SCENARIO I: A PATIENT IS BROUGHT IN BY PARAMEDICS AFTER A ROAD TRAFFIC ACCIDENT. YOU ARE THE FIRST DOCTOR THEY MEET. WHAT WILL YOU DO?

SCENARIO II: A PATIENT AFTER HEMIARTHROPLASTY HAS A HIGH K+ LEVEL 4 HOURS AFTER. WHAT INVESTIGATIONS WILL YOU DO AND WHAT

SCENARIO III: YOU ARE IN A & E, A PATIENT COMES IN WITH EXACERBATION OF COPD. HOW WILL YOU APPROACH AND MANAGE THIS PATIENT.

SCENARIOS IV: A PATIENT WHO IS A KNOWN CASE OF COPD PRESENTS WITH SOB. ON EXAMINATION PATIENT HAD BI-BASAL CREPITATION, WHAT WOULD YOU DO?

• First assess ABC and connect him to monitor.
• If O2 is < 88% start 24% oxygen via Venturi mask.
• Start medications which should include Salbutamol and Hydrocortisone and give him Furesemide.
• Perform chest X-ray and ABG

SCENARIO V: A PATIENT HAS COME TO YOU WITH BREATHLESSNESS AND WHEEZE. SHE IS AN OLD LADY WHO IS A KNOWN CASE OF COPD. HER SPO2 IS 88%. HOW WILL YOU MANAGE?

• I will do A, B, C, D assessment and APVU assessment.
• I will then start her with 24 % oxygen via mask and monitor her spO2
• Then I will start her on Salbutamol and hydrocrtisone if needed.
• Once the patient is comfortable I will take detailed history and examination.
• I will inform my senior.
• I will then send patient’s investigations which should include CBC, electrolytes and Urea to do CURB65 scoring in any case if she has differential as Pneumonia, LFTs, ABG, Chest X-ray.
• If an infection is suspected and established by investigations I will consult with my senior and give her antibiotics according to hospital protocol.
• ABG report shows pH to be low, pCO2 high and pO2 low, how will you manage further: I will repeat ABG and if pCO2 is still high despite all treatments we have given I will consider her for non-invasive ventilation after consulting my senior and a respiratory physician. If she still doesn’t respond  and has low pH and high PCO2  I will inform my senior and consult anesthetist and discuss intubating my patient.

SCENARIO VI: A PATIENT COMES WITH CENTRAL CHEST PAIN. WHAT WILL YOU DO AND WHAT DIFFERENTIAL DIAGNOSIS WILL BE IN YOUR MIND?

SCENARIO VII: A 60+ YEAR OLD MALE COMES WITH LIF PAIN. HE SCORES THE PAIN AROUND 7 /10. HIS BLOOD PRESSURE IS 110/70 mm Hg AND RR IS 14 b/ min. WHAT WILL YOU DO FOR HIM? WHAT INVESTIGATIONS WIL YOU DO? WHAT DO YOU THINK HE HAS?

SCENARIO VIII: THERE’S A TWO PATIENT WHO COMES IN SIMULTANEOUSLY. ONE BANGED HIS HEAD AND LOST CONSCIOUSNESS AND THE OTHER HAS K+ 7.5. YOU ARE THE ONLY DOCTOR IN THE CORRIDOR AND YOU GET THE BLEEP ABOUT THESE TWO PATIENTS. HOW WILL YOU MANAGE THIS SITUATION?

(checking if you can triage patients, coping with stress, realize your limits)

-> First of all, call your registrar and inform him about the two bleeps and he or she will guide as to what to do next.

-> Start him on Calcium gluconate to prevent cardiac arrest and ask nurse to get ECG done for a patient with K+ 7.5 as you already know there will be ECG changes with high potassium level. And go to the patient who has LOC, get more information including bleeding from nose and ears and vomiting. Check ABC his GCS and depending on his status either plan for intubation or/ and ask A & E staff to get his CT scan done. In the mean while go and see the ECG of other patient.

-> Inform your registrar about what you did and ask him if he would like you to add anything in management.

ENT-HEAD AND NECK SURGERY SCENARIOS:

SCENARIO I: You are in operation theater assisting a case. You are also an on call for that day. You got a call from post operative ward saying there’s a patient who is bleeding. At the same time you got the call from emergency department asking you to attend a patient who has come with airway obstruction. What will you do in such situation.

SCENARIO II: There’s a patient in ward who has tracheostomy, how will you care this patient.

SCENARIO II: In Head and Neck cancer ward, there are lot of patients with laryngectomy. How will you take care of patient with laryngectomy?

TRAUMA AND ORTHOPAEDICS SCENARIOS:

SCENARIO I: YOU ARE CALLED TO AN EMERGENCY DEPARTMENT TO SEE A PATIENT WITH FEMORAL NECK FRACTURE. WHAT WOULD YOU DO ? HOW DO YOU CLASSIFY FEMORAL NECK FRACTURE ?

SCENARIO II: A PATIENT COMES IN WITH A SWOLLEN PAINFUL KNEE AND FEVER. THERE’S NO HISTORY OF TRAUMA BUT HAD HIP REPLACEMENT 10 YEARS AGO, WHAT IS YOUR DIAGNOSIS AND HOW WILL YOU MANAGE?

-> Septic Knee Arthritis

SCENARIO III: A PATIENT HAD UNDERGONE A HIP REPLACEMENT 7 DAYS BACK AD NOW HE HAS sob AND HYPO-TENSION. WHAT DO YOU SUSPECT? HOW WILL YOU MANAGE?

-> PE and D/Ds

-> I will introduce myself and take history. I will make sure patient is safe by going through a, b, c

GENERAL SURGERY SCENARIOS:

SCENARIO I: A WOMAN POST MASTECTOMY PRESENTS WITH FEVER AND RASH IN SURGERY DEPARTMENT. HOW WILL YOU MANAGE?

SCENARIO II: WHAT IS PULSE LESS ELECTRICAL ACTIVITY AND IN WHAT CONDITIONS CAN YOU GET THESE?

SCENARIO III: YOU ARE THE ONLY DOCTOR ON THE POST. THERE ARE 2 PATIENTS IN THE WARD. ONE OF THEM DEVELOP

SCENARIOS IV: A 25 YEAR OLD GIRL COMES TO HOSPITAL WITH ABDOMINAL PAIN. WHAT WILL YOU DO?

SCENARIOS V: AN MRI SCAN WAS DONE FOR A MAN AND WAS DISCOVERED HE HAS A BRAIN TUMOUR. HE IS CURRENTLY WITH HIS WIFE IN WARD WHO IS LOOKING VERY ANXIOUS AND WAITING FOR SOMEONE TO TALK WITH. THERE IS NO CONSULTANT OR SENIORS AND YOU ARE LEFT WITH SENIOR NURSE. HOW WOULD YOU BREAK THE NEWS?

GYNAECOLOGICAL SCENARIOS:

SCENARIOS I: A LADY PRESENTS WITH POST MENSTRUAL BLEEDING IN THE CLINIC . HOW WILL YOU APPROACH THE PATIENT IN TERMS OF HISTORY AND EXAMINATION.

SCENARIOS II: YOU ARE IN THE WARD AND NURSE CALLS YOU ALERTING THAT ONE OF POST OPERATIVE PATIENT IS BECOMING HYPOTENSIVE ALL OF A SUDDEN. WHAT CAN BE THE CAUSES AND HO WILL YOU APPROACH IT.

SCENARIOS III: YOU HAVE A PATIENT WHO PRESENTED WITH POST PARTUM HAEMORRHAGE. HOW WILL YOU APPROACH?

PAEDIATRIC EMERGENCY:

SCENARIOS I: WHAT WILL YOU DO IN A SITUATION WHEN YOU SEE A 11 MONTHS OLD CHILD WITH HUMERUS FRACTURE AND YOU ARE SUSPECTING NAI IN CHILD. HOW WILL YOU APPROACH TO THE CASE?

COUNSELLING SCENARIOS

SCENARIO I: WHAT WILL YOU DO IF A PATIENT WITH SORE THROAT COMES IN A & E AND YOU KNOW IT’S NOT AN EMERGENCY

SCENARIO II: YOU DEVELOPED A MANAGEMENT PLAN FOR A PATIENT BUT ONE OF YOUR COLLEAGUES DISAGREE  WITH YOU, WHAT WILL YOU DO IN SUCH SITUATION?

SCENARIOS III: SAY YOU ARE ON YOUR OFF DAYS AND ONE OF YOUR COLLEAGUE ASKED YOU TO COVER FOR HER. HOW WILL YOU APPROACH TO THIS ? (They are basically checking if you are a team player or not?)

SCENARIOS IV: You saw your colleague in the ward trying to treat a patient in such a way that you feel it might cause harm to the patient. What will your next step be? What will you do if you see what he is doing will cause immediate harm to patient?

WHAT IS CLINICAL GOVERNANCE?
-> Clinical governance is defined as “a system through which NHS organizations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.”

WHAT ARE THE MAIN COMPONENT/ PILLARS OF CLINICAL GOVERNANCE?
-> The following are main components of clinical governance:
1) Risk Management
2) Clinical Audit
3) Education, Training and continuing professional development
4) Evidence based care and effectiveness
5) Patient and carers experience and involvement
6) Staffing and staff management
7) Information management

WHAT IS AN AUDIT?
-> Clinical audit is a process that has been defined as “a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change”

WHAT ARE DIFFERENT TYPES OF AUDIT?

1. Standards-based audit – It involves defining standards, collecting data to measure current practice against those standards, and implementing any changes that is necessary. It also involves further audit to see if these changes made is successful or not.
2. Adverse occurrence screening and critical incident monitoring – This is often used  for cases which have caused concern or cases in which there was an unexpected outcome. The multidisciplinary team discusses individual anonymous cases to reflect upon the way the team functioned and to learn for the future. In the primary care setting, this is described as a ‘significant event audit’.
3. Surgical audit – It involves data collection of all surgical cases, followed by ongoing review and assessment of performance and outcomes.
4. Peer review – An assessment of the quality of care provided by a clinical team with a view to improving clinical care. Individual cases are discussed by peers to determine whether the best care was given. This mainly focuses ‘interesting’ or ‘unusual’ cases rather than problematic ones.
5. Patient surveys and focus groups – These are methods used to obtain patient’s views about the quality of care they have received.

DO YOU KNOW THE BASIC STEPS/ STAGES OF AUDIT?

-> The following are the basic steps of audit:

• Stage 1: Identify the problem or issue : involves the selection of a topic or issue to be audited
  
• Stage 2: Define criteria and standards : A criterion here is a measurable outcome of care, aspect of practice or capacity and a standard is the threshold of the expected compliance for each criterion.
• Stage 3: Data collection : data collected should be precise, and only essential information are to be collected.
• Stage 4: Compare performance with criteria and standards
• Stage 5: Implementing change
• Re-audit: Sustaining Improvements

HAVE YOU EVER BEEN A PART OF AN AUDIT?

-> Yes/ NO

HAVE YOU EVER SEEN ANYONE AT WORK CONDUCT AN AUDIT?

-> Yes/ No

WHAT IS RESEARCH?

->Clinical research is the study that determines the safety and effectiveness of new treatments, approaches and medications intended for human use for better health and care ,

It involves collection of evidence to establish that a new treatment or approaches are safe and effective.

HOW IS AUDIT DIFFERENT FROM RESEARCH?

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HAVE YOU EVER BEEN A PART OF AN RESEARCH?

-> Yes/ No

HAVE YOU EVER SEEN ANYONE AT WORK CONDUCT AN RESEARCH?

-> Yes/ No

WHAT IS EVIDENCE- BASED PRACTICE?

-> Evidence-Based Practice (EBP) is defined by  Dr. David Sackett. EBP as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”

-> It is an integration of best research evidence with clinical expertise and patient values which means that when health professionals make a treatment decision with their patient, they base it on their clinical expertise, the preferences of the patient, and the best available evidence.

WHAT ARE THE BASICS STEPS IN EBP?

DO YOU HAVE AN IDEA ABOUT HIERARCHY OF MEDICAL EVIDENCE?