Monday, 13 June 2016

13 June 2016



13 June 2016.

15
How to read exercise & SBA. Extract the key facts for Qs. from SIP 1. 2013. Air Travel & Pregnancy.
16
EMQ. Early pregnancy complications. Diagnoses to exclude.
17
EMQ. Coroner. 1 – 3.
18
SBA. Progestogen-only implants.
19
SBA. Caldicott guardian.

15.   How to read exercise & SBA.
         You are asked to extract key facts from “Air Travel & Pregnancy.” SIP 1. 2013 that might be the basis for exam questions.
         Before reading the SIP, answer the following questions – this might help to focus your efforts.
Question 1.
Lead-in
Which of the following statements, if any, are true in relation to air travel..
Option List
A.         
there is evidence that abruption is more common in passengers
B.          
there is evidence that abruption is more common in flight attendants
C.          
there is evidence that PPROM is more common in passengers
D.         
there is evidence that PPROM is more common in flight attendants
E.          
there is evidence that miscarriage and FDIU are more common in flight attendants
Question 2.
Lead-in
When a plane has reached cruising altitude, approximately what altitude does the cabin pressure equate to?
Option List
A.         
1,00 feet
B.          
3,000 feet
C.          
6,000 feet
D.         
10,000 feet
E.          
20,000 feet
Question 3.
Lead-in
What is the reduction in the blood oxygen saturation at cruising altitude in a commercial aircraft?
Option List
A.         
5%
B.          
10%
C.          
15%
D.         
20%
E.          
25%
Question 4.
Lead-in
Which of the following conditions are likely to lead to problems as a result of the reduced oxygen saturation at cruising altitudes?
Option List
A.         
anaemia: Hb < 9 g/dl
B.          
women with sickle cell disease
C.          
women with recent gastro-intestinal tract surgery involving bowel sutures
D.         
women with recent urinary tract surgery involving sutures to the bladder
E.          
none of the above

16.   EMQ. Early pregnancy complications. Diagnoses to exclude.
         Lead-in.
         The following scenarios relate to early pregnancy. For each, select the diagnosis you most want to exclude. Pick one option from the option list. Each option can be used once, more than once or not at all.
         Scenario 1.
         A 35-year-old primigravida is seen in the EPU with vaginal bleeding and severe left iliac fossa pain. The pregnancy occurred after four cycles of IVF and embryo transfer was performed six weeks ago. Her β-hCG is >1,000 iu/l. An ultrasound scan showed an intra-uterine pregnancy of an appropriate size for the gestation. Normal fetal heart activity was noted. No adnexal masses were seen.
         Scenario 2.
         A 25-year-old woman with known PCOS is seen in the early pregnancy unit after an episode of slight vaginal bleeding. Her LMP was 10 weeks ago. An ultrasound scan shows an intra-uterine pregnancy with CRL of 6 mm. No fetal heart activity is seen.
         Scenario 3.
         A GP phones for advice. She is conducting her morning surgery. A nulliparous woman at 6 weeks’ gestation has returned from France where she has enjoyed the local food, particularly unpasteurised soft cheese and pork meats. She has presented with diarrhoea and mild abdominal pain. A β-hCG is 25 iu/l. She is concerned about listeriosis and toxoplasmosis, about which she has read.
         Scenario 4.
         A 30-year-old parous woman attends the EPU with vaginal bleeding and lower abdominal pain. An ultrasound scan shows a 30 mm. intra-uterine sac but no evidence of fetal heart activity.
         Scenario 5.
         A 45-year-old para 6 is admitted to the A&E department with 6 weeks’ amenorrhoea. A β-hCG is positive. She complains of retrosternal pain and has a history of heartburn and acid reflux. Her BMI is 30. She smokes 40 cigarettes daily and has COAD.

17.   EMQ.  Coroner. 1 – 3.
         Lead-in.
         The following scenarios relate to the role of the Coroner. Pick one option from the option list. Each option can be used once, more than once or not at all.
         Option list.
A.    an independent judicial officer
B.    a barrister acting for the Local Police Authority
C.    the regional representative of the Home Office
D.   the regional representative of the Queen.
E.    an employee of the High Court.
F.     the Local Authority
G.   the Local Police Authority
H.   the Home Office
I.      the High Court
J.      the Queen
         Scenario 1.
         What is the best description of the status of the Coroner?
         Scenario 2.
         Who appoints the Coroner?
         Scenario 3.
         Who pays for the Coroner and the coronial service?
         The Coroner. Question 2.
         Lead-in.
         The following scenarios relate to the role of the Coroner.
         Pick one option from the option list.
         Each option can be used once, more than once or not at all.
         Option list.
A.    must have had experience as a detective in the police force with  rank of Inspector or above
B.    must be a barrister, lawyer or doctor with at least 5 years’ experience
C.    must be a legally qualified individual with at least 5 years’ experience
D.   must be a trained bereavement counsellor
E.    must be able to play the bagpipes
F.     Monday -  Friday; 09.00 - 17.00 hours, including bank holidays
G.   Monday - Friday; 09.00 - 17.00 hours, excluding bank holidays
H.   All the time
I.      to arrest people suspected of unlawful killing
J.      to manage traffic in the vicinity of the Coroner’s court
K.    to make enquiries on behalf of the Coroner
L.     to make enquiries on behalf of the Coroner and provide administrative support
M.  to play bagpipes at coronial funerals
         Scenario 1.
         What qualifications must the Coroner have?
         Scenario 2.
         What are the hours of availability of the Coroner?
         Scenario 3.
         What is the role of the Coroner’s Officers?
         The Coroner. Question 3.
         Lead-in.
         The following scenarios relate to the role of the Coroner.
         Pick one option from the option list.
         Each option can be used once, more than once or not at all.
         Option list.
A.        the death must be reported to the Coroner
B.         the death does not need to be reported to the Coroner
C.         the Coroner must order the return of the body for an inquest
D.        the Coroner must order a post-mortem examination
E.         the Coroner must hold an inquest
F.         the Coroner should arrange for the death to be investigated by the Home Office
G.        the death must be reported to the authorities of the country in which it took place in order that a certificate of death can be issued
H.        a certificate of live birth
I.           a certificate of stillbirth
J.          a certificate of miscarriage
K.         yes
L.          no
M.      none of the above
         Scenario 1.
         A resident of Manchester dies suddenly while visiting the town of his birth in Scotland. His family decides that he will be buried there. His body is held at the premises of a local funeral director. What actions should be taken with regard to the Manchester coroner?
         Scenario 2.
         A resident of London dies suddenly while visiting Manchester, where he was born. His family decides that he will be buried in Manchester. His body is held at the premises of a Manchester funeral director. What actions should be taken with regard to the Manchester coroner?
         Scenario 3.
         A resident of Manchester dies on holiday in his native Greece. The family decide that he will be buried in Greece. What steps must be taken to obtain a valid death certificate?
         Scenario 4.
         A man of 65 dies of terminal lung cancer. The GP visited daily until going on holiday three weeks before the death. He has now returned and says that he will sign a death certificate, but needs to visit the funeral director to see the body first.  Will this be a valid death certificate?
         Scenario 5.
         A man of 65 dies of terminal lung cancer. The GP, who visited daily up to the day of his death and attended to confirm the death, is on holiday. He says that he will sign a death certificate and put it in the post, so that it will arrive in the morning. Will this be a valid death certificate?
         Scenario 6.
         A man of 65 dies of terminal lung cancer. The GP, who visited daily up to the day before his death, has been on holiday since. However, he says that he will sign a death certificate and put it in the post, so that it will arrive in the morning. Will this be a valid death certificate?
         Scenario 7.
         A 65-year-old man dies suddenly 12 hours after admission to the local coronary care unit with chest pain, despite the apparently satisfactory insertion of a coronary artery stent after a diagnosis of coronary artery thrombosis. What action should be taken with regard to the Coroner?
         Scenario 8.
         A 16-year-old girl is admitted at 36 weeks’  gestation in her first pregnancy with placental abruption. She is given the best possible care but develops DIC and hypovolaemic shock and dies after 48 hours. What action should be taken with regard to the coroner?
         Scenario 9.
         A 28-year-old woman is admitted with placental abruption at 36 weeks. She has bruising on the abdominal wall and the admitting midwife suspects that she has been the victim of domestic violence, though the woman denies it. Despite best possible care she dies as a consequence of bleeding. What action should be taken with regard to the coroner?
         Scenario 10.
         A 30-year-old woman delivers normally at home attended by her husband, but has a PPH. The husband practises herbal medicine. He applies various potions but her condition deteriorates. She is admitted to hospital by emergency ambulance some hours later in a shocked condition. She is given the best possible care and is admitted to the ICU. She dies 7 days later of multi-organ failure and ARDS attributed to hypovolaemic shock. What action should be taken with regard to the coroner?
         Scenario 11.
         A woman is admitted at 23 weeks in premature labour. There is evidence of fetal heart activity throughout the labour, with the last record being 5 minutes before the baby delivers. The baby shows no evidence of life at birth. The mother requests a death certificate so that she can register the birth and arrange a funeral. What form of certificate should be issued?
         Scenario 12.
         A woman is admitted at 26 weeks’ gestation in premature labour. The presentation is footling breech. At 8 cm. cervical dilatation the trunk is delivered and the cord prolapses. There is good evidence of fetal life with fetal movements and pulsation of the cord. The head is trapped and it takes 5 minutes to deliver it. The baby is pulseless, apnoeic and without visible movement at birth. Intubation and CPR are carried out for 20 minutes when the baby is declared dead. What action should be taken with regard to the coroner?
         Scenario 13.
         A 65-year-old man dies 2 hours after admission to hospital with an apparent stroke. The coroner requests access to the notes. What access should be provided?
         Option list.
A
provide access to the records by the Coroner in person
B
provide unrestricted access to the medical records by the coroner’s officers
C
provide a copy of the hospital records to the coroner or her officers
D
provide a medical report, but no access to the medical records
E
provide a copy of the letter to the GP about the recent admission
F
none of the above

18.   SBA.  Progestogen-only implants
         Abbreviations.
         ENG:           etonorgestrel
         HFW:          hormone-free week
         LNG:            levonorgestrel
         Question 1.
         Lead-in
         Pick the best option from the list below in relation to the hormone in Nexplanon.
         Option List
A
68 mg. ENG
B
100 mg. ENG
C
100 mg. LNG
D
150 mg. LNG
E
50 mg. ENG + 100 mg. LVG
         Question 2.
         Lead-in
         How does Nexplanon act as a contraceptive?
I     mainly by inducing anovulation
II   mainly by altering cervical mucus to the detriment of sperm transport
III  mainly by thinning the endometrium, preventing implantation
IV  mainly by inducing loss of libido
         Choose the best option from the list below.
         Option List
A.         
I
B.          
I + II
C.          
I + III
D.         
II + III
E.          
III + IV
         Question 3.
         Lead-in
         What is the age range, if any, for which Nexplanon is licensed in the UK?
         Option List
A
15 – 50 years
B
18 – 40 years
C
18 – 45 years
D
20 – 50 years
E
None of the above.
         Question 4.
         Lead-in
         A woman who is not in the licensed age range requests a Nexplanon. How should the advising doctor proceed?
         Option List
A
Advise her about alternative licensed contraceptive methods, but decline to insert Nexplanon
B
Advise her about alternative licensed contraceptive methods and insert Nexplanon
C
Fit her with a LNGIUS
D
Refer her to a colleague who fits anyone who asks with a Nexplanon
E
None of the above
         Question 5.
         Lead-in
         Which, if any, of the following statements best describes the pregnancy rate for women using Nexplanon are true?
         Option List
A
The pregnancy rate is < 1 per 1,000 women during 3 years of use
B
The pregnancy rate is < 5 per 1,000 women during 3 years of use
C
The pregnancy rate is < 10  per 1,000 women during 3 years of use
D
The pregnancy rate is 10-20 per 1,000 women during 3 years of use
E
None of the above
         Question 6.
         Lead-in
         Which, if any, other implants are licensed in the UK?
         Option List
A.         
Implanon
B.          
Norplant
C.          
Norplant-2
D.         
Jadelle
E.          
None of the above
         Question 7.
         Lead-in
         What are the main differences between Nexplanon and Implanon?
         Pick the most suitable answer from the list below.
         Option List
A.         
The dosage was increased from 60 to 68 mg. etonorgestrel
B.          
The dosage was increased from 150 – 175 mg. levonorgestrel
C.          
Barium sulphate was added to Nexplanon to make it radio-opaque
D.         
The number of rods was reduced to 2
E.          
None of the above
         Question 8.
         Lead-in
         What problems is the new applicator designed to minimise?
               I.               non-insertion
             II.               deep insertion
           III.               difficulty with one-handed insertion
           IV.               difficulty with left-handed insertion
             V.               difficulty with insertion in very thin women.
         Option List
A.         
I + II + III + IV
B.          
I + II + III + IV + V
C.          
II + III
D.         
II + III + IV
E.          
II + III + IV + V
         Question 9.
         Lead-in
         How long is Nexplanon licensed for?
         Option List
A.         
1 year
B.          
2 years
C.          
3 years
D.         
5 years
E.          
10 years
         Question 10.
         Lead-in
         What does NICE recommend that patients be told about bleeding patterns with Nexplanon?
                    I.     menstrual bleeding may cease
                  II.     menstrual bleeding may become prolonged
                III.     bleeding may become more frequent
                IV.     menstrual bleeding may become less frequent
                  V.     intermenstrual bleeding can be a problem in the first 6 months
         Option List
A.         
I + II + III
B.          
I + II + III + IV
C.          
II + III + IV + V
D.         
I + III + IV
E.          
I + III + IV + V
         Question 11.
         Lead-in
         What information should women be given about the effect of Nexplanon on pain?
Option List
A.         
Dysmenorrhoea may increase
B.          
Dysmenorrhoea may decrease
C.          
Mittelschmerz is likely to cease
D.         
Pain due to endometriosis is likely to decrease
E.          
Dyspareunia is likely to be alleviated
         Question 12.
         Lead-in
         A 25-year old nulliparous woman has been found to have a few spots of endometriosis in the pouch of Douglas at laparoscopy for pelvic pain. She wishes to avoid pregnancy for 5 years but then wishes to have two children. She has read an article suggesting that a progesterone-only implant provides high levels of contraceptive efficacy and good results in suppressing endometriosis. What advice will you give?
Option List
A.         
Recommend a low-dose COC and tricycling as the best means of suppressing endometriosis plus providing effective contraception
B.          
Recommend a low-dose COC taken continuously as the best means of suppressing endometriosis plus providing effective contraception
C.          
Recommend Nexplanon as the best means of suppressing endometriosis plus providing effective contraception
D.         
Recommend Depot-Provera as the best means of suppressing endometriosis plus providing effective contraception
E.          
None of the above
Question 13.
         Lead-in
         When can a Nexplanon be inserted with no need for additional contraception  in a woman with regular menstrual cycles and no contraindication to its use?
         Option List
A.         
Up to and including day 3 of menstruation
B.          
Up to and including day 5 of menstruation
C.          
Up to and including day 7 of menstruation
D.         
Never
E.          
None of the above
         Question 14.
         Lead-in
         A healthy 25 year-old-woman is recovering well from a normal delivery. She is not breastfeeding and wishes to start Nexplanon.
         Option List
         Pick the best statement from the list below.
A.         
No additional contraception is needed if Nexplanon is inserted by day 7
B.          
No additional contraception is needed if Nexplanon is inserted by day 14
C.          
No additional contraception is needed if Nexplanon is inserted by day 21
D.         
No additional contraception is needed if Nexplanon is inserted by day 28
E.          
No additional contraception is needed if Nexplanon is inserted by day 42
         Question 15.
         Lead-in
         A healthy 20-year-old woman wishes to switch from a COC to Nexplanon. What rules apply to the need for additional contraception?
I
If insertion takes place on day 1 of the HFW, no additional contraception is needed.
II
If insertion takes place on day 5 of the HFW, additional contraception is needed for 7 days.
III
If insertion takes place in week 2 after the HFW, no additional contraception is needed.
IV
If insertion takes place in week 3 after the HFW, no additional contraception is needed.
         Option List
A
I
B
I + II
C
I + II + III
D
II + III + IV
E
I + II + III + IV
         Question 16.
         Lead-in
I
Women switching from a POP to Nexplanon should be advised that additional contraception is required for 7 days.
II
Women switching from a POP to Nexplanon should be advised that additional contraception is not required.
III
Women switching from a LNGIUS to Nexplanon should be advised that additional contraception is required for 7 days.
IV
Women switching from a LNGIUS to Nexplanon, should be advised that additional contraception is not required.
         Option List
A
I + III
B
I + IV
C
II + III
D
II + IV
E
none of the above

19. SBA. Caldicott Guardian.
Question 1.
Lead-in
Which of the following statements is true of the Caldicott Guardian?
Option List
A
it is a large lizard, unique to the Galapagos Islands
B
it is the Trust Board member responsible for child safeguarding procedures
C
it is the Trust Board member responsible for complaint procedures
D
it is the person within a Trust responsible for patient confidentiality in relation to information
E
it is the person within a Trust responsible for dealing with bullying

Question 2.
Lead-in
The Caldicott Report identified 6 basic principles. What are they?
Option list.
There is none. Imagine that there is information about you stored on the computers of the local NHS Trust. What conditions would you want to lay down about sharing of that information within the Trust, with other NHS organisations and with non-NHS organisations?

Question 3.
Lead-in
The Caldicott Report made numerous recommendations. Which was particularly important for major NHS organisations such as Trusts?
Option List
A.       
the need to appoint a Caldicott Guardian
B.       
the need to create a Caldicott Register
C.       
the need to create a Caldicott Police Department
D.       
the need to create a link between the Caldicott Department and the DOH
E.        
none of the above.

Question 4.
Lead-in
What is the definition of the key role deriving from the answer to question 3?
Option List
There is none lest it give you the answer to question 3!


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