JOB INTERVIEWS: CLINICAL SCENARIOS
DIFFERENT SCENARIOS IN A & E , GENERAL MEDICINE AND ACUTE MEDICINE:
SCENARIO I: A PATIENT IS BROUGHT IN BY PARAMEDICS AFTER A ROAD TRAFFIC ACCIDENT. YOU ARE THE FIRST DOCTOR THEY MEET. WHAT WILL YOU DO?
SCENARIO II: A PATIENT AFTER HEMIARTHROPLASTY HAS A HIGH K+ LEVEL 4 HOURS AFTER. WHAT INVESTIGATIONS WILL YOU DO AND WHAT
SCENARIO III: YOU ARE IN A & E, A PATIENT COMES IN WITH EXACERBATION OF COPD. HOW WILL YOU APPROACH AND MANAGE THIS PATIENT.
SCENARIOS IV: A PATIENT WHO IS A KNOWN CASE OF COPD PRESENTS WITH SOB. ON EXAMINATION PATIENT HAD BI-BASAL CREPITATION, WHAT WOULD YOU DO?
- First assess ABC and connect him to monitor.
- If O2 is < 88% start 24% oxygen via Venturi mask.
- Start medications which should include Salbutamol and Hydrocortisone and give him Furesemide.
- Perform chest X-ray and ABG
SCENARIO V: A PATIENT HAS COME TO YOU WITH BREATHLESSNESS AND WHEEZE. SHE IS AN OLD LADY WHO IS A KNOWN CASE OF COPD. HER SPO2 IS 88%. HOW WILL YOU MANAGE?
- I will do A, B, C, D assessment and APVU assessment.
- I will then start her with 24 % oxygen via mask and monitor her spO2
- Then I will start her on Salbutamol and hydrocrtisone if needed.
- Once the patient is comfortable I will take detailed history and examination.
- I will inform my senior.
- I will then send patient’s investigations which should include CBC, electrolytes and Urea to do CURB65 scoring in any case if she has differential as Pneumonia, LFTs, ABG, Chest X-ray.
- If an infection is suspected and established by investigations I will consult with my senior and give her antibiotics according to hospital protocol.
- ABG report shows pH to be low, pCO2 high and pO2 low, how will you manage further: I will repeat ABG and if pCO2 is still high despite all treatments we have given I will consider her for non-invasive ventilation after consulting my senior and a respiratory physician. If she still doesn’t respond and has low pH and high PCO2 I will inform my senior and consult anesthetist and discuss intubating my patient.
SCENARIO VI: A PATIENT COMES WITH CENTRAL CHEST PAIN. WHAT WILL YOU DO AND WHAT DIFFERENTIAL DIAGNOSIS WILL BE IN YOUR MIND?
SCENARIO VII: A 60+ YEAR OLD MALE COMES WITH LIF PAIN. HE SCORES THE PAIN AROUND 7 /10. HIS BLOOD PRESSURE IS 110/70 mm Hg AND RR IS 14 b/ min. WHAT WILL YOU DO FOR HIM? WHAT INVESTIGATIONS WIL YOU DO? WHAT DO YOU THINK HE HAS?
SCENARIO VIII: THERE’S A TWO PATIENT WHO COMES IN SIMULTANEOUSLY. ONE BANGED HIS HEAD AND LOST CONSCIOUSNESS AND THE OTHER HAS K+ 7.5. YOU ARE THE ONLY DOCTOR IN THE CORRIDOR AND YOU GET THE BLEEP ABOUT THESE TWO PATIENTS. HOW WILL YOU MANAGE THIS SITUATION?
(checking if you can triage patients, coping with stress, realize your limits)
-> First of all, call your registrar and inform him about the two bleeps and he or she will guide as to what to do next.
-> Start him on Calcium gluconate to prevent cardiac arrest and ask nurse to get ECG done for a patient with K+ 7.5 as you already know there will be ECG changes with high potassium level. And go to the patient who has LOC, get more information including bleeding from nose and ears and vomiting. Check ABC his GCS and depending on his status either plan for intubation or/ and ask A & E staff to get his CT scan done. In the mean while go and see the ECG of other patient.
-> Inform your registrar about what you did and ask him if he would like you to add anything in management.
ENT-HEAD AND NECK SURGERY SCENARIOS:
SCENARIO I: You are in operation theater assisting a case. You are also an on call for that day. You got a call from post operative ward saying there’s a patient who is bleeding. At the same time you got the call from emergency department asking you to attend a patient who has come with airway obstruction. What will you do in such situation.
SCENARIO II: There’s a patient in ward who has tracheostomy, how will you care this patient.
SCENARIO II: In Head and Neck cancer ward, there are lot of patients with laryngectomy. How will you take care of patient with laryngectomy?
TRAUMA AND ORTHOPAEDICS SCENARIOS:
SCENARIO I: YOU ARE CALLED TO AN EMERGENCY DEPARTMENT TO SEE A PATIENT WITH FEMORAL NECK FRACTURE. WHAT WOULD YOU DO ? HOW DO YOU CLASSIFY FEMORAL NECK FRACTURE ?
SCENARIO II: A PATIENT COMES IN WITH A SWOLLEN PAINFUL KNEE AND FEVER. THERE’S NO HISTORY OF TRAUMA BUT HAD HIP REPLACEMENT 10 YEARS AGO, WHAT IS YOUR DIAGNOSIS AND HOW WILL YOU MANAGE?
-> Septic Knee Arthritis
SCENARIO III: A PATIENT HAD UNDERGONE A HIP REPLACEMENT 7 DAYS BACK AD NOW HE HAS sob AND HYPO-TENSION. WHAT DO YOU SUSPECT? HOW WILL YOU MANAGE?
-> PE and D/Ds
-> I will introduce myself and take history. I will make sure patient is safe by going through a, b, c
GENERAL SURGERY SCENARIOS:
SCENARIO I: A WOMAN POST MASTECTOMY PRESENTS WITH FEVER AND RASH IN SURGERY DEPARTMENT. HOW WILL YOU MANAGE?
SCENARIO II: WHAT IS PULSE LESS ELECTRICAL ACTIVITY AND IN WHAT CONDITIONS CAN YOU GET THESE?
SCENARIO III: YOU ARE THE ONLY DOCTOR ON THE POST. THERE ARE 2 PATIENTS IN THE WARD. ONE OF THEM DEVELOP
SCENARIOS IV: A 25 YEAR OLD GIRL COMES TO HOSPITAL WITH ABDOMINAL PAIN. WHAT WILL YOU DO?
SCENARIOS V: AN MRI SCAN WAS DONE FOR A MAN AND WAS DISCOVERED HE HAS A BRAIN TUMOUR. HE IS CURRENTLY WITH HIS WIFE IN WARD WHO IS LOOKING VERY ANXIOUS AND WAITING FOR SOMEONE TO TALK WITH. THERE IS NO CONSULTANT OR SENIORS AND YOU ARE LEFT WITH SENIOR NURSE. HOW WOULD YOU BREAK THE NEWS?
SCENARIOS I: A LADY PRESENTS WITH POST MENSTRUAL BLEEDING IN THE CLINIC . HOW WILL YOU APPROACH THE PATIENT IN TERMS OF HISTORY AND EXAMINATION.
SCENARIOS II: YOU ARE IN THE WARD AND NURSE CALLS YOU ALERTING THAT ONE OF POST OPERATIVE PATIENT IS BECOMING HYPOTENSIVE ALL OF A SUDDEN. WHAT CAN BE THE CAUSES AND HO WILL YOU APPROACH IT.
SCENARIOS III: YOU HAVE A PATIENT WHO PRESENTED WITH POST PARTUM HAEMORRHAGE. HOW WILL YOU APPROACH?
SCENARIOS I: WHAT WILL YOU DO IN A SITUATION WHEN YOU SEE A 11 MONTHS OLD CHILD WITH HUMERUS FRACTURE AND YOU ARE SUSPECTING NAI IN CHILD. HOW WILL YOU APPROACH TO THE CASE?
SCENARIO I: WHAT WILL YOU DO IF A PATIENT WITH SORE THROAT COMES IN A & E AND YOU KNOW IT’S NOT AN EMERGENCY
SCENARIO II: YOU DEVELOPED A MANAGEMENT PLAN FOR A PATIENT BUT ONE OF YOUR COLLEAGUES DISAGREE WITH YOU, WHAT WILL YOU DO IN SUCH SITUATION?
SCENARIOS III: SAY YOU ARE ON YOUR OFF DAYS AND ONE OF YOUR COLLEAGUE ASKED YOU TO COVER FOR HER. HOW WILL YOU APPROACH TO THIS ? (They are basically checking if you are a team player or not?)
SCENARIOS IV: You saw your colleague in the ward trying to treat a patient in such a way that you feel it might cause harm to the patient. What will your next step be? What will you do if you see what he is doing will cause immediate harm to patient?