. Ask the A&E sister to get the family a cup of tea.
B. Go to tell the family immediately of the outcome. It is not fair to make them
wait.
C. Finish writing the notes from the arrest, compose yourself and arrange to
meet the relatives in the relative room.
D. Hand over the job to your F1. They need the experience.
E. Hand over the job to the doctor who is taking over from you. After all the
family don’t know it was you who ran the arrest and your shift is ending.
68
Scenario 57
You are an F2 doctor in elderly care and have been called to write a
death certificate for one of your patients, who was admitted 2 weeks ago
and died overnight.
You saw him yesterday before going off shift and confirmed with the
nurses that it was an expected death. Overnight, a locum doctor
confirmed death. You have not seen the dead patient’s body since he
died.
What do you do?

A. Go and write the death certificate as soon as is possible.
B. Agree to do the death certificate and then add it to your list of jobs for the
day.
C. Tell the bereavement officer to call the doctor who saw the patient after
death last night.
D. Go and see the body to confirm death yourself and then go and write the
death certificate.
E. Go and write the death certificate as soon as is possible and offer to take
your F1 with you to show them what they should do.
69
Scenario 58
You are an F2 doctor working in General Practice.
Another doctor’s patient attends your surgery, requesting a repeat

prescription of sleeping tablets.
What do you do?

A. Check that the patient is not overusing their medication, issue the script
telling them that they do not need to waste the GP’s time for repeat
prescriptions.
B. Review the notes fully and ask the patient why they need the sleeping
tablets advising them of their potential addictiveness and offer alternative
help.
C. Review the notes fully looking for the commencement date of the
medication and the amount they are using per month. If they are using
them appropriately, then issue a script.
D. Issue the script automatically without review of the notes.
E. Tell the patient they cannot have the prescription and that they need to
see the GP who started them.
70
Scenario 59
You are an F2 doctor working in General Practice. A patient whom you
know very well attends and informs you that her ex-boyfriend is about to
be released from prison and has called her, threatening to kill her. She is
too scared to go to the police.
What do you do?

A. Call the police and tell them about the threats.
B. Give her support, listen to her fears and then tell her that you will call the
police to inform them of the threats made.
C. Give her support, listen to her fears and ask her if she will let you inform
the police of the threats made.
D. Tell her there is nothing you can do as this does not fall within your remit.
E. Give her support, listen to her fears and wish her luck.
71
Scenario 60
You are an F2 doctor in General Practice and whilst on a home visit,
your 92 year old patient tells you that they no longer want to take their
medication for hyperlipidaemia (high cholesterol) as they are ready to
die.
What do you do?

A. Refer them to a psychiatrist to assess their capacity.
B. Ask them to explain why they feel they want to die, offering support
explaining that stopping their medication for high cholesterol is unlikely to
hasten their death.
C. Offer to help them die.
D. Tell them it’s ok, that it’s their choice and if they want to stop they can.
E. Assess their capacity and only if they are competent then tell them it’s ok,
that it’s their choice and if they want to stop they can.
72
Scenario 61
You are an F2 doctor working in General Practice. A 13-year-old girl
attends on her own asking for the combined oral contraceptive pill
(COCP).
What do you do?

A. Assess her to ensure that she understands the nature, purpose and
consequences of both taking the oral contraceptive pill and of not taking
the oral contraceptive pill and if she does, then prescribe it.
B. Refuse to prescribe it. It’s illegal for a 13 year old to have sex.
C. Tell her she must return with an adult before you will prescribe it.
D. Insist she has a contraceptive implant instead once you have ensured she
is not “at risk” and is competent.
E. Prescribe the pill.
73
Scenario 62
You are an F2 doctor working in general surgery. As part of your role,
you run the pre-assessment clinic for patients who are to be admitted
major surgery.
One of the patients you saw in clinic last week has just arrived on the
ward, ready for surgery today and on review of the notes you realise that
you forgot to listen to their heart in clinic. You do this immediately and
hear a murmur.
What do you do?

A. Ignore the murmur; you don’t want to get into trouble with your consultant.
B. Tell the anaesthetist that he may want to listen to the patient’s heart
before proceeding.
C. Document the murmur, inform the patient of what you’ve found and then
inform your consultant that the patient will need further investigations that
are likely to delay the surgery.
D. Document the murmur and inform your consultant that the patient will
need further investigations that are likely to delay the surgery.
E. Document the murmur and run to the echo lab to beg for an urgent echo
in the next 15 minutes before theatre calls the patient for surgery.
74
Scenario 63
You have been asked by your consultant to consent the next patient for
theatre. When you look at the list it is for a Whipple’s procedure
(complicated surgery usually performed for pancreatic cancer) and you
do not know what it is.
What do you do?

A. Consent the patient anyway.
B. Go onto the internet and find out what a Whipples procedure is and then
return to your consultant to ask if they can help you.
C. Contact your registrar (ST3-5) and ask them to come and help you.
D. Go onto the internet and find out what a Whipples procedure is and
proceed with the consent.
E. Go back to your consultant and tell them you cannot proceed with the
consent.
75
Scenario 64
You are an F2 doctor in General Practice. Whilst on a home visit, your
86-year-old patient, who is wheelchair bound following a bilateral below
knee amputation, asks you to help them die.
What do you do?

A. Offer to help them die.
B. Refer them to a psychiatrist. They must be depressed.
C. Explain that you cannot help them die but give them information about
assisted suicide in Switzerland.
D. Assess their capacity and if competent, explain that you cannot help them
die but give them information about assisted suicide in Switzerland.
E. Assess their capacity and if competent assess them for depression.
76
Scenario 65
You are an F2 doctor working in General Practice. A fit and healthy 37-
year old woman attends with a cold. Her examination is normal and so
you decide that it is likely to be a viral infection and explain that
antibiotics will not help her.
She insists that you give her a prescription as her colds “always turn
into chest infections” and it is really difficult to get an appointment to
see you.
What do you do?

A. Refuse to give her the antibiotics with no further explanation.
B. Advise her to go and see another GP who may prescribe them for her
insisting that you won’t.
C. Explain the reason for you not giving antibiotics and offer her an
appointment to return in 48 hours if she is no better.
D. Give her a prescription of antibiotics as she asks.
E. Give her a delayed prescription for antibiotics asking her not to take them
for 48 hours to see if she improves without them.
77
Scenario 66
You are an F2 doctor working in A&E. A 65 year old smoker attends with
a cough that has been present for 6 weeks and he has had 2 episodes of
haemoptysis.
He is otherwise well. He tells you that his GP has refused to give him
antibiotics.
What do you do?

A. Immediately admit the man, he’s obviously got lung cancer.
B. Call the GP and complain that this man has been mistreated.
C. Organise immediate investigations including a chest X-ray and blood

tests.
D. Prescribe antibiotics and refer him back to his GP.
E. Refer him to oncology, he’s obviously got lung cancer.
78
Scenario 67
You are an F2 doctor on call for General Medicine. The nurses on ward H
have called you as they want you to review an ECG that the nurse
practitioner ordered for a patient with chest pain. The patient is stable.
What do you do?

A. Advise them to call the nurse practitioner to review the ECG and if she
needs help to ask her to call you and you will attend immediately.
B. Attend immediately; this may be a myocardial infarction (heart attack).
C. Ask for more information regarding the patient to assess how urgent this
task is.
D. Add it to your list of things to do and attend when it reaches the top of the
list.
E. Advise them to review their own ECG. After all they should not request
investigations that they cannot interpret.
79
Scenario 68
You are an F2 doctor in General Practice and are staying late on your
own in the practice to complete some paperwork. The practice is closed
and all other members of staff have left.
As you are about to leave at 21:00, the fax machine starts to whirl and a
fax arrives. It is from the local haematologist with URGENT written at the
top of the paper. The fax states that one of the practice’s patients has a
haemoglobin of 5 and is profoundly anaemic.
What do you do?

A. Call the haematologist at the hospital and advise them there is no one at
the practice and they need to contact the patient and arrange admission.
B. Ignore it. It is only by chance that you are in the building. Usually no one
would be there to respond to a fax at such a late hour.
C. Place the fax on your desk to ensure that you remember to act on it first
thing in the morning.
D. Read the fax and act on it by calling the patient and arranging an
admission to the local hospital.
E. Read the fax and act on it by calling the patient and advising them to go to
A&E.
80
Scenario 69
You are an F2 doctor working in General Practice. At 9am, one of your
patients, a 25-year-old Eastern European, states that they have severe
toothache and a temperature.
What do you do?

A. Assess the patient for a dental abscess and treat it with antibiotics if
required.
B. Tell them to go and see a dentist.
C. Advise the patient that you are not trained in dental treatment and advise
them to seek help from a dentist.
D. Give them pain killers and advise them to see a dentist.
E. Assess the patient fully to determine why they have a temperature and if it
is a dental cause, refer them to a dentist the same day.
81
Scenario 70
You are an F2 doctor in General Practice. At the end of each surgery,
you are supposed to meet with your trainer to go over any problems that
you may have encountered during the session.
Your trainer always leaves the practice before you have finished and is
never available for your debrief.
What should you do?

A. Nothing.
B. Ask another GP partner in the practice to meet with you at the end of each
surgery.
C. Report your trainer to the deanery.
D. Arrange a meeting with your trainer and tell them you need to see them at
the end of each surgery.
E. Arrange a meeting with your trainer and ask them whether you could
arrange a daily meeting to discuss problems.
82
Scenario 71
You are an F2 in General Practice. An emergency patient comes in with
signs that are consistent with anaphylaxis following a bee sting.
What do you do?

A. Call an ambulance.
B. Assess the patient’s airway, breathing and circulation and give the
appropriate dose of adrenaline.
C. Assess the patient’s airway, breathing and circulation and give the
appropriate dose of atropine.
D. Start basic life support.
E. Assess the patient’s airway, breathing and circulation and call an

ambulance if you are concerned.
83
Scenario 72
You are an F2 doctor in A&E. An otherwise well patient presents with
lower back pain. Following a detailed examination, you notice he has
foot drop and saddle anaesthesia.
What do you do?

A. Refer him immediately to a neurosurgeon.
B. Organise a back X-ray.
C. Organise an urgent MRI.
D. Discharge home.
E. Admit to a medical ward.
84
Scenario 73
You are an F2 doctor working in general surgery. In an outpatient clinic,
you see an 85 year old gentleman with an abdominal aortic aneurysm
that has expanded over the last 3 months and now measures 8cm on
ultrasound.
Your consultant has reviewed the patient, fully explained the procedure
and advised him he needs to come into hospital for an abdominal aortic
aneurysm repair. When the consultant has left the room, the man tells
you he will not have the surgery.
What do you do?

A. Offer to talk to the man to re-explain the advantages and disadvantages of

surgery before talking to your consultant.
B. Advise the man that he must have surgery.
C. Tell him it is his choice if he does not want surgery.
D. Tell your consultant.
E. Assess his capacity and if he is competent then inform him that it is his
choice if he does not want surgery.
85
Scenario 74
You are an F2 doctor working in Obstetrics and Gynaecology. In the
middle of winter, whilst reviewing a lady who is 36 weeks pregnant in
antenatal clinic, you notice that her 3-year-old little girl who is in
attendance with her is wearing severely soiled clothes and has no shoes
on.
You are concerned that the child may be being neglected.
What do you do?

A. Nothing, the child is not your patient.
B. Immediately admit the child to paediatrics.
C. Confront the mother and ask why the child looks so dirty.
D. Ask the patient to wait outside and then call her GP to ask if there are any
concerns regarding the welfare of the child.
E. Ensure you add a comment at the end of your clinic letter to the GP
asking them to review the child.
86
Scenario 75
You are an F2 doctor in General Practice. You receive a hospital letter
regarding one of your patients whom you have been seeing regularly for
antenatal checks stating that her baby was born 5 weeks ago and has
been unexpectedly diagnosed with Down’s Syndrome.
What do you do?

A. Code the diagnosis in the baby’s notes and wait for the 6-week check.
B. Discuss the case with the health visitor and then contact the patient
offering a home visit or a surgery visit if they wish.
C. Arrange to go on a home visit to see the family and talk to your patient
face to face.
D. Contact the patient to express your sympathy offering support if she

needs it.
E. Write to the patient offering support if she needs it.
87
Scenario 76
You are an F2 working in respiratory medicine. After being trained to
perform pleural aspirations, your consultant asks you to perform your
first aspiration without supervision. You agree, feeling confident.
Everything goes well until you try to aspirate the fluid and get a dry tap.
On review of the large pleural effusion on X-ray, you realise that you
have tried to aspirate the wrong side of the chest.
What do you do?

A. Ensure the patient is stable, seek help from your consultant and then
explain what has happened and apologise to the patient.
B. Tell your consultant that it was a dry tap and organise for an ultrasound
guided aspiration for another day
C. Ensure the patient is stable and immediately inform your consultant
D. Ensure the patient is stable and then proceed to aspirate the correct side
E. Ensure the patient is stable, explain what has happened, apologise to the
patient and then seek help from your consultant
88
Scenario 77
You are an F2 doctor in General Practice. A patient comes to see you
and tells you that they will be out of the country travelling for a year and
want you to prescribe 12 months of medication for them.
Their medication includes antidepressants, sleeping pills, thyroxine and

anti-hypertensives.
What do you do?

A. Refuse and ask the patient to submit their NHS card to the primary care
trust (PCT).
B. Prescribe 3 months of medication as this is the maximum your practice

protocol allows.
C. Prescribe a year’s worth of medication.
D. Review the patient’s notes to assess how stable their hypertension and
thyroid hormone levels are and if they are ok then prescribe a years worth
of medication.
E. Advise the patient that the medication they are on requires regular review
and give them the standard supply.
89
Scenario 78
You are an F2 doctor in General Practice and are the allocated “on call”
doctor for the morning. At the beginning of a busy surgery the
receptionist puts a call through to you from a 70-year old man with
central crushing chest pain that has lasted for 45 minutes and was not
relieved by sublingual GTN. He had a heart attack 6 months earlier.
You tell him that you will dial 999 on his behalf from your mobile while
he stays on the practice phone line, but he refuses. He states that he
does not want an ambulance; he wants you to visit him at home and is
willing to wait until the end of morning surgery.
What do you do?
Choose the THREE most appropriate answers to this scenario
A. Agree to go and see him at the end of surgery
B. Call 999 anyway
C. Tell him you will visit him straight away
D. Advise him you will refer him to the medical team at the local hospital and
arrange for an ambulance to take him
E. Advise him he may be having another heart attack and that it is important
he is treated as soon as possible
F. Tell him to take more sublingual GTN and you will call back in 30 minutes
to see if he is any better
G. Advise him you will visit him as soon as possible depending on how busy
your morning clinic is
90
Scenario 79
You are an F2 doctor in General Practice and your trainer has asked you
to go through his blood results to help you learn how to use the practice
computerised system.
On reviewing his results you uncover a problem. A blood test from one
month ago which your trainer has filled as “normal, no action” is grossly
abnormal. The CRP (C-reactive protein) and ESR (Erythrocyte
sedimentation rate) are both elevated and there is a positive rheumatoid
factor. On review of the notes, you discover that the patient is a 36-year
old man with new onset multiple joint pain.
You are concerned that this is a missed diagnosis of early onset

rheumatoid arthritis. What do you do?
A. Nothing, you don’t want to embarrass your trainer.
B. Show your trainer the results and ask them to teach you on it.
C. Fill in an incident form
D. Inform the practice manager of your trainer’s mistake
E. Inform a senior partner of your trainer’s mistake
F. Report your trainer to the GMC
G. Arrange for the patient to be referred immediately to a rheumatologist
91
Scenario 80
You are an F2 doctor working in general medicine. You are just finishing
your shift and leaving the hospital when you see a woman collapse in
the car park. Her friend shouts out for help stating that she is not
breathing.
What do you do?
A. Call 999 from your mobile phone
B. Carry on walking to your car, you’re off duty
C. Immediately go to the collapsed person and assess their airway
D. Immediately go to the collapsed person and give 2 rescue breaths
E. Immediately go to the collapsed person and start ALS (advanced life

support)
F. Tell the “friend to call 999” from their mobile phone
92
Scenario 81
You are an F2 doctor working in paediatrics. On the paediatric
assessment unit you review an 8-year-old child with a mild chest
infection. Whilst mum leaves the ward to go to the toilet, the child tells
you that his father keeps hitting him.
What do you do?
A. Admit the child immediately and inform the registrar on call for child
protection.
B. Tell the child they must not lie about such things and then ask them to tell
you the truth about what happened
C. Listen to them and document everything they say
D. Listen to them and document it if the child repeats the same allegation
E. Wait until mum returns, then ask the child to explain and examine the
child fully.
F. Call the nurse on the admission unit to sit in with you while you listen to
the child and allow them to talk to you
G. Ask the child if this has ever happened before
93
Scenario 82
You are an F2 doctor working in General Practice. You are on your way
into work and bump into a patient who was newly diagnosed with type-1
diabetes one week ago and whom you had sent to hospital to be
commenced on insulin. He is eating a bar of chocolate and drinking a
can of sugary fizzy drink whilst chatting to his friends.
What do you do?
A. Nothing, you are not on duty
B. Confront the patient and ask them why they are eating chocolate
C. Say hello, smile and make a mental note to ask them about it when you
see them next
D. Say hello, smile and make a mental note to call them later to ask them to
come in for a review
E. Say hello, smile and ask how they are.
F. Ensure the patient does not see you, you don’t want to embarrass them
but make a mental note to call them later to ask them to come in for a
review.
94
Scenario 83
You are an F2 doctor working in Obstetrics and Gynaecology. You are
doing the preadmission clinic and see a 21-year-old lady who is
attending the day unit for her 4th termination of pregnancy (TOP).
What do you do?
A. Offer her the contraceptive implant.
B. Advise her that you can insert a coil at the time of TOP if she consents to
it.
C. Give her a supply of the combined oral contraceptive pill.
D. Give her a supply of condoms.
E. Advise her that surgical TOP is dangerous and is not a form of

contraception.
F. Offer her counselling.
95
Scenario 84
You are an F2 doctor working in General Practice. Your patient has not
attended for their appointment and when you look in their notes to
annotate them you notice that this is the 5th consecutive appointment
that they have not attended. They have never tried to cancel an
appointment.
What do you do?
A. Annotate the notes but do nothing else.
B. Inform your practice manager of the non-attendance asking them to make

contact with the patient.
C. Call the patient and ask if they are ok and where they are.
D. Call the patient and demand to know why they have not attended the last
5 appointments.
E. Flag the notes so that when the patient next books an appointment the
receptionists can advise the patient to telephone if they cannot make the
appointment.
F. Write to the patient asking if they are ok and explain the practice policy on
missed appointments.
G. Write to the patient and ask them to find another GP practice.
96
Scenario 85
You are an F2 doctor working in General Practice. You see a patient
whose blood pressure measures 190/100. She is otherwise well.
The patient tells you that it is always normal when the nurses measure it
and that she is scared of seeing the doctor.
What do you do?
A. Believe the patient and ask her to always attend her blood pressure
assessments with the practice nurse.
B. Review the notes and her medication.
C. Advise her she needs to be admitted to the local hospital.
D. Ask her to use a blood pressure monitor at home and record the results.
E. Arrange for a 24-hour blood pressure monitor assessment at the local

hospital.
F. Advise her she needs more medication to control her hypertension.
97
Scenario 86
You are an F2 doctor working in orthopaedics. You discharged an
elderly lady yesterday following a total hip replacement that was
complicated by a deep vein thrombosis (DVT) and she was therefore
sent home on warfarin. As you write her discharge summary, you notice
that her INR on leaving hospital yesterday was 8 (therapeutic range 2-3).
What do you do?
A. Contact the anticoagulant clinic and advise them of the problem.
B. Call the patient and tell them to stop their warfarin.
C. Call the patient and tell them to stop their warfarin and to go to A&E.
D. Arrange for the patient to attend for a repeat INR tomorrow.
E. Arrange for the patient to attend for a repeat INR today.
F. Call the patients GP and advise them of the problem.
G. Immediately contact the patient and ask them to return to the hospital so
you can review them.
98
Scenario 87
You are an F2 doctor working in general surgery. Your consultant has
asked you to discharge a post operative patient back to her care home
immediately as he urgently requires the bed for another patient who is
due to come in for major surgery later that day.
On reviewing the notes of the patient you are due to discharge, you
notice that the occupational therapist (OT) has stated that she needs to
do a “home visit” prior to discharge.
What do you do?
A. Inform the ward manager of the problem.
B. Return to your consultant with the patients notes and ask them what to do
in view of the OT’s entry
C. Return to your consultant and explain that you are unable to discharge the
patient
D. Call the OT and tell them the patient is being discharged
E. Call the OT and ask them when they are able to do the home visit
F. Call the OT and ask them to do the home visit today as the patient is
going home
G. Discharge the patient as your consultant requested
99
Scenario 88
You are an F2 doctor working in General Practice. A patient has attended
the practice with acute onset headache and you are convinced this is a
subarachnoid haemorrhage and requires urgent admission.
You call the medical registrar on call who states that since the patient
has no neurological signs she will not accept the referral.
What do you do?
A. Send the patient to A&E
B. Telephone the consultant on call and request the admission
C. Accept the medical registrars refusal to admit the patient
D. Try another local hospital to see if they will review the patient for you
E. Call the on call hospital manager and make a complaint about the on call
registrar
F. Call the ST1-2 (SHO level) on call and make the referral to them
G. Call the medical registrar back after 5 minutes and tell them that their
patient has neurological signs, even though it is not true.
100
Scenario 89
You are an F2 doctor in General Practice and have looked after a
complicated elderly epileptic patient on multiple medications for
months. You finally get her stabilised on her drugs after 6 months, when
unfortunately she falls and fractures her wrist.
After a 3-day stay in hospital she is discharged back into your care and
you notice from the discharge summary that 3 out of 4 of her
antiepileptic medications have been changed by the hospital doctors.
What do you do?
Choose the TWO most appropriate answers to this scenario
A. Make no changes
B. Immediately change the medication back to what it was preadmission
C. Slowly change the medication back to what it was before admission over
a couple of weeks
D. Call the team who admitted her and ask for clarification of the changes
E. Call the hospital / ward pharmacist and ask for clarification of the drug
changes
F. Write a letter of complaint to the consultant in charge of her care in

hospital
101
Scenario 90
You are an F2 doctor in General Practice. A 50-year-old gentleman tells
you that he wants to be screened for prostatic cancer and he knows
there is a PSA (prostatic specific antigen) blood test.
What do you do?
A. Refuse the test explaining that there is no screening programme for

prostatic cancer
B. Arrange the test
C. Counsel the gentleman with regard to the possible false positive result of
the PSA test
D. Perform a digital rectal examination
E. Counsel the gentleman about the possible false negative result of the test
102
Scenario 91
You are an F2 doctor working in A&E. A woman with a history of breast
cancer attends with severe jaundice and on examination you feel a large
mass in the right upper quadrant consistent with a hard craggy liver.
What do you do?
A. Tell her that the cancer has spread and arrange admission
B. Refer her to the palliative care team
C. Arrange immediate admission
D. Organise urgent tests to include liver function tests, liver MRI and
mammogram
E. Organise urgent blood tests to include liver function tests
F. Tell the patient that there is something wrong with her liver and she needs
more tests. If she asks, tell her that it may be related to the breast cancer.
G. Arrange the community palliative care team to review the patient at home
103
Scenario 92
You are an F2 doctor working in General Practice. You have serious
concerns regarding the welfare of a 2-year-old child whose parents have
just joined the practice and are both drug addicts.
You have seen the child on 3 occasions and have witnessed verbal
abuse from both the parents. You ring social services to make a formal
referral requesting a family assessment and are told by the duty social
worker that, since there is no physical abuse, there are no grounds for
an assessment.
What do you do?
A. Ask to speak to the senior social worker on-call as you are not happy with
the decision that the duty social worker made
B. Insist that the duty social worker take the case on as you have concerns
C. Accept the duty social workers decision
D. Call back the following day as you know there will be a different social
worker on duty
E. Put your concerns in writing and post them to the social work department
F. Put your concerns in writing and send an urgent fax to the social work
department
G. Call the named doctor for child protection
104
Scenario 93
You are an F2 doctor working in general surgery. One morning at an X-
ray meeting, the consultants are discussing the CT results of one of
your patients, a 62-year old woman admitted with abdominal pain.
The radiologist comments on the size of your patient’s uterus

suggesting they need an MRI scan, but you know she had a
hysterectomy 12 years ago.
What do you do?
A. Nothing
B. Go back to the patient later that day and ask them about their
hysterectomy
C. Tell your consultant after the meeting about the hysterectomy
D. Speak up during the meeting stating what the patient has told you about
the hysterectomy
E. Review the patient’s notes later that day to check whether she had a
hysterectomy 12 years ago
F. Quietly approach your consultant as the scan is being reviewed to explain

about the hysterectomy
105
Scenario 94
You are an F2 doctor working in A&E. It is coming to the end of a busy
shift when an 86-year old gentleman is brought in by ambulance. The
paramedics say he called them stating he had central crushing chest
pain.
This is the 8th time this week that the man has called the paramedics
with the same story, his investigations are always normal and he told
you last time that he was lonely and liked seeing everyone in the A&E
department.
What do you do?
A. Refuse to see the patient.
B. Advise the paramedics that he is a non-urgent case and will have to wait.
C. Tell the gentleman that he is wasting NHS time and resources.
D. Tell the paramedics to take him back home.
E. See him as an urgent case.
F. Repeat the same investigations that have been performed every time he
presents to A&E.
G. Ask the gentleman about his family.
106
Scenario 95
You are an F2 doctor working in paediatrics. You are on call and receive
a telephone call from a local GP asking you to review a 4-year-old girl.
The GP says that the child’s examination is normal and that he does not
think there is anything wrong with her, but her mother is insistent on
being referred “just in case” she has meningitis since her temperature
was high that morning.
What do you do?
Choose the ONE most appropriate answer to this scenario
A. Tell the GP to review the child later the same day and if the mother still
wants a referral to send her in then.
B. Advise the GP to refer her as a non-urgent outpatient.
C. Tell the GP to review the child the following day and if the mother still
wants a referral to send her in then.
D. Ask to speak to the mother on the telephone so you can tell her that it is
inappropriate to refer the child to hospital.
E. Tell the GP that, if they are happy that there is nothing wrong with the
child, then they should tell the mother no.
F. Refuse the referral.
G. Accept the referral.
107
Scenario 96
You are an F2 doctor working in General Practice and are on call for the
practice. A 21-year old calls you and requests a home visit as her 3-year-
old daughter has a temperature and a sore throat.
You ask her to come to the practice and she refuses stating that she has
no way of getting to the practice.
What do you do?
A. Suggest ways of attending the practice such as walking, the bus, a taxi or
a neighbour driving her there.
B. Offer the patient money to get a taxi
C. Accept the home visit and go and see the child
D. Insist that the child be brought to the practice
E. Advise her to go to A&E
F. Ask for more details regarding the child’s illness
G. Advise her to call an ambulance
108
Scenario 97
You are an F2 doctor working in general medicine and have accepted a
referral from a GP.
Before you see the patient, you read the GP referral letter. In capital
letters at the top of the letter is written “VIOLENT PATIENT. HAS
PREVIOUSLY ATTACKED A GP AT THE PRACTICE”.
What do you do?
A. Refuse to see the patient without a chaperone
B. Refuse to see the patient
C. Request security attend whilst you see the patient
D. Call the GP who referred the patient and ask for more information
regarding the attack before seeing the patient
E. Call the GP who referred the patient and tell them they should have
warned you when they referred them, as you would then have been able
to refuse the admission
F. See the patient without any precautions
G. Ask your F1 to see the patient
109
Scenario 98
You are an F2 doctor working in A&E. A 38-year-old man attends with a
testicular lump. He is convinced that he has testicular cancer.
When you examine it, you are certain that it is a small, uncomplicated
benign epidymal cyst that requires no treatment.
What do you do?
A. Inform the man of the benign diagnosis and send him home
B. Inform the man of his benign diagnosis but advise him to go to se his GP
if he is still worried
C. Inform the man of his benign diagnosis but tell him to go to his GP and
ask for an ultrasound
D. Refer him to urology
E. Organise an urgent ultrasound to confirm the diagnosis
F. Tell the man that this is not an accident, nor an emergency and he should
see his GP
110
Scenario 99
You are an F2 doctor working in A&E. An 18-year-old female who has
been treated for a sprained ankle tells you that she wants to kill herself.
What do you do?
A. Admit her under the psychiatrists
B. Refer her to psychiatry
C. Assess her fully from a psychiatric perspective
D. Admit her under orthopaedics to enable the nurses to monitor her for 24
hours
E. Do nothing. You have treated the sprain, which is reason she came to
A&E
F. Discharge her ensuring that she has someone to stay with her for 24
hours
G. Assess her suicide risk and if you are not concerned discharge her back
to her GP
111
Scenario 100
You are an F2 doctor working in General Practice. During a routine
immunisation clinic, the mother of a 12-month old boy tells you that she
does not want her child to have the MMR (measles, mumps and rubella)
vaccination.
She will see a Chinese medicine doctor instead for an alternative.
What do you do?
A. Report her to the community paediatric team as this is a form of child

neglect (abuse)
B. Tell her that Chinese medicine will not protect her child from Measles,
Mumps and Rubella
C. Report them to social services as this is a form of child neglect (abuse)
D. Accept the mother’s choice
E. Offer a follow up appointment for the vaccinations
F. Ensure that the mother has all the information about the vaccination
112
Scenario 101
You are an F2 doctor working in A&E. Your friend calls you saying that
they have tonsillitis for the third time this year and cannot get an
appointment with their own GP.
They ask you to send them some antibiotics for them to use.
What do you do?
A. Write an external (FP10) prescription to take to a local pharmacy
B. Take some antibiotics from the A&E stock
C. Write a hospital prescription for some antibiotics
D. Ask a colleague to write an outside prescription (FP10) for your friend to

take to a local pharmacy
E. Refuse to organise the antibiotics
F. Call your friend’s GP and try to organise an appointment for them
G. Call your friend’s GP and ask for some antibiotics for them explaining that
you are certain it is tonsillitis
113
Scenario 102
You are an F2 doctor working in General Practice. One of your patients
was referred urgently to a dermatologist with a suspicious mole. You
were concerned that this is malignant melanoma.
The patient returns to you 4 weeks after your initial referral, saying that
the mole has grown. It is now bleeding and she has still not heard from
the hospital. You are now certain that this is a malignant melanoma.
What do you do?
A. Refer the patient again, the referral must have been lost
B. Tell the patient that you will call the dermatology team and chase up the
appointment later that day
C. Advise the patient to call the hospital themselves to chase up the

appointment
D. Advise the patient that there is nothing you can do
E. Call the dermatology team whilst the patient is still with you to organise an
urgent appointment
F. Arrange for the mole to be biopsied by your GP partner who runs an “in
house “minor surgery session the following day.
114

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GPST STAGE 2

Olivier Picard (CiSCMEDICAL

4th edition: ISBN13: 978-1-905812-22-6

1st Edition: December 2006

© Interview Skills Consulting Limited 2006-2011. All rights reserved.

Printed in the United Kingdom by:

Scenario 1 – Late colleague 13

D Suggested Answers 115

Purpose of the Professional Dilemma paper

 Empathy & Sensitivity

 Coping with Pressure

The full National Person Specification can be found on the national GP

 Type 1: Ranking possible actions

 Type 2: Selecting multiple appropriate actions

See Section B for worked examples of each type of SJT question.

Answering the questions

In simple terms, all exam questions are attempted by several GPs/examiners,

To assist you in this task, in this book you will find:

 2 worked examples (one for each type of scenario)

Good luck with your preparation.

Olivier Picard & Gail Allsopp

Rank in order the following actions in response to this situation

C. Complete the form until 5am and then go to work at 8am.

E. Call in sick the next morning and do the form properly.

Suggested answer: 1:B – 2:A – 3:E – 4:C – 5:D

How to approach this question

From this you can deduce the following:

Option D is a grave offence which would potentially be punished by being

Choose the THREE most appropriate actions to take in this situation:

Suggested answer and approach

D – This places the nurse in a difficult position. It is also a fairly aggressive

The answer is therefore A, B and E. (Note that these do not need to be

What do you do?

Rank in order the following actions in response to this situation

B. Call the police. Theft is a criminal offence.

What do you do?

Choose the THREE most appropriate actions to take in this situation:

B. You arrange a discussion with your colleague, express your discontent

C. You arrange a discussion with your colleague to enquire about the

What do you do?

Rank in order the following actions in response to this situation

What would you do subsequently?

Choose the THREE most appropriate actions to take in this situation:

D. You organise a meeting with your consultant to discuss the reasons

G. You report the admitting doctor to a senior pharmacist for possible

What do you do?

D. Hand over to a nurse and leave the hospital.

On a shopping trip to town, you see him at the wheel picking up a

What do you do?

Rank in order the following actions in response to this situation

A. Report the matter to his boss

D. Report the matter to the DVLA.

What do you do?

Rank in order the following actions in response to this situation

C. Slip away unnoticed.

What do you do?

Choose the THREE most appropriate immediate actions to take in this

B. Call the police as marijuana is an illegal substance.