Test Assignment for MBBS

Part I – Short Answer:

1. You are the lead clinician at a hospital. You have admitted a case of Acute
calculous cholecystitis in the ward. You are managing that case
conservatively. What are the indications for terminating the conservative
management? How do you manage when the conservative management
fails?
2. How do you manage a case of acute poisioning?
3. Describe the proper management of COPD Acute exacerbation.
4. What are the basic principles of chronic disease management?
5. What are the roles of an MBBS at a district level hospital?
Part II – Essay Questions:
1. What are the important characteristics of a good doctor? (200 words max)
2. Why is management an important skill for this position? What are the
important characteristics of being a good manager?(200 words max)
3. What does it mean as a physician to represent your hospital’s best image
in the local community? As Staff Physician, how do you plan to represent
CharikotHospital and Possible’s best image? (350 words max)

1. Patient has acute calculous cholecyastitis. He should get intravenous

fluids, pain control, empiric antibiotics.If any of the three is seen in
usg(emphysematous GB, gangrenous GB, rupture GB),or patient is septic
or crutucally ill meaning conservative management has failed, emergency
laproscopic cholecystectomy needs to be done. If patient improves,
cholecystectomy is done later during same hospital admission(elective).

2. Management of acute poisoning:

Secure ABC first.
A : nasogastric suction, endotracheal intubation if necessary
B: pulse oximetry, ventilator support
C: pulse rate, cardiac monitoring, urine output
Decontaminate patient by removing clothes,place in left lateral position.
Give intravenous fluids,dextrose, thiamine, naloxone stat.
Take proper history to identify the poison, ask for the bottle if available. Proper
physical examination.
Gastric lavage, charcoal administration to decrease gastric absorption
Administration of antitoxins.
Alteration of urine pH for elimination of acidic/basic poison.
Hemodialysis if required.
Continuous patient monitoring.

3. COPD exacerbation

Vitals, Pulse oximetry and oxygen therapy before examination.

Quick physical examination(general,CVS,Respi)
Order tests cbc,bmp,chest xray,abg,bun,creatinine,ecg
Albuterol inhalation stat
Pulse oximetry every 2 hrly(target 88 to 92)
Methyl prednisone iv stat
If required prescribe iv antibiotics(ceftriaxone/levofloxacin)
Continuous cardiac and respiratory monitoring.
Non Invasive Ventilation for severe exacerbation of COPD
Intubation if respiratory failure, hemodynamic instability.

4. Chronic disease management

Based on WHO general principals of chronic care

1. Develop a a treatment partnership with patient
2. Focus on your patients concerns and priorities
3. Assess, advise, agree, assist, arrange(5A)
4. Support patient self management
5. Good follow up
6. Involve peer educators and support staff in your health facility
7. Link to community based resources and support
8. Use written information- registers, treatment plan. Written information for
patients
9. Work as a team
10. Assure continuity of care.

5. Roles of MBBS in district hospital.

Inpatient, outpatient and emergency care.

Undertaking patient consultation and physical examination
Monitoring medication to patients.
Performing basic surgical procedures
Work together with staff including the medical team and non-medical staffs.
Promoting health education
Teaching health care trainees.
 1. Characteristics of good doctor

Being in health care field as a doctor, we have to look onto this profession in a
holistic way. This profession is not just about treating patients by being good at
diagnosis and treatment of patients but is much more. Below are the few points
highlighted:

1. Responsibility: A sense of responsibility will be a key factor for driving

patient care. As a leader of the team doctors should be responsible
towards their patients and the team providing the care.

2. Dedication : A dedicated doctor can be enthusiastic in providing the best

care to patients. Also, this profession needs dedication as it involves your
time, interest and patience.

2. Compassion: A doctor should be compassionate towards the patient.

Being compassionate will help by being a god listener and patients feel
much relieved talking to the doctor that builds a great doctor patient
relationship. Its said that doctors can heal half the pain with their good
words.

3. Professionalism : A good doctor should know about his work ethics

and maintain a professional relation with his patients and the staff
members

4. Good communication skills is necessary to communicate properly with

the patients

5. Team player: Since doctors work as a part of the team that have
members with their own responsibilities, it is essential to be able to
work being as a part of the team.

6. Knowledgeable : A good doctor should also have a good knowledge

base about the diseases and their management. When in doubt always
consult peers and seniors.

2. Being a good manager:

From my experience working in a rural hospital for 2 years I have found that
management skills is very important.
The patient diaspora, availability if resources, expectation of health staff and
patients and environment inside and outside the hospital plays important role in
running the hospital. The doctor highly relies on his health care team. So,
identifying their needs and giving them proper responsibility while helping them
do their role is a must. The patient population is different on every other day and
the care should be delivered accordingly. At times doctors should be able to relay
their purpose or concerns to the local leaders who also have a role in maintaining
a smooth hospital environment.

Maintaining integrity in profession will help in proper management. A doctor

should also be honest while handling concerns of patients and staff. The goal is
always towards an effective patient care and transition of patient care from
hospital to home. A good manager in a health care setting should be a good
motivator too.

3. Possible health and the community

Nepal health care system is mostly based on two health care models. The private
care and the government affiliated health care. While both models have been
there for a long time providing health care for people in both rural and urban
setting this hasn’t brought much difference in terms of sustainable and affordable
care towards patients.

The private health institutions are costly and are within reach of limited people
who can afford the high costs of care. These institutions are also located
centrally and provide care to fixed area in their region. The government facilities
are cheap but are often overcrowded and under resourced, understaffed. The
dissatisfaction can be seen in both patients and the health care team in such
settings.

Possible health care model unites patients and the available health care
institutions to provide a more sustainable and affordable patient care. It is more
focused towards the patients who have to suffer due to the current health care
services. This model has been tried in achham and dolakha districts and there
has been changes like increased services, higher quality services, expanded
services.

Keeping the good changes to one end, there have also been few challenges
including effective stakeholder collaboration, lack of clarity surrounding the
policy, and effective mechanisms to integrate staff. I believe that doctors being
an important part of the team can effectively voice the objectives and services of
possible health. Besides the general duties as a clinician, I know that it is highly
essential to manage the team and work with the stakeholders. I will effectively
voice the requirements and the concerns of both the hospital staff and the patient
population. Being a mediator and taking the best decision for the health care
delivery as a leader is the role I can play while being there. The nature of the
portrayal of the hospital through me will of course be after the discussion with the
concerned people within the hospital.

So , to summarize it the role of a clinician providing a continuous and best

management to the patients while also being a responsible member of the
institution is the role I can play.