Emedica Online MRCGP AKT Revision Service Guidance for authors

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1 Emedica Online MRCGP AKT Revision Service Guidance for authors Thank you for your interest in writing questions for the Emedica online revision service. This guide will clarify the type / format of question we are looking for. If you have any further queries, please contact us at info@emedica.co.uk Payments and copyright Payment is 250 per complete batch of commissioned and approved questions. A batch is 25 questions, these can be any combination of SBA and EMQ questions as specified by Emedica Payment will be made by bank transfer within 10 working days of receipt of a correct invoice after your questions have been accepted. Acceptance of payment transfers ownership of copyright and publication rights to Emedica. We ONLY use original questions for the Emedica online revision service. We DO NOT pay for actual exam questions, and cannot use questions taken from any other source. We will ask you to confirm in writing that all questions you submit are your own work and NOT taken from any other source Samples and Commissions If you are interested in writing MRCGP AKT questions for our service, please write a sample SBA and sample EMQ set of 3. We will review these and either accept you as an author for our service, or suggest changes that need to be made. Upon acceptance of a sample, we will send you a writer s agreement clarifying transfer of publication rights and will commission you to write full batches covering specific topics.

2 If you would like us to include your sample questions as part of your first paid batch please contact us for a specified sample subject before writing. At the point of commissioning Emedica will specify the subject matter and format of each question and allocate a submission deadline. All submissions should be in an editable Microsoft Word format. Text should be in ARIAL 12 point font and formatted as shown in the example questions in this guidance or as specified at the point of commission. Each batch of questions should be submitted in a single document and any reference numbers provided should be included in the document. Writing guidance, example questions and correct layout for each question type are provided in the next section. If you have any further queries, please us: info@emedica.co.uk

3 Guidelines: Single Best Answer (SBA) Each SBA question should include the following: Heading / title that does not reveal the correct answer A clinical scenario appropriate to primary care. 5 answer options of the same type (5 possible diagnoses, 5 drugs / management options, 5 complications etc), all options should be realistic differentials given the information in the scenario and where possible, should include the closest differentials or commonly made mistakes. Feedback about the correct answer as well as a brief detailing of how or why the incorrect answers are incorrect or how they can be excluded using information from the scenario. Answers should start The correct answer is followed by the letter and full option given in the question. High quality feedback will refer to specific guidance and can include links for further reading, diagrams or images. Any images that are not self produced must be reproduced with appropriate permissions or be definitively copyright free An example SBA question is on the next page.

4 Chest Pain A 54 year old male with a history of diabetes is in the waiting room when he begins coughing up frothy pink sputum. He has chest pain, is severely breathless, sweaty, nauseated and anxious. An ambulance has been called. Which of the following is not an appropriate step in management while waiting for this patient to be taken to hospital? a. 40mg furosemide given slowly b. 5.0 mg diamorphine given slowly over 5 minutes c. 7.5mg diamorphine given slowly over 5 minutes d. IV metoclopramide 10 mg e. GTN spray, two puffs The correct answer is c. 7.5mg diamorphine given slowly over 5 minutes This dose is too high, the recommended range for diamorphine for this patient is between 2.5 mg and 5.0 mg, given slowly over 5 minutes. The clinical presentation here is very suggestive of acute pulmonary oedema. NICE recommends the following as appropriate options for managing a patient with suspected acute pulmonary oedema while awaiting admission to hospital: Give an intravenous diuretic (for example furosemide 40 mg to 80 mg, given slowly). Give an intravenous opioid (for example diamorphine 2.5 mg to 5.0 mg, given slowly over 5 minutes). Give an intravenous anti-emetic (for example metoclopramide 10 mg). This can be mixed with diamorphine. Give a nitrate, either sublingually or buccally (for example GTN spray, two puffs). Ref:

5 Guidelines: Extended Matching Questions (EMQ) Each set of 3 questions that make up an EMQ should include the following: The same heading / title The same question The same 6-8 options of the same type (6-8 possible diagnoses, 6-8 drugs / management options, 6-8 complications etc). All options should be realistic across the three scenarios and where possible should include the closest differentials or commonly made mistakes across the three scenarios. Each question within the set should have the following: A different clinical scenario appropriate to primary care. Feedback about the correct answer as well as a brief detailing of how or why the incorrect answers are incorrect or how they can be excluded using information from the scenario. Answers should start The correct answer is followed by the letter and full option given in the question. Feedback to an earlier question should not give away the answer to a later question within a set - where appropriate, additional information regarding guidance may be provided in the feedback for the final question in a set. High quality feedback will refer to specific guidance and can include links for further reading, diagrams or images. Any images that are not self produced must be reproduced with appropriate permissions or be definitively copyright free An example EMQ set of 3 is provided on the next page.

6 Managing a Fitting Child (EMQ set of 3) a. 2.5mg of rectal diezapam b. 2.5mg of rectal diezapam repeated after 5 minutes if fit continues c. 2.5mg of buccal midazolam d. 2.5mg of buccal midazolam repeated after 5 minutes if fit continues e. 5mg of rectal diezapam f. 5mg of rectal diezapam repeated after 5 minutes if fit continues g. 15mg of rectal diezapam h. Call an emergency ambulance Managing a Fitting Child (1 of 3) A three week old baby weighing 4kg is suffering a fit which you suspect to be a febrile convulsion. The child is still fitting after 5 minutes. Select the most appropriate next step in management. The correct answer is b. 2.5mg of rectal diezapam repeated after 5 minutes if fit continues For a fitting child less than 1 month of age and the appropriate dose of rectal diazepam is between 1.25 and 2.5mg repeated after 5 minutes if necessary. Buccal midazolam can be given as a single dose of 300micrograms/kg body weight up to a maximum of 2.5mg for a child up to 6 months. In this case as the child weighs 4kg the correct dose of midazolam would be 1.5mg. Managing a Fitting Child (2 of 3) A 9 year old girl is suffering an ongoing fit of unknown cause. The fit has lasted 5 minutes. Select the most appropriate next step in management. The correct answer is f. 5mg of rectal diezapam repeated after 5 minutes if fit continues For a fitting child aged between 2 and 11 the appropriate dose of rectal diazepam is between 5mg and 10mg repeated after 5 minutes if necessary.

7 Buccal midazolam can be given as a single dose of 7.5mg for a child aged between 5 and 9. Managing a Fitting Child (3 of 3) A 5 year old boy weighing 18kg is suffering a fit, the child was still fitting at 5 minutes and was given a dose of rectal diazepam; a further 5 minutes have elapsed and the child is still fitting. Select the most appropriate next step in management. The correct answer is e. 5mg of rectal diezapam For a fitting child aged between 2 and 11 the appropriate dose of rectal diazepam is between 5mg and 10mg repeated after 5 minutes if necessary. As this patient has already had a dose of rectal diazepam, if the fit does not resolve within 5 minutes of a second dose an emergency ambulance should be called. Buccal midazolam can be given as a single dose of 7.5mg for a child aged between 5 and 9. An emergency ambulance should be called if, 10 minutes after the first dose: The seizure has not stopped or the child has ongoing twitching (even if the larger jerking movements have stopped). Another seizure has begun before the child regains consciousness. To manage a fitting child, protect them from injury by cushioning the head with your hands or soft material, removing harmful objects from nearby, or move the child away from immediate danger, do not restrain a person who is fitting or put anything in the mouth. When the seizure stops, check the airway and place the child in the recovery position. If the seizure lasts more than 5 minutes give rectal diazepam repeated once after 5 minutes if the seizure has not stopped, or one dose of buccal midazolam.

8 Recommended doses of rectal diazepam (repeated after 5 minutes if necessary) are: Less than 1 month of age: mg. 1 month 1 year of age: 5 mg years of age: 5 10 mg. Recommended doses of midazolam are: Less than 6 months of age: 300 micrograms/kg body weight (maximum 2.5 mg). 6 months 11 months of age: 2.5 mg. 1 4 years of age: 5 mg. 5 9 years of age: 7.5 mg. Blood glucose should be measured if a child cannot be roused or is convulsing. Ref: