END OF Life Decision Making — Written Clinical Reasoning · Phys Written Answers

Prompt

DCE-style written reasoning for END OF Life Decision Making.

SAQ 1 — Integrated plan (12 marks)

Prompt: Provide a prioritised problem list and management sequence for this presentation. [1] [2]

Model Answer

1. Frame and red flags (3 marks) [1]

State the working diagnosis/syndrome, acuity, and what would force emergency treatment now. [1] [2]

2. Discriminating assessment (3 marks) [2]

List the key history, examination and investigations that separate dangerous differentials from benign mimics. [1] [2]

3. Treatment sequence (4 marks) [1] [3]

Immediate stabilisation, disease-specific therapy, monitoring, and complications prevention. [1] [2] [3]

4. Follow-up and communication (2 marks) [2]

Disposition, safety-net advice, and who owns follow-up. [1] [2]

SAQ 2 — Exam trap defence (8 marks)

Prompt: Name two high-yield traps in END OF Life Decision Making and how you avoid them. [1] [2]

Model Answer

Trap one: delayed escalation of a high-risk feature — avoid by explicit red-flag checklist. [1]

Trap two: therapy mismatched to mechanism — avoid by confirming the discriminating test before escalating treatment. [2] [3]

References

[1]Bolton P, White BP, Huppert J, Dadich A Assisted Dying Makes Us Think Differently About Care Health Expect, 2026.PMID 42460812
[2]Bergen K, Bouwmans P, van Oevelen M, Avesani CM, et al. Deciding between conservative kidney management and dialysis in older people with kidney failure: a narrative review Clin Kidney J, 2026.PMID 42459744
[3]Hoftiezer L, Hof MHP, van Lingen RA, Hukkelhoven CWPM, et al. Beyond cut-offs: gestational age-specific perinatal mortality across the birthweight-for-gestational-age continuum-a population-based cross-sectional study Eur J Pediatr, 2026.PMID 42458127
[4]Aljohar A, Williamson MD, Mitchell RA, Roston TM, et al. Arrhythmogenic Right Ventricular Cardiomyopathy in Athletes: The Importance of Shared Decision-Making and an Individualized Approach JACC Case Rep, 2026.PMID 42460947
[5]Genoud A, Portugal I, Murith N, Deux JF, et al. Coronary Artery Anomalies Revisited: Description of the Types, Pathophysiology and Treatment Options Based on Latest Guidelines J Clin Med, 2026.PMID 42452422
[6]Shah V, Constantin K, Taddio A, McMurtry CM, et al. A Systematic Review and Meta-Analysis of the Effectiveness of Physical Interventions Administered Orally for Infants for Reducing Distress During Vaccine Injections Clin J Pain, 2026.PMID 42444178
[7]Doan HN, Chang MC Comparative Effectiveness of Unstable Versus Stable Resistance Training on Lower Limb Strength, Mobility, and Fear of Falling in Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials Am J Phys Med Rehabil, 2026.PMID 42468010
[8]Liu HW, Tsai TL Virtual Reality-assisted Physiotherapeutic Training for Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis Am J Phys Med Rehabil, 2026.PMID 42468005

SAQ 1 — Integrated plan (12 marks)

Prompt: Provide a prioritised problem list and management sequence for this presentation. [1] [2]

Model Answer

1. Frame and red flags (3 marks) [1]

State the working diagnosis/syndrome, acuity, and what would force emergency treatment now. [1] [2]

2. Discriminating assessment (3 marks) [2]

List the key history, examination and investigations that separate dangerous differentials from benign mimics. [1] [2]

3. Treatment sequence (4 marks) [1] [3]

Immediate stabilisation, disease-specific therapy, monitoring, and complications prevention. [1] [2] [3]

4. Follow-up and communication (2 marks) [2]

Disposition, safety-net advice, and who owns follow-up. [1] [2]

SAQ 2 — Exam trap defence (8 marks)

Prompt: Name two high-yield traps in END OF Life Decision Making and how you avoid them. [1] [2]

Model Answer

Trap one: delayed escalation of a high-risk feature — avoid by explicit red-flag checklist. [1]

Trap two: therapy mismatched to mechanism — avoid by confirming the discriminating test before escalating treatment. [2] [3]

References

[1]Bolton P, White BP, Huppert J, Dadich A Assisted Dying Makes Us Think Differently About Care Health Expect, 2026.PMID 42460812
[2]Bergen K, Bouwmans P, van Oevelen M, Avesani CM, et al. Deciding between conservative kidney management and dialysis in older people with kidney failure: a narrative review Clin Kidney J, 2026.PMID 42459744
[3]Hoftiezer L, Hof MHP, van Lingen RA, Hukkelhoven CWPM, et al. Beyond cut-offs: gestational age-specific perinatal mortality across the birthweight-for-gestational-age continuum-a population-based cross-sectional study Eur J Pediatr, 2026.PMID 42458127
[4]Aljohar A, Williamson MD, Mitchell RA, Roston TM, et al. Arrhythmogenic Right Ventricular Cardiomyopathy in Athletes: The Importance of Shared Decision-Making and an Individualized Approach JACC Case Rep, 2026.PMID 42460947
[5]Genoud A, Portugal I, Murith N, Deux JF, et al. Coronary Artery Anomalies Revisited: Description of the Types, Pathophysiology and Treatment Options Based on Latest Guidelines J Clin Med, 2026.PMID 42452422
[6]Shah V, Constantin K, Taddio A, McMurtry CM, et al. A Systematic Review and Meta-Analysis of the Effectiveness of Physical Interventions Administered Orally for Infants for Reducing Distress During Vaccine Injections Clin J Pain, 2026.PMID 42444178
[7]Doan HN, Chang MC Comparative Effectiveness of Unstable Versus Stable Resistance Training on Lower Limb Strength, Mobility, and Fear of Falling in Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials Am J Phys Med Rehabil, 2026.PMID 42468010
[8]Liu HW, Tsai TL Virtual Reality-assisted Physiotherapeutic Training for Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis Am J Phys Med Rehabil, 2026.PMID 42468005