Abstract
Clinical Environment, Evidence Management and Quality Improvement Structured SBA Questions
Clinical Environment, Evidence Management and Quality Improvement Structured SBA Questions
Statistics
1. In a survival analysis study for total hip arthroplasty with revision being the end point for failure, the statisticians discovered that 52 patients who were initially thought to be dead in a certain year were actually alive, but all had revisions during that year.
How does this affect the number of individuals at risk for that year?
2. Which of the following is correct in terms of levels of evidence?
A systemic review including prospective cohort studies and retrospective cohort studies and case-control studies all yielding consistent outcomes is level 2 evidence.
A systemic review of multiple well-designed RCTs yielding non-homogenous findings is level 1 evidence
An RCT with a dropout rate leading to the follow-up rates to drop to just below 80% is level 2 evidence
Epidemiology
3. Over a period of 1 year, 10 patients of a population of a 1 000 people develop septic arthritis. The test of choice was aspiration and culture and 15 patients had the test. Of them, 11 tested positive, of whom 2 didn’t actually have the disease. The remaining 4 tested negative, but only 3 of them did not have the disease and 1 actually had the disease despite the negative test.
At New Year’s Eve and assuming that the whole population including the affected were still alive and that there were no other cases recorded prior to that year, which of the following is correct?
Theatre Designs
4. Measurement of colony-forming units per cubic metre (CFU/M3) in theatre resulted in 27 CFU of bacteria / M3 with no Clostridium perfringens and no Staphylococcus aureus CFU.
Where would this be considered acceptable?
5. During a hospital refurbishment, a new orthopaedic theatre suite was built. The engineers mapped 4 zones, with the theatre suite situated in the same corridor leading to ED, ITU and the radiology department.
Which statement describes the zones most accurately?
6. Which of the following is most likely to decrease the risk of airborne contamination?
Patient Warming
7. A patient with an open fracture and compromised vascular function is planned for urgent transfer from the ED to theatre; however, he is found to have a temperature of 35.5°C.
Which of the following action would be most appropriate as per NICE guidelines?
A forced air warming device (Bair Hugger) should be applied intraoperatively (from induction) and set to maximum, then adjusted to maintain the patient temperature at 36.5°C
Active warming should be initiated in the ED even if it means a slight delay in transfer to theatre
All irrigation fluids used intraoperatively should be warmed in a thermostatically controlled cabinet to a temperature of 37°C
Intravenous fluids of 1L or more and blood products should be warmed to 37°C using a fluid-warming device
Skin Preparation
8. Regarding preoperative skin preparation, which of the following is correct as per the NICE Guidelines [April 2019]?
0.5% chlorhexidine in 70% alcohol solution (Hydrex; Prevase) has a UK authorisation for disinfection of the skin prior to deeply invasive medical procedures
Aqueous solution of chlorhexidine is first choice if the surgical site is close to a mucous membrane
Aqueous solution of povidone-iodine is first choice if the surgical site is close to a mucous membrane
Diathermy
9. Which statement best describes diathermy?
Diathermy functions via the passage of high-frequency alternating current through the tissues, generating very high temperatures up to 1 000°C
Diathermy might interfere with the function of cardiac pacemakers and should not be used in the presence of one
Monopolar diathermy has 2 modes: cutting and coag. In the cutting mode the output is continuous and generates lower temperatures than the coag mode, where the output is pulsed and generates higher temperatures
Monopolar diathermy has 2 modes: cutting and coag mode. In the cutting mode the output is continuous and generates temperatures similar to those in the coag mode, where the output is pulsed
Monopolar diathermy has an active electrode that is held by the surgeon and a plate electrode. The plate should be placed on dry, shaved, well-vascularised skin away from metalwork and bony prominences, with a surface area of at least 50cm2
Tourniquet
10. A patient with high BMI and a great toe infected ulcer is in the anaesthetic room prior to having an ORIF for a tibial plateau fracture.
Which of the following best applies to the tourniquet that should be used?
As the patient has a high BMI, several layers of padding are needed underneath the tourniquet to minimise the risk of pressure complications
As this is a lower limb, the tourniquet can be kept on for up to 120 minutes and then if further time is needed it should be deflated for at least 5 minutes then re-inflated
In terms of tourniquet length, there should be at least 2 inches of overlap between the tourniquet ends to achieve adequate strength
The widest tourniquet should be used, and it should be at least one-half the diameter of the limb to minimise the risks of localised pressure problems
Consent
12. As per the GMC guidance for consent, it is the responsibility of the doctor performing a procedure to discuss it with the patient and obtain consent.
If, however, that is not practical then which of the following should occur?
Discussion and consenting could be delegated but only to colleagues who are fully competent to perform the procedure independently
Discussion and consenting could be delegated to a colleague who has sufficient knowledge of the proposed investigation or treatment, and understands the risks involved even if they are not fully competent to perform it independently
If the consent process was delegated, then it becomes the responsibility of the doctor to whom it was delegated to ensure that enough information and time were given to the patient to adequately consent to the procedure
If the consent process was delegated, then it becomes the responsibility of the doctor to whom it was delegated to ensure that consent was obtained prior to starting the investigation or treatment
The procedure has to be delayed until the performing doctor is capable of having the conversation with the patient
13. If you are conducting a clinical trial that involves taking blood samples from a patient using a newly invented needle tip that is currently under testing, with this investigation not related to the current treatment of the patient, then which of the following should occur?
Either written or implied consent would suffice as long as the consent is documented in the clinical notes
Written consent only is needed, as the device is considered an innovative treatment; however, it would have not been indicated if blood samples were taken conventionally, in which case implied consent would have sufficed
Written consent is required, even for a minor procedure, if providing clinical care is not the primary purpose of the procedure
14. Upon assessing the capacity of a young person to consent, which of the following is correct?
A child / young adult who doesn’t have the capacity to consent can be involved in research as long as their parent consents and the parental consent is documented, even if the child is refusing in words or actions
Related posts:
Chapter 6 – Knee II Structured SBA
Chapter 7 – Foot and Ankle Structured SBA
Chapter 20 – Pathology I Structured SBA
Chapter 24 – Prosthetics and Orthotics Structured SBA
Chapter 26 – Clinical Environment, Evidence Management and Quality Improvement Structured SBA
Chapter 15 – Hand II Structured SBA
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