14
August 2025. Role-players:
1. Ibi Tayo
2.
Vinisha Modi
|
15 |
Role-play 1. |
|
16 |
Structured conversation. Labour
ward scenario |
|
17 |
Viva. |
|
18 |
EMQ. Mycoplasma Genitalium |
15.
Role-play
1. Candidate’s
instructions will be e-mailed shortly before the tutorial.
16.
Labour
ward scenario 1.
You are the registrar on duty and responsible for the labour and gynae
wards. You have just had the handover. Your task is to discuss the overall
management of the wards with the examiner, to prioritise the patients and
decide the allocation of staff to care for them.
This station was the first of its kind I used for the OSCE exam when
it was introduced more than 25 years ago. There are phrases and concepts that
reveal this distant origin, but I have retained them for nostalgic reasons. I
ran the tutorial on a Sunday afternoon when I was on-call and used what was
happening on the labour and gynae wards that day. You won’t be asked about
gynae patients in a labour ward station!
Labour Ward. Sunday 13.00 hours.
|
1 |
Mrs JH |
Primigravida. T+8. In labour. Cx. 6
cm. dilated. |
|
2 |
Mrs AH |
Primigravida at T. In labour. Cx. 5 cs. dilated |
|
3 |
Mrs. BH |
Para 2. 30 days post-delivery. 2ry. PPH >
1,000 ml. Hb. 9.3. |
|
4 |
Mrs SB |
Primigravida. 32/52 gestation. Admitted 30
minutes ago. Abdominal pain + 200 ml. bleeding. Nephrostomy tube in situ -
not draining since this morning. Low placenta on 20 week scan. |
|
5 |
Mrs KW |
Para 1. In labour. Cx. 5 cm. Cephalic at
spines. |
|
6 |
Mrs KT |
Para 0+1. 38 weeks. SROM. Cephalic 2
cm. above spines. Clear liquor. |
|
7 |
Mrs TB |
Para 1. T+4. Clinically big baby. Cx
fully dilated for 1 hour. Early decelerations. |
|
8 |
Mrs RJ |
Primigravida. Epidural. RIF pain. Cx fully
dilated for 1 hour. Shallow late decelerations. OT position. Distressed ++.
BP /105. ++ protein. Urine output 50 ml in past 4 hours. |
|
9 |
Mrs KC |
Transfer from ICU. 13 days after delivery of 32
week twins. Laparotomy on day 7 for pelvic pain and fever. Infected
endometriotic cyst removed. IV antibiotics changed to oral. |
Gynaecology ward.
8 major post-operative cases who have been seen on the morning ward
round and are stable. The husband of a patient who had Wertheim
|
1 |
Mrs JB |
10 week incomplete miscarriage. Hb. 10.8.
Moderate fresh bleeding. |
|
2 |
Ms AS |
19 years old. Nulliparous. Just admitted with
left iliac fossa pain. Scan shows unilocular 5 cm. ovarian cyst. |
Medical staff:
Consultant at home. Registrar - you.
Senior House Officer with 12 months experience.
Registrar in Anaesthesia.
Consultant Anaesthetist on call at home.
Midwifery staff:
Senior Sister. Trained to
take theatre cases. Able to site IV infusions and suture episiotomies and
tears.
3 staff midwives. 1 trained to take theatre cases. Two able to site IV
infusions.
1 Community midwife looking after Mrs. KW.
2 Pupil Midwives.
17.
Viva. Topic will be revealed during the tutorial.
18.
Mycoplasma
genitalium.
Abbreviations.
MG: Mycoplasma genitalium.
MSSU: mid-stream specimen of urine.
NAAT: nucleic acid amplification test.
NCSP: National Chlamydia Screening Programme.
NHSCS: NHS Cervical Screening Programme
PID: pelvic
inflammatory disease.
STI: sexually-transmitted
infection.
Scenario 1.
Which, if any, of
the following statements are true in relation to Mg?
|
A |
MG was first isolated in 2001 |
|
B |
MG was first isolated from men with
non-gonococcal urethritis (NGU) |
|
C |
MG belongs to the Cutemollies class |
|
D |
MG is the smallest known yeast with the
ability to self-replicate |
|
E |
MG is the smallest known bacterium with the
ability to self-replicate |
|
F |
MG has an unusual, double-layered cell wall |
|
G |
MG has an unusual protrusion at one end |
|
H |
MG’s protrusion enables it to adhere to
epithelial cells |
|
I |
MG’s protrusion enables it to invade
epithelial cells |
|
J |
MG is best seen on a Gram stain |
Scenario 2.
Which, if any, of
the following statements are true in relation to Mycoplasmas?
|
A |
are the
largest known bacteria |
|
B |
have no cell
wall |
|
C |
have no nuclei |
|
D |
are resistant
to ß-lactam antibiotics |
|
E |
are resistant
to sulphonamides |
|
F |
colonies show
a ‘scrambled egg’ appearance on culture on agar |
|
G |
particularly
affect mucosal surfaces. |
Scenario 3.
Which, if any, of
the following statements are true in relation to Mg?
|
A |
when the
organism was originally found, culture took 50 days |
|
B |
Mg is
facetious |
|
C |
Mg is a
facultative aerobe |
|
D |
Mg is a
facultative anaerobe |
|
E |
Mg is a
facultative aerobe & anaerobe |
|
F |
Mg is
fastidious |
Scenario 4.
Which, if any, of
the following are true in relation to the approximate prevalence of
MG?
|
A |
it is ~ 0.1% |
|
B |
it is ~ 1.0% |
|
C |
it is ~ 5.0% |
|
D |
it is ~ 5-10% |
|
E |
it is > 10% |
|
F |
none of the
above |
Scenario 5.
Which, if any, of
the following is true in relation to screening for MG? This is a true
EMQ with only one correct answer.
|
A |
screening for
MG is now included in the NCSP |
|
B |
screening for
MG is now offered as part of the NHSCS |
|
C |
screening
should be offered to all sexually active women < 30 years old |
|
D |
screening
should only be offered to those with symptoms suggestive of infection |
|
E |
screening
should be offered to all partners of those with MG infection |
|
F |
none of the
above |
Scenario 6.
Which, if any, of
the following are included in BASHHMG as risk factors for infection
with MG?
|
A |
Cigarette
smoking |
|
B |
Multiple
dancing partners |
|
C |
Multiple
sexual partners |
|
D |
Non-white
ethnicity |
|
E |
Younger age |
|
F |
None of the
above |
Scenario 7.
Which of the
following statements is true in relation to MG and co-infection with
other organisms?
|
A |
MG excretes
bactericidal toxins and co-infection is rare |
|
B |
MG
co-infection is most often with chlamydia |
|
C |
MG
co-infection is most often with E. coli |
|
D |
MG
co-infection is most often with HIV |
|
E |
MG
co-infection is most often with TB |
|
F |
None of the
above |
Scenario 8.
Which of the
following statements is true in relation to MG and men?
|
A |
It is the most
common cause of NGU |
|
B |
It is the most
common cause of epididymitis |
|
C |
It is the most
common cause of prostatitis |
|
D |
It is a
well-recognised cause of male sub-fertility |
|
E |
Most men with
MG infection are asymptomatic |
|
F |
None of the
above |
Scenario 9.
Which, if any, of
the following statements are true in relation to MG and women?
|
A |
MG is linked
to an ↑ risk of cervicitis |
|
B |
MG is linked
to an ↑ risk of endometritis |
|
C |
MG is linked
to an ↑ risk of female infertility |
|
D |
MG is linked
to an ↑ risk of miscarriage |
|
E |
MG is linked
to an ↑ risk of otitis media |
|
F |
MG is linked
to an ↑ risk of pelvic inflammatory disease |
|
G |
MG is linked
to an ↑ risk of postcoital bleeding |
|
H |
MG is linked
to an ↑ risk of postmenopausal bleeding |
|
I |
MG is linked
to an ↑ risk of preterm birth |
|
J |
MG is linked
to an ↑ risk of damage to Fallopian tube cilia |
|
K |
MG is linked
to an ↑ risk of puerperal psychosis |
|
L |
MG is linked
to an ↑ risk of puerperal sepsis |
|
M |
Most infected
women are asymptomatic |
|
N |
None of the
above |
Scenario 10.
Which, if any, of
the following statements are true in relation to current concerns
about Mg?
|
A |
It could
become a ‘superbug’, resistant to most antibiotics, within a decade |
|
B |
Infection is
often misdiagnosed as chlamydia with ↑ risk of antibiotic resistance |
|
C |
‘superbug’
status would be likely to lead to an ↑ in renal failure |
|
D |
‘superbug’
status would be likely to lead to an ↑ in female infertility |
|
E |
‘superbug’
status would be likely to lead to an ↑ in male infertility |
Scenario 11.
Which, if any, of
the following are used in the recommended test for MG infection in
women?
|
A |
blood testing
for MG IgG |
|
B |
blood testing
for MG IgM |
|
C |
cervical
smears checked microscopically for the diagnostic intracellular inclusion
bodies |
|
D |
culture and
sensitivity of cervical swab specimens using MG-specific culture medium |
|
E |
culture and
sensitivity of 1st. void MSSU using MG-specific culture medium |
|
F |
culture and
sensitivity of vaginal swab specimens using MG-specific culture medium |
|
G |
NAATs that
detect the MG G-antigen |
|
H |
NAATs that
detect MG DNA |
|
I |
NAATs that
detect MG RNA |
|
J |
serum testing
for MG-specific antigen |
|
K |
vaginal swabs
taken by the woman |
|
L |
none of the
above |
Scenario 12.
Which, if any, of
the following statements are true in relation to testing for antibiotic
resistance after initial tests are +ve for MG?
|
test for resistance to cephalosporins |
|
|
B |
test for resistance to macrolides |
|
C |
test for resistance to penicillin |
|
D |
test for resistance to quinolones |
|
E |
test for resistance to macrolides |
|
F |
test for resistance to streptomycin |
|
F |
test for resistance to sulphonamides |
|
F |
test for resistance to tetracyclines |
|
G |
None of the above |
Scenario 13.
Which, if any, of
the following statements are true in relation to estimates of
antibiotic
resistance in current strains of MG in the UK?
|
A |
20% are resistant to cephalosporins |
|
B |
40% are resistant to macrolides |
|
C |
50% are resistant to penicillin |
|
D |
50% are resistant to quinolones |
|
E |
10% are resistant to streptomycin |
|
F |
90% are resistant to sulphonamides |
|
F |
40% are resistant to tetracyclines |
|
F |
None of the above |
Scenario 14.
Which, if any, of
the following is BASHHMG’s recommended 1st. line treatment of
uncomplicated MG?
|
A |
azithromycin 1
gram daily for 7 days |
|
B |
doxycycline
100 mg twice daily for 7 days |
|
C |
doxycycline
100 mg twice daily for 10 days |
|
D |
doxycycline
100 mg twice daily for 7 days |
|
E |
doxycycline
100 mg twice daily for 7 days then azithromycin 1 gram daily for 2 days |
|
F |
moxifloxacin
400mg orally once daily for 7 days |
|
G |
moxifloxacin
400mg orally once daily for 10 days |
|
H |
none of the
above |
Scenario 15.
Which, if any, of
the following is BASHHMG’s recommended 1st. line treatment of
complicated MG?
|
A |
doxycycline
100 mg twice daily for 10 days |
|
B |
doxycycline
100 mg twice daily for 14 days |
|
C |
moxifloxacin
400mg orally once daily for 10 days |
|
D |
moxifloxacin
400mg orally once daily for 14 days |
|
E |
none of the
above |
Scenario 16.
This is not an EMQ
or SBA! Fill in the gaps in the table below, using option list.
|
Drug name |
Category of
drug |
|
azithromycin |
|
|
doxycycline |
|
|
moxifloxacin |
|
Option List.
|
Category of
drug |
|
macrolide |
|
tetracycline |
|
quinolone |
Scenario 17.
Which, if any, of
the following statements is true in relation to test of cure (TOC) after
treatment of MG?
|
A |
TOC should be
offered to everyone who has been treated for MG |
|
B |
TOC should
only be offered to those who had signs of infection before treatment |
|
C |
TOC should
only be offered to those who had symptoms of infection before treatment |
|
D |
TOC should
only be offered to those who had signs and symptoms before treatment |
|
E |
TOC should
only be offered to those who continue to have signs or symptoms two weeks or
more after the start of treatment |
|
F |
none of the
above |
Scenario 18.
Which, if any, of
the following statements are true in relation to the timing of test of
cure (TOC) after treatment of MG?
|
A |
TOC is best
done at 3 weeks after start of treatment |
|
B |
TOC is best
done at 4 weeks after start of treatment |
|
C |
TOC is best
done at 5 weeks after start of treatment |
|
D |
TOC is best
done at 6 weeks after start of treatment |
|
E |
TOC should not
be done < 2 weeks from the start of treatment |
|
F |
TOC should not
be done < 3 weeks from the start of treatment |
|
G |
TOC should not
be done < 4 weeks from the start of treatment |
