Tutorial 30 July 2012

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Tonight we had an EMQ and 4 essay topics and still managed to finish early.

Essays 30^th. July 2012

With regard to vulval cancer.

1. critically evaluate screening.                                                4 marks.

2. outline the FIGO staging system.                                         6 marks.

3. critically evaluate the modern approach to management.  10 marks.

With regards to Gp B Streptococcal (GBS) infection and pregnancy.

1. outline its significance                                                                                4 marks

2. outline the arguments for and against screening for GBS in pregnancy   4 marks

3. evaluate the steps that can be taken to reduce its impact                     12 marks

A 35 year-old woman books at 6 weeks. She has noted a left breast mass. Breast cancer is suspected.

1. What is the life-time risk of female breast cancer.       1 mark.

2. How does pregnancy affect the risk of breast cancer. 4 marks.

3. Outline the investigation.                                              5 marks.

4. Critically evaluate the management.                           10 marks.

A nulliparous woman is found to have hydrops fetalis on a routine 20 week anomaly scan.

1. List the main causes of hydrops fetalis.            12 marks.

2. Outline the key investigations.                             8 marks.

 

Education.

I am not an expert in this topic and offer this as some help to working out answers if you get a question on teaching methods, which apparently has happened. If you are an expert and can help to improve what follows, that will be much appreciated.

If you get a question in the exam, please try to remember as much as possible, particularly the option list and send it to me.

There are often a variety of different techniques that could be used. I would guess that the exam committee will take care to restrict the option list so that it is clear which is the best option.

Lead-in.

The following scenarios relate to medical education

Pick one option from the option list.

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

Abbreviations.

EMQ:    extended, matching question.

PBL:       problem-based learning.

Scenario 1.

A woman is admitted with an eclamptic seizure. The acute episode is dealt with and she is put on an appropriate protocol. You wish to use the case to outline key aspects of PET and eclampsia to the two medical students who are on the labour ward with you. Which would be the most appropriate approach?

Scenario 2.

You have been asked to provide a summary of the key aspects of the recent Maternal Mortality Meeting to the annual GP refresher course. There are likely to be 100 attendees. Which would be the most appropriate approach?

Scenario 3.

You have been asked to teach a new trainee the use of the ventouse. Which would be the most appropriate approach?

Scenario 4.

You have been asked to teach a group of medical students about PPH. To your surprise you find that they have good basic knowledge. Which technique will you apply to get the most from the teaching session?

Scenario 5.

Your consultant has asked you to get the unit’s medical students to prepare some questions about breech delivery which they can ask of their peers when they next meet. Which technique will you use?

Scenario 6.

You have been asked to discuss 2ry. amenorrhoea with your unit’s medical students. You are uncertain about the amount of basic physiology and endocrinology they remember from basic science teaching. Which technique will you use?

Scenario 7

The RCOG has asked you to chair a Green-top Guideline development committee. You find that there is very little by way of research evidence to help with the process. The College has assembled a team of consultants with expertise and interest in the subject. Which technique would be best to reach consensus on the various elements of the GTG?

Scenario 8

Which of the listed teaching techniques is least likely to lead to deep learning?

Scenario 9

An interactive lecture with EMQs is the best method of teaching. True or false.

Scenario 10

Only 20% of what is taught in a lecture is retained. True or false.

Scenario 11.

The main role of the teacher is information provision. True or false.

Scenario 12.

The main role of the teacher is to be a role model.  True or false.

Option list.

1. brainstorming.
2. brainwashing
3. cream cake circle.
4. Delphi technique.
5. demonstration & practice using clinical model.
6. doughnut round.
7. interactive lecture with EMQs.
8. lecture.
9. 1 minute preceptor method.
10. teaching peers / junior colleagues
11. schema activation.
12. schema refinement.
13. small group discussion.
14. snowballing.
15. snowboarding.
16. true
17. false

Tutorial 19 July 2012

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Ahmed Yassin will hold a tutorial at Stepping Hill on Thursday 2nd. August on uro-gynaecology.
He is an excellent teacher, so don't miss it.
It will not be on Skype as the room he uses does not have internet access, but it will be available as a podcast.
I'll send the various print-outs he uses beforehand.
Julie Morris will hold a tutorial on medical statistics on Monday the 6th. August.
To get the most of it you need to have gone through her on-line tutorials, "Statistics I" and "Statistics II".
 http://www.south.manchester.ac.uk/medicalstatistics/information.asp.
A bit of effort will be rewarded with all the available marks in the MCQs and EMQs.
She, too, is an excellent teacher, so don't miss the session.
I have also asked Claire Candelier to talk on diabetes in pregnancy and infection, Alex Heazell (20th. August) on perinatal mortality and IUGR and Suku George on cancer.
They are also good teachers and these are important topics.
I'll provide more details later.

Tonight we had 2 EMQs then 4 essays.
 

Obstetric cholestasis. (OC). Prevalence.

Lead-in.

The following scenarios relate to the prevalence of OC.

Pick one option from the option list.

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

Abbreviations.

GTG:     RCOG’s Green-top Guideline No. 43. April 2011.

OC:        obstetric cholestasis.

Option list.

A.        0.1%

B.        0.5%

C.        0.7%

D.        1 – 1.2%

E.         1.2% to 1.5%

F.         1.5 – 2%

G.       2.4%

H.        3 – 3.5%

I.          5%

J.          7%

K.        15%

L.         white

M.      brown

N.       blue-green

O.       red-brown, striped

P.        no information in the GTG

Q.       none of the above

Scenario 1.

What is the overall prevalence in the UK population?

Scenario 2.

What is the overall prevalence in the Indian and Pakistani Asian populations?

Scenario 3.

What is the overall prevalence in Scandinavia?

Scenario 4.

What is the overall prevalence in Chile?

Scenario 5.

What is the overall prevalence in Araucanian Indians?

Scenario 6.

What is the overall prevalence in Eskimos?

Scenario 7.

What is the incidence of pruritus in pregnancy?

Scenario 8.

What colour of eggs do Araucanian chickens lay?

Obstetric cholestasis. (OC). Diagnosis.

Lead-in.

The following scenarios relate to the definition and diagnosis.

Pick one option from the option list.

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

Abbreviations.

gamma GT: gamma-glutamyl transferase

GTG:      RCOG’s Green-top Guideline No. 43. April 2011.

OC:         obstetric cholestasis.

Option list.

A.             true

B.             false

C.             don’t be daft

D.             pruritus of pregnancy with no other explanation which is associated with abnormal LFTs, raised bile acids and pale stools, all of which resolve postnatally

E.              pruritus of pregnancy with no other explanation which is associated with abnormal LFTs, ± raised bile acids and pale stools, all of which resolve postnatally

F.              pruritus of pregnancy with no other explanation which is associated with abnormal LFTs, ± raised bile acids, all of which resolve postnatally

G.            pruritus of pregnancy with no other explanation which is associated with abnormal LFTs (using pregnancy-specific ranges), ± raised bile acids and pale stools, all of which resolve postnatally

H.             pruritus of pregnancy with no other explanation which is associated with abnormal LFTs (using pregnancy-specific ranges), ± raised bile acids, all of which resolve postnatally

I.               levels do not usually rise in pregnancy

J.               mostly originates in the placenta

K.             levels vary with the time of day

L.              no information in the GTG

M.           none of the above

Scenario 1.

The international definition of OC was agreed at a conference in Tokyo in 1985.

Scenario 2.

What is the GTG’s definition of OC?

Scenario 3.

What is the incidence of pruritus in pregnancy?

Scenario 4.

Hepatitis B and C, but not hepatitis A, may cause pruritus and abnormal LFTs in pregnancy.

Scenario 5.

Infection with the Ebstein Barr virus may cause pruritus and abnormal LFTs in pregnancy.

Scenario 6.

The cytomegalovirus may cause pruritus and abnormal LFTs in pregnancy.

Scenario 7.

The herpes zoster virus may cause pruritus and abnormal LFTs in pregnancy.

Scenario 8.

Chronic active hepatitis and secondary biliary cirrhosis are included in the GTG’s list of conditions to be considered in the differential diagnosis.

Scenario 9.

Bilirubin levels are normally elevated in the early stages of OC and remain elevated until the condition resolves after delivery.

Scenario 10.

Liver function tests become abnormal as soon as the pruritus is noted.

Scenario 11.

Levels of bile acids commonly rise significantly after meals making fasting levels mandatory for diagnosis.

Scenario 12.

The upper limit of normal for transaminases, gamma GT and bile acids is about 20% lower in pregnancy.

Scenario 13.

Once a diagnosis of OC has been made, tests of liver function should not be repeated until the puerperium

Scenario 14.

LFTs should be checked weekly until they have returned to normal after delivery of the baby in a case of OC.

Scenario 15.

Once a diagnosis of OC has been made, the activated partial thromboplastin time (APTT) should be measured and a full coagulation screen done if it is prolonged.

Scenario 16.

Delivery at 37 weeks should be recommended because of the risk of FDIU in the later weeks of pregnancy.

Scenario 17.

What additional pre-labour monitoring of fetal welfare is advisable in the third trimester?

Scenario 18.

Prophylactic steroids should be offered at 28 weeks because of the risk of spontaneous premature labour.

Essays.

With regard to endometrial cancer.

1. Outline the key features of Type 1 and Type 2 cancers.        4 marks

2. Outline the FIGO histological grading system.                          2 marks

3. Critically evaluate the FIGO staging for endometrial cancer. 6 marks

4. Detail the FIGO staging system for endometrial cancer.        8 marks.

Your consultant is on leave. The Secretary gives you an histology report relating to a 24-year-old woman who had suction evacuation for incomplete miscarriage 10 days before. The histology report is diagnostic of a complete hydatidiform mole.

1.  Justify your immediate management.     8 marks

2.  Detail the subsequent management.    12 marks.

You are the SpR in the antenatal clinic. The consultant is absent due to illness and no other consultant is available. A midwife asks you to see a woman whose scan has shown anencephaly.

1. What steps will you take before seeing the woman?         6 marks

2. Justify the approach you will use during the interview.   10 marks

3. What will you do when the interview is over?                     4 marks          

A woman attends the antenatal clinic at 10 weeks. Her son developed chickenpox two days ago. Her sister is 38 weeks pregnant. Critically evaluate the management.

Tutorial 16 July 2012

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Tonight we had an EMQ then 4 essays.

Lead-in.

The following scenarios relate to parvovirus infection

Pick one option from the option list.

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

Abbreviations.

GOVRIP:        Guidance on Viral Rash in Pregnancy. HPA. 2011

                         http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1294740918985

HPA:               Health Protection Agency

PSVMCA:      peak systolic velocity middle cerebral artery.

PvB19:            parvovirus B19

PvIgG:            parvovirus B19 IgG

PvIgM:           parvovirus B19 IgM

Option list.

There is none: make up your own answers!

Scenario 1.

What type of virus is parvovirus?

Scenario 2.

Is the title B19 something to do with the American B19 bomber, its potentially devastating bomb load and the comparably devastating consequences of the parvovirus on human erythroid cell precursors?

Scenario 3.

PVB19 in the UK occurs in mini-epidemics at 3 – 4 year intervals, usually during the summer months.

Scenario 4.

Which animal acts as the main reservoir for infection?

Scenario 5.

What percentage of UK adults are immune to parvovirus infection?

Scenario 6.

What names are given to acute infection in the human?

Scenario 7.

What is the incubation period for parvovirus infection?

Scenario 8

What is the duration of infectivity for parvovirus infection?

Scenario 9.

What are the usual symptoms of parvovirus infection in the adult?

Scenario 10.

What is the incidence of parvovirus infection in pregnancy?

Scenario 11.

How is recent infection diagnosed?

Scenario 12.

How long does PvIgM persist and why is this important?

Scenario 13.

What is the rate of vertical transmission of parvovirus infection?

Scenario 14.

Are women with parvovirus infection who are asymptomatic less likely to pass the virus to their fetuses?

Scenario 15.

To what degree is parvovirus infection teratogenic?

Scenario 16.

What proportion of pregnancies infected with parvovirus are lost?

Scenario 17.

What is the timescale for the onset of hydrops?

Scenario 18.

Laboratories are advised to retain bloods obtained at booking for at least 2 years for possible future reference. True or false?

Scenario 19.

What ultrasound features would trigger consideration of cordocentesis?

Scenario 20.

Must suspected parvovirus infection be notified to the authorities?

Scenario 21.

Possible parvovirus infection does not need to be investigated after 20 week’s gestation.

Scenario 22

If serum is sent to the laboratory from a woman with a rash in pregnancy for screening for rubella, the laboratory should automatically test for parvovirus infection too.

 

Essays 16 July 2012

13           EMQ. Parvovirus

With regard to hyperemesis gravidarum.

1.  Outline how the diagnosis is made.                                                          2 marks

2.  Outline the immediate consequences.                                                     6 marks

3.  Outline the consequences in later pregnancy.                                        6 marks

4.  Justify your management of a woman seen with HG at 10 weeks.     6 marks

Epilepsy. Pre-pregnancy counselling.

1.   Detail the history you will obtain.       4 marks

2.   Outline the advice you will give.          8 marks

3.   Outline the key features of the management of the pregnancy and labour.  8 marks

How can the perinatal morbidity and mortality associated with multiple pregnancy be reduced?

1.   Discuss the steps that can be taken pre-conceptually to reduce the risks.                 4 marks

2.   Discuss the steps that can be taken during pregnancy to reduce the risks.               10 marks

3.  Discuss the steps that can be taken during labour and delivery to reduce the risks.    6 marks.               

A 20-year-old woman is referred to the gynaecology clinic with a complaint of hirsutism. Critically evaluate the management.

1.  Outline the necessary facts to obtain from the history.  6 marks.

2.  Justify the investigations you would arrange.                                   8 marks.

3.  Outline the key aspects of the management.                                   6 marks.