Past paper long questions Flashcards
Make a schematic presentation of the quality improvement cycle, name the steps and write one sentence about the essence of each step. (10)
- Choose the topic – can relate to any section, function, process in the hospital, initiated by a team who wants to improve quality of care and chooses the topic. Must be specific, relevant and something that can be addressed by the local team.
- Forming the team – Chosen to involve all stakeholders to deal with the issue identidfied. Do not make the team too big, core team vs consultative group
- Set standards – all must agree on the standards,compare to existing standards and those described in evidence based literature. Note links to criteria,levels and time lines.
- Measure present practice – In this step the criteria are measured. This step involves data collection and
presentation. - Reflect on present practice - discuss the results of the survey in terms of standard s and levels that were set.
- Plan and implement change – Decide on an improvement plan using solution thinking and problem solving skills. Set up timelines and allocate roles.
- Measure present (new) practice – After implementation, same measures are done as before. Review the results in terms of previous results and the set standards.
Mrs. L, a 75-year old lady, presents with a sore throat that started 3 weeks ago. She is a known diabetic and
hypertensive patient with a BMI of 32. She smokes 20 cigarettes per day. Her husband recently died from
cancer and Mrs L thinks that her sore throat might be the beginning of a serious illness. She lives alone and
her only income is a small pension. She does not follow a correct diet or exercise program.
Briefly explain your approach to this consultation by applying Stott and Davis’ model. (9)
Firstly I need to pay attention to her presenting problems. She presents with a sore throat that started 3 weeks ago. I need to explore this complaint. I need to ask about any additional complaints and do a systemic enquiry to pick up any recent changes that are not related to her ongoing problems. I need to assess her vitals and examine her systematically and then focus on the problem area. The assessment should include clinical, individual and contextual components.
Secondly I need to enquire about her ongoing problems. She is a known diabetic and hypertensive patient and she is overweight. I need to follow up on any new complaints regarding her diagnosed chronic illnesses. I need to assess her control over these conditions and establish if these conditions have led to any complications. I also need to check her compliance with her medication.
Thirdly I need to be cognizant of any help seeking behavior. Her husband recently died of cancer and she
expresses the fear that her sore throat might be the start of a more severe illness. She also lives alone and is dependent on a small pension. I need to assess whether there is any reason for her to be alarmed about her health and put her at ease is no pathology is found. I also need to enquire whether she is coping socially and offer the appropriate assistance should it be in my power.
Lastly I have to pay attention to health promotion. She is overweight, she smokes 20 cigarettes per day and she does not follow a healthy diet or exercise program. I should address her eating habits and provide guidance on weight loss options and exercise methods tailored to the patient’s situation. I should inform the patients about the risks of smoking and offer help to enable her to quit this habit.
List the steps in using a MDI (asthma pump) correctly as you would describe them to a patient. (6)
- Hold the MDI correctly (with canister on top).
- Shake the MDI well.
- Exhale slowly.
- Place the MDI mouthpiece in the mouth.
- Close the lips tightly around the mouthpiece.
- Press the canister down once and simultaneously inhale deeply…..Continue inhaling.
- Hold the breath for as long as comfortable (?10 secs).
- Remove the inhaler.
- Breathe out slowly.
- (Repeat if needed).
List the steps in using a spacer correctly as you would describe them to a patient. (6)
- Assemble the spacer correctly where applicable.
- Connect the MDI to the spacer.
- Put the mouthpiece in the mouth with the lips tightly around it.
- Activate the MDI once.
- Inhale deep breaths as soon as possible after activating the MDI.
- Repeat, depending on the prescription.
- Wash spacer once a week with a mild detergent, but drip-dry only. Do not wipe it!
This is a basic CPR protocol for an adult victim. There are a few steps missing. Write them down.(5)
- H – Hazards – Exclude, Put on PPP
- H – Hello – Establish verbal contact and triage according to needs P1-P4
- H – Help – Summon the necessary authorities eg. Ambulance, fire brigade etc.
- C – Circulation – Control bleeding, palpate carotid and femoral pulses, IV access
- A – Airway – Ensure patency – do finger sweep, do jaw thrust if injuries above the clavicles are present,
stabilize the c-spine. - B – Breathing – Look, feel and listen for breathing
- CPR – Adult (>8 years old) 30 compressions at a rate of 100 bpm followed by 2 rescue breaths
Child (<8 years old ) 15 compressions at a rate of 100 bpm followed by 2 rescue breaths
Re-assess after 2/3 cycles - Place the patient in the recovery position
- Extend the neck if there is no injury or ensure stability if injury is suspected
- Monitor and observe
Write down the steps in HIV pre-test counselling.(5)
- Assure the patient that both counselling and testing is confidential
- Explain the purpose of the test, and why the test is being done
a. to detect presence of antibody to the virus that is associated with Aids
b. Give info about HIV infection and transmission and its link to AIDs and other STI’s - Give info on the technical aspects of the testing, the tests used, the window period and its implications
and explain the meaning of the terms positive and negative and its implications. - Provide information about the patient’s rights in terms of who to disclose their results to.
- Establish HIV risk activities by asking neutral questions
a. Evaluate risk behaviour and coping resources and support systems in case of a positive result.
b. Date of the most recent known risk activity for HIV infection - Determine if the patient wants to be tested immediately and if so perform the test.
- Explain the test procedure
- Explain when result will be available
Mrs. N, a 65-year old lady, presents with vague chest pains. She is a known diabetic and hypertensive
patient, not well controlled. Her husband recently died due to a myocardial infarction and she fears that the
same might happen to her. She lives alone and her only income is her small pension. She doesn’t follow a
correct diet or exercise program, nor does she regularly follow up at the clinic.
Write an assessment for this patient according to the three stage assessment model. (9)
Clinical Problem List:
Vague chest pain (DDX:? stable/unstable angina, myocardial infarction, gastritis)
Diabetes
Poorly Controlled Hypertension
Individual Problem List:
Diabetes and hypertension is not well controlled
She fears that she might be at risk of a myocardial infarction
Incorrect diet, no exercise, problems following up
Expects me to pay attention to her risk factors
Contextual Problem List:
Elderly
Recently widowed
Lives alone
Inadequate income, dependent on pension, does not work
Problems following up at the clinic, why?
Write down the steps in HIV post-test counselling where the result of the test is positive.(5)
- Tell the patient that the result is positive and that they are in fact infected with the HIV virus
- Explain the significance of the result and difference between HIV and AIDS
- Tell the patient that they are infectious and discuss risk reduction /elimination
- Enquire about personal support
- Advise against making immediate decisions about personal/work commitments
- Emphasise the long term nature of the condition
- Outline the next steps to be taken eg complete physical assessment, follow up HIV test, assessment of
immune function and immunisations. - Provide the patient with contact details of parties rendering social services /NGO’s
- Manage the patient’s immediate concerns and do not overload them with information, answer their
questions honestly and truthfully.
Whilst driving on the N1 highway, an accident happens right in front of you. The driver is the only passenger
and is thrown out of the car. You stop to help. You have your basic rescue kit in the car. Describe your stepwise
management this patient. (10)
- H – Hazards – Exclude, Put on PPP, Block the accident scene with my vehicle
- H – Hello – Establish verbal contact and check the patient’s level of consciousness.
- H – Help – Summon the necessary authorities eg. Ambulance, fire brigade etc.
- C – Circulation – Control bleeding, palpate carotid and femoral pulses, establish IV access
- A – Airway – Ensure patency – do finger sweep, do jaw thrust if injuries above the clavicles are present,
stabilize the c-spine. - B – Breathing – Look, feel and listen for breathing, if not breathing, start CPR
- CPR – Adult (>8 years old) 30 compressions at a rate of 100 bpm followed by 2 rescue breaths using the one
way valve device or Ambubag.
Re-assess after 2/3 cycles - Place the patient in the recovery position
- Extend the neck if there is no injury or ensure stability if injury is suspected
- Monitor and observe and wait for EMS
On a dipstick examination of a patient presenting with dysuria the following was found: HAEMATURIA
Microscopic evaluation of the urine revealed the following: SCHISTOSOMA
What disease is caused by this? (1)
Name the drug you will use to treat this condition: (1)
Bilharzia / Schistosomiasis
Praziquantel 600 mg tablet: 20 mg/kg po tds 4-6
hourly in 24 hours
Explain how you would use a Snellen chart to evaluate a patient’s vision. What does 6/20 vision mean?(5)
- Use a Snellen chart, or tumbling E chart for illiterate patients
- Hang the chart on the wall. It should be at eye level, meaning that the bottom of the chart should be
about 1.5m off the ground. - Stand 6m away from the chart. (Stand with your toes touching the 6m line)
- Cover one eye.
- Read the letters on the chart. Go down each row until you cannot clearly see the letters on the row. It’s
helpful to have another person standing next to the chart to verify that you are saying the right letters. - Calculate your vision score. There is a number next to each line on the Snellen chart. This number
represents the second part of your score. So if the number on the line is 20, your score is 20/20. If the
number on the line is 40, your score is 20/40. This means that you can read a letter at 20 feet that most
people could read at 40 feet–and you should be wearing glasses. - Repeat the eye test for the other eye.
- If the pt cannot read the chart at 1 meter, evaluate if they can count fingers, have light perception or
detect movement.
6/20 vision means that during the Snellen test, the person could see at 6 meters what a normal eye should
be able to see at 20 meters.
Write a prescription for acute bacterial tonsillitis, written according to legal requirements. (8)
Legal prescriptions:
- Legibility.
- Must be written in ink.
- Prescriber’s name, address, telephone number and qualifications.
- Date.
- Patient’s name and address, age or date of birth.
- Prescriber’s signature and qualifications.
- [Retain a copy of your prescription (fraud)].
Check document
Explain the process of rapid sequence intubation
Indication:
Rapid sequence induction is indicated if the patient has a GCS of 8 or less. Or ventilation during general
anaesthesia.
Procedure (6 P’s)
Prepare all the necessary equipment (ET tube, semi-ridget stilet, laryngoscope, syringe with 5ml of
air,connection to ambubag or ventilator, tape, bite blocks, stethoscope etc.
Pre-oxygenate with 100 % oxygen for 5 minutes of at least for 4 deep inhalations with an ambubag and
with cricoid pressure applied.
Pre-treatment with eg. B-Blockers, Lignocaine and induction agents
Paralysis (with the induction) using Scoline
Placement of tube
Post-intubation evaluation – listen over the epigastrium to exclude oesophageal intubation, listen for
ventilation over the axillae and look for vapour formation in the ET tube.
