Examples of Professional Dilemmas and Clinical Problem Solving questions.

Professional Dilemmas questions

Ranking questions

With this type of question you will be presented with scenarios followed by a number of possible options. Unless the scenario says otherwise, consider yourself a second year Foundation Doctor (F2 or FY2) working a rotation.

Rank each option in order from the most appropriate (1) to the least appropriate (5) given the circumstances described in the scenario. You cannot tie ranks. You will be shown how to make your selection before the test begins.

Example

You are a Foundation (F2) doctor working in respiratory medicine outpatients. You are reviewing Eileen, who has been admitted to hospital three times in the last 6 months, with exacerbations of Chronic Obstructive Pulmonary Disease. She tells you that she has been advised to stop smoking but is finding it difficult to do so because she worries a lot about her 25-year-old daughter, Kirsty, who has financial difficulties. Eileen says that she works overtime to try to support Kirsty.

Rank in order the following actions in response to this situation.

1 = Most appropriate

5 = Least appropriate

  • a. Advise Eileen that she must give up smoking for her health.
  • b. Inform Eileen that if she continues to smoke, her health may deteriorate and she may not be able to work at all.
  • c. Suggest to Eileen that it would be beneficial to explore ways to manage her worries.
  • d. Ask Eileen whether Kirsty has sought professional financial advice.
  • e. Suggest to Eileen that Kirsty should not be causing her to put her health at risk.

Correct Key: CDBEA

Rationale

  • C is the most appropriate action to take in response to this situation, as it demonstrates empathy towards Eileen by seeking to address the way she is feeling but still supporting her to stop smoking.
  • D is the next approriate, as targeting the cause of Eileen’s worries may help her to stop worrying and ultimately stop smoking, but it is not as immediately helpful for Eileen and might reflect an assumption you have made about Kirsty’s situation.
  • While B is true, it is not a particularly sensitive thing to say to Eileen and may upset her further.
  • E is unhelpful as it does not recognise what Eileen has already said concerning her worries about her daughter, and so is likely to make Eileen feel like you are dismissing her concerns.
  • A is the least appropriate thing to do, as it is not showing any empathy or sensitivity towards Eileen’s current situation and is unlikely to help her as she already knows she needs to quit smoking.
Multiple choice

In these questions you will be presented with scenarios followed by a number of possible options. For each scenario select the options which together are the most appropriate response to the situation given the circumstances described.

You will be asked to choose 3 options. You will be shown how to make your selection before the test begins.

Example

You are a Foundation (F2) doctor working in ophthalmology. You are on the ward when a fellow F2 doctor, Tom, tells you that he feels upset about the attitude of one of the nurses, Margaret, towards him. Tom tells you that whenever he asks Margaret to perform a task for him, Margaret is reluctant and always seems to have an excuse for not doing it. You have never observed similar behaviour from Margaret.

Choose the 3 most appropriate actions to take in this situation.

  • a. Suggest that Tom thinks about how he usually asks Margaret to perform tasks for him.
  • b. Suggest that Tom speaks with Margaret to discuss their working relationship.
  • c. Suggest that Tom keeps a written record of Margaret's behaviour towards him.
  • d. Suggest that Tom reports Margaret's behaviour to the nurse in charge on the ward.
  • e. Tell Tom that you have not observed such behaviour from Margaret.
  • f. Suggest to Tom that he may be misinterpreting Margaret's behaviour.
  • g. Suggest to Tom that he avoids delegating tasks to Margaret in future.
  • h. Suggest to Tom that you could act as a witness when he next asks Margaret to do something for him.

Correct Key: ABE

Rationale

A, B and E are the most appropriate actions to take together in response to this situation.

  • B encourages Tom to speak with Margaret to try to resolve the situation between themselves, before escalating.
  • A provides Tom with an opportunity to reflect on his own behaviour and how this might be affecting the situation.

Both these are suggested in a sensitive manner, without assuming the cause of the issue or placing any judgement on how Tom is feeling.

  • E is an appropriate thing to say to Tom given that you have not observed such behaviour, and knowing this may influence how Tom approaches his conversation with Margaret. Tom should try to resolve the situation himself before documenting the behaviour (C) or escalating the issue to the nurse in charge (D).
  • F does not demonstrate any empathy towards Tom’s interpretation of the situation.
  • G is impractical and does not resolve the underlying issue.
  • It is not your role to offer H, as a fellow foundation doctor, and this does not show empathy towards Margaret.

Clinical Problem Solving questions

Clinical Problem Solving questions will be drawn from the following topic areas:

  • Cardiovascular
  • Dermatology / ENT / Eyes
  • Endocrinology / Metabolic
  • Gastroenterology / Nutrition
  • Infectious disease / Haematology / Immunology / Allergies / Genetics
  • Musculoskeletal
  • Paediatrics
  • Pharmacology / Therapeutics
  • Psychiatry / Neurology
  • Reproductive (male and female)
  • Renal / Urology
  • Respiratory

They may relate to:

  • disease factors
  • making a diagnosis
  • investigations
  • management plans
  • prescribing
  • emergency care

The example questions illustrate 2 of the question formats that may be used. Other question formats may also be used when appropriate. You will be shown how to make your selection before the test begins. Answers to these example questions are not available.

Single or multiple best answer

Question 1

A 25-year-old woman has a muco-purulent discharge, pelvic pain, cervicitis and urethritis.

Which is the single most likely cause of her symptoms? Choose 1 option only.

  • a. Bacterial vaginosis
  • b. Candida albicans
  • c. Chlamydia Trachomatis
  • d. Herpes simplex
  • e. Trichomaniasis

Question 2

A 55-year-old, obese man was recently diagnosed with type 2 diabetes mellitus. He has been treated with a 3-month trial of lifestyle modification of diet, exercise and smoking cessation. At 3 months his HbA1c remains greater than 7% and he has not lost weight.

Select the single most appropriate management option form the list below. Choose 1 option only.

  • a. Acarbose
  • b. Insulin
  • c. Metformin
  • d. Rosiglitasone
  • e. Sulphonylurea
Extended matching questions

Reduced vision

  • a. Basilar migraine 
  • b. Cerebral tumour 
  • c. Cranial arteritis 
  • d. Macular degeneration 
  • e. Central retinal artery occlusion
  • f. Central retinal vein occlusion
  • g. Optic neuritis (demyelinating)
  • h. Retinal detachment
  • i. Tobacco optic neuropathy

For each patient below, what is the most likely diagnosis? Select 1 option only from the list above. Each option may be selected once, more than once or not at all.

Question 3

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

Question 4

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

Question 5

A 45-year-old woman, who is a heavy smoker, with blood pressure of 170/110 complains of impaired vision in the right eye. She has difficulty discriminating colours and has noticed that her eye aches when looking to the side.

Joint pain

  • a. Gout 
  • b. Osgood-Schlatter’s disease 
  • c. Osteoarthritis 
  • d. Paget’s disease 
  • e. Perthe’s disease 
  • f. Polymyalgia rheumatica
  • g. Rheumatoid arthritis
  • h. Septic arthritis
  • i. Sjogren’s syndrome
  • j. Still’s disease

For each patient below, what is the most likely diagnosis? Select 1 option only from the list above. Each option may be selected once, more than once or not at all.

Question 6

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

Question 7

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

Page last reviewed: 17 February 2022

Multi-Specialty Recruitment Assessment (MSRA) team


Related information