23 June 2016.
20
|
EMQ. Stolen
notes
|
21
|
EMQ. Risk
management
|
22
|
EMQ. Ulipristal
|
23
|
EMQ. COC:
starting and missed pills
|
24
|
EMQ. Headache
|
20. EMQ. Stolen notes.
Lead-in.
A SpR1 has been asked to carry out an audit and 50 sets
of case-notes are to be used.
He is given 49 sets of notes and a day in which to go
through them and extract the necessary data.
This he does in the hospital.
The final set of notes cannot be found initially, but are
found two weeks later.
The doctor is given the notes on a Friday afternoon as he
is leaving for home.
He decides to take the notes home to extract the data.
On the way home he stops at his favourite supermarket.
When he emerges, his car has been stolen with the notes
inside.
He reports the theft to the police.
Abbreviations.
BMA: British
Medical Association
CG: Caldicott
Guardian
MDU: Medical
Defence Union
NHSLA: NHS Litigation Authority
Question 1.
The SPR informs you, the Clinical Director, on the Monday
when he returns to work.
What action will you take?
Option list.
A
|
Report events to the Caldicott Guardian
|
B
|
Report events to the Chief Executive
|
C
|
Report events to the General Medical Council
|
D
|
Report events to the NHSLA as a “never event”
|
E
|
Report events to the NHSLA as a “serious incident”
|
F
|
Report events to the NPHSLA as a “never event”
|
G
|
Report events to the NPSLA as a “serious incident”
|
H
|
Report events to the Risk Management Team
|
I
|
Report events to the Root Cause Analysis Team
|
J
|
Report events to the Trust Information Management
Committee
|
K
|
Suspend the doctor until a full investigation has been
done
|
Question 2.
What action will you take to deal with the SpR?
Option list.
A.
|
Suspend the doctor until a full investigation has been
done
|
B.
|
Report the doctor to the Medical Director
|
C.
|
Report the doctor to the Postgraduate Dean
|
D.
|
Report the doctor to the General Medical Council
|
E.
|
Report the doctor to the NHSLA
|
F.
|
Report the doctor to the Caldicott Guardian
|
G.
|
Report the doctor to the Trust Board member responsible
for safeguarding
|
H.
|
Report the doctor to the BMA
|
I.
|
Report the doctor to the MDU
|
J.
|
None of the above
|
Question 3.
What action will you take in relation to the patient whose
notes are missing?
Option list.
A.
|
Ask the Caldicott Guardian to deal with it
|
B.
|
Ask the Chief Executive to deal with it
|
C.
|
Ask the hospital’s legal team to deal with it
|
D.
|
Ask the patient’s GP to deal with it
|
E.
|
Discuss with the legal team, inform the patient,
discuss the implications and keep her fully-up-to-date
|
F.
|
Tell all those who know about the incident to discuss
it with no one else, particularly the patient
|
G.
|
None of the above
|
21. EMQ. Risk management.
Lead-in.
The following scenarios relate to risk management /
disciplinary procedures.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Abbreviations.
DOH: Department
of Health.
Option list.
A.
allow the practice to
continue
B.
stop the practice
until a full investigation has been done
C.
stop the practice permanently
D.
arrange an
investigation by a senior consultant from another hospital
E.
decide the practice
does not involve added risk
F.
declare the risk to be
acceptable
G.
cancel admissions for
surgery
H.
arrange adverse
incident analysis
I.
arrange audit
J.
arrange research
K.
arrange a formal
warning for the doctor
L.
arrange retirement for
the doctor
M.
arrange dismissal for
the doctor
N.
consult the on-call
consultant
O.
consult the Clinical
Director
P.
consult the
Educational Supervisor / College Tutor
Q.
consult the Medical
Director
R.
consult the Chief
Executive
S.
consult the
Postgraduate Dean.
T.
consult the hospital’s
lawyer
U.
write to Her Majesty
at Buckingham Palace
V.
consult your Medical
Defence Body
W.
consult the British
Medical Association
X.
consult the RCOG
Y.
report the matter to
the GMC
Z.
allow return to work
AA.
allow return to work,
but offer support
BB.
arrange a “return to
work” package specific to the doctor
CC.
none of the above
Scenario 1
You are the Clinical Director.
1 62-year-old Consultant colleague has been off work for 8 weeks with a broken
arm sustained in a skiing accident. He sends you a certificate from his
specialist to say that he is now fit to return to work. He indicates that he
wishes to return to work immediately. What action will you take?
Scenario 2
You are the Clinical Director.
1 62-year-old Consultant colleague has been off work for 8 weeks with a severe
bereavement reaction to the suicide of a family member. He sends you a
certificate from his GP to say that he is now fit to return to work. He
indicates that he wishes to return to work immediately. What action will you
take?
Scenario 3
You are the Clinical Director.
1 62-year-old Consultant colleague has been off work for 6 months after having
a coronary thrombosis. He sends you a certificate from his specialist to say
that he is now fit to return to work. He indicates that he wishes to return to
work immediately. What action will you take?
Scenario 4
You are the Clinical Director.
A 62-year-old Consultant has returned to work after four months’ sick leave
after a coronary thrombosis. He has three cases on his first operating list and
all have complications reported by the Sister on the gynaecology ward. What
action will you take?
Scenario 5.
A Consultant has been in her
first consultant post for two months. Three of the four patients on a single
operating list develop post-operative wound infections. What action will you
take?
Scenario 6.
You have recently been
appointed Clinical Director. A consultant has been in post for ten years and
prefers to operate with the same nurse assistant. No complications have been
reported. What action will you take?
Scenario 7.
You are the Clinical Director. A consultant has an operating list in a peripheral unit 20 miles from the
main hospital. There is no resident doctor with post-operative care being provided
by nurses. The cases dealt with on the list traditionally were minor,
day-cases. You have been told that the
consultant, who was appointed 6 months ago, has recently been doing
hysterectomies and prolapse repairs to get the waiting list down. What action will you take?
Scenario 8.
You are the Clinical Director.
The blood bank informs you that there is a problem with supplies and fully
cross-matched blood cannot be guaranteed for tomorrow’s arranged surgical
cases.
What action will you take?
Scenario 9.
You are the on-call SpR. It is
8 pm. The blood bank informs you that there is a problem with supplies and
fully cross-matched blood cannot be guaranteed for tomorrow’s arranged surgical
cases.
What action will you take?
Scenario 10.
An SpR is half an hour late for
starting his duties on three occasions in one week. His consultant wishes to
have this dealt with as a disciplinary matter to “nip it in the bud” and teach
him a lesson. He reports it to you, the Clinical Director asking you to
discipline the doctor. What action will you take?
Scenario 11
An SpR gets into an argument
with the senior midwife on the labour ward and in the heat of the moment slaps
her across the face. You are the Clinical Director and the matter is reported
to you next day.
Scenario 12
Your consultant is the Clinical
Director and a nasty man. You apply 6 months in advance for study leave for the
week before the written part of the Part Ii MRCOG exam. He tells you that he plans
to go on holiday at that time and you are not going to get any leave. In
addition, he tells you that if you complain about this he will give you a
terrible reference and tell all his consultant friends that you are a waste of
space in order to ruin your career. What action can you take?
Scenario 13
A SpR fails an OSATS, but
falsifies his records to indicate that it has been completed satisfactorily.
You are the Educational Advisor and this is brought to your attention. What
action will you take ?>
Scenario 14
You are the Clinical Director. A
SpR2 uploaded reflective practice putting himself in a good light after a case
which had been handled sub-optimally by him. What action will you take?
Scenario 15
You are an FY2 and assist
the senior consultant at a hysterectomy. The operation goes well initially, but
then there is a lot of bleeding and a ureter is cut. The consultant urologist
attends and repairs the ureter. The woman bleeds vaginally that evening and is
taken back to theatre by another consultant and ends up in the ICU. You became
convinced during the operation that you could smell alcohol on the consultant
gynaecologist’s breath. What are your responsibilities?
Scenario 16
When do you need to inform the Consultant on-call?
Scenario 17
When do you need to inform the Clinical Director?
Scenario 18
When do you need to inform the Medical Director?
Scenario 19
When do you need to inform the GMC?
Scenario 20
What are the roles of the BMA and MDU?
Scenario 21
What are the differences between verbal and written
warnings?
Scenario 22.
Lead-in.
You are the SpR for the delivery unit. During a quiet moment
you head for the staff room adjacent to the operating theatre for a coffee. As
you pass the anaesthetic room you hear loud snoring. You look in and find the
on-call anaesthetic registrar unconscious on his back on the floor with an
anaesthetic mask by his face attached to a cylinder of nitrous oxide.
What action will you take?
Pick one option from the option list.
Option list.
|
|
call for help from the senior midwife
|
|
|
go back to the labour ward and pretend that nothing has
happened
|
|
|
go back to the labour ward and inform the senior midwife
|
|
|
phone the GMC
|
|
|
phone the on-call consultant anaesthetist
|
|
|
phone the on-call consultant obstetrician
|
|
|
phone the police
|
|
|
put the anaesthetist in the recovery position and remove
the mask
|
|
|
none of the above
|
Scenario 23.
Lead-in.
You are the SpR for the delivery unit. During a quiet moment
you head for the staff room adjacent to the operating theatre for a coffee. As
you pass the anaesthetic room you hear loud snoring. You look in and find the
on-call anaesthetic registrar unconscious on his back on the floor with an
anaesthetic mask by his face attached to a cylinder of nitrous oxide.
What action will you take next?
Pick one option from the option list.
Option list.
|
|
call for help from the senior midwife
|
|
|
go back to the labour ward and pretend that nothing has
happened
|
|
|
go back to the labour ward and inform the senior midwife
|
|
|
phone the GMC
|
|
|
phone the on-call consultant anaesthetist
|
|
|
phone the on-call consultant obstetrician
|
|
|
phone the police
|
|
|
put the anaesthetist in the recovery position and remove
the mask
|
|
|
none of the above
|
Scenario 24.
Lead-in.
You are the Clinical Director. It is the morning after the events
in scenarios 22 and 23.
The on-call consultant obstetrician comes to see you are
reports what has happened.
What action will you take?
Pick one option from the option list.
Option list.
|
|
discuss the case with the Chief Executive
|
|
|
discuss the case with the Medical Defence Union
|
|
|
discuss the case with the Medical Director
|
|
|
discuss the case with the Medical Director
|
|
|
discuss the case with the most senior person in the
personnel department
|
|
|
discuss the case with the Postgraduate Dean
|
|
|
report the anaesthetic registrar to the GMC
|
|
|
resign from being Clinical Director to avoid stress
|
|
|
summon the anaesthetic registrar to give him a severe
telling-off
|
22. EMQ. Ulipristal.
Lead-in.
The following scenarios relate to ulipristal. For each,
select the most appropriate from the option list.
Each option can be used once, more than once or not at
all.
Option list.
A
|
GnRH analogue.
|
B
|
Selective serotonin reuptake inhibitor.
|
C
|
19-nortestosterone derived progestagen.
|
D
|
21-hydroxyprogesterone-derived progestagen.
|
E
|
mifepristone derivative.
|
F
|
Selective oestrogen receptor modulator.
|
G
|
Selective progesterone receptor modulator.
|
H
|
Urinary excretion.
|
I
|
Metabolised by renal cytochrome P450 enzyme system.
|
J
|
Metabolised by hepatic cytochrome P450 enzyme system.
|
K
|
30 mg. with dose repeated if vomiting occurs within 3
hours.
|
L
|
100 mg. with dose repeated if vomiting occurs within 3
hours.
|
M
|
150 mg. with dose repeated if vomiting occurs within 3
hours.
|
N
|
phenobarbitone
|
O
|
valium
|
P
|
erythromycin
|
Q
|
12 hours.
|
R
|
18 hours.
|
S
|
32 hours.
|
T
|
72 hours.
|
U
|
120 hours.
|
V
|
Depot-contraception.
|
W
|
Depression.
|
X
|
Emergency contraception.
|
Y
|
Menorrhagia.
|
Z
|
Termination of pregnancy.
|
AA
|
Yes.
|
AB
|
No.
|
AC
|
Maybe.
|
AD
|
Continue.
|
AE
|
Discontinue for 36 hours.
|
AF
|
Discontinue for 72 hours.
|
AG
|
May interfere with contraception containing
progestagen.
|
AH
|
May interfere with contraception containing oestrogen.
|
AI
|
No action if LARC being used.
|
Scenario 1.
What type of drug is ulipristal?
Scenario 2.
How is ulipristal broken down / excreted?
Scenario 3.
What is the half-life of ulipristal?
Scenario 4.
Which drug may prolong the half-life of ulipristal?
Scenario 5.
What is the main use of
ulipristal?
Scenario 6.
What is the dose of ulipristal?
Scenario 7.
What time-scale applies to the
licensed use of ulipristal?
Scenario 8.
What contraceptive advice is
given to those using ulipristal?
Scenario 9.
What advice is given to women
who are breast-feeding?
Scenario 10.
Can treatment with ulipristal
be repeated within 1 month?
Scenario 11.
Which medical conditions are contraindications
to ullipristal use ? – these are not on the option list.
23. EMQ. COC: starting & missed pills.
COC Missed pills. Starting the Pill.
Lead-in.
The following scenarios relate to the combined oral
contraceptive (COC) and missed pills.
For each, select the option that best fits the scenario.
Each option can be used once, more than once or not at
all.
Abbreviations.
UPSI: unprotected
sexual intercourse.
Option list.
A.
pill that is ≥ 12
hours late.
B.
pill that is > 12
hours late.
C.
pill that is ≥ 24
hours late.
D.
pill that is > 24
hours late.
E.
two missed pills at
any time in a single cycle.
F.
the first pill taken
in one’s first love affair, now recalled with fond nostalgia for its
effectiveness in preventing pregnancy, the Prince having been truly a loathsome
toad.
G.
no additional
contraception required.
H.
additional contraception
required for 7 days.
I.
emergency contraception
should be considered.
J.
emergency
contraception should be recommended.
K.
take the missed pill
immediately, but not if it means 2 pills in one day; no additional
contraception needed; pill-free interval as normal.
L.
take the missed pill
immediately, even if it means 2 pills in one day; no additional contraception
needed; pill-free interval as normal.
M.
take the missed pill
immediately, even if it means 2 pills in one day; additional contraception for
7 days; pill-free interval as usual.
N.
take one of the missed
pills immediately, discard the other missed pills, use extra contraception for
7 days and discuss emergency contraception with your doctor.
O.
take the missed pills
immediately, use extra contraception for 7 days and discuss emergency
contraception with your doctor.
P.
continuous combined
preparation.
Q.
bi-phasic preparation.
R.
quadriphasic
preparation.
S.
cannot be answered
from the data given.
T.
none of the above.
Scenario 1.
What is the definition of a
missed pill?
Scenario 2.
What is the definition of two
missed pills?
Scenario 3.
A COC is begun on day 1 of menstruation. What advice
should be given about temporary additional contraception?
Scenario 4.
A COC is begun 5 days after day 1 of menstruation. What
advice should be given about temporary additional contraception?
Scenario 5.
A COC is begun for the first time on day 1 of menstruation.
The fifth pill is missed. What advice should be given?
Scenario 6.
A pill is missed on day 14 of a
21-day pack. What advice should be given?
Scenario 7
A pill is missed on day 21 of a
21-day pack. What advice should be given?
Scenario 8
Two pills are missed in the
first week of a 21-day pack. What advice should be given?
Answer:
Scenario 9
Two pills are missed in the
second week of a 21-day pack. What advice should be given?
Scenario 10
Two pills are missed in the third week of a 21-day pack.
What advice should be given?
Scenario 11
What kind of preparation is
Qlaira?
24. EMQ. Headache.
Lead-in.
The following scenarios relate to headache in pregnancy.
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Option list.
1. abdominal migraine
2. analgesia overuse headache aka medication overuse headache
3. bacterial meningitis
4. benign intracranial hypertension
5. BP check
6. cerebral venous sinus thrombosis
7. chest X-ray
8. cluster headache
9. severe PET / impending eclampsia
10. malaria
11. meningococcal meningitis
12. methyldopa
13. methysergide
14. migraine
15. MRI brain scan
16. nifedipine
17. nitrofurantoin
18. pancreatitis
19. sinusitis
20. subdural haematoma
21. subarachnoid haemorrhage
22. tension headache
23. ultrasound scan of the abdomen
Scenario 1.
A 40-year-old para 3 is
admitted at 38 weeks by ambulance with severe headache of sudden onset. She
describes it as “the worst I’ve ever had”. Which diagnosis needs to be excluded
urgently?
Scenario 2.
A 32-year-old para 1 has
recently experienced headaches. They are worse on exercise, even mild exercise
such as walking up stairs. She experiences photophobia with the headaches. Which
is the most likely diagnosis?
Scenario 3.
A woman returns from a
sub-Saharan area of Africa. She develops severe headache, fever and rigors.
What diagnosis should particularly be in the minds of the attending doctors?
Scenario 4.
A woman at 37 weeks has developed headaches. They
particularly occur at night without obvious triggers. They occur every few days
and she then has
Scenario 5.
A primigravida has had headaches on a regular basis for
many years. They occur most days, are bilateral and are worse when she is stressed.
What is the most likely diagnosis?
Scenario 6.
A woman complains of recent
headaches at 36 weeks. The history reveals that the headaches started soon
after she began treatment with a drug prescribed by her GP. Which is the most
likely of the following drugs to be the culprit: 7. methyldopa, methysergide, nifedipine and Nitrofurantoin?
Scenario 7
A woman is booked for Caesarean
section and wishes regional anaesthesia. She had severe headache due to dural
tap after a previous Caesarean section. She wants to take all possible steps to
reduce the risk of having this again. Which of epidural and spinal anaesthesia has the lower risk of causing
dural tap headache?
Scenario 8
A 25-year-old primigravida
complains of headaches which started two weeks before when she attends for her
20 week scan. There is no significant history of previous headache. The pain
occurs behind her right eye and she describes it as severe and “stabbing” in
nature. The pain is so severe that she cannot sit still and has to walk about. She
has noticed that her right eye becomes reddened and “watery” during the attack
and her nose is “runny”. The attacks have no obvious trigger and mostly occur a
few hours after she has gone to sleep. The usually last about 20 minutes. She
has no other symptoms. She smokes 20 cigarettes a day but does not take any
other drugs, legal or otherwise. What is the most likely diagnosis?
Scenario 9
A woman has a 5-year history of
unilateral, throbbing headache often preceded by nausea, visual disturbances,
photophobia and sensitivity to loud noise. What is the most likely diagnosis?
Scenario 10
A primigravida is admitted at 38 weeks complaining of
headache, abdominal pain and a sensation of flashing lights. What would be the
appropriate initial investigation?
Scenario 11
A woman with BMI of 35 attends for her combined Downs
syndrome screening test. She complains of pain behind her eyes. The pain is
worst last thing at night before she goes to sleep or if she has to get up in
the night. She has noticed she has noticed horizontal diplopia on several occasions. She has no other symptoms.
Examination shows papilloedema.
Scenario 12
A grande multip of 40 years experienced sudden-onset,
severe headache, vomited several times and then collapsed, all within the space
of 30 minutes. She is admitted urgently in a semi-comatose state. Examination
shows neck-stiffness and left hemi-paresis.
Scenario 13.
What did the MMR include as
“red flags” for headache in pregnancy? These are not on the option list – you
need to dig them out of your head.
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