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Question:
A 45-year-old presents with chest pain radiating to the left arm. ECG shows ST elevation in leads V1-V4. What is the most appropriate immediate management?
AI Explanation:
This is an anterior STEMI. The priority is immediate reperfusion. According to NICE guidelines, primary PCI should be offered within 120 minutes of first medical contact...
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Clinical Scenario
You are an FY1 on the surgical ward. During a busy ward round, your registrar asks you to prescribe IV antibiotics for a patient with suspected sepsis. You notice the registrar has written "gentamicin 160mg TDS" in the notes, but you believe this dose may be too high and too frequent for this patient who has mild renal impairment (eGFR 45).
Rank the following actions from most appropriate (1) to least appropriate (5):
Prescribe the antibiotics as instructed by your registrar
Politely ask to speak to your registrar privately after the ward round to discuss your concerns
Refuse to prescribe until you have clarified the dosing with a pharmacist
Raise your concern with the registrar immediately during the ward round
Prescribe a lower dose of gentamicin that you think is appropriate
Following senior instructions shows respect for hierarchy and avoiding public confrontation feels professional. Many trainees fear appearing disrespectful by questioning seniors during rounds.
Patient safety concerns must be raised immediately—gentamicin nephrotoxicity with renal impairment is a serious risk. The GMC explicitly states patient safety trumps hierarchical concerns.
Immediate patient safety > social comfort. When a prescribing error could cause direct harm, speak up straight away—politely but promptly. Waiting "until later" is only appropriate for non-urgent concerns.
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All specialties • 6 - 19 January 2026
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