Thursday 29 June 2017

Tutorial 29th. June 2017

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30
EMQ. BRCA1&2 and breast & ovarian cancer risk
31
EMQ. Borderline ovarian tumours
32
EMQ. Stolen notes
33
EMQ. Risk management

30.   EMQ. BRCA1&2 carriers and breast & ovarian cancer risk
Option lists. Most of the questions have no option list to make you work harder.
Abbreviations.
BSO:                         bilateral salpingo-oophorectomy
EOC:                         epithelial ovarian cancer
HGSOG:                   high-grade serous ovarian cancer
LGSOG:                    low-grade serous ovarian cancer
Scenario 1.
Which, if any, of the following statements are true?
A
EOC is the most common gynaecological cancer in the developed world
B
EOC is the leading cause of death from gynaecological cancer in the developed world
C
50% of EOC is mucinoid
D
HGSOG is 20 times more common than LGSOG
E
HGSOG is the main cause of death from ovarian cancer
F
overall life time risk of EOC is 1 in 70
G
the main risk factors for EOC are cigarette smoking & older age
H
5% of ovarian cancer is due to identified hereditary genetic factors
I
BRCA1 is linked to an ↑ risk of breast, ovarian, pancreatic and prostate cancer
J
BRCA2 is linked to an ↑risk of breast, ovarian, pancreatic and prostate cancer & melanoma
K
The prevalence of BRCA1 & 2 mutations is about 1 in 400 in the general population
L
The prevalence of BRCA1 & 2 mutations is about 1 in 40 in the Ashkenazi Jewish population
M
The risk of developing ovarian cancer by 75 years is BRCA1: 50% and BRCA2: 25%
N
EOC associated with BRCA1 &2 is mostly low-grade mucinous in type
O
The risk of male breast cancer is about 7% with BRCA2, higher than with BRCA1
P
BRCA1 & 2 are DNA repair genes
Q
male breast, pancreatic and prostate cancer are more common with BRCA2 than BRCA1
Scenario 2.
A woman of 30 has two sisters who developed breast cancer before the age of 40. They and she have been proved to be carriers of BRCA1.
She attends the gynaecology clinic requesting information about her lifetime risk of breast cancer.
What is the approximate figure?
Scenario 3.
A woman of 30 has two sisters who developed breast cancer before the age of 40. They and she have been proved to be carriers of BRCA1.
She attends the gynaecology clinic requesting information about her lifetime risk of ovarian cancer.
What is the approximate figure?
Scenario 4.
A woman of 30 has two sisters who developed breast cancer before the age of 40. They and she have been proved to be carriers of BRCA2.
She attends the gynaecology clinic requesting information about her lifetime risk of breast cancer.
What is the approximate figure?
Scenario 5.
A woman of 30 has two sisters who developed breast cancer before the age of 40. They and she have been proved to be carriers of BRCA2.
She attends the gynaecology clinic requesting information about her lifetime risk of ovarian cancer.
What is the approximate figure?
Scenario 6.
The woman asks for the overall figure for lifetime risk of breast cancer in UK women for comparison with her risk. What is the approximate figure?
Scenario 7.
The woman asks for the overall UK figure for lifetime risk of ovarian cancer for comparison with her risk. What is the approximate figure?
Scenario 8
Which of the following genes have mutations that increase the risk of breast cancer?
A
ATM
B
CDH1
C
CHEK1
D
FATHEAD
E
MARBELLA.
F
NBENE
G
p45
H
p53.
I
PALB2
J
PNINE
K
PTEN
L
RADON50
M
RINT1
Scenario 9
A man of 30 has two sisters who developed breast cancer before the age of 40. They and he have been proved to be carriers of BRCA2.
His GP phones to ask about his lifetime risk of breast cancer. What is the approximate figure?
Scenario 10
A man of 30 has two sisters who developed breast cancer before the age of 40. They and he have been proved to be carriers of BRCA2.
His GP phones to ask about his lifetime risk of ovarian cancer. What is the approximate figure?
Scenario 11
A woman of 30 has two sisters who developed breast cancer before the age of 40. They and she have been proved to be carriers of BRCA2.
She attends the gynaecology clinic requesting information about the value of prophylactic mastectomy. What advice will you give about efficacy?
Scenario 12
A woman of 30 has two sisters who developed breast cancer before the age of 40. They and she have been proved to be carriers of BRCA2.
She attends the gynaecology clinic requesting information about the benefits of prophylactic salpingo-oophorectomy – her family is complete and her husband has had vasectomy. What is the approximate figure for the efficacy of BSO in relation to cancer?
Scenario 13.
Which, if any, of the following statements is true in relation to the findings by Kuchenbaecker in relation to the incidence of breast cancer in carriers of a BRCA1 mutation?
Pick one option from the option list.
Option list.
A.       
it rises rapidly until the age of 30-40, then stays constant until age 80
B.       
it rises rapidly from puberty until the age of 30-40, then stays constant until age 80
C.       
it rises rapidly from young adulthood  until the age of 30-40, then stays constant until age 80
D.       
it rises rapidly from puberty until the age of 40-50, then stays constant until age 80
E.        
it rises rapidly from young adulthood  until the age of 40-50, then stays constant until age 80
F.        
it rises rapidly from puberty until the menopause, then stays constant until age 80
G.       
it rises rapidly from young adulthood  until the menopause, then stays constant until age 80
H.       
none of the above
Scenario 14.
Which, if any, of the following statements is true in relation to the findings by Kuchenbaecker in relation to the incidence of breast cancer in carriers of a BRCA2 mutation?
Pick one option from the option list.
Option list.
A.       
it rises rapidly until the age of 30-40, then stays constant until age 80
B.       
it rises rapidly from puberty until the age of 30-40, then stays constant until age 80
C.       
it rises rapidly from young adulthood  until the age of 30-40, then stays constant until age 80
D.       
it rises rapidly from puberty until the age of 40-50, then stays constant until age 80
E.        
it rises rapidly from young adulthood  until the age of 40-50, then stays constant until age 80
F.        
it rises rapidly from puberty until the menopause, then stays constant until age 80
G.       
it rises rapidly from young adulthood  until the menopause, then stays constant until age 80
H.       
none of the above
Scenario 15.
A woman of 30 has two sisters who developed breast cancer before the age of 40. They and she have been proved to be carriers of BRCA1.
She attends the gynaecology clinic requesting information about the benefits of prophylactic salpingo-oophorectomy. What are the disadvantages of BSO?
Scenario 16
A woman of 30 has two sisters who developed breast cancer before the age of 40. They and she have been proved to be carriers of BRCA1.
She attends the gynaecology clinic requesting information about the benefits of prophylactic salpingo-oophorectomy.  What alternatives should be discussed?
Scenario 17
A woman of 25 years is a known carrier of BRCA1. She has no family history of breast cancer. She has a friend who is similar in age and has similar risk factors for breast cancer, including being a BRCA1 carrier, apart from having two 1st. degree relatives with breast cancer. Which, if any of the following statements is true in relation to the risk of breast cancer for the friend compared with the woman?
A.       
her risk is the same
B.       
her risk is 2 x that of the woman
C.       
her risk is 5x that of the woman
D.       
her risk is ½ of that of the woman
E.        
none  of the above
Scenario 18
A woman of 25 years is a known carrier of BRCA2. She has no family history of breast cancer. She has a friend who is similar in age and has similar risk factors for breast cancer, including being a BRCA2 carrier, apart from having two 1st. degree relatives with breast cancer. Which, if any of the following statements is true in relation to the risk of breast cancer for the friend compared with the woman?
A.       
her risk is the same
B.       
her risk is 2 x that of the woman
C.       
her risk is 5x that of the woman
D.       
her risk is ½ of that of the woman
E.        
none  of the above

31.   EMQ. Borderline ovarian tumours
Borderline ovarian tumours.
Some of these are not true EMQs – they may have more than one answer. I do this as it makes the document shorter and saves me some typing.
Abbreviations.
Bagade:  “Management of borderline ovarian tumours”: Bagade P., Edmondson R. & Nayar A.
                 TOG. 2012;14:115–120.
BOT:        borderline ovarian tumour.
Ca125:     Ca125 as iu/ml.
COC:        combined oral contraceptive.
EOT:        epithelial ovarian tumour.
IOC:         invasive ovarian cancer.
MOV:      mean ovarian volume.
MS:          menopause score.
POI:         premature ovarian insufficiency.
RMI:        Risk of Malignancy Index.
SOT:         serous ovarian tumour.
US:           ultrasound score.
Scenario 1.                
Which, if any, of the following statements are true in relation to BOTs?
Option list.
A
show more proliferation than benign ovarian  tumours
B
stromal invasion is absent
C
stromal invasion is < 5 mm from the ovarian surface
D
comprise 10-15% of EOTs
E
comprise 10-15% of GCTOs
F
comprise 10-15% of SOTs
Scenario 2.                
Which, if any, of the following statements are true?
Option list.
A
BOTs constitute   5-10% of ovarian epithelial neoplasia
B
BOTs constitute 10-15% of ovarian epithelial neoplasia
C
BOTs constitute 15-20% of ovarian epithelial neoplasia
D
BOTs constitute   5-10% of ovarian germ-cell neoplasia
E
BOTs constitute 10-15% of ovarian germ-cell neoplasia
F
BOTs constitute 15-20% of ovarian germ-cell neoplasia
Scenario 3.                
Which, if any, of the following statements are true?
Option list.
A
BOTs are less common in women who have taken the COC for > 5 years
B
BOTs are less common in women with a history of lactation
C
BOTs are more common after the menopause
D
BOTs are more common in multiparous women
E
BOTs are more common in women with BRCA1 & 2 mutations
Scenario 4.                
Which, if any, of the following statements are true in relation to BOTs.
Option list.
A
p53 mutations are more common than in invasive ovarian tumours
B
BRAF/KRAS mutations are common than in invasive ovarian tumours
C
BRCA 1 & 2 mutations are more common in women with BOTs
D
BOTs are more common in women from a Lynch syndrome family with a known MSH6 mutation
E
BOTs are more common in women with red hair
Scenario 5.                
Which, if any, of the following statements are true in relation to BOTs.
Option list.
A
Brenner tumours are the most common
B
endometrioid tumours are the most common
C
mucinous tumours are the most common
D
serous tumours are the most common
E
< 10% are bilateral
Scenario 6.                
Which, if any, of the following statements are true in relation to mucinous BOTs.
Option list.
A
are subdivided into endocervical / Müllerian or intestinal categories
B
are subdivided into endocervical / Müllerian, intestinal or renal categories
C
are subdivided into endometrial or intestinal categories
D
pseudomyxoma peritonei occurs in < 1% of cases
E
pseudomyxoma peritonei occurs in about 10% of cases
Scenario 7.                
Which, if any, of the following statements are true in relation to BOTs.
Option list.
A
↑ Ca 125 levels are rare, normally indicating malignancy
B
Ca 19-9 levels are often ↑ in mucinous BOTs
C
CEA levels are often ↑ in serous tumours
D
Ca 15-3 is commonly ↑ in both mucinous and serous BOTs
E
TVS and MRI are useful in the assessment of BOTs
Scenario 8.                
Which, if any, of the following statements are true in relation to BOTs.
Option list.
A
the 5-year survival rate is approximately 80% for stage I disease
B
the 5-year survival rate is approximately 95% for stage I disease
C
the 5-year survival rate is approximately 50% for stage III disease
D
the 5-year survival rate is approximately 60% for stage III disease
E
the overall 10-year survival rate is approximately 75%
Scenario 9.                
Which, if any, of the following statements is true in relation to calculation of the RMI score?
Option list.
A
uses the formula age x Ca125 x US
B
uses the formula Ca125 x MS x MOV
C
uses the formula (Ca125 + MS) x US
D
uses the formula Ca125 + MS + US
E
uses the formula Ca125 x MS x US
F
none of the above
Scenario 10.            
Which, if any, of the following describes the formula used for the calculation of the MOV as used in the RMI score?

Option list.
A
total ovarian volume / 2
B
total ovarian volume / average ovarian number
C
total ovarian volume / ovarian number
D
total volume of the larger ovary
E
p x (mean diameter)3 / 4 of the larger ovary
F
none of the above
Scenario 11.            
Which, if any, of the following as used in the calculation of the MS as used in the RMI score
Option list.
A
prepubertal:             score = 0
B
1ry. amenorrhoea:  score = 1
C
POI:                            score = 2
D
perimenopausal:      score = 3
E
menopausal:             score = 4
F
none of the above
Scenario 12.            
Which, if any, of the following statements is true in relation to calculation of the RMI score?
Option list.
A
uses the formula age x Ca125 x US
B
uses the formula Ca125 x MS x MOV
C
uses the formula (Ca125 + MS) x US
D
uses the formula Ca125 + MS + US
E
uses the formula Ca125 x MS x US
F
none of the above
Scenario 13.            
Which, if any, of the following statements are true in relation to the RMI and BOTs.
Option list.
A
the RMI is particularly useful and should always be considered in the early assessment
B
the RMI is not particularly useful in the majority of possible BOTs
C
the strength of the RMI in the assessment of possible BOTs lies with the elevated Ca125 levels
D
weakness of the RMI in the assessment of possible BOTs is, in part, due to the wide range of Ca125 levels found with BOTs
E
none of the above
Scenario 14.            
Which, if any, of the following statements are true in relation to the measurement of Ca125 in calculating a RMI score.
Option list.
A
the units used are mg/L
B
the units used are mg/mL
C
the units used are mol/L
D
the units used are mol/mL
E
the units used are iu/L
E
the units used are iu/ml
Scenario 15.            
Which, if any, of the following are part of the measurement of US?
Option list.
A
ascites
B
hydrothorax
C
multilocular cysts
D
↑ ovarian blood flow
E
↑ ovarian number
E
↑ ovarian volume
Scenario 16.            
Which, if any, of the following statements describes the best management of BOTs.
Option list.
A
the best management is hysterectomy + BSO + infracolic omentectomy + lymphadenectomy + appendicectomy + excision of extra-ovarian lesions
B
the best management is hysterectomy + BSO + infracolic omentectomy + appendicectomy
C
the best management is hysterectomy + BSO + appendicectomy
D
the best initial management is ovarian cystectomy + histology of frozen section
E
chemotherapy should be offered when the stage is > I
Scenario 17.            
Which, if any, of the following statements describes the recommended management of BOT in the woman who does not wish to retain her fertility?
Option list.
A
the best management is hysterectomy + BSO + infracolic omentectomy + lymphadenectomy + appendicectomy + excision of extra-ovarian lesions
B
the best management is hysterectomy + BSO + infracolic omentectomy + appendicectomy
C
the best management is hysterectomy + BSO + appendicectomy
D
the best initial management is ovarian cystectomy + histology of frozen section
E
none  of the above
Scenario 18.            
Which, if any, of the following statements describes the recommended additional management of BOT in the woman who does not wish to retain her fertility and whose tumour is mucinous?
Option list.
A
appendicectomy
B
appendicectomy after histology of frozen section
C
removal of the other ovary
D
removal of the other ovary after histology of frozen section
E
bilateral salpingectomy
Scenario 19.            
What advice is usually given in relation to the use of clomifene in women treated for BOTs?
Option list.
A
clomifene is contraindicated
B
only offer treatment to women < 35 years
C
only offer treatment to women who have screened –ve for BRCA 1 & 2
D
only offer treatment to women with stage 1 & 2 disease
E
restrict the number of treatment cycles
Scenario 20.            
What is the role of chemotherapy in the management of women with BOTs?
Option list.
A
chemotherapy should be offered routinely after surgery as for invasive disease
B
pre-operative chemotherapy reduces recurrence rates
C
routine chemotherapy is of unproven benefit
D
the main role for chemotherapy is for recurrent disease
E
the main role for chemotherapy is for recurrent disease unsuitable for surgery
Scenario 21.            
Which, if any, of the following statements are true in relation to restaging in the management of women with BOTs?
Option list.
A
should be offered routinely if definitive surgery is not performed initially
B
restaging improves 5-year recurrence rates
C
restaging improves 10-year survival
D
restaging may be appropriate for those with invasive implants
E
restaging may be appropriate for those with DNA aneuploidy
Scenario 22.            
What advice is usually given in relation to the management of women found unexpectedly to have a BOT on histology?
Option list.
A
further surgery, if needed, to remove the ovary and tube
B
adjuvant chemotherapy
C
pelvic radiotherapy
D
close follow-up
E
none of the above
Scenario 23.            
What is the role of laparoscopy in women with actual or suspected BOT?
Option list.
A
laparoscopy has replaced laparotomy in most cases
B
concerns about the risk of recurrence limit its use
C
concerns about worse survival limit its use
D
concerns about port metastasis limit its used
E
none of the above
Scenario 24.            
What is the definition of conservative surgery in the management of  BOTs?
Option list.
A
surgery with conservation of uterus and at least one ovary
B
surgery with conservation of uterus and at least part of one ovary
C
surgery with complete staging + conservation of uterus and at least one ovary
D
surgery with complete staging + conservation of uterus and at least part of one ovary
E
complete staging + omentectomy + conservation of uterus and at least part of one ovary
Scenario 25.            
A nulliparous 24-year-old woman has a right-sided BOT. She has opted for conservative surgery with conservation of the uterus and left ovary and tube. She has asked about the advisability of biopsy of the left ovary at the time of surgery. Which of the following options would reflect your advice.
Option list.
A
biopsy of the apparently normal ovary is recommended
B
biopsy of the apparently normal ovary is not recommended
C
biopsy of the apparently normal ovary is decided on an ad hoc basis by the MDT
D
biopsy of the apparently normal ovary is a matter for informed consent
E
none of the above
Scenario 26.            
A nulliparous 24-year-old woman has a right-sided BOT. She has conservative surgery with conservation of the uterus and left ovary and tube. She has asked about the advisability of removal of the left ovary and tube once she has completed her family.


Option list.
A
LSO is recommended once her family is complete
B
LSO is not recommended
C
LSO once her family is complete is decided on an ad hoc basis by the MDT
D
LSO once her family is complete is a matter for informed consent
E
none of the above
Scenario 27.            
What advice can be given about fertility rates after conservative surgery for a BOT?
Option list.
A
about half of women conceive spontaneously
B
fertility rates are unimpaired by conservative surgery
C
fertility rates are improved by conservative surgery
D
fertility rates after conservative surgery are unknown
E
none of the above

32    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
NPSA:      National Patient Safety Agency             
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

33.   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.
FY:         Foundation year trainee
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? There is no answer on the option list – make your own list.
Scenario 17
When do you need to inform the Clinical Director? There is no answer on the option list – make your own list.
Scenario 18
When do you need to inform the Medical Director? There is no answer on the option list – make your own list.
Scenario 19
When do you need to inform the GMC? There is no answer on the option list – make your own list.
Scenario 20
What are the roles of the BMA and MDU? There is no answer on the option list – make your own list.
Scenario 21
What are the differences between verbal and written warnings? There is no answer on the option list – make your own list.
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.

  1.  
call for help from the senior midwife

  1.  
go back to the labour ward and pretend that nothing has happened

  1.  
go back to the labour ward and inform the senior midwife

  1.  
phone the GMC

  1.  
phone the on-call consultant anaesthetist

  1.  
phone the on-call consultant obstetrician

  1.  
phone the police

  1.  
put the anaesthetist in the recovery position and remove the mask

  1.  
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.

  1.  
call for help from the senior midwife

  1.  
go back to the labour ward and pretend that nothing has happened

  1.  
go back to the labour ward and inform the senior midwife

  1.  
phone the GMC

  1.  
phone the on-call consultant anaesthetist

  1.  
phone the on-call consultant obstetrician

  1.  
phone the police

  1.  
put the anaesthetist in the recovery position and remove the mask

  1.  
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.

  1.  
discuss the case with the Chief Executive

  1.  
discuss the case with the Medical Defence Union

  1.  
discuss the case with the Medical Director

  1.  
discuss the case with the Medical Director

  1.  
discuss the case with the most senior person in the personnel department

  1.  
discuss the case with the Postgraduate Dean

  1.  
report the anaesthetic registrar to the GMC

  1.  
resign from being Clinical Director to avoid stress

  1.  
summon the anaesthetic registrar to give him a severe telling-off