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Gentamicin prescribing safety — SCE Acute Medicine MCQ

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EasyPerioperative, Safety and End-of-Life CareGentamicin prescribing safetySCE Acute Medicine

A 42-year-old man presents with postoperative deterioration, treatment refusal or advanced illness. Relevant history includes recent surgery, frailty or a governance issue. On assessment, physiology and communication context require senior decision-making. Investigations show sepsis requiring gentamicin in CKD and low body weight. What is the most appropriate next step in management?

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Correct answer: D — Use weight-based dosing with renal-adjusted monitoring and document indication

The key discriminator is that sepsis requiring gentamicin in CKD and low body weight, which makes Use weight-based dosing with renal-adjusted monitoring and document indication the single best answer. Provide supportive care and close monitoring is less appropriate because it does not address the dominant acute risk in the vignette; Start anticoagulation after assessing bleeding risk would fit a different presentation or later stage of care. Arrange urgent specialist referral and Give controlled oxygen and senior review are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: BNF gentamicin; NICE NG15