Specialty Recruitment Assessment - what to expect and how to prepare: sample questions with answers

EMQ - Investigations for back pain
1. A 25 year old man is involved in a road traffic accident. He was on a bike and hit from the side. He did not want to attend the hospital, and was taken home by his friends. He now complains of severe pain in his lower back and cannot pass water. He has tingling in his legs below the knee. Select the most suitable investigation from the list.

A	X-ray of the lumbar spine	E	Routine MRI scan lumbar spine
B	X-Ray of sacro-iliac joints	F	Urgent MRI scan lumbar spine
C	Routine CT scan lumbar spine	G	DEXA scan
D	Urgent CT scan lumbar spine	H	No investigations needed

 

The correct answer is F: Urgent MRI Scan.  In cases where there is any suspicion of cord compression, urgent MRI is the investigation of choice, and these patients should be referred to the neurosurgeons or orthopaedic surgeons. A Computed tomography (CT) scan is not commonly used except where MRI is not available.

 

2. A 68 year-old woman with known osteoporosis. She has had a fractured neck of femur in the past after a fall in her garden. She now complains of pain in her lower back, but does not have much muscular tenderness. She has no bowel or bladder symptoms. She has no neurological symptoms. Select the most suitable investigation from the list.

A	X-ray of the lumbar spine	E	Routine MRI scan lumbar spine
B	X-Ray of sacro-iliac joints	F	Urgent MRI scan lumbar spine
C	Routine CT scan lumbar spine	G	DEXA scan
D	Urgent CT scan lumbar spine	H	No investigations needed

 

The correct answer is A: X Ray lumbar spine. In a case of known osteoporosis like this woman, a plain x-ray of the lumbar spine may identify collapse fractures.  Doing a DEXA scan is of no benefit as we already have a diagnosis of osteoporosis.

 

3. A 40 year old labourer attends complaining of severe low back pain after finishing his shift.  He does not have any bowel or bladder problems, and on examination has a straight leg raise of 90 degrees in both legs.  He has no other significant medical history. Select the most suitable investigation from the list.

A	X-ray of the lumbar spine	E	Routine MRI scan lumbar spine
B	X-Ray of sacro-iliac joints	F	Urgent MRI scan lumbar spine
C	Routine CT scan lumbar spine	G	DEXA scan
D	Urgent CT scan lumbar spine	H	No investigations needed

 

The correct answer is H: no investigations needed.  This is a description of mechanical back pain.  Simple mechanical low back pain can typically be managed with non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics, without need for referral or further investigation.

 

SBA – Allergic reactions

4. A 35 year old man has a severe allergic reaction while in hospital. He has no history of past allergic reactions.  Which ONE of the following is most likely to cause a reaction WITHOUT prior exposure or sensitization? Select ONE answer only.

1. Peanuts
2. Hymenoptera stings
3. IV Penicillin
4. IV Contrast media
5. Latex

 

The correct answer is D: IV Contrast Media.  IV contrast media causes a reaction in 1-2% of cases, although it only causes death in about 0.9 per 100,000 cases. It can cause an anaphylactoid reaction, and does not require previous exposure to sensitise the individual.   

 

Professional Dilemma paper

Sample ranking question:
You have just started a job as a medical F2 in a new hospital. Your partner has a chest infection, and is not yet registered with a GP and has asked you to prescribe antibiotics. 
Rank the following options 1-5, 1 being the most effective / best option, 5 being the least effective / worst option:

1. Prescribe the medication as a private prescription, and arrange for your partner to register with a GP the following week.
2. Tell your partner to register with a GP locally.
3. Prescribe the medication on a hospital take home prescription with your partner’s details on it.
4. Prescribe the medication on a hospital take home prescription with one of your patient’s details on it.  Collect the medication from the hospital pharmacy.
5. Pressure one of your FY1 colleagues to write a prescription on a hospital take home script without seeing your partner.

 

The preferred response is BACED

 

1. B. Tell your partner to register with a GP locally.
Your partner could be seen as a temporary resident and register with a local GP. The GMC Good Medical Practice guidance states that “Wherever possible, you should avoid providing medical care to anyone with whom you have a close personal relationship.” This is the best option as it means your partner has been assessed objectively, and is in keeping with GMC guidance on professionalism.    
2. A. Prescribe the medication as a private prescription, and arrange for your partner to register with a GP the following week.
The GMC guidance does allow for you to prescribe for those close to you if absolutely necessary, or in an emergency, but your partner still needs to register with a GP for future care. This is not an emergency, and so this option is not ideal, but this is option is better than C, D, or E which all involve dishonesty or fraudulent beahviour.
3. C. Prescribe the medication on a hospital take home prescription with your partner's details on it.
Take home prescriptions are for patients being seen in the hospital only. This shows a lack of professional integrity and is both an abuse of your position of responsibility and misuse of NHS resources.
4. E. Pressure one of your FY1 colleagues to write a prescription on a hospital take home script without seeing your wife.
This is unfair to your FY1 colleague – he has not seen the patient, yet he would be responsible for any adverse events and may find it difficult to refuse your request. This makes it worse than option C as it is an abuse of your position as a senior colleague.
5. D. Prescribe the medication on a hospital take home prescription with one of your patient's details on it. Collect the medication from the hospital pharmacy.
This is fraudulent, and dishonest. This could lead to you losing your job, and potentially your GMC registration. It could also lead to a prosecution for fraud. This makes it the worst option. 

 

Sample selection question:

You are an F2 in Orthopaedics. An 80 year old lady has a fracture of her right neck of femur. You have been asked to consent her prior to surgery but on talking to her she seems confused. Her daughter tells you she has dementia and this is confirmed in the notes.  She is first on the morning list.  Select the THREE most appropriate actions to manage this situation:

1. Ask her daughter to sign the consent form and state that she is the daughter.
2. Inform your consultant she has dementia and ask him to complete the consent form.
3. Encourage the patient to sign the form as the procedure is in her best interests.
4. Exclude any acute causes that could be worsening her confusion.
5. Discharge the patient as she will be unable to have surgery without consent.
6. Cancel the patient’s operation.
7. Ring the theatre to rearrange the list so this lady is lower down on the list.

H.  Complete the consent form on the patient’s behalf as it is in her best interests.

 

The most appropriate combined response is: D, G and B

D. Exclude any acute causes for her confusion.
G. Ring the theatre to rearrange the list so this lady is lower down on the list.
B. Inform your consultant she has dementia and ask him to complete the consent form.

 

This lady may have an infection, or pain making her confusion worse so it would be sensible to exclude other causes (option D).  There is no mention of the severity of her dementia in the scenario – someone with mild dementia may be able to consent if you deal with any other problems.  Rescheduling this patient (option G) will allow time for the consultant to discuss the case and sign the consent form without rushing.  It will also ensure that another patient can be properly prepared for surgery. Treatment is lawful if it is in her best interests and this decision should be made by someone senior (ideally the consultant) who should also sign the consent form (option B).  Often two senior doctors will discuss this.

 

If the patient is confused and cannot understand the risks and benefits of the procedure, then she does not have capacity to consent for the procedure so option C is not suitable. A family member cannot consent on her behalf (option A) unless they had power of attorney, which is not mentioned. Simply cancelling the operation (option F) or discharging the patient (option E) will leave this patient in pain with no plan to treat her problem. Option H is not ideal as a junior doctor as a best interest decision like this should usually be made by a senior clinician.

 

These sample questions are adapted from the Emedica Specialty Recruitment Assessment study guide, which is available as part of the Emedica Online revision package for the SRA. This has over 2000 questions covering both papers, with answers and explanations to help you prepare.