Website
Contact
The cystic fibrosis EMQ from the previous tutorial caused mayhem. Most people messed it up. If you have not tackled it, I would suggest that you do so and send it to me so that you get my answer and explanation. The feedback I have had is that it is similar to the EMQs in the exam on the subject. It is really easy once you understand the basics of what you are doing.
Tonight we had another EMQ. This time on early pregnancy.
The discussion showed up one or two problems with the option list, which is helpful as I might not have appreciated the problem if I had gone over it 50 times myself.
Early pregnancy complications.
Lead-in.
The following scenarios relate to early pregnancy. For each, select the most appropriate answer from the option list.
Each option can be used once, more than once or not at all.
Abbreviations.
AFC. antral follicle count.
AMH. anti-Mullerian hormone.
CRL. crown-rump length.
EPU. early pregnancy unit.
FSH. follicle stimulating hormone.
GTD. gestational trophoblastic disease.
GTG 17. RCOG Green-top Guideline 17. ”Recurrent Miscarriage.” 2003.
GTG 25. RCOG Green-top Guideline 25. ”The Management of Early Pregnancy Loss.“ 2006.
hCG. human chorionic gonadotrophin
MEUC. medical evacuation of uterine contents.
PUL. pregnancy of unknown location.
PUV. pregnancy of uncertain viability.
RM. recurrent miscarriage.
SEUC. surgical evacuation of uterine contents.
TVS. trans-vaginal scan
USS. ultrasound scan
Scenario 1.
A nulliparous woman attends the booking clinic at 8 weeks’ gestation. An ultrasound scan shows a missed miscarriage of a size commensurate with the gestation. What will be your management?
Scenario 2.
A nulliparous woman attends the booking clinic at 8 weeks’ gestation. An ultrasound scan shows a missed miscarriage of a size commensurate with the gestation. She has had two previous pregnancies; both resulted in 1st. trimester miscarriage. What will be your management?
Scenario 3.
A primigravid woman attends the A&E department with abdominal pain and vaginal bleeding. A home pregnancy test was +ve 1 week ago; the date of the LMP is uncertain. What will be your management?
Scenario 4.
A 40-year old woman is pregnant for the first time. Her periods have been erratic for 12 months and she has occasional hot flushes. She attends the A&E department with abdominal pain and vaginal bleeding. The bleeding is slight and her condition is good. An hCG is +ve and a TVS shows an incomplete miscarriage. What will be your management?
Scenario 5.
A 35-year-old woman has had two normal pregnancies. She attends the booking clinic after an unplanned conception. Her hCG is +ve. A TVS shows endometrial thickening but no evidence of intra-uterine pregnancy. No pelvic abnormality is seen. What will be your management?
Scenario 6.
A 35-year-old woman has had two normal pregnancies. She attends the booking clinic after an unplanned conception. Her hCG is +ve. A TVS shows a 15 mm. intra-uterine sac, but no fetus or yolk sac. What will be your management?
Scenario 7.
A 35-year-old woman has had two normal pregnancies. She attends the booking clinic after an unplanned conception. Her hCG is +ve. A TVS shows a 30 mm. intra-uterine sac, but no fetus. What will be your management?
Scenario 8.
A 35-year-old woman has had two normal pregnancies. She attends the booking clinic after an unplanned conception. Her hCG is +ve. A TVS shows an intra-uterine fetus with crown rump length of 5 mm., but no evidence of fetal heart activity. What will be your management?
Scenario 9.
A 35-year-old woman has had two normal pregnancies. She attends the booking clinic after an unplanned conception. Her hCG is +ve. A TVS shows an intra-uterine fetus with crown rump length of 6 mm. Fetal heart activity is seen. What will be your management?
Scenario 10.
A 35-year-old woman attends the A&E department at 6 weeks’ gestation with pain and bleeding. She became pregnant after IVF. An ultrasound scan shows a viable intrauterine pregnancy of a size compatible with the gestation. What will be your management?
We decided that the option list would be better without “J”. So ignore it.
Option List.
A. Admit as an emergency case.
B. Counsel and arrange TVS in 1 week.
C. Counsel and arrange TV colour Doppler scan.
D. Counsel re expectant management.
E. Explain diagnosis and counsel re MEUC and SEUC.
F. Explain diagnosis and counsel re expectant management and MEUC and SEUC.
G. Explain diagnosis and counsel re expectant management, MEUC and SEUC and refer to the EPU.
H. Explain diagnosis and counsel re treatment options with accent on the relative merits of SEUC and refer to the EPU.
I. Explain diagnosis and counsel re treatment options with accent on the relative merits of MEUC and refer to the EPU.
J. EPU.
K. Explain diagnosis and refer to the EPU for PUL protocol.
L. Explain diagnosis and refer to the EPU for PUV protocol.
M. Manage as ectopic pregnancy until proven otherwise.
N. Arrange progesterone assay.
O. Arrange AFC.
P. Arrange AMH assay.
Q. Arrange serial hCG monitoring for 48 hours.
R. Administer anti-D immunoglobulin.
S. Administer ergometrine 0.5 mg i.m.
T. Prescribe mifepristone.
U. Prescribe misoprostol for vaginal use.
V. Continue with routine booking.
Then we wrote an essay plan: "Critically evaluate screening for gynaecological cancer".
Then we did a roleplay: GP Letter. “Mrs Jones is planning to be pregnant. Her sister recently had a baby with Down’s syndrome. Please see and advise”.
It may seem daft to be doing OSCE stuff when we are preparing for the written.
But it is good to start thinking about the words you are going to use e.g. to introduce yourself and to practise them over and over so that they are routine when you get to the OSCE.
Yes, we will practise them in the OSCE training, but it makes sense to have a good idea of what suits you by the time we get there.
Finally we wrote an essay plan for: "Critically evaluate the 10 Top Recommendations in the recent maternal mortality report".
I am sure that this will come as an essay or a viva one day. It would make a killer topic. Once the examiners have thought of it, I am sure they will introduce it.
It is also an important subject as they are the Report's top recommendations.
Put it on your last-minute revision list as it is difficult to remember for more than a few days.
No comments:
Post a Comment