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Tonight we had an EMQ and 4 essays.
With regard to adhesions that result from
abdominal surgery.
1. Outline
the incidence and possible adverse consequences of adhesion formation after
surgery.
8
marks.
2. How may
the incidence of surgical adhesions be reduced? 12 marks.
A woman is referred to the pre-pregnancy
counselling clinic. She had Caesarean section with her previous pregnancy.
1. Outline the history you will take. 6 marks.
2. Justify the investigations you will
arrange. 4 marks.
3. Justify the advice you will give. 10 marks.
With regard to smoking in pregnancy:
1. outline
the hazards to the mother. 4 marks
2. outline
the hazards to the fetus / child. 6 marks
3.
critically evaluate how smoking cessation programmes can be made more
effective. 10
marks
With regard to Gestational Trophoblastic
Neoplasia.
Outline the factors
influencing prognosis.
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
A SpR2 uploaded reflective
practice putting him in a good light after a case which had been handled
sub-optimally by him.
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?
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