Thursday, 6 August 2020

Tutorial 6 August 2020


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67

Role-play. Farmer’s wife at booking.

68

Structured discussion. Enhanced recovery.

69

Structured discussion. Labour ward prioritisation.

70

EMQ. Family origin questionnaire

71

SBA. Kisspeptin.

 67. Role-play. Farmer’s wife at booking.

Candidate’s instructions.

You are an SpR5 and are running the antenatal clinic – your consultant is absent due to illness. You are about to see Mary Hapsburg. She has been booked by an experienced midwife who has done the relevant investigations and given all the routine booking advice about healthy life-style, Down’s syndrome screening, etc. All that is left is the advice about farming which she was not comfortable about advising on – she has asked you to see Mary to do this.

The GP letter reads: “Please see Mary Hapsburg who is 28 years old. This is her first pregnancy and the gestation will be 10 weeks, calculated from her LMP, by the time of the appointment. She is healthy and rubella-immune. She and her husband are farmers and  she wishes to know the implications for her and her pregnancy. I don’t know much about this and leave it to you to provide expert advice”.

Your task is to take a history and advise her in relation to pregnancy and farming.

 68. Structured discussion. Enhanced Recovery.

Candidate's instructions.

You are a newly-appointed consultant. The Clinical Director has asked you to develop a programme for enhanced recovery for inpatient gynaecological surgery. As a first step, she has asked you to deliver a talk to a unit meeting (all staff can attend) to outline the key features of enhanced recovery. She suspects most of the staff know little about the subject and hopes that your talk will encourage their enthusiastic participation. The examiner will ask you 9 questions pertinent to your talk.

 

69. Structured discussion. Labour ward prioritisation.

Candidate’s instructions.

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 written for the first tutorial I ran for the OSCE exam when it was introduced more than 20 years ago. There are a number of 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 using what was happening on the labour and gynae wards that day.

Labour Ward. Sunday 13.00 hours.

1

Mrs JH

Primigravida. T+8. In labour. 6 cms.

2

Mrs AH

Primigravida at T. In labour. 5 cms.

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. Ceph at spines.

6

Mrs KT

Para 0+1. 38 weeks. SROM. Ceph 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's hysterectomy on the Friday was asking to see a doctor for a report on the operation.

 

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.

 

70. EMQ. Family origin questionnaire.

Question 1.             

What is the main purpose of the Family Origin Questionnaire? This is an EMQ with only one correct answer.

Option list.

A

to identify illegal immigrants

B

to identify those who are not entitled to free NHS care

C

to monitor the degree to which different ethnic groups use the NHS

D

to screen for sickle cell disease

E

to screen for α-thalassaemia

F

none of the above.

Question 2.             

Whose ancestry is asked about in the FOQ? This is not a true EMQ as there may be more than one correct answer.

Option list.

A

the pregnant woman

B

the woman’s partner/husband

C

the biological father of the pregnancy

D

the postman in case he delivered more than the mail

E

the queen

F

the woman’s mother

G

the woman’s father

H

the woman’s siblings

I

none of the above

Question 3.             

Which generations should be included? This is an EMQ with only one correct answer.

Option list.

A

the current generation

B

the current generation + the previous generation

C

the current generation + 2 previous generations

D

the current generation + 3 previous generations

E

the current generation + as many previous generations as possible

F

none of the above

Question 4.             

Who should complete the FOQ? This is an EMQ with only one correct answer.

Option list.

A

the woman

B

the woman’s husband / partner

C

the biological father of the pregnancy

D

the midwife

E

the obstetrician

F

an interpreter if the woman & partner are not fluent in English

G

none of the above

Question 5.             

What other responsibilities does the person completing the FOQ have? There is no option list so as not to make it too easy.

Question 6.             

Which tick boxes are highlighted in yellow on the FAQ. This is an EMQ with one correct answer.

Option list.

A

those that must be completed

B

those that suggest a possible risk of neonatal jaundice

C

those that suggest a possible risk of HepB

D

those that suggest a possible risk of SCD. SCT or thalassaemia

E

those showing areas with a risk of having SCD. SCT or thalassaemia

F

none of the above

Question 7.             

What is the significance of the red ‘hash’ mark  # that appears alongside some of the boxes. There is only one correct answer.

Option list.

A

the box that must be completed

B

just decoration to make the form more pleasing to the eye

C

denotes area with risk of bilharzia

D

denotes area with risk of falciparum malaria

E

denotes area with risk of α-thalassaemia

F

denotes area with risk of β-thalassaemia

G

none of the above

Question 8.             

A woman books at 10 weeks in her 1st. pregnancy. Her husband in Turkish and healthy. What screening for sickle cell and thalassaemia should be offered?

Option list.

A

screening depends on whether the area is high or low risk

B

screening depends on whether the FOQ shows high or low risk

C

the husband should first be screened

D

the woman should be screened using Hb and red cell indices

E

the woman should be screened using electrophoresis

F

none of the above

Question 9.             

A woman books at 10 weeks in her 1st. pregnancy. Her husband is English and healthy. What screening for sickle cell and thalassaemia should be offered?

Option list.

A

screening depends on whether the area is high or low risk

B

screening depends on whether the FOQ shows high or low risk

C

the husband should first be screened

D

the woman should be screened using Hb and red cell indices

E

the woman should be screened using electrophoresis

F

none of the above

 

71. SBA. Kisspeptin.

Lead in.

Pick the best answer from the list below about kisspeptin.

Option list.

A

is a pheromone released by the salivary glands during passionate embraces

B

is a digestive enzyme released by the salivary glands during passionate embraces

C

is a digestive enzyme found in human carnivores but not vegetarians

D

is thought necessary for trophoblastic invasion and low levels have been linked to miscarriage, recurrent miscarriage and risk of PET

E

is named after “Kiss me quick” chocolate

F

does not exist and this question is a very poor joke by someone who should know better