Tutorial 25 July 2011

Website.
Podcast.
Tonight we managed an EMQ and 4 essay plans.
The EMQ was created due to the fact that the FSRH recently updated its advice on missed pills to simplify it.
It and the essays are below.

Missed pills. Starting the Pill. COC.

Lead-in.

The following scenarios relate to the combined oral contraceptive (COC) and missed pills.

For each, select the option that best fits the scenario.

Each option can be used once, more than once or not at all.

Abbreviations.

UPSI:     unprotected sexual intercourse.

Option list.

A.        pill that is ≥ 12 hours late.

B.        pill that is > 12 hours late.

C.        pill that is ≥ 24 hours late.

D.        pill that is > 24 hours late.

E.         two missed pills at any time in a single cycle.

F.         the first pill taken in one’s first love affair, now recalled with fond nostalgia for its effectiveness in preventing pregnancy, the Prince having been truly a loathsome toad.

G.       no additional contraception required.

H.        additional contraception required for 7 days.

I.          emergency contraception should be considered.

J.          emergency contraception should be recommended.

K.        take the missed pill immediately, but not if it means 2 pills in one day; no additional contraception needed; pill-free interval as normal.

L.         take the missed pill immediately, even if it means 2 pills in one day; no additional contraception needed; pill-free interval as normal.

M.      take the missed pill immediately, even if it means 2 pills in one day; additional contraception for 7 days; pill-free interval as usual.

N.       take one of the missed pills immediately, discard the other missed pills, use extra contraception for 7 days and discuss emergency contraception with your doctor.

O.       take the missed pills immediately, use extra contraception for 7 days and discuss emergency contraception with your doctor.

P.        continuous combined preparation.

Q.       bi-phasic preparation.

R.        quadriphasic preparation.

S.         cannot be answered from the data given.

T.         none of the above.

Scenario 1.

What is the definition of a missed pill?

Scenario 2.

What is the definition of two missed pills?

Scenario 3.

A COC is begun on day 1 of menstruation. What advice should be given about temporary additional contraception?

Scenario 4.

A COC is begun 5 days after day 1 of menstruation. What advice should be given about temporary additional contraception?

Scenario 5.

A COC is begun for the first time on day 1 of menstruation. The fifth pill is missed. What advice should be given?

Scenario 6.

A pill is missed on day 14 of a 21-day pack. What advice should be given?

Scenario 7

A pill is missed on day 21 of a 21-day pack. What advice should be given?

Scenario 8

Two pills are missed in the first week of a 21-day pack. What advice should be given?

Answer:

Scenario 9

Two pills are missed in the second week of a 21-day pack. What advice should be given?

Scenario 10

Two pills are missed in the third week of a 21-day pack. What advice should be given?

Scenario 11

What kind of preparation is Qlaira?

Essays 25^th. July 2011.

Question 1.

Critically evaluate the available options for analgesia in labour.

Question 2.

With regard to postnatal mental illness.

1. outline the different categories of mental illness.                   2 marks

2. detail the methods of detecting postnatal mental illness.     2 marks

3. outline the risks to the mother.                                                  4 marks

4. outline the risks to the child.                                                       4 marks

5. outline the principles of management.                                     8 marks

Question 3.

A woman attends the antenatal booking clinic. She wishes to have a home birth.

1. Critically evaluate the pros and cons of home birth that you will discuss with her.                                                                                 

                                                                                                                  6 marks.

2. Outline the key components of the assessment of her suitability to have a home birth.                                                                             

                                                                                                                  6 marks

3. Discuss the practical issues relevant to safe home delivery.   12 marks

Question 4.

A woman is referred after her third consecutive miscarriage at 10 weeks.

1. outline the key features in the history you will take.     4 marks

2. list the main causes of recurrent miscarriage.                 4 marks

3. critically evaluate the investigations you will arrange.   6 marks

4 critically evaluate the available treatments for unexplained recurrent miscarriage.                                                                 

                                                                                                       6 marks 

Tutorial 21 July 2011

Website.
Podcast.
Tonight we attempted an EMQ on statistics. I had only finished writing it before the tutorial, so it was a bit of a test run. I immediately spotted several errors and we found that one of the questions seemed to cause more confusion than enlightenment. I'll need to re-write it. As you will see, I split the tutorial into two as there was a bit in the middle when there was no conversation. But I messed up starting the recording again and the second half is missing. I need to get better at this podcasting business.
The EMQ was e-mailed to everyone. If you did not get it, your name is not on my mailing list. Send me an e-mail.

Tutorial 18 July 2011

Podcast.
Website.
Tonight's essays.

Question 1.

A 25-year-old primigravida attends for a routine scan and echogenic bowel is noted.

1. What is the advice of the National Screening Committee in relation to “soft markers"? 
                                                                               6 marks.

2. What conditions are linked to echogenic bowel?      6 marks.

3. Justify your management.                                    12 marks.

Question 2.

A woman is referred to the pre-pregnancy counselling clinic. She had Caesarean section with her previous pregnancy.

1.  Outline the history you will take.                   6 marks.

2.  Justify the investigations you will arrange.      4 marks.

3.  Justify the advice you will give.                    10 marks.

Question 3.

With regard to epidural anaesthesia in obstetrics:

1.  Outline the main differences between it and spinal anaesthesia.       6 marks.

2.   Outline the main techniques and drugs used.                                4 marks.

2.  Evaluate the main contraindications.                                              4 marks.

3.  Discuss the main uses.                                                                6 marks.

Question 4.

A woman attends the antenatal clinic at 36 weeks. She had read an article in a woman’s magazine about the merits of commercial umbilical cord blood banking and would like to have this done.

1.   Justify the history you will take.                  4 marks

2.   Justify the investigations you will arrange.    2 marks

3.  Justify your management.                          14 marks

Tutorial 14 July 2011

Podcast.
Website.
Tonight we managed four essay plans. I have been helping run the local MRCOG course for the past week and have not had time for much else. In particular, I have not managed to write any EMQs, for which I know there is an insatiable demand. I'll try to do some for the next session.
Tonight's essays were:

With regard to female genital mutilation (FGM).

1. what are the key aspects of the law in the UK relating to FGM.                                                  2 marks.

2. what are the responsibilities of the doctor who suspects that a child may be subjected to FGM?  2 marks.

3. how is FGM graded?                                                                                                                 3 marks.

4.  outline the management of woman found at booking to have had FGM.                                    13 marks.

With regard to blood transfusion in obstetrics:

1. outline the main hazards of blood transfusion.                 2 marks

2. how may the incidence of transfusion be reduced?         4 marks

3. outline the key factors relating to red cell use.                 6 marks

4. critically evaluate the use of fresh frozen plasma.             4 marks

5. critically evaluate the use of platelets.                              2 marks

6. critically evaluate the use of recombinant factor VIIa.      2 marks          

A 41-year-old woman attends for review after a normal hysteroscopy. She now wishes treatment for her incapacitating heavy periods which have not responded to medical management.

1. Outline the history you will take.                                                           4 marks.   

2. Outline the investigations you will consider.                                           4 marks.

3. Critically evaluate your advice on the available management options.    12 marks

A patient is referred for management of premenstrual syndrome.

1. Define PMS and its grades of severity.          4 marks.

2. Outline the investigations you will arrange.      6 marks.

3. Critically evaluate the management options.  10 marks.

Tutorial 11 July 2011

Podcast: http://soundcloud.com/drtmcf/tutorial-11-july-2011
Website: www.drcog-mrcog.info.
Tonight we dicussed 4 topics and demonstrated that we had not read the GTGs in sufficient detail!

Question 1.

A primigravida collapses 1 hour after normal vaginal delivery.

1. Critically evaluate the differential diagnosis of maternal collapse.    6 marks.

2. How may impending maternal collapse be recognised.                 4  marks.

2. Critically evaluate the management of this woman.                      10 marks.

Question 2.

Obstetric cholestasis.

1. Outline the symptoms associated with OC.                                                               4 marks.

2. Critically evaluate the differential diagnosis of OC and the key investigations.        6 marks.

3. Outline the maternal and fetal risks of OC.                                                           4 marks.

4. Justify your management of a case of OC diagnosed at 28 weeks.                        6 marks.

Question 3.

Critically evaluate alternatives to oestrogen HRT in the management of the menopause.

Question 4.

In relation to diagnostic laparoscopy, critically evaluate:

1. the issues to be discussed in obtaining informed consent                       4 marks.

2. the factors that increase the incidence of entry-related injury                 4 marks.

3. how entry-related injuries may be minimised                                       12 marks.