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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