Risk, Capacity & Safeguarding Practice Questions

Q: A 27-year-old woman presents with amenorrhea, weight loss, and excessive exercise. Her BMI is 16 kg/m². She has bradycardia and hypotension. What is the most serious immediate risk?

Cardiac arrhythmias. ***Cardiac arrhythmias*** - The profound state of starvation, signaled by severe **bradycardia** and **hypotension**, places the patient at high immediate risk for sudden cardiac death due to fatal dysrhythmias (e.g., **Torsades de Pointes**). - Chronic malnutrition causes **myocardial atrophy** and increased susceptibility to electrical instability, often compounded by underlying electrolyte defects. *Osteoporosis* - This is a significant **long-term complication** of anorexia nervosa resulting from chronic **hypoestrogenism** and malnutrition, not the most serious immediate life threat. - While important for long-term morbidity, bone demineralization does not contribute to the acute risk of sudden death seen with cardiac compromise. *Renal failure* - **Acute kidney injury** (AKI) resulting from severe dehydration and prerenal failure can occur, but it is typically not the first or most immediate cause of sudden mortality in acute severe anorexia. - Hypoperfusion due to hypotension, while present, does not pose as immediate a fatal threat as underlying **myocardial compromise**. *Hypothermia* - Severe underweight and compromised thermoregulation lead to **hypothermia**, especially in restrictive anorexia. - Although concerning and requiring intensive care, hypothermia is typically less frequently the direct and immediate cause of sudden mortality compared to cardiac electrical instability. *Electrolyte imbalance* - Although crucial, electrolyte imbalances (especially **hypokalemia** and **hypophosphatemia** during refeeding) are primarily the **causes** or contributing factors. - **Cardiac arrhythmias** are the ultimate *outcome* of these imbalances, representing the most serious and immediate threat to life.

Q: A 31-year-old woman presents with amenorrhea, weight loss, and lanugo hair. Her BMI is 15 kg/m². She denies having an eating disorder. What is the most serious immediate risk?

Cardiac arrhythmias. ***Cardiac arrhythmias***- A BMI of 15 kg/m² indicates severe underweight, which, combined with amenorrhea and lanugo, strongly suggests severe anorexia nervosa. This condition leads to severe electrolyte imbalances (e.g., **hypokalemia**, **hypomagnesemia**) and cardiac muscle atrophy, increasing the risk of life-threatening **cardiac arrhythmias**.- **Cardiac arrhythmias** are the leading cause of sudden death in patients with severe anorexia nervosa, making them the most serious *immediate* risk due to acute electrolyte shifts and myocardial changes.*Osteoporosis*- While **osteoporosis** is a common long-term complication of chronic malnutrition and estrogen deficiency associated with amenorrhea, it is not an *immediate* life-threatening risk.- Bone density loss develops over months to years, unlike the acute and potentially fatal cardiac events caused by electrolyte disturbances.*Renal failure*- Although severe dehydration and electrolyte imbalances can impact renal function, **acute renal failure** is not typically the *most immediate and serious* life-threatening complication of severe anorexia nervosa compared to cardiac issues.- While possible, this presentation doesn't strongly point to acute severe kidney injury as the primary immediate threat to life.*Hypothermia*- Individuals with severe underweight and low body fat are prone to **hypothermia** due to impaired thermoregulation.- However, hypothermia is generally not considered the *most immediate and serious* life-threatening risk compared to sudden cardiac events caused by severe electrolyte derangements.*Infection*- Malnutrition can lead to **immunodeficiency**, increasing susceptibility to infections.- However, **infection** is typically a more chronic or opportunistic risk rather than the *most immediate and serious* life-threatening concern in the acute presentation of severe underweight, where cardiac instability is paramount.

Question 1

A 27-year-old woman presents with amenorrhea, weight loss, and excessive exercise. Her BMI is 16 kg/m². She has bradycardia and hypotension. What is the most serious immediate risk?

Accepted Answer

Cardiac arrhythmias

Answer

Osteoporosis

Answer

Renal failure

Answer

Hypothermia

Answer

Electrolyte imbalance

Question 2

A 31-year-old woman presents with amenorrhea, weight loss, and lanugo hair. Her BMI is 15 kg/m². She denies having an eating disorder. What is the most serious immediate risk?

Accepted Answer

Cardiac arrhythmias

Answer

Osteoporosis

Answer

Renal failure

Answer

Hypothermia

Answer

Infection

Question 3

A 67-year-old man presents with confusion and agitation 2 days after hip replacement surgery. He sees insects crawling on the walls and is oriented only to person. His medication includes morphine PCA. Vital signs are stable. What is the most likely diagnosis?

Accepted Answer

Postoperative delirium

Answer

Alcohol withdrawal

Answer

Dementia

Answer

Sepsis

Answer

Fat embolism

Question 4

Which of the following best describes the principle of 'best interests' under the Mental Capacity Act 2005 when making decisions for a person who lacks capacity?

Accepted Answer

The decision must consider the person's past and present wishes, feelings, beliefs and values, alongside other relevant factors

Answer

The decision that the healthcare professional believes is medically optimal

Answer

The decision that the patient's family unanimously agrees upon

Answer

The decision that involves the least restrictive option in all circumstances

Answer

The decision that is most cost-effective for healthcare services

Question 5

A 25-year-old man is assessed following discharge from a psychiatric ward where he was treated for a first episode of psychosis. He describes hearing voices telling him he is worthless and should kill himself. He states he doesn't believe the voices but finds them distressing. He has good insight into his illness, is adherent to medication, and has strong family support. He denies any suicidal ideation or intent. What is the most appropriate risk classification?

Accepted Answer

Low-moderate risk - command hallucinations are present but other protective factors exist

Answer

Low risk - he has insight and denies suicidal intent

Answer

Moderate risk - command hallucinations require intensive monitoring

Answer

Moderate-high risk - first episode psychosis carries inherently high suicide risk

Answer

High risk - command hallucinations to self-harm require immediate hospitalization

Risk, Capacity & Safeguarding — MCQs

Risk, Capacity & Safeguarding — MCQs

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