HEALTH RECORDS OFFICERS

REGISTRATION BOARD OF NIGERIA

LICENSE EXAMINATION

PAST QUESTIONS
AND
ANSWERS

HIGHER NATIONAL DIPLOMA (HND)

2020
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HRORBN. COMPILED BY ERHABOR A. GODSENT (2020)

 COMPUTER,
SEPT.2017
QUESTION 1
a. List ten characteristics of modern database management system

i. Provides security and removes redundancy

ii. Self-describing nature of a database system
iii. Insulation between programs and data abstraction
iv. Support of multiple views of the data
v. Sharing of data and multiuser transaction processing
vi. DBMS allows entities and relations among them to form tables.
vii. It follows the ACID concept (Atomicity, Consistency, Isolation, and Durability).
viii. DBMS supports multi-user environment that allows users to access and manipulate data in
parallel.

b. Explain it relevance to the management of health information in an hospital

i. The digitization of healthcare is driving the need for systems to manage and organize
large amounts of personal health data in order to drive more comprehensive care for
patients across the healthcare continuum.
ii. As more systems continue to be built, there is a large push for strong system
interoperability to connect health data from disparate systems and care providers into a
central location for better patient and provider access to information.
iii. To encourage proper information management, new data standards and regulations are
being enforced to ensure the protection of information and the use of standard processes.
iv. The focus on health information management (HIM) skills for employees will continue
to grow in coming years as disparate systems continue to generate large amounts of
patient data that is critical for successful healthcare delivery.
v. Databases help to access patient records by those who need it. Just as importantly, the
data can be pre-processed so that it arrives in the form required.
vi. In addition to being developed, databases and systems are needed to secure and to avoid
data being stolen or lost during transit or storage

c. Explain five characteristics listed above and the relationship to health information
management

HRORBN. COMPILED BY ERHABOR A. GODSENT (2020)

QUESTION 2
a. Open a file as read only
Open word processing package (Microsoft word)
Click on file
Select open
Select the file then click ok
b. Save a file to another format
Open word processing package (Microsoft word)
Click on file
Select save as
Select location for saving
Select the file extension type
Save

c. Save file automatically as you work

Ctrl + S
d. Save a document
Click on file
Click on save
Select storage location
Input File name
Click on save

QUESTION 3
a. Clinical Decision Support System

A clinical decision support system is a health information technology system that is

designed to provide physicians and other health professionals with clinical decision support, that
is, assistance with clinical decision-making tasks. A clinical decision support system (CDSS) is
an application that analyzes data to help healthcare providers make decisions and improve
patient care
b. Open Source Electronic Medical Records.
OpenEMR is a Free and Open Source electronic health records and medical practice
management application that can run on Windows, Linux, Mac OS X, and many other platforms.
OpenEMR is ONC Complete Ambulatory EHR certified and is one of the most popular open
source electronic medical records in use today. OpenEMR is supported by a strong community

HRORBN. COMPILED BY ERHABOR A. GODSENT (2020)

of volunteers and professionals all with the common goal of making OpenEMR a superior
alternative to its proprietary counterparts

c. Health Information Technology/Interoperability

d. Data standard in electronic health records.

Data Standards are documented agreements on representation, format, definition,
structuring, tagging, transmission, manipulation, use, and management of health records

QUESTION 4
a. Define Desktop publishing,
Desktop publishing, sometimes abbreviated as DTP, is a technique for preparing and
printing professional quality products using microcomputers, software, and printers. Articles on
the subject, presumably by authors who haven't tried to use the technique, still occasionally
suggest that DTP is easy, fast, and cheap.
b. Explain the following Desktop publishing terms
i. Transparency
Transparency is an effect applied to an object causing it to appear transparent and letting
objects underneath show through. A common example of transparency is drop shadow.
Transparency may be applied to an object in a number of different ways. Transparency is
possible in a number of graphic file formats. Transparency in images is something that graphic
designers use a lot to create cool effects in their work.

ii. Text wrap

Text wrap is a feature supported by many word processors that enables you to surround a
picture or diagram with text. The text wraps around the graphic. Text Wrap is also called Text
Flow.

iii. Drop shadow

A drop shadow is effectively a blurred, offset version of the input image's alpha mask,
drawn in a specific color and composited below the image.

iv. Bleed
In printing and desktop publishing terminology, a bleed is an element that extends right
to the edge of the page. You can bleed a photo, a shaded box, a line, a piece of clip art, or even
text

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v. Flow text along a path
This is when a line or shape is drawn and used as a path for text. You can create any
shape and this can make for a more interesting design, drawing the reader in.

QUESTION 5
a. Define acquisition of computer
It is the acquiring of a computer system through various options. The three main options
for acquisition of computer hardware are buying, in-house, and leasing or renting it.
b. Five stages of procurement
i. Identification of needs and analysis. ...
ii. Market profiling - suppliers.
iii. Market engagement strategy.
iv. Market engagement execution.
v. Implementation of contracts and performance management.

c. Six factors that influence the usage of computers that have to be considered during
the acquisition of computers for hospital computerization
i. Appropriateness
ii. Users friendliness
iii. Efficiency
iv. Good documentation
QUESTION 6
a. File management programs
A file management program is a tool for organizing files into folders on your computer, as
well as locating, moving, opening and copying existing files. A file management program is a
tool for organizing the folders and files on your computer or other device, such as a tablet or
smartphone

b. Disk management programs

Disk Management is an extension of the Microsoft Management Console that allows full
management of the disk-based hardware recognized by Windows. Disk Management is used to
manage the drives installed in a computer—like hard disk drives (internal and external), optical
disk drives, and flash drives

c. Data recovery programs

Data recovery software is a type of software that enables the recovery of corrupted,
deleted or inaccessible data from a storage device. This software reviews, scans, identifies,
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extracts and copies data from deleted, corrupted and formatted sectors or in a user-defined
location within the storage device.

QUESTION 7
a. System security operating system
Operating system security (OS security) is the process of ensuring OS integrity,
confidentiality and availability. Security refers to providing a protection system to computer
system resources such as CPU, memory, disk, software programs and most importantly
data/information stored in the computer system.

b. Antivirus programs
An antivirus program is a software utility designed to protect your computer or network
against computer viruses. If and when a virus is detected, the computer displays a warning
asking what action should be done, often giving the options to remove, ignore, or move the file
to the vault

OCT, 2018.

QUESTION 1
a. Explain the following
i. Medical informatics
Medical informatics is a body of knowledge concerned with the use of ICT to support
medical research, education and for promoting health care delivering. It is the application of
computer technology to solve problem in health care relating to patient.

ii. Bioinformatics
It is a field that deals with the application of computer to the collection, organization,
analysis, manipulation, presentation, and sharing of biological data to solve biological problems
on the molecular level.

iii. Geographical informatics

It is a systems of hardware, software and procedures to facilitate the management,
manipulation, analysis, modelling, representation, and display of geo-referenced data to solve
complex problems regarding planning and management of resources.
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 iv. Nursing informatics
It is a specialty that integrate nursing science, computer science and information science to
manage and communicate data/information and knowledge in nursing practice.

v. Patient informatics
It is the application of ICT to provide a mechanism for patients to provide their
clinician(s) with critical information, and to share information with family, friends, and other
patients.

b. Areas in which bioinformatics could be useful in the health industry

i. Drug design
ii. Drug discovering
iii. Protein structure description
iv. To discover disease
v. To diagnose disease

QUESTION 2
Needs of EHR in the hospital

i. Easy data storage and prompt retrieval

ii. No bulky paper records to store, manage and retrieve
iii. To ensure portability of health records
iv. Avoid duplication of records
v. Brings about data atomicity and ensure data security
vi. Easier access to clinical data
vii. The ability to establish and maintain effective clinical workflows
viii. Fewer medical errors, improved patient safety and stronger support for clinical decision-
making
ix. Easier participation in Meaningful Use, Patient-Centered Medical Home (PCMH) and
other quality programs, with electronic prompts ensuring that required data is recorded at
the point of care
x. The ability to gather and analyze patient data that enables outreach to discreet populations
xi. The opportunity to interact seamlessly with affiliated hospitals, clinics, labs and
pharmacies

QUESTION 3
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QUESTION 4
a.

4b. Five steps involved in database design

Determine the purpose of the database

The very first thing you must do is decide the purpose of your database. You need to
determine what it will be used for, how you expect to use it, who you expect to use it, etc. This
will help you develop a mission statement and prepare for the remaining steps.

Find and organize the information

Once you have figured out the purpose of your database, you’ll need to gather the data that
needs to be stored there. After you gather the necessary information, you need to organize it. It’s
usually easiest to organize the information by breaking each piece into its smallest useful parts.

Create tables for the information

Once the information is organized, you’re going to want to divide up the information into
tables. Separate the data into major entities or subjects. Then, each subject will become a table.
Label each table with the subject within that table.

Establish relationships between the tables

It can be hard to use a database with independent or unrelated tables. It is best to look at
each individual table and decide how the data within relates to the data in other tables. You then
can add fields to the tables or create new ones to clarify the established relationships so
everything is connected.

Redefine your design

One of the last database design steps is to take a step back once you’ve “completed” the
database. You want to scan it and analyze the design for any errors. Run the database with the
tables and record to see if you can get the results you want. You should then make adjustments to
get the final result you desire.

QUESTION 5

HRORBN. COMPILED BY ERHABOR A. GODSENT (2020)

Primary key
A primary key, also called a primary keyword, is a key in a relational database that is
unique for each record. It is a unique identifier, such as a driver license number, telephone
number (including area code), or vehicle identification number (VIN). A relational database must
always have one and only one primary key.

Candidate key
A candidate key is a column, or set of columns, in a table that can uniquely identify any
database record without referring to any other data. Each table may have one or more candidate
keys, but one candidate key is unique, and it is called the primary key.
Foreign key
A foreign key is a column or group of columns in a relational database table that provides
a link between data in two tables. It acts as a cross-reference between tables because it references
the primary key of another table, thereby establishing a link between them
Artificial key
An artificial key is one that has no meaning to the business or organization. Artificial
keys are permitted when. 1) No attribute has all the primary key properties, or. 2) The primary
key is large and complex. For Example: Enrollment table from business point of view has
(student, c1ass) combination as primary key
Composite key
A composite key is a combination of two or more columns in a table that can be used to
uniquely identify each row in the table when the columns are combined uniqueness is
guaranteed, but when it taken individually it does not guarantee uniqueness. A composite key is
a candidate key that consists of two or more attributes that together uniquely identify an entity
occurrence.
QUESTION 6.
QUESTION 7
a. What is data model
A data model refers to the logical inter-relationships and data flow between different data
elements involved in the information world. It also documents the way data is stored and
retrieved. Data models facilitate communication business and technical development by

HRORBN. COMPILED BY ERHABOR A. GODSENT (2020)

accurately representing the requirements of the information system and by designing the
responses needed for those requirements. Data models help represent what data is required and
what format is to be used for different business processes.

b. Importance of data modelling in a database design

i. Data models can facilitate interaction among the designer, the applications programmer,
and the end user.
ii. A well-developed data model can even foster improved understanding of the organization
for which the database design is developed.
iii. Data models are a communication tool.
iv. A data model not only improves the conceptual quality of an application, it also lets you
leverage database features that improve data quality.
v. Developers can weave constraints into the fabric of a model and the resulting database

c. Five Characteristics of a good data model in hospital

i. Data in a good model can be easily consumed.
ii. Large data changes in a good model are scalable.
iii. A good model provides predictable performance.
iv. A good model can adapt to changes in requirements, but not at the expense of 1-3.”
v. The data model must be flexible in some way; it must remain agile

OCT, 2019
1. Full meaning of the following;
PDF-Portable Document Format
URL- Uniform Resource Locator
HML-Hypertext Markup Language
UPS-United Parcel Service
OOP-Object-oriented programming
SAN-Storage area network
USB-Universal Serial Bus
ISP-Internet Service Provider
PPP-Point-to-Point Protocol
VRML-Virtual Reality Modeling Language
1b. WWW-world wide web
SMTP-Simple Mail Transfer Protocol
IMAP-Internet Message Access Protocol
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MAN-Metropolitan Area Network
URL-Uniform Resource Locator
TCP-Transmission Control Protocol/Internet Protocol
DHCP-Dynamic host configuration protocol
FTP-File Transfer Protocol
HTPS-Hypertext Transfer Protocol Secure
POP-Post Office Protocol

2. How to secure patients information database in computer system.

Database security concerns the use of a broad range of information security controls to
protect databases against compromises of their confidentiality, integrity and availability. It
involves various types or categories of controls, such as technical, procedural/administrative and
physical.
Information security control are appropriate to databases, including:

1. Access control 2. Auditing 3. Authentication 4. Encryption 5. Integrity controls 6.

Backups 7. Application security 8. Database Security applying Statistical Method.

3a. Types of DBMS

I. Flat file DBMS
II. Hierarchical DBMS
III. Network DBMS
IV. Object oriented DBMS
V. Relational DBMS

3b. see Previous page

4a. Data sharing encourages more connection and collaboration between researchers, which
can result in important new findings within the field. In a time of reduced monetary investment
for science and research, data sharing is more efficient because it allows researchers to share
resources.

4b. issues to be documented in data sharing agreement

i. Administrative issues
ii. privacy and confidentiality issues
iii. informed-consent issues
iv. Business considerations related to data sharing

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v. The business value of data

4c. Data security means protecting digital data, such as those in a database, from destructive
forces and from the unwanted actions of unauthorized users, such as a cyber attack or a data
breach.

Types of data security technologies

1. Data classification

Classification is the foundation of data security. It helps in prioritizing the assets the company
needs to protect. Many tools support both user-driven and automated classification capabilities.
A well-planned data classification system makes essential data easy to find. This can be essential
for risk management, and compliance.

2. Data access policies

Providing the right amount of data access to individual users is crucial for data protection.
Authorising only key members of the teams to handle secure data makes sure that the possible
data breaches are remaining at a very low state. The tools are helping in sensitive data discovery
and cleaning up data access permissions to enforce least privilege.

3. Cloud data protection

Encrypting sensitive data and storing it in the cloud makes system backups safer as well, and
also it makes accessing data much easier for involved parties. Online document management
systems come in handy for every company, as they make accessing files easy, safe and available
for all the involved parties. Always use trustworthy cloud-based document management system,
make sure the server parks are located inside the EU where strict data policy regulations apply,
also, read their contract to see if they have backdoor channels for your files.

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4. Two-factor authentication

Two-factor authentications are very useful for preventing attackers from getting access to one’s
account. Even if your password was guessed correctly by hackers, the 2nd step will stop them
from entering the account. With the use of a 2nd factor it is guaranteed that even if the password
is stolen, attackers cannot get into the account.

5. Tokenization

Substituting a randomly generated value, or a token, for sensitive data like credit card numbers,
bank account numbers, and social security numbers makes it safer to store sensitive information.
Unlike encryption, there is no mathematical relationship between the token and its original data;
to reverse the tokenization, a hacker must have access to the mapping database, and this makes it
much more difficult to read the data.

5a. The bit is a basic unit of information in information theory, computing, and digital
communications. The name is a portmanteau of binary digit. A bit has a single binary value,
either 0 or 1. Although computers usually provide instructions that can test and manipulate bits.

The byte is a unit of digital information that most commonly consists of eight bits.
Historically, the byte was the number of bits used to encode a single character of text in a
computer and for this reason it is the smallest addressable unit of memory in many computer
architectures.

In computing, a nibble is a four-bit aggregation, or half an octet. It is also known as half-

byte or tetrade. In a networking or telecommunication context, the nibble is often called a semi-
octet, quadbit, or quartet. A nibble has sixteen possible values.

In computing, a word is the natural unit of data used by a particular processor design. A
word is a fixed-sized piece of data handled as a unit by the instruction set or the hardware of the
processor. The number of bits in a word is an important characteristic of any specific processor
design or computer architecture.

Storage capacity refers to how much disk space one or more storage devices provides. It
measures how much data a computer system may contain. For an example, a computer with a
500GB hard drive has a storage capacity of 500 gigabytes.

b. Ctrl + X-short form to cut

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Ctrl+A – highlight the entire document

Ctrl+ V- to paste an already copied document

Ctrl+ F- For Navigator

Ctrl+E- to place text on the center/ center alignment

Ctrl+ U to underline content (s)

Ctrl+R- Right alignment /to place content on any of the end side (right)

Ctrl+ J- distributed content evenly between margins

Ctrl+ N-open a new word/ blank page

6a. Database normalization is the process of structuring a relational database in accordance

with a series of so-called normal forms in order to reduce data redundancy and improve data
integrity.

6b. A client/server application is a piece of software that runs on a client computer and
makes requests to a remote server. Many such IT applications are written in high-level visual
programming languages where UI, forms, and most business logic reside in the client
application.

6c. Database security concerns the use of a broad range of information security controls to
protect databases (potentially including the data, the database applications or stored functions,
the database systems, the database servers and the associated network links) against
compromises of their confidentiality, integrity

6d. Primary, foreign key…see previous page.

Secondary Key: is the key that has not been selected to be the primary key. However, it is
considered a candidate key for the primary key. Therefore, a candidate key not selected as a
primary key is called secondary key. Candidate key is an attribute or set of attributes that you can
consider as a Primary key

Table: a table is a collection of related data held in a table format within a database. It consists
of columns, and rows. In relational databases, and flat file databases, a table is a set of data

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elements using a model of vertical columns and horizontal rows, the cell being the unit where a
row and column intersect

Records: In computer science, a record is a basic data structure. Records in a database or

spreadsheet are usually called "rows". A record is a collection of fields, possibly of different data
types, typically in fixed number and sequence. A record is a collection of fields, possibly of
different data types, typically in fixed number and sequence.

FEB. 2020
1. Importance of DBMS
A database management system is important because
 it manages data efficiently
 It allows users to perform multiple tasks with ease.
 A database management system stores, organizes and manages a large amount of
information within a single software application.
 To manage large chunks of data: data can be stored into a spreadsheet, but if you add large
chunks of data into the sheet, it will simply not work. For instance: if your size of data
increases into thousands of records, it will simply create a problem of speed.
 Accuracy: When doing data entry files in a spreadsheet, it becomes difficult to manage the
accuracy as there are no validations present in it.
 Ease of updating data: With the database, you can flexibly update the data according to
your convenience. Moreover, multiple people can also edit data at same time.
 Security of data: There is no denying the fact that your data is less secure in spreadsheets.
Anyone can easily get access to file and can make changes to it. With databases you have
security groups and privileges you set to restrict access.
 Data integrity: Data integrity also becomes a question when storing data in spreadsheets.
In databases, you can be assured of accuracy and consistency of data due to the built in
integrity checks and access controls.

2. Need for adopting EHR

i. Easy data storage and prompt retrieval
ii. No bulky paper records to store, manage and retrieve
iii. To ensure portability of health records
iv. Avoid duplication of records
v. Brings about data atomicity and ensure data security
vi. Easier access to clinical data
vii. The ability to establish and maintain effective clinical workflows

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viii. Fewer medical errors, improved patient safety and stronger support for clinical decision-
making
ix. Easier participation in Meaningful Use, Patient-Centered Medical Home (PCMH) and
other quality programs, with electronic prompts ensuring that required data is recorded at
the point of care
x. The ability to gather and analyze patient data that enables outreach to discreet populations
xi. The opportunity to interact seamlessly with affiliated hospitals, clinics, labs and
pharmacies.

3. Barriers to EHR System adoption in Nigeria

1. Poor power infrastructure Electricity
2. Poor connectivity
3. High cost of purchase of hardware and software
4. Cost of maintenance
5. Human threat (hackers)
6. Fear of computer replacing human (staff)
7. Untrained and retrained staff

4.a What is information System?

Information systems are formal, sociotechnical, organizational systems designed to
collect, process, store, and distribute information. Information systems are interrelated
components working together to collect, process, store, and disseminate information to support
decision making, coordination, control, analysis, and visualization in an organization.
4.b Five qualities of good information
1. Accuracy 2. Completeness 3. Consistency 4. Uniqueness, and 5. Timeliness.

4c. Discuss three categories of Information in Health Information Management

environment

 Operational and tactical information: Operational and tactical information is a

category of information that specifies different operations of the hospital. It’s enhance
easy classification of information.
 Clinical and administrative information: they are meant for managing patient details
on an administrative level.

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  Financial information: financial information is needed for tracking revenue and
managing billing submissions.

5a. what is Data communication

Data communications refers to the transmission of this digital data between two or more
computers and a computer network or data network is a telecommunications network that allows
computers to exchange data.
5b. Explain the three modes of data communication with example each

Simplex

In simplex transmission mode, the communication between sender and receiver occurs in
only one direction. The sender can only send the data, and the receiver can only receive the
data. The receiver cannot reply to the sender. Simplex transmission can be thought of as a one-
way road in which the traffic travels only in one direction—no vehicle coming from the opposite
direction is allowed to drive through.

To take a keyboard / monitor relationship as an example, the keyboard can only send the input to
the monitor, and the monitor can only receive the input and display it on the screen. The monitor
cannot reply, or send any feedback, to the keyboard.

Half Duplex

The communication between sender and receiver occurs in both directions in half duplex
transmission, but only one at a time. The sender and receiver can both send and receive the
information, but only one is allowed to send at any given time. Half duplex is still considered a
one-way road, in which a vehicle traveling in the opposite direction of the traffic has to wait till
the road is empty before it can pass through. For example, in walkie-talkies, the speakers at both
ends can speak, but they have to speak one by one. They cannot speak simultaneously.

Full Duplex

In full duplex transmission mode, the communication between sender and receiver can
occur simultaneously. The sender and receiver can both transmit and receive at the same time.
Full duplex transmission mode is like a two-way road, in which traffic can flow in both
directions at the same time. For example, in a telephone conversation, two people communicate,
and both are free to speak and listen at the same time.

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5c. Advantages of data communication network to HIM

 Safe and stable data exchange environment.

 Joint information protection system.
 Data transmission in compliance with the IP data transmission protocol.
 Quick network connection of new branches and partners.
 Network monitoring and services quality control 24-hours a day.

6a, Data governance

Data governance (DG) is the process of managing the availability, usability, integrity and
security of the data in enterprise systems, based on internal data standards and policies that also
control data usage. Effective data governance ensures that data is consistent and trustworthy and
doesn't get misused.
Data modelling
Data modeling (data modelling) is the process of creating a data model for the data to be
stored in a Database. Data modeling (data modelling) is the analysis of data objects and their
relationships to other data objects. Data modeling is often the first step in database design and
object-oriented programming as the designers first create a conceptual model of how data items
relate to each other.
Data warehouse
A large store of data accumulated from a wide range of sources within a company and
used to guide management decisions.
In computing, a data warehouse, also known as an enterprise data warehouse, is a system used
for reporting and data analysis, and is considered a core component of business intelligence.
DWs are central repositories of integrated data from one or more disparate sources.
Data mining
The practice of examining large pre-existing databases in order to generate new
information. Data mining is the process of discovering patterns in large data sets involving
methods at the intersection of machine learning, statistics, and database systems.
Data fishing
Data fishing or dredging refers to analyses that are done without predefined research
questions. Data dredging (also data fishing, data snooping, data butchery, and p-hacking) is the

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misuse of data analysis to find patterns in data that can be presented as statistically significant,
thus dramatically increasing and understating the risk of false positives
7a. explain the following keys
Primary key
A primary key, also called a primary keyword, is a key in a relational database that is
unique for each record. It is a unique identifier, such as a driver license number, telephone
number (including area code), or vehicle identification number (VIN). A relational database must
always have one and only one primary key.
Candidate key
A candidate key is a column, or set of columns, in a table that can uniquely identify any
database record without referring to any other data. Each table may have one or more candidate
keys, but one candidate key is unique, and it is called the primary key.
Foreign key
A foreign key is a column or group of columns in a relational database table that provides
a link between data in two tables. It acts as a cross-reference between tables because it references
the primary key of another table, thereby establishing a link between them
Artificial key
An artificial key is one that has no meaning to the business or organization. Artificial keys
are permitted when. 1) No attribute has all the primary key properties, or. 2) The primary key is
large and complex. For Example: Enrollment table from business point of view has (student,
c1ass) combination as primary key
Composite key
A composite key is a combination of two or more columns in a table that can be used to
uniquely identify each row in the table when the columns are combined uniqueness is
guaranteed, but when it taken individually it does not guarantee uniqueness. A composite key is
a candidate key that consists of two or more attributes that together uniquely identify an entity
occurrence.

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 HEALTH PLANNING AND MANAGEMENT.
SEPT, 2017

QUESTION 1.
a. With the aid of diagram explain organizational chart

b. Enumerate five importance of organizational structure in a health information

management department of a hospital
i. It allows top-down flow of communication
ii. It gives room for promotion to higher level
iii. It shows the hierarchy of an organization
iv. Departmentalization

c. Identify five motivating and demotivating factors for a staff in health information
management department

Motivating factors
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i. Conducive working environment
ii. Fringe benefit
iii. Prompt payment of salary and Promotion
iv. Recognition and appointment
v. Training and development
Demotivating factors

i. Poor freedom of participation

ii. Poor organizational culture
iii. Poor or lack of incentives
iv. Lack of training
v. Poor salary
d. Differentiate laizze faire from paternalistic leadership approach

i. Laissez-faire leadership: under this type of leadership, the leader do not exercise control
on it followers directly. This type of leadership is also associated with leaders that do not
supervise their team members, failed to provide continuous feedback resulting in high
costs, bad service and others. While

ii. Paternalistic leadership: this is a managerial approach that involves a dominate authority
figure who acts as a patriarch or matriarch and treat employees and partners as though
they are members of a large, extended family.

QUESTION 2
Write short note on each of the following
i. Exist interview

ii. Fringe benefits

This is added services of favour given to a staff working in an establishment. e.g free
medical care, canteen services, and free accommodation, transport allowance utility.

iii. Organization
Organization comprises of people working together in an efficient, powerful productive
and rewarding situation. Organization is the process by which the structure of an enterprises is
created and maintain. It is also refer to as the structuring of resources and activities of the

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institution for the purpose of accomplishing the assigned tasks and the platform of effective
coordination of the resources.

iv. Education
Education can be defined as the process of enlighten an individual, group of persons or
the public on a particular subject matter e.g the prevailing health problems and methods of
preventing them and encouraging participation.

v. Training
Training is a short term education process utilizing a systematic and organized procedure by
which a non-managerial personnel gains technical knowledge and skills for a particular
purpose.

QUESTION 3
a. What is leadership?
Leadership is the action of leading a group of people or and organization. It is also an
influence relationship among leaders and followers who intend real changes and reflect their
mutual purpose.

b. Explain five qualities of a good leader

i. Flexibility
ii. Good communication
iii. He must command respects
iv. He must be approachable
v. He must be friendly and honest

c. Explain five advantages of the following leadership style

Autocratic leadership:
i. This allows autocratic leader to take the ultimate control.
ii. It allow leaders to take prompt decision without consulting others.
iii. An autocratic leader possess high level of power and authority and imposes it will on its
followers.
Democratic leadership:
i. It allow participation or shared leadership.
ii. It is gives room for more ideas.
iii. It leads to more initiatives thus improving productivity.
iv. Since is participatory, it gives room for motivation
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QUESTION 4
a. What is healthcare financing?
Health care financing can be define as the various means through which healthcare is
finance or funded such as tax revenue, Out of pocket payment, Donor funding, Health
insurance and Mandatory pre-payment

b. Discuss the concept of health insurance in funding healthcare

QUESTION 5
i. What is training?
ii. Training is a short term education process utilizing a systematic and organized procedure
by which a non-managerial personnel gains technical knowledge and skills for a particular
purpose.
Methods of training:
i. Apprentice training
ii. On the job
iii. Off the job
iv. Pre service
v. In service

iii. Distinguish between training and development

s/n Training Development

1. Training is a short term education process Development is a long term educational process
utilizing a systematic and organized utilizing a systematic and organized procedure by
procedure by which a non-managerial which managerial personnel gain conceptual and
personnel gains technical knowledge and theoretical knowledge for general purpose.
skills for a particular purpose

2. It is for a short term It is for a long term

3. Technical knowledge and skills conceptual and theoretical knowledge

4. For a particular purpose for general purpose

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 iv. Explain two methods and their benefits, in training health records management
professionals
i. On the job
ii. Off the job

QUESTION SIX
i. What is planning?
Planning is the processing by which one look ahead and which consciously chooses a
course of action from available alternatives for the purpose of achieving desired results or goals.
ii. Discuss the application of the four types of planning used by managers and relate
them to health records management
a) Long term planning
Exercise aim at formulating a long term plan, to meet future need estimated usually by
extrapolation of present or known needs. It begins with the current status and charts out a path to
the projected status, and generally includes short term (operational or tactical plans) for
achieving interim goals.

b) Short term planning

Short term planning are plans that are met to be achieve within a short period of time.
Short term planning looks at the characteristics of the company in the present and develops
strategies for improving them.

c) Medium term planning

It applies more permanent solutions to short term problems. Medium term planning
implements policies and procedures to ensure that short term problems don’t occur. For example
where short term response to equipment failure is to repair the machine, a medium term solution
is to arrange for a service contract.

d) An operational plan

It can be defined as a plan prepared by a components of an organization that clearly

defines actions it will take to support the strategic objectives and plans of upper management.
QUESTION 7
e. Distinguish between job description and job specification
Job description
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It is the summary of the tasks, and responsibilities of a job. It serve as the basis for performance
rating and promotion and makes the duties, tasks and responsibilities clear to the holders.
It is used in contract negotiation with labour unions.
Job specification
It is the summary of the human qualification requirement of a job. This include education,
experience, personal traits, physical requirement, mental ability and working conditions.

OCT. 2018
QUESTION 1
a. What do you understand by performance appraisal?
This is the formal assessment of how well an employee is doing on his or her job. It is a
control as well as evaluation and developmental tool.

b. List and discuss the steps in performance appraisal

1. Step 1: Establish performance expectations and standards.

2. Step 2: Providing regular feedback.
3. Step 3: Measure actual performance.
4. Step 4: Compare actual performance with standards.
5. Step 5: Discuss results of appraisal.
6. Step 6: Come up with corrective measures.
7. To conclude.

QUESTION 2
Discuss Abraham Maslow Hierarchy of needs

It is probably safe to say that the most well-known theory of motivation is Maslow’s need
hierarchy theory Maslow’s theory is based on the human needs. He classified all human needs
into a hierarchical manner from the lower to the higher order. In essence, he believed that once a
given level of need is satisfied, it no longer serves to motivate man. Then, the next higher level
of need has to be activated in order to motivate the man. Maslow identified five levels in his
need hierarchy as shown below.

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1. Physiological Needs: These needs are basic to human life and, hence, include food, clothing,
shelter, air, water and necessities of life.
2. Safety Needs: These needs find expression in such desires as economic security and
protection from physical dangers.
3. Social Needs: Man is a social being. He is, therefore, interested in social interaction,
companionship, belongingness,
4. Esteem Needs: These needs refer to self-esteem and self-respect.
5. Self-Actualisation Needs: The final step under the need hierarchy model is the need for self-
actualization and means to become actualized in what one is potentially good at

QUESTION 3
Explain
i. Staff recruitment
Recruitment refers to the process of identifying, attracting, interviewing, selecting, hiring
and onboarding employees. Staff recruitment is the process of hiring staff to carry out various
activities in an organization.
ii. Staff selection
Staff selection is a term that refers to one of the personnel activities. The purpose of the
selection is to choose for the position (job) and for the organization (co-workers, organizational
culture, etc.) probably the most suitable candidate.
iii. Staff appraisal
Staff performance appraisal is a process often combining both written and oral elements
whereby management evaluates and provides feedback on employee job performance, including
steps to improve or redirect activities as needed. Documenting performance provides a basis for
pay increases and promotions.
iv. Sabbatical leave
Sabbatical leave is defined as a time period in which a person does not report to his
regular job but who remains employed with that company. An example of sabbatical leave is
when an archeology professor takes a semester off to go on a dig. A sabbatical is a rest or break
from work
v. Secondment
It can be refer to as the temporary transfer of an official or worker to another position or
employment. Secondment can also be refer to as the assignment of a member of one organisation
to another organisation for a temporary period.
QUESTION 4.

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a. Explain the term Work flow
It is the sequence of industrial, administrative, or other processes through which a piece
of work passes from initiation to [Link] is the sequence of steps involved in moving from
the beginning to the end of a working process. Workflow” is how you get work done. It's a series
of tasks you need to complete in order to reach some repeatable business goal.
b. Importance of workflow
Workflows can help streamline and automate repeatable tasks, minimizing room for
errors and increasing overall efficiency. This, in turn, dramatically improves your business.
Managers can make quicker, smarter decisions and employees are empowered to collaborate in a
more productive and agile way.

c. With the aid of diagram describe Organizational chart of a health records

management department

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QUESTION 5
Write short notes on the following motivation theories
a. Abraham Maslow Hierarchy of needs…..SEE ABOVE

b. Herzberg’s two factor theory

The psychologist Frederick Herzberg extended the work of Maslow and propsed a new
motivation theory popularly known as Herzberg’s Motivation Hygiene (Two-Factor) Theory.
According to Herzberg, the opposite of satisfaction is not dissatisfaction. The underlying reason,
he says, is that removal of dissatisfying characteristics from a job does not necessarily make the
job satisfying. He believes in the existence of a dual continuum. The opposite of ‘satisfaction’ is
‘no satisfaction’ and the opposite of ‘dissatisfaction’ is ‘no dissatisatisfaction’.

c. Theory x and y
Theory X and Theory Y are theories of human work motivation and management. They
were created by Douglas McGregor while he was working at the MIT Sloan School of
Management in the 1950s, and developed further in the 1960s. [1] McGregor's work was rooted in
motivation theory alongside the works of Abraham Maslow, who created the hierarchy of needs.
The two theories proposed by McGregor describe contrasting models of workforce motivation
applied by managers in human resource management, organizational behavior, organizational
communication and organizational development. Theory X explains the importance of
heightened supervision, external rewards, and penalties, while Theory Y highlights the
motivating role of job satisfaction and encourages workers to approach tasks without direct
supervision. Management use of Theory X and Theory Y can affect employee motivation and
productivity in different ways, and managers may choose to implement strategies from both
theories into their practices
d. Expectancy theory of motivation
Expectancy theory is a motivation theory first proposed by Victor Vroom.
Expectancy Theory of Motivation is a theory of motivation in the workplace. It states that
an individual within your team will be motivated when they believe they can hit their targets,
they know they will be rewarded for hitting those targets, and they value the reward. Expectancy
theory proposes that an individual will behave or act in a certain way because they are motivated

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to select a specific behavior over others due to what they expect the result of that selected
behavior will be.
QUESTION 6
Write short notes on the following
i. Job enlargement-
Job enlargement means increasing the scope of a job through extending the range of its
job duties and responsibilities generally within the same level and periphery. Job enlargement
involves combining various activities at the same level in the organization and adding them to
the existing job.
ii. Secondment-SEE ABOVE

iii. Job satisfaction-

Job satisfaction is defined as the level of contentment employees feel with their job. This
goes beyond their daily duties to cover satisfaction with team members/managers, satisfaction
with organizational policies, and the impact of their job on employees' personal lives
iv. Sabbatical leave-SEE BELOW

v. Job specification-
A job specification is a written statement of educational qualifications, specific qualities,
level of experience, physical, emotional, technical and communication skills required to perform
a job, responsibilities involved in a job and other unusual sensory demands.
QUESTION 7
a. What is a committee
A group of people appointed for a specific function by a larger group and typically
consisting of members of that group. A body of persons delegated to consider, investigate, take
action on, or report on some matter. A committee is a group of people who meet to make
decisions or plans for a larger group or organization that they represent.

b. Discuss the pro and cons of committee system

Advantages committee system

Using a committee for a task allows for several things:

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 Greater expertise: Skills and experience of the group offer a greater knowledge base. By
including multiple internal stakeholders from different departments and levels within the
organization, you see an issue from multiple angles. It may be a more realistic appraisal of the
situation, deterring one-sided, subjective decisions.

Communication: Committees typically have mechanisms to report to superiors, and those

peers and subordinates with a vested interest. The committee itself may be an exchange of ideas,
and a place to address doubt, ambiguity, and any unwritten objectives.

Teamwork: Hopefully, participation on the committee will foster a team spirit for a
common goal. A committee is often seen as a democratic process. Interactions between
employees, often crossing job titles and departments, may promote mutual understanding and
appreciation of another’s vantage point. The ability to participate in making decisions may
motivate and increase morale.

Delayed actions: A committee often buys just enough time to reveal the goal is not a path the
company should pursue.

Disadvantages

Businesses should be aware of some of the shortcomings of the committee model, including:

Cost/inefficiencies: Committee meetings, research and other tasks are time-consuming,

taking individuals away from their primary job responsibilities. There may be instances where a
group is indecisive or takes longer than an individual to draw a conclusion because of differing
opinions. If you need an answer quickly, a committee may not be the right choice.

Groupthink and logrolling: Groupthink is the most notable obstacle in coming up with
accurate conclusions and suggestions. This occurs when the conclusions are a compromise and
do not represent any single opinion within the group. It is acceptable to everyone on the
committee but is not the best solution. Logrolling is another situation where decision-making is
compromised. It occurs when management is expecting a specific result, and this dominates
committee conversations.

No accountability: Because the group presents the findings, no individual is held

personally responsible for a wrong decision or for passing the buck.

Controlling personalities: When one or two members dominate the group, it ceases to be
a democratic process. Individual opinions may be suppressed, ignored and discouraged.
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Proceed with caution

There are many advantages in pursuing this method of analysis, but organizations need to
be aware of the pitfalls associated with committees. If your company creates a group, it must
caution participants against potential inefficiencies and biases.

OCT, 2019.
1a. Formal Organization is an organisation in which job of each member is clearly defined,
whose authority, responsibility and accountability are fixed.
Informal Organization is formed within the formal organisation as a network of interpersonal
relationship when people interact with each other.
1b. Features of Formal organisation:
1. The formal organisational structure is created intentionally by the process of organising.
2. The purpose of formal organisation structure is achievement of organisational goal.
3. In formal organisational structure each individual is assigned a specific job.
4. In formal organisation every individual is assigned a fixed authority or decision-making
power.
5. Formal organisational structure results in creation of superior-subordinate relations.
6. Formal organisational structure creates a scalar chain of communication in the organisation.

Features of informal organisation:

1. Informal organisational structure gets created automatically without any intended efforts of
managers.
2. Informal organisational structure is formed by the employees to get psychological
satisfaction.
3. Informal organisational structure does not follow any fixed path of flow of authority or
communication.
4. Source of information cannot be known under informal structure as any person can
communicate with anyone in the organisation.
5. The existence of informal organisational structure depends on the formal organisation
structure.

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1c. Benefits of Formal Organisation:

1. Systematic Working: Formal organisation structure results in systematic and smooth

functioning of an organisation.

2. Achievement of Organisational Objectives: Formal organisational structure is established

to achieve organisational objectives.

3. No Overlapping of Work: In formal organisation structure work is systematically divided

among various departments and employees. So there is no chance of duplication or
overlapping of work.

4. Co-ordination: Formal organisational structure results in coordinating the activities of

various departments.

5. Creation of Chain of Command: Formal organisational structure clearly defines superior

subordinate relationship, i.e., who reports to whom.

6. More Emphasis on Work: Formal organisational structure lays more emphasis on work
than interpersonal relations.

Benefits of Informal Organisation:

1. Fast Communication: Informal structure does not follow scalar chain so there can be
faster spread of communication.

2. Fulfills Social Needs: Informal communication gives due importance to psychological

and social need of employees which motivate the employees.

3. Correct Feedback: Through informal structure the top level managers can know the real
feedback of employees on various policies and plans.

2a. Health care financing system is a process by which revenues are collected from primary
and secondary sources, e.g., out-of-pocket payments (OOPs), indirect and direct taxes, donor
funding, co-payment, voluntary prepayments, mandatory prepayment, which are accumulated in
fund pools so as to share risk across large population groups and using the revenues to purchase
goods and services from public and private providers for identified needs of the population, e.g.,
fee for service, capitation, budgeting and salaries.

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2b. Household Out-Of-Pocket (OOP) Health Expenditure: this is also referred to as user-
charges. The health facility owners impose some charges on individuals for healthcare services
up-take. OOP health expenditure could be incurred directly by a patient to a health service
provider without reimbursement. This covers on the spot payment for health care services
received
Tax-based Public Sector Health Financing: this source of health care financing is
derived from proceeds of tax-based revenue of government across all levels and sectors. At the
federal level, the pool of taxes entails crude oil and gas export proceeds, petroleum profit tax,
royalties and the component proceeds of domestic crude oil sales/other oil revenues, companies’
income tax, customs and exercise duties, Value-Added Tax (VAT), tax on petroleum products,
education tax among others
Private Sector (Donor Funding): In view of the enormous demand for the funding of
healthcare, government alone cannot shoulder the responsibility of good and quality health care
provisioning given the dwindling economy culminating in an abysmally poor budgetary
allocation to health sector.
Community-Based Health Financing (CBHF): this is also referred to as Community-
Based Health Insurance (CBHI). It is designed to provide financial protection from the cost of
seeking health care. It has three main components, namely: prepayment for health services by
community members, community control, and voluntary membership

2c. Out-Of-Pocket (OOP) ABOVE

3i. A staff performance appraisal also referred to as a performance review, performance
evaluation, development discussion, or employee appraisal is a method by which the job
performance of an employee is documented and evaluated
3ii. Evaluation of Health Services
This involve periodic assessment of health program achievements in relation to services
objectives. Evaluation permit the measurement of the impact of the service on the population in
terms of efficiency, coverage, and effectiveness.
3iii. Out of pocket ….ABOVE
3iv. Leadership
Leadership can be define as the action of leading a group of people or and organization. It
is also an influence relationship among leaders and followers who intend real changes and reflect
their mutual purpose.

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 3v. Motivation
Motivation is the word derived from the word 'motive' which means needs, desires, wants
or drives within the individuals. It is the process of stimulating people to actions to accomplish
the goals. In the work goal context the psychological factors stimulating the people's behaviour
can be desire for money, success and so on. It is a reason or reasons for acting or behaving in a
particular way.
4a. What is training?
Training is any learning activity, which Is directed towards the acquisition of a specific
knowledge and skills for the purpose of occupation or task.
a. List and Explain the two types of training
i. Off the job training
It is a type of training done outside the working place, it encourage total concentration as
well as focus on the learning experience.
ii. On the job training
This kind of training is done as normal work goes on, it encourage senior staffs to train
newly employed staff as work goes on and newly employed staff are expected to learn from
observations.
b. List and explain the Steps in training process

i. Assess training need :

The first step in developing a training program is to identify and assess needs.
ii. Set organizational training objectives:
The training needs assessment (organizational, task and individual) will identify any gaps in your
current training initiatives and employee’s skill sets.
iii. Create training action plan:
The next steps is to create a comprehensive action plan that includes learning theories,
instructional design, content, materials and any other training elements.
iv. Implement training initiatives:
The implementation phase is where the training program comes to live. Organization needs to
decide whether training will be delivered in house or externally coordinated.
v. Evaluate and revise training:
As mentioned in the last segment, the training program should be continually monitored. At the
end, the entire program should be evaluated to determine if it was successful and meet training
objective

c. Benefits of staff training in health information management profession

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i. It will motivate health information managers to improve more on themselves so as to
bring regards to the profession.
ii. It will help eliminate malpractice against the ethics of the profession since they will be
well trained in accordance with the ethics, moral and norms of the profession.
iii. In return, serve and represent and display the good image of the hospital since health
information managers serves as public relation to the general public, hence bring regards
to the profession.
iv. It leads to job satisfaction and high productivity

5.a. Utilization committee

The main purpose of this committee is to see the maintenance of high quality of patient
care and hospital service to guide against overcrowding of quality and works towards reduction
in the cause of health service. This committee review patient during hospitalization to determine
the health necessity for continued hospitalization.

Pharmacy advisory committee

This committee is responsible for developing policy and practice relating to selection and
distribution as well as safe effective use of the pharmaceutical. This is to ensure safe and
maximum utilization of drugs with minimum potentials for hazards.

Medical records committee

The medical records committee is responsible for all matters relating to the content of the
medical records and the provision of medical records services in the hospital. The committee
ensure quantitative and qualitative health care services to the patients.
Composition of medical records committee
i. Medical superintendent
ii. Three senior consultant (various specialist)
iii. Administrator
iv. HOD, Health records department
v. HOD, quality system
vi. HOD, OP/IP
vii. Nursing superintendent

Tissue committee
The main objective of the tissue committee is to improve the surgical care of patient by
reviewing the documented surgical work.

6a. What is staff motivation?

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 It is the process of stimulating staff to actions to accomplish organizational goals. In the
work goal context the psychological factors stimulating the staff behaviour can be desire for
money, success and so on. It is a reason or reasons for acting or behaving in a particular way.
6b. Maslow's and Herzberg's theory of motivation both assume that specific needs energize
human behavior .

Differences between Maslow’s and Herzberg’s Theory of Motivation

i. Maslow’s Theory is a general theory of motivation which expresses that the urge to
satisfy needs is the principle variable in motivation. In contrast, Herzberg’s Theory on
motivation reveals that there are some variables existing at the workplace that results in
job satisfaction or dissatisfaction.
ii. Maslow’s theory is descriptive, whereas the theory propounded by Herzberg is simple
and prescriptive.
iii. The basis of Maslow’s theory is human needs and their satisfaction. On the other hand,
the Herzberg’s theory relies on reward and recognition.
iv. In Maslow’s theory, there is a proper sequence of needs from lower to higher.
Conversely, no such sequence exists in the case of Herzberg’s theory.
v. Maslow’s theory states that unsatisfied needs of an individual act as the stimulator. As
against, Herberg’s theory reveals that gratified needs govern the behaviour and
performance of an individual.
vi. The needs of an individual are divided into two categories i.e. survival/deficiency needs
and growth needs as per Maslow. On the contrary, in Herzberg’s model, the needs of an
individual are classified into Hygiene and motivator factors.
vii. In Maslow’s theory, any unsatisfied need of an individual serves as the motivator. Unlike
in the case of Herzberg, only higher level needs are counted as the motivator.

7. A privilege
A privilege is a certain entitlement to immunity granted by the state or another authority to
a restricted group, either by birth or on a conditional basis. By contrast, a right is an inherent,
irrevocable entitlement held by all citizens or all human beings from the moment of birth.
Training refers to an act of inculcating specific skills in a person. Education is all about
gaining theoretical knowledge in the classroom or any institution. Training is a way to develop
specific skills, whereas education is a typical system of learning. The training prepares a
person for the present job.

The difference between salary and wages.

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 The essential difference between a salary and wages is that a salaried person is paid a
fixed amount per pay period and a wage earner is paid by the hour. Someone who is paid wages
receives a pay rate per hour, multiplied by the number of hours worked.
Management is all about plans and actions, but the administration is concerned with
framing policies and setting objectives. The manager looks after the management of the
organization, whereas administrator is responsible for the administration of the organization. ...
Management focuses on managing people and their work.
Appraisal is a judgment or assessment of the value of something, especially a formal one
while evaluation is an assessment, such as an annual personnel performance review used as the
basis for a salary increase or bonus, or a summary of a particular situation.

DISEASE CLASSIFICATION AND CLINICAL CODING.

AUGUST, 2016.

QUESTION 1
As a professional in esa oke teaching hospital in osun state. Design a disease index card for
single card system

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 ESA OKE TEACHING HOSPITAL
ESA OKE OSUN STATE
DISEASE DIAGNOSTIC INDEX TO INTERNATIONAL LIST
DIAGNOSIS______________________________________
CODE NO: _______________________________________
NAME HOSP SEX DEPT DATE DATE OF DISCH OPERATION DIAGNOSIS P/M CONSULTANT
NO AGE OF ADM YES/NO

HR-53
a. Design a disease index card for cross indexing
ESA OKE TEACHING HOSPITAL
ESA OKE OSUN STATE
DISEASE DIAGNOSTIC INDEX TO INTERNATIONAL LIST
DIAGNOSIS______________________________________
CODE NO: _______________________________________
NAME HOSP SEX DEPT PRINC COMP ASSOC DATE DATE OPERATION DIAGNOSIS P/M CONSUL.
NO AGE OF ADM OF DISCH YES/NO

HR-53
b. State five advantages and disadvantages for the designed cards in a & b.
Advantages of single card system
1. Group of cases incidence for particular disease or operation code can be listed.
2. Easy retrieval of similar cases for research.
3. It is very simple to enter into index card
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Disadvantages of single card system
1. Group of cases with a combination of disease and/or operation procedure cannot be
retrieved
2. Complication and associated diseases peculiar to some diagnosis statement cannot be
ascertain.

Advantages of cross index system

1. Much information is collected and as such creates adequate data base for multi-
disciplinary research
2. Complication and associated diseases peculiar to some diagnostic statement can be
ascertained.
Disadvantages of cross index system
1. Entering of data into index card is time consuming
2. It is strenuous
3. It requires commitment and concentration.
QUESTION 2
a. List ten examples of medical term that can be coded
1. Amnesia
2. Ankyloglossia
3. Hyperplasia
4. Dysmenorrhea
5. Osteomalacia
6. Arteriosclerosis
7. Asepsis
8. Osteoporosis
9. Hydrocephalus
10. Encephalitis

b. List ten (10) steps to take to abstract a final diagnosis from a patient’s case note.

i. Read through the patient case note

ii. Identify the statement of diagnosis already documented by attended physician.
iii. Consult the appropriate section of the Alphabetical index.

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 iv. Identify the lead term for disease or injury or pathology condition to know the
section of the alphabetical index to consult to know if diagnosis is classifiable under
ICD-9 or ICD-10
v. Consult alphabetical index which is vol II, ICD-9 or vol III, ICD-10
vi. Be guided by word in parenthesis, square bracket and also cross reference( see or
see)
vii. Confirm code number found from the alphabetical index in the main tabular list vol I
(ICD 9 or 10)
viii. Assign the code numbers to the statement of diagnosis

Note: queried diagnosis is not coded

c. List five coding tools
i. Discharged patient notes ii. Medical and English dictionary
iii. ICD/CSO iv. Textbook on medical and surgical abbreviation
v Biro/pencil vi. Computer/ index card

d. State five uses of coding tools

i. Discharge summary is needed to extract the diagnosis
ii. ICD/CSO is needed to extract the internationally recognized code number to be assign to
the diagnosis
iii. Medical dictionary is needed to search for medical terms that are not familiar with the
coder.
iv. Textbooks on medical and surgical are needed to check for strange medical abbreviations
v. Index card or computer is needed for data entering during indexing.
QUESTION 3
a. Explain the morphology of neoplasm
It contains a coded nomenclature for the morphology of neoplasms, which is reproduced
here for those who wish to use it in conjunction with chapter II of the ICD. The morphology
code number consist of five digits; the first four identify the histological type of the neoplasm
and the fifth indicates it behavior.

b. Explain the special tabulation list

The special tabulation list are derived directly from the core classification for use in data
presentation and to facilitate analysis of health status and trend at the international, national and
sub national levels. The special tabular list recommended for international comparisons and
publications are included in volume I of the ICD-10. There are five such lists, four for mortality
and one for morbidity.
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QUESTION 4
Discuss the following
i. Causes of death
It is simply defined as all those diseases, morbid conditions or injuries which either
resulted in or contributed to death and circumstances of the accident or violence which produce
any such injuries.
It is not what killed the deceased but contributing factor(s) to the death.

ii. Underlying cause of death

This can be viewed from two aspect, ( a and b)
a. This is the disease or injury which initiate the train of morbid events leading directly to death
of a deceased or

b. The circumstances of the accident or violence which produced the fatal injury.
iii. List two uses of death certificate
1. It is use for obtaining burial permit for the deceased by the next of kin/ relatives
2. It is a vital instrument or source of mortality statistics
3. It is used for obtaining heirship certificate
4. It is also useful as a proof to claim family pension, insurance benefits among others that
may be derived from the deceased
iv. What are the guidelines for completing a death certificate
The important points relating to the completion of medical certificate of cause of death is
the selection of the underlying cause of death.
The general principle rule
When more than one condition is entered on the certificate, select the condition on the
lowest used line of part 1 only if it could have given rise to all the conditions entered above it. In
a well complete certificate, the underlying cause must have been entered alone on the lowest
used line of part I and all other conditions arose as a consequence of this underlying cause must
be entered above it in ascending casual order of sequence one condition to a line. For example
(a) Uremia
(b) Retention of urine
(c) Hypertrophy of prostate
You select the last one which is hypertrophy of prostate
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Other rules which apply to the selection of the underlying cause are as follows:
Rule I
If the general principal does not apply and there is a reported sequence terminating in the
condition first entered on the certificate, select the originating cause of this sequence. If there is
more than one sequence terminating in the condition mentioned first, select the originating cause
of the first mentioned sequence, for example
(a) Bronchopneumonia
(b) Cerebra infarction
Originating cause of the first mentioned sequence is selected.
(a) Oesophageal varies and congestive heart failure
(b) Chronic rheumatic heart disease and cirrhosis of liver
Select cirrhosis of liver. The sequence terminating in the condition first entered on the certificate
is oesophageal varies due to cirrhosis of liver.
Rule II
If there is no reported sequence terminating in the condition first entered on the certificate,
select the first mentioned condition. For example
(a) Pernicious Anaemia and Gangrene of foot
(b) Atherosclerosis
Select pernicious Anaemia

Rule III
If the conditions selected by the general principle or rule I or II is obviously a direct
consequence of another reported condition, whether in part I or II select this primary condition.
(a) Nephrectomy
(b) Clear cell carcinoma of kidney; select clear cell carcinoma of kidney. There is no doubt
that nephrectomy was performed for the malignant neoplasm of kidney.
(a) Cancer of ovary
(b) HIV disease
Select malignant neoplasm of ovary.

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 QUESTION 5
As HOD of HIM in Umuahia General Hospital
a. Write the meaning of the under listed symbols
i. ------- Diagnosis
ii. ------ differential diagnosis (the list of possible diagnoses, and the effort to narrow that
list
iii. tid-------- "ter in die" which in Latin means three times a day.
iv. bid------- "bis in die" which in Latin means twice a day.
v. r/o--------rule out
vi. ca-------- cancer and carcinoma
vii. ht--------hypertension or total hyperopia.
viii. Hb-------Hemoglobin
ix. q,d------ means one a day (from the Latin quaque die).
x. +ve----- positive (as in the result of a test)

b. Write out the medical terms for the underlisted numbers

i. 0- means not to take tablet
ii. 1- means to take tablet
iii. 100-1–0–0 meaning to take the medicine once daily in morning,

QUESTION 6
Write the plural of the under listed terms

Singular Plural
1. Ovum Ova

2. Calculus Calculi

3. Nucleus Nuclei

4. Vertebra Vertebrae

5. Apex Apices

6. Varix Varies

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 7. Ganglion Ganglions

8. Fibroma Fibromae

9. Anastomosis Anastomoses

10. Bacterium Bacteria

QUESTION 7
a. Write out the meaning of the under listed synonyms
Addiction-state of being addicted
Adduction-act of bringing toward
Abduction-act of moving away
Alveolus-part of alveoli
Alveus- a canal or trough.
Alvus- An obsolete term for the abdomen and the viscera contained therein.
Antiseptic-prevent infection
Aseptic-free from/without infection
Asepsis- the absence of bacteria, viruses, and other microorganisms.

Cabuncle- A carbuncle is a red, swollen, and painful cluster of boils that are connected to
each other under the skin.
Caruncle- the red prominence at the inner corner of the eye.
Furuncle- A painful, pus-filled bump under the skin caused by infected, inflamed hair follicles.

b. Write out the meaning of the under listed eponyms

i. Zieglers’s operation-
ii. Whitehead operation-hemorrhoidectomy

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 iii. Werthim’s operation-radical hysterectomy
iv. Watkin’s operation
v. Gillian’s operation
vi. St,vitus dances-cholera
vii. Pott’s fracture-fibula fracture of a few inches above the ankle
viii. Pott’s disease-kyphosis resulting from TB of the spine
ix. Paget’s disease-a breast carcinoma involving the nipple and the areolar and the larger duct.
x. Parkinson’s disease- tremor of the limbs

SEPT. 2017.

QUESTION 1
a. Write short note on each of the followings indexing system
i. Manual indexing
This is the entering of patients details into an index card through the use of hand or by
hand. Diseases or operation code numbers are entered by hand or posted on each appropriate
disease or operative indexing card.

ii. Mechanical indexing

This is the entering of patient’s details into an index card through the use of machine such
as punching machine. Diseases or operation code numbers are entered by machine on the index
card.

iii. Electronic indexing

This is an automated or the use of computer or for indexing of diseases and operations .In
this, index card is not needed, the entering is done by entering details into the computer system.

b. Explain the imitations of each system

Despite having different means of entering data, the three system still possess the same
characteristics of using the same coding tools, similar coding procedure, purpose and sources.
Coding tools
Discharged patient notes, medical and English dictionary, ICD/CSO textbook on medical
and surgical abbreviation.
Purpose of indexing
Its purpose is to make readily available group or records of patient who have had the same
or related diagnosis and or operation.
Sources

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 The front sheet of a referral letter
The discharge summary sheet
Operation report note
Laboratory investigation report among others

c. How would you ensure all discharged records in your hospital are coded and
indexed?

i. Ensure there are complete coding and indexing tools and a comfortable room for it purpose.
ii. Ensure records are complete and encourage legible handwriting
iii. Discharged case note must be collected from the various wards and file in a “specific
drawer”until it is action on them.
iv. Ensure that every records is coded and indexed. (Make sure that only summarized
discharged notes are coded.
v. Alert doctors that are concerned to summarized them.
vi. After indexing a mark should be place on the summary sheet of the coded case notes.
vii. Try to ensure accuracy and avoid error in coding and indexing through employment of
sufficient power, trained and skilled health record personnel who are knowledgeable in
coding and indexing.
QUESTION 2
a. List eight functions of health records department in relation to the cancer registry
1. Sending general letters to patients
2. Schedule follow up letters
3. Conduct research for doctors
4. Act as an information source for utilization review.
5. They keep diary of patients appointment
6. Maintain a book that indicate patient who still attend or not.
7. Keep a card of index of patient
8. Updating of information on each visit.

b. Explain the importance of a cancer registry in the health care system.

Cancer registry is a place where all information about people who have all types of malignant
tumor, diseases or some diseases that are likely to become malignant in future are kept.
Cancer registry is one of the special records in the hospital.
Cancer registry is important because after registration, patient are followed throughout their lives
whether well or not.
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c. State two aims of confidentiality measure in cancer registry
i. Patients privacy
ii. Legal issues
QUESTION 3
Write short notes on the following
i. Underlying cause of deaths
This can be viewed from two aspect, ( a and b)
a. This is the disease or injury which initiate the train of morbid events leading directly to
death of a deceased or
b. The circumstances of the accident or violence which produced the fatal injury.

ii. Death certificate

Death certificate can be defined as a legal document issued and signed by the physician in
charge of the patient to the next of kin to the deceased after the confirmation of death. It serves
as a proof or an evidence of death, which is needed for inheritance and insurance purposes

iii. Live birth

This is the complete expulsion or extraction from its mother of a product of conception
irrespective of the duration of pregnancy, which after such separation, breaths or show any other
evidence of life such as beating of the umbilical cord or definite movement of voluntary muscles.
iv. Classification system
Classification system is a system where by group of related or interrelated things are
grouped or arranged together. Classification system is a system of categories to which certain
entities are assigned according to some established criteria. Example of classification system is
disease or health data classification.

QUESTION 4
a. What do you understand by coding error?
Coding is the assigning of ICD/CSO code number to the statement of diagnosis found in
the patient case note after discharge. Coding error is an error committed when a wrong code
number is given to a diagnosis which can be due to untrained staff, shortage of staff/workload,
illegible handwriting, poor illumination and uncomfortable coding room among others.

b. Explain how coding error may be introduced by

i. Clinician
i. Illegible handwriting

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 ii. Incomplete health records by clinician
iii. Doctors not writing discharged summary sheet.

iv. The coder

v. Using incomplete coding and indexing tools.
vi. Negligence, not ensuring that every records is coded and indexed
vii. Not ensuring discharged case note are collected and file in a “specific drawer” until it is
action on them.
viii. After indexing, if a mark is not placed on the summary sheet of the coded case notes, it
may lead to duplication of code number.
ix. Untrained and unskilled health record personnel

Enumerate five ways of reducing clinical coding error in the hospital.

i. Ensure there are complete coding tools and a comfortable room for it purpose.
ii. Ensure records are complete and encourage legible handwriting
iii. Discharged case note must be collected from the various wards and file in a “specific
drawer” until it is action on them.
iv. After indexing a mark should be place on the summary sheet of the coded case notes.
v. Try to ensure accuracy and avoid error in coding and indexing through employment of
sufficient power, trained and skilled health record personnel who are knowledgeable in
coding and indexing.

SECTION B

QUESTION 5
a. Explain the meaning of the following surgical suffixes and give examples of each

s/n Surgical suffixes Example

1. Centesis Craniocentesis

2. Scopy Endoscopy

3. Desis Arthrodesis

4. pexy Ochidopexy

5. ostomy Craniostomy

6. Plagia Dysplagia

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 7. tomy gastrotomy

8. osis, sis Onychocryptosis

9. rhoea Dysmenorrhea

10. rhage Hemorrhage

QUESTION 6
a. Write out the full meaning of the under listed Latin abbreviations
i. a.c -------antecebum--------before meal
ii. c.---------cum----------------with
iii. O.S------ mouth
iv. p.c--------post cibum--------after meal
v. q.h--------quaque hora-------every hour
vi. q.i.d------quarter in die------four times daily
vii. q.m-------quaque mane------every morning
viii. q.n-----quaque nocte-----every night
ix. Rh-----
x. S.S------semis----------------half

b. Explain the meaning of the under listed phobia

i. Entomophobia-fear of insect
ii. Newphobia---fear for anything new
iii. Zoophobia---fear for animal
iv. Necrophobia--morbi fear for corpses
v. Bathphobia---persistent fear of depth
vi. Demophobia—persistent fear of evil
vii. Electrophobia---fear of electricity
viii. Pyophobia-----fear of pus
ix. Bibliophobia—fear for book
x. Trichophobia---fear for hair

QUESTION 7
a. Explain how medical terms are composed
Medical terminology are usually composed of several syllables/ elements, which can be divided
into three classes of words element.
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The basic component of medical terminology are;
Prefix, stem/root word and suffix
Prefix:
This is refer to as word beginning. It usually form the first syllable of a medical [Link] a
word part that is place before a word and changes its meaning. NOTE, it is not all word part that
goes before a word that is a prefix. It could be a stem in a compound word. Examples of prefix
are anti, dys, hyper and so on
Stem/ Root word:
This is the foundation of the word, it can stands alone, start and end a medical term e.g gastric,
gastritis, pachyderma
Suffix
This is a word ending, a suffix consists of one or more syllable added to the essential or basic
part of a word to show various relationships and give further meaning.

b. Every professional health record practitioner should know how to compose medical
terms. Discuss the importance of language of medicine as a course in health records
practice.
1. It helps to understand the language of medicine
2. It is needed for communication within the medical practice or among practitioners
3. It knowledge is needed for coding of diagnosis.

OCT, 2019.
1. A PROPOSAL FOR ESTABLISHMENT OF A CLINICAL CODING AND
INDEXING UNIT IN THE DEPARTMENT

Coding and indexing is the assigning of internationally recognized number of a disease or

operation procedure and make readily available group or records of patient who have had the
same or related diagnosis and or operation. After coding is done, the coded numbers are used
for indexing, hence it is filed numerically.
Importance of coding and indexing.
i. to assign internationally recognized number of a particular disease or operation procedure

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 ii. It is done to ease the compilation of national and international statistics on disease
occurrence
iii. Easy retrieval and reporting of conditions to the appropriate bodies.
iv. it is needed for research
v. Coding is necessary in order to permit subsequent statistical data analysis
vi. It is to review cases of a given disease in order to provide insight into management of a
current health problem
vii. To evaluate quality of care in the hospital
viii. It is used to conduct epidemiological and infection control studies.
ix. It is use to obtain data on the utilization of hospital facilities and to determine the need
for new development and equipment like beds and others.
x. To review specific cases for study and research purposes
xi. It is used to provide educational materials for medical and other health related
professional students.
xii. It is used to determine the incidence of medical and surgical complications.
xiii. Helps in planning and evidenced based decision making.

Manual indexing
This is the entering of patients details into an index card through the use of hand or by
hand. Diseases or operation code numbers are entered by hand or posted on each appropriate
disease or operative indexing card.

Mechanical indexing
This is the entering of patient’s details into an index card through the use of machine such
as punching machine. Diseases or operation code numbers are entered by machine on the index
card.
Electronic indexing
This is an automated or the use of computer or for indexing of diseases and operations .In
this, index card is not needed, the entering is done by entering details into the computer system.

How to ensure all discharged records in the hospital are coded and indexed?

1. Ensure there are complete coding and indexing tools and a comfortable room for it
purpose.
2. Ensure records are complete and encourage legible handwriting
3. Discharged case note must be collected from the various wards and file in a “specific
drawer” until it is action on them.
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4. Ensure that every records is coded and indexed. (Make sure that only summarized
discharged notes are coded.
5. Alert doctors that are concerned to summarized them.
6. After indexing a mark should be place on the summary sheet of the coded case notes.
7. Try to ensure accuracy and avoid error in coding and indexing through employment of
sufficient power, trained and skilled health record personnel who are knowledgeable in
coding and indexing.

Coding error
Coding error is an error committed when a wrong code number is given to a diagnosis
which can be due to untrained staff, shortage of staff/workload, illegible handwriting, poor
illumination and uncomfortable coding room among others.

Causes of coding error

ii. Clinician
1. Illegible handwriting
2. Incomplete health records by clinician
3. Doctors not writing discharged summary sheet.

iii. The coder

1. Using incomplete coding and indexing tools.
2. Negligence, not ensuring that every records is coded and indexed
3. Not ensuring discharged case note are collected and file in a “specific drawer” until it is
action on them.
4. After indexing, if a mark is not placed on the summary sheet of the coded case notes, it
may lead to duplication of code number.
5. Untrained and unskilled health record personnel
Ways of reducing coding error in the hospital.
1. Ensure there are complete coding tools and a comfortable room for it purpose.
2. Ensure records are complete and encourage legible handwriting
3. Discharged case note must be collected from the various wards and file in a “specific
drawer” until it is action on them.
4. After indexing a mark should be place on the summary sheet of the coded case notes.
5. Try to ensure accuracy and avoid error in coding and indexing through employment of
sufficient power, trained and skilled health record personnel who are knowledgeable in
coding and indexing.
Steps to take to abstract a final diagnosis from a patient’s case note.

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 i. Read through the patient case note
ii. Identify the statement of diagnosis already documented by attended physician.
iii. Consult the appropriate section of the Alphabetical index.
iv. Identify the lead term for disease or injury or pathology condition to know the section of
the alphabetical index to consult to know if diagnosis is classifiable under ICD-9 or ICD-
10
v. Consult alphabetical index which is vol II, ICD-9 or vol III, ICD-10
vi. Be guided by word in parenthesis, square bracket and also cross reference( see or see)
vii. Confirm code number found from the alphabetical index in the main tabular list vol I (ICD
9 or 10)
viii. Assign the code numbers to the statement of diagnosis

Note: queried diagnosis is not coded

Coding and indexing tools
ii. Discharged patient notes ii. Medical and English dictionary
iii. ICD/CSO iv. Textbook on medical and surgical abbreviation
v Biro/pencil vi. Computer/ index card vii. Index cards

2. Differences between

s/n ICD-9 OPCS

1. It has three volume Two volume
2. For classification of morbidity and mortality For operation or surgical
procedure
3 Contain classification for both disease and operation Only operation

Similarities

1. Both are classification used by clinical coders

2. They contain alphabetical and tabular list

3. They serve statistical and indexing purpose.

4. They are internally recognized.

2b. procedure for coding …..See previous page.

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3i. A disease index may be: an alphabetical list of diseases with information about each
condition, such as the CDC's Diseases & Conditions A-Z Index. a listing of patients seen in a
hospital organized by discharge diagnosis code.

ii. Operation/Procedure [Link] is- a listing for a specific operative procedure, according to a
recognized nomenclature. each operative procedure is assigned a code number and listed with
other cases having the same or similar code number.

iii. The Physician’s Index is comprised of a comprehensive, online bibliographic database of

professional publications and feature articles that address vital topics in depth. It is a reference
resource designed to help clinicians keep up-to-date with current and emerging ethical issues,
and to make better ethical decisions in clinical practice.

iv. A cancer registry is an information system designed for the collection, storage, and
management of data on persons with cancer.

4a

4b. Principal diagnosis is defined as the condition, after study, which occasioned the
admission to the hospital, according to the ICD-10-CM Official Guidelines for Coding and
Reporting. Many people define it as the diagnosis that “bought the bed,” or the diagnosis that led
the physician to decide to admit the patient.

Secondary diagnosis means a diagnosis other than the principal diagnosis for which an
inpatient is admitted to a hospital. Secondary diagnoses are “conditions that coexist at the time of
admission, that develop subsequently, or that affect the treatment received and/or length of stay.
These diagnoses are vital to documentation and have the potential to impact a patient's severity
of illness and risk of mortality.

Associate diagnosis is the diagnosis discovered or that is assocaiated to the primary

diagnosis discover during the cause of medical care.

Comorbidity It is the disease that accompany the main diagnosis and require treatment
and additional care, in addition to the treatment for the condition for which the patient was
admitted.

Complication is a disease that appear during the episode of care due to preexisting
condition or arising as a result of the care received by the patient.

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5.

Prefix Form word State the Meaning

Endo Endometrium Inner wall of the uterus

Glyco Glycouria Presence of sugar in urine

Blephao Blepharitis Inflammation of the eyelids

Blasto Blastocyte A thin walled hollow structure in early embryonic

development that contains a cluster of cells inner cell mass

Brady bradycardia Abnormal slow heart beat

Cephalo acephalous Headless

Chole Cholelithiasis Gallstone in the bladder or bile duct
Gyneco Gynecomastia Enlargement of the breast in male.
Hom Homonomy Being homonomous
Cyan Cyanosis Bluish color of the skin
Peri Pericarditis Inflammation of the pericardium
Phleb phlebostenosis Constriction of a vein
pneum Pneumonitis Inflammation of the lungs
Eu Eunuch A man castrated and incapable of reproducing
Acro Acromegaly Enlargement of bone of hands, feet and face.
Dia Diaphysis Main (mid) section of a long bone
Ecto Ectopia Abnormal position of a part or organ.
Epi Epicardium The innermost of the two layers of the pericardium
leuko Leukocyte Blood cells that engulf and digest bacteria and fungi.
A Aphagia Not eating or inability to eat

6. Explain the layman terms of the following medical term

s/n Medical term Layman meaning

1. Erythrocyte Red blood cell
2. Normocyte A red blood cell of normal size, shape, and color.
3. neutrophil type of white blood cell that protect us from infections
4. Polymorphonuclear A type of immune cell that has granules (small particles) with
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 enzymes that are released during infections, allergic
reactions, and asthma
5. Leucocyte a WBC which circulates in the blood and body fluids and is
involved in counteracting foreign substances and disease.
6. Antihaemophylic is a naturally occurring protein in the blood that helps blood to
clot
7. Coagulation Blood clothing
8. Haematopolesis Haematopoiesis refers to the commitment and differentiation
processes that lead to the formation of all blood cells from
haematopoietic stem cells
9. Sanguinification The formation of blood;
10. Leucocyte
11. Cryptomnesia an implicit memory phenomenon in which people mistakenly
believe that a current thought or idea is a product of their own
creation when, in fact, they have encountered it previously and
then forgotten it.
12. Decapitation Decapitation is the complete separation of the head from the
body.
13. Paraglossia inflammation of the tissues under or about the tongue.
14. Entreritis inflammation of the intestine, especially the small intestine,
usually accompanied by diarrhoea.
15. Hydrocephalus Is a condition in which an accumulation of cerebrospinal fluid
(CSF) occurs within the brain.
16. Arteriosclerosis The thickening and hardening of the walls of the arteries,
occurring typically in old age.
17. Arthroclesis Arthrodesis, also known as artificial ankylosis or syndesis, is the
artificial induction of joint ossification between two bones by
surgery
18. Condropathy Chondropathy refers to a disease of the cartilage
19. Glossoplegia Paralysis of the tongue.
20. Dextroversion Dextroversion of the heart is a form of dextrocardia resulting
from congenital malrotation of the heart about its long axis

7. Write in full the following abbreviation

1. AIDS- Acquired immunodeficiency syndrome
2. HIV- human immunodeficiency virus
3. BSE- bovine spongiform encephalopathy
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4. SARS- Severe acute respiratory syndrome
5. IBS- Irritable bowel syndrome
6. DNA-Deoxyribonucleic acid
7. RNA- Ribonucleic acid
8. ATP- Adenosine triphosphate
9. TTP- Thrombotic thrombocytopenic purpura
10. ALL- Acute lymphoblastic leukemia
11. CLL- Chronic lymphocytic leukemia
12. ITP- Immune thrombocytopenic purpura
13. CML- Chronic myelogenous leukemia
14. AMA- American Medical Association
15. CBC- complete blood count
16. BMR- Basal Metabolic Rate
17. COLDx-chronic obstructive lung disease
18. HRORBN-Health Records Officers Registration Board of Nigeria
19. CVA-Cerebrovascular Accident
20. CSM- Cardiosynchronous Myostimulator

8. Explain and give three examples of each of the following components of a medical
term
Prefix:
This is refer to as word beging. It usually form the first syllable of a medical [Link] a
word part that is place before a word and changes its [Link], it is not all word part that
goes before a word that is a prefix. It could be a stem in a compound word. Examples of prefix
are anti, dys, hyper and so on
Stem/ Root word:
This is the foundation of the word, it can stands alone, start and end a medical term e.g
gastric, gastritis, pachyderma
Suffix
This is a word ending, a suffix consists of one or more syllable added to the essential or
basic part of a word to show various relationships and give further meaning.

8b.
s/n Medical term prefix Root Combining vowel Suffix
i. Cardiomyopathy cardiomyo o pathy
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 ii. Intravenous Intra Venous
iii. Osteoarthritis Osteo/Arthr o itis
iv. Hepatomegaly hepato o Megally
v. Gastroenteritis gastroenter i Itis

ANATOMY AND PHYSIOLOGY

AUGUST.2016.

1a. the lobes of the brain.

The cerebrum is divided into four regions called lobes that control senses, thoughts, and
movements. The four lobes are the occipital, temporal, frontal, and parietal lobes. Although each
lobe has a different task to perform, they all must work together.

The occipital lobe, found in the back of your cerebrum, plays a role in processing visual
information. It can be related to oculus, the Latin word for eye.

There are two temporal lobes, one in each hemisphere - close to where your ears are. It
primarily functions in auditory processing. However, it may also be involved in emotion,
learning, and pronunciation/learning a new language. If you hear a loud tempo or beat, you may
cover your ears, thus blocking the sounds from getting to your temporal lobe.

The frontal lobe allows you to solve a complex task, undergo voluntary movement of
your body parts, form complete sentences, and is responsible for your personality traits. Think
about the last time you had a difficult exam, what was your first reaction? You probably put your
elbow on the table and your hand on your forehead, precisely where your frontal lobe is located.

The parietal lobe functions in general sensation and feeling. If you stand too close to a
campfire, you probably take a few steps backwards to avoid the excessive heat. Building a
snowman without gloves may also bring you discomfort, but your parietal lobe helps to
communicate this information with the rest of your brain. Although all sensations are not bad, it
is important to point out how they help us avoid potentially harmful situations. The parietal lobe
is found in between the frontal and occipital lobe.

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1b. The sulci

Sulci, the grooves, and gyri, the folds or ridges, make up the folded surface of the cerebral
cortex. Larger or deeper sulci are termed fissures, and in many cases the two terms are
interchangeable. The folded cortex creates a larger surface area for the brain in humans and other
mammals. When looking at the human brain, two-thirds of the surface are hidden in the grooves.
The sulci and fissures are both grooves in the cortex, but they are differentiated by size. A sulcus
is a shallower groove that surrounds a gyrus. A fissure is a large furrow that divides the brain
into lobes and also into the two hemispheres as the longitudinal fissure.

1c. two main other parts of the cerebrum

The cerebrum consists of two cerebral hemispheres that are partially connected with
each other by corpus callosum. Each hemisphere contains a cavity called the lateral ventricle.
The cerebrum is arbitrarily divided into five lobes: frontal, parietal, temporal, occipital, and
insula.

1d. Three main fibres/tracts

A nerve tract is a bundle of nerve fibers (axons) connecting nuclei of the central nervous
system.[1][2][3] In the peripheral nervous system this is known as a nerve, and has associated
connective tissue. The main nerve tracts in the central nervous system are of three types:
association fibers, commissural fibers, and projection fibers.

Association fibers

The tracts that connect cortical areas within the same hemisphere are called association
[4]
tracts. Long association fibers connect different lobes of a hemisphere to each other whereas
short association fibers connect different gyri within a single lobe. Among their roles, association
tracts link perceptual and memory centers of the brain.[5]

The cingulum is a major association tract. The cingulum forms the white matter core of
the cingulate gyrus and links from this to the entorhinal cortex. Another major association tract is
the superior longitudinal fasciculus (SLF) that has three parts.

Commissural fibers

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 Commissural tracts connect corresponding cortical areas in the two hemispheres. They
cross from one cerebral hemisphere to the other through bridges called commissures. The great
majority of commissural tracts pass through the largest commissure the corpus callosum. A few
tracts pass through the much smaller anterior and posterior commissures. Commissural tracts
enable the left and right sides of the cerebrum to communicate with each other. Other
commissures are the hippocampal commissure, and the habenular commissure.

Projection fibers

Projection tracts connect the cerebral cortex with the corpus striatum, diencephalon,
brainstem and the spinal cord. The corticospinal tract for example, carries motor signals from the
cerebrum to the spinal cord. Other projection tracts carry signals upward to the cerebral cortex.
Superior to the brainstem, such tracts form a broad, dense sheet called the internal capsule
between the thalamus and basal nuclei, then radiate in a diverging, fanlike array to specific areas
of the cortex.

QUESTION 2

a. Male Rep. Organ

2b. Describe the prostate gland

The prostate is a walnut-sized gland located between the bladder and the penis. The
prostate is just in front of the rectum. The urethra runs through the center of the prostate, from
the bladder to the penis, letting urine flow out of the body.

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The prostate secretes fluid that nourishes and protects sperm. During ejaculation, the prostate
squeezes this fluid into the urethra, and it’s expelled with sperm as semen.

3a. what is puberty?

Puberty is the process of physical changes through which a child's body matures into an
adult body capable of sexual reproduction. It is initiated by hormonal signals from the brain to
the gonads: the ovaries in a girl, the testes in a boy.

3b. changes that occur in girls puberty

During puberty the ovaries get bigger and body will start to produce two hormones -
oestrogen and progesterone. Oestrogen causes your breast to grow bigger and helps your vagina,
uterus and fallopian tubes to develop. It also makes you grow taller and also changes the way fat
is stored on your body making your waist, hips and buttocks more obvious and appearance of
pubic hair among others.

Question 4.
a. Draw and label the liver

b. Functions of liver
i. Carbonhydrate metabolism
ii. Protein metabolism
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iii. Fats metabolism
iv. Inactivation of hormones
v. Production of heat
vi. Secretion of bile
vii. Storage of substance e.g glycogen vitamin
viii. Defense against microbes
ix. Breakdown of erythrocytes
x. Detoxification of drugs and other toxic substance
xi. Composition of bile

Question 5.
a. Describe the urinary bladder

The urinary bladder is a muscular sac in the pelvis, just above and behind the pubic bone.
When empty, the bladder is about the size and shape of a pear.

Urine is made in the kidneys and travels down two tubes called ureters to the bladder. The
bladder stores urine, allowing urination to be infrequent and controlled. The bladder is lined by
layers of muscle tissue that stretch to hold urine. The normal capacity of the bladder is 400-600
mL.

During urination, the bladder muscles squeeze, and two sphincters (valves) open to allow urine
to flow out. Urine exits the bladder into the urethra, which carries urine out of the body. Because
it passes through the penis, the urethra is longer in men (8 inches) than in women (1.5 inches).

b. Describe the male urethra

The male urethra is a narrow fibromuscular tube that conducts urine and semen from the
bladder and ejaculatory ducts, respectively, to the exterior of the body (see the image below).
Although the male urethra is a single structure, it is composed of a heterogeneous series of
segments: prostatic, membranous, and spongy.

Question 6
Draw and label the structure of the eye

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Question 7
a. Parts of the large intestine
In mammals, the colon consists of six sections:
The cecum plus the ascending colon
The transverse colon
The descending colon
The sigmoid colon and
The rectum

b. Cecum and appendix

The cecum is the first section of the colon and involved in the digestion, while the
appendix which develops embryologically from it, is a structure of the colon, not involved in
digestion and considered to be part of the gut-associated lymphoid tissue. The function of the
appendix is uncertain, but some sources believe that the appendix has a role in housing a sample
of the colon's microflora, and is able to help to repopulate the colon with bacteria if the
microflora has been damaged during the course of an immune reaction. The appendix has also
been shown to have a high concentration of lymphatic cells.

Ascending colon

The ascending colon is the first of four main sections of the large intestine. It is connected
to the small intestine by a section of bowel called the cecum. The ascending colon runs upwards
through the abdominal cavity toward the transverse colon for approximately eight inches
(20 cm).

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One of the main functions of the colon is to remove the water and other key nutrients from waste
material and recycle it. As the waste material exits the small intestine through the ileocecal
valve, it will move into the cecum and then to the ascending colon where this process of
extraction starts. The unwanted waste material is moved upwards toward the transverse colon by
the action of peristalsis. The ascending colon is sometimes attached to the appendix via Gerlach's
valve. In ruminants, the ascending colon is known as the spiral colon.[16][17][18] Taking into
account all ages and sexes, colon cancer occurs here most often (41%).[19]

Transverse colon

The transverse colon is the part of the colon from the hepatic flexure, also known as the
right colic, (the turn of the colon by the liver) to the splenic flexure also known as the left colic,
(the turn of the colon by the spleen). The transverse colon hangs off the stomach, attached to it
by a large fold of peritoneum called the greater omentum. On the posterior side, the transverse
colon is connected to the posterior abdominal wall by a mesentery known as the transverse
mesocolon.

The transverse colon is encased in peritoneum, and is therefore mobile (unlike the parts of the
colon immediately before and after it).

The proximal two-thirds of the transverse colon is perfused by the middle colic artery, a branch
of the superior mesenteric artery (SMA), while the latter third is supplied by branches of the
inferior mesenteric artery (IMA). The "watershed" area between these two blood supplies, which
represents the embryologic division between the midgut and hindgut, is an area sensitive to
ischemia.

Descending colon

The descending colon is the part of the colon from the splenic flexure to the beginning of
the sigmoid colon. One function of the descending colon in the digestive system is to store feces
that will be emptied into the rectum. It is retroperitoneal in two-thirds of humans. In the other
third, it has a (usually short) mesentery. [20] The arterial supply comes via the left colic artery. The
descending colon is also called the distal gut, as it is further along the gastrointestinal tract than
the proximal gut. Gut flora are very dense in this region.

Sigmoid colon

The sigmoid colon is the part of the large intestine after the descending colon and before
the rectum. The name sigmoid means S-shaped (see sigmoid; cf. sigmoid sinus). The walls of the
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sigmoid colon are muscular, and contract to increase the pressure inside the colon, causing the
stool to move into the rectum.

The sigmoid colon is supplied with blood from several branches (usually between 2 and 6) of the
sigmoid arteries, a branch of the IMA. The IMA terminates as the superior rectal artery.

Sigmoidoscopy is a common diagnostic technique used to examine the sigmoid colon.

Rectum

The rectum is the last section of the large intestine. It holds the formed feces awaiting
elimination via defecation.

SEPT. 2017.

1a. briefly describe the process of fertilization in humans-SEE PREVIOUS YEAR

1b. Describe the process of lactation

By the fifth or sixth month of pregnancy, the breasts are ready to produce milk. During the
latter part of pregnancy, the woman’s breasts enter into the lactogenesis I stage. This is when the
breasts make colostrum, a thick, sometimes yellowish fluid. At this stage, high levels of
progesterone inhibit most milk production. It is not a medical concern if a pregnant woman leaks
any colostrum before her baby’s birth, nor is it an indication of future milk production.

At birth, prolactin levels remain high, while the delivery of the placenta results in a sudden drop
in progesterone, estrogen, and human placental lactogen levels. This abrupt withdrawal of
progesterone in the presence of high prolactin levels stimulates the copious milk production of
the lactogenesis II stage. When the breast is stimulated, prolactin levels in the blood rise and
peak in about 45 minutes, then return to the pre-breastfeeding state about three hours later. The
release of prolactin triggers the cells in the alveoli to make milk.

2. Compare and contrast the action of sympathetic and parasympathetic nervous system

Sympathetic Autonomic Nervous System: It is the part of the autonomic nervous

system, located near the thoracic and lumbar regions in the spinal cord. Its primary function is to

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stimulate the body’s fight or flight response. It does this by regulating the heart rate, rate of
respiration, pupillary response and more.

Parasympathetic Autonomic Nervous System: It is located in between the spinal cord

and the medulla. It primarily stimulates the body’s “rest and digest” and “feed and breed”
response.

3a. with the aid of a well labelled diagram describe the human stomach-SEE PREVIOUS
YEARS

3b. In a tabular form list the types of cells in the mucusa and their secretion

s/n Types of cells function

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 1. Mucous cells secrete an alkaline mucus that protects the
epithelium against shear stress and acid
2. Parietal cells secrete hydrochloric acid

3. Chief cells secrete pepsin, a proteolytic enzyme

4. G cells secrete the hormone gastrin

4a. with aid of a well labelled diagram describe the urinary system

4b. describe urine formation process involved in formation of urine in the kidney

The kidneys filter unwanted substances from the blood and produce urine to excrete
them. There are three main steps of urine formation: glomerular filtration, reabsorption, and
secretion. These processes ensure that only waste and excess water are removed from the body.

i. The Glomerulus Filters Water and Other Substances from the Bloodstream

Each kidney contains over 1 million tiny structures called nephrons. Each nephron has a
glomerulus, the site of blood filtration. The glomerulus is a network of capillaries surrounded by
a cuplike structure, the glomerular capsule (or Bowman’s capsule). As blood flows through the
glomerulus, blood pressure pushes water and solutes from the capillaries into the capsule through
a filtration membrane. This glomerular filtration begins the urine formation process.

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ii. Reabsorption Moves Nutrients and Water Back into the Bloodstream

The resulting filtrate contains waste, but also other substances the body needs: essential
ions, glucose, amino acids, and smaller proteins. When the filtrate exits the glomerulus, it flows
into a duct in the nephron called the renal tubule. As it moves, the needed substances and some
water are reabsorbed through the tube wall into adjacent capillaries.

iii. Secretion

The filtrate absorbed in the glomerulus flows through the renal tubule, where nutrients and
water are reabsorbed into capillaries. At the same time, waste ions and hydrogen ions pass from
the capillaries into the renal tubule. This process is called secretion. The secreted ions combine
with the remaining filtrate and become urine. The urine flows out of the nephron tubule into a
collecting duct. It passes out of the kidney through the renal pelvis, into the ureter, and down to
the bladder.

5a. draw and label a cross section of the male reproductive system-SEE PREVIOUS
YEARS

5b. Show the route followed by the spermatozoa during ejaculation

5c. what are the functions of the human testicle

The testicles are housed in the scrotum just behind the penis. The testicles are the male
gonads the primary male reproductive organs. They have two, very important functions that are
very important to the male reproductive system: they produce gametes, or sperm, and they
secrete hormones, primarily testosterone.

6. using a well labelled discuss blood flow in the human circulatory system

7. Discuss the cavities of the human body anatomy.

OCT. 2019.
1a. what is immunity?

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 The ability of an organism to resist a particular infection or toxin by the action of specific
antibodies or sensitized white blood cells. Immunity is a state of resistance of an organism to
invading biotic or abiotic pathogens and their harmful effects that prevents the development of
infection and maintains organism's integrity by counteracting, neutralizing, and clearing
pathogens.

1b. Describe antibody mediated immunity in the body.

Antibody mediated immunity (AMI) is also called as humoral immunity. Each and every
antigen has different antigenic determinants on the surface of the antigen. Antibody molecules
may be bound to cell membrane or may remain free. The functions of antibody are agglutination
of bacteria and virus. Binding of antibody to an antigen on a microorganism activates the
complement system by opsonization of bacteria, leading to phagocyctosis by cells; and
neutralization of toxins released by bacteria.

AMI provides defense against bacteria and virus that infect respiratory and intestinal tract.
It also takes part in immediate hypersensitivity reactions and in certain autoimmune diseases.
When a bacterium enters the body, it is recognized by the macrophages, which engulf the
bacterium and present its antigens on its surface.

2a. Describe the thyroid gland:

A gland that makes and stores hormones that help regulate the heart rate, blood pressure,
body temperature, and the rate at which food is converted into energy. Thyroid hormones are
essential for the function of every cell in the body. They help regulate growth and the rate of
chemical reactions (metabolism) in the body. Thyroid hormones also help children grow and
develop.

The thyroid gland is located in the lower part of the neck, below the Adam's apple, wrapped
around the trachea (windpipe). It has the shape of a butterfly: two wings (lobes) attached to one
another by a middle part called the isthmus.

The thyroid uses iodine, a mineral found in some foods and in iodized salt, to make its hormones.
The two most important thyroid hormones are thyroxine (T4) and triiodothyronine (T3). Thyroid
stimulating hormone (TSH), which is produced by the pituitary gland, acts to stimulate hormone
production by the thyroid gland. The thyroid gland also makes the hormone calcitonin, which is
involved in calcium metabolism and stimulating bone cells to add calcium to bone.

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2b. in a tabular form differentiate between the effects of hyper and hypo secretion of the
thyroid gland

s/n Hypothyroidism Hyperthyroidism

1. slowed metabolism Fast metabolism
2. tiredness, and weight gain more energy and weight loss
3. Decrease or slow down your bodily Increase or fasten your bodily functions.
functions.
4. Feel depressed. Feel anxious
5. Decrease in hormones. an increase in hormone production

3a. Draw the anatomy of the pancreas

3b. List the hormones secreted by the endocrine pancreas

3c. Describe the actions of the hormones above

Primary hormones secreted by the pancreas include:

 Gastrin: This hormone aids digestion by stimulating certain cells in the stomach to
produce acid.
 Glucagon: Glucagon helps insulin maintain normal blood glucose by working in the
opposite way of insulin. It stimulates your cells to release glucose, and this raises your
blood glucose levels.
 Insulin: This hormone regulates blood glucose by allowing many of your body’s cells to
absorb and use glucose. In turn, this drops blood glucose levels.

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 Somatostatin: When levels of other pancreatic hormones, such as insulin and glucagon,
get too high, somatostatin is secreted to maintain a balance of glucose and/or salt in the
blood.
 Vasoactive intestinal peptide (VIP): This hormone helps control water secretion and
absorption from the intestines by stimulating the intestinal cells to release water and salts
into the intestines.

3d. Explain how blood glucose level is regulated in the body

This involve two hormones secreted by the pancreas which work in opposite of the other.
They are the Insulin and Glucagon

Glucagon helps insulin maintain normal blood glucose by working in the opposite way of
insulin. It stimulates your cells to release glucose, and this raises your blood glucose levels while
Insulin: This hormone regulates blood glucose by allowing many of your body’s cells to absorb
and use glucose. In turn, this drops blood glucose levels.

[Link] is fertilization

The action or process of fertilizing an egg or a female animal or plant, involving the fusion of
male and female gametes to form a zygote. Fertilization happens when a sperm cell successfully
meets an egg cell in the fallopian tube.

4b. Describe the process of fertilization

The process of fertilization involves a sperm fusing with an ovum. The most common
sequence begins with ejaculation during copulation, follows with ovulation, and finishes with
fertilization. Various exceptions to this sequence are possible, including artificial insemination,
in vitro fertilization, external ejaculation without copulation, or copulation shortly after
ovulation.[3][4][5] Upon encountering the secondary oocyte, the acrosome of the sperm produces
enzymes which allow it to burrow through the outer jelly coat of the egg. The sperm plasma then
fuses with the egg's plasma membrane, triggering the sperm head to disconnect from its
flagellum as the egg travels down the Fallopian tube to reach the uterus.

In vitro fertilization (IVF) is a process by which egg cells are fertilized by sperm outside the
womb,

4c. what are the factors that hinder fertilization

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 i. Age. Female age is the most important factor affecting fertility.
ii. Previous Pregnancy.
iii. Duration of subfertility.
iv. Timing and Frequency of Sexual Intercourse.
v. Weight.
vi. Smoking and Alcohol
vii. Caffeine
viii. Drug abuse
ix. Medical conditions e.g blood group, low sperm count, infections

4. Draw and label the structure of the eye. SEE PREVIOUS YEARS

5. Draw and label the internal organ of the female reproductive system

7a. Name the organ and accessory organs of digestion

Organs
Mouth, oesophagus, stomach, small and large intestine
Accessory digestive organ:
Tongue, salivary glands, pancreas, liver, and gallbladder.

7b. draw and label the stomach –SEE PREVIOUS YEARS.

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 HEALTH RECORDS MANAGEMENT.
AUGUST.2016.

1a. PROPOSAL FOR QUALITY ASSURANCE

Quality assurance
This is the maintenance of a desired level of quality in service, especially by means of
attention to every stage of the process of delivery service. It is also a way of preventing mistakes
and negligence in health care delivering and avoiding problems when delivering serves.
STEPS
 Ensure well-structured organisation of various unit and trained personnel
 Policies should be based on health records system (paper based or EHRs)
 Security, privacy and confidentiality.
 Filing, numbering and tracer system should be effective
 There should be regular medical audit

2a. To ensure security

1. By exercising caution around suspicious links or e-mail attachment.
2. Users should formulate a data recovery plan for their computers. Such a program will help
victims recover their data for free if they ever experience an infection.
3. People can protect against malware by always checking the domain of a login page for
their web account
4. Use of password
5. Unauthorized person should not be allowed into the library.

2b. information to be retained before destruction of records

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 i. summary of patient clinical information vi. Records of patients with litigation
ii. Demographic information vii. Records of attending physicain
iii. Records of deceased viii. Consent forms
iv. Records of the minor ix. Records of patients involving insurance policies
v. Records of patients with disability x. Records of referred patients

3a. Cases in which health records can be used as an evidence

i. insurance case
ii. Malpractice claim
iii. Workers compensation claim
iv. Criminal cases
v. Compensation for work hazard

3b. Conditions in which patients information can be released without consent.

i. Teaching of medical and paramedical students without the patient identification data.
ii. Court order
iii. For research study
iv. Continuation of patient care
v. Referral purpose
4a. a diagram that describe the HIM Department as the hub around which other
departments hinges.

Nursing department
Laboratory
Clinical department
department

Administrative Radiology
HIM service
services

Physiotherapy
Pharmaceutical
Medical rehab. sevices
services
Services

4b. Need for cooperative and pleasant relationship between HIM dept and other
departments of the hospital.
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i. it leads to better work flow
ii. it improves quality of service
iii. it prevents conflicts\
iv. better productivity
v. facilitate better communication
vi. reduces working time
vii. it leads to better patients satisfaction

4c. Roles of HIM as front desk officers

[Link] of records
ii. councellor
iii. Reassure the patient
iv. Maintain orderliness in the clinic
v. collect patients information such as personal data
vi. Signboard that points or gives direction
vii. Patients documentation
viii. Serves as reminder to
ix. Transportation of records to and fro
x. retrieving and filing of records

5a. Types of medical records

i. Source-oriented medical records
ii. Problem-Oriented Medical records

Problem-oriented medical is a best format for medical records. patients conditions are
highlighted and discussed systematically. Here the physician consider everything that has to do
with patients such as source, history, complains and so on. It is the itemizing of patients
condition from the onset to the end.

Source-oriented medical records it is the origin of patients problem. That is transmissible.

5b. codes of ethics
i. conduct yourself in the practices of the performance of the profession so as to bring
honour and dignity to yourself, the medical profession and your employer
ii. Accord every patients utmost courtesy, warmth and hospitality, and retrieval of patients
records should be treated with urgency.
iii. Place service before material gain and strive at all times to provide services consistent
with the need for quality healthcare and treatment to all who are ill and injured
iv. Preserve and secure the medical and health records, the information contained there in
and the appropriate secondary records in your department

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v. custody in accordance with professionalism management practices, employees policies
and existing legal provision
vi. Hold up the doctrine of confidentiality and the individuals rights to privacy in the
disclosure of personality identifiable medical and social information
vii. Recognize the source of authority and the powers delegated to you and consciously
discharge the duties and the responsibilities entrusted
viii. refuse to participate in or conceal unethical practices or procedures in your relationship
with other individuals or organisation.
ix. disclose to no one but the proper authorities any evidence of conduct or practices revealed
in medical report or observed that indicated.

OCT. 2018

1i. Patients information security

Patient information security outlines the steps health practitioners must take to guard
"protected health information" (PHI) from unauthorized access or breaches of
privacy/confidentiality. Security also refers to maintaining the integrity of electronic medical
information.

1ii. OWNERSHIP OF HEALTH RECORDS

The medical records is the property of the hospital, in that the materials and men used to
produce the records are of the hospital, where as the data contained within the record is
considered a privileged communication in which the patient have a vested interest.
1iii. Release of patients information
It is important that the medical records officer (MRO) is aware of the need to maintain
confidentiality and the patient right to privacy. As the person in charge of the medical records
department they are responsible for seeing that UNAUTHORISED PERSON DO NOT have
access to the medical records and that information is not given out without the patient written
consent.
The physical medical record is the property of the hospital and the information in the
medical records is of the patient and cannot be released without the consent of the patient.
Exception to these, which include the use of information:
 By doctors and other health professionals for continuing care of patient
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 For medical research where the patient is not identified.
 For the collection of health care statistics, when the individual patient is not identify.
1iv. Discharge summary
A discharge summary is a clinical report prepared by a health professional at the
conclusion of a hospital stay or series of treatments. It is often the primary mode of
communication between the hospital care team and aftercare providers.
2a. Clinical documentation
Clinical documentation (CD) is the creation of a digital or analog record detailing a
medical treatment, medical trial or clinical test. Clinical documents must be accurate, timely and
reflect specific services provided to a patient.

2b. Quality of clinical documentation could be the determining factor to effective and
efficient patient care. Discuss
It serves as documentary evidence to demonstrate that care and treatment actually occurred
1. It represents the primary communication among multi-disciplinary care givers for efficient
and effective patient care.
2. It is used for continuity of care and follow up treatment
3. Effective documentation is also used for performance of equipment and risk management
4. Cumulative health data documented are used for future and present decision making
5. Clinical documentation is used as a tool to measure the quality of service rendered before
granting accreditation or certification to health care organization.

3. Health records department is the hub on which patients care management revolves.
Discuss.
Functions of the sections (Health Record Department)
1. Creation, care, custody, storage and retrieval of patient Health Information
2. Documentation and registration of patients physical and social information
3. Provision of statistical inform from the health records for medical, research, and
administrative purpose.
4. Rendering of associated service concern with the released of patient health information
such as; legal services, insurance services and services to international health agency such
as WHO, UNICEF, UNESCO.
5. Coding and indexing of diseases including surgical operation compilation of morbidity
and mortality health information at local state and national level for the purpose of
identifying specific area of intervention.

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6. Privacy, confidentiality and security
Confidentiality
This is a medical records term, it has to do with not disclosing any information of patient
been privilege to known or communicated to you by a patient to a third party, of such is against
the code of ethics of medical profession unless otherwise a consent of the patient is been seek
and it is approved.
Privacy
This is the act of securing or protecting a patient records from the access of an
unauthorized person in order word safeguarding the records.
Security
Securing data, file, record in a way that disallow, authorized access, loss, corruption and
ensure usability for long period of time.

5a. medical negligence

An act or omission (failure to act) by a medical professional that deviates from the
accepted medical standard of care. Medical negligence is substandard care that's been provided
by a medical professional to a patient, which has directly caused injury or caused an existing
condition to get worse. There's a number of ways that medical negligence can happen such as
misdiagnosis, incorrect treatment or surgical mistakes.

5b. A contract is a legally binding agreement that recognises and governs the rights and
duties of the parties to the agreement. A contract is legally enforceable because it meets the
requirements and approval of the law. An agreement typically involves the exchange of goods,
services, money, or promises of any of those

5c. list and discuss the four elements of negligence

Duty:
A duty is simply a legal obligation. In order to be sued for Negligence, the Defendant
must have owed a duty to the Plaintiff.

Breach:
A breach is a violation of a law or duty. The Defendant must breach his duty in order to be
liable for negligence.

Cause:
The breach of duty must have caused harm to the Plaintiff.

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Harm:
The Plaintiff must suffer harm in order to sue for negligence. If he suffers no harm, he
cannot sue.

6. Medical records library

Medical records library is where all the document (case note) that explains all detail about
the patient’s history, clinical findings, diagnostic test results, pre and postoperative care, patient’s
progress and medication are kept (file in a logical and systematic way for easy retrieval when
needed).
Effective records management service ensures that information is properly managed and is
available whenever and wherever there is a justified need for that information as follows:

• to support patient care and continuity of care

• to support day-to-day business which supports the delivery of care
• to support evidence-based clinical practice
• to support sound administrative and managerial decision making
• to meet legal requirements, including requests from patients under the Data Protection Act
• to assist clinical and other types of audits
• to support archival functions by taking account of the historical importance of data and the
needs of future research.

Following the implementation of the patient file records management system at the
Records Department, significant improvements and benefits have been achieved for both
Records Staff and file users throughout the organisation. The Records Management Team
continues to work closely with Nursing Management to try to resolve issues on the management
of records and improve services

7a. Records Linkage is the act of bringing together patients information, which are recorded
in different places or at different times (e.g. medicine, education, insurance, taxation) by means
of common identification (e.g. names, date of birth, etc) which ensure that they are assigned to
the correct file.
7b.
7c. Requirements for a successful records linkage
1. Practical/technical: storage space for data
2. Software compatibility;
3. Mandatory: to comply with law and professional guidance
4. Essential: to ensure support of HCPs;
5. Preferable: to increase support and active engagement with the system.

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7d. Factors that militate against effective records linkage in Nigeria

Poor facilities

Fear of hackers/ breaches

High maintenance

Unskilled personnel

OCT. 2019
1. Write short notes on the following
a. Doctrine of Res Ipsa loquito
In many cases doctrine of res ipsa loquitur (things speak for itself) can be applied as
medical records itself show the negligence on part of treating physician or surgeon. Records are
requested by the court through court order to serve as a prove of assertion, and records are
presented to speak for itself.

b. Medical Malpractice
Medical malpractice is a legal cause of action that occurs when a medical or health care
professional deviates from standards in his or her profession, thereby causing injury to a patient.
Medical malpractice occurs when a hospital, doctor or other health care professional, through a
negligent act or omission, causes an injury to a patient. The negligence might be the result of
errors in diagnosis, treatment, after care or health management.

c. Negligence
Negligence is a failure to exercise appropriate and or ethical ruled care expected to be
exercised amongst specified circumstances. The area of tort law known as negligence involves
harm caused by failing to act as a form of carelessness possibly with extenuating circumstances

d. Contract law or tort

Contract law is the body of law that relates to making and enforcing agreements. A
contract is an agreement that a party can turn to a court to enforce. Contract law is the area of
law that governs making contracts, carrying them out and fashioning a fair remedy when there's
a breach.

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e. Ownership of health records
Ownership of health records can be viewed from two perspectives, in terms of contents
and components. That is both the hospital and the patients owns the health records.
In terms of contents.
The data/ information documented in the case notes in the course of patient care belongs to the
patients, hence must be kept confidential and the patient have right over it.
In terms of components
The physical components/ case notes and other forms through which information is generated
form the patients, be it demographic or clinical data is the property of the hospital.

2a. Patients Demographic data

These are data that identify a particular patients in the hospital, usually generated and
documented during registration of patients at the Central registration centre or any other unit. It
include name, sex, age, address, phone number among others.

2b. Important of demographic data

Demographic data is needed to identify patients so as to identify and locate his/her records.
2c. list five demographic data: Name, sex, age, next of kin, date of birth.

3a. Clinical audit

Clinical audit is a process that has been defined as "a quality improvement process that
seeks to improve patient care and outcomes through systematic review of care against explicit
criteria and the implementation of change. The goals of an audit are to provide efficient and
better delivery of care and to improve the financial health of your medical provider

3b. Peer review is a quality control measure for medical research. It is a process in which
professionals review each other's work to make sure that it is accurate, relevant, and significant.
Scientific researchers aim to improve medical knowledge and find better ways to treat disease.

3c. Quantitative analysis:

Quantitative analysis is a review of prescribed areas of the medical record for identifying
specific deficiencies. The specific areas are usually written in a procedure developed jointly by
the facilities medical record officer and health care providers in accordance with facility’s
medical staff by laws and administrative policies and standards of its licensing accrediting and
certifying agencies.
Components of quantitative analysis
(1)Patient’s identification on every form. (2)Presence of all necessary reports (3)Required
authentication on all entries (4)Good recording practices
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Qualitative Analysis:
Review of the content of medical record entries for in consistencies and omissions which may
signify that the medical record is inaccurate or incomplete
Components of qualitative analysis
(1)Complete recording of diagnostic statements (2) Consistency in entries by all health
care providers (3)Justification for the course of the patients’ hospitalization (4)
Recording all necessary instances of informal consent (5)Application of good
documentation of practices

4. OBAFEMI AWOLOWO UNIVERSITY TEACHING HOSPITALS COMPLEX,

ILE-IFE

INTERNAL MEMO

From: HOD, HIM DEPT. To: Chief Medical Director

Ref: OU/HI/24
Date: 14/10/2020
Sir,
Causes of Divulgement of Patients Information and Solution
There had been frequent cases of negligence in regards to divulgement of patients’ information
to unauthorized persons. Below are few of the observed causes.
i. Employment of non-health information professional
ii. Poor or lack of orientation on the subject matter.
iii. Negligence on the part of professionals
iv. Poor access control to Health records library
v. Poor security measures for EHRs

Possible solutions
i. Employment of well trained and licensed professionals
ii. Proper orientation on the subject matter
iii. Adoption of Proper security measures.

I hope these will be put into consideration so as to reduce the problem of divulgement.
Thanks,

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 Godwin Hope.

5. PREPOSAL ON THE CAUSES OF OVERCROWDING AND LONGER STAY OF

PATIENTS IN OUTPATIENT DEPARTMENT.
The subject matter can be analyzed from two perspective;
1. Appointment system
2. Waiting time of patient
APPOINTMENT
Appointment system is the booking system whereby patients are given specific time and
date to visit the hospital for consultation and care. Appointment is the type of arrangement or
system of booking a patient for specific period and time to be seen on the hospital, out-patient
clinic for clinical consultation or it is a system of pre-timing a patient for consultation with
his/her doctor or physician.

Waiting list
Waiting lists are list of patient needed to be admitted in the hospital but cannot be
immediately admitted due to lack of available bed. These patient ought to have being accessed
by doctors confirms that their medical cases does not need urgent attention.
Causes of overcrowding and long stay of patients (Problems)
i. poor booking and waiting list system
ii. booking appointments on public holiday
iii. doctors absenting themselves from clinic without
iv. lateness of doctor
v. high rate of patient influx and shortage of staff
vi. misfiling and misplacing
vii. poor tracer system
Solutions
i. There should be room for orderliness
ii. Workload should be spread over the clinic session with the aid of individual booking time
of appointment system.
iii. Advance the knowledge of patient coming to the clinic.
iv. Adoption of effective booking and waiting list system
v. Avoid booking appointments on public holiday
vi. There should be proper notification by doctors absenting themselves from clinic without
vii. Punctuality of doctor
viii. High rate of employment to meet the population of patients
ix. Adoption of adequate measures to prevent misfiling and misplacing e.g poor tracer system
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6. What is misfiling in health records management?
Misfiling
This is a major problem associated with filing. It is the process or where by a patient health
records is been filed in a wrong place which may be as a result of different factors such as:
i. stress due to much workload on the health records staff
ii. poor illumination: no much light in the library
iii. Incompetency or negligence on the part of the health records staff.
Strategies for preventing misfiling and misplacing patients’ records
i. Adoption of good tracer system to monitor the movement of case-note
ii. Usage of convenient filing system
iii. Making provision for good illumination
iv. Employment of adequate staffs to match the workload
v. Adequate supervision should be ensure during filing
vi. Employment of qualified and competent staffs
vii. Making sure hospital numbers written bold and clear
viii. Avoiding duplication of hospital number
ix. Provision of adequate filing space

7a. Electronic health records can be defined as the way of making use of electronic device
to document health records. It is the act of storing data in the electronic device through electronic
form, which is more secure, retrieve and can generate different result.
The following are some of the need for implementation of EHRs
i. Security
Securing data, file, and record in a way that disallow, authorized access, loss, corruption
and ensure usability for long period of time.
ii. Storage facilities and capacity
Storage of data and information in a way that can be quickly retrieve, with the use of tape
and disk reduce the physical storage facilities (shelves, table, library and cabinets).
Intruder cannot get access to it (rodents, disaster, and theft). It needs backup e.g. energy or
data backup energy backup is a most during backup of data.
iii. Accessibility and timeliness
Easy access by different health professional contributing to patient care through the use of
computer system (workstations and server) which can be connected together through
wireless or wire means (Cable, wifi, Bluetooth and the likes).
iv. Cost reduction
Although initial capital of EHRs is always high such as Hard and soft but later on will
reduce staff and salary, less maintenance of physical library in terms of burglary proof in
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 library less paper base, forms and paper, case note, biro, shelves, cabinet, less air condition
in server than physical library.
v. Data redundancy
Duplication of patients records with paper base leads to duplication of records along diff
clinic within the hospital but EHRs help to store records centrally and access by all.

i. 7b. Challenges to the implementation

ii. Cost of hardware and software
iii. Cost of staff training and maintenance
iv. Electronic/ power failure
v. Negative attitude of staff towards implementation since it will reduce the numbers of
health records staffs
vi. The hospital administrative policy
vii. Improper mapping of Global positioning system (GPS)
viii. Poor networking

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 OCT. 2019. BIOSTATISTICS

1a. Routine sources are health facility and community information systems. Routine data
sources provide data that are collected on a continuous basis, such as information that clinics
collect on the patients utilizing their services. Although these data are collected continuously,
processing them and reporting on them usually occur only periodically, for instance, aggregated
monthly and reported quarterly.

Ad hoc sources are those that are collected during post marketing surveillance studies.
b. Write short notes on
Clinical trials are experiments or observations done in clinical research. Such prospective
biomedical or behavioral research studies on human participants are designed to answer specific
questions. Clinical trials are a type of research that studies new tests and treatments and evaluates
their effects on human health outcomes

Double blind trials

A type of clinical trial in which neither the participants nor the researcher knows which
treatment or intervention participants are receiving until the clinical trial is over.
Crossover design
A crossover design is a repeated measurements design such that each experimental unit
(patient) receives different treatments during the different time periods, i.e., the patients cross
over from one treatment to another during the course of the trial.
Cohort study
A cohort study is a particular form of longitudinal study that samples a cohort (a group of
people who share a defining characteristic, typically those who experienced a common event in a
selected period, such as birth or graduation), performing a cross-section at intervals through time.
Non-Sampling Error

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 In statistics, non-sampling error is a catch-all term for the deviations of estimates from
their true values that are not a function of the sample chosen, including various systematic errors
and random errors that are not due to sampling. Non-sampling errors are much harder to quantify
than sampling errors.
3.
4a. A population census is the total process of collecting, compiling, evaluating, analysing
and publishing or otherwise disseminating demographic, economic and social data pertaining, at
a specified time, to all persons in a country or in a well delimited part of a country.
4b. describe the two approaches to conducting population census.
i. The traditional approach relies completely on intensive efforts to achieve a direct count
(physical enumeration) of the entire population.
ii. The alternative approach, an integrated combination of enumeration and estimation,
also starts with physical enumeration, but completes the count with statistical sampling
and survey techniques.
c. 10 Demographic information: Sex, Age, Occupation, Marital status, date of birth, place of
origin, LGA, State of origin.
5.
6.
7explain the following
i. Proportion
A part, share, or number considered in comparative relation to a whole.
ii. Rate
A rate is the ratio between two related quantities in different units.
iii. Percentage
A percentage is a number or ratio that represents a fraction of 100. It is often denoted by
the symbol "%" or simply as "percent" or "pct." For example, 35% is equivalent to the decimal
0.35, or the fraction.
iv. Population
A population is the entire pool from which a statistical sample is drawn. A population may
refer to an entire group of people, objects, events, hospital visits, or measurements. A population
can thus be said to be an aggregate observation of subjects grouped together by a common
feature.

v. Women of child bearing age

Women of child bearing age are those women who are in their fertile age usually between
the age of 15-49 years of age used for calculation in demography.

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vi. Survey: A Survey is defined as a research method used for collecting data from a pre-
defined group of respondents to gain information and insights on various topics of interest.
Surveys have a variety of purposes and can be carried out in many ways depending on the
methodology chosen and the objectives to be achieved.
vii. Morbidity: Morbidity Refers to having a disease or a symptom of disease, or to the
amount of disease within a population. Morbidity also refers to medical problems caused by a
treatment.
viii. Mortality: Mortality rate, or death rate, is a measure of the number of deaths in a
particular population, scaled to the size of that population, per unit of time.
ix. Fertality: Fertility is the natural capability to produce offspring. As a measure, fertility
rate is the number of offspring born per mating pair, individual or population. Fertility differs
from fecundity, which is defined as the potential for reproduction.

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