|
25 |
EMQ. Clue cells, koilocytes etc. |
|
26 |
Structured conversation. Maternity
Dashboard |
|
27 |
EMQ. Leflunomide |
|
28 |
EMQ. Risk management |
25. EMQ. Clue cells, koilocytes etc.
LGV: lymphogranuloma
venereum
Option list.
|
A |
Actinomyces |
|
B |
Bacterial
vaginosis |
|
C |
Bacteroides |
|
D |
Chlamydia
trachomatis |
|
E |
Chlamydial
infection of the genital tract |
|
F |
Herpes Simplex |
|
G |
Human
Papilloma Virus |
|
H |
Lymphogranuloma
venereum |
|
I |
Monilia |
|
J |
Neisseria
gonorrhoeae |
|
K |
Trichomonas
vaginalis |
Scenario 1
Which option or options from the option list best fit with
“clue cells”
Scenario 2
Which option or options from the option list
best fit with “fishy odour”?
Scenario 3
Which option or options from the option list
best fit with “flagellate organisms”?
Scenario 4
Which option or options from the option list
best fit with “inflammatory smear”?
Scenario 5
Which option or options from the option list
best fit with “koilocytes”?
Scenario 6
Which option or options from the option list
best fit with “non-specific urethritis in the male”?
Scenario 7
Which option or options from the option list
best fit with “strawberry cervix”?
Scenario 8
Which option or options from the option list
best fit with “thin grey/ white discharge”?
Scenario 9
Which option or options from the option list
best fit with “white, curdy discharge”?
Scenario 10
Which option or options from the option list
best fit with “frothy yellow discharge”?
Scenario 11
Which option or
options from the option list best fit with “protozoan”?
Scenario 12
Which option or
options from the option list best fit with “obligate intracellular organism”?
Scenario 13
Which option or
options from the option list best fit with “blindness”?
Scenario 14
Which option or
options from the option list best fit with “LGV”?
Scenario 15
Which option or
options from the option list best fit with “multinucleated cells”?
Scenario 16
Which option or
options from the option list best fit with “serotypes D–K”?
Scenario 17
Which option or
options from the option list best fit with “serovars L1-L3”?
Scenario 18
Which of the
following are true in relation to Amsel’s criteria?
|
A |
used for the diagnosis of bacterial vaginosis |
|
B |
used for the diagnosis of trichomonal infection |
|
C |
clue cells present on microscopy of wet preparation of
vaginal fluid |
|
D |
flagellate organism present on microscopic examination of
vaginal fluid |
|
E |
pH ≤ 4.5 |
|
F |
pH > 4.5 |
|
G |
thin, grey-white, homogeneous discharge present |
|
H |
frothy, yellow-green discharge present |
|
I |
fishy smell on adding alkali (10%KOH) |
|
J |
fishy smell on adding acid (10%HCl) |
|
K |
koilocytes present |
|
L |
absence of vulvo-vaginal irritation |
Scenario 19
Which of the
following are true in relation to Nugent’s Amsel’s criteria?
|
A |
used for the diagnosis of bacterial vaginosis |
|
B |
used for the diagnosis of trichomonal infection |
|
C |
clue cells present on microscopy of wet preparation of
vaginal fluid |
|
D |
pH ≤ 4.5 |
|
E |
pH > 4.5 |
|
F |
count of lactobacilli |
|
G |
count of Gardnerella and Bacteroides |
|
H |
count of white cells |
Scenario 20
Gardnerella
vaginallis can be cultured from the vagina of what proportion of normal women?
|
A |
< 10% |
|
B |
11 - 20% |
|
C |
21 - 30% |
|
D |
31 - 40% |
|
E |
41 - 50% |
|
F |
> 50% |
26. Structured conversation. Maternity
Dashboard.
Candidate’s instructions.
This is a viva station about the RCOG’s maternity
dashboard. The examiner will ask you 14 questions.
When you have finished a question, you will not be
allowed to return to it as later questions may indicate the answer. If you
return, no marks will be awarded, even for correct answers.
27. EMQ. Leflunomide.
This seems a
very obscure question, but it has been asked in the exam.
Question 1.
What kind of drug
is Leflunomide?
Option list.
|
A |
antibiotic |
|
B |
antiemetic |
|
C |
cytotoxic drug
related to methotrexate |
|
D |
non-steroidal anti-inflammatory
drug |
|
E |
disease-modifying
anti-rheumatic drug |
|
F |
disease-modifying
anti-leprosy drug |
|
G |
none of the
above |
Question 2.
Why is leflunomide
of particular interest to O&G specialists?
This is not a true
EMQ as there may be more than one correct answer.
Option list.
|
A |
it is a proven
human teratogen |
|
B |
women must
avoid pregnancy for at least 6 months after stopping treatment |
|
C |
women require a
‘washout’ with cholestyramine or activated charcoal before conception |
|
D |
it is
anti-oestrogenic and impairs the efficacy of the combined oral contraceptive |
|
E |
it is
anti-progestogenic and impairs the progestogen-based contraception, including
the Mirena |
|
F |
it increases
the risk of gestational diabetes mellitus |
|
G |
it is an inhibitor of pyrimidine synthesis |
|
H |
none of the
above. |
Question 3.
Who may prescribe
leflunomide?
Option list.
|
A |
any doctor who
has checked the BNF |
|
B |
General Practitioners, but only those who are MRCGP-
qualified |
|
C |
only
maternal-fetal-medicine specialists |
|
D |
only
specialists in family planning |
|
E |
only
specialists in the management of diabetes |
|
F |
only
specialists in the management of leprosy |
|
G |
only
specialists in the management of rheumatoid arthritis |
Question 4.
What monitoring
should be done for those taking leflunomide?
Option list.
|
A |
assay of alanine aminotransferase (ALT) |
|
B |
assay of gamma-glutamyl transferase (GGT) |
|
C |
assay of glutamo-pyruvate transferase (GPT) |
|
D |
full blood count (FBC) |
|
E |
glucose tolerance |
|
F |
renal function |
|
G |
respiratory function |
|
H |
none of the above |
28. EMQ. Risk management.
Lead-in. The following scenarios relate to risk
management / disciplinary procedures.
Abbreviations.
BMA: British
Medical Association
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. A 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. A 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. A 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 and 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. A 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, A 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. 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.
He informs you, the Clinical
Director, on the Monday when he returns to work. What action will you take?
Scenario 23. 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?
Option list.
|
A. |
call for help |
|
B. |
go back to the labour ward and pretend that nothing has
happened |
|
C. |
go back to the labour ward and inform the senior
midwife |
|
D. |
phone the GMC |
|
E. |
phone the on-call consultant anaesthetist |
|
F. |
phone the on-call consultant obstetrician |
|
G. |
phone the police |
|
H. |
put the anaesthetist in the recovery position and
remove the mask |
|
I.
|
none of the above |
Scenario 24. This is a follow-on from the previous station. What
action will you take next?
Scenario 25.
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.
|
A. |
discuss the case with the Chief Executive |
|
B. |
discuss the case with the Medical Defence Union |
|
C. |
discuss the case with the BMA |
|
D. |
discuss the case with the Medical Director |
|
E. |
discuss the case with the most senior person in the
personnel department |
|
F. |
discuss the case with the Postgraduate Dean |
|
G. |
report the anaesthetic registrar to the GMC |
|
H. |
resign from being Clinical Director to avoid stress |
|
I.
|
summon the anaesthetic registrar to give him a severe
telling-off |
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