Clinical Governance Extra Questions

1. A 32-year-old is in labour for the last 8 h. She had a previous uneventful vaginal birth at term. She has just broken her waters and there is meconium staining of the liquor amnii. The CTG shows late decelerations. Per vaginam examination shows that the cervix is 6 cm dilated with presenting part at −3 station. You suggest an emergency caesarean section in view of fetal distress, but she declines the same and wants to continue trying for a vaginal birth as she believes she will be fine as it is her second delivery. What should you do?

A. Contact social services for the interest of the unborn fetus who is at risk of harm.
B. Inform her husband and get him to consent for the caesarean section.
C. Respect her choice and continue monitoring and documenting the labour.
D. Stop treating her as she is obviously determined to pursue her own wishes.
E. Transfer her care to another consultant as she is not listening to you.

2. Ethics is the understanding of the nature of conflicts arising from duties and obliga- tions. The four-principle approach provides a way of thinking about ethical issues/ problems in a simple and accessible way that should cut across cultural differences. Which of the following is not included in these ‘four principles’?

A. Beneficence
B. Maleficence
C. Obligation to avoid causing harm
D. Justice
E. Respect for autonomy

3. A clinical teacher plays all roles except:

A. Assessor
B. Examiner
C. Facilitator
D. Planner
E. Role model

4. A 17-year-old girl attends the gynaecology outpatient with complaints of irregular periods. She migrated to the UK with her family a year back and gives history sug- gestive of female genital mutilation (FGM). As a doctor practising in the UK, which of the following is an appropriate action for you as a gynaecologist?

A. Inform the police about her genital mutilation issue within 1 month.
B. Confirm from her parents if the surgery was done in safe and hygienic conditions.
C. Reassure her that FGM is a known practice in many countries and it is appropriate to conduct such procedures due to cultural reasons.
D. Treat her for her irregular periods only as that is her primary complaint.
E. You are not obliged to inform the police of the FGM procedure that was done with the girl’s consent.

5. A 30-year-old primigravida receives her 12th week booking blood test results and finds that she has hepatitis C infection. She abused psychotropic drugs in the past and relates that to her infection. After consulting the gastroenterologist, she wants to opt for interferon therapy and hence wants a termination of pregnancy. She has told you that she wants to keep the information about the infection confidential. Her husband and her mother do not understand why she wants a termination and want an answer from you. Which of the following is applicable to this situation?

A. You can tell the husband as he has a right to know the reason for termination.
B. You can tell her mother as she would act in the woman’s best interest.
C. The unborn fetus is being compromised so you must inform child protection authorities and try to save the fetus.
D. You do not have to tell either the husband or the mother.
E. You should advise her to delay her treatment with interferon.

6. Which of the following is not an essential component of elements that fulfil the criteria of a valid consent?

A. Communicating
B. Deciding
C. Motivating
D. Retaining
E. Understanding

7. The mental capacity act applies to people over the age of:

A. 12 years
B. 14 years
C. 16 years
D. 18 years
E. 20 years

8. Which is not a component of five steps of ‘the 1-min preceptor’?

A. Commitment
B. Positive reinforcement
C. Judgement
D. Application
E. Correction of mistakes

9. What is the most appropriate statement regarding a lawsuit on medical negligence?

A. Medical negligence is part of the tort law and is part of criminal law.
B. The plaintiff can claim a breach of moral duty by the defendant to take care resulting in damage to claimant.
C. The plaintiff has to establish that the defendant owed him/her a duty of care.
D. A breach of duty need not be established in all cases.
E. Once a breach of care is established, the onus is on the defendant to disprove the causal link on a balance of probabilities.

10. The primary duty of the Caldicott guardian in any NHS trust is:

A. To conduct workshops for patients’ awareness of their rights B. To make sure regular clinical audits are happening
C. To protect staff interests
D. To protect patient confidentiality issues
E. To provide litigation support to patients who feel unfairly treated

11. If involved in a serious incident requiring investigations (SIRI),initial steps would involve completing an incident form, ensuring comple- tion of notes accurately and participating in team debrief.If a trainee is involved in an SIRI, what action should be taken as soon as possible?

A. Discuss with the medical defence organisation
B. Engage fully with the investigation
C. Meet with the educational supervisor to discuss the case
D. Write a formal statement
E. Write a reflection of the vent

12. An early reporting system ensures that trainees get the right support and they are advised to meet with their educational supervisor as soon as possible to discuss the case.
In surrogacy arrangement ,the commissioning couple to obtain parental orders. Within what time frame after delivery must these be made?

A. 6 months
B. 12 months
C. 18 months
D. 24 months
E. 36 months

13. When managing a patient with surrogate pregnancy, who decides about the treatment required for any clinical situation that may affect the pregnancy?

A. The binding agreement
B. The commissioning father
C. The commissioning mother
D. The surrogate mother
E. The unborn child

14. A primigravida at 24 weeks gestation has come to the antenatal clinic with a fear of childbirth and is asking for elective caesarean section as a mode of delivery.
What would be the recommended management?

A. Adequate exploration of the fears with counselling by trained personnel
B. Discharging the patient to midwife care with advise for vaginal delivery
C. Enlisting the patient for elective caesarean section
D. Referral to another obstetrician for second opinion
E. Referral to the supervisor of midwife

15. Women requesting caesarean section on maternal request might have posttraumatic stress disorder (PTSD) after previous childbirth. What is the incidence of PTSD after childbirth?

A. 0–1%
B. 6–7%
C. 12–13%
D. 24–25%
E. 36–37%

16. Among those receiving gynaecological treatment, what is the reported incidence of domestic violence in the United Kingdom?

A. 11%
B. 21%
C. 31%
D. 41%
E. 51%

17. When obtaining consent for a procedure, a doctor should take rea- sonable care in communicating with the patients, as their inability to recall from such discussion is often evident.
What percentage of the information that is discussed during the pro- cess of obtaining consent before surgery is retained at 6 months?

A. 10%
B. 20%
C. 30%
D. 40%
E. 50%

18. One of the main challenges faced by clinical trials is a lower than expected rate of recruitment.
What is the key to successful recruitment?

A. Collaboration and collective effort in multicentric trials
B. Do nothing, as clinical trials are not important
C. Provide incentives for participation in medical studies
D. Wait for colleagues to publish clinical trials
E. Withhold care to patients if they do not agree to participate in clinical trials

19. Improved outcomes are often observed in women participating in a clinical trial. What is the reason behind this improved outcome, irrespective of study findings?

A. Positive change in the behaviour of clinicians and partici- pants along with improved delivery of care
B. There is no difference in the outcome of care
C. Treatment is provided in a new hospital with latest technology
D. Treatment is provided in a tertiary hospital
E. Treatment is usually based on postal delivery of medication

20. On completing a consent form with a patient for a diagnostic laparoscopy, you mention that the chances of suffering a bowel injury is ‘uncommon’.How would you define ‘uncommon’ in this context in numerical terms?

A. 1/1–1/10
B. 1/10–1/100
C. 1/100–1/1000
D. 1/1000–1/10,000
E. <1/10,000

21. Your hospital is taking part in a large multicentre clinical trial into the management of reduced fetal movements. One of your consultants is the nominated lead for the conduct of the trial in your hospital.

What’s the name of the consultant’s role?

A. Chief investigator.
B. Local chief investigator.
C. Principal investigator.
D. Sponsor.
E. Supervising investigator.

22. A RCOG Green-top Guideline makes a recommendation based on a well-conducted systematic review of RCTs. e evidence is directly applicable to the target population of the recommendation.

Whatistheclassifcationo thislevelo evidence?

A. 1++.
B. 1+.
C. 1−.
D. A.

23. The operating department of your hospital runs a teaching day on human factors. Which is a department of Health‘NeverEvent’?

A. A healthy 25 year old is diagnosed with breech presentation at 37 weeks’ gestation. She declines ECV and agrees to elective caesarean section, which is booked for 39+2 weeks. She spontaneously labours in the night at 38+6 weeks’ gestation, and on arrival is found to be 3 cm dilated with regular contractions. A caesarean section is performed. ere is extension into the right uterine angle and unexpected hypotonicity. e ST1 performing the caesarean section desperately, but unfruitfully, attempts to get haemostasis. She appears to lose her situational awareness and refuses to seek assistance. e theatre sister and anaesthetist agree to summon help, but unfortunately the ST5 is dealing with a major PPH in the labour ward. e consultant is summoned from home but his car breaks down, delaying his arrival. Extensive blood products are used, but the resuscitation e orts cannot keep up with the haemorrhage. e surgical ST5 comes to help, but the patient has a cardiac arrest on the operating table while he is scrubbing. A er 60 minutes of cardiopulmonary resuscitation (CPR) a decision is made to stop.
B. A laparoscopic BSO is performed for ovarian torsion in a 57-year-old woman. A er removing the second a ected ovary from the abdomen, the operator goes to remove the healthy ovary which he has le in the pelvis a er earlier removal for later retrieval. e ovary cannot be found and, a er 30 minutes of searching laparoscopically, it is decided that laparotomy would be of greater harm than benefit
C. A patient is diagnosed with a le -sided ectopic pregnancy and is consented for a le salpingectomy. At laparoscopy, the ectopic is on the right side and the right tube is removed.
D. A 33-year-old para 4 (four previous caesarean sections) undergoes elective caesarean section. A placenta accreta is found; the surgeon tries to remove the placenta rmly and tears it. Bleeding is catastrophic and, despite excellent resuscitation e orts and a caesarean hysterectomy, the woman dies. Later the antenatal care is criticized for not looking more closely at the placenta on the 20-week scan.
E. A 37-year-old morbidly obese para (previous spontaneous vaginal deliveries) undergoes elective caesarean section for breech presentation. e uterine incision extends into the angle and there is severe hypotonicity. Despite surgical salvage and anaesthetic resuscitation she bleeds catastrophically, quicker than blood can be replaced. She has an asystolic cardiac arrest on the operating table, and resuscitation attempts fail.

24. You are asked to teach gynaecologic emergencies at the emergency department monthly teaching. Unfortunately you have not been able to ascertain the grade or level of previous gynaecology experience of those who are attending. You start by getting the casualty doctors to discuss basic pelvic anatomy and then the basics of early pregnancy. Next you base the level of your further teaching on the level of knowledge they displayed in these initial basic subjects.

What would best describe this teaching method?

A. Brainstorming.
B. Delphi technique.
C. Fish bowl.
D. Problem-based learning.
E. Snowballing.

25. A ST1 colleague is confused at the array of assessments available in the electronic training portfolio and asks you which are formative and which are summative.
Which of the following is an example of a formative assessment?

A. ARCP.
B. MRCOG Part 1.
C. MRCOG Part 2.
D. MRCOG Part 3.
E. TO1.

26. A consultant is nding it cumbersome preparing for an appraisal. How frequently should the appraisal normally take place?

A. Annually.
B. Biannually.
C. Every 3 years.
D. Every 5 years.
E. Every 10 years.

Clinical Governance Extra Questions

Clinical Governance Extra Questions

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